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Shrimpton AJ, Quayle AC, Sleep DL, Brown JM, Cook TM. Quantification of aerosol generation during positive pressure ventilation via a supraglottic airway with an intentional leak. Anaesthesia 2024; 79:318-320. [PMID: 38217363 DOI: 10.1111/anae.16197] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/15/2024]
Affiliation(s)
| | - A C Quayle
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - D L Sleep
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J M Brown
- North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Shrimpton AJ, Brown V, Vassallo J, Nolan JP, Soar J, Hamilton F, Cook TM, Bzdek BR, Reid JP, Makepeace CH, Deutsch J, Ascione R, Brown JM, Benger JR, Pickering AE. A quantitative evaluation of aerosol generation during cardiopulmonary resuscitation. Anaesthesia 2024; 79:156-167. [PMID: 37921438 PMCID: PMC10952244 DOI: 10.1111/anae.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
It is unclear if cardiopulmonary resuscitation is an aerosol-generating procedure and whether this poses a risk of airborne disease transmission to healthcare workers and bystanders. Use of airborne transmission precautions during cardiopulmonary resuscitation may confer rescuer protection but risks patient harm due to delays in commencing treatment. To quantify the risk of respiratory aerosol generation during cardiopulmonary resuscitation in humans, we conducted an aerosol monitoring study during out-of-hospital cardiac arrests. Exhaled aerosol was recorded using an optical particle sizer spectrometer connected to the breathing system. Aerosol produced during resuscitation was compared with that produced by control participants under general anaesthesia ventilated with an equivalent respiratory pattern to cardiopulmonary resuscitation. A porcine cardiac arrest model was used to determine the independent contributions of ventilatory breaths, chest compressions and external cardiac defibrillation to aerosol generation. Time-series analysis of participants with cardiac arrest (n = 18) demonstrated a repeating waveform of respiratory aerosol that mapped to specific components of resuscitation. Very high peak aerosol concentrations were generated during ventilation of participants with cardiac arrest with median (IQR [range]) 17,926 (5546-59,209 [1523-242,648]) particles.l-1 , which were 24-fold greater than in control participants under general anaesthesia (744 (309-2106 [23-9099]) particles.l-1 , p < 0.001, n = 16). A substantial rise in aerosol also occurred with cardiac defibrillation and chest compressions. In a complimentary porcine model of cardiac arrest, aerosol recordings showed a strikingly similar profile to the human data. Time-averaged aerosol concentrations during ventilation were approximately 270-fold higher than before cardiac arrest (19,410 (2307-41,017 [104-136,025]) vs. 72 (41-136 [23-268]) particles.l-1 , p = 0.008). The porcine model also confirmed that both defibrillation and chest compressions generate high concentrations of aerosol independent of, but synergistic with, ventilation. In conclusion, multiple components of cardiopulmonary resuscitation generate high concentrations of respiratory aerosol. We recommend that airborne transmission precautions are warranted in the setting of high-risk pathogens, until the airway is secured with an airway device and breathing system with a filter.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - V. Brown
- Critical Care, South Western Ambulance Service NHS Foundation TrustUK
- Great Western Air Ambulance CharityBristolUK
| | - J. Vassallo
- Institute of Naval MedicineGosportUK
- Academic Department of Military Emergency MedicineRoyal Centre for Defence MedicineBirminghamUK
| | - J. P. Nolan
- University of Warwick, Warwick Medical SchoolCoventryUK
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - J. Soar
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - F. Hamilton
- MRC Integrative Epidemiology UnitUniversity of BristolUK
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - C. H. Makepeace
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - J. Deutsch
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - R. Ascione
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- University Hospital Bristol Weston NHS TrustBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - J. R. Benger
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - A. E. Pickering
- Department of AnaesthesiaUniversity Hospitals Bristol and WestonBristolUK
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
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Brown JM, Steffensen A, Trump B. Clinical features and overall survival of osteosarcoma of the mandible. Int J Oral Maxillofac Surg 2023; 52:524-530. [PMID: 36243646 DOI: 10.1016/j.ijom.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/08/2022] [Accepted: 10/06/2022] [Indexed: 04/09/2023]
Abstract
Osteosarcoma is the most common bone sarcoma and is typically found in the distal femur, proximal tibia, and proximal humerus. While several factors are known to influence survival, less is known regarding the influence of primary tumor location. This study describes the clinical features and prognosis of mandibular osteosarcoma. The SEER database was utilized to identify cases of mandibular osteosarcoma diagnosed between 2004 and 2015. Sex, age, grade, histological subtype, tumor size, tumor extension, presence of metastasis at diagnosis, and therapeutic intervention were determined. Osteosarcomas originating from other sites were assessed for comparison. There were 164 cases of mandibular osteosarcoma identified, representing 5.5% of all surveyed osteosarcomas. The 2-, 5-, and 10-year overall survival rates were 79.9%, 65.6% and 58.5%, respectively. Survival was worse for patients with older age, larger tumor size, metastatic disease, and absence of surgical resection. Compared to other sites, mandibular osteosarcomas were significantly smaller tumors and were far less likely to metastasize. Mandibular osteosarcoma manifested at an older age than the more common extremity osteosarcomas and presented with smaller tumors. Rates of metastasis of jaw osteosarcoma were much lower than osteosarcoma found in the extremities, while mortality rates were comparable.
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Affiliation(s)
- J M Brown
- Department of Orthopaedics, Huntsman Cancer Institute, Salt Lake City, Utah, USA.
| | - A Steffensen
- University of Utah School of Dentistry, Salt Lake City, Utah, USA
| | - B Trump
- University of Utah School of Dentistry, Salt Lake City, Utah, USA
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Shrimpton AJ, O'Farrell G, Howes HM, Craven R, Duffen AR, Cook TM, Reid JP, Brown JM, Pickering AE. A quantitative evaluation of aerosol generation during awake tracheal intubation. Anaesthesia 2023; 78:587-597. [PMID: 36710390 DOI: 10.1111/anae.15968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/31/2023]
Abstract
Aerosol-generating procedures are medical interventions considered high risk for transmission of airborne pathogens. Tracheal intubation of anaesthetised patients is not high risk for aerosol generation; however, patients often perform respiratory manoeuvres during awake tracheal intubation which may generate aerosol. To assess the risk, we undertook aerosol monitoring during a series of awake tracheal intubations and nasendoscopies in healthy participants. Sampling was undertaken within an ultraclean operating theatre. Procedures were performed and received by 12 anaesthetic trainees. The upper airway was topically anaesthetised with lidocaine and participants were not sedated. An optical particle sizer continuously sampled aerosol. Passage of the bronchoscope through the vocal cords generated similar peak median (IQR [range]) aerosol concentrations to coughing, 1020 (645-1245 [120-48,948]) vs. 1460 (390-2506 [40-12,280]) particles.l-1 respectively, p = 0.266. Coughs evoked when lidocaine was sprayed on the vocal cords generated 91,700 (41,907-166,774 [390-557,817]) particles.l-1 which was significantly greater than volitional coughs (p < 0.001). For 38 nasendoscopies in 12 participants, the aerosol concentrations were relatively low, 180 (120-525 [0-9552]) particles.l-1 , however, five nasendoscopies generated peak aerosol concentrations greater than a volitional cough. Awake tracheal intubation and nasendoscopy can generate high concentrations of respiratory aerosol. Specific risks are associated with lidocaine spray of the larynx, instrumentation of the vocal cords, procedural coughing and deep breaths. Given the proximity of practitioners to patient-generated aerosol, airborne infection control precautions are appropriate when undertaking awake upper airway endoscopy (including awake tracheal intubation, nasendoscopy and bronchoscopy) if respirable pathogens cannot be confidently excluded.
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Affiliation(s)
- A J Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and Neuroscience, University of Bristol, UK
| | - G O'Farrell
- Department of Anaesthesia, University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - H M Howes
- Department of Anaesthesia, University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - R Craven
- Department of Anaesthesia, University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - A R Duffen
- Department of Anaesthesia, University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK
| | - J P Reid
- School of Chemistry, University of Bristol, UK
| | - J M Brown
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - A E Pickering
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and Neuroscience, University of Bristol, UK.,Department of Anaesthesia, University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
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Jeziorska DM, Tunnacliffe EAJ, Brown JM, Ayyub H, Sloane-Stanley J, Sharpe JA, Lagerholm BC, Babbs C, Smith AJH, Buckle VJ, Higgs DR. On-microscope staging of live cells reveals changes in the dynamics of transcriptional bursting during differentiation. Nat Commun 2022; 13:6641. [PMID: 36333299 PMCID: PMC9636426 DOI: 10.1038/s41467-022-33977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Determining the mechanisms by which genes are switched on and off during development is a key aim of current biomedical research. Gene transcription has been widely observed to occur in a discontinuous fashion, with short bursts of activity interspersed with periods of inactivity. It is currently not known if or how this dynamic behaviour changes as mammalian cells differentiate. To investigate this, using an on-microscope analysis, we monitored mouse α-globin transcription in live cells throughout erythropoiesis. We find that changes in the overall levels of α-globin transcription are most closely associated with changes in the fraction of time a gene spends in the active transcriptional state. We identify differences in the patterns of transcriptional bursting throughout differentiation, with maximal transcriptional activity occurring in the mid-phase of differentiation. Early in differentiation, we observe increased fluctuation in transcriptional activity whereas at the peak of gene expression, in early erythroblasts, transcription is relatively stable. Later during differentiation as α-globin expression declines, we again observe more variability in transcription within individual cells. We propose that the observed changes in transcriptional behaviour may reflect changes in the stability of active transcriptional compartments as gene expression is regulated during differentiation.
