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Noyes J, Crozier J. 323 Post-Take Pause Quality Improvement Project. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.250] [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: 11/05/2022]
Abstract
Abstract
Aim
To introduce a structured review of important clinical factors on the post-take surgical ward round for each patient, to reduce their risk of adverse events.
Method
In a surgical assessment unit of a district general hospital, QI methodology was used to gather baseline data from 31 post-take interactions; monitoring 13 clinical domains. Additionally, surveys were circulated among staff. Cycle two implemented the ‘Post-Take Pause’, a ten-point checklist requiring a consultant signature, with all medical staff receiving information about its use. Cycle three incorporated further involvement of the nursing and advanced nurse practitioner team. The final fourth cycle implemented a revised checklist based on feedback from users.
Results
Baseline data collection and surveys showed that a number of important clinical factors were not being routinely reviewed on the post-take surgical ward round. Areas of particular concern included: medicine reconciliation, venous-thromboembolism prophylaxis, and prescription chart review. Inadequate time for documentation was also highlighted. Cycle two and three reviewed 21 post-take interactions each and found completion of 33% and 66% respectively. Cycle four reviewed 18 interactions with 72% of checklists completed. Common themes identified through the Post-Take Pause included: anticoagulant and steroid use, missed thromboprophylaxis and regular medicines, hyperglycaemia, ECG review and escalation plans.
Conclusions
The Post-Take Pause ensures a consultant led systematic review of important clinical information in the post-take surgical ward round. Our results show that the involvement of the wider surgical team, alongside checklist edits based on feedback, significantly improved the compliance of the Post-Take Pause.
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Affiliation(s)
- J Noyes
- Forth Valley Royal Hospital , Larbert , United Kingdom
| | - J Crozier
- Forth Valley Royal Hospital , Larbert , United Kingdom
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2
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Cheng J, Simons K, Crozier J, Liew D, McNeil J, O’Connell H. Urinary incontinence in community dwelling Australian adults aged 70 years and above: Prevalence and causal associations. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33671-5] [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: 11/17/2022] Open
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3
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Deshmukh A, Crozier J, LaBree K, Greenwalt J. Implementation of a Pregnancy Testing Policy in a Comprehensive Cancer Center for Oncology Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1143] [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: 12/01/2022]
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4
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Homer A, Soares B, Collins S, Merck D, Crozier J, Woo A, Soares G, Ahn S, Homer A. 04:12 PM Abstract No. 352 3-D printing and interventional radiology training: production of a vascular model and evaluation of 3-D printing media. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.423] [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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5
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Tourniaire G, Milési C, Baleine J, Crozier J, Lapeyre C, Combes C, Nagot N, Cambonie G. [Anemia, a new severity factor in young infants with acute viral bronchiolitis?]. Arch Pediatr 2018. [PMID: 29523379 DOI: 10.1016/j.arcped.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The role of anemia is raised as a risk of low respiratory infection of the child, but there are no data on anemia as a severity factor in acute viral bronchiolitis (AVB) in infants. METHODS All infants less than 16 weeks old admitted to Montpellier University Hospital from 2015/10/01 to 2016/04/01 for AVB were included in a retrospective observational study. The primary objective was to determine whether the hemoglobin (Hb) concentration on admission was an independent factor of clinical severity, judged by the modified Wood's clinical asthma score (m-WCAS). The secondary objective was to assess the impact of Hb level on the characteristics of hospitalization, including the type and duration of respiratory support. RESULTS The m-WCAS was used at least once during hospitalization in 180 out of 220 patients (82%), making it possible to distinguish patients with mild AVB (maximum m-WCAS<2, n=81) from patients with severe AVB (maximum m-WCAS>2, n=99). A logistic regression model indicated that the Hb concentration, for every 1g/dL decrement, was an independent factor of AVB severity (OR 1.16 [1.03-1.29], P=0.026). A level under 10g/dL on admission was associated with a higher use of continuous positive airway pressure (P<0.001), as well as a longer duration of respiratory support (P=0.01). CONCLUSION This study suggested that anemia may influence the clinical expression of AVB in young infants.
