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Robert G, Milne R. A Delphi study to establish national cost-effectiveness research priorities for positron emission tomography. Eur J Radiol 1999; 30:54-60. [PMID: 10389013 DOI: 10.1016/s0720-048x(98)00139-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to determine the key cost-effectiveness research questions relating to positron emission tomography (PET) in the UK. METHODS A systematic literature review was conducted to establish the existing knowledge base relating to the cost-effectiveness of PET in the various conditions for which it has been proposed. A three-round postal Delphi study of relevant individuals was used to determine the key cost-effectiveness research questions relating to PET in the UK. The content and structure of the Delphi study was informed by the results of the literature review. RESULTS The most important cost-effectiveness research priorities for the National Health Service (NHS) relating to PET were in the clinical areas of lung cancer, breast cancer and the assessment of myocardial viability. Gamma camera PET using coincidence imaging was highlighted as a modality whose, clinical role needed to be determined urgently. CONCLUSION Underlying the cost-effectiveness research priorities which were established is the need for evidence that the use of the various PET modalities as a diagnostic technique will alter patient management as compared to existing diagnostic strategies. The findings of the project provide a contemporary overview of the potential role for PET in the NHS and will be relevant to other countries.
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Trakhanov S, Parkin S, Raffaï R, Milne R, Newhouse YM, Weisgraber KH, Rupp B. Structure of a monoclonal 2E8 Fab antibody fragment specific for the low-density lipoprotein-receptor binding region of apolipoprotein E refined at 1.9 A. ACTA CRYSTALLOGRAPHICA SECTION D: BIOLOGICAL CRYSTALLOGRAPHY 1999; 55:122-8. [PMID: 10089402 DOI: 10.1107/s090744499800938x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/1998] [Accepted: 07/09/1998] [Indexed: 11/10/2022]
Abstract
The crystal structure of the Fab fragment of 2E8, the monoclonal IgG1,kappa antibody specific for the low-density lipoprotein (LDL) receptor-binding region of apolipoprotein E (apoE), has been solved by molecular replacement and refined at 1.9 A resolution (PDB entry 12E8). Two 2E8 Fab molecules in the asymmetric unit are related by noncrystallographic symmetry and are hydrogen bonded through a beta-sheet-like intermolecular contact between the heavy-chain complementarity-determining regions 3 (CDRH3) of each molecule. The structure has been refined to an R value of 0.22 (Rfree = 0.27). The initially ill-defined heavy-chain constant domain (CH1) of 2E8 has been retraced with the aid of automatic refinement, confirming the beta-sheet tracing independently of any starting models. As a resolution better than 2 A is not common for Fab fragments, this model represents a well defined Fab structure and should prove useful in MR solution of other Fab fragments. Furthermore, in the absence of an LDL-receptor structure, the homology of the 2E8 CDRH2 to the ligand-binding domain of the LDL receptor has been exploited to model the apoE-LDL-receptor interaction.
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Milne R, Wright T, Kaplan H, Dean D. Spruce budworm elastase precipitates Bacillus thuringiensis delta-endotoxin by specifically recognizing the C-terminal region. INSECT BIOCHEMISTRY AND MOLECULAR BIOLOGY 1998; 28:1013-1023. [PMID: 9887517 DOI: 10.1016/s0965-1748(98)00090-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A gut juice protein from Choristoneura fumiferana (spruce budworm) larvae that precipitates certain delta-endotoxins shows a unique specificity for the C-terminal amino acid sequence. Using homolog scanning mutants, we have identified a contiguous region of the Cry1Aa toxin which interacts with the 75-kDa toxin precipitating protein (TPP-75)' resulting in precipitation. The contiguous region from Cry1Aa can be transferred to Cry1Ac and results in an identical precipitation reaction. The precipitation reaction occurs rapidly and is unique in that the ratio of precipitating protein to toxin is low (estimated at 0.01), unlike antibody-antigen reactions which exhibit mole ratios close to 1. TPP-75 has been characterized as an elastase-like serine protease. We have taken advantage of this serine protease character and incorporated a radiolabel using an irreversible inhibitor. The radiolabel has allowed us to show the coincidence of the catalytically-inhibited TPP-75 with the toxin in a blotting assay and to follow the degradation of TPP-75 during storage. TPP-75 represents the first evidence that gut juice proteins may selectively attenuate the activity of delta-endotoxins, prior to binding to putative receptors on susceptible cells. TPP-75 should be evaluated as a possible resistance mechanism for those larvae that do not exhibit a receptor-based resistance.