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Affiliation(s)
- D. M. Jeziorska
- grid.4991.50000 0004 1936 8948MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK ,Present Address: Nucleome Therapeutics Ltd., BioEscalator, The Innovation Building, Old Road Campus, Oxford, OX3 7FZ UK
| | - E. A. J. Tunnacliffe
- grid.4991.50000 0004 1936 8948MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK
| | - J. M. Brown
- grid.4991.50000 0004 1936 8948MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK
| | - H. Ayyub
- grid.4991.50000 0004 1936 8948MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK
| | - J. Sloane-Stanley
- grid.4991.50000 0004 1936 8948MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK
| | - J. A. Sharpe
- grid.4991.50000 0004 1936 8948MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK
| | - B. C. Lagerholm
- grid.4991.50000 0004 1936 8948Wolfson Imaging Centre, MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK ,grid.4991.50000 0004 1936 8948Present Address: The Kennedy Institute Of Rheumatology, University of Oxford, Old Road Campus, Oxford, OX3 7FY UK
| | - C. Babbs
- grid.4991.50000 0004 1936 8948MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK
| | - A. J. H. Smith
- grid.4991.50000 0004 1936 8948MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK ,grid.4305.20000 0004 1936 7988Present Address: MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU UK
| | - V. J. Buckle
- grid.4991.50000 0004 1936 8948MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK
| | - D. R. Higgs
- grid.4991.50000 0004 1936 8948MRC Weatherall Institute for Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK ,grid.4991.50000 0004 1936 8948Chinese Academy of Medical Sciences Oxford Institute, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7BN UK
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Shrimpton AJ, Osborne CED, Brown JM, Cook TM, Penfold C, Rooshenas L, Pickering AE. Anaesthetists' current practice and perceptions of aerosol-generating procedures: a mixed-methods study. Anaesthesia 2022; 77:959-970. [PMID: 35864419 PMCID: PMC9543704 DOI: 10.1111/anae.15803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 01/11/2023]
Abstract
The evidence base surrounding the transmission risk of 'aerosol-generating procedures' has evolved primarily through quantification of aerosol concentrations during clinical practice. Consequently, infection prevention and control guidelines are undergoing continual reassessment. This mixed-methods study aimed to explore the perceptions of practicing anaesthetists regarding aerosol-generating procedures. An online survey was distributed to the Membership Engagement Group of the Royal College of Anaesthetists during November 2021. The survey included five clinical scenarios to identify the personal approach of respondents to precautions, their hospital's policies and the associated impact on healthcare provision. A purposive sample was selected for interviews to explore the reasoning behind their perceptions and behaviours in greater depth. A total of 333 survey responses were analysed quantitatively. Transcripts from 18 interviews were coded and analysed thematically. The sample was broadly representative of the UK anaesthetic workforce. Most respondents and their hospitals were aware of, supported and adhered to UK guidance. However, there were examples of substantial divergence from these guidelines at both individual and hospital level. For example, 40 (12%) requested respiratory protective equipment and 63 (20%) worked in hospitals that required it to be worn whilst performing tracheal intubation in SARS-CoV-2 negative patients. Additionally, 173 (52%) wore respiratory protective equipment whilst inserting supraglottic airway devices. Regarding the use of respiratory protective equipment and fallow times in the operating theatre: 305 (92%) perceived reduced efficiency; 376 (83%) perceived a negative impact on teamworking; 201 (64%) were worried about environmental impact; and 255 (77%) reported significant problems with communication. However, 269 (63%) felt the negative impacts of respiratory protection equipment were appropriately balanced against the risks of SARS-CoV-2 transmission. Attitudes were polarised about the prospect of moving away from using respiratory protective equipment. Participants' perceived risk from COVID-19 correlated with concern regarding stepdown (Spearman's test, R = 0.36, p < 0.001). Attitudes towards aerosol-generating procedures and the need for respiratory protective equipment are evolving and this information can be used to inform strategies to facilitate successful adoption of revised guidelines.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolUK
| | - C. E. D. Osborne
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United Hospital NHS TrustBathUK
| | - C. Penfold
- NIHR Bristol Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust and University of BristolUK
| | - L. Rooshenas
- Bristol Medical School, Bristol Population Health Science InstituteUniversity of BristolUK
| | - A. E. Pickering
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolUK
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Shrimpton AJ, Brown JM, Cook TM, Penfold CM, Reid JP, Pickering AE. Quantitative evaluation of aerosol generation from upper airway suctioning assessed during tracheal intubation and extubation sequences in anaesthetized patients. J Hosp Infect 2022; 124:13-21. [PMID: 35276282 PMCID: PMC9172909 DOI: 10.1016/j.jhin.2022.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Open respiratory suctioning is defined as an aerosol generating procedure (AGP). Laryngopharyngeal suctioning, used to clear secretions during anaesthesia, is widely managed as an AGP. However, it is uncertain whether upper airway suctioning should be designated as an AGP due to the lack of both aerosol and epidemiological evidence. AIM To assess the relative risk of aerosol generation by upper airway suctioning during tracheal intubation and extubation in anaesthetized patients. METHODS This prospective environmental monitoring study was undertaken in an ultraclean operating theatre setting to assay aerosol concentrations during intubation and extubation sequences, including upper airway suctioning, for patients undergoing surgery (N=19). An optical particle sizer (particle size 0.3-10 μm) sampled aerosol 20 cm above the patient's mouth. Baseline recordings (background, tidal breathing and volitional coughs) were followed by intravenous induction of anaesthesia with neuromuscular blockade. Four periods of laryngopharyngeal suctioning were performed with a Yankauer sucker: pre-laryngoscopy, post-intubation, pre-extubation and post-extubation. FINDINGS Aerosol was reliably detected {median 65 [interquartile range (IQR) 39-259] particles/L} above background [median 4.8 (IQR 1-7) particles/L, P<0.0001] when sampling in close proximity to the patient's mouth during tidal breathing. Upper airway suctioning was associated with a much lower average aerosol concentration than breathing [median 6.0 (IQR 0-12) particles/L, P=0.0007], and was indistinguishable from background (P>0.99). Peak aerosol concentrations recorded during suctioning [median 45 (IQR 30-75) particles/L] were much lower than during volitional coughs [median 1520 (IQR 600-4363) particles/L, P<0.0001] and tidal breathing [median 540 (IQR 300-1826) particles/L, P<0.0001]. CONCLUSION Upper airway suctioning during airway management was not associated with a higher aerosol concentration compared with background, and was associated with a much lower aerosol concentration compared with breathing and coughing. Upper airway suctioning should not be designated as a high-risk AGP.
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Affiliation(s)
- A J Shrimpton
- Anaesthesia, Pain and Critical Care, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
| | - J M Brown
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK
| | - C M Penfold
- Bristol Biomedical Research Centre, University of Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - J P Reid
- School of Chemistry, University of Bristol, Bristol, UK
| | - A E Pickering
- Anaesthesia, Pain and Critical Care, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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Shrimpton AJ, Brown JM, Gregson FKA, Cook TM, Scott DA, McGain F, Humphries RS, Dhillon RS, Reid JP, Hamilton F, Bzdek BR, Pickering AE. Quantitative evaluation of aerosol generation during manual facemask ventilation. Anaesthesia 2022; 77:22-27. [PMID: 34700360 PMCID: PMC8653000 DOI: 10.1111/anae.15599] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 01/13/2023]
Abstract
Manual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol-generating procedure. This designation is based on one epidemiological study suggesting an association between facemask ventilation and transmission during the SARS-CoV-1 outbreak in 2003. There is no direct evidence to indicate whether facemask ventilation is a high-risk procedure for aerosol generation. We conducted aerosol monitoring during routine facemask ventilation and facemask ventilation with an intentionally generated leak in anaesthetised patients. Recordings were made in ultraclean operating theatres and compared against the aerosol generated by tidal breathing and cough manoeuvres. Respiratory aerosol from tidal breathing in 11 patients was reliably detected above the very low background particle concentrations with median [IQR (range)] particle counts of 191 (77-486 [4-1313]) and 2 (1-5 [0-13]) particles.l-1 , respectively, p = 0.002. The median (IQR [range]) aerosol concentration detected during facemask ventilation without a leak (3 (0-9 [0-43]) particles.l-1 ) and with an intentional leak (11 (7-26 [1-62]) particles.l-1 ) was 64-fold (p = 0.001) and 17-fold (p = 0.002) lower than that of tidal breathing, respectively. Median (IQR [range]) peak particle concentration during facemask ventilation both without a leak (60 (0-60 [0-120]) particles.l-1 ) and with a leak (120 (60-180 [60-480]) particles.l-1 ) were 20-fold (p = 0.002) and 10-fold (0.001) lower than a cough (1260 (800-3242 [100-3682]) particles.l-1 ), respectively. This study demonstrates that facemask ventilation, even when performed with an intentional leak, does not generate high levels of bioaerosol. On the basis of this evidence, we argue facemask ventilation should not be considered an aerosol-generating procedure.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | | | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United Hospital NHS TrustBathUK
| | - D. A. Scott
- Department of Critical CareUniversity of Melbourne; St. Vincent's Hospital MelbourneAustralia
| | - F. McGain
- Western HealthFootscrayVictoriaAustralia
| | - R. S. Humphries
- Climate Science CentreCSIRO Oceans and AtmosphereAspendaleVictoriaAustralia
| | - R. S. Dhillon
- Department of NeurosurgerySt Vincent's Hospital MelbourneFitzroyVictoriaAustralia
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - F. Hamilton
- Department of Population Health SciencesUniversity of BristolBristolUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - A. E. Pickering
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
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Shrimpton AJ, Gregson FKA, Brown JM, Cook TM, Bzdek BR, Hamilton F, Reid JP, Pickering AE. A quantitative evaluation of aerosol generation during supraglottic airway insertion and removal. Anaesthesia 2021; 76:1577-1584. [PMID: 34287820 DOI: 10.1111/anae.15542] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/30/2022]
Abstract
Many guidelines consider supraglottic airway use to be an aerosol-generating procedure. This status requires increased levels of personal protective equipment, fallow time between cases and results in reduced operating theatre efficiency. Aerosol generation has never been quantitated during supraglottic airway use. To address this evidence gap, we conducted real-time aerosol monitoring (0.3-10-µm diameter) in ultraclean operating theatres during supraglottic airway insertion and removal. This showed very low background particle concentrations (median (IQR [range]) 1.6 (0-3.1 [0-4.0]) particles.l-1 ) against which the patient's tidal breathing produced a higher concentration of aerosol (4.0 (1.3-11.0 [0-44]) particles.l-1 , p = 0.048). The average aerosol concentration detected during supraglottic airway insertion (1.3 (1.0-4.2 [0-6.2]) particles.l-1 , n = 11), and removal (2.1 (0-17.5 [0-26.2]) particles.l-1 , n = 12) was no different to tidal breathing (p = 0.31 and p = 0.84, respectively). Comparison of supraglottic airway insertion and removal with a volitional cough (104 (66-169 [33-326]), n = 27), demonstrated that supraglottic airway insertion/removal sequences produced <4% of the aerosol compared with a single cough (p < 0.001). A transient aerosol increase was recorded during one complicated supraglottic airway insertion (which initially failed to provide a patent airway). Detailed analysis of this event showed an atypical particle size distribution and we subsequently identified multiple sources of non-respiratory aerosols that may be produced during airway management and can be considered as artefacts. These findings demonstrate supraglottic airway insertion/removal generates no more bio-aerosol than breathing and far less than a cough. This should inform the design of infection prevention strategies for anaesthetists and operating theatre staff caring for patients managed with supraglottic airways.
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Affiliation(s)
- A J Shrimpton
- Pain and Critical Care Sciences and School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - F K A Gregson
- School of Chemistry, University of Bristol, Bristol, UK
| | - J M Brown
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK
| | - B R Bzdek
- School of Chemistry, University of Bristol, Bristol, UK
| | - F Hamilton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J P Reid
- School of Chemistry, University of Bristol, Bristol, UK
| | - A E Pickering
- Pain and Critical Care Sciences and School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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10
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Shrimpton AJ, Brown JM, Cook TM, Pickering AE. A quantitative evaluation of aerosol generation during supraglottic airway insertion and removal. Anaesthesia 2021; 77:230-231. [PMID: 34432884 DOI: 10.1111/anae.15572] [Citation(s) in RCA: 2] [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] [Accepted: 08/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - J M Brown
- North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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11
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Brown JM, Yelland MJ, Pullen T, Silva E, Martin A, Gold I, Whittle L, Wisse P. Novel use of social media to assess and improve coastal flood forecasts and hazard alerts. Sci Rep 2021; 11:13727. [PMID: 34215770 PMCID: PMC8253846 DOI: 10.1038/s41598-021-93077-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/13/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022] Open
Abstract
Coastal communities and infrastructure need protection from flooding and wave overtopping events. Assessment of hazard prediction methods, used in sea defence design, defence performance inspections and forecasting services, requires observations at the land-sea interface but these are rarely collected. Here we show how a database of hindcast overtopping events, and the conditions that cause them, can be built using qualitative overtopping information obtained from social media. We develop a database for a case study site at Crosby in the Northwest of England, use it to test the standard methods applied in operational flood forecasting services and new defence design, and suggest improvements to these methods. This novel approach will become increasingly important to deliver long-term, cost-effective coastal management solutions as sea-levels rise and coastal populations grow. At sites with limited, or no, monitoring or forecasting services, this approach, especially if combined with citizen science initiatives, could underpin the development of simplified early warning systems.
