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Egan A, Kearns J, Khalil M, O'Connor M. 194 TIA IMAGING: ARE WE FOLLOWING NICE 2020 GUIDELINES? Age Ageing 2021. [DOI: 10.1093/ageing/afab219.194] [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: 02/25/2023] Open
Abstract
Abstract
Background
CT brain imaging is customary in clinical practice after Transient Ischemic Attack (TIA). However, NICE (2020) guidelines recommend MRI brain with diffusion weighted and blood-sensitive sequences; to be completed on the same day as the assessment. The purpose is to detect the ischemic territory, haemorrhage, or other pathology. The aim of this audit was to assess the diagnostic radiology investigations performed on patients, over the age of sixty-five years, presenting with TIA to a university teaching hospital.
Methods
We conducted a retrospective audit of all patients coded as TIA on the Hospital Inpatient-Enquiry (HIPE) system between July 2019 to July 2020. Data on brain imaging was accessed using the National Integrated Medical Imaging System (NIMIS) system. Hospital attendance records were accessed via the Emergency Department patient database. Data was analysed using Microsoft Excel.
Results
Eighty patients had brain imaging performed (n = 38 CT brain only; n = 1 MRI only; n = 41 CT and MRI). Of these patients, only three had an MRI brain completed within twenty-four hours where thirty-nine patients had an MRI scans outside of twenty-four hours. Forty-one patients had both a CT and MRI brain imaging performed. The median time to MRI brain was three days and one and a half hours and the median time to CT brain was two hours and forty-nine minutes.
Conclusion
This audit confirms duplication of TIA brain imaging and CT as the primary imaging tool for TIA which is not in keeping with best practice (NICE, 2020). This has implications for resources, radiation exposure and patient’s length of stay. Development of dedicated ambulatory care pathways for TIA must incorporate rapid MRI access as the primary imaging modality.
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Affiliation(s)
- A Egan
- Univeristy Hospital Limerick (UHL) , Limerick, Ireland
| | - J Kearns
- Univeristy Hospital Limerick (UHL) , Limerick, Ireland
| | - M Khalil
- Univeristy Hospital Limerick (UHL) , Limerick, Ireland
| | - M O'Connor
- Univeristy Hospital Limerick (UHL) , Limerick, Ireland
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Courtwright A, Kamoun M, Kearns J, Diamond J, Ahya V, Cevasco M, Christie J, Clausen E, Hadjiliadis D, Lee J, Patel N, Salgado J, Cantu E, Crespo M, Bermudez C. Lung Transplantation Outcomes after Crossing Low Level Donor Specific Antibodies without Augmented Immunosuppression. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.490] [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: 10/21/2022] Open
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3
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Ansite J, Balamurugan AN, Barbaro B, Battle J, Brandhorst D, Cano J, Chen X, Deng S, Feddersen D, Friberg A, Gilmore T, Goldstein JS, Holbrook E, Khan A, Kin T, Lei J, Linetsky E, Liu C, Luo X, McElvaney K, Min Z, Moreno J, O'Gorman D, Papas KK, Putz G, Ricordi C, Szot G, Templeton T, Wang L, Wilhelm JJ, Willits J, Wilson T, Zhang X, Avila J, Begley B, Cano J, Carpentier S, Holbrook E, Hutchinson J, Larsen CP, Moreno J, Sears M, Turgeon NA, Webster D, Deng S, Lei J, Markmann JF, Bridges ND, Czarniecki CW, Goldstein JS, Putz G, Templeton T, Wilson T, Eggerman TL, Al-Saden P, Battle J, Chen X, Hecyk A, Kissler H, Luo X, Molitch M, Monson N, Stuart E, Wallia A, Wang L, Wang S, Zhang X, Bigam D, Campbell P, Dinyari P, Kin T, Kneteman N, Lyon J, Malcolm A, O'Gorman D, Onderka C, Owen R, Pawlick R, Richer B, Rosichuk S, Sarman D, Schroeder A, Senior PA, Shapiro AMJ, Toth L, Toth V, Zhai W, Johnson K, McElroy J, Posselt AM, Ramos M, Rojas T, Stock PG, Szot G, Barbaro B, Martellotto J, Oberholzer J, Qi M, Wang Y, Bayman L, Chaloner K, Clarke W, Dillon JS, Diltz C, Doelle GC, Ecklund D, Feddersen D, Foster E, Hunsicker LG, Jasperson C, Lafontant DE, McElvaney K, Neill-Hudson T, Nollen D, Qidwai J, Riss H, Schwieger T, Willits J, Yankey J, Alejandro R, Corrales AC, Faradji R, Froud T, Garcia AA, Herrada E, Ichii H, Inverardi L, Kenyon N, Khan A, Linetsky E, Montelongo J, Peixoto E, Peterson K, Ricordi C, Szust J, Wang X, Abdulla MH, Ansite J, Balamurugan AN, Bellin MD, Brandenburg M, Gilmore T, Harmon JV, Hering BJ, Kandaswamy R, Loganathan G, Mueller K, Papas KK, Pedersen J, Wilhelm JJ, Witson J, Dalton-Bakes C, Fu H, Kamoun M, Kearns J, Li Y, Liu C, Luning-Prak E, Luo Y, Markmann E, Min Z, Naji A, Palanjian M, Rickels M, Shlansky-Goldberg R, Vivek K, Ziaie AS, Fernandez L, Kaufman DB, Zitur L, Brandhorst D, Friberg A, Korsgren O. Purified Human Pancreatic Islets, CIT Culture Media with Lisofylline or Exenatide. CellR4 Repair Replace Regen Reprogram 2017; 5:e2377. [PMID: 30613755 PMCID: PMC6319648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Doherty U, Hawke AL, Kearns J, Kelly M. Fitness to drive in cognitive impairment--a quantitative study of GPs' experience. Ir Med J 2015; 108:112-114. [PMID: 26016301] [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: 06/04/2023]
