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Omar I, Townsend A, Hadfield O, Zaimis T, Ismaiel M, Wilson J, Magee C. Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study. Hernia 2024:10.1007/s10029-024-02975-4. [PMID: 38446277 DOI: 10.1007/s10029-024-02975-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Incisional hernia (IH) is a common complication following abdominal surgery. Surgical repair of IH is associated with the alleviation of symptoms and improvement of quality of life. Operative intervention can pose a significant burden to the patient and healthcare facilities. This study aims to describe and compare outcomes of elective and emergency surgical repair of IH. METHODS This study is a single-centre comparative retrospective study including patients who had repair of IH. Patients were divided into Group I (Emergency) and Group II (Elective), and a comparison was conducted between them. RESULTS Two hundred sixty-two patients were identified with a mean age of 61.8 ± 14.2 years, of which 152 (58%) were females. The mean BMI was 31.6 ± 7.2 kg/m2. More than 58% had at least one comorbidity. 169 (64.5%) patients had an elective repair, and 93 (35.5%) had an emergency repair. Patients undergoing emergency repair were significantly older and had higher BMI, p = 0.031 and p = 0.002, respectively. The significant complication rate (Clavien-Dindo III and IV) was 9.54%. 30 and 90-day mortality rates were 2.3% (n = 6) and 2.68% (n = 7), respectively. In the emergency group, the overall complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p ≤ 0.001, 0.002 and 0.001, respectively. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) experienced a recurrence, and 41 (15.71%) were readmitted within 90 days, without significant differences between the two groups. CONCLUSION Patients who underwent emergency repair were significantly older and had a higher BMI than the elective cases. Emergency IH repair is associated with higher complication rates and mortality than elective repair.
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Affiliation(s)
- I Omar
- Department of General Surgery, The Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, Uxbridge Middlesex, UB8 3NN, UK.
| | - A Townsend
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - O Hadfield
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - T Zaimis
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - M Ismaiel
- Department of General Surgery, Altnagelvin Area Hospital, Londonderry, UK
| | - J Wilson
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - C Magee
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
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Vijayagopal K, Majeed T, Wilson J, Magee C. 198 Caveat Chirurgicus- Opioid Use Following Surgery. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Over the last 20-years there has been increasing opioid related deaths, in the context of a worldwide epidemic of misuse including addiction and overdose. Startlingly, opioid commencement is usually iatrogenic. Most published data is from the USA with little evidence from UK surgical practice.
Method
Retrospective analysis of surgical unit opioid prescriptions. Data included opioids prescribed on discharge, 1, 3- and 6-months post-discharge usage and milligrams-of-morphine equivalence(mgEq) used to compare regimes.
Results
One hundred cases reviewed. 35% of patients were opioid naïve on admission and of these 20%, 5.71% and 8.57% remained on opioids at 1, 3- and 6-months post discharge respectively.
Females more likely to remain on long-term opioids at 6 months at lower doses (42% v 30%).
Only 6% of discharge summaries recommended GP follow-up and assessment of opioid requirements. Furthermore, none were prescribed a tapering dosage regime on-discharge.
Patients receiving Acute Pain Team reviews, more likely to remain on long-term opioids, at lower doses (30.67mgEq, 29.25mgEq and 32.63mgEq at 1-, 3- and 6-months post-discharge) compared to those without (69.16mgEq, 74.25mgEq and 65.13mgEq).
Only 11% of patients with pre-existing opioid prescriptions were reviewed by the acute pain team.
Worryingly, there was no documented assessment of opioid misuse risk in patients.
Conclusions
Standardised assessments i.e., opioid Risk Assessment Tools and mgEq need to be documented and monitored in primary and tertiary care. Acute pain team services should be offered to more patients. Our study hopes to raise awareness of the need for effective opioid stewardship in surgical patients.
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Affiliation(s)
| | - T. Majeed
- Wirral University Teaching Hospital, Wirral, United Kingdom
| | - J. Wilson
- Wirral University Teaching Hospital, Wirral, United Kingdom
| | - C. Magee
- Wirral University Teaching Hospital, Wirral, United Kingdom
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O'Halloran R, Coulson R, Magee C. 211 A Snapshot Audit of Time to Intervention for Gallstone Pancreatitis During the First Wave of COVID-19. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aim
We evaluated time to definitive treatment of Gallstone Pancreatitis (GSP) against the BSG guidelines during the first wave of COVID-19, comparing it to data of the same time period the previous year. Did the first wave of Covid-19 impact on time to intervention for patients diagnosed with GSP?
Method
Data were obtained retrospectively for 40 patients identified via the hospital coding department that presented with GSP between March 2019 - June 2019 and March 2020 – June 2020. Patient demographics, length of stay, time to intervention and re-admission awaiting intervention were recorded.
Results
Twenty-three patients were admitted during the non-COVID period. 30% (n = 7) of the non-COVID cohort had definitive management of GSP during index admission or within 2 weeks.
Seventeen patients were admitted during the first wave of Covid-19. 64.7% (n = 11) of the COVID-19 cohort had definitive management of GSP during the index admission or within 2 weeks.
Conclusions
Prior to COVID-19, we were not meeting guidelines for definitive management on index admission / within 2 weeks. During the first wave of COVID-19, more patients received definitive management of GSP during index admission / within 2 weeks than during the non-COVID period. A higher percentage of patients received surgical management within 2 weeks than in the non-COVID cohort. Those that did not receive management within 2 weeks, waited longer for intervention and had higher rates of re-admission than the non-COVID cohort. Despite anticipated future waves of COVID-19, prioritisation of urgent OP services is essential for those diagnosed with GSP to help reduce re-admission rates whilst awaiting intervention.
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Affiliation(s)
| | - R. Coulson
- Ulster Hospital Dundonald, Belfast, United Kingdom
| | - C. Magee
- Ulster Hospital Dundonald, Belfast, United Kingdom
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Issa M, Ahmad S, Vijayagopal K, Freeborn S, Omolokun O, Griffine A, Wilson J, Magee C. 302 Metastatic: Benign Lymph Node Ratio (LNR) and Lymph Node Yield (LNY) as Predictors of Survival in Resected Colorectal Cancer (CRC). Br J Surg 2022. [DOI: 10.1093/bjs/znac039.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Lymphadenectomy is central to tumor prognosis. 12 LNY during CRC resection is a standard of good oncological resection, but 30–50 percent of resections do not achieve this. LNR was suggested to be a more accurate predictive factor.
Aim
To examine the prognostic significance of LNY and LNR on survival in patients with non-metastatic CRC.
Method
A retrospective study on patients with CRC treated at a DGH from January 2015 to February 2017. Outcome measures were Disease-Free (DFS) and Overall Survival (OS).
Results
265 cases were identified. The mean age was (71.4±11.3) years with a median follow-up of 56 (range 0–72) months. Median LNY was 18 (range 0–66) nodes. 74.9% of the cases have> 12 LNY and only 25.1% of the cases have < 12 LN yielded in the specimen; however, 76.4% have LNR of 0-<0.25. Increasing LNR was associated with poorer OS and
DFS (p-value 0.0001). An LNR of (0.75–1) was associated with a very poor prognosis (p-value 0.0001); it showed 30 and 33 months less in median OS and DFS retrospectively than LNR
(0-<0.25). LNY did not show any statistically significant predictive factor in survival.
Multivariate analysis showed OS and DFS are affected (R2 = 27.3% and 26.1% retrospectively) mainly by LNR. It did not show statistical significance with the other variables, including TNM, LNY, and Dukes' stages.
Conclusions
Increasing LNR was a marker of poor survival; however, LNY was not a statistically significant predictive factor. LNR is better in predicting survival than TNM and Dukes' staging.
