Erythroplastosis Foetalis, and Additional Papers

The great interest which has been taken in haematology in the past ten or fifteen years and which has led to a rational classification of abnormal blood conditions, and to not a few therapeutic discoveries such as the liver treatment of pernicious anaemia, has not been confined to adult medicine. In paediatrics great strides have been made not only with regard to the diseases of the blood, but also in connection with the physiological changes in the haematology of the normal child from birth until the adult type of haematopoiesis has been acquired. In the adult the dyshaematopoietic anaemias like pernicious anaemia and microcytic hypochromic anaemia, which is so common in women, are of greater importance than the haemolytic anaemias. In childhood, however, the haemolytic anaemias are relatively more important, although nutritional or dyshaemopoietic anaemias are, as in adults, of greater frequency. Haemolytic anaemia in childhood is chiefly found in the neo-natal period, when it is known as erythroblastosis foetalis. This is a not uncommon condition, and, as I shall show, not less than 29 cases were observed in the Royal Hospital for Sick Children, Glasgow, in three years. It is principally with erythroblastosis foetalis that I deal in this thesis, but additional papers - one on acholuric jaundice in childhood, with special reference to red cell morphology, and another on the red cell shape in conditions of acidosis and alkalosis - have been added

DETERMINING LOCATIONS FOR RURAL MEDICAL CLINICS: A MODEL AND ITS USE

Community/Rural/Urban Development,

Investigation of the 17-oxosteroids in the hepatic porphyrias

During the past eighty years, there has been much clinical and experimental evidence presented by a wide variety of investigations confirming the deleterious interplay of endocrine and genetic factors in the natural history of these diseases known as the porphyriae. The porphyrin-inducing Sa-H Sb-H 17-oxosteroids that have been identified delineate one category of endogenous agents through which such an endocrine-genetic interplay may be affected in some subjects, and it is the purpose of this investigation to examine the relevance of the part played, if any, by some of these 5a-H and 5p-H 17-oxosteroids in the pathogenesis of the porphyrias in humans. Preliminary experiments included the setting-up and evaluation of methods for the measurement of four 17-oxosteroid sulphates and eight 17-oxosteroid glucuronides in urine and the measurement of their levels in urine in seventy- five normal subjects, consisting of thirty-eight males and thirty-seven females. A pattern similar to that obtained by Hamburger (1948) for the total urinary 17-oxosteroids excretion of different age groups was obtained for the individual urinary 17-oxosteroid levels in this control group. These methods were then applied to the study of the urinary levels of these 17-oxosteroids in patients suffering from acute intermittent porphyria (AIP), hereditary coproporphyria (HCP), variegate porphyria (UP) and porphyria cutanea tarda (PCT). In total, thirty-four patients with AIP, five patients with HCP, two patients with UP and fourteen patients with PCT were investigated. Of the thirty-four patients with AIP, a total of twenty-three had elevated levels of certain of these 17-oxosteroids, especially dehydroepiandrosterone sulphate (DMAS) and aetiocholanolone glucuronide (EG) and sulphate (ES) in the urine. The seven patients with AIP who were investigated during or shortly after attack had levels of urinary 17-oxosteroids well beyond the range of the normal control group. Similar results were obtained with the five patients with HCP, with the exception that the elevations of these 17-oxosteroids were observed only in the urine of the three patients who were in attack and not in those who were in remission. In one patient with AIP and two patients with HCP from whom serial 24-hour urine specimens were obtainable, significant linear correlations were found between the values of the ratio of urinary aetiocholanolone to androsterone and the levels of 6-aminolaevulic acid (ALA) and porphobilinogen (PBG) in the individual urines. The two patients with UP who were investigated were in remission and did not show any elevations of these steroids in the urine. The fourteen patients with PCT who were studied did not show any elevations of the urinary levels of these 17-oxosteroids, but it was noted that this group tended to excrete lower levels of steroids than the similarly aged normal controls. More specific investigations were undertaken with one male patient who had suffered from several acute attacks of porphyria. During those attacks, his DMAS and EG were the predominantly raised urinary steroids. After treatment with dexamethasone, which suppresses the activity of the adrenal cortex, his clinical condition improved, his urinary oxosteroid levels fell sharply, corresponding with an equally sharp fall in urinary porphyrins and precursors (ALA and PBG). Having established these irregularities in the levels of 17-oxosteroids in the urine of some of these porphyric patients, this pathway of research was further pursued by setting up and carefully evaluating a method for estimating the four main 17-oxosteroid sulphates in plasma. As with the urinary studies, a similar control group of wide age range consisting of fifty-three males and thirty-nine females was studied initially. Some of the subjects from the control group were investigated for fluctuations due to diurnal variation and for cyclic fluctuations due to different phases of the normal menstrual cycle. Having established normal values for the concentrations of these 17-oxosteroid sulphates in plasma, investigation of their concentrations in the plasma of patients suffering from hepatic porphyria was undertaken. As with the urinary results, no elevations of the levels of these steroids beyond the normal range were observed in the plasma of patients with PCT but,in the plasma of patients with AIP, elevations of these steroids, predominantly DHAS and ES, were observed, in most cases corresponding with similar urinary elevations. These results, along with the observations of other investigations, do suggest that although the primary genetic defect may not be an endocrine one, the effects of many of the factors involved in the initiation, provocation and aggravation of the hepatic porphyrias may be mediated through interaction with an endogenous regulatory system of steroid metabolism in the liver. This interference with normal endogenous steroid metabolism may result in direct overproduction and accumulation in the liver of a steroid with strong porphyrinogenic inducing activity (perhaps aetiocholanolone or dehydroepiandrosterone) or indirectly in antagonism of the hypophysis, hypothalamus and endocrine glands which form a functional unit for the homeostatic regulation of the plasma levels of hormones. The suggestion is also put forward that dehydroepiandrosterone or a close metabolite may possibly act as a constant stimulus to haem biosynthesis in the human hepatic cell