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Affiliation(s)
- J M Brown
- National Oceanography Centre, 6 Brownlow Street, Liverpool, L3 5AD, UK.
| | - M J Yelland
- National Oceanography Centre, European Way, Southampton, SO14 3ZH, UK
| | - T Pullen
- HR Wallingford, Howbery Park, Wallingford, Oxfordshire, OX10 8BA, UK
| | - E Silva
- HR Wallingford, Howbery Park, Wallingford, Oxfordshire, OX10 8BA, UK
| | - A Martin
- Sefton Council, Trinity Road, Bootle, Liverpool, L20 3NJ, UK
| | - I Gold
- Environment Agency, Richard Fairclough House, Knutsford Road, Warrington, WA4 1HT, UK
| | - L Whittle
- Sefton Council, Trinity Road, Bootle, Liverpool, L20 3NJ, UK
| | - P Wisse
- Sefton Council, Trinity Road, Bootle, Liverpool, L20 3NJ, UK
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12
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Slade AL, Retzer A, Ahmed K, Kyte D, Keeley T, Armes J, Brown JM, Calman L, Gavin A, Glaser AW, Greenfield DM, Lanceley A, Taylor RM, Velikova G, Turner G, Calvert MJ. Systematic review of the use of translated patient-reported outcome measures in cancer trials. Trials 2021; 22:306. [PMID: 33902699 PMCID: PMC8074490 DOI: 10.1186/s13063-021-05255-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/08/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) are used in clinical trials to assess the effectiveness and tolerability of interventions. Inclusion of participants from different ethnic backgrounds is essential for generalisability of cancer trial results. PRO data collection should include appropriately translated patient-reported outcome measures (PROMs) to minimise missing data and sample attrition. METHODS Protocols and/or publications from cancer clinical trials using a PRO endpoint and registered on the National Institute for Health Research Portfolio were systematically reviewed for information on recruitment, inclusion of ethnicity data, and use of appropriately translated PROMs. Semi-structured interviews were conducted with key stakeholders to explore barriers and facilitators for optimal PRO trial design, diverse recruitment and reporting, and use of appropriately translated PROMs. RESULTS Eighty-four trials met the inclusion criteria, only 14 (17%) (n = 4754) reported ethnic group data, and ethnic group recruitment was low, 611 (13%). Although 8 (57%) studies were multi-centred and multi-national, none reported using translated PROMs, although available for 7 (88%) of the studies. Interviews with 44 international stakeholders identified a number of perceived barriers to ethnically diverse recruitment including diverse participant engagement, relevance of ethnicity to research question, prominence of PROs, and need to minimise investigator burden. Stakeholders had differing opinions on the use of translated PROMs, the impact of trial designs, and recruitment strategies on diverse recruitment. Facilitators of inclusive research were described and examples of good practice identified. CONCLUSIONS Greater transparency is required when PROs are used as primary or secondary outcomes in clinical trials. Protocols and publications should demonstrate that recruitment was accessible to diverse populations and facilitated by trial design, recruitment strategies, and appropriate PROM usage. The use of translated PROMs should be made explicit when used in cancer clinical trials.
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Affiliation(s)
- A L Slade
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK. .,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, West Midlands, UK.
| | - A Retzer
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - K Ahmed
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - D Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK.,National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK
| | - T Keeley
- Patient Centred Outcomes, GlaxoSmithKline, Brentford, UK
| | - J Armes
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,School of Health Sciences, University of Surrey, Guildford, UK.,NIHR Applied Research Collaboration Kent Surrey & Sussex University of Surrey, Guildford, UK
| | - J M Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - L Calman
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Highfield Campus, Southampton, UK
| | - A Gavin
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Northern Ireland Cancer Registry, Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - A W Glaser
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - D M Greenfield
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - A Lanceley
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R M Taylor
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - G Turner
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - M J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, West Midlands, UK.,National Institute for Health Research Applied Research Collaboration, University of Birmingham, Birmingham, West Midlands, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, West Midlands, UK
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13
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Downey CL, Croft J, Ainsworth G, Buckley H, Shinkins B, Randell R, Brown JM, Jayne DG. Trial of remote continuous versus intermittent NEWS monitoring after major surgery (TRaCINg): a feasibility randomised controlled trial. Pilot Feasibility Stud 2020; 6:183. [PMID: 33292669 PMCID: PMC7684886 DOI: 10.1186/s40814-020-00709-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/16/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite medical advances, major surgery remains high risk with up to 44% of patients experiencing postoperative complications. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability. The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient's mobility. The aim of this study was to evaluate the feasibility, acceptability and clinical outcomes of continuous remote monitoring after major surgery. METHODS The study was a randomised, controlled, unblinded, parallel group, feasibility trial. Adult patients undergoing elective major surgery were randomly assigned to receive continuous remote monitoring and normal National Early Warning Score (NEWS) monitoring (intervention group) or normal NEWS monitoring alone (control group). Continuous remote monitoring was achieved using the SensiumVitals® wireless patch which is worn on the patient's chest and monitors heart rate, respiratory rate and temperature continuously, and alerts the nurse when there is deviation from pre-set physiological norms. Feasibility was assessed by evaluating recruitment rate, adherence to protocol and randomisation and the amount of missing data. Clinical outcomes included time to antibiotics in cases of sepsis, length of hospital stay, number of critical care admissions and rate of hospital readmission within 30 days of discharge. RESULTS One hundred and thirty-six patients were randomised between October 2018 and April 2019: 67 to the control group and 69 to the intervention group. Recruitment was completed prior to the 12 month target with a high rate of eligibility and consent. Missing data was limited only to questionnaire responses; no participants were lost to follow-up and only one participant was withdrawn due to loss of capacity. The number of patients classed as 'drop-out' due to design (8.1%) were less than anticipated, and there were no participants who crossed over into the alternative trial allocation group. Seventeen participants in the intervention group (28%) did not adhere to the monitoring protocol. No formal comparisons between arms was undertaken; however, participants had fewer unplanned critical care admissions (1 versus 5) and had a shorter average length of hospital stay (11.6 days (95% confidence interval 9.5-13.7 days) versus 16.2 days (95% confidence interval 11.3-21.2 days)) in the continuous vital signs monitoring group. The time taken to receive antibiotics in cases of sepsis was similar in both arms. A cost-utility analysis indicated that the remote monitoring system was cost-saving when compared to standard NEWS monitoring alone. CONCLUSIONS It is feasible to perform a large-scale randomised controlled trial of continuous remote monitoring after major surgery. Progression to a definitive multicentre randomised controlled trial would be appropriate, taking consideration of factors, such as patient adherence, that might mask the potential benefit of additional monitoring. TRIAL REGISTRATION ISRCTN registry with study ID ISRCTN16601772 . Registered 30 August 2017.
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Affiliation(s)
- C L Downey
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS9 7TF, UK.
- St James's University Hospital, Level 7, Clinical Sciences Building, Leeds, LS9 7TF, UK.
| | - J Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL, UK
| | - G Ainsworth
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL, UK
| | - H Buckley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL, UK
| | - B Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, LS2 9NL, UK
| | - R Randell
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT, UK
| | - J M Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL, UK
| | - D G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS9 7TF, UK
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14
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Emmerson J, Brown JM. Understanding Survival Analysis in Clinical Trials. Clin Oncol (R Coll Radiol) 2020; 33:12-14. [PMID: 32788065 DOI: 10.1016/j.clon.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/30/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
Affiliation(s)
- J Emmerson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - J M Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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15
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Papadimitriou-Olivgeri I, Brown JM, Kilpatrick AFR, Gill HS, Athanasou NA. Correction to: Solochrome cyanine: A histological stain for cobalt-chromium wear particles in metal-on-metal periprosthetic tissues. J Mater Sci Mater Med 2019; 30:110. [PMID: 31555914 PMCID: PMC6828412 DOI: 10.1007/s10856-019-6312-0] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- I Papadimitriou-Olivgeri
- Department of Histopathology, NDORMS, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7HE, UK
| | - J M Brown
- Department of Histopathology, NDORMS, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7HE, UK
| | - A F R Kilpatrick
- Chemistry Research Laboratory, Mansfield Road, Oxford, OX1 3TA, UK
| | - H S Gill
- Department of Mechanical Engineering, University of Bath, Bath, BA2 7AY, UK
| | - N A Athanasou
- Department of Histopathology, NDORMS, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7HE, UK.
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16
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Papadimitriou-Olivgeri I, Brown JM, Kilpatrick AFR, Gill HS, Athanasou NA. Solochrome cyanine: A histological stain for cobalt-chromium wear particles in metal-on-metal periprosthetic tissues. J Mater Sci Mater Med 2019; 30:103. [PMID: 31493091 PMCID: PMC6731196 DOI: 10.1007/s10856-019-6304-0] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/23/2019] [Indexed: 06/10/2023]
Abstract
Metal-on-metal (MoM) hip arthroplasties produce abundant implant-derived wear debris composed mainly of cobalt (Co) and chromium (Cr). Cobalt-chromium (Co-Cr) wear particles are difficult to identify histologically and need to be distinguished from other wear particle types and endogenous components (e.g., haemosiderin, fibrin) which may be present in MoM periprosthetic tissues. In this study we sought to determine whether histological stains that have an affinity for metals are useful in identifying Co-Cr wear debris in MoM periprosthetic tissues. Histological sections of periprosthetic tissue from 30 failed MoM hip arthroplasties were stained with haematoxylin-eosin (HE), Solochrome Cyanine (SC), Solochrome Azurine (SA) and Perls' Prussian Blue (PB). Sections of periprosthetic tissue from 10 cases of non-MoM arthroplasties using other implant biomaterials, including titanium, ceramic, polymethylmethacrylate (PMMA) and ultra-high molecular weight polyethylene (UHMWP) were similarly analysed. Sections of 10 cases of haemosiderin-containing knee tenosynovial giant cell tumour (TSGCT) were also stained with HE, SC, SA and PB. In MoM periprosthetic tissues, SC stained metal debris in phagocytic macrophages and in the superficial necrotic zone which exhibited little or no trichrome staining for fibrin. In non-MoM periprosthetic tissues, UHMWP, PMMA, ceramic and titanium particles were not stained by SC. Prussian Blue, but not SC or SA, stained haemosiderin deposits in MoM periprosthetic tissues and TSGT. Our findings show that SC staining (most likely Cr-associated) is useful in distinguishing Co-Cr wear particles from other metal/non-metal wear particles types in histological preparations of periprosthetic tissue and that SC reliably distinguishes haemosiderin from Co-Cr wear debris.
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Affiliation(s)
- I Papadimitriou-Olivgeri
- Department of Histopathology, NDORMS, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7HE, UK
| | - J M Brown
- Department of Histopathology, NDORMS, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7HE, UK
| | - A F R Kilpatrick
- Chemistry Research Laboratory, Mansfield Road, Oxford, OX1 3TA, UK
| | - H S Gill
- Department of Mechanical Engineering, University of Bath, Bath, BA2 7AY, UK
| | - N A Athanasou
- Department of Histopathology, NDORMS, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7HE, UK.
