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Biomedical subjects

S J Taylor

Publications and source records attributed to S J Taylor.

At least 19 recordsLinked to original sources
PubMed2007

Faecal incontinence.

BACKGROUND: Faecal incontinence is a life style-limiting condition with multiple aetiologies. Surgical cure is not often possible. METHODS AND RESULTS: A review of the literature was undertaken using Medline, Cochrane database and standard textbooks. Advanced imaging techniques now inform the treatment algorithm and objectively assess success. The long-term outcome of anal surgery is uncertain. Modern approaches favour conservative measures, such as biofeedback, and less invasive surgical procedures. Stoma formation is a definitive option for some patients. CONCLUSION: Current treatment of faecal incontinence is evolving from a sphincter-focused view to a more holistic one, recognizing the influence of the pelvic floor and psyche in maintaining continence. Modern imaging modalities direct treatment strategies.

Adult↗
PubMed2006

Nasointestinal intubation with tiger tubes: a case series indicates risk of mucosal damage.

Abstract In five intubations using the tiger tube (Cook) two were successfully placed into the small intestine. Two of the three intubation failures were due to early death due to the underlying condition. Nasointestinal placement permitted successful enteral feeding. Unfortunately, both nasointestinal placements were associated with mucosal damage that appears to be related to the tube "flaps". The tiger tube facilitates nasointestinal tube placement but until concerns regarding safety are addressed its clinical use cannot be recommended.

Adult↗
PubMed2005

Confirmation of nasogastric tube position by pH testing.

INTRODUCTION: In 2004, the Medicines and Healthcare products Regulatory Agency (MHRA) advised that nasogastric (NG) tube position should be confirmed using pH strips or paper. However, gastric pH is raised by the use of H2-blockers and proton-pump inhibitors (PPIs) potentially producing false negative pH tests resulting in delayed feeding. In addition, colorimetric differentiation using pH strips may be more prone to bias and inaccuracy than direct pH measurements largely used to establish the threshold. METHOD: To quantify this problem a 1 day survey of all the patients requiring NG and nasointestinal (NI) feeding was undertaken, to establish the numbers of patients receiving H2-Blockers or PPIs, with or without a safe swallow and the methods currently being used to confirm tube positioning. A second observational study was performed to establish the accuracy of six pH strips available to NHS trusts against four unlabelled pH solutions. RESULTS: Forty-two per cent of patients receiving NG feeding were on H2-blockers or PPIs, including 13% who had a safe swallow for acidic drinks that could be subsequently aspirated to confirm position. In the second study 'testers' correctly identified pH's 3, 4, 5 and 6 with Mackery-Nagel 0-6, BDH 0-6 and 0-14 strips but overestimated pH 4 as pH 5 with Johnson 0-11 paper, underestimated pH 6 as pH 5 with Pehanon 0-12 paper and with Litmus classified pH 3-5 as acid (all), but half also classified pH 6 as acid. CONCLUSION: Theoretically 29% of NG tube positions could not be confirmed by pH testing because of the usage of PPIs or H2-blockers and lack of swallow. Some pH strips are either inaccurate or their result misinterpreted by staff. Large surveys and trials of the actual efficacy and accuracy of pH testing are required.

Cross-Sectional Studies↗
PubMed2004

Breast screening: the use of consensus opinion for all recalls.

The quality of a breast-screening programme is measured not only by it's cancer detection rates (sensitivity), but also by it's recall rates and positive predictive values (specificity). False positive screens, which lead to assessments with benign outcomes, can cause psychological and physical morbidity in previously well women. In 1999 the Wiltshire breast-screening programme adopted a novel recall strategy whereby all films marked for recall are subject to consensus opinion--even women "recalled" by both original readers may be returned to routine screening. Since 1999 our recall rates have fallen from above to below the national averages (prevalent 7.2% and incident 3.0% in 2001/02). Specificity has increased over the same period such that approximately one in seven women assessed will be diagnosed with cancer. The consensus meetings provide a forum for teaching and are very popular with our film readers, who all report reduced levels of stress.

Breast Neoplasms↗
PubMed2004

Peripheral parenteral nutrition in a case of chyle leak following neck dissection.

