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Elçioğlu ZC, Errington L, Metes B, Sendama W, Powell J, Simpson AJ, Rostron AJ, Hellyer TP. Pooled prevalence of lymphopenia in all-cause hospitalisations and association with infection: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:848. [PMID: 38042792 PMCID: PMC10693046 DOI: 10.1186/s12879-023-08845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Lymphopenia is defined as a decrease below normal value (often 1.0 x 109 cells/L) of blood circulating lymphocyte count. In the general population, lymphopenia is associated with an increased risk of hospitalisation secondary to infection, independent of traditional clinical risk factors. In hospital, lymphopenia is associated with increased risk of healthcare-associated infection and mortality. By summarising lymphopenia's prevalence and impact on clinical outcomes, we can identify an at-risk population and inform future studies of immune dysfunction following severe illness. METHODS Peer-reviewed search strategy was performed on three databases. Primary objective was to summarise the pooled prevalence of lymphopenia. Primary outcome was infection including pre-existing lymphopenia as a risk factor for admission with infection and as an in-hospital risk factor for healthcare-associated infection. Secondary outcomes were length of stay and mortality. Mortality data extracted included in-hospital, 28/30-day ('early'), and 90-day/1-year ('late') mortality. Meta-analysis was carried out using random-effects models for each outcome measure. Heterogeneity was assessed using I2 statistic. Joanna Briggs Institute checklist for cohort studies was used to assess risk of bias. The protocol was published on PROSPERO. RESULTS Fifteen observational studies were included. The pooled prevalence of lymphopenia in all-cause hospitalisations was 38% (CI 0.34-0.42, I2= 97%, p< 0.01). Lymphopenia was not associated with an infection diagnosis at hospital admission and healthcare associated infection (RR 1.03; 95% CI 0.26-3.99, p=0.97, I2 = 55% and RR 1.31; 95% CI 0.78-2.20, p=0.31, I2=97%, respectively), but was associated with septic shock (RR 2.72; 95% CI 1.02-7.21, p=0.04, I2 =98%). Lymphopenia was associated with higher in-hospital mortality and higher 'early' mortality rates (RR 2.44; 95% CI 1.71-3.47, p < 0.00001, I2 = 89% and RR 2.05; 95% CI 1.64-2.56, p < 0.00001, I2 = 29%, respectively). Lymphopenia was associated with higher 'late' mortality (RR 1.59; 1.33-1.90, p < 0.00001, I2 = 0%). CONCLUSIONS This meta-analysis demonstrates the high prevalence of lymphopenia across all-cause hospitalisations and associated increased risk of septic shock, early and late mortality. Lymphopenia is a readily available marker that may identify immune dysfunctional patients. Greater understanding of immune trajectories following survival may provide insights into longer-term poor clinical outcomes.
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Affiliation(s)
- Z C Elçioğlu
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - L Errington
- Faculty of Medical Sciences Library, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - B Metes
- Faculty of Medical Sciences Library, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - W Sendama
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP, UK
| | - J Powell
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - A J Simpson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP, UK
| | - A J Rostron
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
- Integrated Critical Care Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, SR4 7TP, UK
| | - T P Hellyer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK.
- Department of Critical Care Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP, UK.
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Labine LM, Pereira EAO, Kleywegt S, Jobst KJ, Simpson AJ, Simpson MJ. Environmental metabolomics uncovers oxidative stress, amino acid dysregulation, and energy impairment in Daphnia magna with exposure to industrial effluents. Environ Res 2023; 234:116512. [PMID: 37394164 DOI: 10.1016/j.envres.2023.116512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/29/2023] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
Anthropogenic activities are regarded as point sources of pollution entering freshwater bodies worldwide. With over 350,000 chemicals used in manufacturing, wastewater treatment and industrial effluents are comprised of complex mixtures of organic and inorganic pollutants of known and unknown origins. Consequently, their combined toxicity and mode of action are not well understood in aquatic organisms such as Daphnia magna. In this study, effluent samples from wastewater treatment and industrial sectors were used to examine molecular-level perturbations to the polar metabolic profile of D. magna. To determine if the industrial sector and/or the effluent chemistries played a role in the observed biochemical responses, Daphnia were acutely (48 h) exposed to undiluted (100%) and diluted (10, 25, and 50%) effluent samples. Endogenous metabolites were extracted from single daphnids and analyzed using targeted mass spectrometry-based metabolomics. The metabolic profile of Daphnia exposed to effluent samples resulted in significant separation compared to the unexposed controls. Linear regression analysis determined that no single pollutant detected in the effluents was significantly correlated with the responses of metabolites. Significant perturbations were uncovered across many classes of metabolites (amino acids, nucleosides, nucleotides, polyamines, and their derivatives) which serve as intermediates in keystone biochemical processes. The combined metabolic responses are consistent with oxidative stress, disruptions to energy metabolism, and protein dysregulation which were identified through biochemical pathway analysis. These results provide insight into the molecular processes driving stress responses in D. magna. Overall, we determined that the metabolic profile of Daphnia could not be predicted by the chemical composition of environmentally relevant mixtures. The findings of this study demonstrate the advantage of metabolomics in conjunction with chemical analyses to assess the interactions of industrial effluents. This work further demonstrates the ability of environmental metabolomics to characterize molecular-level perturbations in aquatic organisms exposed to complex chemical mixtures directly.
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Affiliation(s)
- L M Labine
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, ON, M5S 3H6, Canada; Environmental NMR Centre and Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON, M1C 1A4, Canada
| | - E A Oliveira Pereira
- Environmental NMR Centre and Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON, M1C 1A4, Canada
| | - S Kleywegt
- Technical Assessment and Standards Development Branch, Ontario Ministry of the Environment, Conservation and Parks, Toronto, ON, M4V 1M2, Canada
| | - K J Jobst
- Department of Chemistry, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - A J Simpson
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, ON, M5S 3H6, Canada; Environmental NMR Centre and Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON, M1C 1A4, Canada
| | - M J Simpson
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, ON, M5S 3H6, Canada; Environmental NMR Centre and Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON, M1C 1A4, Canada.
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Jones WS, Suklan J, Winter A, Green K, Craven T, Bruce A, Mair J, Dhaliwal K, Walsh T, Simpson AJ, Graziadio S, Allen AJ. Diagnosing ventilator-associated pneumonia (VAP) in UK NHS ICUs: the perceived value and role of a novel optical technology. Diagn Progn Res 2022; 6:5. [PMID: 35144691 PMCID: PMC8830125 DOI: 10.1186/s41512-022-00117-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosing ventilator-associated pneumonia (VAP) in an intensive care unit (ICU) is a complex process. Our aim was to collect, evaluate and represent the information relating to current clinical practice for the diagnosis of VAP in UK NHS ICUs, and to explore the potential value and role of a novel diagnostic for VAP, which uses optical molecular alveoscopy to visualise the alveolar space. METHODS Qualitative study performing semi-structured interviews with clinical experts. Interviews were recorded, transcribed, and thematically analysed. A flow diagram of the VAP patient pathway was elicited and validated with the expert interviewees. Fourteen clinicians were interviewed from a range of UK NHS hospitals: 12 ICU consultants, 1 professor of respiratory medicine and 1 professor of critical care. RESULTS Five themes were identified, relating to [1] current practice for the diagnosis of VAP, [2] current clinical need in VAP diagnostics, [3] the potential value and role of the technology, [4] the barriers to adoption and [5] the evidence requirements for the technology, to help facilitate a successful adoption. These themes indicated that diagnosis of VAP is extremely difficult, as is the decision to stop antibiotic treatment. The analysis revealed that there is a clinical need for a diagnostic that provides an accurate and timely diagnosis of the causative pathogen, without the long delays associated with return of culture results, and which is not dangerous to the patient. It was determined that the technology would satisfy important aspects of this clinical need for diagnosing VAP (and pneumonia, more generally), but would require further evidence on safety and efficacy in the patient population to facilitate adoption. CONCLUSIONS Care pathway analysis performed in this study was deemed accurate and representative of current practice for diagnosing VAP in a UK ICU as determined by relevant clinical experts, and explored the value and role of a novel diagnostic, which uses optical technology, and could streamline the diagnostic pathway for VAP and other pneumonias.
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Affiliation(s)
- W S Jones
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK.
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
| | - J Suklan
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - A Winter
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - K Green
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - T Craven
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK
| | - A Bruce
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - J Mair
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - K Dhaliwal
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - T Walsh
- Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK
| | - A J Simpson
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - S Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - A J Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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Jardine L, Cytlak U, Gunawan M, Reynolds G, Green K, Wang XN, Pagan S, Paramitha M, Lamb CA, Long AK, Hurst E, Nair S, Jackson GH, Publicover A, Bigley V, Haniffa M, Simpson AJ, Collin M. Donor monocyte-derived macrophages promote human acute graft-versus-host disease. J Clin Invest 2021; 130:4574-4586. [PMID: 32453711 PMCID: PMC7456218 DOI: 10.1172/jci133909] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Myelopoiesis is invariably present and contributes to pathology in animal models of graft-versus-host disease (GVHD). In humans, a rich inflammatory infiltrate bearing macrophage markers has also been described in histological studies. In order to determine the origin, functional properties, and role in pathogenesis of these cells, we isolated single-cell suspensions from acute cutaneous GVHD and subjected them to genotype, transcriptome, and in vitro functional analysis. A donor-derived population of CD11c+CD14+ cells was the dominant population of all leukocytes in GVHD. Surface phenotype and NanoString gene expression profiling indicated the closest steady-state counterpart of these cells to be monocyte-derived macrophages. In GVHD, however, there was upregulation of monocyte antigens SIRPα and S100A8/9 transcripts associated with leukocyte trafficking, pattern recognition, antigen presentation, and costimulation. Isolated GVHD macrophages stimulated greater proliferation and activation of allogeneic T cells and secreted higher levels of inflammatory cytokines than their steady-state counterparts. In HLA-matched mixed leukocyte reactions, we also observed differentiation of activated macrophages with a similar phenotype. These exhibited cytopathicity to a keratinocyte cell line and mediated pathological damage to skin explants independently of T cells. Together, these results define the origin, functional properties, and potential pathogenic roles of human GVHD macrophages.