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Affiliation(s)
- G Tourniaire
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - C Milési
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - J Baleine
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - J Crozier
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - C Lapeyre
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - C Combes
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - N Nagot
- Département de l'information médicale, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - G Cambonie
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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6
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Thomas R, Crozier J, Empey J. Guess the Weight Prospective Audit. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.286] [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: 10/18/2022]
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Johnson E, Rutherford M, Edgington S, Flood J, Crozier J, Cafá G, Buddie A, Offord L, Elliott S, Christie K. First report of
Moniliophthora roreri
causing frosty pod rot on
Theobroma cacao
in Jamaica. ACTA ACUST UNITED AC 2017. [DOI: 10.5197/j.2044-0588.2017.036.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- E.S. Johnson
- Inter‐American Institute for Cooperation on Agriculture (IICA)Hope GardensKingston6Jamaica
| | | | - S. Edgington
- CABIBakeham LaneEghamSurreyTW20 9TYUnited Kingdom
| | - J. Flood
- CABIBakeham LaneEghamSurreyTW20 9TYUnited Kingdom
| | - J. Crozier
- CABIBakeham LaneEghamSurreyTW20 9TYUnited Kingdom
| | - G. Cafá
- CABIBakeham LaneEghamSurreyTW20 9TYUnited Kingdom
| | - A.G. Buddie
- CABIBakeham LaneEghamSurreyTW20 9TYUnited Kingdom
| | - L. Offord
- CABIBakeham LaneEghamSurreyTW20 9TYUnited Kingdom
| | - S.M. Elliott
- Ministry of IndustryCommerce, Agriculture & FisheriesBodles Research StationOld HarbourSt. CatherineJamaica
| | - K.V. Christie
- Ministry of IndustryCommerce, Agriculture & FisheriesPlant Quarantine & Produce InspectionHope GardensKingston6Jamaica
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Eysseric-Degrugillier F, Baleine J, Milesi C, Crozier J, Vigue M, Delcourt M, Guyon G, Cambonie G, Jeziorski E. Dépistage immunitaire lors d’infections sévères en réanimation pédiatrique. Arch Pediatr 2016. [DOI: 10.1016/j.arcped.2016.09.046] [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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9
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Gill G, Butt P, Reade MC, Crozier J, Williams A, Thomas T, Flint B, Matthews G, Duff N, Brown G, Chambers A, Courtenay B, Innes D, Malley BO. HOSPEX in the antipodes. J ROY ARMY MED CORPS 2014; 161:336-40. [PMID: 25512440 DOI: 10.1136/jramc-2014-000378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 11/09/2014] [Indexed: 11/04/2022]
Abstract
The Australian Army recently adopted the British concept of hospital exercise (HOSPEX) as a means of evaluating the capabilities of its deployable NATO Role 2E hospital, the 2nd General Health Battalion. The Australian approach to HOSPEX differs from the original UK model. This article describes the reasons why the Australian Army needed to adopt the HOSPEX concept, how it was adapted to suit local circumstances and how the concept may evolve to meet the needs of the wider Australian Defence Force and our allies.
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Affiliation(s)
- Gerard Gill
- 3rd Health Support Battalion, Keswick Barracks, Keswick, South Australia, Australia
| | - P Butt
- 3rd Health Support Battalion, Keswick Barracks, Keswick, South Australia, Australia
| | - M C Reade
- 3rd Health Support Battalion, Keswick Barracks, Keswick, South Australia, Australia Joint Health Command, Australian Defence Force, Herston, Queensland, Australia
| | - J Crozier
- Joint Health Command, Australian Defence Force, Herston, Queensland, Australia
| | - A Williams
- Directorate Army Health, Russell Offices Canberra ACT 2600, Russell, Australian Capital Territory, Australia
| | - T Thomas
- 3rd Health Support Battalion, Keswick Barracks, Keswick, South Australia, Australia
| | - B Flint
- 2nd General Health Battalion, Gallipoli Barracks, Enoggera, Queensland, Australia
| | - G Matthews
- 3rd Health Support Battalion, Keswick Barracks, Keswick, South Australia, Australia
| | - N Duff
- 2nd General Health Battalion, Gallipoli Barracks, Enoggera, Queensland, Australia
| | - G Brown
- 3rd Health Support Battalion, Keswick Barracks, Keswick, South Australia, Australia
| | - A Chambers
- 3rd Health Support Battalion, Keswick Barracks, Keswick, South Australia, Australia
| | - B Courtenay
- HQ 5th Brigade, Holsworthy Barracks, Holsworthy, New South Wales, Australia
| | - D Innes
- 3rd Health Support Battalion, Keswick Barracks, Keswick, South Australia, Australia
| | - B O Malley
- 3rd Health Support Battalion, Keswick Barracks, Keswick, South Australia, Australia
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10
