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Bischof J, Brand CA, Somogyi K, Májer I, Thome S, Mori M, Schwarz US, Lénárt P. Publisher Correction: A cdk1 gradient guides surface contraction waves in oocytes. Nat Commun 2018; 9:200. [PMID: 29321627 PMCID: PMC5762764 DOI: 10.1038/s41467-017-02520-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Johanna Bischof
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Christoph A Brand
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Philosophenweg 19, 69120, Heidelberg, Germany
| | - Kálmán Somogyi
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Imre Májer
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Sarah Thome
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Masashi Mori
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Ulrich S Schwarz
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Philosophenweg 19, 69120, Heidelberg, Germany
| | - Péter Lénárt
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany.
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Bischof J, Brand CA, Somogyi K, Májer I, Thome S, Mori M, Schwarz US, Lénárt P. A cdk1 gradient guides surface contraction waves in oocytes. Nat Commun 2017; 8:849. [PMID: 29021609 PMCID: PMC5636809 DOI: 10.1038/s41467-017-00979-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/09/2017] [Indexed: 11/29/2022] Open
Abstract
Surface contraction waves (SCWs) in oocytes and embryos lead to large-scale shape changes coupled to cell cycle transitions and are spatially coordinated with the cell axis. Here, we show that SCWs in the starfish oocyte are generated by a traveling band of myosin II-driven cortical contractility. At the front of the band, contractility is activated by removal of cdk1 inhibition of the RhoA/RhoA kinase/myosin II signaling module, while at the rear, contractility is switched off by negative feedback originating downstream of RhoA kinase. The SCW's directionality and speed are controlled by a spatiotemporal gradient of cdk1-cyclinB. This gradient is formed by the release of cdk1-cyclinB from the asymmetrically located nucleus, and progressive degradation of cyclinB. By combining quantitative imaging, biochemical and mechanical perturbations with mathematical modeling, we demonstrate that the SCWs result from the spatiotemporal integration of two conserved regulatory modules, cdk1-cyclinB for cell cycle regulation and RhoA/Rok/NMYII for actomyosin contractility.Surface contraction waves (SCWs) are prominent shape changes coupled to cell cycle transitions in oocytes. Here the authors show that SCWs are patterned by the spatiotemporal integration of two conserved modules, cdk1-cyclinB for cell cycle regulation and RhoA/Rok/NMYII for actomyosin contractility.
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Affiliation(s)
- Johanna Bischof
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Christoph A Brand
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Philosophenweg 19, 69120, Heidelberg, Germany
| | - Kálmán Somogyi
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Imre Májer
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Sarah Thome
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Masashi Mori
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Ulrich S Schwarz
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Philosophenweg 19, 69120, Heidelberg, Germany
| | - Péter Lénárt
- Cell Biology and Biophysics Unit, European Molecular Biology Laboratory (EMBL), Meyerhofstrasse 1, 69117, Heidelberg, Germany.
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Brand CA, Linke M, Weißenbruch K, Richter B, Bastmeyer M, Schwarz US. Tension and Elasticity Contribute to Fibroblast Cell Shape in Three Dimensions. Biophys J 2017; 113:770-774. [PMID: 28755755 DOI: 10.1016/j.bpj.2017.06.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/13/2017] [Accepted: 06/30/2017] [Indexed: 11/16/2022] Open
Abstract
The shape of animal cells is an important regulator for many essential processes such as cell migration or division. It is strongly determined by the organization of the actin cytoskeleton, which is also the main regulator of cell forces. Quantitative analysis of cell shape helps to reveal the physical processes underlying cell shape and forces, but it is notoriously difficult to conduct it in three dimensions. Here we use direct laser writing to create 3D open scaffolds for adhesion of connective tissue cells through well-defined adhesion platforms. Due to actomyosin contractility in the cell contour, characteristic invaginations lined by actin bundles form between adjacent adhesion sites. Using quantitative image processing and mathematical modeling, we demonstrate that the resulting shapes are determined not only by contractility, but also by elastic stress in the peripheral actin bundles. In this way, cells can generate higher forces than through contractility alone.