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Terrisse L, Poirier J, Bertrand P, Merched A, Visvikis S, Siest G, Milne R, Rassart E. Increased levels of apolipoprotein D in cerebrospinal fluid and hippocampus of Alzheimer's patients. J Neurochem 1998; 71:1643-50. [PMID: 9751198 DOI: 10.1046/j.1471-4159.1998.71041643.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Apolipoprotein D (apoD) is a member of the lipocalin family of proteins. Most members of this family are transporters of small hydrophobic ligands, although in the case of apoD, neither its physiological function(s) nor its putative ligand(s) have been unequivocally identified. In humans, apoD is expressed in several tissues, including the CNS, and its synthesis is greatly increased during regeneration of rat peripheral nerves. As apoD may have an important function in the nervous system and, particularly, in nerve regeneration, we measured immunoreactive apoD levels in the hippocampus and in CSF of patients with either Alzheimer's disease (AD) or other neuropathologies. In parallel, we determined the concentrations of apolipoprotein E (apoE), another apolipoprotein also implicated in nerve regeneration and in the etiology of AD. Levels of apoD but not apoE were increased in the hippocampus of AD patients compared with controls. ApoD concentrations, as determined by radioimmunoassay, were significantly increased in the CSF of AD patients (4.23 +/- 1.58 microg/ml) and patients with other pathologies (3.29 +/- 1.35 microg/ml) compared with those in the CSF of normal subjects (1.15 +/- 0.71 microg/ml). Although the differences were smaller than for apoD, the mean apoE concentrations in the CSF of both groups of patients were also significantly higher than those of controls. In AD patients, apoD, but not apoE, levels in CSF and hippocampus increased as a function of inheritance of the epsilon4 apoE allele. This study therefore demonstrates that increased apoD levels in the hippocampus and in CSF are a marker of neuropathology, including that associated with AD, and are independent of apoE concentrations.
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Wang X, Bucala R, Milne R. Epitopes close to the apolipoprotein B low density lipoprotein receptor-binding site are modified by advanced glycation end products. Proc Natl Acad Sci U S A 1998; 95:7643-7. [PMID: 9636203 PMCID: PMC22709 DOI: 10.1073/pnas.95.13.7643] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Advanced glycation end products (AGEs) are thought to contribute to the abnormal lipoprotein profiles and increased risk of cardiovascular disease of patients with diabetes and renal failure, in part by preventing apolipoprotein B (apoB)-mediated cellular uptake of low density lipoproteins (LDL) by LDL receptors (LDLr). It has been proposed that AGE modification at one site in apoB, almost 1,800 residues from the putative apoB LDLr-binding domain, may be sufficient to induce an apoB conformational change that prevents binding to the LDLr. To further explore this hypothesis, we used 29 anti-human apoB mAbs to identify other potential sites on apoB that may be modified by in vitro advanced glycation of LDL. Glycation of LDL caused a time-dependent decrease in its ability to bind to the LDLr and in the immunoreactivity of six distinct apoB epitopes, including two that flank the apoB LDLr-binding domain. ApoB appears to be modified at multiple sites by these criteria, as the loss of glycation-sensitive epitopes was detected on both native glycated LDL and denatured, delipidated glycated apoB. Moreover, residues directly within the putative apoB LDLr-binding site are not apparently modified in glycated LDL. We propose that the inability of LDL modified by AGEs to bind to the LDLr is caused by modification of residues adjacent to the putative LDLr-binding site that were undetected by previous immunochemical studies. AGE modification either eliminates the direct participation of the residues in LDLr binding or indirectly alters the conformation of the apoB LDLr-binding site.
