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Casey KA, Fraser KA, Schenkel JM, Moran A, Abt MC, Beura LK, Lucas PJ, Artis D, Wherry EJ, Hogquist K, Vezys V, Masopust D. Antigen-independent differentiation and maintenance of effector-like resident memory T cells in tissues. THE JOURNAL OF IMMUNOLOGY 2012; 188:4866-75. [PMID: 22504644 DOI: 10.4049/jimmunol.1200402] [Citation(s) in RCA: 478] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Differentiation and maintenance of recirculating effector memory CD8 T cells (T(EM)) depends on prolonged cognate Ag stimulation. Whether similar pathways of differentiation exist for recently identified tissue-resident effector memory T cells (T(RM)), which contribute to rapid local protection upon pathogen re-exposure, is unknown. Memory CD8αβ(+) T cells within small intestine epithelium are well-characterized examples of T(RM), and they maintain a long-lived effector-like phenotype that is highly suggestive of persistent Ag stimulation. This study sought to define the sources and requirements for prolonged Ag stimulation in programming this differentiation state, including local stimulation via cognate or cross-reactive Ags derived from pathogens, microbial flora, or dietary proteins. Contrary to expectations, we found that prolonged cognate Ag stimulation was dispensable for intestinal T(RM) ontogeny. In fact, chronic antigenic stimulation skewed differentiation away from the canonical intestinal T cell phenotype. Resident memory signatures, CD69 and CD103, were expressed in many nonlymphoid tissues including intestine, stomach, kidney, reproductive tract, pancreas, brain, heart, and salivary gland and could be driven by cytokines. Moreover, TGF-β-driven CD103 expression was required for T(RM) maintenance within intestinal epithelium in vivo. Thus, induction and maintenance of long-lived effector-like intestinal T(RM) differed from classic models of T(EM) ontogeny and were programmed through a novel location-dependent pathway that was required for the persistence of local immunological memory.
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Kanatas A, Needs C, Smith A, Moran A, Jenkins G, Worrall S. Short-term outcomes using the Christensen patient-specific temporomandibular joint implant system: a prospective study. Br J Oral Maxillofac Surg 2012; 50:149-53. [DOI: 10.1016/j.bjoms.2011.01.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 01/10/2011] [Indexed: 11/16/2022]
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Meyerson JR, White TA, Bliss D, Moran A, Bartesaghi A, Borgnia MJ, de la Cruz MJV, Schauder D, Hartnell LM, Nandwani R, Dawood M, Kim B, Kim JH, Sununu J, Yang L, Bhatia S, Subramaniam C, Hurt DE, Gaudreault L, Subramaniam S. Determination of molecular structures of HIV envelope glycoproteins using cryo-electron tomography and automated sub-tomogram averaging. J Vis Exp 2011:2770. [PMID: 22158337 PMCID: PMC3304575 DOI: 10.3791/2770] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Since its discovery nearly 30 years ago, more than 60 million people have been infected with the human immunodeficiency virus (HIV) (www.usaid.gov). The virus infects and destroys CD4+ T-cells thereby crippling the immune system, and causing an acquired immunodeficiency syndrome (AIDS) 2. Infection begins when the HIV Envelope glycoprotein "spike" makes contact with the CD4 receptor on the surface of the CD4+ T-cell. This interaction induces a conformational change in the spike, which promotes interaction with a second cell surface co-receptor 5,9. The significance of these protein interactions in the HIV infection pathway makes them of profound importance in fundamental HIV research, and in the pursuit of an HIV vaccine. The need to better understand the molecular-scale interactions of HIV cell contact and neutralization motivated the development of a technique to determine the structures of the HIV spike interacting with cell surface receptor proteins and molecules that block infection. Using cryo-electron tomography and 3D image processing, we recently demonstrated the ability to determine such structures on the surface of native virus, at ˜20 Å resolution 9,14. This approach is not limited to resolving HIV Envelope structures, and can be extended to other viral membrane proteins and proteins reconstituted on a liposome. In this protocol, we describe how to obtain structures of HIV envelope glycoproteins starting from purified HIV virions and proceeding stepwise through preparing vitrified samples, collecting, cryo-electron microscopy data, reconstituting and processing 3D data volumes, averaging and classifying 3D protein subvolumes, and interpreting results to produce a protein model. The computational aspects of our approach were adapted into modules that can be accessed and executed remotely using the Biowulf GNU/Linux parallel processing cluster at the NIH (http://biowulf.nih.gov). This remote access, combined with low-cost computer hardware and high-speed network access, has made possible the involvement of researchers and students working from school or home.