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Affiliation(s)
- M. Issa
- Prince Charles Hospital, Myrther Tydfil, United Kingdom
| | - S. Ahmad
- Arrowe Park Hospital, Wirral, United Kingdom
| | | | - S. Freeborn
- Arrowe Park Hospital, Wirral, United Kingdom
| | - O. Omolokun
- Arrowe Park Hospital, Wirral, United Kingdom
| | - A. Griffine
- Arrowe Park Hospital, Wirral, United Kingdom
| | - J. Wilson
- Arrowe Park Hospital, Wirral, United Kingdom
| | - C. Magee
- Arrowe Park Hospital, Wirral, United Kingdom
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MOOLLAN N, Dorman A, Magee C, Durcan L. POS-473 A FLARE OF LUPUS NEPHRITIS LEADING TO A DIAGNOSIS OF POLYCYSTIC KIDNEY DISEASE. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.503] [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: 11/27/2022] Open
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McGurk S, Majeed T, Magee C. 719 The Routine Use of Opioid Medication for Post-Operative Pain Relief Can Risk Long Term Dependence, In Patients Previously Opiate Naive. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Post-operative pain relief commonly involves opiates. Rising concerns about misuse has increased scrutiny of prescribing practices. In the UK, 12.5% of prescriptions are for opiates. In the US, the Department of Health and Human Services has declared an epidemic of opiate misuse. We aimed to evaluate opiate prescribing practices post-operatively, within a UK teaching hospital, and establish the risk of prolonged opiate use.
Method
A pan-speciality retrospective observational cohort study was performed. Patients who underwent surgery in the year 2018 were included. Patients were opiate naïve if their admission Medicine reconciliation and GP record described no opiates for the previous year. Endpoints: the proportion of patients discharged with opiates and the proportion of patients remaining on opiates at 1- and 2-years post admission.
Results
20526 operations were performed on 17524 patients, across pan-specialities. 8772 patients were discharged on opiates. 673 required further opiates from their GP after discharge, of which 331 were previously opiate naive. At 1 year post op, 180 previously naive patients remained on opiates.
Conclusions
Attention needs to be given to the risk of developing opiate dependence post-operatively. An evidence-based approach should support clinicians in preventing an opiate crisis in the UK.
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Affiliation(s)
- S McGurk
- Arrowe Park Hospital, Birkenhead, United Kingdom
| | - T Majeed
- Arrowe Park Hospital, Birkenhead, United Kingdom
| | - C Magee
- Arrowe Park Hospital, Birkenhead, United Kingdom
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STOYANOV V, Magee C. POS-162 COMPARATIVE ANTI-GBM ANTIBODIES CLEARANCE IN PLASMA EXCHANGE IN TWO SIMULTANEOUS CASES OF RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.172] [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: 11/15/2022] Open
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Salman S, Asghar A, Magee C, Winger Q, Bouma G, Bruemmer J. 90 Establishment and characterization of Day 30 equine chorionic girdle and allantochorion cell lines. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Establishing cell lines is a good model for experimental applications to study molecular mechanisms and cell-specific gene expression. Equids have a diffuse epitheliochorial placenta, where the invasive trophoblast is represented by the chorionic girdle (CG) and the noninvasive trophoblast by the allantochorion (AC). Embryonic CG cells are unique to horses and have a crucial role in equine chorionic gonadotropin (eCG) production and maintenance of pregnancy during the first trimester. This study had three objectives: (1) establishing a stable cell line from Day 30 CG cells and AC using lentivirus encoding hTERT; (2) characterisation of Day 30 CG cells and AC cell morphology and expression of eCG α (eCGA) and β (eCGB) subunits, major histocompatibility complex class II (MHCII), and Kisspeptin receptor (KISS1R) in CG and AC cells; (3) investigating eCG protein production invitro from Day 30 CG and AC cells. Three mares (n=3) were used to collect Day 30 conceptuses by non-surgical uterine lavage on Day 30 of pregnancy. All 3 conceptuses were dissected for CG and AC cells then cultured invitro to confluency in cell culture plates. Second-generation lentiviral particles were generated using a three-vector system including transfer vector pLV-hTERT-IRES-hygro, and human telomerase reverse transcriptase (hTERT) lentivirus was utilised to establish stable hygromycin-resistant equine embryonic cell lines. Reverse-transcription PCR (RT-PCR) was used to study gene expression in cells and radioimmunoassay was used to investigate protein presence in the media. We established a hygromycin-resistant Day 30 CG and AC cell lines that express eCGA, eCGB, and hTERT and confirmed using RT-PCR yielding the predicted bands. The cell lines were maintained for 16 passages (7±2 days/passage), 10 of which were cultured after the lentiviral infection steps. Also, we characterised CG cells as fast-growing, large, binucleated, and epithelioid, and AC cells as rapid-growing showing smaller, squamous, mononucleate, epithelioid, and elongated fibroblastic cells. The RT-PCR results showed eCGA and eCGB subunits are expressed by both Day 30 CG and AC cells, but MHCII and KISS1R genes were not expressed in either of cells. Moreover, radioimmunoassay results showed that Day 30 CG cells did produce eCG protein (35.42ngmL−1) invitro earlier than what previous literature has shown. However, Day 30 AC cells did not produce eCG protein (0.042ngmL−1) invitro, and both CG and AC cell lines stopped secreting eCG in the media after the lentiviral infection. To conclude, establishing stable and hygromycin-resistant cell lines from Day 30 equine CG and AC cells using lentivirus encoding pLV-hTERT-IRES-hygro is attainable. Also, equine chorionic gonadotropin eCG protein is produced invitro as early as Day 30 from CG cells.
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9
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Montagnat O, Magee C, Slejko J, McCaffrey P. Determination of chemical links from methylamphetamine profiling data sets. AUST J FORENSIC SCI 2019. [DOI: 10.1080/00450618.2019.1571103] [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: 10/27/2022]
Affiliation(s)
- O. Montagnat
- Chemical Drug Intelligence Unit, Forensic Services Department, Victoria Police (VPFSD), Melbourne, Australia
| | - C. Magee
- Chemical Drug Intelligence Unit, Forensic Services Department, Victoria Police (VPFSD), Melbourne, Australia
| | - J Slejko
- Chemical Drug Intelligence Unit, Forensic Services Department, Victoria Police (VPFSD), Melbourne, Australia
| | - P. McCaffrey
- Chemical Drug Intelligence Unit, Forensic Services Department, Victoria Police (VPFSD), Melbourne, Australia
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Clooney L, Ronayne A, Glennon K, Brennan M, Hickey N, Magee C, Cooley S, Eogan M, Drew RJ. Impact of Introduction of a Clinical Pathway for the Management of Pyelonephritis on Obstetric Patients: a Quality Improvement Project. Ir Med J 2019; 112:951. [PMID: 31538439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aim To determine whether the introduction of a clinical pathway for the treatment of pyelonephritis in obstetric patients would improve outcomes. Methods This was a retrospective study conducted in a maternity hospital using quantitative analysis methods. Patients who met laboratory and clinical criteria for pyelonephritis during data collection were included. Results The study included analysis of 23 patients pre-intervention and 19 post-intervention. Baseline and patient characteristics were similar for both groups. A statistically significant difference was seen in 3 of 7 outcome measures. Increased use of gentamicin (13% Vs 52% p=0.006), Increased number of renal ultrasounds (17% Vs 47%, p=0.04) and increased use of prophylaxis (21% Vs 68%, p=0.003). The proportion of patients receiving ≥ 10 days of IV antimicrobials decreased from 48% to 21% post-intervention (p=0.07). Discussion This study has shown that the introduction of a pathway for the treatment of pyelonephritis in pregnancy had a positive impact on several important clinical outcomes.