Abstract
Assessing fitness to drive is part of the role of general practitioners. Cognitive impairment may affect an individual's ability to drive safely. The aims of our study were to question GPs about their experience of assessing patients with cognitive impairment for driving fitness and to explore their attitudes to this role. We carried out a quantitative cross-sectional anonymous postal survey of 200 GPs in counties Galway, Mayo and Roscommon. Ethical approval was obtained from the Irish College of General Practitioners. Data was analysed using Epi Info. The response rate was 62.5% (n=125). 86 (68.8%) GPs used guidelines when assessing fitness to drive in cognitive impairment. 83 (66.4%) respondents formally assess cognitive function. 52 (41.6%) GPs would certify someone as fit to drive with verbal restrictions. 102 (81.6%) respondents feel confident in assessing fitness to drive. 98 (78.4%) GPs have referred patients for further assessment.
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Harb W, Lieu C, Beeram M, Power L, Sloss C, Kearns J, Nering R, Moyo V, Wolf B, Adjei A. A First-In-Human Study Evaluating the Safety and Pharmacology of Mm-151, a Novel Oligoclonal Anti-Egfr Antibody Combination in Patients with Refractory Solid Tumors. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu331.17] [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: 11/13/2022] Open
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6
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Flanagan EP, McKeon A, Lennon VA, Kearns J, Weinshenker BG, Krecke KN, Matiello M, Keegan BM, Mokri B, Aksamit AJ, Pittock SJ. Paraneoplastic isolated myelopathy: Clinical course and neuroimaging clues. Neurology 2011; 76:2089-95. [DOI: 10.1212/wnl.0b013e31821f468f] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [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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Kamoun M, Kearns J. Renal transplantation in patients with pretransplant donor-specific antibodies and negative flow cytometry crossmatches. Am J Transplant 2008; 8:723; author reply 724. [PMID: 18294173 DOI: 10.1111/j.1600-6143.2007.02081.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Goral S, Prak EL, Kearns J, Bloom RD, Pierce E, Doyle A, Grossman R, Naji A, Kamoun M. Preformed donor-directed anti-HLA-DP antibodies may be an impediment to successful kidney transplantation. Nephrol Dial Transplant 2007; 23:390-2. [DOI: 10.1093/ndt/gfm703] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Kamoun M, Israni AK, Joffe MM, Hoy T, Kearns J, Mange KC, Feldman D, Goodman N, Rosas SE, Abrams JD, Brayman KL, Feldman HI. Assessment of differences in HLA-A, -B, and -DRB1 allele mismatches among African-American and non-African-American recipients of deceased kidney transplants. Transplant Proc 2007; 39:55-63. [PMID: 17275474 DOI: 10.1016/j.transproceed.2006.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Indexed: 02/08/2023]
Abstract
Among recipients of deceased donor kidney transplants, African-Americans experience a more rapid rate of kidney allograft loss than non-African-Americans. The purpose of this study was to characterize and quantify the HLA-A, -B, and -DRB1 allele mismatches and amino acid substitutions at antigen recognition sites among African-American and non-African-American recipients of deceased donor kidney transplants matched at the antigen level. In recipients with zero HLA antigen mismatches, the degree of one or two HLA allele mismatches for both racial groups combined was 47%, 29%, and 11% at HLA-DRB1, HLA-B, and HLA-A, respectively. There was a greater number of allele mismatches in African-Americans than non-African-Americans at HLA-A (P < .0001), -B (P = .096), and -DRB1 loci (P < .0001). For both racial groups, the HLA allele mismatches were predominantly at A2 for HLA-A; B35 and B44 for HLA-B; but multiple specificities for HLA-DRB1. The observed amino acid mismatches were concentrated at a few functional positions in the antigen binding site of HLA-A and -B and -DRB1 molecules. Future studies are ongoing to assess the impact of these HLA mismatches on kidney allograft loss.