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Moran A, Stein E, Tischler H, Bar-Gad I. Decoupling neuronal oscillations during subthalamic nucleus stimulation in the parkinsonian primate. Neurobiol Dis 2011; 45:583-90. [PMID: 22001603 DOI: 10.1016/j.nbd.2011.09.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 09/25/2011] [Accepted: 09/29/2011] [Indexed: 11/17/2022] Open
Abstract
Subthalamic nucleus (STN) stimulation is a popular treatment for Parkinson's disease; however, its effect on neuronal activity is unclear. We performed simultaneous multi-electrode recordings in the STN and its targets, the globus pallidus internus (GPi) and externus (GPe) in the parkinsonian non-human primate during high frequency STN macro-stimulation. Our results indicate that in the parkinsonian state the abnormal neuronal oscillatory activity in the 10-15 Hz range is coherent within and between nuclei. We further show that STN macro-stimulation results in a reduction of oscillatory activity in the globus pallidus. In addition, a functional decoupling of the STN from its pallidal targets is evidenced by the reduced STN-GPi coherence, that effectively removes the STN synchronous oscillatory drive of basal ganglia output. This decoupling results in reduced coherence between neurons within the GPi which resume an independent neuronal activity pattern. This decorrelation of the basal ganglia output may result in a reduction of the fluctuations of the basal ganglia inhibitory control over thalamic neurons which may potentially contribute to the beneficial effects of deep brain high-frequency stimulation.
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Varkevisser R, Nalos L, Jonsson MKB, Duker G, De Boer TP, Van Veen TAB, Van Der Heyden MAG, Vos MA, Milberg P, Frommeyer G, Ghezelbash S, Eckardt L, Bingen BO, Askar SFA, Ypey DL, Van Der Laarse A, Schalij MJ, Pijnappels DA, Mor M, Beharier O, Blumenthal D, Gheber LA, Peretz A, Katz A, Moran A, Etzion Y, Uldry L, Virag N, Vesin JM, Kappenberger L, Marques-Neto SR, Pimenta MC, Marocolo-Junior M, Maior AS, Nascimento JHM, Flevari P, Theodorakis G, Leftheriotis D, Kroupis C, Kolokathis F, Dima K, Kremastinos D, Anastasiou-Nana M, Jowhari H, Jaydari F, Taati M, Manteghi A, Liew R, Katwadi KB, Gu Y, Mohamed Atan MSB, Moe KT, Urbanek B, Ruta J, Kudrynski K, Kaczmarek K, Chudzik M, Ptaszynski P, Wranicz JK. Basic Science. Europace 2011. [DOI: 10.1093/europace/eur230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gany F, Lee T, Ramirez J, Massie D, Moran A, Crist M, McNish T, Leng JCF. Are our severely ill patients hungry? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nathan B, Moran A. Treatment recommendations for cystic fibrosis-related diabetes: too little, too late? Thorax 2011; 66:555-6. [DOI: 10.1136/thx.2010.157883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Huang CJ, Butler AE, Moran A, Rao PN, Wagner JE, Blazar BR, Rizza RA, Manivel JC, Butler PC. A low frequency of pancreatic islet insulin-expressing cells derived from cord blood stem cell allografts in humans. Diabetologia 2011; 54:1066-74. [PMID: 21331470 PMCID: PMC3071928 DOI: 10.1007/s00125-011-2071-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 01/10/2011] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS We sought to establish if stem cells contained in cord blood cell allografts have the capacity to differentiate into insulin-expressing beta cells in humans. METHODS We studied pancreases obtained at autopsy from individuals (n = 11) who had prior opposite-sex cord blood transplants to reconstitute haematopoiesis. Pancreatic tissue sections were stained first by XY-fluorescence in situ hybridisation and then insulin immunohistochemistry. Pancreases obtained at autopsy from participants without cord blood cell infusions served as controls (n = 11). RESULTS In the men with prior transplant of female cord blood, there were 3.4 ± 0.3% XX-positive insulin-expressing islet cells compared with 0.32 ± 0.05% (p < 0.01) in male controls. In women with prior transplant of male cord blood cells we detected 1.03 ± 0.20% XY insulin-expressing islet cells compared with 0.03 ± 0.03 in female controls (p < 0. 001). CONCLUSIONS/INTERPRETATION Cord blood stem cells have the capacity to differentiate into insulin-expressing cells in non-diabetic humans. It remains to be established whether these cells have the properties of beta cells.