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Affiliation(s)
- Laura Jardine
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Northern Centre for Bone Marrow Transplantation and.,NIHR Newcastle Biomedical Research Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Urszula Cytlak
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Merry Gunawan
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gary Reynolds
- NIHR Newcastle Biomedical Research Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Cellular Medicine and
| | - Kile Green
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Sarah Pagan
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Maharani Paramitha
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christopher A Lamb
- NIHR Newcastle Biomedical Research Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Cellular Medicine and
| | - Anna K Long
- NIHR Newcastle Biomedical Research Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Cellular Medicine and
| | - Erin Hurst
- Northern Centre for Bone Marrow Transplantation and
| | - Smeera Nair
- Northern Centre for Bone Marrow Transplantation and
| | - Graham H Jackson
- Northern Centre for Bone Marrow Transplantation and.,Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amy Publicover
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Northern Centre for Bone Marrow Transplantation and.,NIHR Newcastle Biomedical Research Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Venetia Bigley
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Northern Centre for Bone Marrow Transplantation and.,NIHR Newcastle Biomedical Research Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Muzlifah Haniffa
- NIHR Newcastle Biomedical Research Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Cellular Medicine and
| | - A J Simpson
- NIHR Newcastle Biomedical Research Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Cellular Medicine and
| | - Matthew Collin
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Northern Centre for Bone Marrow Transplantation and.,NIHR Newcastle Biomedical Research Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Biswas JS, Lentaigne J, Burns DS, Osborne JC, Simpson AJ, Hutley EJ, Hill NE, Bailey MS. Undifferentiated febrile illnesses in South Sudan: a case series from Operation TRENTON from June to August 2017. BMJ Mil Health 2020; 167:358-361. [PMID: 32094218 DOI: 10.1136/jramc-2019-001238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/03/2022]
Abstract
Undifferentiated febrile illnesses present diagnostic and treatment challenges in the Firm Base, let alone in the deployed austere environment. We report a series of 14 cases from Operation TRENTON in South Sudan in 2017 that coincided with the rainy season, increased insect numbers and a Relief in Place. The majority of patients had headaches, myalgia, arthralgia and back pain, as well as leucopenia and thrombocytopenia. No diagnoses could be made in theatre, despite a sophisticated deployed laboratory being available, and further testing in the UK, including next-generation sequencing, was unable to establish an aetiology. Such illnesses are very likely to present in tropical environments, where increasing numbers of military personnel are being deployed, and clinicians must be aware of the non-specific presentation and treatment, as well as the availability of Military Infection Reachback services to assist in the management of these cases.
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Affiliation(s)
- Jason S Biswas
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK .,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - J Lentaigne
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - D S Burns
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - J C Osborne
- Rare and Imported Pathogens Laboratory, Public Health England Porton, Salisbury, UK
| | - A J Simpson
- Rare and Imported Pathogens Laboratory, Public Health England Porton, Salisbury, UK
| | - E J Hutley
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
| | - N E Hill
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - M S Bailey
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Ostermeier GC, Cardona C, Moody MA, Simpson AJ, Mendoza R, Travis AJ. Impacts of test (TES and Tris) yolk buffer and cooling on the ability of human sperm to capacitate. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Sperm must mature functionally in the process of capacitation to become able to fertilize. Capacitation depends on membrane lipid changes, and can be quantitatively assessed by redistribution of the ganglioside GM1, the basis of the Cap‐Score™ sperm function test. Here, differences in Cap‐Score were compared among and within men at two time points. Ejaculates were liquefied, washed, and incubated for 3 hr under capacitating (Cap) conditions, then fixed and analyzed immediately (Day0); after being incubated 3 hr under Cap conditions then maintained 22–24 hr in fix (Day1‐fix); or after 22–24 hr incubation under Cap conditions prior to fixation (Day1). In all cases, a light fixative previously shown to allow membrane lipid movements was used. Day1‐fix and Day1 Cap‐Scores were greater than Day0 (p < 0.001; n = 25), whereas Day1‐fix and Day1 Cap‐Scores were equivalent (p = 0.43; n = 25). In 123 samples from 52 fertile men, Cap‐Score increased more than 1SD (7.7; calculated previously from a fertile cohort) from Day0 to Day1‐fix in 44% (54/123) of the samples. To test whether timing of capacitation was consistent within an individual, 52 samples from 11 fertile men were classified into either “early” or “late” capacitation groups. The average capacitation group concordance within a donor was 81%. Median absolute deviation (MAD; in Cap‐Score units) was used to assess the tightness of clustering of the difference from Day0 to Day1‐fix within individuals. The average (2.21) and median (1.98) MAD confirmed consistency within individuals. Together, these data show that the timing of capacitation differed among men and was consistent within men.
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Affiliation(s)
| | | | | | | | | | | | - Alexander J. Travis
- Androvia LifeSciencesMountainsideNew Jersey
- Baker Institute for Animal Health, College of Veterinary MedicineCornell UniversityIthacaNew York
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Dickson SJ, Clay KA, Adam M, Ardley C, Bailey MS, Burns DS, Cox AT, Craig DG, Espina M, Ewington I, Fitchett G, Grindrod J, Hinsley DE, Horne S, Hutley E, Johnston AM, Kao RLC, Lamb LE, Lewis S, Marion D, Moore AJ, Nicholson-Roberts TC, Phillips A, Praught J, Rees PS, Schoonbaert I, Trinick T, Wilson DR, Simpson AJ, Wang D, O'Shea MK, Fletcher TE. Enhanced case management can be delivered for patients with EVD in Africa: Experience from a UK military Ebola treatment centre in Sierra Leone. J Infect 2018; 76:383-392. [PMID: 29248587 PMCID: PMC5903873 DOI: 10.1016/j.jinf.2017.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/28/2017] [Accepted: 12/10/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Limited data exist describing supportive care management, laboratory abnormalities and outcomes in patients with Ebola virus disease (EVD) in West Africa. We report data which constitute the first description of the provision of enhanced EVD case management protocols in a West African setting. METHODS Demographic, clinical and laboratory data were collected by retrospective review of clinical and laboratory records of patients with confirmed EVD admitted between 5 November 2014 and 30 June 2015. RESULTS A total of 44 EVD patients were admitted (median age 37 years (range 17-63), 32/44 healthcare workers), and excluding those evacuated, the case fatality rate was 49% (95% CI 33%-65%). No pregnant women were admitted. At admission 9/44 had stage 1 disease (fever and constitutional symptoms only), 12/44 had stage 2 disease (presence of diarrhoea and/or vomiting) and 23/44 had stage 3 disease (presence of diarrhoea and/or vomiting with organ failure), with case fatality rates of 11% (95% CI 1%-58%), 27% (95% CI 6%-61%), and 70% (95% CI 47%-87%) respectively (p = 0.009). Haemorrhage occurred in 17/41 (41%) patients. The majority (21/40) of patients had hypokalaemia with hyperkalaemia occurring in 12/40 patients. Acute kidney injury (AKI) occurred in 20/40 patients, with 14/20 (70%, 95% CI 46%-88%) dying, compared to 5/20 (25%, 95% CI 9%-49%) dying who did not have AKI (p = 0.01). Ebola virus (EBOV) PCR cycle threshold value at baseline was mean 20.3 (SD 4.3) in fatal cases and 24.8 (SD 5.5) in survivors (p = 0.007). Mean national early warning score (NEWS) at admission was 5.5 (SD 4.4) in fatal cases and 3.0 (SD 1.9) in survivors (p = 0.02). Central venous catheters were placed in 37/41 patients and intravenous fluid administered to 40/41 patients (median duration of 5 days). Faecal management systems were inserted in 21/41 patients, urinary catheters placed in 27/41 and blood component therapy administered to 20/41 patients. CONCLUSIONS EVD is commonly associated life-threatening electrolyte imbalance and organ dysfunction. We believe that the enhanced levels of protocolized care, scale and range of medical interventions we report, offer a blueprint for the future management of EVD in resource-limited settings.
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Affiliation(s)
- S J Dickson
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - K A Clay
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - M Adam
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - C Ardley
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - M S Bailey
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D S Burns
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A T Cox
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D G Craig
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - M Espina
- Royal Canadian Medical Services, Ottawa, Canada
| | - I Ewington
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - G Fitchett
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - J Grindrod
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D E Hinsley
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - S Horne
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - E Hutley
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A M Johnston
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - R L C Kao
- Royal Canadian Medical Services, Ottawa, Canada
| | - L E Lamb
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - S Lewis
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D Marion
- Royal Canadian Medical Services, Ottawa, Canada
| | - A J Moore
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - T C Nicholson-Roberts
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A Phillips
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - J Praught
- Royal Canadian Medical Services, Ottawa, Canada
| | - P S Rees
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | | | - T Trinick
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D R Wilson
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A J Simpson
- Rare and Imported Pathogens Laboratory, Public Health England, Porton, United Kingdom
| | - D Wang
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - M K O'Shea
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - T E Fletcher
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom.
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Simpson AJ, Cunningham MO, Baker MR. Electrodiagnostic applications of somatosensory evoked high-frequency EEG oscillations: Technical considerations. Brain Res Bull 2018; 137:351-355. [PMID: 29366907 DOI: 10.1016/j.brainresbull.2018.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/02/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION High frequency oscillations (HFOs) embedded within the somatosensory evoked potential (SEP) are not routinely recorded/measured as part of standard clinical SEPs. However, HFOs could provide important additional diagnostic/prognostic information in various patient groups in whom SEPs are tested routinely. One area is the management of patients with hypoxic ischaemic encephalopathy (HIE) in the intensive care unit (ICU). However, the sensitivity of standard clinical SEP recording techniques for detecting HFOs is unknown. METHODS SEPs were recorded using routine clinical methods in 17 healthy subjects (median nerve stimulation; 0.5 ms pulse width; 5 Hz; maximum 4000 stimuli) in an unshielded laboratory. Bipolar EEG recordings were acquired (gain 50 k; bandpass 3Hz-2 kHz; sampling rate 5 kHz; non-inverting electrode 2 cm anterior to C3/C4; inverting electrode 2 cm posterior to C3/C4). Data analysis was performed in MATLAB. RESULTS SEP-HFOs were detected in 65% of controls using standard clinical recording techniques. In 3 controls without significant HFOs, experiments were repeated using a linear electrode array with higher spatial sampling frequency. SEP-HFOs were observed in all 3 subjects. CONCLUSIONS Currently standard clinical methods of recording SEPs are not sufficiently sensitive to permit the inclusion of SEP-HFOs in routine clinical diagnostic/prognostic assessments. Whilst an increase in the number/density of EEG electrodes should improve the sensitivity for detecting SEP-HFOs, this requires confirmation. By improving and standardising clinical SEP recording protocols to permit the acquisition/analysis of SEP-HFOs, it should be possible to gain important insights into the pathophysiology of neurological disorders and refine the management of conditions such as HIE.