Chylothorax is an uncommon condition which is potentially life-threatening if untreated. The following case study of a 75-year-old man with chyle leak following surgery shows how prompt dietetic action prevented further compromise in immune function and nutritional status. Dietetic recommendation to minimize enteral intake rapidly stopped chyle flow and promoted wound closure. Peripheral parenteral nutrition (PPN) was administered in order to prevent malnutrition. There is limited literature available for evidence of best practice for cases of chyle leakage, however, this particular case demonstrates PPN should be considered despite the potential risks.

Aged↗
PubMed2004

Hot topic: using a stearoyl-CoA desaturase transgene to alter milk fatty acid composition.

Stearoyl-CoA desaturase enzyme converts specific medium- and long-chain saturated fatty acids to their monounsaturated form. Transgenic goats expressing a bovine beta-lactoglobulin promoter-rat stearoyl-CoA desaturase cDNA construct in mammary gland epithelial cells were produced by pronuclear microinjection. The fatty acid composition of milk from 4 female transgenic founders was analyzed on d 7, 14, and 30 of their first lactation. In 2 animals, the expression of the transgene changed the overall fatty acid composition of the resulting milk fat to a less saturated and more monounsaturated fatty acid profile at d 7 of lactation; however, this effect diminished by d 30. In addition, one animal had an increased proportion of the rumen-derived monounsaturated fatty acid C18:1 trans11 converted by stearoyl-CoA desaturase to the conjugated linoleic acid isomer C18:2 cis9 trans11. Milk that has higher proportions of monounsaturated fatty acids and conjugated linoleic acid may have benefits for human cardiovascular health.

Animals↗
PubMed2003

Splenic lymphocytes of adult Xenopus respond differentially to PMA in vitro by either dying or dividing: significance for cancer resistance in this species.

Wild-type populations of amphibians, unlike mammalians, appear to be resistant to spontaneous and chemically induced neoplasms. Few true cancers have been reported for non-isogeneic members of Xenopus laevis, despite their widespread use in laboratories around the world. Injection of even the most powerful direct mammalian oncogens e.g. N-methyl N-nitrosourea, that depleted specific populations of T lymphocytes, did not induce cancer. Phorbol diesters, e.g. PMA, are mitogens and apoptogens in both amphibian, and mammalian immunocytes. In mammalian cells, regulation of the cell cycle and of apoptosis are often intimately linked, however, a disjunction in time between early apoptosis and later cell cycling, has been observed with PMA-treated Xenopus splenocytes. Thus, a particular difference between amphibians and mammals may be the requirement to enter the cell cycle before a progression to death by apoptosis. This hypothesis was tested here using dual staining flow cytometry. Xenopus laevis splenocytes were cultured for 8, 24 and 48 hours with phorbol 12-myristate 13-acetate (PMA), previously shown to be mitogenic and apoptotic with mature Xenopus lymphocytes. The cells were stained with FITC-conjugated Annexin V or with FITC-labeled deoxyuridine triphosphates (FITC-dUTP) to assay for the apoptotic markers phosphotidylserine or DNA strand breaks respectively. Phycoerythrin (PE)-conjugated anti-human proliferating cell nuclear antigen (PE-PCNA) was used as a cell cycle marker that is present during the entire cell cycle. Propidium iodide (PI) binds DNA and was used to assay for late stage apoptosis, as well as to assess DNA content. Significantly higher levels of apoptosis develop rapidly in PMA-exposed splenocytes and are maintained at 24 hours, declining by 48 hours. Cells expressing PCNA or incorporating PI in excess of the normal genomic level were found by 48 hours following PMA exposure. The absence of any significant rise in a small (<5%) dual staining cell population indicates that the apoptotic cell population remained distinct from cells already in the cell cycle from the onset of PMA exposure. Thus, Xenopus splenocytes respond differentially to PMA. Those that undergo apoptosis rapidly were quiescent, non-cycling small lymphocytes. Moreover, the cells that eventually begin division, following PMA exposure, were unaffected by the early apoptosis and do not themselves die while in the cell cycle. The rapid apoptotic response of X. laevis cells to PMA may confer a natural cancer resistance in this species, as cells that fail to enter the cell cycle after exposure to cancer promoting reagents cannot express genetic destabilization that might have led to transformation.

Animals↗
PubMed2003

Increasing dietary levels of cracked pima cottonseed increase plasma gossypol but do not influence productive performance of lactating Holstein cows.