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Affiliation(s)
- M Kamoun
- Department of Pathology and Laboratory Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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10
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Hou JY, Luning Prak E, Kearns J, Wu J, Bassinger S, Birkos S, Williams TM, Kamoun M. A nonsense mutation in exon 3 results in the HLA-B null allele B*5127N. Tissue Antigens 2002; 60:262-5. [PMID: 12445310 DOI: 10.1034/j.1399-0039.2002.600309.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: 11/23/2022]
Abstract
A new HLA-B null allele has been identified within the B*51 group by combined serological and molecular typing of an Italian Caucasoid family. Serological data indicated that the proband typed homozygous for A2 and B60. Confirmatory typing using sequence specific oligonucleotide hybridization (SSPOH) detected a second B allele within the B*51 group. Allele specific typing (SSP) for B*51 subtypes, including the known B*5111N allele, was performed, and typing results were consistent with B*5101, suggesting the presence of a new null variant. Cloning and sequencing of this allele identified a B*5101 variant with a nonsense mutation in exon 3. This new null allele has been designated B*5127N. The combined use of serologic and DNA-based typing methods facilitates the identification of null and low-expression alleles. An overview of null alleles of class I HLA is presented.
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Affiliation(s)
- J Y Hou
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19035, USA
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11
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Williams TM, Wu J, Bassinger S, Feldman D, Birkos S, Kearns J, Kamoun M. New HLA-B alleles identified and sequences extended in potential bone marrow donors: B*5804, B*4418, B*1558, and B*4805. Tissue Antigens 2002; 60:186-8. [PMID: 12392514 DOI: 10.1034/j.1399-0039.2002.600210.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nucleic acid-based methods for allele identification have revealed more than 470 polymorphic variants at the HLA-B locus. Screening of potential bone marrow donors with sequence specific primer polymerase chain reactions and sequence specific oligonucleotide probe hybridization assays revealed apparent variants within the B*58, *44, *15, and *48 allele groups. DNA sequencing of cloned DNA identified the new alleles B*5804, B*4418, and B*1558 within these groups and observed new sequence information for the previously reported allele B*4805. These findings further extend our knowledge of the substantial genetic variation present at the HLA-B locus within human populations.
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Affiliation(s)
- T M Williams
- Department of Pathology, University of New Mexico, Albuquerque 87131-5051, USA.
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Feldman D, Kearns J, Wu J, Bassinger S, Montoya GD, McKeen M, Birkos S, Williams TM, Kamoun M. Identification and sequencing of HLA-B*0714 and B*2718 alleles and novel exon 1 sequences of B*0709 and B*2714 alleles in potential bone marrow donors. Tissue Antigens 2002; 59:426-9. [PMID: 12144629 DOI: 10.1034/j.1399-0039.2002.590512.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sequence specific oligonucleotide probe hybridization and sequence specific primer PCR typing of volunteer bone marrow donors suggested the presence of variants of known HLA-B alleles in two individuals. PCR products encompassing HLA-B locus exons 1, 2, and 3 were prepared, subcloned and sequenced. A Hispanic individual had a novel B*07 allele (B*0714) and a Chinese individual had a novel B*27 allele (B*2718). In two other individuals, a previously unknown sequence of exon 1 was determined for HLA-B*0709 (African American) and B*2714 (Native American). These findings further illustrate the substantial genetic variation present at the HLA-B locus within human populations. We discuss the structural variation in the protein sequence for these HLA-B alleles and its potential functional effects.
