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Kelham M, Jones TN, Rathod KS, Guttmann O, Proudfoot A, Wragg A, Baumbach A, Jain A, Weerackody R, Mathur A, Jones DA. P2671The addition of admission lactate to the CREST risk score to determine prognosis in out of hospital cardiac arrest: the C-AREST score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
There has been an increasing focus on the development of scoring systems for patients admitted following resuscitation from out-of-hospital cardiac arrest (OHCA) to determine both prognosis and short-term management. One such system, the CREST score, has been shown to predict circulatory aetiology death in patients without ST-elevation myocardial infarction, however with an increasing number of OHCAs seen, general scoring systems to predict outcome in OHCA would be helpful.
Aims
We sought to determine whether the addition of an admission lactate ≥8 mmol/l to the existing CREST score was able to better predict in-hospital mortality in patients admitted with OHCA.
Methods and results
We retrospectively analysed the data of 500 patients admitted with an OHCA of presumed cardiac origin to our tertiary cardiac centre between June 2014 and Oct 2018. Mean age was 62.6y (±14.7), 379 (76%) were male and 250 (50%) were Caucasian. 313 (62.6%) were admitted with ST elevation myocardial infarction or equivalent. 48.6% (243/500) of patients died in hospital and of those that survived, 20.2% (52/257) were left with hypoxic brain injury (CPC score 3–4).
When analysed independently, all individual factors other than history of Coronary artery disease (OR 1.47, p=0.084) significantly predicted in-hospital mortality: Admission lactate ≥8 mmol/l (OR 6.78, p<0.0001), non-shockable Rhythm (OR 10.9, p<0.0001), Ejection fraction <30% (OR 5.84, p<0.0001), Shock at presentation (OR 5.49, p<0.0001) and ischaemic Time >25 minutes (OR 12.8, p<0.0001).
When each factor was assigned one point and totalled, both increasing CREST and C-AREST scores were associated with increasing in-hospital mortality: CREST (0–5 points): 4.3%, 30.5%, 41.5%, 85.6%, 95.2%, 100% vs C-AREST (0–6 points): 9.1%, 28.3%, 41.9%, 62.8%, 97.6%, 96.4%, 100%. When analysed with stepwise logistic regression, the addition of admission lactate ≥8 mmol/l to the model improved the prediction of in-hospital mortality: CREST (40.8% of variance explained) vs C-AREST (43.3%), with admission lactate remaining an independently significant predictor (OR 3.67, p=0.002).
Conclusion
We describe a novel modification to the previously described CREST scoring system for OHCA: the C-AREST score. The addition of admission lactate ≥8 mmol/l may have a role in differentiating those in intermediate risk categories (score between 2 and 3) where the predicted in hospital mortality would otherwise vary greatly. Given the relative ease of obtaining admission lactate, this scoring system may further improve stratification of patients who may or may not benefit from invasive management.
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Beirne A, Rathod K, Jain A, Mathur A, Wragg A, Smith EJ, Jones DA, Kalra S, Malik I, Redwood S, MacCarthy P, Bogle R, Firoozi S, Dalby M. P6516The association between prior coronary artery bypass graft surgery and outcome after percutaneous coronary intervention (PCI): an observational study of 123,780 patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Limited information exists regarding procedural success and clinical outcomes in patients with previous CABG undergoing percutaneous coronary intervention (PCI). We sought to compare outcomes in patients undergoing PCI with or without previous coronary artery bypass grafts (CABG).
Methods
This was an observational cohort study of 123,780 consecutive PCI procedures from the Pan-London (United Kingdom) PCI registry, from January 2005 to December 2015. The primary end-point was all-cause mortality at a median follow-up of 3.0 years (interquartile range 1.2–4.6 years).
Results
12,641 (10.2%) patients had a history of previous CABG, of whom 29.3% (n=3,703) underwent PCI to native vessels and 70.7% (n=8,938) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. The risk of mortality during follow-up was significantly higher in patients with prior CABG (23.2%) (p=0.0005) compared to patients with no history of prior CABG (12.1%) and was seen for patients who underwent either native vessel (20.1%) or bypass graft PCI (24.2%, p<0.0001). However, after adjustment for baseline characteristics, there was no significant difference in outcomes seen between the groups when PCI was performed in native vessels in patients with previous CABG (HR 1.02, 95% CI 0.77–1.34; P=0.89) but a significant increase in mortality among patients with PCI to bypass grafts (HR 1.33 95% CI 1.03–1.71, P=0.026). This was seen after multivariate adjustment and propensity matching.