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Affiliation(s)
- Christoph A Brand
- BioQuant-Center for Quantitative Biology, Heidelberg University, Heidelberg, Germany; Institute for Theoretical Physics, Heidelberg University, Heidelberg, Germany
| | - Marco Linke
- BioQuant-Center for Quantitative Biology, Heidelberg University, Heidelberg, Germany; Institute for Theoretical Physics, Heidelberg University, Heidelberg, Germany
| | - Kai Weißenbruch
- Cell and Neurobiology, Zoological Institute, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany; Institute of Functional Interfaces (IFG), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Benjamin Richter
- Cell and Neurobiology, Zoological Institute, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Martin Bastmeyer
- Cell and Neurobiology, Zoological Institute, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany; Institute of Functional Interfaces (IFG), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany; HEiKA - Heidelberg Karlsruhe Research Partnership, Heidelberg University, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| | - Ulrich S Schwarz
- BioQuant-Center for Quantitative Biology, Heidelberg University, Heidelberg, Germany; Institute for Theoretical Physics, Heidelberg University, Heidelberg, Germany; HEiKA - Heidelberg Karlsruhe Research Partnership, Heidelberg University, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
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Oakes PW, Wagner E, Brand CA, Probst D, Linke M, Schwarz US, Glotzer M, Gardel ML. Optogenetic control of RhoA reveals zyxin-mediated elasticity of stress fibres. Nat Commun 2017; 8:15817. [PMID: 28604737 PMCID: PMC5477492 DOI: 10.1038/ncomms15817] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [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: 12/05/2016] [Accepted: 04/29/2017] [Indexed: 12/27/2022] Open
Abstract
Cytoskeletal mechanics regulates cell morphodynamics and many physiological processes. While contractility is known to be largely RhoA-dependent, the process by which localized biochemical signals are translated into cell-level responses is poorly understood. Here we combine optogenetic control of RhoA, live-cell imaging and traction force microscopy to investigate the dynamics of actomyosin-based force generation. Local activation of RhoA not only stimulates local recruitment of actin and myosin but also increased traction forces that rapidly propagate across the cell via stress fibres and drive increased actin flow. Surprisingly, this flow reverses direction when local RhoA activation stops. We identify zyxin as a regulator of stress fibre mechanics, as stress fibres are fluid-like without flow reversal in its absence. Using a physical model, we demonstrate that stress fibres behave elastic-like, even at timescales exceeding turnover of constituent proteins. Such molecular control of actin mechanics likely plays critical roles in regulating morphodynamic events. Cellular contractility is regulated by the GTPase RhoA, but how local signals are translated to a cell-level response is not known. Here the authors show that targeted RhoA activation results in propagation of force along stress fibres and actin flow, and identify zyxin as a regulator of stress fibre mechanics and homeostasis.
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Affiliation(s)
- Patrick W Oakes
- Institute for Biophysical Dynamics, University of Chicago, Chicago, Illinois 606037, USA.,James Franck Institute, University of Chicago, Chicago, Illinois 606037, USA.,Department of Physics, University of Chicago, Chicago, Illinois 606037, USA.,Department of Physics &Astronomy, University of Rochester, Rochester, New York 14627, USA.,Department of Biology, University of Rochester, Rochester, New York 14627, USA
| | - Elizabeth Wagner
- Department of Molecular Genetics and Cell Biology, University of Chicago, Chicago, Illinois 60637, USA
| | - Christoph A Brand
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Heidelberg 69120, Germany
| | - Dimitri Probst
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Heidelberg 69120, Germany
| | - Marco Linke
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Heidelberg 69120, Germany
| | - Ulrich S Schwarz
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Heidelberg 69120, Germany
| | - Michael Glotzer
- Department of Molecular Genetics and Cell Biology, University of Chicago, Chicago, Illinois 60637, USA
| | - Margaret L Gardel
- Institute for Biophysical Dynamics, University of Chicago, Chicago, Illinois 606037, USA.,James Franck Institute, University of Chicago, Chicago, Illinois 606037, USA.,Department of Physics, University of Chicago, Chicago, Illinois 606037, USA
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Ackerman IN, Bohensky MA, de Steiger R, Brand CA, Eskelinen A, Fenstad AM, Furnes O, Garellick G, Graves SE, Haapakoski J, Havelin LI, Mäkelä K, Mehnert F, Pedersen AB, Robertsson O. Substantial rise in the lifetime risk of primary total knee replacement surgery for osteoarthritis from 2003 to 2013: an international, population-level analysis. Osteoarthritis Cartilage 2017; 25:455-461. [PMID: 27856293 DOI: 10.1016/j.joca.2016.11.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 08/02/2016] [Revised: 10/07/2016] [Accepted: 11/07/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate and compare the lifetime risk of total knee replacement surgery (TKR) for osteoarthritis (OA) between countries, and over time. METHOD Data on primary TKR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, Norway and Sweden. Life tables and population data were also obtained for each country. Lifetime risk of TKR was calculated for 2003 and 2013 using registry, life table and population data. RESULTS Marked international variation in lifetime risk of TKR was evident, with females consistently demonstrating the greatest risk. In 2013, Finland had the highest lifetime risk for females (22.8%, 95%CI 22.5-23.1%) and Australia had the highest risk for males (15.4%, 95%CI 15.1-15.6%). Norway had the lowest lifetime risk for females (9.7%, 95%CI 9.5-9.9%) and males (5.8%, 95%CI 5.6-5.9%) in 2013. All countries showed a significant rise in lifetime risk of TKR for both sexes over the 10-year study period, with the largest increases observed in Australia (females: from 13.6% to 21.1%; males: from 9.8% to 15.4%). CONCLUSIONS Using population-based data, this study identified significant increases in the lifetime risk of TKR in all five countries from 2003 to 2013. Lifetime risk of TKR was as high as 1 in 5 women in Finland, and 1 in 7 males in Australia. These risk estimates quantify the healthcare resource burden of knee OA at the population level, providing an important resource for public health policy development and healthcare planning.