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Affiliation(s)
- D Feldman
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
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13
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Gourley IS, Kearns J, McKeen M, Birkos S, Brown M, Kamoun M. HLA Class I typing of volunteers for a bone marrow registry: QC analysis by DNA-based methodology identifies serological typing discrepancies in the assignment of HLA-A and B antigens. Tissue Antigens 2002; 59:211-5. [PMID: 12074711 DOI: 10.1034/j.1399-0039.2002.590305.x] [Citation(s) in RCA: 14] [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: 11/23/2022]
Abstract
Until recently, the majority of newly recruited volunteer donors were typed for HLA-A and -B by serology onto the National Marrow Donor Program Registry. Quality control of this serological typing performed by contracted laboratories was carried out by retesting approximately 1% of each laboratory's test volume utilizing DNA-based techniques (SSOP). The criteria used for selection included samples presumed to be homozygotes, samples with split antigen specificities and samples with antigens considered to be difficult to define. Out of 1983 samples analyzed, 156 HLA-A (3.9%) and 265 HLA-B (6.7%) locus discrepancies were identified. Review of these discrepancies by both the serological and QC laboratory revealed that the majority of discrepancies were due to errors in serological typing. Serological discrepancies were categorized as follows: blank antigens identified (36.8%) and misassignments (63.2%). Misassignments were defined as either the incorrect assignment of antigens within a group ("wrong split"), or a complete misassignment. Antigens reported as blanks most frequently belonged to the A19 and A28 groups and to the B70, 46 and 40 groups. The most frequent misassignments within groups were the A19 and A10 groups, and the B40 and B15 groups. Other HLA-A misassignments included A2 vs A28 or A2 vs A69, while other HLA-B misassignments included B35 and B70. This QC analysis showed that serological typing of class I antigens for the purposes of NMDP registry typing is prone to a significant error rate. Careful evaluation and selection of contracted laboratories by the NMDP suggests methodological limitations rather than poor performance as the main cause of these observations.
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Affiliation(s)
- I S Gourley
- Department of Pathology and Laboratory Medicine university of Pennsylvania, Philadelphia 19035, USA
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Abstract
The release of a quantum of neurotransmitter from an active zone of a bouton is accompanied by the flow of extracellular current that creates a potential field about the site of transmitter action beneath the bouton. It is shown theoretically that the density of the field at the peak of the quantal current gives rise to an extracellular potential that declines to values of less than 5 microV at 1.3 microm distance in the circumferential direction around the neuron and equally rapidly in the radial direction away from the neuron. A loose-patch electrode placed over a bouton distorts the quantal field about the bouton and calculations show that under current-clamp conditions, potentials of over 40 microV can be recorded with an electrode of tip diameter 2 microm, provided the separation between the tip and the neuron's surface is about 0.1 microm. Quantal release recorded from visualized boutons on rat monopolar pelvic ganglion cells with loose-patch electrodes is in agreement with the properties of the quantal potential field given in the theoretical analysis.
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Affiliation(s)
- J Kearns
- Department of Physiology, Institute for Biomedical Research, New South Wales, 2006, Australia
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Gourley IS, Kearns J, Hou J, Wu J, Bassinger S, Montoya GD, McKeen M, Birkos S, Williams TM, Kamoun M. Novel HLA-B alleles identified in potential marrow donors: B*3917, B*1405 and B*3528. Tissue Antigens 2001; 58:201-4. [PMID: 11703832 DOI: 10.1034/j.1399-0039.2001.580312.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sequence-specific oligonucleotide probe hybridization and sequence-specific primer polymerase chain reaction (PCR) typing of volunteer bone marrow donors suggested the presence of variants of known HLA-B alleles in five individuals. PCR products encompassing HLA-B locus exons 1 through 3 were prepared and subcloned. Three African-American individuals had a novel HLA-B*39 allele (B*3917), and another African-American was found to have a novel HLA-B*14 allele (B*1405). In a third individual of Hispanic origin, a novel HLA-B*35 allele (B*3528) was identified. These findings further illustrate the substantial genetic variation present at the HLA-B locus within human populations.