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17
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Mullane KM, Morrison VA, Camacho LH, Arvin A, McNeil SA, Durrand J, Campbell B, Su SC, Chan ISF, Parrino J, Kaplan SS, Popmihajlov Z, Annunziato PW, Cerana S, Dictar MO, Bonvehi P, Tregnaghi JP, Fein L, Ashley D, Singh M, Hayes T, Playford G, Morrissey O, Thaler J, Kuehr T, Greil R, Pecherstorfer M, Duck L, Van Eygen K, Aoun M, De Prijck B, Franke FA, Barrios CHE, Mendes AVA, Serrano SV, Garcia RF, Moore F, Camargo JFC, Pires LA, Alves RS, Radinov A, Oreshkov K, Minchev V, Hubenova AI, Koynova T, Ivanov I, Rabotilova B, Minchev V, Petrov PA, Chilingirov P, Karanikolov S, Raynov J, Grimard D, McNeil S, Kumar D, Larratt LM, Weiss K, Delage R, Diaz-Mitoma FJ, Cano PO, Couture F, Carvajal P, Yepes A, Torres Ulloa R, Fardella P, Caglevic C, Rojas C, Orellana E, Gonzalez P, Acevedo A, Galvez KM, Gonzalez ME, Franco S, Restrepo JG, Rojas CA, Bonilla C, Florez LE, Ospina AV, Manneh R, Zorica R, Vrdoljak DV, Samarzija M, Petruzelka L, Vydra J, Mayer J, Cibula D, Prausova J, Paulson G, Ontaneda M, Palk K, Vahlberg A, Rooneem R, Galtier F, Postil D, Lucht F, Laine F, Launay O, Laurichesse H, Duval X, Cornely OA, Camerer B, Panse J, Zaiss M, Derigs HG, Menzel H, Verbeek M, Georgoulias V, Mavroudis D, Anagnostopoulos A, Terpos E, Cortes D, Umanzor J, Bejarano S, Galeano RW, Wong RSM, Hui P, Pedrazzoli P, Ruggeri L, Aversa F, Bosi A, Gentile G, Rambaldi A, Contu A, Marei L, Abbadi A, Hayajneh W, Kattan J, Farhat F, Chahine G, Rutkauskiene J, Marfil Rivera LJ, Lopez Chuken YA, Franco Villarreal H, Lopez Hernandez J, Blacklock H, Lopez RI, Alvarez R, Gomez AM, Quintana TS, Moreno Larrea MDC, Zorrilla SJ, Alarcon E, Samanez FCA, Caguioa PB, Tiangco BJ, Mora EM, Betancourt-Garcia RD, Hallman-Navarro D, Feliciano-Lopez LJ, Velez-Cortes HA, Cabanillas F, Ganea DE, Ciuleanu TE, Ghizdavescu DG, Miron L, Cebotaru CL, Cainap CI, Anghel R, Dvorkin MV, Gladkov OA, Fadeeva NV, Kuzmin AA, Lipatov ON, Zbarskaya II, Akhmetzyanov FS, Litvinov IV, Afanasyev BV, Cherenkova M, Lioznov D, Lisukov IA, Smirnova YA, Kolomietz S, Halawani H, Goh YT, Drgona L, Chudej J, Matejkova M, Reckova M, Rapoport BL, Szpak WM, Malan DR, Jonas N, Jung CW, Lee DG, Yoon SS, Lopez Jimenez J, Duran Martinez I, Rodriguez Moreno JF, Solano Vercet C, de la Camara R, Batlle Massana M, Yeh SP, Chen CY, Chou HH, Tsai CM, Chiu CH, Siritanaratkul N, Norasetthada L, Sriuranpong V, Seetalarom K, Akan H, Dane F, Ozcan MA, Ozsan GH, Kalayoglu Besisik SF, Cagatay A, Yalcin S, Peniket A, Mullan SR, Dakhil KM, Sivarajan K, Suh JJG, Sehgal A, Marquez F, Gomez EG, Mullane MR, Skinner WL, Behrens RJ, Trevarthe DR, Mazurczak MA, Lambiase EA, Vidal CA, Anac SY, Rodrigues GA, Baltz B, Boccia R, Wertheim MS, Holladay CS, Zenk D, Fusselman W, Wade III JL, Jaslowsk AJ, Keegan J, Robinson MO, Go RS, Farnen J, Amin B, Jurgens D, Risi GF, Beatty PG, Naqvi T, Parshad S, Hansen VL, Ahmed M, Steen PD, Badarinath S, Dekker A, Scouros MA, Young DE, Graydon Harker W, Kendall SD, Citron ML, Chedid S, Posada JG, Gupta MK, Rafiyath S, Buechler-Price J, Sreenivasappa S, Chay CH, Burke JM, Young SE, Mahmood A, Kugler JW, Gerstner G, Fuloria J, Belman ND, Geller R, Nieva J, Whittenberger BP, Wong BMY, Cescon TP, Abesada-Terk G, Guarino MJ, Zweibach A, Ibrahim EN, Takahashi G, Garrison MA, Mowat RB, Choi BS, Oliff IA, Singh J, Guter KA, Ayrons K, Rowland KM, Noga SJ, Rao SB, Columbie A, Nualart MT, Cecchi GR, Campos LT, Mohebtash M, Flores MR, Rothstein-Rubin R, O'Connor BM, Soori G, Knapp M, Miranda FG, Goodgame BW, Kassem M, Belani R, Sharma S, Ortiz T, Sonneborn HL, Markowitz AB, Wilbur D, Meiri E, Koo VS, Jhangiani HS, Wong L, Sanani S, Lawrence SJ, Jones CM, Murray C, Papageorgiou C, Gurtler JS, Ascensao JL, Seetalarom K, Venigalla ML, D'Andrea M, De Las Casas C, Haile DJ, Qazi FU, Santander JL, Thomas MR, Rao VP, Craig M, Garg RJ, Robles R, Lyons RM, Stegemoller RK, Goel S, Garg S, Lowry P, Lynch C, Lash B, Repka T, Baker J, Goueli BS, Campbell TC, Van Echo DA, Lee YJ, Reyes EA, Senecal FM, Donnelly G, Byeff P, Weiss R, Reid T, Roeland E, Goel A, Prow DM, Brandt DS, Kaplan HG, Payne JE, Boeckh MG, Rosen PJ, Mena RR, Khan R, Betts RF, Sharp SA, Morrison VA, Fitz-Patrick D, Congdon J, Erickson N, Abbasi R, Henderson S, Mehdi A, Wos EJ, Rehmus E, Beltzer L, Tamayo RA, Mahmood T, Reboli AC, Moore A, Brown JM, Cruz J, Quick DP, Potz JL, Kotz KW, Hutchins M, Chowhan NM, Devabhaktuni YD, Braly P, Berenguer RA, Shambaugh SC, O'Rourke TJ, Conkright WA, Winkler CF, Addo FEK, Duic JP, High KP, Kutner ME, Collins R, Carrizosa DR, Perry DJ, Kailath E, Rosen N, Sotolongo R, Shoham S, Chen T. Safety and efficacy of inactivated varicella zoster virus vaccine in immunocompromised patients with malignancies: a two-arm, randomised, double-blind, phase 3 trial. The Lancet Infectious Diseases 2019; 19:1001-1012. [DOI: 10.1016/s1473-3099(19)30310-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022]
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Kotecha T, Martinez-Naharro A, Lambe T, Francis RD, Chacko LIZA, Brown JM, Knight DS, Hawkins PN, Moon JM, Kellman PN, Bulluck H, Hausenloy DS, Rakhit RD, Fontana M. 48Quantification of myocardial infarct size and microvascular obstruction using dark-blood late gadolinium enhancement. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez112.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Kotecha
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Martinez-Naharro
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - T Lambe
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - R D Francis
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - L I Z A Chacko
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Brown
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - D S Knight
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - P N Hawkins
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - P N Kellman
- National Institutes of Health, Bethesda, United States of America
| | - H Bulluck
- Norfolk and Norwich University Hospital, Norwich, United Kingdom of Great Britain & Northern Ireland
| | - D S Hausenloy
- National Heart Centre Singapore, Singapore, Singapore
| | - R D Rakhit
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
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Kotecha T, Martinez-Naharro A, Little C, Chacko LIZA, Manmathan G, Brown JM, Knight DS, Hawkins PN, Moon JM, Xue H, Lockie T, Rakhit RD, Kellman PN, Patel N, Fontana M. 303Quantitative CMR perfusion mapping to detect microvascular dysfunction in patients without obstructive coronary disease. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez119.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Kotecha
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Martinez-Naharro
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - C Little
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - L I Z A Chacko
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - G Manmathan
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Brown
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - D S Knight
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - P N Hawkins
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - T Lockie
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - R D Rakhit
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - P N Kellman
- National Institutes of Health, Bethesda, United States of America
| | - N Patel
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
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Kotecha T, Monteagudo JM, Martinez-Naharro A, Little C, Chacko LIZA, Brown JM, Knight D, Hawkins PN, Moon JM, Xue H, Kellman PN, Patel N, Lockie T, Rakhit RD, Fontana M. 302Redefining assessment of adenosine stress response using CMR perfusion mapping: An alternative to splenic switch off. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Kotecha
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Monteagudo
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Martinez-Naharro
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - C Little
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - L I Z A Chacko
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Brown
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - D Knight
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - P N Hawkins
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - P N Kellman
- National Institutes of Health, Bethesda, United States of America
| | - N Patel
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - T Lockie
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - R D Rakhit
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- Royal Free Hospital , Cardiology, London, United Kingdom of Great Britain & Northern Ireland
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21
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Bolton WS, Aruparayil N, Quyn A, Scott J, Wood A, Bundu I, Gnanaraj J, Brown JM, Jayne DG. Disseminating technology in global surgery. Br J Surg 2019; 106:e34-e43. [DOI: 10.1002/bjs.11036] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Effective dissemination of technology in global surgery is vital to realize universal health coverage by 2030. Challenges include a lack of human resource, infrastructure and finance. Understanding these challenges, and exploring opportunities and solutions to overcome them, are essential to improve global surgical care.
Methods
This review focuses on technologies and medical devices aimed at improving surgical care and training in low- and middle-income countries. The key considerations in the development of new technologies are described, along with strategies for evaluation and wider dissemination. Notable examples of where the dissemination of a new surgical technology has achieved impact are included.
Results
Employing the principles of frugal and responsible innovation, and aligning evaluation and development to high scientific standards help overcome some of the challenges in disseminating technology in global surgery. Exemplars of effective dissemination include low-cost laparoscopes, gasless laparoscopic techniques and innovative training programmes for laparoscopic surgery; low-cost and versatile external fixation devices for fractures; the LifeBox pulse oximeter project; and the use of immersive technologies in simulation, training and surgical care delivery.
Conclusion
Core strategies to facilitate technology dissemination in global surgery include leveraging international funding, interdisciplinary collaboration involving all key stakeholders, and frugal scientific design, development and evaluation.