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Affiliation(s)
- I N Ackerman
- Monash University, Melbourne, Australia; The University of Melbourne, Melbourne, Australia.
| | - M A Bohensky
- The University of Melbourne, Melbourne, Australia.
| | - R de Steiger
- The University of Melbourne, Melbourne, Australia; Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia.
| | - C A Brand
- Monash University, Melbourne, Australia; The University of Melbourne, Melbourne, Australia.
| | - A Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland.
| | - A M Fenstad
- The Norwegian Arthroplasty Register, Bergen, Norway.
| | - O Furnes
- The Norwegian Arthroplasty Register, Bergen, Norway; University of Bergen, Bergen, Norway.
| | - G Garellick
- University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden.
| | - S E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia.
| | - J Haapakoski
- The Finnish Arthroplasty Register, Helsinki, Finland.
| | - L I Havelin
- The Norwegian Arthroplasty Register, Bergen, Norway; University of Bergen, Bergen, Norway.
| | - K Mäkelä
- The Finnish Arthroplasty Register, Helsinki, Finland; Turku University Hospital, Turku, Finland.
| | - F Mehnert
- Aarhus University Hospital, Aarhus, Denmark; Danish Knee Arthroplasty Register, Aarhus, Denmark.
| | - A B Pedersen
- Aarhus University Hospital, Aarhus, Denmark; Danish Knee Arthroplasty Register, Aarhus, Denmark.
| | - O Robertsson
- The Swedish Knee Arthroplasty Register, Lund, Sweden; Lund University, Lund, Sweden.
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Morello RT, Morris RL, Hill KD, Haines TP, Arendts G, Redfern J, Etherton-Beer CD, Lowthian JA, Brand CA, Liew D, Watts JJ, Barker AL. RESPOND: a programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for an economic evaluation. Inj Prev 2016; 23:124-130. [PMID: 28330932 DOI: 10.1136/injuryprev-2016-042169] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Falls remain common for community-dwelling older people and impose a substantial economic burden to the healthcare system. RESPOND is a novel falls prevention programme that aims to reduce secondary falls and fall injuries among older people who present to a hospital emergency department (ED) with a fall. The present protocol describes a prospective economic evaluation examining the incremental cost-effectiveness of the RESPOND programme, compared with usual care practice, from the Australian health system perspective. METHODS AND DESIGN This economic evaluation will recruit 528 participants from two major tertiary hospital EDs in Australia and will be undertaken alongside a multisite randomised controlled trial. Outcome and costing data will be collected for all participants over the 12-month trial. It will compare the RESPOND falls prevention programme with usual care practice (current community-based falls prevention practices) to determine its incremental cost-effectiveness according to three intermediate clinical outcomes: (1) falls prevented, (2) fall injuries prevented and (3) injurious falls prevented. In addition, utilities will be derived from a generic quality-of-life measure (EQ-5D-5L) and used to calculate the 'incremental cost per quality-adjusted life years gained'. DISCUSSION The results of this study will provide healthcare decision makers with evidence to assist with setting spending thresholds for preventive health programmes and inform selection of emergency and community service models of care. TRIAL REGISTRATION NUMBER The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684); Pre-results.