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Affiliation(s)
- A J Simpson
- Institute of Neuroscience, The Medical School, Newcastle University, NE2 4HH, UK
| | - M O Cunningham
- Institute of Neuroscience, The Medical School, Newcastle University, NE2 4HH, UK
| | - M R Baker
- Institute of Neuroscience, The Medical School, Newcastle University, NE2 4HH, UK; Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK; Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK.
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10
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Toellner H, Hughes G, Beswick W, Crooks MG, Donaldson C, Forrest I, Hart SP, Leonard C, Major M, Simpson AJ, Chaudhuri N. Early clinical experiences with nintedanib in three UK tertiary interstitial lung disease centres. Clin Transl Med 2017; 6:41. [PMID: 29101500 PMCID: PMC5670096 DOI: 10.1186/s40169-017-0172-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/22/2017] [Indexed: 01/09/2023] Open
Abstract
Background Nintedanib has been shown to slow disease progression in patients with idiopathic pulmonary fibrosis (IPF). It was approved by the National Institute for Health and Care Excellence (NICE) in January 2016 for IPF patients with a forced vital capacity (FVC) of 50–80% in the United Kingdom (UK). Aim To report real world data about our early clinical experience using nintedanib in 187 patients with a multi-disciplinary (MDT) diagnosis of IPF in a manufacturer funded patient in need scheme (three UK centres) prior to NICE approval. Methods All patients with a MDT diagnosis of IPF from December 2014 to January 2016 commenced on nintedanib were included. Demographic details, adverse events (AEs) and where available lung function results were retrospectively collected from clinical letters. Results 187 patients (76% males) with a median age of 72 years (49–89) were treated with nintedanib. The average pre-treatment FVC was 81.1 ± 19.8% and diffusion capacity of the lungs for carbon monoxide was 43.9 ± 15% (n = 82). Fifty percent of patients started nintedanib because they were ineligible for pirfenidone due to an FVC > 80%. The median treatment course was 8 ± 4 months. The majority of patients experienced 1–3 AEs with nintedanib (52%, n = 97). The most frequent AEs were diarrhoea (50%), nausea (36%), reduced appetite (24%), tiredness (20%) and gastro-oesophageal reflux (18%). The majority of AEs resulted in no change in treatment (64%, n = 461). 21% (n = 150) of AEs resulted in a dose reduction and 13% (n = 94) necessitated discontinuation of treatment. 1 in 5 patients discontinued treatment either temporarily or on a permanent basis during the monitoring period. In a select cohort of patients, a statistically significant greater proportion of patients remained stable or improved and a lower proportion declined, as depicted by FVC changes of > 5% after nintedanib commencement (P < 0.05 using Chi squared test). Conclusions Nintedanib is well tolerated and has an acceptable safety profile. Only 8% of those reporting diarrhoea discontinued treatment either on a temporary or permanent basis. There were no signals with respect to increased cardiovascular morbidity or major bleeding risk. This is in keeping with the INPULSIS clinical trial findings but in a real world cohort.
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Affiliation(s)
- Hannah Toellner
- Manchester Medical School, University of Manchester, Stopford Building, Oxford Rd, Manchester, M13 9PT, UK.
| | - G Hughes
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK
| | - W Beswick
- Hull and East Yorkshire Hospitals NHS Trust, Castle Road, Cottingham, HU16 5JQ, UK
| | - M G Crooks
- Hull and East Yorkshire Hospitals NHS Trust, Castle Road, Cottingham, HU16 5JQ, UK
| | - C Donaldson
- Newcastle Upon Tyne Hospitals NHS Trust, Queen Victoria Rd, Newcastle upon Tyne, NE1 4LP, UK
| | - I Forrest
- Newcastle Upon Tyne Hospitals NHS Trust, Queen Victoria Rd, Newcastle upon Tyne, NE1 4LP, UK
| | - S P Hart
- Hull and East Yorkshire Hospitals NHS Trust, Castle Road, Cottingham, HU16 5JQ, UK
| | - C Leonard
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK
| | - M Major
- Hull and East Yorkshire Hospitals NHS Trust, Castle Road, Cottingham, HU16 5JQ, UK
| | - A J Simpson
- Newcastle Upon Tyne Hospitals NHS Trust, Queen Victoria Rd, Newcastle upon Tyne, NE1 4LP, UK
| | - N Chaudhuri
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK
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11
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Hamid U, Krasnodembskaya A, Fitzgerald M, Shyamsundar M, Kissenpfennig A, Scott C, Lefrancais E, Looney MR, Verghis R, Scott J, Simpson AJ, McNamee J, McAuley DF, O'Kane CM. Aspirin reduces lipopolysaccharide-induced pulmonary inflammation in human models of ARDS. Thorax 2017; 72:971-980. [PMID: 28082531 PMCID: PMC5858553 DOI: 10.1136/thoraxjnl-2016-208571] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 11/24/2016] [Accepted: 12/03/2016] [Indexed: 12/15/2022]
Abstract
RATIONALE Platelets play an active role in the pathogenesis of acute respiratory distress syndrome (ARDS). Animal and observational studies have shown aspirin's antiplatelet and immunomodulatory effects may be beneficial in ARDS. OBJECTIVE To test the hypothesis that aspirin reduces inflammation in clinically relevant human models that recapitulate pathophysiological mechanisms implicated in the development of ARDS. METHODS Healthy volunteers were randomised to receive placebo or aspirin 75 or 1200 mg (1:1:1) for seven days prior to lipopolysaccharide (LPS) inhalation, in a double-blind, placebo-controlled, allocation-concealed study. Bronchoalveolar lavage (BAL) was performed 6 hours after inhaling 50 µg of LPS. The primary outcome measure was BAL IL-8. Secondary outcome measures included markers of alveolar inflammation (BAL neutrophils, cytokines, neutrophil proteases), alveolar epithelial cell injury, systemic inflammation (neutrophils and plasma C-reactive protein (CRP)) and platelet activation (thromboxane B2, TXB2). Human lungs, perfused and ventilated ex vivo (EVLP) were randomised to placebo or 24 mg aspirin and injured with LPS. BAL was carried out 4 hours later. Inflammation was assessed by BAL differential cell counts and histological changes. RESULTS In the healthy volunteer (n=33) model, data for the aspirin groups were combined. Aspirin did not reduce BAL IL-8. However, aspirin reduced pulmonary neutrophilia and tissue damaging neutrophil proteases (Matrix Metalloproteinase (MMP)-8/-9), reduced BAL concentrations of tumour necrosis factor α and reduced systemic and pulmonary TXB2. There was no difference between high-dose and low-dose aspirin. In the EVLP model, aspirin reduced BAL neutrophilia and alveolar injury as measured by histological damage. CONCLUSIONS These are the first prospective human data indicating that aspirin inhibits pulmonary neutrophilic inflammation, at both low and high doses. Further clinical studies are indicated to assess the role of aspirin in the prevention and treatment of ARDS. TRIAL REGISTRATION NUMBER NCT01659307 Results.
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Affiliation(s)
- U Hamid
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - A Krasnodembskaya
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - M Fitzgerald
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - M Shyamsundar
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - A Kissenpfennig
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - C Scott
- School of Pharmacy, Queen's University of Belfast, Belfast, Northern Ireland, UK
| | - E Lefrancais
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - M R Looney
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - R Verghis
- Northern Ireland Clinical Trials Unit, Royal Victoria Hospital, Belfast, UK
| | - J Scott
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle-upon Tyne, UK
| | - A J Simpson
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle-upon Tyne, UK
| | - J McNamee
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - D F McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.,Regional Intensive Care Unit, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - C M O'Kane
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
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12
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Davis S, Allen AJ, O'Leary R, Power M, Price DA, Simpson AJ, Tunbridge A, Vale L, Whiteside M, Evans C, Raza M. Diagnostic accuracy and cost analysis of the Alere™ i Influenza A&B near-patient test using throat swabs. J Hosp Infect 2017; 97:301-309. [PMID: 28558954 DOI: 10.1016/j.jhin.2017.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical diagnostic sensitivity alone is inadequate in the diagnosis of influenza. Polymerase chain reaction (PCR) testing is sensitive but the inherent delays in result availability potentially prolong time to isolation and treatment. Until recently no near-patient test (NPT) has demonstrated adequate sensitivity for routine clinical use. AIM To evaluate diagnostic accuracy, time to result availability, clinical impact, and cost consequences of Alere™ i Influenza A&B NPT (Alere Inc., Waltham, MA, USA) using off-label throat swabs. METHODS Prospective, multi-centre [four UK National Health Service (NHS) hospitals], diagnostic accuracy cohort study with cost modelling. Throat swab samples from suspected influenza patients were tested for influenza using the reference standard of PCR; a second throat swab was tested using NPT. FINDINGS A total of 827 participants were recruited; 589 were suitable for analysis: sensitivity was 75.8% [95% confidence interval (CI): 67.0-84.6]; specificity was 96.8% (95% CI: 95.2-98.3). Sensitivity varied between Sheffield (Northern General Hospital: 82.1%; Royal Hallamshire Hospital: 83.3%) and other sites (Doncaster Royal Infirmary: 71.4%; Newcastle's Royal Victoria Infirmary: 50.0%) whereas specificity was high (92-100%). Positive predictive value (PPV) was 81.2% (95% CI: 72.9-89.5) with negative predictive value 95.6% (95% CI: 93.9-97.4) with observed prevalence of 15.4%. Median time to result for PCR was 1.1 days (on-site laboratories) and 5.2 days (remote laboratories). Isolation findings: 75% influenza positive not isolated; 69% of isolated participants did not have influenza. For a cohort of 1000 participants, annual estimated non-diagnostic cost savings with NPT are £215,040. CONCLUSION This first prospective study of the Alere i NPT using throat swabs demonstrates high specificity, high PPV during seasonal epidemics, and rapid result availability which could lead to substantial cost savings.