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Kebbell MR, Milne R. Police officers' perceptions of eyewitness performance in forensic investigations. THE JOURNAL OF SOCIAL PSYCHOLOGY 1998; 138:323-30. [PMID: 9577722 DOI: 10.1080/00224549809600384] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Few contemporary data support the assertion that eyewitnesses are important in police investigations. In the present study, 159 UK police officers were surveyed regarding their perceptions of eyewitnesses and eyewitness performance. The respondents indicated that eyewitnesses usually provide the central leads in criminal investigations; however, the police officers also believed that eyewitnesses rarely provide sufficient information, especially descriptive details as opposed to action details. Nevertheless, the officers believed that eyewitnesses are rarely incorrect. A sizable minority reported that witnesses rarely come forward to the police and that those who do are often reluctant to testify in court. Many officers indicated that they do not have enough time to conduct good eyewitness interviews.
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Oldfield K, Milne R, Vessey M. The effects on mortality of the use of combined oral contraceptives. THE BRITISH JOURNAL OF FAMILY PLANNING 1998; 24:2-6. [PMID: 9719700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess, using a computerised model, the effects on mortality of the use of combined oral contraceptives (COCs). DESIGN Two hypothetical cohorts of one million women each, identical except for their use of contraception. The impact of COC use was explored by applying, to each cohort, death rates which were adjusted according to a series of assumptions about the risks associated with COC use. The model also explored the effects of a number of different patterns of COC use. SETTINGS AND SUBJECTS Women aged 16, followed through to ages 50 and 75, exposed to 1994 UK death rates. MAIN OUTCOME MEASURES Numbers of deaths from various cancers and cardiovascular diseases attributable to COC use. RESULTS Based on the standard pattern of use, there were 1.7 per cent more deaths in the COC cohort to age 50. The important effects on mortality of different patterns of use and of different assumptions about risks in ex-users were illustrated. CONCLUSIONS The results confirm the findings of earlier work and provide some reassurance about the likely adverse effects of COC use.
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Stevens A, Milne R. A knowledge-based health service: how do the new initiatives work? J R Soc Med 1998; 91 Suppl 35:26-31. [PMID: 9797747 PMCID: PMC1296361 DOI: 10.1177/014107689809135s07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Greenhalgh T, Stein K, Milne R, Best L, Boothby H, Zaidi SMN, Seth V, Khalaf S, Jameel H, Mahomed S, Yassiri A, Hooper P, Whitehead AM, Jones RW, Mann JB, Saunders SA. Advertisements for donepezil. BMJ : BRITISH MEDICAL JOURNAL 1997. [DOI: 10.1136/bmj.315.7122.1623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Stein K, Milne R, Best L. Advertisements for donepezil. BMJ should require advertisements to detail actual state of evidence. BMJ (CLINICAL RESEARCH ED.) 1997; 315:1623-4. [PMID: 9437304 PMCID: PMC2127989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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87
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Jones DC, Anthony D, Best L, Milne R, Stein K. Rationing of growth hormone: who reviews the experts? Lancet 1997; 350:1483-4; author reply 1484. [PMID: 9371200 DOI: 10.1016/s0140-6736(05)64256-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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88
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Söderlund N, Csaba I, Gray A, Milne R, Raftery J. Impact of the NHS reforms on English hospital productivity: an analysis of the first three years. BMJ (CLINICAL RESEARCH ED.) 1997; 315:1126-9. [PMID: 9374885 PMCID: PMC2127733 DOI: 10.1136/bmj.315.7116.1126] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To evaluate the effect of purchaser mix, market competition, and trust status on hospital productivity within the NHS internal market. METHODS Hospital cost and activity data were taken from routinely collected data for acute NHS hospitals in England for 1991-2 to 1993-4. Cross sectional and longitudinal regression methods were used to estimate the effect of trust status, competition, and purchaser mix on average hospital costs per inpatient, after adjusting for outpatient activity levels, casemix, teaching activity, regional salary variation, hospital size, scale of activity, and scope of cases treated. RESULTS Real productivity gains were apparent across the study period for NHS hospitals on average. Casemix adjustment drastically improved cross sectional comparisons between hospitals. Gaining trust status and increasing host district purchaser share were associated with productivity increases after adjustment for casemix, regional salary differences, and hospital size and scope. Hospitals that became trusts during the study period were on average less productive at the beginning of the period than those that did not, and there were no significant productivity differences between trust waves at the end of the period in 1993-4. Market concentration was not associated with productivity differences. CONCLUSION Further analysis is needed to determine whether overall and trust associated productivity gains are transient effects, one off shifts, or self perpetuating reorientations of organisational behaviour. Hospitals may have chosen to become trusts because they anticipated being able to increase productivity. Increases in the proportions of small purchasers were associated with increasing costs. Importantly, this study could not adjust for changes in the quality of care.