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Affiliation(s)
- R T Morello
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - R L Morris
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - T P Haines
- Department of Physiotherapy, Monash University, Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - G Arendts
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia
| | - J Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - C D Etherton-Beer
- University of Western Australia, Perth, Western Australia, Australia.,Western Australian Institute for Medical Research, Perth, Western Australia, Australia
| | - J A Lowthian
- Pre-Hospital, Emergency and Trauma Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C A Brand
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - D Liew
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J J Watts
- Centre for Population Health Research, Deakin University, Melbourne, Victoria, Australia
| | - A L Barker
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Soiné JRD, Brand CA, Stricker J, Oakes PW, Gardel ML, Schwarz US. Model-based traction force microscopy reveals differential tension in cellular actin bundles. PLoS Comput Biol 2015; 11:e1004076. [PMID: 25748431 PMCID: PMC4352062 DOI: 10.1371/journal.pcbi.1004076] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/08/2014] [Indexed: 01/02/2023] Open
Abstract
Adherent cells use forces at the cell-substrate interface to sense and respond to the physical properties of their environment. These cell forces can be measured with traction force microscopy which inverts the equations of elasticity theory to calculate them from the deformations of soft polymer substrates. We introduce a new type of traction force microscopy that in contrast to traditional methods uses additional image data for cytoskeleton and adhesion structures and a biophysical model to improve the robustness of the inverse procedure and abolishes the need for regularization. We use this method to demonstrate that ventral stress fibers of U2OS-cells are typically under higher mechanical tension than dorsal stress fibers or transverse arcs. Adherent cells respond very sensitively not only to biochemical, but also to physical properties of their environment. For example, it has been shown that stem cell differentiation can be guided by substrate rigidity, which is sensed by cells by actively pulling on their environment with actomyosin-generated forces. A commonly used method to measure cell forces during essential biological processes is traction force microscopy, which uses the deformations of a soft elastic substrate to calculate cell forces. However, the standard setup for traction force microscopy suffers from mathematical limitations in calculating forces from displacements. In order to improve this method, we combine image data and biophysical modelling to arrive at a procedure which is more robust and in addition allows us to make statements about the force distribution not only at the cell-substrate interface, but also inside the cell. Here we demonstrate this approach for the contractility of actin stress fibers, which we investigate experimentally with U2OS-cells and theoretically with an active cable network model.
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Affiliation(s)
- Jérôme R. D. Soiné
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Heidelberg, Germany
| | - Christoph A. Brand
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Heidelberg, Germany
| | - Jonathan Stricker
- Institute for Biophysical Dynamics, Department of Physics, and The James Franck Institute, University of Chicago, Chicago, United States of America
| | - Patrick W. Oakes
- Institute for Biophysical Dynamics, Department of Physics, and The James Franck Institute, University of Chicago, Chicago, United States of America
| | - Margaret L. Gardel
- Institute for Biophysical Dynamics, Department of Physics, and The James Franck Institute, University of Chicago, Chicago, United States of America
| | - Ulrich S. Schwarz
- Institute for Theoretical Physics and BioQuant, Heidelberg University, Heidelberg, Germany
- * E-mail:
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Morris RL, Brand CA, Hill KD, Ayton DR, Redfern J, Nyman SR, Lowthian JA, Hill AM, Etherton-Beer CD, Flicker L, Hunter PC, Barker AL. RESPOND: a patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall-protocol for a mixed methods programme evaluation. Inj Prev 2014; 22:153-60. [PMID: 25392367 DOI: 10.1136/injuryprev-2014-041453] [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] [Received: 10/07/2014] [Accepted: 10/26/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Programme evaluations conducted alongside randomised controlled trials (RCTs) have potential to enhance understanding of trial outcomes. This paper describes a multi-level programme evaluation to be conducted alongside an RCT of a falls prevention programme (RESPOND). OBJECTIVES (1) To conduct a process evaluation in order to identify the degree of implementation fidelity and associated barriers and facilitators. (2) To evaluate the primary intended impact of the programme: participation in fall prevention strategies and the factors influencing participation. (3) To identify the factors influencing RESPOND RCT outcomes: falls, fall injuries and emergency department (ED) re-presentations. METHODS/DESIGN 528 community-dwelling adults aged 60-90 years presenting to two EDs with a fall will be recruited and randomly assigned to the intervention or standard care group. All RESPOND participants and RESPOND clinicians will be included in the evaluation. A mixed methods design will be used and a programme logic model will frame the evaluation. Data will be sourced from interviews, focus groups, questionnaires, clinician case notes, recruitment records, participant-completed calendars, hospital administrative datasets and audio-recordings of intervention contacts. Quantitative data will be analysed via descriptive and inferential statistics and qualitative data will be interpreted using thematic analysis. DISCUSSION The RESPOND programme evaluation will provide information about contextual and influencing factors related to the RESPOND RCT outcomes. The results will assist researchers, clinicians and policy makers regarding decisions about future falls prevention interventions. Insights gained may be applicable to a range of chronic conditions where similar preventive intervention approaches are indicated. TRIAL REGISTRATION NUMBER This programme evaluation is linked to the RESPOND RCT which is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
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Affiliation(s)
- R L Morris
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C A Brand
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - D R Ayton
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - S R Nyman
- Department of Psychology, Faculty of Science and Technology, Bournemouth University Dementia Institute, Bournemouth University, Poole, Dorset, UK
| | - J A Lowthian
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A M Hill
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - C D Etherton-Beer
- University of Western Australia, Perth, Western Australia, Australia Department of Psychology Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - L Flicker
- University of Western Australia, Perth, Western Australia, Australia Department of Psychology Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - P C Hunter