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Affiliation(s)
- W S Bolton
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - N Aruparayil
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - A Quyn
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - J Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Wood
- Department of Orthopaedic Surgery, Leeds General Infirmary, Leeds, UK
| | - I Bundu
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - J Gnanaraj
- Karunya Institute of Technology and Science, Karunya Nagar, Coimbatore, India
| | - J M Brown
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - D G Jayne
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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22
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Zhu W, Buffa JA, Wang Z, Warrier M, Schugar R, Shih DM, Gupta N, Gregory JC, Org E, Fu X, Li L, DiDonato JA, Lusis AJ, Brown JM, Hazen SL. Flavin monooxygenase 3, the host hepatic enzyme in the metaorganismal trimethylamine N-oxide-generating pathway, modulates platelet responsiveness and thrombosis risk. J Thromb Haemost 2018; 16:1857-1872. [PMID: 29981269 PMCID: PMC6156942 DOI: 10.1111/jth.14234] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 06/26/2018] [Indexed: 12/21/2022]
Abstract
Essentials Microbe-dependent production of trimethylamine N-oxide (TMAO) contributes to thrombosis risk. The impact of host flavin monooxygenase 3 (FMO3) modulation on platelet function is unknown. Genetic manipulation of FMO3 in mice alters systemic TMAO levels and thrombosis potential. Genetic manipulation of FMO3 is associated with alteration of gut microbial community structure. SUMMARY Background Gut microbes play a critical role in the production of trimethylamine N-oxide (TMAO), an atherogenic metabolite that impacts platelet responsiveness and thrombosis potential. Involving both microbe and host enzymatic machinery, TMAO generation utilizes a metaorganismal pathway, beginning with ingestion of trimethylamine (TMA)-containing dietary nutrients such as choline, phosphatidylcholine and carnitine, which are abundant in a Western diet. Gut microbial TMA lyases use these nutrients as substrates to produce TMA, which upon delivery to the liver via the portal circulation, is converted into TMAO by host hepatic flavin monooxygenases (FMOs). Gut microbial production of TMA is rate limiting in the metaorganismal TMAO pathway because hepatic FMO activity is typically in excess. Objectives FMO3 is the major FMO responsible for host generation of TMAO; however, a role for FMO3 in altering platelet responsiveness and thrombosis potential in vivo has not yet been explored. Methods The impact of FMO3 suppression (antisense oligonucleotide-targeting) and overexpression (as transgene) on plasma TMAO levels, platelet responsiveness and thrombosis potential was examined using a murine FeCl3 -induced carotid artery injury model. Cecal microbial composition was examined using 16S analyses. Results Modulation of FMO3 directly impacts systemic TMAO levels, platelet responsiveness and rate of thrombus formation in vivo. Microbial composition analyses reveal taxa whose proportions are associated with both plasma TMAO levels and in vivo thrombosis potential. Conclusions The present studies demonstrate that host hepatic FMO3, the terminal step in the metaorganismal TMAO pathway, participates in diet-dependent and gut microbiota-dependent changes in both platelet responsiveness and thrombosis potential in vivo.
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Affiliation(s)
- W. Zhu
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - J. A. Buffa
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - Z. Wang
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - M. Warrier
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - R. Schugar
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - D. M. Shih
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - N. Gupta
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - J. C. Gregory
- Departments of Human Genetics and Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - E. Org
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - X. Fu
- Departments of Human Genetics and Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - L. Li
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - J. A. DiDonato
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - A. J. Lusis
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - J. M. Brown
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
- Departments of Human Genetics and Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - S. L. Hazen
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Armstrong G, Croft J, Corrigan N, Brown JM, Goh V, Quirke P, Hulme C, Tolan D, Kirby A, Cahill R, O'Connell PR, Miskovic D, Coleman M, Jayne D. IntAct: intra-operative fluorescence angiography to prevent anastomotic leak in rectal cancer surgery: a randomized controlled trial. Colorectal Dis 2018; 20:O226-O234. [PMID: 29751360 PMCID: PMC6099475 DOI: 10.1111/codi.14257] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/02/2018] [Indexed: 02/06/2023]
Abstract
AIM Anastomotic leak (AL) is a major complication of rectal cancer surgery. Despite advances in surgical practice, the rates of AL have remained static, at around 10-15%. The aetiology of AL is multifactorial, but one of the most crucial risk factors, which is mostly under the control of the surgeon, is blood supply to the anastomosis. The MRC/NIHR IntAct study will determine whether assessment of anastomotic perfusion using a fluorescent dye (indocyanine green) and near-infrared laparoscopy can minimize the rate of AL leak compared with conventional white-light laparoscopy. Two mechanistic sub-studies will explore the role of the rectal microbiome in AL and the predictive value of CT angiography/perfusion studies. METHOD IntAct is a prospective, unblinded, parallel-group, multicentre, European, randomized controlled trial comparing surgery with intra-operative fluorescence angiography (IFA) against standard care (surgery with no IFA). The primary end-point is rate of clinical AL at 90 days following surgery. Secondary end-points include all AL (clinical and radiological), change in planned anastomosis, complications and re-interventions, use of stoma, cost-effectiveness of the intervention and quality of life. Patients should have a diagnosis of adenocarcinoma of the rectum suitable for potentially curative surgery by anterior resection. Over 3 years, 880 patients from 25 European centres will be recruited and followed up for 90 days. DISCUSSION IntAct will rigorously evaluate the use of IFA in rectal cancer surgery and explore the role of the microbiome in AL and the predictive value of preoperative CT angiography/perfusion scanning.
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Affiliation(s)
| | - J. Croft
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - N. Corrigan
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - J. M. Brown
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - V. Goh
- School of Biomedical Engineering and Imaging SciencesKing's College London and Honorary Consultant RadiologistGuy's and St Thomas’ Hospitals NHS Foundation TrustLondonUK
| | | | - C. Hulme
- Academic Unit of Health EconomicsLeeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - D. Tolan
- Leeds Teaching Hospital TrustLeedsUK
| | | | - R. Cahill
- University College DublinDublinIreland
| | | | | | - M. Coleman
- Derriford HospitalPlymouth NHS TrustPlymouthUK
| | - D. Jayne
- Leeds Institute of Biological and Clinical SciencesSt James's University HospitalLeedsUK
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Downey CL, Croft J, Buckley H, Randell R, Brown JM, Jayne DG. Trial of Remote Continuous versus Intermittent NEWS monitoring after major surgery (TRaCINg): protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2018; 4:112. [PMID: 29992041 PMCID: PMC5994656 DOI: 10.1186/s40814-018-0299-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/21/2018] [Indexed: 01/21/2023] Open
Abstract
Background Despite medical advances, major surgery remains high risk. Up to 44% of patients experience postoperative complications, which can have huge impacts for patients and the healthcare system. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability. The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient's mobility. The aim of this study is to evaluate the feasibility, acceptability and clinical impacts of continuous remote monitoring after major surgery. Methods The study is a randomised, controlled, unblinded, parallel group, feasibility trial. Adult patients undergoing elective major surgery will be invited to participate if they have the capacity to provided informed, written consent and do not have a cardiac pacemaker or an allergy to adhesives. Participants will be randomly assigned to receive continuous remote monitoring and normal National Early Warning Score (NEWS) monitoring (intervention group) or normal NEWS monitoring alone (control group). Continuous remote monitoring will be achieved using the SensiumVitals® wireless patch which is worn on the patient's chest and monitors heart rate, respiratory rate and temperature continuously and alerts the nurse when there is deviation from pre-set physiological norms. Participants will be followed up throughout their hospital admission and for 30 days after discharge. Feasibility will be assessed by evaluating recruitment rate, adherence to protocol and randomisation, and the amount of missing data. The acceptability of the patch to nursing staff and patients will be assessed using questionnaires and interviews. Clinical outcomes will include time to antibiotics in cases of sepsis, length of hospital stay, number of critical care admissions and rate of readmission within 30 days of discharge. Discussion Early detection and treatment of complications minimises the need for critical care, improves patient outcomes, and produces significant cost savings for the healthcare system. Remote continuous monitoring systems have the potential to allow earlier detection of complications, but evidence from the literature is mixed. Demonstrating significant benefit over intermittent monitoring to offset the practical and economic implications of continuous monitoring requires well-controlled studies in high-risk populations to demonstrate significant differences in clinical outcomes; this feasibility trial seeks to provide evidence of how best to conduct such a confirmatory trial. Trial registration This study is listed on the ISRCTN registry with study ID ISRCTN16601772.
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Affiliation(s)
- C L Downey
- Leeds Institute of Biomedical and Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Level 7 Clinical Sciences Building, Leeds, LS9 7TF UK
| | - J Croft
- 2Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL UK
| | - H Buckley
- 2Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL UK
| | - R Randell
- 3School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT UK
| | - J M Brown
- 2Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL UK
| | - D G Jayne
- Leeds Institute of Biomedical and Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Level 7 Clinical Sciences Building, Leeds, LS9 7TF UK
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Downey CL, Chapman S, Randell R, Brown JM, Jayne DG. The impact of continuous versus intermittent vital signs monitoring in hospitals: A systematic review and narrative synthesis. Int J Nurs Stud 2018; 84:19-27. [PMID: 29729558 DOI: 10.1016/j.ijnurstu.2018.04.013] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [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: 12/05/2017] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Continuous vital signs monitoring on general hospital wards may allow earlier detection of patient deterioration and improve patient outcomes. This systematic review will assess if continuous monitoring is practical outside of the critical care setting, and whether it confers any clinical benefit to patients. METHODS MEDLINE®, MEDLINE® In-Process, EMBASE, CINAHL and The Cochrane Library were searched for articles that evaluated the clinical or non-clinical outcomes of continuous vital signs monitoring in adults outside of the critical care setting. The protocol was registered with PROSPERO (CRD42017058098). FINDINGS Twenty-four studies met the inclusion criteria and reported outcomes on a total of 40,274 patients and 59 ward staff in nine countries. The majority of studies showed benefits in terms of critical care use and length of hospital stay. Larger studies were more likely to demonstrate clinical benefit, particularly critical care use and length of hospital stay. Three studies showed cost-effectiveness. Barriers to implementation included nursing and patient satisfaction and the burden of false alerts. CONCLUSIONS Continuous vital signs monitoring outside the critical care setting is feasible and may provide a benefit in terms of improved patient outcomes and cost efficiency. Large, well-controlled studies in high-risk populations are required to evaluate the clinical benefit of continuous monitoring systems.
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Affiliation(s)
- C L Downey
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom.
| | - S Chapman
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom
| | - R Randell
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - J M Brown
- Leeds Institute of Clinical Trials Research, Worsley Building, University of Leeds, Leeds, LS2 9NL, United Kingdom
| | - D G Jayne
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom
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Downey CL, Brown JM, Jayne DG, Randell R. Patient attitudes towards remote continuous vital signs monitoring on general surgery wards: An interview study. Int J Med Inform 2018; 114:52-56. [PMID: 29673603 DOI: 10.1016/j.ijmedinf.2018.03.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/07/2017] [Accepted: 03/23/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vital signs monitoring is used to identify deteriorating patients in hospital. The most common tool for vital signs monitoring is an early warning score, although emerging technologies allow for remote, continuous patient monitoring. A number of reviews have examined the impact of continuous monitoring on patient outcomes, but little is known about the patient experience. This study aims to discover what patients think of monitoring in hospital, with a particular emphasis on intermittent early warning scores versus remote continuous monitoring, in order to inform future implementations of continuous monitoring technology. METHODS Semi-structured interviews were undertaken with 12 surgical inpatients as part of a study testing a remote continuous monitoring device. All patients were monitored with both an early warning score and the new device. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. FINDINGS Patients can see the value in remote, continuous monitoring, particularly overnight. However, patients appreciate the face-to-face aspect of early warning score monitoring as it allows for reassurance, social interaction, and gives them further opportunity to ask questions about their medical care. CONCLUSION Early warning score systems are widely used to facilitate detection of the deteriorating patient. Continuous monitoring technologies may provide added reassurance. However, patients value personal contact with their healthcare professionals and remote monitoring should not replace this. We suggest that remote monitoring is best introduced in a phased manner, and initially as an adjunct to usual care, with careful consideration of the patient experience throughout.
