Guy's and St Thomas' NHS Foundation Trust

About: Guy's and St Thomas' NHS Foundation Trust is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Randomized controlled trial. The organization has 7686 authors who have published 9631 publications receiving 399353 citations. The organization is also known as: Guy's and St Thomas' National Health Service Foundation Trust & Guy's and St Thomas' National Health Service Trust.

The influence of the route of oestrogen administration on serum levels of cortisol‐binding globulin and total cortisol

Abstract: Summary Objectives Oral oestrogen preparations increase total cortisol concentration by increasing circulating cortisol-binding globulin (CBG) levels. Transdermal oestrogen treatments are being used increasingly in clinical practice. These topical preparations may have less of an effect on CBG and hence on total serum cortisol levels by reducing hepatic oestrogen exposure. The purpose of this study was to compare the effects of oral and topical oestrogen treatments on CBG, total serum cortisol and salivary cortisol levels. Design and Patients This was a single-centre, cross-sectional study of 37 women aged 33 ± 6 years (mean ± SD). Fourteen women were using oral oestrogen therapy, eight were using transdermal therapy and 15 were oestrogen-naive control subjects. Measurements Following a screening visit, the subjects attended the endocrine investigation unit following an overnight fast. Blood and salivary samples were taken from 0830 to 0930 h between days 10 and 18 of the menstrual cycle (where appropriate). Results Total serum cortisol concentrations were 67% higher in those receiving oral oestrogen when compared to control subjects (660·9 ± 89·9 vs. 395·4 ± 53·2 nmol/l, P < 0·001). Values in those receiving transdermal oestrogen (334·7 ± 72·0 nmol/l) were no different from the control group. CBG levels were higher in those on oral oestrogen therapy (110·9 ± 19·6 mg/l, P < 0·001) when compared with either those on transdermal oestrogen (51·0 ± 5·4 mg/l) or the control population (49·0 ± 11·8 mg/l). Similar salivary cortisol concentrations were recorded in the three groups (controls 13·8 ± 2·6 nmol/l, oral oestrogen 15·5 ± 2·6 nmol/l, transdermal oestrogen 15·7 ± 3·9 nmol/l). Conclusions Oral oestrogen-containing preparations increase total cortisol levels by increasing circulating CBG concentration. These effects were not seen in patients using transdermal oestrogen replacement. Although further studies are indicated, it is probably unnecessary to routinely discontinue transdermal oestrogen replacement when performing an assessment of the hypothalamic–pituitary–adrenal (HPA) axis or evaluating adequacy of hydrocortisone replacement.

Malnutrition in children with food allergies in the UK.

Abstract: Background The mainstay of dietary management of food allergies remains the elimination diet. However, the removal of major food groups may predispose children to an inadequate nutrient intake. We therefore set out to establish growth status in food allergic children receiving dietetic input in the UK. Methods Dietitians were approached via the Food Allergy and Intolerance Specialist Group from the British Dietetic Association and asked to submit anthropometrical data for children with food allergies. Data collected related to the systems involved and number of foods excluded. Malnutrition was defined according to World Health Organization standards. Results Data from 13 different centres yielded 97 patients (51 male and 46 female) of which 66 excluded ≤2 foods and 31 excluded ≥3 foods. Data indicated that 8.5% had a weight for age ≤ −2 Z-score and, conversely, 8.5% were ≥2 Z-score. For height for age, 11.1% were ≤ −2 Z-score and, for weight for height, 3.7% were ≤ −2 Z-score and 7.5% ≥2 Z-score. Type of allergy, system involved and specific food elimination did not impact on the level of malnutrition. However, the elimination of ≥3 foods significantly impacted on weight for age (P = 0.044). Conclusions The present study demonstrates that children with food allergies are more underweight than the general UK population, which appears to be linked to the number of foods excluded. However, the impact of the disease process itself should not be disregarded. Additionally, obesity can also occur in this population despite dietary elimination.

Assessing patients' beliefs about cardiac rehabilitation as a basis for predicting attendance after acute myocardial infarction.

Abstract: Background: Some sociodemographic and psychological variables such as patients’ belief about illness are associated with attendance at cardiac rehabilitation. Exploration of patients’ beliefs about treatment regarding cardiac rehabilitation has been limited to qualitative studies; their role in relation to attendance at cardiac rehabilitation after acute myocardial infarction (AMI) remains speculative. Objectives: To develop a valid and reliable measure of patients’ beliefs regarding cardiac rehabilitation and to ascertain the relationship between such beliefs and attendance. Design: A prospective questionnaire-based study. Setting: Coronary care unit of a London teaching hospital. Patients: 130 patients with AMI; 104 (83%) men; mean age 58.4 (standard deviation (SD) 10.7) years. Interventions: Patients completed a 26-item questionnaire consisting of statements pertaining to beliefs about cardiac rehabilitation. Main outcome measures: Cardiac rehabilitation attendance; beliefs of patients about cardiac rehabilitation. Results: Four subscales pertaining to patients’ beliefs about cardiac rehabilitation were produced, accounting for 65.3% of the attendance variance: perceived necessity of cardiac rehabilitation (α = 0.71), concerns about exercise (α = 0.79), practical barriers (α = 0.70) and perceived personal suitability (α = 0.74). Patients who attended were more likely to believe that cardiac rehabilitation was necessary and to understand its role compared with non-attenders (17.7 (SD 2.7) v 16.9 (SD 3.0), p = 0.029). Patients who thought cardiac rehabilitation was suitable for a younger, more active person were less likely to attend (5.6 (SD 1.9) v 4.6 (SD 1.7), p = 0.007). Patients who expressed concerns about exercise or who reported practical barriers to attendance were less likely to attend, although these did not reach statistical significance. Conclusion: Beliefs about cardiac rehabilitation can be quantified and differ between attenders and non-attenders of cardiac rehabilitation.

Molecular Photoacoustic Tomography with Colloidal Nanobeacons

Abstract: Spotting clots: Vascularly constrained colloidal gold nanobeacons (GNBs; see picture) can be used as exogenous photoacoustic contrast agents for the targeted detection of fibrin, a major biochemical feature of thrombus. Fibrin-targeted GNBs provide a more than tenfold signal enhancement in photoacoustic tomography in the near-IR wavelength window, indicating their potential for diagnostic imaging.

Guidelines for the measurement of BCR-ABL1 transcripts in chronic myeloid leukaemia

Abstract: Molecular testing for the BCR-ABL1 fusion gene by real time quantitative polymerase chain reaction (RT-qPCR) is the most sensitive routine approach for monitoring the response to therapy of patients with chronic myeloid leukaemia. In the context of tyrosine kinase inhibitor (TKI) therapy, the technique is most appropriate for patients who have achieved complete cytogenetic remission and can be used to define specific therapeutic milestones. To achieve this effectively, standardization of the laboratory procedures and the interpretation of results are essential. We present here consensus best practice guidelines for RT-qPCR testing, data interpretation and reporting that have been drawn up and agreed by a consortium of 21 testing laboratories in the United Kingdom and Ireland in accordance with the procedures of the UK Clinical Molecular Genetics Society.