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Moss EL, Moran A, Douce G, Parkes J, Todd RW, Redman CWE. Cervical cytology/histology discrepancy: a 4-year review of patient outcome. Cytopathology 2011; 21:389-94. [PMID: 20482721 DOI: 10.1111/j.1365-2303.2010.00754.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the diagnosis, review and management of women identified as having a cytology/histology discrepancy. METHODS A review of all patients diagnosed with a discrepancy between referral smear and cervical histology was performed between January 2003 and December 2004. Cases were followed for a minimum of 4 years and patient management and outcome reviewed. RESULTS A significant discrepancy was identified in 79 cases, 0.1% of all smears (n = 80,926) analysed during the study period. A discrepancy between cytology and histology, obtained from large loop excision of the transformation zone (LLETZ), was confirmed by multidisciplinary review in 42 cases (53.2%). In 37 cases (46.8%) the cytological and/or histological diagnosis was revised; the cytology was significantly more likely than the histology to be amended (chi square P = 0.005), most often because cytology had been overcalled. Of the confirmed discrepancy cases, 33 (78.6%) were due to high-grade squamous cell or glandular abnormalities on cytology with a negative, inflammatory or human papillomavirus (HPV) infection on histology (HGC/NH). HGC/NH cases were managed by cytological follow-up in 29 (87.9%), of which 72.4% of the smears were negative when performed at least 6 months post-excision. During the 4-year follow-up period six women with a confirmed HGC/NH underwent a repeat cervical excision (hysterectomy or LLETZ), and of these, HPV effect was seen in two cases but no cervical intraepithelial neoplasia was detected in any of the histological specimens. CONCLUSION Cytology overcall was responsible for the majority of cytology/histology discrepancies. A confirmed discrepancy is not an indication for a further excisional biopsy but follow-up is essential because a small percentage of patients may have disease that has been missed.
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Apostolova N, Gomez-Sucerquia LJ, Moran A, Alvarez A, Blas-Garcia A, Esplugues JV. Enhanced oxidative stress and increased mitochondrial mass during efavirenz-induced apoptosis in human hepatic cells. Br J Pharmacol 2010; 160:2069-84. [PMID: 20649602 DOI: 10.1111/j.1476-5381.2010.00866.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Efavirenz (EFV) is widely used in the treatment of HIV-1 infection. Though highly efficient, there is growing concern about EFV-related side effects, the molecular basis of which remains elusive. EXPERIMENTAL APPROACH In vitro studies were performed to address the effect of clinically relevant concentrations of EFV (10, 25 and 50 microM) on human hepatic cells. KEY RESULTS Cellular proliferation and viability were reduced in a concentration-dependent manner. Analyses of the cell cycle and several cell death parameters (chromatin condensation, phosphatidylserine exteriorization, mitochondrial proapoptotic protein translocation and caspase activation) revealed that EFV triggered apoptosis via the intrinsic pathway. In addition, EFV directly affected mitochondrial function in a reversible manner, inducing a decrease in mitochondrial membrane potential and an increase in mitochondrial superoxide production, followed by a reduction in cellular glutathione content. The rapidity of these actions rules out any involvement of mitochondrial DNA replication, which, until now, was thought to be the main mechanism of mitochondrial toxicity of antiretroviral drugs. Importantly, we also observed an increase in mitochondrial mass, manifested as an elevated cardiolipin content and enhanced expression of mitochondrial proteins, which was not paralleled by an increase in the mtDNA/nuclear DNA copy number ratio. The toxic effect of EFV was partially reversed by antioxidant pretreatment, which suggests ROS generation is involved in this effect. CONCLUSION AND IMPLICATIONS Clinically relevant concentrations of EFV were shown to be mitotoxic in human hepatic cells in vitro, which may be pertinent to the understanding of the hepatotoxicity associated with this drug.