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Milner P, Walshe K, Lipp A, Milne R. The future of healthcare systems. Method for rigorously assessing cost effectiveness of new drugs must be set up. BMJ (CLINICAL RESEARCH ED.) 1997; 315:953. [PMID: 9361566 PMCID: PMC2127630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Toeller M, Buyken A, Heitkamp G, Brämswig S, Mann J, Milne R, Gries FA, Keen H. Protein intake and urinary albumin excretion rates in the EURODIAB IDDM Complications Study. Diabetologia 1997; 40:1219-26. [PMID: 9349605 DOI: 10.1007/s001250050810] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
For people with insulin-dependent diabetes mellitus (IDDM) renal disease represents a life-threatening and costly complication. The EURODIAB IDDM Complications Study, a cross-sectional, clinic-based study, was designed to determine the prevalence of renal complications and putative risk factors in stratified samples of European individuals with IDDM. The present study examined the relationship between dietary protein intake and urinary albumin excretion rate (AER). Food intake was assessed centrally by a standardized 3-day dietary record. Urinary AER was determined in a central laboratory from a timed 24-h urine collection. Complete data were available from 2696 persons with IDDM from 30 centres in 16 European countries. In individuals who reported protein consumption less than 20% of total food energy intake, mean AER was below 20 microg/min. In those in whom protein intake constituted more than 20%, mean AER increased, a trend particularly pronounced in individuals with hypertension and/or poor metabolic control. Trends reached statistical significance for intakes of total protein (% of energy, p = 0.01) and animal protein (% of energy, p = 0.02), while no association was seen for vegetable protein (p = 0.83). These findings support the current recommendation for people with diabetes not to exceed a protein intake of 20% of total energy. Monitoring and adjustment of dietary protein appears particularly desirable for individuals with AER exceeding 20 microg/min (approximately 30 mg/24h), especially when arterial pressure is raised and/or diabetic control is poor.
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Benoist F, Lau P, McDonnell M, Doelle H, Milne R, McPherson R. Cholesteryl ester transfer protein mediates selective uptake of high density lipoprotein cholesteryl esters by human adipose tissue. J Biol Chem 1997; 272:23572-7. [PMID: 9295295 DOI: 10.1074/jbc.272.38.23572] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We have determined the role of cholesteryl ester transfer protein (CETP) in selective uptake of high density lipoprotein (HDL)-derived cholesteryl esters (CE) by human adipose tissue, using organ culture or collagenase-digested adipocytes. Incubation of the fresh tissue fragments with HDL containing [3H]CE or 125I-apoprotein (apo) A-I resulted in significant uptake of HDL-CE-derived label. Addition of recombinant CETP (rCETP) increased CE uptake in a dose-response fashion. In contrast, little association of 125I-apoA-I with adipose tissue was noted, and addition of rCETP did not alter apoA-I uptake or degradation. Incubation of adipose tissue with TP2, an anti-CETP monoclonal antibody, which inhibits neutral lipid transfer, markedly reduced selective uptake of HDL-CE. Studies using human adipocytes isolated by collagenase digestion also demonstrated selective uptake of HDL-CE and enhancement of this process by rCETP. To confirm that the association of HDL-CE-derived radioactivity with adipose tissue was not due to neutral lipid exchange between adipocytes and HDL, we measured changes in HDL composition following incubation of HDL and rCETP with isolated adipocytes. A decrease in HDL-CE concentration in the medium was observed, an effect which was markedly attenuated when incubations were carried out in the presence of monoclonal antibody TP2. Furthermore, the decrease in HDL-CE was accompanied by an increase in HDL free cholesterol, likely representing efflux of adipocyte cholesterol to HDL. There were no significant changes in phospholipid, apoA-I, or apoA-II in the medium following incubation with adipocytes. These data demonstrate a novel and important role for CETP in selective uptake of HDL-cholesteryl esters by human adipocytes and suggest that this pathway may be of quantitative physiological significance in HDL remodeling and adipocyte cholesterol accumulation.