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Affiliation(s)
- C L Downey
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom.
| | - J M Brown
- Leeds Institute of Clinical Trials Research, Worsley Building, University of Leeds, Leeds, LS2 9NL, United Kingdom
| | - D G Jayne
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom
| | - R Randell
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT, United Kingdom
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Tiemeier GL, Brown JM, Pratap SE, McCarthy C, Kastrenopoulou A, Bradley K, Wilson S, Orosz Z, Gibbons CLMH, Oppermann U, Athanasou NA. Pleomorphic liposarcoma of bone: a rare primary malignant bone tumour. Clin Sarcoma Res 2018; 8:2. [PMID: 29449935 PMCID: PMC5807841 DOI: 10.1186/s13569-018-0089-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/05/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Liposarcoma is an extremely rare primary bone sarcoma. CASE PRESENTATION We report a case of primary pleomorphic liposarcoma that arose in an 18 year old male in the metaphysis of the left tibia. Plain radiographs showed a partly sclerotic lesion and MR imaging a heterogeneous tumour predominantly isointense on T1- and high-signal on T2-weighted sequences with focal areas of increased T1 signal that suppressed with fat saturation. PET/CT showed marked FDG uptake (SUV = 17.1) in the primary tumour as well as a metastasis in the right distal femur and multiple small pulmonary metastases. Histologically, the tumour was a pleomorphic liposarcoma containing large tumour cells with vacuolated cytoplasm and hyperchromatic pleomorphic nuclei as well as numerous lipoblasts and scattered brown fat-like cells. Tumour cells strongly expressed FABP4/aP2, a marker of adipocyte differentiation, and UCP1, a marker of brown fat, but not S100. The case was treated with neoadjuvant MAP chemotherapy, resulting in extensive (> 95%) necrosis in the primary tumour and almost complete resolution of the femoral and pulmonary metastases. CONCLUSIONS Pleomorphic liposarcoma can present as a sclerotic primary malignant bone tumour; markers of adipose differentiation are useful in histological diagnosis and neoadjuvant MAP chemotherapy results in significant tumor necrosis.
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Affiliation(s)
- G. L. Tiemeier
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
| | - J. M. Brown
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
| | - S. E. Pratap
- Sarcoma Service, Nuffield Orthopaedic Centre, Oxford, UK
| | - C. McCarthy
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford, UK
| | - A. Kastrenopoulou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
| | - K. Bradley
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - S. Wilson
- Sarcoma Service, Nuffield Orthopaedic Centre, Oxford, UK
| | - Z. Orosz
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
| | | | - U. Oppermann
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
| | - N. A. Athanasou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, OX3 7HE UK
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Vidanapathirana AK, Thompson LC, Herco M, Odom J, Sumner SJ, Fennell TR, Brown JM, Wingard CJ. Acute intravenous exposure to silver nanoparticles during pregnancy induces particle size and vehicle dependent changes in vascular tissue contractility in Sprague Dawley rats. Reprod Toxicol 2018; 75:10-22. [PMID: 29154916 PMCID: PMC6241519 DOI: 10.1016/j.reprotox.2017.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/26/2017] [Accepted: 11/13/2017] [Indexed: 12/17/2022]
Abstract
The use of silver nanoparticles (AgNP) raises safety concerns during susceptible life stages such as pregnancy. We hypothesized that acute intravenous exposure to AgNP during late stages of pregnancy will increase vascular tissue contractility, potentially contributing to alterations in fetal growth. Sprague Dawley rats were exposed to a single dose of PVP or Citrate stabilized 20 or 110nm AgNP (700μg/kg). Differential vascular responses and EC50 values were observed in myographic studies in uterine, mesenteric arteries and thoracic aortic segments, 24h post-exposure. Reciprocal responses were observed in aortic and uterine vessels following PVP stabilized AgNP with an increased force of contraction in uterine artery and increased relaxation responses in aorta. Citrate stabilized AgNP exposure increased contractile force in both uterine and aortic vessels. Intravenous AgNP exposure during pregnancy displayed particle size and vehicle dependent moderate changes in vascular tissue contractility, potentially influencing fetal blood supply.
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Affiliation(s)
- A K Vidanapathirana
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - L C Thompson
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - M Herco
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - J Odom
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - S J Sumner
- Discovery Sciences, RTI International, Research Triangle Park, NC, 27709, USA; Department of Nutrition School of Public Health University of North Carolina at Chapel Hill, Kannapolis, NC, 28081, USA
| | - T R Fennell
- Discovery Sciences, RTI International, Research Triangle Park, NC, 27709, USA
| | - J M Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, CO, 80045, USA
| | - C J Wingard
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA; Department of Physical Therapy, Bellarmine University, Louisville, KY, 40205, USA.
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Abstract
A solid phase in the mixed water-carbon dioxide system, previously identified as carbonic acid, was observed in the high-pressure diamond-anvil cell. The pressure-temperature paths of both its melting and peritectic curves were measured, beginning at 4.4 GPa and 165 °C (where it exists in a quadruple equilibrium, together with an aqueous fluid and the ices H2O(VII) and CO2(I)) and proceeding to higher pressures and temperatures. Single-crystal X-ray diffraction revealed a triclinic crystal with unit cell parameters (at 6.5 GPa and 20 °C) of a = 5.88 Å, b = 6.59 Å, c = 6.99 Å, α = 88.7°, β = 79.7°, and γ = 67.7°. Raman spectra exhibit a major line at ~1080 cm−1 and lattice modes below 300 cm−1.
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Affiliation(s)
- E H Abramson
- Department of Earth and Space Sciences, University of Washington, Seattle, WA, 98195-1310, USA.
| | - O Bollengier
- Department of Earth and Space Sciences, University of Washington, Seattle, WA, 98195-1310, USA
| | - J M Brown
- Department of Earth and Space Sciences, University of Washington, Seattle, WA, 98195-1310, USA
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McDonald TJ, Franko KL, Brown JM, Jenkins SL, Nathanielsz PW, Nijland MJ. Betamethasone in the Last Week of Pregnancy Causes Fetal Growth Rtardation but Not Adult Hypertension in Rats. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1071-55760300151-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- T J. McDonald
- Laboratory for Pregnancy and Newborn Research, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
| | | | | | | | | | - M. J. Nijland
- Laboratory for Pregnancy and Newborn Research, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
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Cheng D, Xu X, Boudyguina E, Simon T, Deng Z, VerHague M, Lord C, Brown JM, Lee AH, Weinberg RB, Parks JS. Abstract 540: Very Low Density Lipoprotein Assembly is Required for cAMP Responsive Element-binding Protein H Processing and Hepatic Apolipoprotein A-IV Expression in Mouse Models of Acute Steatosis. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.540] [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: 11/16/2022]
Abstract
Background:
Our previous studies have demonstrated that hepatic expression of apolipoprotein A-IV (apoA-IV) is increased in mouse models of chronic steatosis and is closely correlated with hepatic triglyceride (TG) content. We have also shown that steatosis-induced hepatic apoA-IV gene expression is regulated by processing of the nuclear transcription factor cAMP responsive element-binding protein H (CREBH). Herein, we explored the mechanisms that mediate steatosis-induced CREBH processing.
Methods:
We measured hepatic CREBH processing, apoA-IV gene expression, and lipid content in several mouse models of attenuated or enhanced VLDL assembly that were subjected to acute steatosis induced by a 16 hour overnight fast or by feeding a ketogenic diet for 6 days.
Results:
Both fasting and the ketogenic diet induced acute hepatic TG accumulation associated with increased CREBH processing and apoA-IV gene expression, which were associated with hepatic TG content in C57BL/6 mice. All mouse models of attenuated VLDL secretion (shRNA-induced apoB knock down, liver specific microsomal triglyceride transfer protein (MTP) knockout, treatment with the MTP inhibitor BMS212122, and comparative gene identification-58 (CGI-58) deficiency) had increased hepatic TG accumulation, but displayed repressed CREBH processing and reduced apoA-IV gene expression compared to controls. When deficient VLDL assembly in liver-specific MTP knockout mice was reconstituted by adenoviral infection with a human MTP transgene, steatosis-induced CREBH processing and apoA-IV expression were restored. In a mouse model of enhanced VLDL assembly (transgenic overexpression of human MTP), apoA-IV gene expression correlated with bulk hepatic TG accumulation, but not with VLDL secretion rate, indicating that other steatosis-related factors participate in apoA-IV gene regulation.
Conclusions:
Taken together, these data provide compelling evidence that VLDL assembly and secretion is required for hepatic CREBH processing and enhanced apoA-IV gene expression in the setting of acute steatosis. These data further suggest that CREBH and apoA-IV play central roles in VLDL-mediated hepatic lipid efflux.
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Affiliation(s)
- Dongmei Cheng
- Dept of Internal Medicine/Section on Molecular Medicine, Wake Forest Sch of Medicine, Winston-Salem, NC
| | - Xu Xu
- Dept of of Pathology and Laboratory Medicine, Weill Cornell Med College, New York, NY
| | - Elena Boudyguina
- Dept of Internal Medicine/Section on Molecular Medicine, Wake Forest Sch of Medicine, Winston-Salem, NC
| | - Trang Simon
- Dept of Gastroenterology, Wake Forest Sch of Medicine, Winston-Salem, NC
| | - Zhiyong Deng
- Dept of Cancer Biology, Wake Forest Sch of Medicine, Winston-Salem, NC
| | - Melissa VerHague
- Dept of Internal Medicine/Section on Molecular Medicine, Wake Forest Sch of Medicine, Winston-Salem, NC
| | - Caleb Lord
- Dept of Internal Medicine/Section on Molecular Medicine, Wake Forest Sch of Medicine, Winston-Salem, NC
| | - J. M Brown
- Dept of Cellular and Molecular Medicine, Cleveland Clinic Lerner Rsch Institute, Cleveland, OH
| | - Ann-Hwee Lee
- Dept of of Pathology and Laboratory Medicine, Weill Cornell Med College, New York, NY
| | - Richard B Weinberg
- Dept of Internal Medicine/Section of Gastroenterology, Wake Forest Sch of Medicine, Winston-Salem, NC
| | - John S Parks
- Dept of Internal Medicine/Section on Molecular Medicine, Wake Forest Sch of Medicine, Winston-Salem, NC
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Affiliation(s)
- J M Brown
- Aneurin Bevan University Health Board , UK
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Brown JM, Shanor C, Wright EM, Kolesik M. Carrier-wave shape effects in optical filamentation. Opt Lett 2016; 41:859-862. [PMID: 26974064 DOI: 10.1364/ol.41.000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Strong-field ionization in optical filaments created by ultrashort pulses with sub-cycle engineered waveforms is studied theoretically. To elucidate the physics of the recently demonstrated enhanced ionization yield and spatial control of the optical filament core in two color pulses, we employ two types of quantum models integrated into spatially resolved pulse-propagation simulations. We show that the dependence of the ionization on the shape of the excitation carrier is adiabatic in nature, and is driven by local temporal peaks of the electric field. Implications for the modeling of light-matter interactions in multicolor optical fields are also discussed.
