Teenage pregnancy and reproductive health: summary review

Teenage pregnancy, by and large unplanned, has become one of the major public health issues of our time. Despite the widespread and improved availability of contraception, the problem is unresolved and in some areas is increasing. Both live births and abortions in teenagers in England are among the highest in Europe. The circumstances of teenage pregnancy in the UK, including medical, social and public health implications have been examined by the RCOG Study Group and their findings are given in a comprehensive volume of proceedings, of which this is a summary. Recent headlines point to a teenage sex health crisis fuelled by drink and drugs, as well as confused messages from role models, and the lack of a coordinated national approach. Yet there is some hope of a way forward. The Study Group reveals the factors associated with success, including locally coordinated strategies, comprehensive education programmes, accessible contraceptive services, as well as wider social issues such as workforce training and recognition of vulnerable groups. I recommend this Summary Review to all concerned about this issue, and this must surely include all of us. I want to thank and congratulate the organisers and contributors to the Study Group for a fine piece of work and for sound advice. Allan Templeton President, Royal College of Obstetricians and Gynaecologist

Liquid-like behaviour of gold nanowire bridges

A combination of Focused Ion Beam (FIB) and Reactive Ion Etch (RIE) was used to fabricate free standing gold nanowire bridges with radii of 30 nm and below. These were subjected to point loading to failure at their mid-points using an Atomic Force Microscope (AFM), providing strength and deformation data. The results demonstrate a dimensionally dependent transition from conventional solid metallic properties to liquid-like behaviour including the unexpected reformation of a fractured bridge. The work reveals mechanical and materials properties of nanowires which could have significant impact on nanofabrication processes and nanotechnology devices such as Nano Electro Mechanical Systems (NEMS)

Life Sciences, Technology, and the Law - Symosium Transcript - March 7, 2003

Life sciences, Technology, and the Law Symposium held at the University of Michigan Law School Friday, March 7, 200

Upper GI biopsies for adenocarcinoma: how many biopsies should endoscopists take?

Aims: There is evidence that 4 or 5 gastric cancer biopsies are required for accurate HER2 interpretation. However, the number of biopsies that need to be taken to reach this number of viable cancer biopsies is without evidence. This study aimed to address this gap by assessing the number of biopsies required to get at least 4 viable biopsies containing cancerMethods and results: 105 consecutive biopsy cases of gastric and oesophageal adenocarcinoma were retrieved from file. Only definite cancer diagnoses were included; missed cancers or unproven cases were not considered. The cases were reviewed and the number of biopsies taken, and the number containing viable tumour was recorded. In total, 667 biopsies were taken of which 471 had viable tumour (70.6%) 70/105 cases (67%) had 4 viable tumour biopsies but only 47/105 (45%) had 5 viable tumour biopsies. In order to have a >90% chance of having 4 viable tumour biopsies, 7 biopsies needed to be taken, while 10 or more biopsies were required for a >90% chance of 5 viable tumour biopsies. Mathematically, using a 0.7 probability for a single biopsy, 8 biopsies would be required for a 94% chance of at least 4 viable tumour biopsies.Conclusion: In our large upper GI cancer centre, many biopsy cases do not contain sufficient material for adequate HER2 assessment. In order to meet the 4 biopsy requirement for adequate HER2 assessment in >90% of cases, at least 8 biopsies need to be taken, while 10 biopsies would be required for the 5 cancer biopsy threshold

Orbital inflammatory complications of Crohn’s disease: a rare case series

Orbital inflammatory disease is a rare ophthalmic manifestation of Crohn’s disease. Inflammation is characteristically non-specific, involving one or multiple structures of the orbit. Mechanisms of disease and optimal methods of treatment are poorly understood. The aim of this report is to present three cases of orbital involvement in Crohn’s disease. A retrospective case note review of patients with orbital inflammatory disease and Crohn’s disease was performed at our academic centre to determine the clinical, imaging and histopathological features of this condition and its relationship to intestinal Crohn’s disease. Three patients were identified with orbital inflammatory manifestations complicating Crohn’s disease. All patients described were female with active intestinal disease and had a history of treatment with immunosuppressive therapies. Similarities were observed in clinical presentations with variance noted in radiological and histopathological findings. In all cases, symptoms improved with oral corticosteroids or non-steroidal drugs in combination with anti-tumour necrosis factor (anti-TNF) agents. Inflammatory bowel disease-related orbital complications are rare but potentially vision-threatening. It is important to consider mimics of orbital inflammatory disease such as systemic inflammatory disease, malignancy, congenital malformations, infection and trauma when formulating a comprehensive differential diagnosis. Therapeutic intervention is directed towards preservation of vision and orbital function and reducing the acute inflammatory process. Corticosteroids are typically the initial treatment of choice for moderate-to-severe disease, although several classes of immunomodulatory agents have been variably useful in treating this condition. Heightened awareness and close cooperation between gastroenterologists and ophthalmologists is mandatory

Why Do Men Report More Opposite-Sex Sexual Partners Than Women? Analysis of the Gender Discrepancy in a British National Probability Survey.