Lactating Holstein cows were fed diets with increasing levels of cracked Pima cottonseed to determine its effects on plasma gossypol concentrations as well as milk yield and composition and dry matter (DM) intake in a short-term study. All diets contained 12.8% cottonseed, 43.5% concentrate, and 43.7% chopped alfalfa hay on a DM basis. The proportion of whole Upland cottonseed to cracked Pima cottonseed in the four dietswas 100:0, 67:33, 33:67, and 0:100. Four primiparous cows were fed the diets in a 4 x 4 Latin square design, and three multiparous cows were fed the diets in a Youden square design with five periods. All periods were 35 d. Upland and cracked Pima cottonseed contained 0.64 and 1.00% total gossypol (DM) with 41 and 52% of gossypol as the (-) isomer, respectively. Gossypol is a natural defense compound in the plant that protects it against pests and diseases, but can have antinutritional quality effects when consumed by dairy cattle. Total plasma gossypol concentrations increased linearly with increasing proportions (100:0, 67:33, 33:67, and 0:100) of cracked Pima cottonseed in the diet for primiparous (4.4, 6.0, 7.7, and 8.9 microg/ml) and multiparous (4.3, 7.3, 9.7, and 11.4 microg/ml) cows, respectively. While primiparous cows responded similarly to gossypol intake, the response of plasma gossypol intake in multiparous cows differed among cows. This indicates the importance of animal variation when relating plasma gossypol levels with gossypol intake. Milk yield, as well as its components and DM intake, were not affected by increasing dietary inclusion levels of cracked Pima cottonseedup to 8.6% of DM intake for either primiparous or multiparous cows, even though plasma gossypol concentrations increased sharply over this dietary inclusion range. Although the highest dietary inclusion level of Pima cottonseed (i.e., 12.8%) numerically depressed performance of cows of both parities, these differences failed to reach statistical significance in these short-term trials with few cows.

Animals↗
PubMed2001

GABAergic blockade of cocaine-associated cue-induced increases in nucleus accumbens dopamine.

Environments previously associated with drug use can become one of the most common factors triggering relapse to drug-seeking behavior. To better understand the neurochemical mechanisms potentially mediating these cues, we measured nucleus accumbens dopamine levels in animals exposed to environmental cues previously paired with cocaine administration. In animals exposed to a cocaine-paired environment nucleus accumbens dopamine increased by 25%. When administered 2.5 h prior to presentation of the environmental trigger, racemic vigabatrin (an irreversible inhibitor of gamma-aminobutyric acid (GABA)-transaminase) abolished this cue-induced increase. Conversely, R-(-)-vigabatrin, the inactive enantiomer, had no effect. Combined with our earlier findings, these studies support the potential therapeutic benefit of this enzyme-based GABAergic strategy to modulate brain dopamine and the subsequent treatment of drug addiction.

4-Aminobutyrate Transaminase↗
PubMed2001

Forces and moments telemetered from two distal femoral replacements during various activities.

Two distal femoral replacements were instrumented to measure axial force, torque and bending moments in the prosthesis shaft. Data are reported up to 2.5 years for the following activities: uni- and bi-lateral standing, walking, stair climbing and descending, treadmill walking, jogging and jumping. In the first subject the greatest averaged peak shaft forces found were: jogging 3.6Bodyweight (BW), stair descending 3.1BW, walking 2.8BW, treadmill walking 2.75BW, and stair ascending 2.8BW. Bending moments about the antero-posterior axis (varus-valgus) and medio-lateral axis (flexion-extension) peaked in the range 8.5-9.8 and 4.7-7.6BWcm respectively, over the follow-up period. Axial torques peaked in the range 0.2-1.3BWcm, outwardly directed. At most follow-up sessions, forces and moments during jogging were generally greater than those for other gait activities. In the second subject forces and moments were generally only 45-70% of those in the first subject, due to inadequate musculature around the knee. The data can be applied to the design and testing of distal femoral replacements and even to total knee replacements, and contributes to the knowledge of forces acting in the distal femur during activity.

Adult↗
PubMed2001

Performance of a new pubertal self-assessment questionnaire: a preliminary study.