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Malone M, Lau NS, White J, Novak A, Xuan W, Iliopoulos J, Crozier J, Dickson HG. The effect of diabetes mellitus on costs and length of stay in patients with peripheral arterial disease undergoing vascular surgery. Eur J Vasc Endovasc Surg 2014; 48:447-51. [PMID: 25116276 DOI: 10.1016/j.ejvs.2014.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 04/15/2014] [Accepted: 07/04/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the impact of diabetes mellitus (DM) and other comorbidities on length of stay (LOS) and costs in patients with peripheral arterial disease (PAD) admitted to a vascular surgical unit. METHODS A retrospective study was conducted between January 2011 and July 2012 at a tertiary referral hospital in Sydney. Demographic, laboratory, and operative data were obtained from the Australasian Vascular Audit database and hospital diagnostic-related group (DRG) reports. Patients with confirmed PAD with or without DM requiring hospital admission for a diagnosis of claudication, rest pain, ulcer/gangrene, and infection that required lower limb surgical intervention were included. Associations between LOS, surgical procedure, and DRG were explored. RESULTS Five hundred and sixty-eight admissions (492 patients) were identified: 292 admissions with PAD and 276 admissions with PAD in conjunction with DM (PADDM). Mean LOS for patients with PAD was 10 ± 13.7 days compared with 15 ± 18.2 days for PADDM (p < .01; 95% confidence interval 2.7-8.0). LOS and costs were greatest in patients with PADDM undergoing major amputation (37 ± 13.7 days; US$42,236; p < .01). Analysis of variance indicated that the best predictors of LOS were the presence of DM, bypass surgery, amputation, chronic kidney disease (CKD) stage V, infection, and emergency admission. Over 18 months, the estimated total inpatient costs associated with lower limb intervention for PAD with and without DM amounted to US$7,598,597. People with DM incurred greater inpatient costs, averaging US$1,912 more per episode of admission and a total of US$528,029 over 18 months. CONCLUSION The impact of diabetes as a comorbid condition in patients with PAD is significant, both clinically and economically. Factors that predict increased LOS in patients with PAD are DM, bypass surgery, amputation, CKD stage V, infection, and emergency admission.
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Affiliation(s)
- M Malone
- High Risk Foot Service, Liverpool Hospital, Liverpool, NSW 2170, Australia; LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.
| | - N S Lau
- LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, NSW, Australia
| | - J White
- High Risk Foot Service, Liverpool Hospital, Liverpool, NSW 2170, Australia; LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - A Novak
- Diabetes Foot Service, Western Health, Victoria, Australia
| | - W Xuan
- LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - J Iliopoulos
- LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Department of Vascular Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - J Crozier
- LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Department of Vascular Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - H G Dickson
- LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Ambulatory Care, Liverpool Hospital, Liverpool, NSW, Australia
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11
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Malik HZ, Crozier J, Murray L, Carter R. Chyle leakage and early enteral feeding following pancreatico-duodenectomy: management options. Dig Surg 2007; 24:418-22. [PMID: 17855780 DOI: 10.1159/000108324] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [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] [Received: 04/10/2006] [Accepted: 07/06/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chyle leaks are a rare complication following abdominal surgery. The aim of this study is to describe the management of chyle leaks following surgery for pancreatico-duodenal malignancy. METHODS Data were collated from a consecutive series of 105 patients who had undergone a pancreatico-duodenectomy for malignancy. From this cohort, patients who developed significant chyle leaks, defined as drainage of more than 600 ml of amylase-poor chylous fluid per day, were identified and their management reviewed. RESULTS A total of 7 (6.7%) patients with significant chyle leaks were identified. All but one of the chyle leaks were identified between the 5th and 9th post-operative day. Early restoration of enteral feeding appeared to increase the incidence of chyle leak. Six of the 7 patients were successfully treated conservatively with total parenteral nutrition and after a median of 7.5 days the chyle leak had resolved. One patient required a peritoneovenous shunt for chylous ascites. CONCLUSION This study has described a high incidence of chyle leak among patients undergoing surgery for pancreatico-duodenal malignancy. Early introduction of enteral feed may encourage development. However, patients who develop an abdominal chyle leak remain clinically well and the leak can be managed relatively easily with parenteral nutrition.