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Affiliation(s)
- I S Gourley
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19035, USA
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Abstract
OBJECTIVE Research has consistently demonstrated that, among adolescents, the characteristics of one's peers are important predictors of substance abuse. The impact of the peer network on adult drinking, however, has received considerably less attention. The purpose of the present study was to examine social network characteristics that are associated with heavy drinking in adulthood prior to marriage. METHOD Couples were recruited at the time of their first marriage. Husbands and wives were each given identical questionnaire packets to complete at home, independently, as well as a postage-paid envelope for packet return. A broad range of constructs was assessed; included were personality characteristics, relationship functioning, drinking behavior and social network characteristics. Complete data were obtained from 471 husbands and 471 wives. RESULTS The social networks of heavy-drinking men, compared to men drinking regularly or infrequently, were younger, more likely to be male and unmarried and consisted of friends rather than family or others. For both men and women, "drinking buddies" accounted for nearly 75% of the heavy drinkers' peer networks. The overall ratings of support and conflict created by peers did not differ according to drinking group, for either men or women. CONCLUSIONS Prior to marriage, the social networks of heavy drinkers differ considerably from the networks of regular or infrequent drinkers with regard to the drinking patterns of their peers. An important finding was that heavy drinkers appear to experience a similar level of emotional, financial and practical support from their peer network compared to regular or infrequent drinkers.
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Affiliation(s)
- K E Leonard
- Research Institute on Addictions, State University of New York at Buffalo, 14203, USA
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Williams TM, Wu J, Bassinger S, Montoya GD, Yee J, Griffith BB, Kearns J, McKeen M, Birkos S, Gourley IS, Kamoun M. Novel HLA-B*15 alleles identified in potential marrow donors. Tissue Antigens 2000; 55:455-9. [PMID: 10885568 DOI: 10.1034/j.1399-0039.2000.550510.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Several methods for low-resolution class I typing of potential bone marrow donors are available. The National Marrow Donor Program (NMDP) has initiated pilot projects for large-scale DNA-based class I typing to initially characterize donors. Sequence-specific oligonucleotide probe hybridization and sequence-specific primer polymerase chain reaction (PCR) screening of 3,500 NMDP potential donors suggested the presence of variants of known HLA-B*15 variants in 3 donors. PCR products encompassing HLA-B locus exons 1 through 3 were prepared and subcloned. Sequencing revealed 3 alleles differing from known HLA-B*15 alleles by nucleotide substitutions resulting in predicted novel HLA-B antigens. The new alleles occur in distinct ethnic groups. These findings further illustrate the substantial genetic variation present at the HLA-B locus within human populations.
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Affiliation(s)
- T M Williams
- Department of Pathology, University of New Mexico, Albuquerque 87131-5051, USA.
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Gourley IS, Wu J, Bassinger S, Montoya GD, Yee J, Griffith BB, Kearns J, McKeen M, Birkos S, Williams TM, Kamoun M. A novel HLA-B*40 allele and novel exon 1 sequences of two B*40 alleles identified in potential marrow donors. Tissue Antigens 2000; 55:374-7. [PMID: 10852391 DOI: 10.1034/j.1399-0039.2000.550413.x] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sequence-specific oligonucleotide probe hybridization and sequence-specific primer polymerase chain reaction (PCR) typing suggested the presence of variants of HLA-B*40 in three individuals. Two were part of 3,500 potential marrow donors being screened for the National Marrow Donor Program, while the third was a clinical specimen. PCR products encompassing HLA-B locus exons 1 through 3 were prepared and subcloned. In one individual, a native of the Pacific Islands, sequencing revealed a novel HLA-B*40 allele (B*4023). In two other individuals, a previously unknown exon 1 sequence was determined for HLA-B*4016 (ethnicity unknown) and B*4020 (Hispanic). These findings further illustrate the substantial genetic variation present at the HLA-B locus within human populations.