- Alfred Health, Melbourne, Victoria, Australia Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - A L Barker
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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9
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Barker AL, Cameron PA, Hill KD, Flicker L, Haines TP, Lowthian JA, Waldron N, Arendts G, Redfern J, Forbes A, Brand CA, Etherton-Beer CD, Hill AM, Hunter P, Nyman SR, Smit D. RESPOND--A patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for a multicentre randomised controlled trial. Inj Prev 2014; 21:e1. [PMID: 24958769 DOI: 10.1136/injuryprev-2014-041271] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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
INTRODUCTION Participation in falls prevention activities by older people following presentation to the emergency department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND programme, an intervention designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. DESIGN AND SETTING A RCT at two tertiary referral EDs in Melbourne and Perth, Australia. PARTICIPANTS 528 community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who require an interpreter or hands-on assistance to walk; live in residential aged care or >50 km from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or a history of psychosis; are receiving palliative care or are unable to use a telephone will be excluded. METHODS Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates (1) a home-based risk factor assessment; (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and (3) healthcare provider communication and community linkage delivered over 6 months. Primary outcomes are falls and fall injuries per person-year. DISCUSSION RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease; however, evidence to support this approach in falls prevention is limited. TRIAL REGISTRATION NUMBER The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
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Affiliation(s)
- A L Barker
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P A Cameron
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia
| | - L Flicker
- University of Western Australia, Perth, Western Australia, Australia Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - T P Haines
- Department of Physiotherapy, Monash University, and Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - J A Lowthian
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - N Waldron
- Health Networks Branch, System Policy and Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - G Arendts
- University of Western Australia, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - J Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C A Brand
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - C D Etherton-Beer
- University of Western Australia, Perth, Western Australia, Australia Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - A M Hill
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - P Hunter
- Alfred Health, Melbourne, Victoria, Australia
| | - S R Nyman
- Bournemouth University Dementia Institute and Psychology Department, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, UK
| | - D Smit
- Alfred Health, Melbourne, Victoria, Australia
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Bohensky MA, Jolley D, Sundararajan V, Pilcher DV, Evans S, Brand CA. Empirical aspects of linking intensive care registry data to hospital discharge data without the use of direct patient identifiers. Anaesth Intensive Care 2011; 39:202-8. [PMID: 21485667 DOI: 10.1177/0310057x1103900208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In the field of intensive care, clinical data registries are commonly used to support clinical audit and develop evidence-based practice. However, they are often restricted to the intensive care unit episode only, limiting their ability to follow long-term patient outcomes and identify patient readmissions. Data linkage can be used to supplement existing data, but a lack of unique patient identifiers may compromise the accuracy of the linkage process. The aim of this study was to assess the quality of linking the Australia/New Zealand critical care registry to a state financial claims database using a method without direct patient identifiers and to identify possible sources of bias from this method. We used a linkage method relying on indirect patient identifiers and compared the accuracy of this method to one that also included the patient medical record number and date of birth. The overall linkage rate using the method with indirect identifiers was 92.3% compared to 94.5% using the method with direct identifiers. Factors most strongly associated with not being a correct link in the first method included patients at one study hospital, admissions in 2002 and 2003 and having a hospital length of stay of 20 days or more. Linking the Australia/New Zealand critical care without direct patient identifiers is a valid linkage method that will enable the measurement of long-term patient survival and readmissions. While some sources of bias have been identified, this method provides sufficient quality linkage that will support broad analyses designed to signal future in-depth research.
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Affiliation(s)
- M A Bohensky
- Centre for Research Excellence and Patient Safety, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Brand CA, Sundararajan V. A 10-year cohort study of the burden and risk of in-hospital falls and fractures using routinely collected hospital data. Qual Saf Health Care 2010; 19:e51. [PMID: 20558479 DOI: 10.1136/qshc.2009.038273] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To document the burden of in-hospital falls and fractures, and to identify factors that may increase the risk of these events. DESIGN A retrospective cohort analysis. SETTING The study was set in the State of Victoria, Australia. PARTICIPANTS Hospital episode data collected in the Victoria Admitted Episodes Dataset, for all multiday-stay patients 18 years or more admitted to Victorian public hospitals; 1 July 1998 to 30 June 2008. Diagnoses were defined by the International Classification of Disease, 10th Revision, Australian Modification (ICD-10-AM), which includes an in-hospital diagnostic timing code. Outcome measures included rates of in-hospital falls and fractures, length of hospital stay and mortality. Variables included in risk adjustment included financial year, individual demographic and comorbidity data, and hospital characteristics. RESULTS There were 3,345,415 episodes: 21,250 (0.64%) in-hospital falls and 4559 (0.14%) fractures. In-hospital fall (IHF) episode rates increased over the study period, but fracture episode rates were stable. Mortality (HR 1.3, CI 1.3 to 1.5) and length of stay (median 19 days vs 5 days, p<0.0001) were increased with IHF. Risk factors for IHF included dementia (rate ratio 1.7, CI 1.6 to 1.8) and delirium (rate ratio 1.8, CI 1.6 to 2.0). CONCLUSIONS Routinely collected data that include a hospital diagnostic timing code offer a standard method of quantifying in-hospital falls and fractures. Unselected in-hospital falls data may be subject to reporting and documentation bias. The utility of using robust selected injuries such as IHF-related fracture as a quality-of-care indicator requires further investigation.