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Affiliation(s)
- H Z Malik
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
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12
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Bailey BA, Bae H, Strem MD, Roberts DP, Thomas SE, Crozier J, Samuels GJ, Choi IY, Holmes KA. Fungal and plant gene expression during the colonization of cacao seedlings by endophytic isolates of four Trichoderma species. Planta 2006; 224:1449-1464. [PMID: 16832690 DOI: 10.2135/cropsci2000.404923x] [Citation(s) in RCA: 299] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Accepted: 04/18/2006] [Indexed: 05/27/2023]
Abstract
Endophytic isolates of Trichoderma species are being considered as biocontrol agents for diseases of Theobroma cacao (cacao). Gene expression was studied during the interaction between cacao seedlings and four endophytic Trichoderma isolates, T. ovalisporum-DIS 70a, T. hamatum-DIS 219b, T. harzianum-DIS 219f, and Trichoderma sp.-DIS 172ai. Isolates DIS 70a, DIS 219b, and DIS 219f were mycoparasitic on the pathogen Moniliophthora roreri, and DIS 172ai produced metabolites that inhibited growth of M. roreri in culture. ESTs (116) responsive to endophytic colonization of cacao were identified using differential display and their expression analyzed using macroarrays. Nineteen cacao ESTs and 17 Trichoderma ESTs were chosen for real-time quantitative PCR analysis. Seven cacao ESTs were induced during colonization by the Trichoderma isolates. These included putative genes for ornithine decarboxylase (P1), GST-like proteins (P4), zinc finger protein (P13), wound-induced protein (P26), EF-calcium-binding protein (P29), carbohydrate oxidase (P59), and an unknown protein (U4). Two plant ESTs, extensin-like protein (P12) and major intrinsic protein (P31), were repressed due to colonization. The plant gene expression profile was dependent on the Trichoderma isolate colonizing the cacao seedling. The fungal ESTs induced in colonized cacao seedlings also varied with the Trichoderma isolate used. The most highly induced fungal ESTs were putative glucosyl hydrolase family 2 (F3), glucosyl hydrolase family 7 (F7), serine protease (F11), and alcohol oxidase (F19). The pattern of altered gene expression suggests a complex system of genetic cross talk occurs between the cacao tree and Trichoderma isolates during the establishment of the endophytic association.
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Affiliation(s)
- B A Bailey
- Sustainable Perennial Crops Laboratory, BARC-West, Beltsville, MD 20705, USA.
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13
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Bailey BA, Bae H, Strem MD, Roberts DP, Thomas SE, Crozier J, Samuels GJ, Choi IY, Holmes KA. Fungal and plant gene expression during the colonization of cacao seedlings by endophytic isolates of four Trichoderma species. Planta 2006; 224:1449-64. [PMID: 16832690 DOI: 10.1007/s00425-006-0314-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Accepted: 04/18/2006] [Indexed: 05/10/2023]
Abstract
Endophytic isolates of Trichoderma species are being considered as biocontrol agents for diseases of Theobroma cacao (cacao). Gene expression was studied during the interaction between cacao seedlings and four endophytic Trichoderma isolates, T. ovalisporum-DIS 70a, T. hamatum-DIS 219b, T. harzianum-DIS 219f, and Trichoderma sp.-DIS 172ai. Isolates DIS 70a, DIS 219b, and DIS 219f were mycoparasitic on the pathogen Moniliophthora roreri, and DIS 172ai produced metabolites that inhibited growth of M. roreri in culture. ESTs (116) responsive to endophytic colonization of cacao were identified using differential display and their expression analyzed using macroarrays. Nineteen cacao ESTs and 17 Trichoderma ESTs were chosen for real-time quantitative PCR analysis. Seven cacao ESTs were induced during colonization by the Trichoderma isolates. These included putative genes for ornithine decarboxylase (P1), GST-like proteins (P4), zinc finger protein (P13), wound-induced protein (P26), EF-calcium-binding protein (P29), carbohydrate oxidase (P59), and an unknown protein (U4). Two plant ESTs, extensin-like protein (P12) and major intrinsic protein (P31), were repressed due to colonization. The plant gene expression profile was dependent on the Trichoderma isolate colonizing the cacao seedling. The fungal ESTs induced in colonized cacao seedlings also varied with the Trichoderma isolate used. The most highly induced fungal ESTs were putative glucosyl hydrolase family 2 (F3), glucosyl hydrolase family 7 (F7), serine protease (F11), and alcohol oxidase (F19). The pattern of altered gene expression suggests a complex system of genetic cross talk occurs between the cacao tree and Trichoderma isolates during the establishment of the endophytic association.
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Affiliation(s)
- B A Bailey
- Sustainable Perennial Crops Laboratory, BARC-West, Beltsville, MD 20705, USA.