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Oliveira HC, Ma L, Milne R, Marcovina SM, Inazu A, Mabuchi H, Tall AR. Cholesteryl ester transfer protein activity enhances plasma cholesteryl ester formation. Studies in CETP transgenic mice and human genetic CETP deficiency. Arterioscler Thromb Vasc Biol 1997; 17:1045-52. [PMID: 9194753 DOI: 10.1161/01.atv.17.6.1045] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The plasma cholesteryl ester transfer protein (CETP) promotes the removal of HDL cholesteryl esters and is thought to stimulate reverse cholesterol transport (RCT). However, mechanisms by which CETP may stimulate RCT are poorly understood. Thus, we examined the relationship between plasma CETP expression and plasma cholesteryl ester formation in CETP transgenic (Tg) mice, hamsters, and human subjects with genetic CETP deficiency. Incubation of CETP Tg mouse plasma showed a 20% to 40% increase in plasma cholesterol esterification rate (CER, P < .05) compared with control mice. Injection of a neutralizing CETP monoclonal antibody (MAb) (TP2) into natural flanking region CETP Tg mice resulted in an increase in plasma free cholesterol (FC) concentration, FC/CE ratio, FC/phosphatidylcholine ratio, and hepatic CETP mRNA. In hamsters, CETP inhibition also resulted in an increase in plasma FC/phosphatidylcholine ratio and increased CETP mRNA in adipose tissue. In humans with two common CETP gene mutations (an intron 14 splicing defect and a D442G missense mutation), mean plasma CERs were 39 and 60, respectively, compared with 89 nmol x mL-1 x h-1 in normal subjects. By contrast, lecithin:cholesterol acyltransferase (LCAT) mass was normal in CETP-deficient subjects. MAb neutralization of CETP activity in incubated human plasma did not alter the LCAT reaction, even after supplementation with discoidal HDL and VLDL. Thus, genetic alterations in CETP levels lead to secondary changes in the plasma LCAT reaction, possibly because of remodeling of HDL by CETP acting in concert with other factors in vivo. In human genetic CETP deficiency, a moderate impairment in the plasma LCAT reaction may contribute to a defect in RCT, providing a potential mechanism to explain the recently observed excess of coronary heart disease in these subjects.
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Trave-Massuyes L, Milne R. Gas-turbine condition monitoring using qualitative model-based diagnosis. ACTA ACUST UNITED AC 1997. [DOI: 10.1109/64.590070] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
We investigated the association of Dupuytren’s contracture with smoking and with alcohol by a case-control study in which 222 patients having an operation for this condition were matched for age, operation date and gender with control patients having other orthopaedic operations. Fifty of the cases were also each matched with four community controls. Data were collected by postal questionnaire. Dupuytren’s contracture needing operation was strongly associated with current cigarette smoking (adjusted odds ratio 2.8 (95% confidence interval (CI) 1.5 to 5.2)). The mean lifetime cigarette consumption was 16.7 pack-years for the cases compared with 12.0 pack-years for the controls (p = 0.016). Dupuytren’s contracture was also associated with an Alcohol Use Disorders Test score greater than 7 (adjusted odds ratio 1.9 (95% CI 1.02 to 3.57)). Mean weekly alcohol consumption was 7.3 units for cases and 5.4 units for controls (p = 0.016). The excess risk associated with alcohol did not appear to be due to a confounding effect of smoking, or vice versa. Smoking increases the risk of developing Dupuytren’s contracture and may contribute to its prevalence in alcoholics, who tend to smoke heavily.