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Affiliation(s)
- L Clooney
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - A Ronayne
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - K Glennon
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - M Brennan
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - N Hickey
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - C Magee
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - S Cooley
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - M Eogan
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - R J Drew
- The Rotunda Hospital, Parnell Square, Dublin 1
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Pesce M, Magee C, Holloway RH, Gyawali CP, Roman S, Pioche M, Savarino E, Quader F, Sarnelli G, Sanagapalli S, Bredenoord AJ, Sweis R. The treatment of achalasia patients with esophageal varices: an international study. United European Gastroenterol J 2019; 7:565-572. [PMID: 31065374 DOI: 10.1177/2050640619838114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/22/2019] [Indexed: 01/10/2023] Open
Abstract
Background Treatment options for achalasia include endoscopic and surgical techniques that carry the risk of esophageal bleeding and perforation. The rare coexistence of esophageal varices has only been anecdotally described and treatment is presumed to carry additional risk. Methods Experience from physicians/surgeons treating this rare combination of disorders was sought through the International Manometry Working Group. Results Fourteen patients with achalasia and varices from seven international centers were collected (mean age 61 ± 9 years). Five patients were treated with botulinum toxin injections (BTI), four had dilation, three received peroral endoscopic myotomy (POEM), one had POEM then dilation, and one patient underwent BTI followed by Heller's myotomy. Variceal eradication preceded achalasia treatment in three patients. All patients experienced a significant symptomatic improvement (median Eckardt score 7 vs 1; p < 0.0001) at 6 months follow-up, with treatment outcomes resembling those of 20 non-cirrhotic achalasia patients who underwent similar therapy. No patients had recorded complications of bleeding or perforation. Conclusion This study shows an excellent short-term symptomatic response in patients with esophageal achalasia and varices and demonstrates that the therapeutic outcomes and complications, other than transient encephalopathy in both patients who had a portosystemic shunt, did not differ to disease-matched patients without varices.
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Affiliation(s)
- M Pesce
- Department of Gastroenterology, Department of GI Physiology, University College London Hospitals, London, UK.,University of Naples "Federico II", Naples, Italy
| | - C Magee
- Department of Gastroenterology, Department of GI Physiology, University College London Hospitals, London, UK
| | | | - C P Gyawali
- Division of Gastroenterology, Washington University, St Louis, MO, USA
| | - S Roman
- Department of Gastroenterology, Digestive Physiology, Hospices Civils de Lyon and Lyon University, Lyon, France
| | - M Pioche
- Department of Gastroenterology, Digestive Physiology, Hospices Civils de Lyon and Lyon University, Lyon, France
| | | | - F Quader
- Division of Gastroenterology, Washington University, St Louis, MO, USA
| | - G Sarnelli
- University of Naples "Federico II", Naples, Italy
| | - S Sanagapalli
- Department of Gastroenterology, Department of GI Physiology, University College London Hospitals, London, UK.,St. Vincent's Hospital Sydney, Sydney, Australia
| | - A J Bredenoord
- Division of Gastroenterology and Hepatology, Amsterdam Medical Centre, Amsterdam, Netherlands
| | - R Sweis
- Department of Gastroenterology, Department of GI Physiology, University College London Hospitals, London, UK
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Everson M, Herrera L, Li W, Luengo IM, Ahmad O, Banks M, Magee C, Alzoubaidi D, Hsu HM, Graham D, Vercauteren T, Lovat L, Ourselin S, Kashin S, Wang HP, Wang WL, Haidry RJ. Artificial intelligence for the real-time classification of intrapapillary capillary loop patterns in the endoscopic diagnosis of early oesophageal squamous cell carcinoma: A proof-of-concept study. United European Gastroenterol J 2019; 7:297-306. [PMID: 31080614 PMCID: PMC6498793 DOI: 10.1177/2050640618821800] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022] Open
Abstract
Background Intrapapillary capillary loops (IPCLs) represent an endoscopically visible feature of early squamous cell neoplasia (ESCN) which correlate with invasion depth - an important factor in the success of curative endoscopic therapy. IPCLs visualised on magnification endoscopy with Narrow Band Imaging (ME-NBI) can be used to train convolutional neural networks (CNNs) to detect the presence and classify staging of ESCN lesions. Methods A total of 7046 sequential high-definition ME-NBI images from 17 patients (10 ESCN, 7 normal) were used to train a CNN. IPCL patterns were classified by three expert endoscopists according to the Japanese Endoscopic Society classification. Normal IPCLs were defined as type A, abnormal as B1-3. Matched histology was obtained for all imaged areas. Results This CNN differentiates abnormal from normal IPCL patterns with 93.7% accuracy (86.2% to 98.3%) and sensitivity and specificity for classifying abnormal IPCL patterns of 89.3% (78.1% to 100%) and 98% (92% to 99.7%), respectively. Our CNN operates in real time with diagnostic prediction times between 26.17 ms and 37.48 ms. Conclusion Our novel and proof-of-concept application of computer-aided endoscopic diagnosis shows that a CNN can accurately classify IPCL patterns as normal or abnormal. This system could be used as an in vivo, real-time clinical decision support tool for endoscopists assessing and directing local therapy of ESCN.
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Affiliation(s)
- M Everson
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - Lcgp Herrera
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - W Li
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - I Muntion Luengo
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - O Ahmad
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - M Banks
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - C Magee
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - D Alzoubaidi
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - H M Hsu
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - D Graham
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - T Vercauteren
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - L Lovat
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - S Ourselin
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - S Kashin
- Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - R J Haidry
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
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Simpson G, Saunders R, Wilson J, Magee C. The role of the neutrophil:lymphocyte ratio (NLR) and the CRP:albumin ratio (CAR) in predicting mortality following emergency laparotomy in the over 80 age group. Eur J Trauma Emerg Surg 2017; 44:877-882. [PMID: 29134253 DOI: 10.1007/s00068-017-0869-4] [Citation(s) in RCA: 3] [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] [Received: 06/08/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Emergency laparotomy in the elderly is an increasingly common procedure which carries high morbidity and mortality. Risk prediction tools, although imperfect, can help guide management decisions. Novel markers of surgical outcomes may contribute to these scoring systems. The neutrophil:lymphocyte ratio (NLR) and CRP:albumin ratio (CAR) have been associated with outcomes in malignancy and sepsis. We assessed the use of ratio NLR and CAR as prognostic indicators in patients over the age of 80 undergoing emergency laparotomy. METHODS A retrospective analysis of all patients over the age of 80 who underwent emergency laparotomy during a 3 year period was conducted. Pre and post-operative NLR and CAR were assessed in relation to outcome measures including inpatient, 30-day and 90-day mortality. Statistical analysis was conducted with Mann-Whitney U, receiver operating characteristics, Spearmans rank correlation coefficient and chi-squared tests. RESULTS One hundred and thirty-six patients over the age of 80 underwent emergency laparotomy. Median age was 84 years (range 80-96 years). Overall inpatient mortality was 19.2%. Pre-operative and post-operative NLR and CAR were significantly raised in patients with sepsis v no sepsis (p < 0.05). Pre-operative NLR was significantly associated with inpatient (p = 0.046), 30-day (p = 0.02) and 90-day mortality (p = 0.01) in patients with visceral perforation. A pre-operative NLR value of greater than 8 was associated with significantly increased mortality (p = 0.016, AUC:0.78). CAR was not associated with mortality. CONCLUSION Pre-operative NLR is associated with mortality in patients with visceral perforation undergoing emergency laparotomy. NLR > 8 is associated with a poorer outcome in this group of patients. CAR was not associated with mortality in over-80s undergoing emergency laparotomy.
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Affiliation(s)
- G Simpson
- Division of GI Surgery, Wirral University Teaching Hospitals, Wirral, UK
| | - R Saunders
- University of Liverpool Division of Oncology and Surgery, Liverpool, UK
| | - J Wilson
- Division of GI Surgery, Wirral University Teaching Hospitals, Wirral, UK
| | - C Magee
- Division of GI Surgery, Wirral University Teaching Hospitals, Wirral, UK.