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Abstract
Cystic fibrosis related diabetes (CFRD) is the most common co-morbidity in persons with cystic fibrosis (CF). As the life expectancy of persons with CF continues to increase, the need to proactively diagnose and aggressively treat CFRD and its potential complications has become more apparent. CFRD negatively impacts lung function, growth and mortality, making its diagnosis and management crucial in a population already at high risk for early mortality. Compared to type 1 and type 2 diabetes, CFRD is a unique entity, requiring a thorough understanding of its unique pathophysiology to facilitate the creation and utilization of an effective medical treatment plan. The physiology of CFRD is complex, likely consisting of a combination of insulin deficiency, insulin resistance and a genetic predisposition towards the development of diabetes. However, the hallmark of CFRD is insulin deficiency, necessitating the use of exogenous insulin as the mainstay of therapy. Insulin administration, in combination with a multidisciplinary team of health professionals with expertise in the care of patients with CF and CFRD, is the cornerstone of the care for these patients. The goals of treatment of the CFRD population are to reverse protein catabolism, maintain a healthy weight, and reduce acute and chronic diabetes complications. Creating a partnership between the treatment team and the patient is the ideal way to accomplish these goals and is essential for successful diabetes care.
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Morrison C, Moran A, Vidaurre MH, Carrick M, Tweardy D. Neutrophil Apoptosis in the Early Post-Resuscitation Period Is Associated with Decreased Heart Rate and Temperature in Trauma Patients with Hemorrhagic Shock. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Moeller H, Moran A. Poor Progress in Breast Cancer Control in the Elderly in the UK. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:In 1998 England introduced a national cancer target, to reduce cancer mortality in the under 75 year olds from 1996 to 2010 by 20%. This might potentially lead to inequalities between younger and elderly cancer patients. In this study we assessed progress in breast cancer control in the elderly in the UK by comparing cancer mortality rates in the elderly with younger age groups in the UK and by comparing the elderly in the UK with other similar countries.Material and Methods:Mortality data for the UK, USA, Northern Europe (Denmark, Finland, Iceland, Sweden and Norway) and Western Europe (Germany, Netherlands, Luxembourg, Austria, France Switzerland) was obtained from the WHO mortality database. Age specific cancer mortality rates for the age bands 55-64, 65-74, 75-84 and 85 plus were calculated for the different geographies for the three year periods 1995-97 and 2003-05. Change in the differences between the age bands was assessed as the ratio between the youngest age group 55-64, which was set to 1, and the older age groups. The number of excess deaths in the UK was calculated by applying the lowest rate observed in each age band to the UK population, assuming that the UK could achieve the same rate.Results:Compared to other countries the UK had the highest breast cancer mortality rates in all age bands in 1995-07 and 2003-05 and rates were statistically significantly higher in 2003-05 at the 95% Confidence interval limit. In the younger age groups (55-64 and 65-74) the UK had the biggest decrease from 1995-97 to 2003-05 and is decreasing the gap to the other countries. In contrast the UK was the only geography with an increase in mortality rates in the over 85 year olds and only ranked second after the USA in the 75 to 84 year olds. If the UK had the same mortality rates as the lowest observed in each age band 681 breast cancer deaths could be prevented in the 55 to 74 year olds and 1590 in the over 75 year olds each year. The UK also had the greatest increase in the ratio between the 55-64 year olds and 85plus year olds, with and increase of a 100% from 3.5 to 4.5 from 1995-97 to 2003-05. The USA had the lowest rates in each age group.Conclusion:Little progress has been made in decreasing breast cancer mortality rates in the elderly in the UK. The gap in breast cancer mortality in the elderly compared to the younger age groups as well as the other countries is increasing. The gap with other countries will be closed only if there is a marked decrease in death rates in the over 75s. Future analysis should also look at the causes of higher mortality in the UK, taking the USA as the gold standard.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2059.