Figure 1. Kaplan-Meier Curves
Conclusion
Patients with prior CABG are older, with a greater comorbid burden and more complex procedural characteristics, but after adjustment for these differences clinical outcomes are similar to patients undergoing PCI without prior CABG. In these patients, native vessel PCI was associated with better outcomes compared to the treatment of vein grafts.
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Jones TN, Kelham MD, Rathod KS, Guttmann O, Proudfoot A, Wragg A, Baumbach A, Jain A, Mathur A, Jones CA, Jones DA. P2665An observational study assessing the impact of a cardiac arrest centre on patient outcome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Out-of-hospital cardiac arrest (OHCA) is a major cause of death in Europe and the United States. There has been recent literature to suggest that the centralisation of OHCA services may benefit patient outcomes. In 2015, two major tertiary cardiac centres in the UK agglomerated to form a large dedicated tertiary cardiac centre. The previous centre had strict criteria on which OHCA patients could be admitted, with the vast majority of cases being STEMI-related. After the agglomeration, admission criteria were relaxed to include all OHCA cases within geographic range with a suspected cardiac cause.
Purpose
This study aimed to compare the short-term mortality of patients admitted with an OHCA to a tertiary cardiac centre before-and-after a major agglomeration of services had taken place and admission criteria had been relaxed.
Methods
We retrospectively analysed the data of patients admitted before and after agglomeration (2015) with OHCA who were resuscitated via conventional cardiopulmonary resuscitation. Baseline demographic characteristics were recorded, along with factors relating to the cardiac arrest. Primary endpoint was in-hospital mortality.
Results
A total of 650 patients (189 before and 461 after the agglomeration) with an OHCA between 2013 and 2018 were analysed. Patients admitted pre merger were older (67.7 vs 62.4 years, p=0.022), otherwise there were similar baseline demographic characteristics between patients admitted before and after the agglomeration (pre vs post) in terms of gender (74.4% vs 75.9% male, p=0.827), ethnicity (66.7% vs 58.9% Caucasian, p=0.588) and existing coronary artery disease (22.8% vs 22.7%, p=0.432). There were also similar peri-arrest characteristics, with a comparable number of patients having a non-shockable rhythm (15.4% vs 25.4%, p=0.164) and similar total downtimes between the groups (33 vs 32.3 mins, p=0.883). Interestingly there was a decrease in those with cardiogenic shock on arrival (92.3% vs 57.0%, p=0.0001) and fewer patients with an ejection fraction <30% (63.2 vs 38.7%, p=0.0003) post-agglomeration.
There was a greater proportion of non-ACS-related OHCA admission after the agglomeration (16.9% vs 24.1%, p=0.047) and a corresponding decrease in those admitted with a STEMI (81.5% vs 62.3%, p=0.032) and those treated with PCI (77.8% vs 54.0%, p=0.034). Despite this, in-hospital mortality was lower after the agglomeration (69.7% vs 47.1%, p=0.019), which persisted after adjustment for the previously described demographic and arrest-related characteristics using stepwise logistic regression (p=0.036) between the two groups.
Conclusion
Despite an increase in non-ACS-related-OHCA cases, the formation of a centralised invasive heart centre was associated with improved survival in OHCA patients. This suggests there may be a benefit for an out-of-hospital cardiac arrest-centre model of care, supporting a centralised strategy for immediate post-resuscitation care in OHCA patients.
Acknowledgement/Funding
None
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Abstract
Chronic cough is a common presentation to primary care and constitutes a significant volume of referrals to secondary care. It affects around 10% of the adult population and has a plethora of respiratory and non-respiratory causes. It can have a significant impact on the quality of life of affected individuals. In many patients, minimal baseline investigations lead to an easily identifiable and treatable cause. In others, no cause can be identified even after extensive investigations in specialized cough clinics. This evidence-based review article outlines the approach to the adult patient presenting with chronic cough and focuses upon current management strategies in those with chronic idiopathic cough. It includes results from trials of speech and language therapies, and the emerging concept of chronic idiopathic cough as a neuropathic disorder with its own bespoke approach to management including the use of neuromodulatory agents.