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Rupasinghe S, Toorish C, Mustafa A, Griffiths E, Jones O, Wilson J, Magee C. Outcomes of cholecystectomy in dysfunctional gallbladder syndrome: Time to redefine the threshold? Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.439] [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: 10/20/2022]
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15
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Chhabra R, Magee C. A case of posterior reversible encephalopathy syndrome. Clin Med (Lond) 2016; 16 Suppl 3:s27. [PMID: 27252330 PMCID: PMC4989945 DOI: 10.7861/clinmedicine.16-3-s27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - C Magee
- Beaumont Hospital, Dublin, Ireland
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16
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Rathore F, Berzan E, Magee C. Vaccination in Renal Transplant Patients (VcRtp study). Ir Med J 2016; 109:362. [PMID: 27685696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- F Rathore
- Department of Renal Medicine, Beaumont Hospital, Dublin 9
| | - E Berzan
- Department of Renal Medicine, Beaumont Hospital, Dublin 9
| | - C Magee
- Department of Renal Medicine, Beaumont Hospital, Dublin 9
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Medani S, O'Kelly P, O'Brien KM, Mohan P, Magee C, Conlon P. Bladder cancer in renal allograft recipients: risk factors and outcomes. Transplant Proc 2015; 46:3466-73. [PMID: 25498074 DOI: 10.1016/j.transproceed.2014.06.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/13/2014] [Accepted: 06/17/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Solid organ transplant recipients have an increased cancer risk owing to immunosuppression and oncogenic viral infections. We report on the incidence and types of bladder cancer in kidney transplant recipients in Ireland, describing possible additional risk factors and outcomes in these patients. METHODS We identified kidney transplant recipients diagnosed with de novo bladder cancer between January 1, 1994, and July 31, 2012, by integrating data from the Irish National Cancer Registry and National Renal Transplant Registry. We calculated the standardized incidence ratio (SIR) and examined patient and tumor characteristics and 1-year survival rate. RESULTS Fifteen patients were diagnosed with de novo bladder cancer during the study period, representing 0.48% of kidney transplant recipients. The SIR was 2.5 (95% CI, 1.4-4.2; P < .001). The mean interval between transplantation and diagnosis of bladder tumor was 8.6 years and mean age at time of diagnosis was 55.7 years. Sixty percent of patients were male. The tumor types were transitional cell carcinoma (9 patients), squamous cell carcinoma (3 patients), adenocarcinoma (1 patient), carcinoma in situ (1 patient), and diffuse large B-cell lymphoma (1 patient). Beside immunosuppression, risk factors associated with bladder cancer were urogenital disease (6 patients), cyclophosphamide exposure (2 patients), BK nephropathy (1 patient), analgesic nephropathy (1 patient), and extensive smoking (1 patient). Eight patients underwent radical cystectomy for invasive tumors, with resection of other pelvic organs in 7 patients. Mortality rate within the first year was 40%. CONCLUSION Bladder cancer occurred more commonly in kidney transplant recipients with a predominance of aggressive tumors and a high mortality. In patients with preexisting risk factors such as urologic abnormalities and cyclophosphamide exposure careful assessment before transplantation and vigilant monitoring posttransplantation with a low threshold for cystoscopy may improve outcomes.
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Affiliation(s)
- S Medani
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland.
| | - P O'Kelly
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | | | - P Mohan
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - C Magee
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - P Conlon
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
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Ryan J, Sgromo B, Magee C, Pavlides M, Ainsworth M, Collier J, Barnes E, Cobbold J. Prevalence of NASH cirrhosis in morbidly obese patients undergoing bariatric surgery. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.158] [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: 10/24/2022]
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19
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Vella S, Cliff D, Magee C, Okely A. Associations between sports participation and psychological difficulties during childhood: A two-year follow up. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.123] [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: 11/29/2022]
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Magee C, Bruemmer J, Sharp D, Nett T, Squires E, Clay C. Kisspeptin has a direct effect on equine gonadotropes. J Equine Vet Sci 2014. [DOI: 10.1016/j.jevs.2013.10.076] [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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22
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O'Rourke J, Zimmermann JA, Shields W, McLaughlin D, Cunningham P, Magee C, Hickey DP. Organ donation following the circulatory determination of death (DCD): an audit of donation and outcomes following renal transplantation. Ir Med J 2014; 107:11-14. [PMID: 24592639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Organ Donation following the Circulatory determination of Death was introduced in Beaumont Hospital during 2011. The Intensive Care Society of Ireland formally endorsed a national DCD clinical practice guideline in 2012. This retrospective audit covers a 2-year period during which eleven patients were considered suitable for DCD and where consent was obtained. Nine patients died within the ninety-minute period following the withdrawal of life sustaining therapies and subsequently donated organs (82%). Eighteen kidneys were recovered and seventeen patients received renal transplants--one patient received a nephron-dosing dual renal transplant. Lungs were recovered on two occasions and one patient received a lung transplant. Heart valves were recovered on one occasion. To date sixteen of seventeen recipient patients have functioning renal transplants (94%). In conclusion, this model of deceased donation has proven acceptable to families, nursing and medical staff and the outcomes reported are consistent with international best practice.
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Affiliation(s)
- J O'Rourke
- Department of Anaesthesia and Intensive Care Medicine, Beaumont Hospital, Beaumont, Dublin 9.
| | - J A Zimmermann
- Department of Anaesthesia and Intensive Care Medicine, Beaumont Hospital, Beaumont, Dublin 9
| | - W Shields
- Department of Anaesthesia and Intensive Care Medicine, Beaumont Hospital, Beaumont, Dublin 9
| | - D McLaughlin
- Department of Anaesthesia and Intensive Care Medicine, Beaumont Hospital, Beaumont, Dublin 9
| | - P Cunningham
- Department of Anaesthesia and Intensive Care Medicine, Beaumont Hospital, Beaumont, Dublin 9
| | - C Magee
- Department of Anaesthesia and Intensive Care Medicine, Beaumont Hospital, Beaumont, Dublin 9
| | - D P Hickey
- Department of Anaesthesia and Intensive Care Medicine, Beaumont Hospital, Beaumont, Dublin 9
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Magee C, Bruemmer J, Nett T, Squires E, Clay C. Kisspeptide in the estrous mare: Is it an appropriate ovulation-inducing agent? Theriogenology 2012; 78:1987-96. [DOI: 10.1016/j.theriogenology.2012.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 01/23/2023]
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Abstract
There have been few studies of patients with renal allografts functioning for more than 20 years. We sought to identify clinical factors associated with ultra long-term (>20 year) renal allograft survival and to describe the clinical features of these patients. We performed a retrospective analysis of the Irish Renal Transplant Database and included 1174 transplants in 1002 patients. There were 255 (21.74%) patients with graft function for 20 years or more. Multivariate analysis identified recipient age (HR 1.01, CI 1.01-1.02), gender (male HR 1.25, CI 1.08-1.45), acute rejection (HR 1.26, CI 1.09-1.45) and transplant type (living related donor vs. deceased donor) (HR 0.52, CI 0.40-0.66) as significantly associated with long-term graft loss. Median serum creatinine was 115 μmol/L. The 5-year graft survival in 20-year survivors was 74.7%. The mean age at death was 62.7 years (±10.6). The most common causes of death were cardiovascular disease and malignancy. The two major causes of graft loss were death (with function) and interstitial fibrosis/tubular atrophy. Comorbidities included skin cancer (36.1%), coronary heart disease (17.3%) and other malignancies (14.5%). This study identifies factors associated with long-term allograft survival and a high rate of morbidity and early mortality in long-term transplant recipients.
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Affiliation(s)
- C Traynor
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
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Kennedy C, McCarthy C, Alken S, McWilliams J, Morgan RK, Denton M, Conlon PJ, Magee C. Pleuroperitoneal leak complicating peritoneal dialysis: a case series. Int J Nephrol 2011; 2011:526753. [PMID: 21876802 PMCID: PMC3161202 DOI: 10.4061/2011/526753] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 03/06/2011] [Revised: 06/06/2011] [Accepted: 06/14/2011] [Indexed: 11/20/2022] Open
Abstract
Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.