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Moran A, Scott PA, Darbyshire P. Existential boredom: the experience of living on haemodialysis therapy. MEDICAL HUMANITIES 2009; 35:70-75. [PMID: 23674698 DOI: 10.1136/jmh.2009.001511] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Empathy is an essential component of professional nursing practice. In order to empathise appropriately with patients, it is crucial that nurses appreciate, understand and respond to their patients' experience of illness. This study sought to explore the experiences of 16 people with end stage renal disease on haemodialysis therapy in Ireland. A hermeneutical phenomenological methodology was employed incorporating qualitative interviews. The data were analysed using qualitative interpretive analysis. The experience of waiting was significant for the participants in the study. The experience of waiting was constituted by two themes labelled killing time and wasting time. It is suggested that the participants' experience of waiting is reminiscent of Heidegger's existential account of boredom. Moreover, the existential perspective of boredom contained within the participants' accounts is also depicted by Beckett in his play Waiting for Godot. Consequently, the literature of both existential writers is incorporated to provide a more in-depth description of the participants' experience of waiting. It is hoped that the insights provided in this paper will enable practitioners to gain a new awareness and understanding of patients' experiences of end stage renal disease and haemodialysis therapy. This would subsequently enable these professionals to empathise more effectively with their patients' situation and respond more appropriately to their care needs.
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Moran A, Bar-Gad I. Revealing neuronal functional organization through the relation between multi-scale oscillatory extracellular signals. J Neurosci Methods 2009; 186:116-29. [PMID: 19900473 DOI: 10.1016/j.jneumeth.2009.10.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 10/25/2009] [Accepted: 10/30/2009] [Indexed: 12/01/2022]
Abstract
The spatial organization of neuronal elements and their connectivity make up the substrate underlying the information processing carried out in the networks they form. Conventionally, anatomical findings make the initial structure which later combines with superimposed neurophysiological information to create a functional organization map. The most common neurophysiological measure is the single neuron spike train extracted from an extracellular recording. This single neuron firing pattern provides valuable clues on information processing in a given brain area; however, it only gives a sparse and focal view of this process. Even with the increase in number of simultaneously recorded neurons, inference on their large-scale functional organization remains problematic. We propose a method of utilizing additional information derived from the same extracellular recording to generate a more comprehensive picture of neuronal functional organization. This analysis is based on the relationship between the oscillatory activity of single neurons and their neighboring neuronal populations. Two signals that reflect the multiple scales of neuronal populations are used to complement the single neuron spike train: (1) the high-frequency background unit activity representing the spiking activity of small localized sub-populations and (2) the low-frequency local field potential that represents the synaptic input to a larger global population. The three coherences calculated between pairs of these three signals arising from a single source of extracellular recording are then used to infer mosaic representations of the functional neuronal organization. We demonstrate this methodology on experimental data and on simulated leaky integrate-and-fire neurons.
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Geraci M, Eden TOB, Alston RD, Moran A, Arora RS, Birch JM. Geographical and temporal distribution of cancer survival in teenagers and young adults in England. Br J Cancer 2009; 101:1939-45. [PMID: 19888224 PMCID: PMC2788264 DOI: 10.1038/sj.bjc.6605410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Between 1979 and 2001, an analysis of cancer survival in young people in England, aged 13 to 24 years, showed overall improvements. However, for some diagnostic groups, little or no increases were observed. The aim of this study was to analyse the regional distribution of cancer survival in teenagers and young adults in England in order to identify patterns and potential for improvements at a regional scale. Methods: We examined geographical and temporal patterns in relative survival in cancer patients aged 13–24 years in England during the time period 1979–2001. Cancer cases were grouped according to an internationally recognised morphology-based diagnostic scheme. Results: For most diagnostic groups, there was little variation in survival between regions, except for testicular germ cell tumours (P=0.006) and colorectal carcinoma (P=0.002). For certain diagnostic groups, the temporal pattern in survival differed between regions. However, in regions that showed poor survival during the early part of the study period, greatest improvements were observed in groups such as acute lymphoid leukaemia, acute myeloid leukaemia, testicular tumours and melanoma. Conclusion: In conclusion, there was a reduction in the differences in survival between regions during the study period.