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Affiliation(s)
- S Davis
- Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - A J Allen
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Newcastle, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - R O'Leary
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Newcastle, Newcastle upon Tyne, UK
| | - M Power
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Newcastle, Newcastle upon Tyne, UK
| | - D A Price
- Department of Infectious Diseases, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - A J Simpson
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Newcastle, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - A Tunbridge
- Department of Infectious Diseases, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - L Vale
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | - M Whiteside
- Department of Acute Medicine, Doncaster Royal Infirmary, Doncaster, UK
| | - C Evans
- Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Raza
- Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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13
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Moody MA, Cardona C, Simpson AJ, Smith TT, Travis AJ, Ostermeier GC. Validation of a laboratory-developed test of human sperm capacitation. Mol Reprod Dev 2017; 84:408-422. [PMID: 28418600 PMCID: PMC5485017 DOI: 10.1002/mrd.22801] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 11/10/2022]
Abstract
Sperm must undergo capacitation to become fertilization competent. Here we validated that monosialotetrahexosylganglioside (GM1 ) localization patterns, which were assessed in the Cap-Score™ Sperm Function Test, reflect a capacitated state in human sperm. First, we defined patterns representing sperm that do or do not respond to stimuli for capacitation. Sperm with "capacitated" patterns had exposed acrosomal carbohydrates and underwent acrosome exocytosis in response to calcium ionophore (A23187). Precision was evaluated by percent change of the Cap-Score measured for 50, 100, 150, and 200 sperm. Changes of 11%, 6%, and 5% were observed (n ≥ 23); therefore, we counted ≥150 sperm per condition. Variance within and between readers was evaluated using 20 stitched image files generated from unique ejaculates. Two trained readers randomly resampled each image 20 times, reporting an average standard deviation of 3 Cap-Score units and coefficient of variation of 13% when rescoring samples, with no difference between readers. Semen liquefaction times ≤2 hr and mechanical liquefaction with Pasteur or wide-orifice transfer pipettes did not alter Cap-Score values. However, liquefaction with chymotrypsin (p = 0.002) and bromelain (p = 0.049) reduced response to capacitating stimuli and induced membrane damage, while counterintuitively improving sperm motility. Together, these data validate the Cap-Score assay for the intended purpose of providing information on sperm capacitation and male fertility. In addition to its clinical utility as a diagnostic tool, this test of sperm function can reveal the impact of common practices of semen handling on the ability of sperm to respond to capacitation stimuli.
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Affiliation(s)
| | | | | | | | - Alexander J. Travis
- Androvia LifeSciencesMountainsideNew Jersey
- Baker Institute for Animal Health, College of Veterinary MedicineCornell UniversityIthacaNew York
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14
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Cardona C, Neri QV, Simpson AJ, Moody MA, Ostermeier GC, Seaman EK, Paniza T, Rosenwaks Z, Palermo GD, Travis AJ. Localization patterns of the ganglioside G M1 in human sperm are indicative of male fertility and independent of traditional semen measures. Mol Reprod Dev 2017; 84:423-435. [PMID: 28418610 PMCID: PMC5485082 DOI: 10.1002/mrd.22803] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/23/2017] [Indexed: 11/17/2022]
Abstract
Semen analysis lacks a functional component and best identifies extreme cases of infertility. The ganglioside GM1 is known to have functional roles during capacitation and acrosome exocytosis. Here, we assessed whether GM1 localization patterns (Cap‐Score™) correspond with male fertility in different settings: Study 1 involved couples pursuing assisted reproduction in a tertiary care fertility clinic, while Study 2 involved men with known fertility versus those questioning their fertility at a local urology center. In Study 1, we examined various thresholds versus clinical history for 42 patients; 13 had Cap‐Scores ≥39.5%, with 12 of these (92.3%) achieving clinical pregnancy by natural conception or ≤3 intrauterine insemination cycles. Of the 29 patients scoring <39.5%, only six (20.7%) attained clinical pregnancy by natural conception or ≤3 intrauterine insemination cycles. In Study 2, Cap‐Scores were obtained from 76 fertile men (Cohort 1, pregnant partner or recent father) and compared to 122 men seeking fertility assessment (Cohort 2). Cap‐Score values were normally distributed in Cohort 1, with 13.2% having Cap‐Scores more than one standard deviation below the mean (35.3 ± 7.7%). Significantly, more men in Cohort 2 had Cap‐Scores greater than one standard deviation below the normal mean (33.6%; p = 0.001). Minimal/no relationship was found between Cap‐Score and sperm concentration, morphology, or motility. Together, these data demonstrate that Cap‐Score provides novel, clinically relevant insights into sperm function and male fertility that complement traditional semen analysis. Furthermore, the data provide normal reference ranges for fertile men that can help clinicians counsel couples toward the most appropriate fertility treatment.
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Affiliation(s)
| | - Queenie V Neri
- The Ronald O. Perelman & Claudia Cohen Center for Reproductive Medicine & Infertility, Weill Cornell Medical College, New York, New York
| | | | | | | | | | - Theodore Paniza
- The Ronald O. Perelman & Claudia Cohen Center for Reproductive Medicine & Infertility, Weill Cornell Medical College, New York, New York
| | - Zev Rosenwaks
- The Ronald O. Perelman & Claudia Cohen Center for Reproductive Medicine & Infertility, Weill Cornell Medical College, New York, New York
| | - Gianpiero D Palermo
- The Ronald O. Perelman & Claudia Cohen Center for Reproductive Medicine & Infertility, Weill Cornell Medical College, New York, New York
| | - Alexander J Travis
- Androvia LifeSciences, Mountainside, New Jersey.,Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, New York
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15
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Simpson AJ, Romer LM, Kippelen P. Exercise-induced dehydration alters pulmonary function but does not modify airway responsiveness to dry air in athletes with mild asthma. J Appl Physiol (1985) 2017; 122:1329-1335. [PMID: 28280109 PMCID: PMC5451531 DOI: 10.1152/japplphysiol.01114.2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 11/22/2022] Open
Abstract
This study is the first to investigate the effect of whole body dehydration on airway responsiveness. Our data suggest that the airway response to dry air hyperpnea in athletes with mild asthma and/or exercise-induced bronchoconstriction is not exacerbated in a state of mild dehydration. On the basis of recorded alterations in lung volumes, however, exercise-induced dehydration appears to compromise small airway function. Local airway water loss is the main physiological trigger for exercise-induced bronchoconstriction (EIB). Our aim was to investigate the effects of whole body water loss on airway responsiveness and pulmonary function in athletes with mild asthma and/or EIB. Ten recreational athletes with a medical diagnosis of mild asthma and/or EIB completed a randomized, crossover study. Pulmonary function tests, including spirometry, whole body plethysmography, and diffusing capacity of the lung for carbon monoxide (DlCO), were conducted before and after three conditions: 1) 2 h of exercise in the heat with no fluid intake (dehydration), 2) 2 h of exercise with ad libitum fluid intake (control), and 3) a time-matched rest period (rest). Airway responsiveness was assessed 2 h postexercise/rest via eucapnic voluntary hyperpnea (EVH) to dry air. Exercise in the heat with no fluid intake induced a state of mild dehydration, with a body mass loss of 2.3 ± 0.8% (SD). After EVH, airway narrowing was not different between conditions: median (interquartile range) maximum fall in forced expiratory volume in 1 s was 13 (7–15)%, 11 (9–24)%, and 12 (7–20)% in dehydration, control, and rest conditions, respectively. Dehydration caused a significant reduction in forced vital capacity (300 ± 190 ml, P = 0.001) and concomitant increases in residual volume (260 ± 180 ml, P = 0.001) and functional residual capacity (260 ± 250 ml, P = 0.011), with no change in DlCO. Mild exercise-induced dehydration does not exaggerate airway responsiveness to dry air in athletes with mild asthma/EIB but may affect small airway function. NEW & NOTEWORTHY This study is the first to investigate the effect of whole body dehydration on airway responsiveness. Our data suggest that the airway response to dry air hyperpnea in athletes with mild asthma and/or exercise-induced bronchoconstriction is not exacerbated in a state of mild dehydration. On the basis of alterations in lung volumes, however, exercise-induced dehydration appears to compromise small airway function.
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Affiliation(s)
- A J Simpson
- Centre for Human Performance, Exercise, and Rehabilitation, Division of Sport, Health, and Exercise Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - L M Romer
- Centre for Human Performance, Exercise, and Rehabilitation, Division of Sport, Health, and Exercise Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - P Kippelen
- Centre for Human Performance, Exercise, and Rehabilitation, Division of Sport, Health, and Exercise Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
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16
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Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R, Wijesinghe M, Harrison RN, Steen N, Simpson AJ, Gibson GJ, Bourke SC. The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD. Thorax 2017; 72:686-693. [PMID: 28235886 PMCID: PMC5537524 DOI: 10.1136/thoraxjnl-2016-209298] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/03/2017] [Accepted: 01/17/2017] [Indexed: 12/23/2022]
Abstract
Background One in three patients hospitalised due to acute exacerbation of COPD (AECOPD) is readmitted within 90 days. No tool has been developed specifically in this population to predict readmission or death. Clinicians are unable to identify patients at particular risk, yet resources to prevent readmission are allocated based on clinical judgement. Methods In participating hospitals, consecutive admissions of patients with AECOPD were identified by screening wards and reviewing coding records. A tool to predict 90-day readmission or death without readmission was developed in two hospitals (the derivation cohort) and validated in: (a) the same hospitals at a later timeframe (internal validation cohort) and (b) four further UK hospitals (external validation cohort). Performance was compared with ADO, BODEX, CODEX, DOSE and LACE scores. Results Of 2417 patients, 936 were readmitted or died within 90 days of discharge. The five independent variables in the final model were: Previous admissions, eMRCD score, Age, Right-sided heart failure and Left-sided heart failure (PEARL). The PEARL score was consistently discriminative and accurate with a c-statistic of 0.73, 0.68 and 0.70 in the derivation, internal validation and external validation cohorts. Higher PEARL scores were associated with a shorter time to readmission. Conclusions The PEARL score is a simple tool that can effectively stratify patients' risk of 90-day readmission or death, which could help guide readmission avoidance strategies within the clinical and research setting. It is superior to other scores that have been used in this population. Trial registration number UKCRN ID 14214.