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Affiliation(s)
- C Kennedy
- Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland
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26
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Al-Aradi A, Phelan PJ, O'Kelly P, Khan AH, Rahman MA, Hanley A, Ho C, Kheradmand F, Hickey D, Spencer S, Magee C, Walshe JJ, Morgan N, Conlon PJ. An assessment of the long-term health outcome of renal transplant recipients in Ireland. Ir J Med Sci 2011; 178:407-12. [PMID: 19495831 DOI: 10.1007/s11845-009-0363-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 05/05/2009] [Indexed: 01/14/2023]
Abstract
BACKGROUND Renal transplantation remains the preferred method of renal replacement therapy in terms of patient survival, quality of life and cost. However, patients have a high risk of complications ranging from rejection episodes, infection and cancer, amongst others. AIMS AND METHODS In this study, we sought to determine the long-term health outcomes and preventive health measures undertaken for the 1,536 living renal transplant patients in Ireland using a self-reported questionnaire. Outcomes were divided into categories, namely, general health information, allograft-related information, immunosuppression-related complications and preventive health measures. RESULTS The results demonstrate a high rate of cardiovascular, neoplastic and infectious complications in our transplant patients. Moreover, preventive health measures are often not undertaken by patients and lifestyle choices can be poor. CONCLUSIONS This study highlights the work needed by the transplantation community to improve patient education, adjust immunosuppression where necessary and aggressively manage patient risk factors.
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Affiliation(s)
- A Al-Aradi
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
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Marty FM, Petschnigg EM, Hammond SP, Ready JE, Ho VT, Soiffer RJ, Magee C, Milner DA, Antin JH, Baden LR. Invasive Fungal Disease after Remote Inoculation in Transplant Recipients. Clin Infect Dis 2011; 52:e7-10. [DOI: 10.1093/cid/ciq040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kirmani B, Rintoul R, Win T, Magee C, Magee L, Choong C, Wells F, Coonar A. 39 Stage migration: lymph node dissection in the era of modern imaging and invasive staging for lung cancer. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70039-3] [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: 11/30/2022]
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Kennedy C, Magee C, Eltayeb E, Gulmann C, Conlon PJ. Nephrogenic systemic fibrosis. Ir Med J 2010; 103:208-210. [PMID: 20845600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Nephroaenic systemic fibrosis (NSF) is a potentiallv fatal dermatiological condition found exclusively in patients with advanced renal I failure. There is minimal literature regarding the epidemiology and outcomes of patients with NSF in Ireland. A retrospective chart review was performed for all patients with NSF in Ireland. Ireland's experience with the disease was examined in light of international reports. There have been three cases of NSF in Ireland; an area which serves 1915 dialysis patients--giving a point prevalence among Irish end-stage kidney disease patients of 0.002. There was a large variation in disease severity between the three patients. All three patients had significant exposure to gadolinium chelate. Caution with gadolinium administration must be exercised in patients with advanced renal failure.
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Affiliation(s)
- C Kennedy
- Department of Nephrology, Beaumont Hospital, Beaumont, Dublin 9.
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Thomson K, Khera G, Howes N, Page R, Magee C. The Effect of Body Mass Index (Bmi) on Outcomes Following Oesophagectomy. Int J Surg 2010. [DOI: 10.1016/j.ijsu.2010.07.055] [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: 11/26/2022]
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Phelan P, O’Kelly P, O’Neill D, Little D, Hickey D, Keogan M, Walshe J, Magee C, Conlon P. Analysis of waiting times on Irish renal transplant list. Clin Transplant 2009; 24:381-5. [DOI: 10.1111/j.1399-0012.2009.01085.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Magee C, Arreguin-Arevalo J, Cantlon J, Mrdutt M, Nett T, Clay C. Luteinizing hormone-induced release by kisspeptide in primary cultures of equine pituitary cells. Theriogenology 2008. [DOI: 10.1016/j.theriogenology.2008.05.009] [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: 11/28/2022]
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Magee C, Bruemmer J, Foradori C, McCue P, Clay C. Evaluation of kisspeptin in the hypothalamic-pituitary-gonadal axis of the mare. Theriogenology 2007. [DOI: 10.1016/j.theriogenology.2007.05.020] [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: 11/25/2022]
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Cutler C, Henry N, Li S, Kim H, Magee C, Alyea E, Ho V, Soiffer R, Antin J. Sirolimus and thrombotic microangiopathy after allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2005. [DOI: 10.1016/j.bbmt.2004.12.011] [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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Camara-Artigas A, Magee C, Goetsch A, Allen JP. The structure of the heterodimer reaction center from Rhodobacter sphaeroides at 2.55 å resolution. Photosynth Res 2002; 74:87-93. [PMID: 16228547 DOI: 10.1023/a:1020882402389] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Crystals have been obtained of reaction centers of the heterodimer mutant that has significantly different properties than wild type due to the primary donor being formed from both a bacteriochlorophyll and bacteriopheophytin rather than two bacteriochlorophylls as found for wild type. The crystals belong to the trigonal space group P3(1)21 and the structure has been refined to a resolution limit of 2.55 A with an R factor of 19.0%. The electron density maps confirm that a primary donor does indeed contain a bacteriopheophytin due to the His to Leu substitution at M202 that coordinates the corresponding bacteriochlorophyll in wild-type. Other structural changes compared to wild type are relatively minor with the relative orientation and positioning of the two tetrapyrroles forming the primary donor being unchanged within the error. Compared to wild type, the only significant alterations are small shifts of residues M196 to M206, a rotation of the side chain of Ile M206, and the loss of a bound water molecule that in wild-type is hydrogen-bonded to both His M202 and the bacteriochlorophyll monomer on the active branch. Since hydrogen-bonding interactions strongly influence the energies of tetrapyrroles, the loss of the water molecule should result in changes in the energies of the bacteriochlorophyll monomer that contributes to the observed functional differences with wild-type.
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Affiliation(s)
- A Camara-Artigas
- Center for the Study of Early Events in Photosynthesis and Department of Chemistry and Biochemistry, Arizona State University, Tempe, AZ, 85287-1604, USA,
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Magee C, Nurminskaya M, Linsenmayer TF. UDP-glucose pyrophosphorylase: up-regulation in hypertrophic cartilage and role in hyaluronan synthesis. Biochem J 2001; 360:667-74. [PMID: 11736658 PMCID: PMC1222271 DOI: 10.1042/0264-6021:3600667] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previously, we have performed subtractive hybridization to identify genes up-regulated in hypertrophic chondrocytes of the avian epiphyseal growth plate. In the present study, we report the identification of one of the clones as UDP-glucose pyrophosphorylase (UDPG-PPase) and propose a possible function for this enzyme in regulating hyaluronan (HA) synthesis in hypertrophic cartilage. We have cloned the 2.6 kb full-length cDNA for avian UDPG-PPase and confirmed its up-regulation in hypertrophic versus non-hypertrophic cartilage by Northern-blot analysis. The 6-fold increase in mRNA was paralleled by an equivalent increase in enzymic activity. The enzyme catalyses the conversion of glucose 1-phosphate into UDP-glucose, which is used to synthesize a number of cellular components, including HA. Overexpression of enzymically active UDPG-PPase in non-hypertrophic chondrocytes resulted in a 2-3-fold increase in total HA, as determined by a competitive binding assay and immunohistochemistry. In the developing growth plate, HA synthesis was elevated in the hypertrophic zone along with the up-regulation of the HA synthase (HAS)-2 gene. Our data suggest that an increase in both activities, UDPG-PPase and HAS-2, is required for non-hypertrophic chondrocytes to synthesize an amount of HA comparable with that in hypertrophic chondrocytes. Therefore we conclude that HA synthesis during chondrocyte differentiation is regulated at the level of the substrate-provider gene, UDPG-PPase, as well as the HAS genes.