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Cooper IA, Brown JM, Getty T. A role for ecology in the evolution of colour variation and sexual dimorphism in Hawaiian damselflies. J Evol Biol 2015; 29:418-27. [DOI: 10.1111/jeb.12796] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/01/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- I. A. Cooper
- Department of Zoology Kellogg Biological Station Michigan State University Hickory Corners MI USA
- Department of Biology James Madison University Harrisonburg VA USA
| | - J. M. Brown
- Department of Biology Grinnell College Grinnell IA USA
| | - T. Getty
- Department of Zoology Kellogg Biological Station Michigan State University Hickory Corners MI USA
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Glazer DI, Davenport MS, Khalatbari S, Cohan RH, Ellis JH, Caoili EM, Stein EB, Childress JC, Masch WR, Brown JM, Mollard BJ, Montgomery JS, Palapattu GS, Francis IR. Mass-like peripheral zone enhancement on CT is predictive of higher-grade (Gleason 4 + 3 and higher) prostate cancer. ACTA ACUST UNITED AC 2015; 40:560-70. [PMID: 25193787 DOI: 10.1007/s00261-014-0233-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether focal peripheral zone enhancement on routine venous-phase CT is predictive of higher-grade (Gleason 4 + 3 and higher) prostate cancer. MATERIALS AND METHODS IRB approval was obtained and informed consent waived for this HIPAA-compliant retrospective study. Forty-three patients with higher-grade prostate cancer (≥Gleason 4 + 3) and 96 with histology-confirmed lower-grade (≤Gleason 3 + 4 [n = 47]) or absent (n = 49) prostate cancer imaged with venous-phase CT comprised the study population. CT images were reviewed by ten blinded radiologists (5 attendings, 5 residents) who scored peripheral zone enhancement on a scale of 1 (benign) to 5 (malignant). Mass-like peripheral zone enhancement was considered malignant. Likelihood ratios (LR) and specificities were calculated. Multivariate conditional logistic regression analyses were conducted. RESULTS Scores of "5" were strongly predictive of higher-grade prostate cancer (pooled LR+ 9.6 [95% CI 5.8-15.8]) with rare false positives (pooled specificity: 0.98 [942/960, 95% CI 0.98-0.99]; all 10 readers had specificity ≥95%). Attending scores of "5" were more predictive than resident scores of "5" (LR+: 14.7 [95% CI 5.8-37.2] vs. 7.6 [95% CI 4.2-13.7]) with similar specificity (0.99 [475/480, 95% CI 0.98-1.00] vs. 0.97 [467/480, 95% CI 0.96-0.99]). Significant predictors of an assigned score of "5" included presence of a peripheral zone mass (p < 0.0001), larger size (p < 0.0001), and less reader experience (p = 0.0008). Significant predictors of higher-grade prostate cancer included presence of a peripheral zone mass (p = 0.0002) and larger size (p < 0.0001). CONCLUSION Focal mass-like peripheral zone enhancement on routine venous-phase CT is specific and predictive of higher-grade (Gleason 4 + 3 and higher) prostate cancer.
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Affiliation(s)
- D I Glazer
- Department of Radiology, University of Michigan Health System, B2-A209P, Ann Arbor, MI, 48109, USA
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Bahl A, Brown JM, Wright EM, Kolesik M. Assessment of the metastable electronic state approach as a microscopically self-consistent description for the nonlinear response of atoms. Opt Lett 2015; 40:4987-4990. [PMID: 26512500 DOI: 10.1364/ol.40.004987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This Letter presents the first quantitative assessment of the recently proposed metastable electronic state approach (MESA) for calculation of the nonlinear optical response of noble gas atoms. Based on the single active electron potentials for several atomic species, Stark resonant states are used to extract the nonlinear polarization and ionization rates free of any additional fitting parameters. It is shown that even the simplest version of the method provides a viable, first-principle-based, and self-consistent alternative to the standard model commonly used for simulations in the field of extreme nonlinear optics.
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Brown JM, Price SJ, Price RA. Predicting risk after aneurysm surgery. Anaesthesia 2015; 70:1320. [PMID: 26449294 DOI: 10.1111/anae.13241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - R A Price
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Holland NA, Becak DP, Shannahan JH, Brown JM, Carratt SA, Winkle L, Pinkerton KE, Wang CM, Munusamy P, Baer DR, Sumner SJ, Fennell TR, Lust RM, Wingard CJ. Cardiac Ischemia Reperfusion Injury Following Instillation of 20 nm Citrate-capped Nanosilver. ACTA ACUST UNITED AC 2015; 6. [PMID: 26966636 DOI: 10.4172/2157-7439.s6-006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Silver nanoparticles (AgNP) have garnered much interest due to their antimicrobial properties, becoming one of the most utilized nano-scale materials. However, any potential evocable cardiovascular injury associated with exposure has not been reported to date. We have previously demonstrated expansion of myocardial infarction after intratracheal (IT) instillation of carbon-based nanomaterials. We hypothesized pulmonary exposure to Ag core AgNP induces a measureable increase in circulating cytokines, expansion of cardiac ischemia-reperfusion (I/R) injury and is associated with depressed coronary constrictor and relaxation responses. Secondarily, we addressed the potential contribution of silver ion release on AgNP toxicity. METHODS Male Sprague-Dawley rats were exposed to 200 μl of 1 mg/ml of 20 nm citrate-capped Ag core AgNP, 0.01, 0.1, 1 mg/ml Silver Acetate (AgAc), or a citrate vehicle by intratracheal (IT) instillation. One and 7 days following IT instillation the lungs were evaluated for inflammation and the presence of silver; serum was analyzed for concentrations of selected cytokines; cardiac I/R injury and coronary artery reactivity were assessed. RESULTS AgNP instillation resulted in modest pulmonary inflammation with detection of silver in lung tissue and alveolar macrophages, elevation of serum cytokines: G-CSF, MIP-1α, IL-1β, IL-2, IL-6, IL-13, IL-10, IL-18, IL-17α, TNFα, and RANTES, expansion of I/R injury and depression of the coronary vessel reactivity at 1 day post IT compared to vehicle treated rats. Silver within lung tissue was persistent at 7 days post IT instillation and was associated with an elevation in cytokines: IL-2, IL-13, and TNFα and expansion of I/R injury. AgAc resulted in a concentration dependent infarct expansion and depressed vascular reactivity without marked pulmonary inflammation or serum cytokine response. CONCLUSIONS Based on these data, IT instillation of AgNP increases circulating levels of several key cytokines, which may contribute to persistent expansion of I/R injury possibly through an impaired vascular responsiveness.
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Affiliation(s)
- N A Holland
- Department of Physiology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - D P Becak
- Department of Physiology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Jonathan H Shannahan
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado Anschutz Medical Campus, Aurora, USA
| | - J M Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado Anschutz Medical Campus, Aurora, USA
| | - S A Carratt
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California at Davis, Davis, California, USA
| | - Lsv Winkle
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California at Davis, Davis, California, USA
| | - K E Pinkerton
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California at Davis, Davis, California, USA
| | - C M Wang
- Pacific Northwest National Laboratory, EMSL, Richland, USA
| | - P Munusamy
- Pacific Northwest National Laboratory, EMSL, Richland, USA
| | - Don R Baer
- Pacific Northwest National Laboratory, EMSL, Richland, USA
| | - S J Sumner
- RTI International, Discovery Sciences, Research Triangle Park, USA
| | - T R Fennell
- RTI International, Discovery Sciences, Research Triangle Park, USA
| | - R M Lust
- Department of Physiology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - C J Wingard
- Department of Physiology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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Viale E, Martinez-Sañudo I, Brown JM, Simonato M, Girolami V, Squartini A, Bressan A, Faccoli M, Mazzon L. Pattern of association between endemic Hawaiian fruit flies (Diptera, Tephritidae) and their symbiotic bacteria: Evidence of cospeciation events and proposal of "Candidatus Stammerula trupaneae". Mol Phylogenet Evol 2015; 90:67-79. [PMID: 25959751 DOI: 10.1016/j.ympev.2015.04.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 04/18/2015] [Accepted: 04/28/2015] [Indexed: 11/18/2022]
Abstract
Several insect lineages have evolved mutualistic association with symbiotic bacteria. This is the case of some species of mealybugs, whiteflies, weevils, tsetse flies, cockroaches, termites, carpenter ants, aphids and fruit flies. Some species of Tephritinae, the most specialized subfamily of fruit flies (Diptera: Tephritidae), harbour co-evolved vertically transmitted, bacterial symbionts in their midgut, known as "Candidatus Stammerula spp.". The 25 described endemic species of Hawaiian tephritids, plus at least three undescribed species, are taxonomically distributed among three genera: the cosmopolitan genus Trupanea (21 described spp.), the endemic genus Phaeogramma (2 spp.) and the Nearctic genus Neotephritis (2 spp.). We examined the presence of symbiotic bacteria in the endemic tephritids of the Hawaiian Islands, which represent a spectacular example of adaptive radiation, and tested the concordant evolution between host and symbiont phylogenies. We detected through PCR assays the presence of specific symbiotic bacteria, designated as "Candidatus Stammerula trupaneae", from 35 individuals of 15 species. The phylogeny of the insect host was reconstructed based on two regions of the mitochondrial DNA (16S rDNA and COI-tRNALeu-COII), while the bacterial 16S rRNA was used for the symbiont analysis. Host and symbiont phylogenies were then compared and evaluated for patterns of cophylogeny and strict cospeciation. Topological congruence between Hawaiian Tephritinae and their symbiotic bacteria phylogenies suggests a limited, but significant degree of host-symbiont cospeciation. We also explored the character reconstruction of three host traits, as island location, host lineage, and host tissue attacked, based on the symbiont phylogenies under the hypothesis of cospeciation.
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Affiliation(s)
- E Viale
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova - Agripolis, Viale dell'Università, 16, 35020 Legnaro, Padova, Italy.
| | - I Martinez-Sañudo
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova - Agripolis, Viale dell'Università, 16, 35020 Legnaro, Padova, Italy.
| | - J M Brown
- Department of Biology, Grinnell College, Grinnell, IA 50012, USA.
| | - M Simonato
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova - Agripolis, Viale dell'Università, 16, 35020 Legnaro, Padova, Italy.
| | - V Girolami
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova - Agripolis, Viale dell'Università, 16, 35020 Legnaro, Padova, Italy
| | - A Squartini
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova - Agripolis, Viale dell'Università, 16, 35020 Legnaro, Padova, Italy.
| | - A Bressan
- Bayer Crop Science LP, R&D Trait Research, 3500 Paramount Parkway, Morrisville, NC 27560, USA.
| | - M Faccoli
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova - Agripolis, Viale dell'Università, 16, 35020 Legnaro, Padova, Italy.
| | - L Mazzon
- Department of Agronomy, Food, Natural Resources, Animals and Environment (DAFNAE), University of Padova - Agripolis, Viale dell'Università, 16, 35020 Legnaro, Padova, Italy.
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Ordidge KL, Brown JM, Succony L, Navani N, Hardavella G, Lawrence DR, Fraioli F, Groves A, Janes SM. Massive pulmonary carcinoid tumor deemed inoperable until (68)Ga DOTATATE positron emission tomography/magnetic resonance imaging. Am J Respir Crit Care Med 2014; 190:e16-7. [PMID: 25171317 DOI: 10.1164/rccm.201309-1635im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- K L Ordidge
- 1 Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, Rayne Building, University College London, London, United Kingdom
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McDunn BA, Brown JM, Hale RG. Fuzzy memories and boundary extension: Individual scenes or episodic experiences. J Vis 2014. [DOI: 10.1167/14.10.872] [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: 11/24/2022] Open
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Schneider CM, Repka CP, Brown JM, Lalonde TL, Dallow KT, Barlow CE, Hayward R. Demonstration of the need for cardiovascular and pulmonary normative data for cancer survivors. Int J Sports Med 2014; 35:1134-7. [PMID: 24995960 DOI: 10.1055/s-0034-1375691] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite evidence that cancer and its treatments severely reduce cardiorespiratory fitness (CRF), normative data for cancer survivors do not exist. The present study identifies age and gender-specific CRF distributions in a cancer population. The use of cancer-specific normative CRF data may help stratify initial fitness status and assess improvements in response to exercise interventions in cancer survivors. Data from 703 cancer survivors were analyzed for this study. Quintiles were compiled for peak oxygen consumption (VO2peak), forced vital capacity (FVC), and forced expiratory volume (FEV1) for males and females in 5 age groups (19-39, 40-49, 50-59, 60-69, and ≥70 years of age). VO2peak values for the cancer population were significantly lower than the general US population. The cancer population average in each age group fell within the "very poor" classification of VO2peak values for the general population. FVC values in the cancer population were similar to the general population. Cancer survivors had very low age group-specific VO2peak values compared to the apparently healthy general US population. Previously, CRF values of cancer survivors were compared to normative values for the apparently healthy general population, which yielded imprecise classifications of initial fitness and changes in fitness, resulting in patient discouragement.