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Cizmeci MN, Khalili N, Claessens NHP, Groenendaal F, Liem KD, Heep A, Benavente-Fernández I, van Straaten HLM, van Wezel-Meijler G, Steggerda SJ, Dudink J, Išgum I, Whitelaw A, Benders MJNL, de Vries LS, Woerdeman P, ter Horst H, Dijkman K, Ley D, Fellman V, de Haan T, Brouwer A, van ‘t Verlaat E, Govaert P, Smit B, Agut Quijano T, Barcik U, Mathur A, Graca A. Assessment of Brain Injury and Brain Volumes after Posthemorrhagic Ventricular Dilatation: A Nested Substudy of the Randomized Controlled ELVIS Trial. J Pediatr 2019; 208:191-197.e2. [PMID: 30878207 DOI: 10.1016/j.jpeds.2018.12.062] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/26/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the effect of early and late intervention for posthemorrhagic ventricular dilatation on additional brain injury and ventricular volume using term-equivalent age-MRI. STUDY DESIGN In the Early vs Late Ventricular Intervention Study (ELVIS) trial, 126 preterm infants ≤34 weeks of gestation with posthemorrhagic ventricular dilatation were randomized to low-threshold (ventricular index >p97 and anterior horn width >6 mm) or high-threshold (ventricular index >p97 + 4 mm and anterior horn width >10 mm) groups. In 88 of those (80%) with a term-equivalent age-MRI, the Kidokoro Global Brain Abnormality Score and the frontal and occipital horn ratio were measured. Automatic segmentation was used for volumetric analysis. RESULTS The total Kidokoro score of the infants in the low-threshold group (n = 44) was lower than in the high-threshold group (n = 44; median, 8 [IQR, 5-12] vs median 12 [IQR, 9-17], respectively; P < .001). More infants in the low-threshold group had a normal or mildly increased score vs more infants in the high-threshold group with a moderately or severely increased score (46% vs 11% and 89% vs 54%, respectively; P = .002). The frontal and occipital horn ratio was lower in the low-threshold group (median, 0.42 [IQR, 0.34-0.63]) than the high-threshold group (median 0.48 [IQR, 0.37-0.68], respectively; P = .001). Ventricular cerebrospinal fluid volumes could be calculated in 47 infants and were smaller in the low-threshold group (P = .03). CONCLUSIONS More brain injury and larger ventricular volumes were demonstrated in the high vs the low-threshold group. These results support the positive effects of early intervention for posthemorrhagic ventricular dilatation. TRIAL REGISTRATION ISRCTN43171322.
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Mathur A. De motu cordis: the future of regenerative medicine. Neth Heart J 2019; 27:70-72. [PMID: 30623302 PMCID: PMC6352616 DOI: 10.1007/s12471-018-1222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Srivastava AK, Shukla S, Srivastava P, Dhole TN, Nayak MT, Nayak A, Mathur A. Real time detection and quantification of Epstein Barr virus in different grades of oral gingivitis and periodontitis patients. JOURNAL OF EXPERIMENTAL THERAPEUTICS AND ONCOLOGY 2019; 13:9-14. [PMID: 30658021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/24/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Periodontal diseases are of microbial etiology and are globally causing loss of teeth in adult population. Many severe oral diseases have been recently associated to Herpes viruses, of which Epstein Barr Virus (EBV) and human cytomegalovirus (HCMV) have been indicated in the etiology of periodontal diseases. AIM The purpose of the study was to compare the effect of EBV in different types of periodontal diseases namely acute gingivitis, chronic gingivitis, acute and chronic, localized and generalized aggressive (juvenile) periodontitis and apical periodontitis. MATERIAL AND METHOD 70 individuals were included in this study. Supragingival plaque and plaque from two deepest sites of the periodontal pockets were collected then stored at 70° c and prepared for nucleic acid extraction. For EBV detection, DNA were extracted from the plaque samples with the QIAamp DNA mini kit. Q-PCR was performed by targeting the non-polymorphic Epstein-Barr nuclear antigen-1 (EBNA-1) gene using Corbett Research 6000 Q-PCR instrument and Rotor gene 6000 software. RESULTS Overall prevalence of EBV in the disease group was 60% (27/45 patients) as compared to only 8% (4/25 people) in the normal population. The mean copy number of EBV DNA was found to be significantly higher in periodontitis (2234 ± 1811.34) when compared to gingivitis (554 ± 537.64, p = .001) and normal patients (370 ± 161.03, p < .001). CONCLUSION Here, we found that the prevalence of EBV as well as copy number of EBV was significantly higher in periodontitis patients as compared to gingivitis patients or normal population.