In a closed population and defined time period, the mean number of opposite-sex partners reported by men and women should be equal. However, in all surveys, men report more partners. This inconsistency is pivotal to debate about the reliability of self-reported sexual behavior. We used data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability sample survey of the British population, to investigate the extent to which survey sampling, accounting strategies (e.g., estimating versus counting), and (mis)reporting due to social norms might explain the inconsistency. Men reported a mean of 14.14 lifetime partners; women reported 7.12. The gender gap of 7.02 reduced to 5.47 after capping the lifetime partner number at the 99th percentile. In addition, adjusting for counting versus estimation reduced the gender gap to 3.24, and further adjusting for sexual attitudes narrowed it to 2.63. Together, these may account for almost two-thirds of the gender disparity. Sampling explanations (e.g., non-U.K.-resident partners included in counts; sex workers underrepresented) had modest effects. The findings underscore the need for survey methods that facilitate candid reporting and suggest that approaches to encourage counting rather than estimating may be helpful. This study is novel in interrogating a range of potential explanations within the same nationally representative data set

Diagnosing dysplasia in Barrett’s oesophagus still requires Seattle protocol biopsy in the era of modern video endoscopy: results from a tertiary centre Barrett’s dysplasia database.

Objectives: The role of random, four-quadrant biopsy (i.e. systematic biopsy) in Barrett’s oesophagus surveillance has been questioned given its drawbacks and the emergence of high-resolution endoscopy and advanced imaging modalities. Our study aims to assess whether neoplastic pathology is typically diagnosed in routine clinical practice by random, four-quadrant or targeted biopsy whilst using high-resolution endoscopy. Methods: The Nottingham University Hospital Barrett’s oesophagus dysplasia database was retrospectively analysed. Endoscopic and histopathologic data pertaining to the initial endoscopy in which pathology was diagnosed was extracted from the medical records. The most advanced histopathologic abnormality at initial diagnosis and within twelve months were noted. The corresponding endoscopic impression at initial diagnosis was used to group cases per type of biopsy – random, four-quadrant or targeted. Pearson’s chi-squared test of independence was used to analyse the relationship between the type of biopsy and diagnosis, indication for endoscopy, endoscopist level and advanced techniques used. Results: Of the 222 patients involved in the study - a higher proportion were diagnosed through random, four-quadrant biopsy (72.97%) than targeted biopsy (27.03%). 90.91% of low-grade dysplasia, 71.43% of high-grade dysplasia and 50% of intramucosal adenocarcinoma cases were diagnosed by random, four-quadrant biopsy. Across all grades of clinicians, patients were typically diagnosed through random, four-quadrant biopsy. However, amongst specialist consultant endoscopists (n=10) the proportion was equal. Conclusions: Our findings strongly emphasize the importance of random, four-quadrant biopsy in the detection of not only low-grade dysplasia, but also high-grade dysplasia and early invasive carcinoma as part of Barrett’s oesophagus surveillance

Ocular Gene Transfer with Self-Complementary AAV Vectors

PURPOSE. Self-complementary AAV (scAAV) vectors have been developed to circumvent rate-limiting second-strand synthesis in single-stranded AAV vector genomes and to facilitate robust transgene expression at a minimal dose. In this study, the authors investigated the effects of intraocular injections of type 2 scAAV.GFP in mice. METHODS. Dose-response experiments were performed to compare conventional single-strand AAV type 2 (ssAAV2) vectors with scAAV2 vectors encoding an identical expression cassette. RESULTS. Subretinal injection of 5 X 108viral particles (vp) of scAAV.CMV-GFP resulted in green fluorescent protein (GFP) expression in almost all retinal pigment epithelial (RPE) cells within the area of the small detachment caused by the injection by 3 days and strong, diffuse expression by 7 days. Expression was strong in all retinal cell layers by days 14 and 28. In contrast, 3 days after subretinal injection of 5 X 108vp of ssAAV.CMV-GFP, GFP expression was detectable in few RPE cells. Moreover, the ssAAV vector required 14 days for the attainment of expression levels comparable to those observed using scAAV at day 3. Expression in photoreceptors was not detectable until day 28. Dose-response experiments confirmed that onset of GFP expression was more rapid and robust after subretinal injection of scAAV.CMV-GFP than of ssAAV.CMV-GFP, resulting in pronounced expression in photoreceptors and other retinal neurons. Similar results were obtained for intravitreous injections. CONCLUSIONS. These data suggest that scAAV vectors may be advantageous for ocular gene therapy, particularly in retinal diseases that require rapid and robust transgene expression in photoreceptor cells