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Moran A, Cocoman A, Scott PA, Matthews A, Staniuliene V, Valimaki M. Restraint and seclusion: a distressing treatment option? J Psychiatr Ment Health Nurs 2009; 16:599-605. [PMID: 19689553 DOI: 10.1111/j.1365-2850.2009.01419.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The effectiveness of restraint and seclusion interventions in the nursing management of disturbed and aggressive clients remains questionable. Considerable debate continues regarding the use of these treatment options in psychiatric hospitals. The existing literature suggests that the controversial nature of restraint and seclusion creates a complex dilemma for nurses, which initiates emotional distress. This study specifically explored the emotions and feelings experienced by a group of psychiatric nurses working in Ireland in relation to incidents of restraint and seclusion. A qualitative research approach was employed incorporating focus group discussions. A total of 23 nurses participated in three focus group interviews. The data were analysed using qualitative interpretive analysis. Three themes were created consisting of: (1) the last resort - restraint and seclusion; (2) emotional distress; and (3) suppressing unpleasant emotions. It is suggested that the nurses' experience of restraint and seclusion created a dynamic movement between the release and suppression of distressing emotions. The oscillatory characteristics embedded within the nurses' emotional responses were reminiscent of a model of suffering developed by Morse in 2001. Consequently, this model is incorporated throughout the discussion of the findings to provide a more in-depth description of the emotional distress experienced by the nurses in the study.
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Gujral K, Petryk A, Steffen L, Baker K, Perkins J, Kelly AS, Zhou X, Sinaiko A, Moran A, Steinberger J. Growth hormone deficiency and cardiovascular risk factors in childhood cancer survivors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6614 Background: Childhood cancer survivors (CCS) have a high frequency of growth hormone deficiency (GHD) and risk of early cardiovascular disease (CVD). This study examined the relations between GHD and risk factors for CVD in CCS. Methods: Anthropometrics, blood pressure, lipids, growth hormone (GH) stimulation test, dual-energy x-ray absorptiometry, abdominal CT, and insulin resistance (IR) (euglycemic, hyperinsulinemic clamp - low M/lbm signifies IR) were obtained in 174 CCS, mean age 15±2 years and 89 healthy sibling controls, mean age 13.5±3 years. Linear regression evaluated the relations between GHD and CVD risk factors, adjusted for sex, age, pubertal stage, and body mass index (BMI) or visceral fat. Results: 62 CCS (36%) had GHD. There were no significant measurement differences between non-GHD CCS and controls. Compared to controls, GHD CCS who never received GH (N = 34) had greater BMI (24.8 vs 20.8 kg/m2, p < 0.0001), percent body fat (36.1% vs 25.8%, p < 0.0001), visceral fat (34.8 vs 19.6 cm2, p < 0.0001), and triglycerides (TG) (120.2 vs 83.8 mg/dL, p = 0.001) and were more IR (M/lbm 11.1 vs 14.2 mg/kg/min, p = 0.0006). Adjustment for BMI and visceral fat did not change the IR or TG results. GHD CCS currently on GH had lower BMI (21.9 kg/m2, p = 0.02), percent body fat (31.2%, p = 0.08), and visceral fat (26.5 cm2, p = 0.03) compared to those not treated. IR and TG were not different between treated and not treated GHD CCS. Conclusions: GHD is a common finding in CCS and is significantly associated with adiposity, IR, and elevated TG.There is a suggestion that GH treatment had a positive impact on adiposity, but not IR and TG levels. These study findings imply that CVD risk factors are present in CCS with GHD independent of body fatness, suggesting that the cancer diagnosis or treatments received may lead to early cardiovascular disease in childhood cancer survivors. No significant financial relationships to disclose.