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Affiliation(s)
- I S Gourley
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia 19305, USA
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19
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DeNofrio D, Rho R, Morales FJ, Kamoun M, Kearns J, Dorozinsky C, Rosengard BR, Acker MA, Loh E. Detection of anti-HLA antibody by flow cytometry in patients with a left ventricular assist device is associated with early rejection following heart transplantation. Transplantation 2000; 69:814-8. [PMID: 10755532 DOI: 10.1097/00007890-200003150-00024] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with a left ventricular assist device (LVAD) as a bridge to heart transplantation (HT) often have elevated levels of panel reactive antibodies (PRA). The clinical significance of anti-human histocompatibility leukocyte antigen (HLA) antibodies detected by flow cytometry in PRA negative patients remains unclear. METHODS Eighteen patients who underwent LVAD placement as a successful bridge to HT had standard anti-human globulin complement-dependent cytotoxicity and retrospective flow cytometry assays performed to detect class I anti-HLA antibodies. A positive flow result was defined as a fluorescent ratio of 23:1 versus a negative control. RESULTS Six patients had anti-HLA antibodies detected by flow cytometry. Univariate analysis demonstrated more moderate-severe rejection episodes (ISHLT > or = IIIA) at 2 months (0.83+/-0.75 vs. 0; P=0.04) and a trend toward decreased time to first rejection (61+/-17 vs. 225+/-62 days; P=0.06) in these patients. No differences were observed in donor-recipient HLA mismatch or 1 year Kaplan-Meier survival between patients with or without anti-HLA antibodies. CONCLUSION Despite a negative PRA, LVAD patients with class I anti-HLA antibodies detected by flow cytometry have a greater incidence of moderate-severe rejection in the first 2 months after HT. Flow cytometry may be a useful clinical tool in screening PRA negative LVAD patients before transplantation. Patients with positive anti-HLA antibody screening by flow cytometry may require more intensive immunosuppression in the early post-HT period.
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Affiliation(s)
- D DeNofrio
- Department of Medicine, University of Pennsylvania Health System, Philadelphia 19104, USA
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Abstract
There is some controversy regarding the relationship between development of median nerve dysfunction and employment activities. We performed nerve conduction studies of median nerve function on individuals before and after starting employment in the pork processing industry. After working an average of 64 days, employees (n = 45) showed significant prolongation of median motor and sensory nerve latency when comparing initial and final testing results in both dominant and non-dominant hands (P = < 0.01 to 0.03). A similar trend was found when testing a smaller group of employees (n = 17) who were already working (mean of 3 days), though this did not generally reach statistical significance. This study supports the conclusion that prolongation of median motor and sensory nerve latency can occur within as little as 2 months after beginning employment in the pork processing industry.
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Affiliation(s)
- J Kearns
- Ohio State University/MedOhio Occupational Health Centers, Columbus 43229-3747, USA
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21
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Choi JK, Kearns J, Palevsky HI, Montone KT, Kaiser LR, Zmijewski CM, Tomaszewski JE. Hyperacute rejection of a pulmonary allograft. Immediate clinical and pathologic findings. Am J Respir Crit Care Med 1999; 160:1015-8. [PMID: 10471633 DOI: 10.1164/ajrccm.160.3.9706115] [Citation(s) in RCA: 54] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The clinical and pathologic findings seen in hyperacute rejection are well documented in renal and cardiac allografts. We describe the second case of hyperacute rejection in a pulmonary allograft and detail the immediate clinicopathologic findings. The patient underwent a single lung transplant for severe COPD with postoperative course complicated by acute rejection and graft failure. Eleven days later, the patient underwent a second transplant with intra-operative course complicated by rapid pulmonary edema and copious production of frothy, pink fluid from the bronchial orifice of the allograft followed by death within four hours of anastomoses. Intraoperative biopsy and autopsy demonstrated platelet/fibrin thrombi, marked interstitial neutrophilia, alveolar edema, and antibody deposition on the endothelial surface and vasculature walls. Prior to the first transplant, the patient's serum had 0% panel reactive antibody and was crossmatch compatible with the first allograft. The patient's serum prior to the second transplant contained cross-reacting antibodies to the donor's B and T lymphocytes. The immediate clinical findings in this case are similar to the findings in a previously reported case. This report is the first documentation of the immediate pathologic features of hyperacute rejection in a lung allograft which are similar to those seen with other organ allografts.