Loss of head in elbows and tees

Thesis (BS)--University of Illinois, 1912Typescrip

A Push-Button Molecular Switch

The preparation, characterization, and switching mechanism of a unique single-station mechanically switchable hetero[2]catenane are reported. The facile synthesis utilizing a “threading-followed-by-clipping” protocol features Cu^(2+)-catalyzed Eglinton coupling as a mild and efficient route to the tetrathiafulvalene-based catenane in high yield. The resulting mechanically interlocked molecule operates as a perfect molecular switch, most readily described as a “push-button” switch, whereby two discrete and fully occupied translational states are toggled electrochemically at incredibly high rates. This mechanical switching was probed using a wide variety of experimental techniques as well as quantum-mechanical investigations. The fundamental distinctions between this single-station [2]catenane and other more traditional bi- and multistation molecular switches are significant

Exploring the use of Fitbit consumer activity trackers to support active lifestyles in adults with Type 2 Diabetes : a mixed methods study

Background: People with type 2 diabetes are less active than those without the condition. Physical activity promotion within diabetes health care is limited. This project explored the use of Fitbit activity trackers (Fitbit, San Francisco, CA, USA) to support active lifestyles in adults with type 2 diabetes through a mixed-methods study. Methods: Two stages were conducted. In stage 1, adults with type 2 diabetes used a Fitbit Charge 4 (Fitbit, San Francisco, CA, USA) for 4 weeks. Fitbit and self-reported physical activity data was examined through quantitative analysis. Qualitative analysis was conducted to explore the experiences of participants. In stage 2, health professionals were interviewed to examine their views on using Fitbit activity trackers within type 2 diabetes care. Results: Adults with type 2 diabetes were recruited for stage 1 and adult health care and fitness professionals were recruited for stage 2. Stage 1 participants’ self-reported increases in physical activity (mean weekly minutes of walking increased from 358.75 to 507.50 min, p = 0.046) and a decrease in sedentary behaviour (mean daily hours of sedentary behaviour decreased from 10.65 to 10.05 h, p = 0.575). Fitbit activity data ranges identified individuals who led inactive and sedentary lifestyles below levels recommended and in need of physical activity support to reduce the risk to their health. During interviews, participants stated that the Fitbit activity tracker motivated them to be more active. Stage 2 participants intimated that Fitbit activity trackers could improve the promotion of physical activity within type 2 diabetes care. Interventions involving the Fitbit premium service, community prescription and combined use of Fitbits with physical activity behaviour change models were recommended by stage 2 participants. Conclusion: This study found that there is future scope for using Fitbit activity trackers to support active lifestyles in adults diagnosed with type 2 diabetes