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14
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Mosley K, Tam FWK, Edwards RJ, Crozier J, Pusey CD, Lightstone L. Urinary proteomic profiles distinguish between active and inactive lupus nephritis. Rheumatology (Oxford) 2006; 45:1497-504. [PMID: 17046860 DOI: 10.1093/rheumatology/kel351] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Key aims of the treatment of lupus nephritis (LN) are to induce and maintain remission with minimal side effects. However, assessing ongoing renal inflammatory activity is poorly served by current diagnostic tests apart from renal biopsy, but frequent biopsies cannot be justified. Our long-term aim is to identify novel biomarkers from urinary protein profiles to improve diagnosis and monitoring of activity and response to therapy in LN. METHODS We used surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) to identify biomarkers able to discriminate between urine samples from patients with inactive (n= 49) and active (n= 26) LN. Discriminant function analysis was used to define the minimum number of proteins whose levels best distinguished between the two patient groups. Serial urines of six biopsied patients were studied prospectively, and multiple regression (MR) scores calculated. RESULTS Proteins with masses of 3340 and 3980 distinguished active from inactive LN with 92% sensitivity and specificity of 92% each. The prospective study of the biopsied patients demonstrated that MR scores could predict both relapse and remission earlier than traditional clinical markers. CONCLUSIONS SELDI-TOF MS identified potential biomarker profiles strongly associated with activity in LN. Identification of these proteins will allow us to devise specific assays to routinely monitor disease progression, and alter immunosuppressive drug regimens accordingly. These proteins may also play a critical role in the pathogenesis of glomerulonephritis, and could therefore provide targets for therapeutic intervention.
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Affiliation(s)
- K Mosley
- Renal Section, Division of Medicine, Imperial College London, Hammersmith Campus, London, UK.
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15
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Fisher CM, Fletcher JP, May J, White GH, Lord RS, Crozier J, Conner G. No additional benefit from laser in balloon angioplasty of the superficial femoral artery. Eur J Vasc Endovasc Surg 1996; 11:349-52. [PMID: 8601248 DOI: 10.1016/s1078-5884(96)80084-0] [Citation(s) in RCA: 7] [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: 01/31/2023]
Abstract
OBJECTIVES To evaluate the efficacy of the addition of plaque ablation by hot-tip laser to balloon angioplasty. DESIGN Prospective randomised clinical trial. MATERIALS AND METHODS Patients with either occlusion orf > 50% diameter stenosis less than 3 cm in length in the superficial femoral artery, and with two or three calf vessel run-off were eligible and randomised to receive either balloon angioplasty alone or with laser assistance. Treatment failure in follow-up was defined as reocclusion or recurrence of greater that 50% stenosis at the site of angioplasty. RESULTS Ninety limbs (82 patients) were entered into the study. Forty-four patients had mild claudication, 32 more severe symptoms and 6 rest pain or ulceration. More patients with diabetes (5 of 5, p = 0.04, Fisher's exact test) and occlusions (16 of 22, p < 0.05, chi(2)) were randomised to the laser group. Initial technical success was obtained in all lesions. The median duration of follow-up was 1 year. Failure occurred in 40 limbs during follow-up. Three segments, all with initial occlusions and undergoing laser angioplasty re-occluded within 2 days, one requiring immediate thrombectomy. Another 20 limbs underwent further intervention. Overall success (+/- S.D.) (Kaplan-Meier) at 1 year was 67% (+/- 5%) and at 2 years 43% (+/- 7%). Only increased age, initial occlusion, female sex, and not smoking were significantly (p < 0.05, Cox's proportional hazards) associated with failure; on multivariate analysis, age and occlusion were the best independent predictors. There was no significant difference (p > 0.05) in outcome between limbs undergoing laser assisted balloon angioplasty and balloon alone either overall of within the stenosis or occlusion subgroups. CONCLUSIONS This study found no significant benefit was gained by the addition of laser to balloon angioplasty and that the long term success was modest for lesions considered to be suitable for angioplasty.