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Baker KS, Kelly AS, Petryk A, Sinaiko AR, Steffen LM, Moran A, Mulrooney D, Dengel DR, Gujral K, Zhou X, Steinberger J. Cardiometabolic risk in survivors of childhood cancer who received hematopoietic cell transplant (HCT). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6532 Background: Evidence suggests that survivors of childhood cancer are at increased risk for cardiovascular disease (CVD) and type 2 diabetes with even higher risk in those who received HCT. The purpose of this study was to compare the cardiometabolic risk factor profile in HCT patients and healthy sibling controls. Methods: Measures of insulin resistance (euglycemic hyperinsulinemic clamp adjusted for lean body mass [Mlbm], low Mlbm represents insulin resistance), fasting glucose, insulin, lipids, anthropometry, blood pressure (BP), and carotid artery compliance and distensibility (lower values represent arterial stiffness) were determined in 87 children and young adults (current age 27.3 yr, 57% male) who had received HCT for hematologic malignancy during childhood (mean age at HCT 11.8 yr) and 55 healthy sibling controls (current age=25.2 yr, 51% male). Linear regression models were used to evaluate risk factors between groups after adjusting for age, gender, pubertal stage, body mass index (BMI), and carotid lumen diameter (stiffness measures only). Results: Metabolic syndrome (ATP III criteria for adults, modified criteria for children) was present in 13 (14.9%) HCT survivors and 4 (7.3%) controls (p=0.19). Thirty-one (35.6%) survivors and 9 (16.4%) controls had two or more components of the metabolic syndrome (p=0.11). There were no differences between groups for BMI, waist circumference, percent body fat, or BP. HCT survivors had higher triglycerides, fasting glucose and insulin, lower HDL cholesterol, arterial distensibility, and were more insulin resistant (Table). Conclusions: HCT survivors have increased cardiometabolic risk factors independent of obesity suggesting that cancer itself and/or associated treatment exposures have a direct influence on CVD risk and that early screening and management of cardiometabolic risk factors should be considered in HCT survivors. [Table: see text] No significant financial relationships to disclose.
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Moran A, Bergman H, Israel Z, Bar-Gad I. Subthalamic nucleus functional organization revealed by parkinsonian neuronal oscillations and synchrony. Brain 2008; 131:3395-409. [DOI: 10.1093/brain/awn270] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bellin MD, Kandaswamy R, Parkey J, Zhang HJ, Liu B, Ihm SH, Ansite JD, Witson J, Bansal-Pakala P, Balamurugan AN, Papas KK, Sutherland DER, Moran A, Hering BJ. Prolonged insulin independence after islet allotransplants in recipients with type 1 diabetes. Am J Transplant 2008; 8:2463-70. [PMID: 18808408 PMCID: PMC4312281 DOI: 10.1111/j.1600-6143.2008.02404.x] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We sought to determine the long-term outcomes in type 1 diabetic recipients of intraportal alloislet transplants on a modified immunosuppressive protocol. Six recipients with hypoglycemia unawareness received one to two islet infusions. Induction therapy was with antithymocyte globulin (ATG) plus etanercept for tumor necrosis factor-alpha blockade. Recipients received cyclosporine and everolimus for maintenance immunosuppression for the first year posttransplant, with mycophenolic acid or mycophenolate mofetil subsequently substituted for everolimus. Recipients have been followed for 1173 +/- 270 days since their last infusion for islet graft function (insulin independence, hemoglobin A(1c) levels and C-peptide production) and for adverse events associated with the study protocol. Of the six recipients, five were insulin-independent at 1 year, and four continue to be insulin-independent at a mean of 3.4 +/- 0.4 years posttransplant. None of the six recipients experienced recurrence of severe hypoglycemia. Measured glomerular filtration rate decreased from 110.5 +/- 21.2 mL/min/1.73 m(2) pretransplant to 82.6 +/-19.1 mL/min/1.73 m(2) at 1 year posttransplant. In conclusion, islet transplants restored insulin independence for a mean of >3 years in four of six recipients treated with ATG and etanercept induction therapy and with cyclosporine and, initially, everolimus for maintenance. Our results suggest this immunosuppressive protocol may allow long-term graft survival.