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Affiliation(s)
- C M Schneider
- Rocky Mountain Cancer Rehabilitation Institute, University of Northern Colorado, Greeley, United States
| | - C P Repka
- Rocky Mountain Cancer Rehabilitation Institute, University of Northern Colorado, Greeley, United States
| | - J M Brown
- Rocky Mountain Cancer Rehabilitation Institute, University of Northern Colorado, Greeley, United States
| | - T L Lalonde
- Department of Applied Statistics and Research Methods, University of Northern Colorado, Greeley, United States
| | - K T Dallow
- Family Medicine, North Colorado Medical Center, Greeley, United States
| | - C E Barlow
- Research Department, The Cooper Institute, Dallas, United States
| | - R Hayward
- Rocky Mountain Cancer Rehabilitation Institute, University of Northern Colorado, Greeley, United States
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Lathia JD, Hale JS, Sloan AE, Gladson CL, Hazen SL, Horbinski C, Rich JN, Brown JM. INTEGRATION OF CANCER STEM CELL MAINTENANCE AND LIPID METABOLISM BY SCAVENGER RECEPTORS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou206.62] [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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Abstract
Tumours have two main ways to develop a vasculature: by angiogenesis, the sprouting of endothelial cells from nearby blood vessels, and vasculogenesis, the formation of blood vessels from circulating cells. Because tumour irradiation abrogates local angiogenesis, the tumour must rely on the vasculogenesis pathway for regrowth after irradiation. Tumour irradiation produces a marked influx of CD11b(+) myeloid cells (macrophages) into the tumours, and these are crucial to the formation of blood vessels in the tumours after irradiation and for the recurrence of the tumours. This process is driven by increased tumour hypoxia, which increases levels of HIF-1 (hypoxia-inducible factor 1), which in turn upregulates SDF-1 (stromal cell-derived factor 1 or CXCL12), the main driver of the vasculogenesis pathway. Inhibition of HIF-1 or of its downstream target SDF-1 prevents the radiation-induced influx of the CD11b(+) myeloid cells and delays or prevents the tumours from recurring following irradiation. Others and we have shown that with a variety of tumours in both mice and rats, the inhibition of the SDF-1/CXCR4 pathway delays or prevents the recurrence of implanted or autochthonous tumours following irradiation or following treatment with vascular disrupting agents or some chemotherapeutic drugs such as paclitaxel. In addition to the recruited macrophages, endothelial progenitor cells (EPCs) are also recruited to the irradiated tumours, a process also driven by SDF-1. Together, the recruited proangiogenic macrophages and the EPCs reform the tumour vasculature and allow the tumour to regrow following irradiation. This is a new paradigm with major implications for the treatment of solid tumours by radiotherapy.
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Affiliation(s)
- J M Brown
- Division of Radiation and Cancer Biology, Department of Radiation Oncology, Stanford University, Stanford, CA, USA
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Vidanapathirana AK, Thompson LC, Odom J, Holland NA, Sumner SJ, Fennell TR, Brown JM, Wingard CJ. Vascular Tissue Contractility Changes Following Late Gestational Exposure to Multi-Walled Carbon Nanotubes or their Dispersing Vehicle in Sprague Dawley Rats. ACTA ACUST UNITED AC 2014; 5. [PMID: 27066300 DOI: 10.4172/2157-7439.1000201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Multi-walled carbon nanotubes (MWCNTs) are increasingly used in industry and in nanomedicine raising safety concerns, especially during unique life-stages such as pregnancy. We hypothesized that MWCNT exposure during pregnancy will increase vascular tissue contractile responses by increasing Rho kinase signaling. Pregnant (17-19 gestational days) and non-pregnant Sprague Dawley rats were exposed to 100 μg/kg of MWCNTs by intratracheal instillation or intravenous administration. Vasoactive responses of uterine, mesenteric, aortic and umbilical vessels were studied 24 hours post-exposure by wire myography. The contractile responses of the vessel segments were different between the pregnant and non-pregnant rats, following MWCNT exposure. Maximum stress generation in the uterine artery segments from the pregnant rats following pulmonary MWCNT exposure was increased in response to angiotensin II by 4.9 mN/mm2 (+118%), as compared to the naïve response and by 2.6 mN/mm2 (+40.7%) as compared to the vehicle exposed group. Following MWCNT exposure, serotonin induced approximately 4 mN/mm2 increase in stress generation of the mesenteric artery from both pregnant and non-pregnant rats as compared to the vehicle response. A significant contribution of the dispersion medium was identified as inducing changes in the contractile properties following both pulmonary and intravenous exposure to MWCNTs. Wire myographic studies in the presence of a Rho kinase inhibitor and RhoA and Rho kinase mRNA/protein expression of rat aortic endothelial cells were unaltered following exposure to MWCNTs, suggesting absent/minimal contribution of Rho kinase to the enhanced contractile responses following MWCNT exposure. The reactivity of the umbilical vein was not changed; however, mean fetal weight gain was reduced with dispersion media and MWCNT exposure by both routes. These results suggest a susceptibility of the vasculature during gestation to MWCNT and their dispersion media-induced vasoconstriction, predisposing reduced fetal growth during pregnancy.
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Affiliation(s)
- A K Vidanapathirana
- Department of Physiology, Brody School of Medicine, East Carolina University, NC 27834, USA
| | - L C Thompson
- Department of Physiology, Brody School of Medicine, East Carolina University, NC 27834, USA
| | - J Odom
- Department of Physiology, Brody School of Medicine, East Carolina University, NC 27834, USA
| | - N A Holland
- Department of Physiology, Brody School of Medicine, East Carolina University, NC 27834, USA
| | - S J Sumner
- Discovery Sciences, RTI International, Research Triangle Park, NC, 27709, USA
| | - T R Fennell
- Discovery Sciences, RTI International, Research Triangle Park, NC, 27709, USA
| | - J M Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, CO, 80045, USA
| | - C J Wingard
- Department of Physiology, Brody School of Medicine, East Carolina University, NC 27834, USA
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Walters MJ, Ebsworth K, Berahovich RD, Penfold MET, Liu SC, Al Omran R, Kioi M, Chernikova SB, Tseng D, Mulkearns-Hubert EE, Sinyuk M, Ransohoff RM, Lathia JD, Karamchandani J, Kohrt HEK, Zhang P, Powers JP, Jaen JC, Schall TJ, Merchant M, Recht L, Brown JM. Inhibition of CXCR7 extends survival following irradiation of brain tumours in mice and rats. Br J Cancer 2014; 110:1179-88. [PMID: 24423923 PMCID: PMC3950859 DOI: 10.1038/bjc.2013.830] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [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] [Revised: 12/12/2013] [Accepted: 12/18/2013] [Indexed: 12/26/2022] Open
Abstract
Background: In experimental models of glioblastoma multiforme (GBM), irradiation (IR) induces local expression of the chemokine CXCL12/SDF-1, which promotes tumour recurrence. The role of CXCR7, the high-affinity receptor for CXCL12, in the tumour's response to IR has not been addressed. Methods: We tested CXCR7 inhibitors for their effects on tumour growth and/or animal survival post IR in three rodent GBM models. We used immunohistochemistry to determine where CXCR7 protein is expressed in the tumours and in human GBM samples. We used neurosphere formation assays with human GBM xenografts to determine whether CXCR7 is required for cancer stem cell (CSC) activity in vitro. Results: CXCR7 was detected on tumour cells and/or tumour-associated vasculature in the rodent models and in human GBM. In human GBM, CXCR7 expression increased with glioma grade and was spatially associated with CXCL12 and CXCL11/I-TAC. In the rodent GBM models, pharmacological inhibition of CXCR7 post IR caused tumour regression, blocked tumour recurrence, and/or substantially prolonged survival. CXCR7 expression levels on human GBM xenograft cells correlated with neurosphere-forming activity, and a CXCR7 inhibitor blocked sphere formation by sorted CSCs. Conclusions: These results indicate that CXCR7 inhibitors could block GBM tumour recurrence after IR, perhaps by interfering with CSCs.
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Affiliation(s)
- M J Walters
- ChemoCentryx Inc., 850 Maude Ave, Mountain View, CA 94043, USA
| | - K Ebsworth
- ChemoCentryx Inc., 850 Maude Ave, Mountain View, CA 94043, USA
| | - R D Berahovich
- ChemoCentryx Inc., 850 Maude Ave, Mountain View, CA 94043, USA
| | - M E T Penfold
- ChemoCentryx Inc., 850 Maude Ave, Mountain View, CA 94043, USA
| | - S-C Liu
- Department of Radiation Oncology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - R Al Omran
- Department of Radiation Oncology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - M Kioi
- Department of Radiation Oncology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - S B Chernikova
- Department of Radiation Oncology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - D Tseng
- Department of Radiation Oncology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - E E Mulkearns-Hubert
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - M Sinyuk
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - R M Ransohoff
- 1] Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA [2] Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - J D Lathia
- 1] Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA [2] Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - J Karamchandani
- Department of Pathology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - H E K Kohrt
- Department of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - P Zhang
- ChemoCentryx Inc., 850 Maude Ave, Mountain View, CA 94043, USA
| | - J P Powers
- ChemoCentryx Inc., 850 Maude Ave, Mountain View, CA 94043, USA
| | - J C Jaen
- ChemoCentryx Inc., 850 Maude Ave, Mountain View, CA 94043, USA
| | - T J Schall
- ChemoCentryx Inc., 850 Maude Ave, Mountain View, CA 94043, USA
| | - M Merchant
- Department of Neurology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - L Recht
- Department of Neurology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - J M Brown
- Department of Radiation Oncology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
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Brown JM, Hardavella G, Carroll B, Falzon M, Navani N, George PJ, Janes SM. S129 The natural history of bronchial pre-invasive disease. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.136] [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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48
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Brown JM, Newton CJ. Quantified three-dimensional imaging of pitted aluminium surfaces using laser scanning confocal microscopy. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/000705994798267476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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49
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Alexander SK, Brown JM, Graham A, Nestor PJ. CADASIL presenting with a behavioural variant frontotemporal dementia phenotype. J Clin Neurosci 2013; 21:165-7. [PMID: 24035425 DOI: 10.1016/j.jocn.2013.02.025] [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: 01/29/2013] [Accepted: 02/02/2013] [Indexed: 10/26/2022]
Abstract
The behavioural variant of frontotemporal dementia (bvFTD) is characterised by personality change with a decline in cognition. We describe two patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukencephalopathy (CADASIL) who presented with behavioural phenotypes similar to bvFTD. The first patient presented with progressive personality and behavioural change, had florid white matter hyperintensity, and had a novel missense mutation C366W in exon 7 of the Notch3 gene. The second patient presented with progressive memory impairment and marked personality changes after a transient ischaemic attack. In this second patient, the radiological features were subtle and only the family history of stroke prompted testing for CADASIL using Notch3 genotyping. We present these patients to demonstrate that CADASIL may mimic bvFTD, with little clinical or radiological evidence to distinguish the two. CADASIL may be an under-recognised diagnosis in apparent bvFTD. Screening Notch3 in a substantial and unselected cohort of frontotemporal dementia patients might be appropriate to investigate this possibility.
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Affiliation(s)
- S K Alexander
- Department of Clinical Neurosciences, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
| | - J M Brown
- Department of Clinical Neurosciences, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - A Graham
- Department of Clinical Neurosciences, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - P J Nestor
- German Center for Neurodegenerative diseases (DZNE), Magdeburg, Germany
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50
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McDunn BA, Brown JM, Aisha SP, Hale RG. Testing the influence of stimulus variability on visual memory for scenes. J Vis 2013. [DOI: 10.1167/13.9.1313] [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: 11/24/2022] Open
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