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Affiliation(s)
- C Echevarria
- North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - J Steer
- North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK
| | - K Heslop-Marshall
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.,Royal Victoria Hospital, Newcastle upon Tyne, UK
| | - S C Stenton
- Royal Victoria Hospital, Newcastle upon Tyne, UK
| | - P M Hickey
- Northern General Hospital, Sheffield, South Yorkshire, UK
| | - R Hughes
- Northern General Hospital, Sheffield, South Yorkshire, UK
| | | | - R N Harrison
- University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
| | - N Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - A J Simpson
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - G J Gibson
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - S C Bourke
- North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
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Abstract
The human lung produces a variety of peptides and proteins which have intrinsic antimicrobial activity. In general these molecules have broad spectra of antimicrobial activity, kill micro-organisms rapidly, and evade resistance generated by pathogens. In recent years it has become increasingly apparent that the antimicrobial peptides (AMPs) simultaneously possess immunomodulatory functions, suggesting complex roles for these molecules in regulating the clearance of, and immune response to, invading pathogens. These collective properties have stimulated considerable interest in the potential clinical application of endogenous AMPs. This article outlines the biology of AMPs, their pattern of expression in the lung, and their functions, with reference to both antimicrobial and immunomodulatory activity. We then consider the biological importance of AMPs, before concentrating on the potential to use AMPs to therapeutic effect. The principles discussed in the article apply to innate immune defence throughout the body, but particular emphasis is placed on AMPs in the lung and the potential application to pulmonary infection.
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Affiliation(s)
- M A Gibbons
- Rayne Laboratory, MRC Centre for Inflammation Research, Edinburgh University Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland, UK
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18
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Dismore L, Echevarria C, Van-Wersch A, Simpson AJ, Gibson GJ, Bourke SC. P213 Positive drivers and potential barriers to implementation of hospital at home selected by low risk decaf score. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Echevarria C, Hartley T, Gray J, Muirhead C, Van-Wersch A, Miller J, Steer J, Simpson AJ, Gibson GJ, Bourke SC. S116 Hot decaf: a rct comparing home treatment and inpatient care in copd exacerbations selected by low risk decaf score. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wort AS, Gale M, Devine K, Simpson AJ, Sails AD, Spencer DA, Thomas MF, Brodlie M. S73 Viruses associated with community-acquired pneumonia in children – a large prospective study in the post-prevenar 13 era. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nolan TJ, Gadsby NJ, Hellyer TP, Templeton KE, McMullan R, McKenna JP, Rennie J, Robb CT, Walsh TS, Rossi AG, Conway Morris A, Simpson AJ. Low-pathogenicity Mycoplasma spp. alter human monocyte and macrophage function and are highly prevalent among patients with ventilator-acquired pneumonia. Thorax 2016; 71:594-600. [PMID: 27071419 PMCID: PMC4941152 DOI: 10.1136/thoraxjnl-2015-208050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/12/2016] [Accepted: 02/04/2016] [Indexed: 12/02/2022]
Abstract
BACKGROUND Ventilator-acquired pneumonia (VAP) remains a significant problem within intensive care units (ICUs). There is a growing recognition of the impact of critical-illness-induced immunoparesis on the pathogenesis of VAP, but the mechanisms remain incompletely understood. We hypothesised that, because of limitations in their routine detection, Mycoplasmataceae are more prevalent among patients with VAP than previously recognised, and that these organisms potentially impair immune cell function. METHODS AND SETTING 159 patients were recruited from 12 UK ICUs. All patients had suspected VAP and underwent bronchoscopy and bronchoalveolar lavage (BAL). VAP was defined as growth of organisms at >10(4) colony forming units per ml of BAL fluid on conventional culture. Samples were tested for Mycoplasmataceae (Mycoplasma and Ureaplasma spp.) by PCR, and positive samples underwent sequencing for speciation. 36 healthy donors underwent BAL for comparison. Additionally, healthy donor monocytes and macrophages were exposed to Mycoplasma salivarium and their ability to respond to lipopolysaccharide and undertake phagocytosis was assessed. RESULTS Mycoplasmataceae were found in 49% (95% CI 33% to 65%) of patients with VAP, compared with 14% (95% CI 9% to 25%) of patients without VAP. Patients with sterile BAL fluid had a similar prevalence to healthy donor BAL fluid (10% (95% CI 4% to 20%) vs 8% (95% CI 2% to 22%)). The most common organism identified was M. salivarium. Blood monocytes from healthy volunteers incubated with M. salivarium displayed an impaired TNF-α response to lipopolysaccharide (p=0.0003), as did monocyte-derived macrophages (MDMs) (p=0.024). MDM exposed to M. salivarium demonstrated impaired phagocytosis (p=0.005). DISCUSSION AND CONCLUSIONS This study demonstrates a high prevalence of Mycoplasmataceae among patients with VAP, with a markedly lower prevalence among patients with suspected VAP in whom subsequent cultures refuted the diagnosis. The most common organism found, M. salivarium, is able to alter the functions of key immune cells. Mycoplasmataceae may contribute to VAP pathogenesis.
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Affiliation(s)
- T J Nolan
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - N J Gadsby
- Clinical Microbiology, NHS Lothian, Edinburgh, UK
| | - T P Hellyer
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | | | - R McMullan
- Centre for Infection and Immunity, Queen's University, Belfast, UK
| | - J P McKenna
- Department of Microbiology, Belfast Health & Social Care Trust, Belfast, UK
| | - J Rennie
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - C T Robb
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - T S Walsh
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - A G Rossi
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - A Conway Morris
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - A J Simpson
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
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Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R, Wijesinghe M, Harrison RN, Steen N, Simpson AJ, Gibson GJ, Bourke SC. Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD. Thorax 2016; 71:133-40. [PMID: 26769015 PMCID: PMC4752621 DOI: 10.1136/thoraxjnl-2015-207775] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Hospitalisation due to acute exacerbations of COPD (AECOPD) is common, and subsequent mortality high. The DECAF score was derived for accurate prediction of mortality and risk stratification to inform patient care. We aimed to validate the DECAF score, internally and externally, and to compare its performance to other predictive tools. Methods The study took place in the two hospitals within the derivation study (internal validation) and in four additional hospitals (external validation) between January 2012 and May 2014. Consecutive admissions were identified by screening admissions and searching coding records. Admission clinical data, including DECAF indices, and mortality were recorded. The prognostic value of DECAF and other scores were assessed by the area under the receiver operator characteristic (AUROC) curve. Results In the internal and external validation cohorts, 880 and 845 patients were recruited. Mean age was 73.1 (SD 10.3) years, 54.3% were female, and mean (SD) FEV1 45.5 (18.3) per cent predicted. Overall mortality was 7.7%. The DECAF AUROC curve for inhospital mortality was 0.83 (95% CI 0.78 to 0.87) in the internal cohort and 0.82 (95% CI 0.77 to 0.87) in the external cohort, and was superior to other prognostic scores for inhospital or 30-day mortality. Conclusions DECAF is a robust predictor of mortality, using indices routinely available on admission. Its generalisability is supported by consistent strong performance; it can identify low-risk patients (DECAF 0–1) potentially suitable for Hospital at Home or early supported discharge services, and high-risk patients (DECAF 3–6) for escalation planning or appropriate early palliation. Trial registration number UKCRN ID 14214.
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Affiliation(s)
- C Echevarria
- Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - J Steer
- Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK
| | - K Heslop-Marshall
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK Chest Clinic, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - S C Stenton
- Chest Clinic, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - P M Hickey
- Department of Respiratory Medicine, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - R Hughes
- Department of Respiratory Medicine, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - M Wijesinghe
- Department of Respiratory Medicine, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - R N Harrison
- Department of Respiratory Medicine, University Hospital of North Tees, Hardwick Hall, Stockton-on-Tees, Cleveland, UK
| | - N Steen
- Institute of Health and Society, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK
| | - A J Simpson
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - G J Gibson
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - S C Bourke
- Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
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Simpson AJ, Bood JR, Anderson SD, Romer LM, Dahlén B, Dahlén SE, Kippelen P. A standard, single dose of inhaled terbutaline attenuates hyperpnea-induced bronchoconstriction and mast cell activation in athletes. J Appl Physiol (1985) 2016; 120:1011-7. [PMID: 26846550 PMCID: PMC4894945 DOI: 10.1152/japplphysiol.00700.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/28/2016] [Indexed: 12/30/2022] Open
Abstract
This study provides the first in vivo evidence for a mast cell stabilizing effect of the short-acting inhaled β2-adrenoceptor agonist terbutaline, when administered prophylactically at a clinically recommended dose (0.5 mg) before bronchial provocation with dry air. Our data therefore support the proposal that β2-adrenoceptor agonist-mediated mast cell stabilization is a major contributor to bronchoprotection in individuals with exercise-induced bronchoconstriction. Release of bronchoactive mediators from mast cells during exercise hyperpnea is a key factor in the pathophysiology of exercise-induced bronchoconstriction (EIB). Our aim was to investigate the effect of a standard, single dose of an inhaled β2-adrenoceptor agonist on mast cell activation in response to dry air hyperpnea in athletes with EIB. Twenty-seven athletes with EIB completed a randomized, double-blind, placebo-controlled, crossover study. Terbutaline (0.5 mg) or placebo was inhaled 15 min prior to 8 min of eucapnic voluntary hyperpnea (EVH) with dry air. Pre- and postbronchial challenge, urine samples were analyzed by enzyme immunoassay for 11β-prostaglandin F2α (11β-PGF2α). The maximum fall in forced expiratory volume in 1 s of 14 (12–20)% (median and interquartile range) following placebo was attenuated to 7 (5–9)% with the administration of terbutaline (P < 0.001). EVH caused a significant increase in 11β-PGF2α from 41 (27–57) ng/mmol creatinine at baseline to 58 (43–72) ng/mmol creatinine at its peak post-EVH following placebo (P = 0.002). The rise in 11β-PGF2α was inhibited with administration of terbutaline: 39 (28–44) ng/mmol creatinine at baseline vs. 40 (33–58) ng/mmol creatinine at its peak post-EVH (P = 0.118). These data provide novel in vivo evidence of mast cell stabilization following inhalation of a standard dose of terbutaline prior to bronchial provocation with EVH in athletes with EIB.