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Affiliation(s)
- C A Brand
- Centre of Research Excellence in Patient Safety, Department of Preventive Medicine, Monash University, 89 Commercial Road Melbourne, Victoria 3004, Australia.
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Stockman A, Tait BD, Wolfe R, Brand CA, Rowley MJ, Varney MD, Buchbinder R, Muirden KD. Clinical, laboratory and genetic markers associated with erosions and remission in patients with early inflammatory arthritis: a prospective cohort study. Rheumatol Int 2005; 26:500-9. [PMID: 16151812 DOI: 10.1007/s00296-005-0027-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 09/09/2004] [Accepted: 07/03/2005] [Indexed: 11/24/2022]
Abstract
We investigated the relationship between clinical, laboratory and genetic markers and outcome measures in 159 patients with recent onset of inflammatory arthritis (IA). The majority of patients were managed in community-based rheumatology practice. Median duration of arthritis at baseline was 3 months with median follow-up of 4.0 years (range 0-10). Markers of disease activity and 1987 ACR criteria for rheumatoid arthritis (RA) were estimated every 6 months for the first 2 years and annually thereafter. Presence of shared epitopes (SE) was established by PCR-based method. Main outcome variables were attainment of remission and presence of erosions on X-rays of hands and feet at 3 years. Remission was seen in 34.3% of patients and was independently related to age 60 and older (odds ratio (OR) 3.2; 95% confidence interval (CI), 1.2-8.7) and inversely to the presence of rheumatoid factor (RF) (OR 8.3; 95% CI, 3.2-21.3 for persistent arthritis). Patients with two SE were likely to have persistent arthritis (P=0.006), but this was not significant when corrected for RF. Independent predictors for erosions at 3 years were RF (OR 7.5; 95% CI, 1.9-29.5) and area under the curve for number of swollen joints (OR 1.08; 95% CI, 1.02-1.16). SE status was not predictive of erosions at 3 years (OR 1.6; 95% CI, 0.7-3.7). In univariate analysis, patients possessing DERAA motif on DRB1 were less likely to have erosive disease than without this motif at 4 years (OR 0.21; 95% CI, 0.0-0.9, P=0.037) but this finding was partly explained by adjusting for RF (adjusted OR 0.24; 95% CI 0.04-1.37). In this study of recent onset IA, active disease and RF were associated with poor outcome. Whilst SE did not predict erosive disease, patients with DERAA motif may be protected against erosions whilst the presence of two SE alleles suggests persistence of arthritis.
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Affiliation(s)
- A Stockman
- Rheumatology Unit, Royal Melbourne Hospital, Grattan Street, Parkville, 3050, Victoria, Australia.