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Burge P, Hoy G, Regan P, Milne R. Smoking, alcohol and the risk of Dupuytren's contracture. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 1997; 79:206-10. [PMID: 9119843 DOI: 10.1302/0301-620x.79b2.6990] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We investigated the association of Dupuytren's contracture with smoking and with alcohol by a case-control study in which 222 patients having an operation for this condition were matched for age, operation date and gender with control patients having other orthopaedic operations. Fifty of the cases were also each matched with four community controls. Data were collected by postal questionnaire. Dupuytren's contracture needing operation was strongly associated with current cigarette smoking (adjusted odds ratio 2.8 (95% confidence interval (CI) 1.5 to 5.2)). The mean lifetime cigarette consumption was 16.7 pack-years for the cases compared with 12.0 pack-years for the controls (p = 0.016). Dupuytren's contracture was also associated with an Alcohol Use Disorders Test score greater than 7 (adjusted odds ratio 1.9 (95% CI 1.02 to 3.57)). Mean weekly alcohol consumption was 7.3 units for cases and 5.4 units for controls (p = 0.016). The excess risk associated with alcohol did not appear to be due to a confounding effect of smoking, or vice versa. Smoking increases the risk of developing Dupuytren's contracture and may contribute to its prevalence in alcoholics, who tend to smoke heavily.
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Hodgins DC, Leigh G, Milne R, Gerrish R. Drinking goal selection in behavioral self-management treatment of chronic alcoholics. Addict Behav 1997; 22:247-55. [PMID: 9113218 DOI: 10.1016/s0306-4603(96)00013-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The relationship between individuals' choice of abstinence or moderate drinking during outpatient behavioral management treatment and outcome over 12 months' posttreatment was examined. At the initial assessment, 46% of 106 chronic alcoholic subjects chose abstinence, 44% chose moderate drinking, and 9% were unsure. Over the course of treatment, subjects were more likely to move from moderation to abstinence goals, and after the first 4 weeks of treatment, two-thirds chose abstinence. These subjects were older, had more severe alcohol problems (i.e., higher MAST scores), and were more likely to maintain their weekly alcohol consumption goals during the 16-week treatment period. Moreover, these subjects reported less alcohol use in the 12 month follow-up period, and a greater proportion were judged as having successful outcomes. The implications of these findings are discussed.
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Toeller M, Buyken A, Heitkamp G, Milne R, Klischan A, Gries FA. Repeatability of three-day dietary records in the EURODIAB IDDM Complications Study. Eur J Clin Nutr 1997; 51:74-80. [PMID: 9049564 DOI: 10.1038/sj.ejcn.1600364] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Repeatability of a dietary method is important in determining the quality of nutritional data. It should be assessed in the population of interest. This study evaluated the repeatability of nutritional data from standardized three-day dietary records, from the clinic-based, cross-sectional multi-centre EURODIAB IDDM Complications Study. DESIGN AND SUBJECTS 15% of the total EURODIAB cohort was randomly selected to test the repeatability of nutritional intake data. Two three-day records, completed three weeks apart, were available for 216 diabetic patients (7.5%) representative of the total cohort. All records were analysed centrally, for intakes of protein (animal and vegetable), fat (saturated fat and cholesterol), carbohydrate, fibre, alcohol and energy. Repeatability was measured comparing mean intakes, determining the proportion of patients classified into the same/opposite quartile by the two three-day records and assessing mean differences with standard deviations (s.d.d). RESULTS There were no significant differences in mean energy and nutrient intakes between the first and second records. Classification of individuals into the opposite quartile occurred only in 0-4% of patients and overall about 50% (range 44-74%) of the subjects were classified into the same quartiles of intakes. Only small mean differences were found for energy intake (-156 (1633) kJ; 95% confidence limits -375, 63 kJ) and nutrients with s.d.ds comparable to intra-individual variations in the general population. The differences in energy intake were randomly distributed over the range of intakes. CONCLUSIONS The present study demonstrates that standardized three day dietary records show a high degree of repeatability within a short period of time in a sample of European IDDM patients. The good repeatability strengthens the conclusions drawn from the nutritional data in the EURODIAB IDDM Complications Study.