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Affiliation(s)
- A J Simpson
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, United Kingdom
| | - J R Bood
- Unit for Experimental Asthma Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Unit for Clinical Asthma Research, Department of Internal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; and
| | - S D Anderson
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - L M Romer
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, United Kingdom
| | - B Dahlén
- Unit for Clinical Asthma Research, Department of Internal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; and
| | - S-E Dahlén
- Unit for Experimental Asthma Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; and
| | - P Kippelen
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, United Kingdom;
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Dutta P, Avery P, Mansell L, Griffiths B, Forrest I, Simpson AJ. P30 Efficacy of pulsed cyclophosphamide and methyl-prednisolone therapy in patients with progressive interstitial lung disease. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R, Wijesinghe M, Harrison RN, Steen N, Simpson AJ, Gibson GJ, Bourke SC. S58 The PEARL score predicts 90 day readmission or death following hospitalisation for an exacerbation of COPD: Abstract S58 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Koustas S, Peel A, Scott J, Davison J, Jiwa K, Carnell S, Simpson AJ, De Soyza A. S84 Sputum neutrophils but not Interleukin-8 (IL-8) or Interleukin 17 (IL-17) correlate with the Bronchiectasis Severity Index (BSI). Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Perruchoud LH, Jones MD, Sutrisno A, Zamble DB, Simpson AJ, Zhang XA. A ratiometric NMR pH sensing strategy based on a slow-proton-exchange (SPE) mechanism. Chem Sci 2015; 6:6305-6311. [PMID: 30090248 PMCID: PMC6054103 DOI: 10.1039/c5sc02145f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 07/18/2015] [Indexed: 12/16/2022] Open
Abstract
Real time and non-invasive detection of pH in live biological systems is crucial for understanding the physiological role of acid-base homeostasis and for detecting pathological conditions associated with pH imbalance. One method to achieve in vivo pH monitoring is NMR. Conventional NMR methods, however, mainly utilize molecular sensors displaying pH-dependent chemical shift changes, which are vulnerable to multiple pH-independent factors. Here, we present a novel ratiometric strategy for sensitive and accurate pH sensing based on a small synthetic molecule, SPE1, which exhibits exceptionally slow proton exchange on the NMR time scale. Each protonation state of the sensor displays distinct NMR signals and the ratio of these signals affords precise pH values. In contrast to standard NMR methods, this ratiometric mechanism is not based on a chemical shift change, and SPE1 binds protons with high selectivity, resulting in accurate measurements. SPE1 was used to measure the pH in a single oocyte as well as in bacterial cultures, demonstrating the versatility of this method and establishing the foundation for broad biological applications.
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Affiliation(s)
- L H Perruchoud
- Department of Chemistry , University of Toronto , Toronto , ON M5S 3H6 , Canada . ; ;
- Department of Environmental and Physical Sciences , University of Toronto Scarborough , Toronto , ON M1C 1A4 , Canada
| | - M D Jones
- Department of Chemistry , University of Toronto , Toronto , ON M5S 3H6 , Canada . ; ;
| | - A Sutrisno
- Department of Chemistry , University of Toronto , Toronto , ON M5S 3H6 , Canada . ; ;
- Department of Environmental and Physical Sciences , University of Toronto Scarborough , Toronto , ON M1C 1A4 , Canada
| | - D B Zamble
- Department of Chemistry , University of Toronto , Toronto , ON M5S 3H6 , Canada . ; ;
- Department of Biochemistry , University of Toronto , Toronto , ON M5S 1A8 , Canada
| | - A J Simpson
- Department of Chemistry , University of Toronto , Toronto , ON M5S 3H6 , Canada . ; ;
- Department of Environmental and Physical Sciences , University of Toronto Scarborough , Toronto , ON M1C 1A4 , Canada
| | - X-A Zhang
- Department of Chemistry , University of Toronto , Toronto , ON M5S 3H6 , Canada . ; ;
- Department of Environmental and Physical Sciences , University of Toronto Scarborough , Toronto , ON M1C 1A4 , Canada
- Department of Biological Sciences , University of Toronto Scarborough , Toronto , ON M1C 1A4 , Canada
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Walker NF, Brown CS, Youkee D, Baker P, Williams N, Kalawa A, Russell K, Samba AF, Bentley N, Koroma F, King MB, Parker BE, Thompson M, Boyles T, Healey B, Kargbo B, Bash-Taqi D, Simpson AJ, Kamara A, Kamara TB, Lado M, Johnson O, Brooks T. Evaluation of a point-of-care blood test for identification of Ebola virus disease at Ebola holding units, Western Area, Sierra Leone, January to February 2015. ACTA ACUST UNITED AC 2015; 20. [PMID: 25846490 DOI: 10.2807/1560-7917.es2015.20.12.21073] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Current Ebola virus disease (EVD) diagnosis relies on reverse transcription-PCR (RT-PCR) technology, requiring skilled laboratory personnel and technical infrastructure. Lack of laboratory diagnostic capacity has led to diagnostic delays in the current West African EVD outbreak of 2014 and 2015, compromising outbreak control. We evaluated the diagnostic accuracy of the EVD bedside rapid diagnostic antigen test (RDT) developed by the United Kingdom's Defence Science and Technology Laboratory, compared with Ebola virus RT-PCR, in an operational setting for EVD diagnosis of suspected cases admitted to Ebola holding units in the Western Area of Sierra Leone. From 22 January to 16 February 2015, 138 participants were enrolled. EVD prevalence was 11.5%. All EVD cases were identified by a positive RDT with a test line score of 6 or more, giving a sensitivity of 100% (95% confidence interval (CI): 78.2-100). The corresponding specificity was high (96.6%, 95% CI: 91.3-99.1). The positive and negative predictive values for the population prevalence were 79.0% (95% CI: 54.4-93.8) and 100% (95% CI: 96.7-100), respectively. These results, if confirmed in a larger study, suggest that this RDT could be used as a 'rule-out' screening test for EVD to improve rapid case identification and resource allocation.
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Affiliation(s)
- N F Walker
- King s Sierra Leone Partnership, King's Centre for Global Health, King's College London, and King s Health Partners, London, United Kingdom
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Nolan TJ, Gadsby N, Hellyer TP, Templeton K, McMullan R, McKenna J, Rennie J, Robb CT, Walsh TS, Rossi AG, Simpson AJ, Morris A. Low-pathogenicity mycoplasma species induce immunoparesis and are highly prevalent amongst patients with ventilator-associated pneumonia. Crit Care 2015. [PMCID: PMC4470596 DOI: 10.1186/cc14169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Moncayo-Nieto OL, Reid P, Laurenson IF, Simpson AJ. Improving the use of sputum cultures in lower respiratory tract infection. J R Coll Physicians Edinb 2014; 43:108-13. [PMID: 23734350 DOI: 10.4997/jrcpe.2013.204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical value of sputum culture in suspected lower respiratory tract infection (LRTI) remains contentious. The quality of samples submitted significantly impacts their clinical usefulness. METHODS Using pre-defined criteria we prospectively analysed the appropriateness of sputum samples submitted from consecutive patients with suspected LRTI attending two acute hospital units over ten weeks. We then provided an education package for staff on when and how to collect appropriate sputum samples, and repeated the evaluation. RESULTS Our intervention reduced sample numbers from 347 to 133, simultaneously increasing the proportion of appropriately sent samples from 40.5 to 60.2% (p=0.001) and reducing cost. Appropriate sampling was associated with a higher yield of pathogens (relative risk 1.51, 95% confidence intervals 1.03-2.21, p=0.03). The rate at which sputum samples appeared to alter clinicians' management remained low and constant at 18% pre- and post-intervention. CONCLUSION A simple educational intervention can significantly increase appropriateness of sputum sampling, reducing workload and cost.
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Affiliation(s)
- O L Moncayo-Nieto
- Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
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Macfarlane JG, Ruchaud-Sparagano MH, Scott JA, Bulmer DA, Khan CMA, Simpson AJ. P142 Src kinase inhibition attenuates neutrophil degranulation without impairing bacterial killing: a possible therapeutic strategy for acute lung injury? Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Robinson L, Yeung A, Ali T, Worthy SA, Mulvenna PM, Wilkinson M, Simpson AJ. S108 Statin use and cigarette smoking are associated with lower incidence of radiation pneumonitis. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Popplewell CR, Ruchaud-Sparagano MH, Scott J, Corris PA, Simpson AJ. P10 Carboplatin and gemcitabine impair neutrophil phagocytic function. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Walsh TS, Morris AC, Simpson AJ. Ventilator associated pneumonia: can we ensure that a quality indicator does not become a game of chance? Br J Anaesth 2013; 111:333-7. [PMID: 23946358 DOI: 10.1093/bja/aet131] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Christie M, Jorissen RN, Mouradov D, Sakthianandeswaren A, Li S, Day F, Tsui C, Lipton L, Desai J, Jones IT, McLaughlin S, Ward RL, Hawkins NJ, Ruszkiewicz AR, Moore J, Burgess AW, Busam D, Zhao Q, Strausberg RL, Simpson AJ, Tomlinson IPM, Gibbs P, Sieber OM. Different APC genotypes in proximal and distal sporadic colorectal cancers suggest distinct WNT/β-catenin signalling thresholds for tumourigenesis. Oncogene 2013; 32:4675-82. [PMID: 23085758 PMCID: PMC3787794 DOI: 10.1038/onc.2012.486] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/20/2012] [Accepted: 09/04/2012] [Indexed: 01/05/2023]
Abstract
Biallelic protein-truncating mutations in the adenomatous polyposis coli (APC) gene are prevalent in sporadic colorectal cancer (CRC). Mutations may not be fully inactivating, instead producing WNT/β-catenin signalling levels 'just-right' for tumourigenesis. However, the spectrum of optimal APC genotypes accounting for both hits, and the influence of clinicopathological features on genotype selection remain undefined. We analysed 630 sporadic CRCs for APC mutations and loss of heterozygosity (LOH) using sequencing and single-nucleotide polymorphism microarrays, respectively. Truncating APC mutations and/or LOH were detected in 75% of CRCs. Most truncating mutations occurred within a mutation cluster region (MCR; codons 1282-1581) leaving 1-3 intact 20 amino-acid repeats (20AARs) and abolishing all Ser-Ala-Met-Pro (SAMP) repeats. Cancers commonly had one MCR mutation plus either LOH or another mutation 5' to the MCR. LOH was associated with mutations leaving 1 intact 20AAR. MCR mutations leaving 1 vs 2-3 intact 20AARs were associated with 5' mutations disrupting or leaving intact the armadillo-repeat domain, respectively. Cancers with three hits had an over-representation of mutations upstream of codon 184, in the alternatively spliced region of exon 9, and 3' to the MCR. Microsatellite unstable cancers showed hyper-mutation at MCR mono- and di-nucleotide repeats, leaving 2-3 intact 20AARs. Proximal and distal cancers exhibited different preferred APC genotypes, leaving a total of 2 or 3 and 0 to 2 intact 20AARs, respectively. In conclusion, APC genotypes in sporadic CRCs demonstrate 'fine-tuned' interdependence of hits by type and location, consistent with selection for particular residual levels of WNT/β-catenin signalling, with different 'optimal' thresholds for proximal and distal cancers.