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Patel K, Chehab O, Barakat MF, Jerrum M, Queenan H, Bedford K, Broyd C, Ozkor M, Kennon S, Mathur A, Mullen M. P6314Outcomes with transcathether aortic valve implantation in patients with acute decompensated aortic stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ramasamy A, Chen Y, Zanchin T, Rathod K, Jones D, Parasa R, Zhang YJ, Amersey R, Westwood M, Ozkor M, Baumbach A, Mathur A, Serruys PW, Crake T, Bourantas CV. P2631Accuracy of optical coherence tomography in predicting functional significance of coronary stenosis determined by fractional flow reserve: a meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mansell J, Guttmann O, Bajaj R, Rathod KS, Baumbach A, Mohiddin S, Mathur A, Jones DA. P4647Long-term outcome in patients with myocardial infarction and unobstructed coronary arteries (MINOCA): ST elevation means worse outcomes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jones DA, Whittaker P, Rathod KS, Richards AJ, Andiapen M, Antoniou S, Mathur A, Ahluwalia A. P2564Sodium nitrite-mediated cardioprotection in primary percutaneous coronary intervention for ST-elevation myocardial infarction: a cost-effectiveness analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jones DA, Jones T, Kelham M, Rathod KS, Baumbach A, Proudfoot A, Jain A, Wragg A, Mathur A, Weerackody R. P834Validation of the CREST risk score in out of hospital cardiac arrest. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McBeath K, Cadd M, Guttman O, Rathod KS, Knight CJ, Amersey R, Bourantas C, Baumbach A, Mathur A, Jones DA. P5500Improved clinical outcomes post percutaneous coronary intervention (PCI) with the use of an enhanced visualisation system (CLEARstent). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Castle EV, Rathod K, Treibel T, Davies C, Guttmann O, Curtis M, Knight C, Moon J, Smith E, Weerackody R, Bourantas C, Wragg A, Mathur A, Pugliese F, Jones D. P1781An observational study assessing the value of computed tomography cardiac angiography (CTCA) in planning invasive angiographic procedures in patients with previous coronary artery bypass grafts (CABG). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Colicchia M, Hussain MA, Weeraman D, Hamshere S, Rathod KS, Veerapen DJ, Martin J, Baumbach A, Jones DA, Mathur A. P587Does the immune response to granulocyte-colony stimulating factor therapy vary in ischaemic versus non-ischaemic dilated cardiomyopathy? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Samways JW, Rathod KS, Guttmann O, Wragg A, Baumbach A, Weerackody R, Smith EJ, Mathur A, Amersey RA, Jones DA. P1665Outcomes and risk factors for recurrent restenosis in patients treated for coronary in-stent restenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Spagnolo M, Colicchia M, Rathod KS, Smith E, Knight C, Mathur A, Weerackody R, Andiapen M, Baumbach A, Jones DA. P5609Complete revascularisation in STEMI patients with multi-vessel disease: inpatient versus outpatient staged revascularisation results in similar clinical outcomes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rathod K, Koganti S, Mathur A, Wragg A, Jones D. Culprit lesion versus multi-vessel intervention in patients with cardiogenic shock complicating myocardial infarction: Incidence and outcomes from the London heart attack group. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ramasamy A, Ng J, Foin N, Girard M, Dijkstra J, Zanchin T, Crake T, Torii R, Rakhit R, Serruys PW, Raber L, Baumbach A, Mathur A, Bourantas CV. P6496Advantages and limitations of the attenuation-compensated technique in assessing plaque and neointima morphology in optical coherence tomography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rathod KS, Koganti S, Jain A, Sirker A, Mathur A, Knight C, Wragg A, Jones DA. P3586Patients with prior CABG treated with primary PCI have high long-term adverse outcome: an observational study of 26,799 patients with STEMI from the London heart attack group. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stefanski HE, Mathur A. Decreased Expression and Function of Vß6+ and Vß14+ T Cells is Associated with Decreased Th1 Cytokine Production in Mice with Plasma Cell Tumors. TUMORI JOURNAL 2018; 82:22-6. [PMID: 8623498 DOI: 10.1177/030089169608200104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background We have found that polyclonally stimulated T cells from mice bearing ascitic plasma cell tumors demonstrate specific decreases in Th1 cytokine production. In this study we investigated whether loss of Th1 responses in the plasma cell tumor system was associated with alterations in the Vß T cell receptor repertoire. Methods We examined the cell surface expression of specific Vß expressing splenic CD4+ or CD8+ T cells from normal and tumor bearing mice using direct three-color flowcytometry. In order to determine the Th phenotype of Vß expressing T cells, we enriched for Vß6, Vß14 or Vß8.1,8.2 cells, polyclonally stimulated them and measured the levels of the cytokines interleukin-4 (IL-4), IL-2 and interferon-gamma (IFN-gamma). Results We find that there is a statistically significant decrease in the frequency of Vß6+ and Vß14+ CD8+ T cells in mice bearing a plasma cell tumor (B53) as compared to normals (p<0.05). Stimulated Vß6+ and Vß14+ T cells exhibit an exclusively Th1 phenotype. Stimulated Vß6+ and Vß14+ T cells from B53 mice are deficient in production of the Th1 cytokines. In contrast, stimulated Vß8.1,8.2+ T cells, which are not altered in B53 mice, reveal a Th2 phenotype. Conclusions The significance of this study is our demonstration that decreased expression and function of Vß6+ and Vß14+ T cells may be, at least in part, responsible for the decrease in the production of IL-2 and/or IFN-gamma observed in hosts with tumors.
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Vellarikkal SK, Jayarajan R, Verma A, Ravi R, Senthilvel V, Kumar A, Saini L, Gulati S, Lal M, Mathur A, Chhetri MK, Faruq M, Scaria V, Sivasubbu S. A founder mutation MLC1 c.736delA associated with megalencephalic leukoencephalopathy with subcortical cysts-1 in north Indian kindred. Clin Genet 2018; 94:271-273. [PMID: 29667716 DOI: 10.1111/cge.13251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/01/2018] [Accepted: 03/19/2018] [Indexed: 11/28/2022]
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Lee JS, Han P, Song E, Kim D, Lee H, Labowsky M, Taavitsainen J, Ylä-Herttuala S, Hytönen J, Gülcher M, Perampaladas K, Sinusas AJ, Martin J, Mathur A, Fahmy TM. Magnetically Coated Bioabsorbable Stents for Renormalization of Arterial Vessel Walls after Stent Implantation. NANO LETTERS 2018; 18:272-281. [PMID: 29268605 DOI: 10.1021/acs.nanolett.7b04096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The insertion of a stent in diseased arteries is a common endovascular procedure that can be compromised by the development of short- and long-term inflammatory responses leading to restenosis and thrombosis, respectively. While treatment with drugs, either systemic or localized, has decreased the incidence of restenosis and thrombosis these complications persist and are associated with a high mortality in those that present with stent thrombosis. We reasoned that if stents could be made to undergo accelerated endothelialization in the deployed region, then such an approach would further decrease the occurrence of stent thrombosis and restenosis thereby improving clinical outcomes. Toward that objective, the first step necessitated efficient capture of progenitor stem cells, which eventually would become the new endothelium. To achieve this objective, we engineered intrinsic ferromagnetism within nonmagnetizable, biodegradable magnesium (Mg) bare metal stents. Mg stents were coated with biodegradable polylactide (PLA) polymer embedding magnetizable iron-platinum (FePt) alloy nanoparticles, nanomagnetic particles, nMags, which increased the surface area and hence magnetization of the stent. nMags uniformly distributed on stents enabled capture, under flow, up to 50 mL/min, of systemically injected iron-oxide-labeled (IO-labeled) progenitor stem cells. Critical parameters enhancing capture efficiency were optimized, and we demonstrated the generality of the approach by showing that nMag-coated stents can capture different cell types. Our work is a potential paradigm shift in engineering stents because implants are rendered as tissue in the body, and this "natural stealthiness" reduces or eliminates issues associated with pro-inflammatory immune responses postimplantation.
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Mathur A, Dempsey OJ. Electronic cigarettes: a brief update. J R Coll Physicians Edinb 2018; 48:346-351. [DOI: 10.4997/jrcpe.2018.415] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Cotton JM, Webb KE, Mathur A, Martin JF, Humphries SE. Impact of the -455G>A Promoter Polymorphism in the B Fibrinogen Gene on Stimulated Fibrinogen Production following Bypass Surgery. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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