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Affiliation(s)
- C Magee
- Department of Anatomy and Cellular Biology, Tufts University Medical School, 136 Harrison Avenue, Boston, MA 02111, U.S.A
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Piper NY, Bishoff JT, Magee C, Haffron JM, Flanigan RC, Mintiens A, Van Poppel HP, Thompson IM, Harmon WJ. Is a 1-CM margin necessary during nephron-sparing surgery for renal cell carcinoma? Urology 2001; 58:849-52. [PMID: 11744443 DOI: 10.1016/s0090-4295(01)01393-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [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: 10/18/2022]
Abstract
OBJECTIVES To determine whether a 1-cm margin is necessary for cancer control during nephron-sparing surgery (NSS) for renal cell carcinoma (RCC). METHODS A retrospective review of 67 patients who underwent NSS for RCC between 1990 and 2000 was conducted. The data collected included patient demographics, tumor size and location, histologic type and grade, margin status (positive or negative), and the shortest distance of normal parenchyma (in millimeters) around the tumor in the final pathologic specimen. Recurrence was determined from the clinical follow-up, which included physical examination, ultrasonography or computed tomography, and various laboratory tests. RESULTS Fifty-five cases were performed open and 12 laparoscopically. The mean follow-up was 60 months (range 5 to 124). The mean tumor size was 3.0 cm (range 0.9 to 11.0). Seven patients were found to have a positive margin; 1 died of metastatic RCC, 1 was alive with systemic recurrence, and 5 had no evidence of disease. Of 11 patients with a negative margin distance of less than 1 mm, 9 were recurrence free, 1 had simultaneous local and pulmonary relapse, and the other had pulmonary recurrence only. The remainder of the study patients (n = 49) had negative margins greater than 1 mm, and all were alive without evidence of disease at the last follow-up. CONCLUSIONS This review questions the necessity of a 1-cm margin to prevent recurrence after NSS for RCC. Additional studies to determine the optimal margin distance should be conducted.
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Affiliation(s)
- N Y Piper
- Department of Urology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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Kang H, Magee C, Mahan C, Lee K, Murphy F, Jackson L, Matanoski G. Pregnancy outcomes among U.S. Gulf War veterans: a population-based survey of 30,000 veterans. Ann Epidemiol 2001; 11:504-11. [PMID: 11557183 DOI: 10.1016/s1047-2797(01)00245-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [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: 11/16/2022]
Abstract
PURPOSE We evaluated an association between veterans' Gulf War service and reported adverse pregnancy outcomes. METHODS We conducted a health survey in which selected reproductive outcomes of a population-based sample of 15,000 Gulf War veterans representing four military branches and three unit components (active, reserve, and National Guard) were compared to those of 15,000 non-Gulf veteran controls. RESULTS Male Gulf veterans, compared with their non-Gulf veteran controls, reported a significantly higher rate of miscarriage (odds ratio [OR] = 1.62; 95% confidence interval [CI] = 1.32-1.99). Female Gulf veterans also reported more miscarriages than their respective controls, although their excess was not statistically significant (OR= 1.35; CI = 0.97-1.89). Both men and women deployed to the Gulf theater reported significant excesses of birth defects among their liveborn infants. These excess rates also extended to the subset of "moderate to severe" birth defects [males: OR= 1.78 (CI = 1.19-2.66); females: OR = 2.80 (CI = 1.26-6.25)]. No statistically significant differences by deployment status were found among men or women for stillbirths, pre-term deliveries or infant mortality. CONCLUSION The risk of veterans reporting birth defects among their children was significantly associated with veteran's military service in the Gulf War. This observation needs to be confirmed by a review of medical records to rule out possible reporting bias.
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Affiliation(s)
- H Kang
- Environmental Epidemiology Service, Department of Veterans Affairs, 1120 20th Street NW, Washington, DC 20036, USA
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40
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Koniaris LG, Chan DY, Magee C, Solomon SB, Anderson JH, Smith DO, De Weese T, Kavoussi LR, Choti MA. Focal hepatic ablation using interstitial photon radiation energy. J Am Coll Surg 2000; 191:164-74. [PMID: 10945360 DOI: 10.1016/s1072-7515(00)00295-7] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intratumoral ablative therapy is being used increasingly for the treatment of primary and secondary hepatic malignancies. The interstitial point-source photon radiosurgery system (PRS) is a novel ablative technique that uses radiation therapy similar in dosimetry to interstitial brachytherapy. STUDY DESIGN To determine the feasibility, toxicity, and local tissue destructive capabilities of the PRS in the liver, preliminary studies in a nontumor-bearing canine model were examined. A 6-month survival study was conducted. Each animal received three radiation treatments, in the right, central, and left hepatic regions. Three low-dose treatments were delivered to each of six animals (group A), generating a 2.0-cm-diameter radiated sphere with a dose of 20 Gy at the lesion edge. Three high-dose treatments were delivered to each of six animals (group B), generating a 3.0-cm-diameter radiated sphere with 20 Gy at the lesion edge. RESULTS The treatment reproducibly generated sharply demarcated hepatic ablative lesions proportional to the administered dose. Mean lesion diameter at 1 month was 1.6+/-0.2 cm in group A and 3.4+/-1.0 cm in group B. Lesion size was independent of intrahepatic location, including near vascular structures. PRS therapy, when applied to portal structures, resulted in hilar damage. Hilar damage appeared to be associated with arteriolar thrombosis and bile duct injury. Treatment of regions adjacent to large hepatic veins and the IVC was not associated with vessel thrombosis or stricture. CONCLUSIONS PRS ablation is a generally well-tolerated method that results in consistent, well-demarcated, symmetric lesions of complete necrosis with minimal adjacent parenchymal injury. Application of such an approach for the treatment of liver tumors is promising.
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Affiliation(s)
- L G Koniaris
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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41
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Gomez-Jorge J, Venbrux AC, Magee C. Percutaneous deployment of a valved bovine jugular vein in the swine venous system: a potential treatment for venous insufficiency. J Vasc Interv Radiol 2000; 11:931-6. [PMID: 10928534 DOI: 10.1016/s1051-0443(07)61813-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [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: 11/23/2022] Open
Abstract
PURPOSE To develop a system for potential use in the treatment of chronic venous insufficiency by using percutaneous techniques. MATERIALS AND METHODS A segment of a glutaraldehyde-fixed bovine external jugular vein with valves was trimmed and sutured to a nitinol stent. Animals were premedicated and anesthetized (n = 11). Venography of the right external jugular vein, inferior vena cava (IVC), and common iliac vein was performed. Deployment was accomplished via a sheath (12-24 F) with use of fluoroscopic guidance. Eleven bioprostheses were deployed in 11 animals. Bioprostheses were deployed in the IVC (n = 3) or right external iliac vein (n = 6). Animals were killed immediately after deployment (n = 7) at 1 week (n = 1) or at 2 weeks (n = 2). One animal was found dead in the cage. At necropsy, each bioprosthesis (n = 4) was explanted and histopathologic analysis was performed. RESULTS Deployments of the bioprostheses were successful in nine of 11 swine. Two deployments were unsuccessful (one accidental deployment in the right renal vein, one deployment in the IVC caused rupture of the vein). Postdeployment venography (n = 9) confirmed no reflux (in the recumbent position of the swine) of the valve leaflets and patency of the vein inferior to the level of the bioprostheses. in the first group of animals (n = 5), valve leaflets were normal and competent. In the survival animal group (n = 4), the bioprostheses remained patent without evidence of thrombus formation by ascending and descending venography. Gross inspection of the explanted bioprostheses (n = 4) demonstrated grossly normal valves that fully occluded the lumen. Complications included hemarthrosis (n = 1), death (n = 1), and bioprosthesis thrombosis immediately after deployment (n = 1). Histopathologic analysis showed endothelial cells covering the luminal surfaces. The wall of the bioprostheses had granulomatous response and foreign body reaction. Bacterial contamination was noted in one bioprosthesis. CONCLUSIONS Deployment of a glutaraldehyde-fixed bovine vein sutured to a self-expanding nitinol stent in the swine iliac vein or IVC is technically feasible. Development of a venous bioprosthesis that can be placed percutaneously may have important clinical applications as an endovascular treatment for chronic venous insufficiency when it is due to valvular incompetence.