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Jiang X, Francone OL, Bruce C, Milne R, Mar J, Walsh A, Breslow JL, Tall AR. Increased prebeta-high density lipoprotein, apolipoprotein AI, and phospholipid in mice expressing the human phospholipid transfer protein and human apolipoprotein AI transgenes. J Clin Invest 1996; 98:2373-80. [PMID: 8941656 PMCID: PMC507689 DOI: 10.1172/jci119050] [Citation(s) in RCA: 153] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Human plasma phospholipid transfer protein (PLTP) circulates bound to high density lipoprotein (HDL) and mediates both net transfer and exchange of phospholipids between different lipoproteins. However, its overall function in lipoprotein metabolism is unknown. To assess the effects of increased plasma levels of PLTP, human PLTP transgenic mice were established using the human PLTP gene driven by its natural promoter. One line of PLTP transgenic mice with moderate expression of PLTP mRNA and protein was obtained. The order of human PLTP mRNA expression in tissues was: liver, kidney, brain, small intestine > lung > spleen > heart, adipose tissue. Western blotting using a human PLTP monoclonal antibody revealed authentic human PLTP (Mr 80 kD) in plasma. Plasma PLTP activity was increased by 29% in PLTP transgenic mice. However, plasma lipoprotein analysis, comparing PLTP transgenic mice to control littermates, revealed no significant changes in the plasma lipoprotein lipids or apolipoproteins. Since previous studies have shown that human cholesteryl ester transfer protein and lecithin:cholesterol acyltransferase only function optimally in human apoAI transgenic mice, the human PLTP transgenic mice were cross-bred with human apoAI transgenic mice. In the human apoAI transgenic background, PLTP expression resulted in increased PLTP activity (47%), HDL phospholipid (26%), cholesteryl ester (24%), free cholesterol (37%), and apoAI (22%). There was a major increase of apoAI in prebeta-HDL (56%) and a small increase in alpha-HDL (14%). The size distribution of HDL particles within alpha- and prebeta-migrating species was not changed. The results suggest that PLTP increases the influx of phospholipid and secondarily cholesterol into HDL, leading to an increase in potentially antiatherogenic prebeta-HDL particles.
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MESH Headings
- Animals
- Antibodies, Monoclonal/immunology
- Apolipoprotein A-I/genetics
- Apolipoprotein A-I/metabolism
- Apolipoproteins/analysis
- Apolipoproteins/blood
- Blotting, Western
- Brain/metabolism
- Carrier Proteins/blood
- Carrier Proteins/genetics
- Carrier Proteins/immunology
- Carrier Proteins/metabolism
- Cholesterol/metabolism
- Cholesterol Esters/metabolism
- Cloning, Molecular
- DNA/analysis
- Female
- Gene Expression Regulation
- Humans
- Intestine, Small/metabolism
- Kidney/metabolism
- Lipoproteins/analysis
- Lipoproteins/blood
- Lipoproteins, HDL/metabolism
- Liver/metabolism
- Lung/metabolism
- Membrane Proteins/blood
- Membrane Proteins/genetics
- Membrane Proteins/immunology
- Membrane Proteins/metabolism
- Mice
- Mice, Inbred C57BL
- Mice, Inbred CBA
- Mice, Transgenic/genetics
- Mice, Transgenic/metabolism
- Muscles/metabolism
- Myocardium/metabolism
- Nucleic Acid Hybridization
- Phospholipid Transfer Proteins
- RNA/analysis
- RNA, Messenger/analysis
- RNA, Messenger/metabolism
- Spleen/metabolism
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Milne R, Oliver S. Evidence-based consumer health information: developing teaching in critical appraisal skills. Int J Qual Health Care 1996; 8:439-45. [PMID: 9117197 DOI: 10.1093/intqhc/8.5.439] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To help people who give health information to the public develop the skills they need to make sense of evidence about effectiveness. DESIGN Educational approach, preceded by careful planning with representatives of possible participants. SETTING AND STUDY OF PARTICIPANTS: Staff in consumer health information services and members of maternity self-help groups in the UK in summer 1995. INTERVENTIONS Pairs of half-day workshops introducing participants to randomised controlled trials and systematic reviews and to their critical appraisal. The workshops were run participatively and had at their centre a critical appraisal session in small groups. MAIN OUTCOME MEASURES Attendance at workshops, satisfaction and enjoyment of workshops; comments at a follow-on event. RESULTS Four pairs of workshops were held (three for consumer health information services, one for maternity self-help groups), 54 people attended a pair of workshops and a further 34 attended individual workshops. The workshops were enjoyed and found to be a good use of time. CONCLUSIONS It is feasible to introduce critical appraisal skills to people whose primary role is to give health information to the public. There is a need for comparative evaluation of different approaches.
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