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Affiliation(s)
- M Christie
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - R N Jorissen
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - D Mouradov
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - A Sakthianandeswaren
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - S Li
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - F Day
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - C Tsui
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - L Lipton
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - J Desai
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - I T Jones
- Department of Colorectal Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - S McLaughlin
- Department of Colorectal Surgery, Western Hospital, Footscray, Victoria, Australia
| | - R L Ward
- Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - N J Hawkins
- Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - A R Ruszkiewicz
- Pathology Department, Institute of Medical and Veterinary Science, Adelaide, South Australia, Australia
| | - J Moore
- Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A W Burgess
- Epithelial Biology Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - D Busam
- J Craig Venter Institute, Rockville, MD, USA
| | - Q Zhao
- J Craig Venter Institute, Rockville, MD, USA
| | - R L Strausberg
- Department of Neurosurgery, Ludwig Collaborative Laboratory for Cancer Biology and Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Ludwig Institute for Cancer Research Ltd, New York, NY, USA
| | - A J Simpson
- Department of Neurosurgery, Ludwig Collaborative Laboratory for Cancer Biology and Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Ludwig Institute for Cancer Research Ltd, New York, NY, USA
| | - I P M Tomlinson
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Oxford, OX, UK
| | - P Gibbs
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - O M Sieber
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Simpson AJ, Tufvesson E, Anderson SD, Romer LM, Bjermer L, Kippelen P. Effect of terbutaline on hyperpnoea-induced bronchoconstriction and urinary club cell protein 16 in athletes. J Appl Physiol (1985) 2013; 115:1450-6. [PMID: 24030662 DOI: 10.1152/japplphysiol.00716.2013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Repeated injury of the airway epithelium caused by hyperpnoea of poorly conditioned air has been proposed as a key factor in the pathogenesis of exercise-induced bronchoconstriction (EIB) in athletes. In animals, the short-acting β2-agonist terbutaline has been shown to reduce dry airflow-induced bronchoconstriction and the associated shedding of airway epithelial cells. Our aim was to test the efficacy of inhaled terbutaline in attenuating hyperpnoea-induced bronchoconstriction and airway epithelial injury in athletes. Twenty-seven athletes with EIB participated in a randomized, double-blind, placebo-controlled, crossover study. Athletes completed an 8-min eucapnic voluntary hyperpnoea (EVH) test with dry air on two separate days 15 min after inhaling 0.5 mg terbutaline or a matching placebo. Forced expiratory volume in 1 s (FEV1) and urinary concentration of the club cell (Clara cell) protein 16 (CC16, a marker of airway epithelial perturbation) were measured before and up to 60 min after EVH. The maximum fall in FEV1 of 17 ± 8% (SD) on placebo was reduced to 8 ± 5% following terbutaline (P < 0.001). Terbutaline gave bronchoprotection (i.e., post-EVH FEV1 fall <10%) to 22 (81%) athletes. EVH caused an increase in urinary excretion of CC16 in both conditions (P < 0.001), and terbutaline significantly reduced this rise (pre- to postchallenge CC16 increase 416 ± 495 pg/μmol creatinine after placebo vs. 315 ± 523 pg/μmol creatinine after terbutaline, P = 0.016). These results suggest that the inhalation of a single therapeutic dose of terbutaline offers significant protection against hyperpnoea-induced bronchoconstriction and attenuates acute airway epithelial perturbation in athletes.
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Affiliation(s)
- A J Simpson
- Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge, United Kingdom
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Conway Morris A, Anderson N, Brittan M, Wilkinson TS, McAuley DF, Antonelli J, McCulloch C, Barr LC, Dhaliwal K, Jones RO, Haslett C, Hay AW, Swann DG, Laurenson IF, Davidson DJ, Rossi AG, Walsh TS, Simpson AJ. Combined dysfunctions of immune cells predict nosocomial infection in critically ill patients. Br J Anaesth 2013; 111:778-87. [PMID: 23756248 DOI: 10.1093/bja/aet205] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nosocomial infection occurs commonly in intensive care units (ICUs). Although critical illness is associated with immune activation, the prevalence of nosocomial infections suggests concomitant immune suppression. This study examined the temporal occurrence of immune dysfunction across three immune cell types, and their relationship with the development of nosocomial infection. METHODS A prospective observational cohort study was undertaken in a teaching hospital general ICU. Critically ill patients were recruited and underwent serial examination of immune status, namely percentage regulatory T-cells (Tregs), monocyte deactivation (by expression) and neutrophil dysfunction (by CD88 expression). The occurrence of nosocomial infection was determined using pre-defined, objective criteria. RESULTS Ninety-six patients were recruited, of whom 95 had data available for analysis. Relative to healthy controls, percentage Tregs were elevated 6-10 days after admission, while monocyte HLA-DR and neutrophil CD88 showed broader depression across time points measured. Thirty-three patients (35%) developed nosocomial infection, and patients developing nosocomial infection showed significantly greater immune dysfunction by the measures used. Tregs and neutrophil dysfunction remained significantly predictive of infection in a Cox hazards model correcting for time effects and clinical confounders {hazard ratio (HR) 2.4 [95% confidence interval (CI) 1.1-5.4] and 6.9 (95% CI 1.6-30), respectively, P=0.001}. Cumulative immune dysfunction resulted in a progressive risk of infection, rising from no cases in patients with no dysfunction to 75% of patients with dysfunction of all three cell types (P=0.0004). CONCLUSIONS Dysfunctions of T-cells, monocytes, and neutrophils predict acquisition of nosocomial infection, and combine additively to stratify risk of nosocomial infection in the critically ill.
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Affiliation(s)
- A Conway Morris
- MRC/University Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
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Jones RO, Murchison JT, Casali G, Simon EJ, Anderson N, Simpson AJ, Walker WS. P111 Bronchoalveolar Lavage does not affect the Acute Inflammatory Response Following Bronchoscopy and Mediastinoscopy. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kerrin A, Weldon S, Chang A, Craig T, Simpson AJ, O’Kane C, McAuley DF, Taggart C. S76 Proteolytic Cleavage of Elafin by 20S Proteasome May Contribute to Inflammation in Acute Lung Injury. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Williamson ED, Packer PJ, Waters EL, Simpson AJ, Dyer D, Hartings J, Twenhafel N, Pitt MLM. Recombinant (F1+V) vaccine protects cynomolgus macaques against pneumonic plague. Vaccine 2011; 29:4771-7. [PMID: 21570437 DOI: 10.1016/j.vaccine.2011.04.084] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/14/2011] [Accepted: 04/21/2011] [Indexed: 11/18/2022]
Abstract
Cynomolgus macaques, immunised at the 80 μg dose level with an rF1+rV vaccine (two doses, three weeks apart), were fully protected against pneumonic plague following inhalational exposure to a clinical isolate of Yersinia pestis (strain CO92) at week 8 of the schedule. At this time, all the immunised animals had developed specific IgG titres to rF1 and rV with geometric mean titres of 96.83±20.93 μg/ml and 78.59±12.07 μg/ml, respectively, for the 40 μg dose group; by comparison, the 80 μg dose group had developed titres of 114.4±22.1 and 90.8±15.8 μg/ml to rF1 and rV, respectively, by week 8. For all the immunised animals, sera drawn at week 8 competed with the neutralising and protective Mab7.3 for binding to rV antigen in a competitive ELISA, indicating that a functional antibody response to rV had been induced. All but one of the group immunised at the lower 40 μg dose-level were protected against infection; the single animal which succumbed had significantly reduced antibody responses to both the rF1 and rV antigens. Although a functional titre to rV antigen was detected for this animal, this was insufficient for protection, indicating that there may have been a deficiency in the functional titre to rF1 and underlining the need for immunity to both vaccine antigens to achieve protective efficacy against plague. This candidate vaccine, which has been evaluated as safe and immunogenic in clinical studies, has now been demonstrated to protect cynomolgus macaques, immunised in the clinical regimen, against pneumonic plague.
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MESH Headings
- Animals
- Antibodies, Bacterial/blood
- Antibodies, Neutralizing/blood
- Antigens, Bacterial/administration & dosage
- Antigens, Bacterial/genetics
- Antigens, Bacterial/immunology
- Bacterial Proteins/administration & dosage
- Bacterial Proteins/genetics
- Bacterial Proteins/immunology
- Disease Models, Animal
- Enzyme-Linked Immunosorbent Assay
- Immunization, Secondary/methods
- Macaca fascicularis
- Plague/prevention & control
- Plague Vaccine/administration & dosage
- Plague Vaccine/genetics
- Plague Vaccine/immunology
- Pore Forming Cytotoxic Proteins/administration & dosage
- Pore Forming Cytotoxic Proteins/genetics
- Pore Forming Cytotoxic Proteins/immunology
- Primate Diseases/prevention & control
- Vaccination/methods
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/genetics
- Vaccines, Synthetic/immunology
- Yersinia pestis/immunology
- Yersinia pestis/pathogenicity
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Al-Adhami AS, Simpson AJ, Reid JH, MacDougall M, Murchison JT. Prognostic significance of the lung scintigraphy scan result and corresponding chest X-ray in patients with suspected pulmonary embolism. J R Coll Physicians Edinb 2010; 40:196-200. [DOI: 10.4997/jrcpe.2010.302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Simpson AJ, de Souza SJ, Camargo AA, Brentani RR. Definition of the gene content of the human genome: the need for deep experimental verification. Comp Funct Genomics 2010; 2:169-75. [PMID: 18628909 PMCID: PMC2447206 DOI: 10.1002/cfg.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2001] [Accepted: 04/05/2001] [Indexed: 11/06/2022] Open
Abstract
Based on the analysis of the drafts of the human genome sequence, it is being speculated that our species may possess an unexpectedly low number of genes. The quality of the drafts, the impossibility of accurate gene prediction and the lack of sufficient transcript sequence data, however, render such speculations very premature. The complexity of human gene structure requires additional and extensive experimental verification of transcripts that may result in major revisions of these early estimates of the number of human genes.