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Affiliation(s)
- J Gomez-Jorge
- Johns Hopkins Hospital Division of Cardiovascular/Interventional Radiology, Baltimore, Maryland, USA.
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Chan DY, Koniaris L, Magee C, Ferrell M, Solomon S, Lee BR, Anderson JH, Smith DO, Czapski J, Deweese T, Choti MA, Kavoussi LR. Feasibility of ablating normal renal parenchyma by interstitial photon radiation energy: study in a canine model. J Endourol 2000; 14:111-6. [PMID: 10772501 DOI: 10.1089/end.2000.14.111] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE A miniature photon radiosurgery system (PRS) has been described as an alternative to surgical resection and external-beam radiation for tumors and may now offer an alternative for ablation of renal lesions. We evaluated the feasibility of ablation by PRS in a normal parenchyma canine model. MATERIALS AND METHODS Twelve mongrel dogs were used in this survival study. In the left and right kidneys of each animal, a peripheral lesion and central-hilar lesion, respectively, were induced with PRS. The probes were placed in the renal parenchyma, and local radiation of 15 Gy at a radius of 1.3 cm was delivered over 10 minutes. Serum electrolytes were measured serially. Computed tomography scans were obtained, and the animals were sacrificed for pathologic correlation. In a separate study, the liver received three additional treatments of 10 to 20 minutes of radiation. RESULTS Eleven dogs survived this 6-month study and were sacrificed as scheduled. One animal expired after 2 weeks from radiation-induced fulminant hepatic failure with normal renal function. No other complications were observed. The average lesion size was 2.5 cm in diameter. Histologic analysis confirmed coagulative necrosis with sharp demarcation from the surrounding parenchyma. CONCLUSION Preliminary studies demonstrate the feasibility of PRS ablation of the renal parenchyma. Further tumor model testing will be important to determine the ultimate efficacy of local photon radiation energy.
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Affiliation(s)
- D Y Chan
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Solomon SB, Magee C, Acker DE, Venbrux AC. TIPS placement in swine, guided by electromagnetic real-time needle tip localization displayed on previously acquired 3-D CT. Cardiovasc Intervent Radiol 1999; 22:411-4. [PMID: 10501894 DOI: 10.1007/s002709900416] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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: 10/18/2022]
Abstract
PURPOSE To determine the feasibility of guiding a transjugular intrahepatic portosystemic shunt (TIPS) procedure with an electromagnetic real-time needle tip position sensor coupled to previously acquired 3-dimensional (3-D) computed tomography (CT) images. METHODS An electromagnetic position sensor was placed at the tip of a Colapinto needle. The real-time position and orientation of the needle tip was then displayed on previously acquired 3-D CT images which were registered with the five swine. Portal vein puncture was then attempted in all animals. RESULTS The computer calculated accuracy of the position sensor was on average 3 mm. Four of five portal vein punctures were successful. In the successes, only one or two attempts were necessary and success was achieved in minutes. CONCLUSION A real-time position sensor attached to the tip of a Colapinto needle and coupled to previously acquired 3-D CT images may potentially aid in entering the portal vein during the TIPS procedure.
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Affiliation(s)
- S B Solomon
- Division of Cardiovascular and Interventional Radiology, Department of Radiology, Johns Hopkins School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA
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Vella JP, Magee C, Vos L, Womer K, Rennke H, Carpenter CB, Hancock W, Sayegh MH. Cellular and humoral mechanisms of vascularized allograft rejection induced by indirect recognition of donor MHC allopeptides. Transplantation 1999; 67:1523-32. [PMID: 10401758 DOI: 10.1097/00007890-199906270-00005] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To investigate the role and mechanisms of indirect allorecognition in allograft rejection, we studied whether priming T cells with donor-derived MHC allopeptides could accelerate rejection in a vascularized allograft model. METHODS Lewis recipients of fully mismatched Wistar Furth cardiac allografts were immunized before transplantation with donor MHC allopeptides. RESULTS Animals immunized with immunogenic class II MHC allopeptides rejected their grafts in a significantly accelerated fashion compared with controls. Additional studies demonstrated that a single immunodominant RT1.D (HLA-DR like) allopeptide was responsible for accelerating the rejection process. Histological analysis of rejected allografts revealed marked vascular rejection in the accelerated, although not the control, group as well as severe cellular rejection. Peak production of IgM and IgG donor-specific alloantibodies was detected by flow cytometry 1 week earlier in the sera of the accelerated group compared with the control group. Immunohistological analysis of grafts from the accelerated compared with the control group showed increased endothelial deposition of IgG2b, C3, and fibrin, and up-regulation of class II MHC molecule expression. Increased intragraft expression of interferon-y and the interferon-gamma-induced chemokines, inducible protein-10 and Mig, and infiltration by activated mononuclear cells expressing CXCR3, the receptor for inducible protein-10 and Mig, was also seen. CONCLUSION These novel data provide evidence of a definitive link between indirect allorecognition of donor-derived MHC class II peptides and the cellular and humoral mechanisms of vascularized allograft rejection.
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Affiliation(s)
- J P Vella
- Laboratory of Immunogenetics and Transplantation, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Knoflach A, Azuma H, Magee C, Denton M, Murphy B, Iyengar A, Buelow R, Sayegh MH. Immunomodulatory functions of low-molecular weight hyaluronate in an acute rat renal allograft rejection model. J Am Soc Nephrol 1999; 10:1059-66. [PMID: 10232693 DOI: 10.1681/asn.v1051059] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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: 11/03/2022] Open
Abstract
Low molecular weight hyaluronate (LMW-HA) blocks interactions between T lymphocyte CD44 and hyaluronate (HA), a heteropolysaccharide that is expressed on the surface of endothelial cells and ubiquitously in the extracellular matrix. This study was undertaken to assess the ability of LMW-HA to modify the course of experimental acute renal allograft rejection. Lewis (LEW) rats were bilaterally nephrectomized and received an orthotopic, fully MHC-mismatched, Wistar-Furth (WF) kidney transplant. Animals received either no treatment, low doses of cyclosporin A (CsA) on days 0 to 5, LMW-HA on days 0 to 5, or CsA plus LMW-HA on days 0 to 5 after transplantation. With no treatment, CsA monotherapy, or HA monotherapy, animals rejected their allografts at a median of 15, 13, and 7.5 d, respectively (P = NS). In contrast, combined CsA plus LMW-HA therapy prevented acute rejection and significantly prolonged graft survival (P = 0.008) to a median of 49.0 d. CsA/LMW-HA-treated grafts also demonstrated better preservation of renal function at day 30 (serum creatinine level, 1.38+/-0.8 mg/dl), compared with surviving animals treated with CsA alone (2.9+/-0.55 mg/dl, P<0.05). Histologic graft analysis of CsA/LMW-HA-treated animals at day 7 after transplantation showed minimal rejection and leukocyte infiltration, compared with all other groups. Intragraft gene expression analysis, using semiquantitative reverse transcription-PCR, at the same time point showed reductions of CD4, CD8, and interferon-gamma transcript levels in the combined-treatment group. This is the first study demonstrating the immunomodulatory functions of LMW-HA in vivo in the setting of organ transplantation. Defining the exact mechanisms that underlie this immunomodulation may provide the rationale to develop novel strategies for use in clinical transplantation.