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Affiliation(s)
- J K Choi
- Department of Pathology Hospital of the University of Pennsylvania, Philadelphia, USA
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Abstract
In the order Kinetoplastida, genetic exchange has been demonstrated only in the genus Trypanosoma. Analysis of kinetoplast DNA (kDNA) in genetic crosses of T. brucei has shown that whereas maxicircles are inherited uniparentally, minicircles are inherited from both parents. This result was confirmed for a new cross of T. b. brucei and T. b. rhodesiense by restriction enzyme digestion and Southern analysis of purified kDNA. By hybridisation with small minicircle-derived probes, we could demonstrate the presence of particular parental minicircles in the kDNA of hybrid progeny clones. All hybrid clones had inherited two minicircles from one parent despite two of the four clones having maxicircles from the other parent. The results suggest that rather than small-scale exchange of minicircles between parental networks, gross breakdown and reassembly of the minicircle network occurs during genetic exchange.
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Affiliation(s)
- W Gibson
- Department of Genetics, University of Leicester, UK.
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Betz JK, Ketchum RJ, Levy MM, Park DH, Perloff JR, Grodberg JB, Kearns J, Zmijewski CM, Brayman KL. Microlymphocytotoxicity assay to assess reactivity of rodent sera to large animal T lymphocytes. Transplant Proc 1994; 26:3449-50. [PMID: 7998216 DOI: pmid/7998216] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J K Betz
- Department of Surgery, University of Pennsylvania Medical Center, Philadelphia
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Friedman DF, Kwittken P, Cizman B, Argyris E, Kearns J, Yang SY, Zmijewski C, Bunin N, Douglas SD, Monos D. DNA-based HLA typing of nonhematopoietic tissue used to select the marrow transplant donor for successful treatment of transfusion-associated graft-versus-host disease. Clin Diagn Lab Immunol 1994; 1:590-6. [PMID: 8556506 PMCID: PMC368345 DOI: 10.1128/cdli.1.5.590-596.1994] [Citation(s) in RCA: 8] [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: 01/31/2023]
Abstract
Transfusion-associated graft-versus-host disease (TAGVHD) is a rare and usually fatal complication of blood transfusion which can arise when immunocompetent lymphocytes from the donor of a cellular blood product are transfused into a severely immunocompromised recipient. We describe the case of an 8-month-old male with a severe combined immunodeficiency syndrome who developed TAGVHD after receiving an unirradiated transfusion. Serologic HLA typing of the parents, the patient, and the blood donor demonstrated the foreign origin of circulating lymphocytes, confirming the diagnosis of TAGVHD. The manifestations of TAGVHD did not respond to medical immunosuppressive therapy, and bone marrow transplantation was planned to treat the underlying immunodeficiency as well as the TAGVHD. By using DNA-based class I and class II HLA typing, the child's HLA type was determined from nonhematopoietic tissues. This information proved critical in selecting the bone marrow donor. The child received immunosuppression, myeloablation, and a T-depleted, maternal bone marrow graft mismatched at one HLA class II allele. Trilineage hematopoietic engraftment occurred within 3 weeks, and the child remains clinically stable with no evidence of TAGVHD more than 2 years after the transplant. This case illustrates that TAGVHD can be successfully treated by allogeneic bone marrow transplantation and that DNA-based HLA typing can play a unique role in the diagnosis and management of TAGVHD.
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Affiliation(s)
- D F Friedman
- Department of Pathology, University of Pennsylvania Medical Center, Philadelphia, USA
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Kamoun M, Kearns J, Shlomchik M, Sloan S, Monos D, Zmijewski C. A novel method for the detection and descrimination of specific HLA class I and class II alloantibodies in the screening of potential transplant recipients using expanded and cryopreserved peripheral blood T cells. Hum Immunol 1991. [DOI: 10.1016/0198-8859(91)90252-5] [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: 12/01/2022]
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Kearns J. Confidentiality and informed consent. West J Med 1982. [DOI: 10.1136/bmj.284.6311.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kearns J. General practitioner in the factory. West J Med 1981. [DOI: 10.1136/bmj.283.6300.1187-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kearns J. Remuneration of NHS occupational health physicians. West J Med 1978. [DOI: 10.1136/bmj.2.6152.1647-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kearns J. Points from Letters: Unity. West J Med 1964. [DOI: 10.1136/bmj.1.5388.987-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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