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Bellin MD, Kandaswamy R, Parkey J, Zhang HJ, Liu B, Ihm SH, Ansite JD, Witson J, Bansal-Pakala P, Balamurugan AN, Papas KK, Papas K, Sutherland DER, Moran A, Hering BJ. Prolonged insulin independence after islet allotransplants in recipients with type 1 diabetes. Am J Transplant 2008. [PMID: 18808408 DOI: 10.1111/j.1600-6143.2008.02404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We sought to determine the long-term outcomes in type 1 diabetic recipients of intraportal alloislet transplants on a modified immunosuppressive protocol. Six recipients with hypoglycemia unawareness received one to two islet infusions. Induction therapy was with antithymocyte globulin (ATG) plus etanercept for tumor necrosis factor-alpha blockade. Recipients received cyclosporine and everolimus for maintenance immunosuppression for the first year posttransplant, with mycophenolic acid or mycophenolate mofetil subsequently substituted for everolimus. Recipients have been followed for 1173 +/- 270 days since their last infusion for islet graft function (insulin independence, hemoglobin A(1c) levels and C-peptide production) and for adverse events associated with the study protocol. Of the six recipients, five were insulin-independent at 1 year, and four continue to be insulin-independent at a mean of 3.4 +/- 0.4 years posttransplant. None of the six recipients experienced recurrence of severe hypoglycemia. Measured glomerular filtration rate decreased from 110.5 +/- 21.2 mL/min/1.73 m(2) pretransplant to 82.6 +/-19.1 mL/min/1.73 m(2) at 1 year posttransplant. In conclusion, islet transplants restored insulin independence for a mean of >3 years in four of six recipients treated with ATG and etanercept induction therapy and with cyclosporine and, initially, everolimus for maintenance. Our results suggest this immunosuppressive protocol may allow long-term graft survival.
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Steffen LM, Vessby B, Jacobs DR, Steinberger J, Moran A, Hong CP, Sinaiko AR. Serum phospholipid and cholesteryl ester fatty acids and estimated desaturase activities are related to overweight and cardiovascular risk factors in adolescents. Int J Obes (Lond) 2008; 32:1297-304. [PMID: 18560369 PMCID: PMC2832613 DOI: 10.1038/ijo.2008.89] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM/HYPOTHESIS The objective of this study was to describe the relation of serum fatty acids and desaturase activity (DA) to overweight, insulin sensitivity and cardiovascular disease (CVD) risk factors in adolescents. METHODS The relations of % serum phospholipid (PL) and cholesteryl ester (CE) fatty acids and estimated DA with CVD risk factors were examined in 264 adolescents (average age 15 years). Fatty acids were determined by gas liquid chromotography. Surrogate measures of DA were expressed as ratios of serum fatty acids: Delta9 DA=16:0/16:1; Delta6 DA=20:3,n6/18:2,n6 (PL) or 18:3,n6/18:2,n6 (CE); and Delta5 DA=20:4,n6/20:3,n6. Spearman partial correlations of fatty acids (%) and DA ratios with CVD risk factors were reported, adjusting for age, sex, race, Tanner stage, energy intake and physical activity. RESULTS Overweight adolescents compared to normal weight had more adverse levels of CVD risk factors, composition of PL and CE fatty acids in serum, and Delta6 DA and Delta5 DA ratios. Linoleic acid was inversely related to body mass index (BMI), waist circumference and triglycerides (P CONCLUSION These findings support those observed in adults, that factors, such as type of dietary fat, physical activity, and obesity, may influence fatty acid metabolism and are important in the development of adverse CVD risk factors as early as adolescence.
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Zaidel A, Moran A, Marjan G, Bergman H, Israel Z. Prior pallidotomy reduces and modifies neuronal activity in the subthalamic nucleus of Parkinson's disease patients. Eur J Neurosci 2008. [DOI: 10.1111/j.1460-9568.2008.05822.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Moran A, Simon JA, Pickering TG, Krauss RM. Response to "Is There Overlap in Blood-pressure Response to the Blockers of the Renin-Angiotensin System Between Lower and Higher Renin Subjects?". Am J Hypertens 2008. [DOI: 10.1038/ajh.2007.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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