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Cook AD, Stockman A, Brand CA, Tait BD, Mackay IR, Muirden KD, Bernard CC, Rowley MJ. Antibodies to type II collagen and HLA disease susceptibility markers in rheumatoid arthritis. Arthritis Rheum 1999; 42:2569-76. [PMID: 10616002 DOI: 10.1002/1529-0131(199912)42:12<2569::aid-anr9>3.0.co;2-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To seek associations between antibodies to native and denatured type II collagen (NCII and DCII) and HLA in rheumatoid arthritis (RA). METHODS One hundred fourteen patients with clinically well-defined RA were HLA-DR and DQ typed. Those who were DR4 positive were subtyped for DRB1*0401-*0408 alleles by polymerase chain reaction using allele-specific oligonucleotide probes. Antibodies to human NCII and DCII (heat-denatured) were measured by enzyme-linked immunosorbent assay. The frequency of HLA alleles was compared in patients grouped according to the presence and absence of antibodies to NCII and DCII. RESULTS Twenty-seven patients (24%) were positive for antibodies to NCII. There was a significant increase in the frequency of HLA-DR7 in anti-NCII-positive patients compared with anti-NCII-negative patients (30% versus 9%; P = 0.019) and a significant decrease in HLA-DR3 (7% versus 28%; P = 0.044). Repeating the analyses after excluding the 16 patients who were DR7 positive revealed a significant increase in the frequency of HLA-DR1 in anti-NCII-positive patients compared with anti-NCII-negative patients (63% versus 27%; P = 0.045). Moreover, antibodies to NCII were associated with the third hypervariability region susceptibility sequence QRRAA that is present in DRB1*0101, *0404, *0405, and *0408 (84% versus 47%; P = 0.0085); 24 of 27 anti-NCII-positive patients were positive for either DR7, DR1, or DRB1*0404 or *0408. Thirty patients (26%) were positive for antibodies to DCII. There was a significant increase in the frequency of HLA-DR3 in anti-DCII-positive patients compared with anti-DCII-negative patients (40% versus 18%; P = 0.028). CONCLUSION The genetic associations between HLA-DR alleles and antibodies to CII in RA patients is in keeping with the collagen-induced arthritis model and implicates autoimmunity to CII as a major component in the multifactorial pathogenesis of RA.
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Affiliation(s)
- A D Cook
- Monash University, Clayton, Victoria, Australia
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Brand CA, Jolley D, Tellus M, Muirden KD, Wark JD. Risk factors for osteoporosis and fracture in patients attending rheumatology outpatient clinics. Aust N Z J Med 1999; 29:197-202. [PMID: 10342017 DOI: 10.1111/j.1445-5994.1999.tb00683.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) scanning is the best predictor of osteoporotic fracture but may not be cost effective for all patient groups. Risk factors (RF) other than BMD may be useful for fracture prediction. AIM To assess the prevalence of RF for osteoporosis (OP) and fracture in patients attending a public hospital rheumatology clinic and to document physician awareness of these RF. METHODS Two hundred and twenty rheumatology outpatients completed a self-administered questionnaire pertaining to known RF for OP and fracture. Initiatives were documented by the treating rheumatologist. RESULTS One hundred and fifty-four females and 66 males completed questionnaires: 57% had an inflammatory disorder and 32% had received significant glucocorticoid therapy. Forty-five (68%) males and 126 (82%) females had three or more RF for OP and fracture. Diagnosis of rheumatoid arthritis or connective tissue disorder (CTD) was the variable most significantly associated with increasing numbers of RF. Antiosteoporotic medication (AOM) use at assessment (64/219, 29.2%) was accounted for primarily by the use of hormone replacement therapy in females between 45-54 years. Prednisolone use predicted intervention in 103 (48%) patients. CONCLUSION Many rheumatology outpatients have multiple RF for OP and fracture. Infrequent AOM use could be explained by inadequate awareness of high risk patients and the lack of an ideal long term agent. With restricted outpatient resources, the feasibility of identifying high risk patients for OP and fracture would increase if the hierarchical status of RF was better understood.
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Affiliation(s)
- C A Brand
- Department of Rheumatology, Royal Melbourne Hospital, Vic
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Rowley MJ, Stockman A, Brand CA, Tait BD, Rowley GL, Sherritt MA, Mackay IR, Muirden KD, Bernard CC. The effect of HLA-DRB1 disease susceptibility markers on the expression of RA. Scand J Rheumatol 1998; 26:448-55. [PMID: 9433406 DOI: 10.3109/03009749709065718] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The study was designed to examine the effect on clinical expression of rheumatoid arthritis (RA) of HLA alleles, particularly DR4 and DR1 that contain susceptibility sequences for RA in the third hypervariable region (HVR3) of HLA-DRB1. We studied 114 consecutive Australian patients with RA attending a hospital outpatient clinic. The effects on indices of disease severity and activity of HLA DR4 and DR1, the DRB1*04 subtypes, and the polymorphism in the RA susceptibility sequence (QRRAA or QKRAA) were examined. The patients were initially divided into 6 groups, DR4,4; DR4,1; DR1,1; DR4/X; DR1,X, and DRX/X, and then further subdivided according to the actual HVR3 susceptibility sequence. The high risk conferred by the HVR3 susceptibility sequence, present in 76%, was confirmed, but 24% of the patients with long-standing seropositive erosive RA lacked this sequence. Among these those with DR2 had early-onset severe disease, and those with DR3 had late-onset milder disease. Differences in expression correlated with polymorphisms in the susceptibility sequence, in that active RA was associated more with QRRAA than QKRAA. There was no correlation of any HLA allele with disease severity. Our finding that the presence of the HVR3 sequence confers susceptibility and also influences the clinical expression and tempo of progression of RA suggests a role in pathogenesis for antigen presentation, whether of an autoantigenic molecule or a persisting infection.