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Affiliation(s)
- A J Simpson
- The Ludwig Institute for Cancer Research, Rua Professor Antônio Prudente 109, São Paulo, SP 01509-010, Brazil.
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Richards JMJ, Shaw CA, Lang NN, Semple SI, Crawford JH, Mills NL, Dhaliwal K, Simpson AJ, Burdess A, Roddie H, McKillop G, Atkinson AP, Forrest E, Connolly TM, Feuerstein GZ, Barclay GR, Turner ML, Newby DE. 074 In vivo cell tracking of superparamagnetic iron oxide-labelled mononuclear cells in humans. Heart 2010. [DOI: 10.1136/hrt.2010.195966.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Venkatesh H, Watson D, Laurenson IF, Patel D, Simpson AJ. Panton-Valentine Leucocidin (PVL) Pneumonia: case report. Scott Med J 2010. [DOI: 10.1258/rsmsmj.55.2.58h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- H Venkatesh
- Specialist Registrar in Microbiology, Royal Infirmary of Edinburgh
| | - D Watson
- Consultant Anaesthetist, Royal Infirmary of Edinburgh
| | - IF Laurenson
- Consultant Microbiologist, Royal Infirmary of Edinburgh
| | - D Patel
- Consultant Radiologist, Royal Infirmary of Edinburgh
| | - AJ Simpson
- Consultant in Respiratory Medicine, Royal Infirmary of Edinburgh
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Jones A, Stockton DL, Simpson AJ, Murchison JT. Idiopathic venous thromboembolic disease is associated with a poorer prognosis from subsequent malignancy. Br J Cancer 2009; 101:840-2. [PMID: 19654574 PMCID: PMC2736833 DOI: 10.1038/sj.bjc.6605210] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Methods: We carried out a retrospective study of prognosis in Scottish patients diagnosed with cancer within 5 years after a venous thromboembolism (VTE). Results and conclusions: Prognosis was significantly poorer if a VTE occurred up to 2 years before cancer diagnosis, most notably if the cancer was diagnosed in the 6 months after a VTE.
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Affiliation(s)
- A Jones
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK.
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46
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Akram AR, Cowell GW, Logan LJA, Macdougall M, Reid JH, Murchison JT, Simpson AJ. Clinically suspected acute pulmonary embolism: a comparison of presentation, radiological features and outcome in patients with and without PE. QJM 2009; 102:407-14. [PMID: 19376792 DOI: 10.1093/qjmed/hcp041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Relatively little is known about prognosis in patients for whom suspected pulmonary embolism (PE) is refuted by imaging. AIM This prospective study of suspected PE therefore compared clinico-radiological features and outcome in patients with and without PE. DESIGN AND METHODS Computed tomographic pulmonary angiography (CTPA) confirmed or refuted PE in consecutive patients. Clinical, laboratory and radiological features were recorded at baseline, and mortality at 1 year determined. Univariate and multivariate analyses identified variables associated with PE. RESULTS PE was diagnosed in 45 patients and refuted in 141. The PE and 'non-PE' groups were similar with regard to extravascular radiology (though consolidation was significantly more common in the PE group [present in 24 (53%) of the PE group and 42 (30%) of the non-PE group, P < 0.01)], comorbidities (no significant differences), and baseline characteristics (only serum D-dimer concentrations were independently associated with PE by multivariate analysis, P = 0.001). Right ventricular dimensions were significantly higher in the PE group, [right ventricular to left ventricular ratio was 0.98 (range 0.64-2.48) in the PE group and 0.92 (range 0.66-1.95) in the non-PE group, P < 0.05]. In the PE group, right ventricular dimensions rose sharply when 10 or more segmental pulmonary arteries were occluded. One year all-cause mortality was 6.7% in the PE group and 13.5% in the non-PE group (no significant difference, P = 0.218). CONCLUSION Among a cohort of patients presenting with clinically suspected PE, clinical characteristics, co-morbidities and radiological features were similar when comparing groups with CTPA-proven or CTPA-refuted PE. However RV dimensions, radiological consolidation on imaging and D-dimer levels were significantly higher in the PE group. Patients with suspected PE have a poor prognosis irrespective of whether PE is confirmed. This appears accentuated in patients without PE, a finding possibly under-recognized in clinical practice.
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Affiliation(s)
- A R Akram
- Respiratory Medicine Unit, New Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, Scotland, UK.
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47
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Morris AC, Kefala K, Simpson AJ, Wilkinson TS, Everingham K, Kerslake D, Raby S, Laurenson IF, Swann DG, Walsh TS. Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia. Thorax 2009; 64:516-22. [PMID: 19213771 DOI: 10.1136/thx.2008.110239] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The optimal method for diagnosing ventilator-associated pneumonia (VAP) is controversial and its effect on reported incidence uncertain. This study aimed to model the impact of using either endotracheal aspirate or bronchoalveolar lavage on the reported incidence of pneumonia and then to test effects suggested from theoretical modelling in clinical practice. METHODS A three-part single-centre study was undertaken. First, diagnostic performance of aspirate and lavage were compared using paired samples from 53 patients with suspected VAP. Secondly, infection surveillance data were used to model the potential effect on pneumonia incidence and antibiotic use of using exclusively aspirate or lavage to investigate suspected pneumonia (643 patients; 110 clinically suspected pneumonia episodes). Thirdly, a practice change initiative was undertaken to increase lavage use; pneumonia incidence and antibiotic use were compared for the 12 months before and after the change. RESULTS Aspirate overdiagnosed VAP compared with lavage (89% vs 21% of clinically suspected cases, p<0.0001). Modelling suggested that changing from exclusive aspirate to lavage diagnosis would decrease reported pneumonia incidence by 76% (95% CI 67% to 87%) and antibiotic use by 30% (95% CI 20% to 42%). After the practice change initiative, lavage use increased from 37% to 58%. Although clinically suspected pneumonia incidence was unchanged, microbiologically confirmed VAP decreased from 18 to 9 cases per 1000 ventilator days (p = 0.001; relative risk reduction 0.61 (95% CI 0.46 to 0.82)), and mean antibiotic use fell from 9.1 to 7.2 antibiotic days (21% decrease, p = 0.08). CONCLUSIONS Diagnostic technique impacts significantly on reported VAP incidence and potentially on antibiotic use.
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Affiliation(s)
- A Conway Morris
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Little France Crescent, Edinburgh, UK
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48
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Young EC, Mills NL, Henriksen PA, Murchison JT, Salter DM, Hayward RL, Newby DE, Simpson AJ. A 29-year-old male with chest pain and haemoptysis. Eur Respir J 2008; 32:1404-7. [PMID: 18978140 DOI: 10.1183/09031936.00016108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- E C Young
- Dept of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
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49
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Cowell GW, Reid JH, Simpson AJ, Murchison JT. A profile of lower-limb deep-vein thrombosis: the hidden menace of below-knee DVT. Clin Radiol 2007; 62:858-63; discussion 864-5. [PMID: 17662733 DOI: 10.1016/j.crad.2007.01.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 01/22/2007] [Accepted: 01/29/2007] [Indexed: 11/24/2022]
Abstract
AIMS To describe the anatomical site and laterality of deep-vein thrombosis (DVT) in symptomatic patients using contrast venography (CV), and to assess age, sex distribution, and accuracy of pre-test clinical suspicion of DVT. METHODS One thousand, five hundred and seventy-two patients undergoing CV because of a clinical suspicion of DVT at a large teaching hospital from October 1995 to March 2003 were prospectively studied. RESULTS Thrombi were demonstrated in 511 (32.5%) of all CV studies. Isolated, below-knee thrombi were identified in 29.4% of positive studies. There was a left-sided predominance of DVT (ratio 1.24:1) that was most evident in the elderly and in more proximal veins. CONCLUSION Almost a third of positive cases were shown to be isolated, below-knee thrombi. These are thrombi that are more difficult to detect by non-invasive means. A left-sided predominance of DVT is evident.
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Affiliation(s)
- G W Cowell
- Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
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Slade P, O'Neill C, Simpson AJ, Lashen H. The relationship between perceived stigma, disclosure patterns, support and distress in new attendees at an infertility clinic. Hum Reprod 2007; 22:2309-17. [PMID: 17580298 DOI: 10.1093/humrep/dem115] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A model suggesting that high perception of stigma is associated with reduced disclosure to others, leading to lower social support and higher distress in new attendees at an infertility clinic is tested. METHODS Questionnaires measuring stigmatization (Stigma consciousness questionnaire), disclosure of fertility difficulties (Disclosure questionnaire), social support (Duke-UNC Functional Social Support Questionnaire) and fertility-related [Fertility Problem Inventory (FPI)] and generic distress [Hospital Anxiety and Depression Scale (HADS)] were completed by 87 women and 64 men. Data were analysed by gender comparisons, correlations and path analysis. RESULTS Women reported higher stigma and disclosure than men. For women, stigma and disclosure were unrelated but in men higher stigma was associated with lower disclosure. Perceptions of stigma were related to low social support for both genders. Social support was negatively related to anxiety, depression and overall infertility distress and showed greater predictive capacity than satisfaction with partner relationship. Testing the model showed that, for men, stigma was linked to lower disclosure and support and higher fertility-related and generic distress. Disclosure itself did not link to support. For women, greater disclosure linked only to higher generic distress. Stigma was directly linked to fertility-related distress and to low perceived support which mediated a relationship with generic distress. CONCLUSIONS Stigma and the wider social context should be considered when supporting people with fertility problems. Greater disclosure may be associated with higher distress in women.
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Affiliation(s)
- P Slade
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield, UK.
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