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Affiliation(s)
- C M Fisher
- University of Sydney and Westmead Hospital, Australia
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16
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Appleberg M, Cottier D, Crozier J, Graham J, Lane R. Carotid endarterectomy for asymptomatic carotid artery stenosis: patients with severe bilateral disease a high risk subgroup. Aust N Z J Surg 1995; 65:160-5. [PMID: 7887857 DOI: 10.1111/j.1445-2197.1995.tb00599.x] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Carotid endarterectomy if advised for asymptomatic disease must be associated with a low peri-operative morbidity and mortality and satisfactory long-term results. Over a 12 year period between 1978-1989 181 carotid endarterectomies were performed on 163 patients with asymptomatic carotid artery stenosis. There were 112 males and 51 females with a mean age of 64.9 years. All patients had a high-grade lesion (> 70% stenosis). The combined operative mortality and stroke rate was 2.8%. On long-term follow up six patients suffered a stroke. Only one patient however sustained a stroke in the same territory as the previously operated carotid artery. Four years following surgery 78% of patients were alive. Carotid restenosis or occlusion occurred in 8.3% of the remaining patients, all of whom were asymptomatic. All the immediate postoperative strokes occurred in patients with severe bilateral carotid artery disease. These patients with severe bilateral disease appear to constitute a high risk sub-group for peri-operative stroke. The role of 'normal pressure-hyperperfusion breakthrough' syndrome as the presumed aetiology of two of the postoperative cerebral haemorrhages is discussed.
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Affiliation(s)
- M Appleberg
- Department of Vascular Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Savdie E, Keogh AM, Macdonald PS, Spratt PM, Graham AM, Golovsky D, Stricker PD, Spicer T, Hayes JM, Crozier J. Simultaneous transplantation of the heart and kidney. Aust N Z J Med 1994; 24:554-60. [PMID: 7848159 DOI: 10.1111/j.1445-5994.1994.tb01757.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Multiple organ transplants have become frequent. Combined heart-and-kidney grafting has been reported recently and we have pursued this in selected cases. AIMS To devise a protocol for simultaneous heart-and-kidney transplantation, review our clinical experience with the procedure and the causes of cardiac and renal disease in this group. METHODS Seven patients with advanced cardiac failure (LV ejection fraction < 0.29 units; five with IDCM), and chronic renal failure (serum creatinine > 375 mumol/L) due to a variety of causes, were accepted for combined heart-and-kidney transplantation. Four males, of mean age 33 years, underwent the procedure. Each received his organs from a single cadaveric donor with ABO blood group compatibility and a negative 'current' lymphocytotoxic cross-match, but without regard to HLA-antigen matching. Cardiac ischaemic time averaged 3 hours 40 minutes, the renal first warm time was 0 minutes in all cases, and renal cold and second warm ischaemic times averaged 5 hours 17 minutes and 52 minutes respectively. The heart was grafted first and the kidney second in a procedure which averaged seven hours. Immunosuppression was achieved by induction with antithymocyte globulin, thence steroids, azathioprine and cyclosporin A. RESULTS No patient required post-operative dialysis. One patient had early urological complications requiring operative correction, but no serious opportunistic infections were observed. Early cardiac rejection on biopsy (ISHT grade 3a) was seen in three patients at four-ten weeks and responded promptly to increased steroids, but severe steroid-resistant rejection of both heart and kidney contemporaneously occurred in one of these three at 19 months and required a course of muromonab-CD3. All four patients developed hypertension. Mean creatinine clearance was 1.23 +/- 0.22 mL/second (74 +/- 13 mL/minute) at last follow-up. All four recipients were alive, well and rehabilitated 5, 20, 28 and 35 months after grafting. Two patients died while waiting for the double procedure and another patient eventually died after being taken off the dual waiting list and receiving a renal transplant only. CONCLUSIONS In experienced hands, combined heart-and-kidney transplantation is feasible and offers a compelling therapeutic solution in the treatment of advanced cardiac and renal failure. IDCM is a frequent cause of the heart failure in this group.
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Affiliation(s)
- E Savdie
- Department of Nephrology, St Vincent's Hospital, Sydney, NSW
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Doughty B, Crozier J. [Chemical neuromediators and their reactions]. Infirm Can 1977; 19:24-9. [PMID: 12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Doughty B, Crozier J. Understanding neurotransmitters and related drugs. Can Nurse 1976; 72:38-42. [PMID: 8207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chemical neurotransmitter substances are released at the axon terminals of the central, autonomic, and peripheral nervous systems of the human body. The most well-known of the neurotransmitters are acetylcholine, norepinephrine, dopamine, and serotonin. It is these substances that facilitate the conduction of nerve impulses throughout the body, allowing the coordination of body functions and enabling response to the environment. The efective action of neurotransmitters makes the difference between health and disease states. A nurse's understanding of neurotransmitters and of many common drugs influencing their function is essential to safe nursing practice.
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