We describe the performance of a new, self-assessment questionnaire that aims to measure pubertal status by using gender-specific line drawings of the Tanner puberty stages. The study was carried out on 103 children aged 12-16 years attending a paediatric endocrinology outpatient clinic and used physical examination by clinic doctors as the 'gold standard'. Of 133 consecutive, eligible children, 108 (81%) agreed to participate in the study. Data were collected from 62 (60%) males and 41 (40%) females. Mean age was 14.78 years (SD = 1.26 years, range 12.08-16.98 years). For the pubic hair distribution Tanner stage, there was agreement to within one Tanner stage for 90 children (88%), weighted kappa statistic for inter-rater agreement = 0.68 [95% CI 0.49,0.87]. For the female breast/male genitalia Tanner stage, there was agreement to within one Tanner stage for 75 children (76%), kappa = 0.48 [95% CI 0.31,0.64]. The children tended to underestimate their stage of pubertal development. Overall, the kappa statistics implied good agreement for the pubic hair question and moderate agreement for the breast/genitalia stage question in both girls and boys. The questionnaire may prove useful in situations such as large-scale epidemiological studies, in which direct examination of children to determine pubertal status is not possible, and further validation in normal adolescents is warranted.

Adolescent↗
PubMed2001

Direct explanations for the development and use of a multi-layer perceptron network that classifies low-back-pain patients.

Using a new method published by the first author, this article shows how direct explanations can be provided to interpret the classification of any input case by a standard multilayer perceptron (MLP) network. The method is demonstrated for a real-world MLP that classifies low-back-pain patients into three diagnostic classes. The application of the method leads to the discovery of a number of mis-diagnosed training and test cases and to the development of a more optimal low-back-pain MLP network.

Humans↗
PubMed2001

Cost-benefit analysis of a Haemophilus influenzae type b meningitis prevention programme in The Philippines.

BACKGROUND: Haemophilus influenzae type b (Hib) meningitis is associated with high mortality and serious sequelae in children under 5 years of age. Vaccines which can prevent this infection are available. OBJECTIVE: To evaluate the costs and benefits of a 3-dose immunisation schedule in Manila, Philippines. PERSPECTIVE: Government and societal perspectives. DESIGN AND PARTICIPANTS: A cost-benefit analysis based on a birth cohort of 100,000 children. The state of health of the cohort with and without a Hib immunisation programme was modelled over a 5-year period. A survey of medical records of patients with Hib in Manila provided data on the extent and cost of sequelae following infection. INTERVENTION: A 3-dose Hib vaccination programme given at ages 2, 3 and 4 months. RESULTS: The model predicted that vaccinating children against Hib meningitis would prevent 553 cases per year in a birth cohort of 100,000, at a cost of 56,200 Philippine pesos (PHP) [$US1,605; 1998 exchange rate] per case (base case assumptions of 90% vaccine efficacy rate, 95 per 100,000 Hib incidence rate, 85% vaccination coverage). Results from the cost-benefit analyses indicated that the saving to the government would be around PHP39 million ($US1.11 million), and the saving to society would be PHP255 million ($US7.28 million). CONCLUSION: There would be a positive economic benefit for the Philippine government and for the Filipino society if a Hib vaccination programme was introduced in Manila.

Algorithms↗
PubMed2001

Fatty acid and triglyceride composition of milk fat from lactating Holstein cows in response to supplemental canola oil.

The objective was to determine the influence of dietary lipid on total and sn-2 fatty acid composition and triglyceride structure of milk fat in lactating Holstein cows. Five primiparous Holstein cows surgically fitted with ruminal and duodenal cannulas were used in a 4 x 5 incomplete Latin square. All cows received a basal diet. Treatments consisted of a basal diet with no supplemental canola oil (control), basal diet with canola oil added to the concentrate portion of the diet to provide 1.6% fat, basal diet with 330 g of canola oil infused directly into the rumen, and basal diet with 330 g of canola oil infused directly into the abomasum. Canola oil treatments decreased palmitic acid and increased oleic acid content of milk fat compared with the control. Stearate was higher when canola oil was rumen available compared with control and abomasal infusion. Abomasal infusion increased linoleic and linoleic acids in milk fat compared with the other treatments. The sn-2 fatty acid composition reflected total fatty acid composition. All canola oil treatments reduced palmitic acid and increased oleic acid content at the sn-2 position. Changes in sn-2 composition reflect specificity of the acyl transferases and substrate concentration. Triglyceride composition reported as carbon number was altered by canola oil. Triglycerides in carbon number C50, C52, and C54 were increased while C32, C34, and C36 were decreased.

Abomasum↗