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Affiliation(s)
- M J Rowley
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Australia
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Rowley MJ, Mackay IR, Brand CA, Bateman JF, Chan D. Epitope specificity of antibodies to type II collagen in rheumatoid arthritis and systemic lupus erythematosus. Rheumatol Int 1992; 12:65-9. [PMID: 1384102 DOI: 10.1007/bf00300979] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [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: 12/26/2022]
Abstract
Antibodies to human type II collagen were examined in the sera of 105 patients with rheumatoid arthritis (RA), 44 patients with systemic lupus erythematosus (SLE) and 11 patients who fulfilled the criteria of both diseases (RA-SLE overlap), using a solid-phase radioimmunoassay (RIA). The frequencies of antibodies to native and denatured human type II collagen were 20% and 27% in RA, 14% and 16% in SLE, and 45% and 36% in RA-SLE overlap. The specificity of the antibodies was further examined by inhibition with native and denatured type II collagen, by immunoblotting on native and denatured type II collagen, and by immunoblotting on cyanogen-bromide derived polypeptides of type II collagen. We could not identify any disease-specific patterns of reactivity. Thus, in the three disease groups the antibody response was polyclonal; there were antibody populations that reacted with native and/or denatured collagen, and epitopes could be assigned to at least three CB peptides, CB10.5, CB11 and CB8.
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Affiliation(s)
- M J Rowley
- Centre for Molecular Biology and Medicine, Monash University, Clayton, Victoria, Australia
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Brand CA, Rowley MJ, Tait BD, Muirden KD, Whittingham SF. Coexistent rheumatoid arthritis and systemic lupus erythematosus: clinical, serological, and phenotypic features. Ann Rheum Dis 1992; 51:173-6. [PMID: 1550399 PMCID: PMC1005653 DOI: 10.1136/ard.51.2.173] [Citation(s) in RCA: 28] [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: 12/27/2022]
Abstract
The clinical and serological features and HLA phenotypes are reported for 11 patients with coexistent features of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). All patients had a symmetrical small joint polyarthritis and features of SLE such as rash, photosensitivity, oral ulceration, serositis, cytopenia, and biopsy proved lupus nephritis. Eight had hypocomplementaemia. Autoantibodies were characteristic of the two diseases: all patients had rheumatoid factor and antibodies to double stranded DNA, eight (73%) had antibodies to collagen, and five (46%) had antibodies to Ro (SS-A). There was also an overlap of HLA phenotypes. Six patients were DR4 and seven were DR2 or DR3 positive, and of the five patients who were DR4 negative, four shared class I alleles often associated with DR4. If RA and SLE share a common autoimmune dysfunction, those patients who have the two diseases do so because they have genetic determinants of both.
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Affiliation(s)
- C A Brand
- Rheumatology Unit, Royal Melbourne Hospital, Victoria, Australia
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Littlejohn GO, Hall S, Brand CA, Davidson A. New bone formation in acromegaly: pathogenetic implications for diffuse idiopathic skeletal hyperostosis. Clin Exp Rheumatol 1986; 4:99-104. [PMID: 3731577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Radiographs of spinal and heel entheseal areas and the skull were examined for new bone formation in 30 acromegalic patients. Forty-seven percent satisfied accepted criteria for Diffuse Idiopathic Skeletal Hyperostosis (DISH), 67% had marked heel enthesopathic change and 87% had Hyperostosis Frontalis Interna (HFI). Such hyperostotic changes were indistinguishable from those seen in DISH and the extent and degree of such changes increased with duration of acromegaly. It is proposed that a common metabolic factor, e.g., hyperinsulinaemia, may be responsible for the hyperostotic changes seen in both DISH and acromegaly.
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Abstract
Thirty-four patients who clinically were suspected of having deep venous thrombosis (DVT) underwent Tc-99m red blood cell (RBC) venography followed by contrast venography. The sensitivity (88%) and specificity (94%) of Tc-99m RBC venography for DVT confirmed findings of previous studies. Twenty-four patients who had proved popliteal cysts and swollen calves also were examined using Tc-99m RBC venography. Large cysts (greater than 9 X 4 X 4 cm) showed lack of DVT features, photon deficient cold areas in the popliteal fossa, and diversion of venous flow around the photon deficient area. These features were seen in 25% of the study population (six patients), and assisted in the distinction between the two conditions.
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Brand CA, Littlejohn GO. Psoriatic arthritis and myasthenia gravis. J Rheumatol 1984; 11:244. [PMID: 6726723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A B27 positive woman, with a past history of myasthenia gravis and thymectomy, was found to have psoriatic arthritis. The implications of this association are briefly discussed.
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