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Affiliation(s)
- A Knoflach
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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46
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Knoflach A, Magee C, Denton MD, Kim KS, Buelow R, Hancock WW, Sayegh MH. Immunomodulatory functions of hyaluronate in the LEW-to-F344 model of chronic cardiac allograft rejection. Transplantation 1999; 67:909-14. [PMID: 10199742 DOI: 10.1097/00007890-199903270-00020] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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: 11/26/2022]
Abstract
BACKGROUND CD44 is an important leukocyte cell surface glycoprotein with diverse functions including cell adhesion, homing, migration, and activation. METHODS Because administration of the principal ligand of CD44, hyaluronate (HA), in soluble form, can inhibit CD44-HA interaction, we tested the effects of HA in vivo in an established model of chronic allograft rejection. Control F344 recipients of LEW hearts received either no treatment or low-dose cyclosporine (CsA) for 30 days from the day of transplantation. Experimental animals received 30 days of CsA in combination with 30 or 90 days of low molecular weight HA (LMW-HA). RESULTS CsA therapy alone resulted in approximately 40% long-term (>100 days) graft survival, whereas CsA + LMW-HA (30-day and 90-day protocols) significantly increased long-term graft survival to 60% and 92%, respectively. Light microscopy and immunohistology of CsA-treated and CsA + LMW-HA-treated grafts harvested at day 30 after transplantation demonstrated that LMW-HA + CsA therapy decreased mononuclear cell infiltration and afforded better preservation of myocardial architecture. In addition, LMW-HA + CsA-treated grafts exhibited decreased expression of interferon-gamma and the growth factors transforming growth factor-beta, platelet-derived growth factor, and fibrogenic growth factor-beta. Long-term surviving grafts were assessed for arteriosclerosis, the sine qua non of chronic rejection in this model. Using a standardized scoring system, significantly less arteriosclerosis was seen in grafts from LMW-HA + CsA-treated animals at 120 days after transplantation compared with CsA alone-treated grafts. This difference was not significant, however, in grafts harvested at >150 days. CONCLUSION This is the first report indicating that CD44-HA interactions play an important role in chronic allograft rejection.
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Affiliation(s)
- A Knoflach
- Brigham and Women's Hospital, and Department of Pathology, Harvard Medical School, Boston, Massachusetts 02115, USA
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Correa-Villaseñor A, Ferencz C, Loffredo C, Magee C. Paternal exposures and cardiovascular malformations. The Baltimore-Washington Infant Study Group. J Expo Anal Environ Epidemiol 1998; 3 Suppl 1:173-85. [PMID: 9857303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Possible associations between paternal exposures and cardiovascular malformations were evaluated in the Baltimore-Washington Infant Study, a population based case-control investigation of congenital heart disease and environmental factors. Home interviews of case and control parents elicited information on parental home and occupational exposures. Analysis focused on twelve cardiac diagnostic groups and paternal exposures incurred during the six months preceding the pregnancy. Associations were identified between jewelry making and atrial septal defect (Odds ratio: 12.6; 95% confidence interval: 2.3-68.6) and membranous ventricular septal defect (8.1; 2.0-33.3), welding and endocardial cushion defect with Down syndrome (1.8; 1.1-3.0), lead soldering and pulmonary atresia (2.3; 1.1-4.9) and ionizing radiation and endocardial cushion defect without Down syndrome (4.7; 1.7-12.6). Ionizing radiation was found to be associated with endocardial cushion defect with Down syndrome only when father was present at interview (5.6; 1.7-17.9); a similar effect of father at interview was noted for paint stripping in relation to coarctation of the aorta (3.5; 1.5-8.0) and muscular ventricular septal defect (3.5; 1.5-8.5). Also, paint stripping was associated with hypoplastic left heart only in the presence of family history of cardiac defects (11.9; 2.4-60.0). This large study on cardiac diagnostic groups and specific preconceptional exposures provides new leads for further assessment of the role of paternal exposures on adverse pregnancy outcome.
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Affiliation(s)
- A Correa-Villaseñor
- Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205, USA
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Abstract
BACKGROUND Clostridium difficile-associated diarrhoea (CDAD) is a potentially life-threatening illness which has been shown to be more common and more severe in patients with chronic renal failure (CRF) than in other groups. A review of CDAD in our nephrology unit was carried out. METHODS A review of microbiology and histology records identified 32 cases of CDAD in the nephrology unit over a 24-month period. Patient notes were reviewed to identify risk factors, clinical features and outcome. Available isolates of C. difficile underwent 16S ribosomal RNA typing. RESULTS The incidence of CDAD in the nephrology unit was 10.7 per 1000 admissions, compared to 2.7 per 1000 in other areas of the hospital (P<0.0001). CDAD was considered the sole or principal cause of death in six (19%) and was considered a contributing factor in a further seven (22%). Mortality was significantly higher among patients with established CRF (P=0.04). Seven cases occurred as a cluster, over a 1-month period. Isolates from this cluster, along with comparative strains from other areas of the hospital, were found to be PCR type 1. Diarrhoea occurred in 28 (89%) of cases, pyrexia in 17 (53%) and ileus or abdominal pain in 14 (44%). Six patients responded to discontinuation of antibiotics alone and 22 required metronidazole and/or vancomycin. Three patients had colectomy and one caecostomy because of toxic megacolon. Four patients died before specific therapy could be given and in two of these cases the diagnosis was made at autopsy. Twenty-six patients had a record of recent antibiotic therapy. Of these, 15 had at least one agent considered to be inappropriate (excessively broad spectrum agent in 11, excessive duration of therapy in four). Nine patients had only received antibiotics prior to admission. CONCLUSIONS CDAD carries a high mortality in nephrology patients, especially those with established CRF. The diagnosis may be missed if a careful antibiotic history is not taken, including agents received prior to admission. Rational antibiotic prescribing and adherence to infection control measures are vital to reduce the incidence of this serious condition.
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Affiliation(s)
- R J Cunney
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
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Magee C, Staunton H, Tormey W, Walshe JJ. Hyponatraemia, seizures and stupor associated with ecstasy ingestion in a female. Ir Med J 1998; 91:178. [PMID: 9973755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- C Magee
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
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Nurminskaya M, Magee C, Nurminsky D, Linsenmayer TF. Plasma transglutaminase in hypertrophic chondrocytes: expression and cell-specific intracellular activation produce cell death and externalization. J Cell Biol 1998; 142:1135-44. [PMID: 9722623 PMCID: PMC2132883 DOI: 10.1083/jcb.142.4.1135] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/1998] [Revised: 07/07/1998] [Indexed: 02/08/2023] Open
Abstract
We previously used subtractive hybridization to isolate cDNAs for genes upregulated in chick hypertrophic chondrocytes (Nurminskaya, M. , and T.F. Linsenmayer. 1996. Dev. Dyn. 206:260-271). Certain of these showed homology with the "A" subunit of human plasma transglutaminase (factor XIIIA), a member of a family of enzymes that cross-link a variety of intracellular and matrix molecules. We now have isolated a full-length cDNA for this molecule, and confirmed that it is avian factor XIIIA. Northern and enzymatic analyses confirm that the molecule is upregulated in hypertrophic chondrocytes (as much as eightfold). The enzymatic analyses also show that appreciable transglutaminase activity in the hypertrophic zone becomes externalized into the extracellular matrix. This externalization most likely is effected by cell death and subsequent lysis-effected by the transglutaminase itself. When hypertrophic chondrocytes are transfected with a cDNA construct encoding the zymogen of factor XIIIA, the cells convert the translated protein to a lower molecular weight form, and they initiate cell death, become permeable to macromolecules and eventually undergo lysis. Non-hypertrophic cells transfected with the same construct do not show these degenerative changes. These results suggest that hypertrophic chondrocytes have a novel, tissue-specific cascade of mechanisms that upregulate the synthesis of plasma transglutaminase and activate its zymogen. This produces autocatalytic cell death, externalization of the enzyme, and presumably cross-linking of components within the hypertrophic matrix. These changes may in turn regulate the removal and/or calcification of this hypertrophic matrix, which are its ultimate fates.
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Affiliation(s)
- M Nurminskaya
- Department of Anatomy and Cellular Biology, Tufts University School of Medicine, Boston, Massachusetts 02111, USA
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