1
|
Noor M, McGrath O, Parry N, Aslam T, Ashworth J. 15 Retinopathy in patients with mucopolysaccharidosis. BMJ Open Ophthalmol 2023; 8:A5-A6. [PMID: 37798001 DOI: 10.1136/bmjophth-2023-biposa.15] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
The mucopolysaccharidoses are a group of inherited metabolic disorders resulting in abnormal degradation of glycosaminoglycans within lysosomes. Ophthalmic manifestations resulting in visual loss include corneal clouding, optic neuropathy and raised intraocular pressure, and retinopathy which occurs in MPS type I, II, III, IV. While corneal clouding may be stabilised with early treatment with HSCT or surgically treated with a corneal transplant, there is currently no known effective treatment for retinopathy.We conducted a prospective observational study of patients with MPS who underwent fundus examination, OPTOS imaging, OCT, and electroretinography.76 patients with MPS were studied, comprised of 45 MPSI, 9 MPSII, 13 MPSIV and 9 MPSVI patients. The age range was 3- 58 years of age. OPTOS imaging was performed in 65 individuals, OCT in 61, and electrodiagnostic assessments in 37 patients. Ten patients (7 MPSI, 3 MPS II) had fundoscopic signs of retinopathy, of which 5 had abnormal ERGs. Twenty one patients (17 MPSI, 2 MPSII, 2 MPSVI) had abnormalities on ERG, of which 5 had concurrent fundoscopic evidence of retinopathy. The onset of retinopathy in MPS patients was observed over a broad age range, with initial detection occurring between 2 and 53 years of age.Retinopathy can be diagnosed on examination, imaging, or ERG in MPS patients as young as 2 years of age. The development of novel medicines, such as gene therapy, have potential to stabilise or improve retinopathy in the future. Therefore, phenotypic and natural history information pertaining to retinopathy in MPS is extremely valuable.
Collapse
Affiliation(s)
- M Noor
- Manchester Royal Eye Hospital, Manchester, UK
| | - O McGrath
- Manchester Royal Eye Hospital, Manchester, UK
| | - N Parry
- Manchester Royal Eye Hospital, Manchester, UK
| | - T Aslam
- Manchester Royal Eye Hospital, Manchester, UK
| | - J Ashworth
- Manchester Royal Eye Hospital, Manchester, UK
| |
Collapse
|
2
|
Kellett S, Petrushkin H, Ashworth J, Connor A, McLoone E, Schmoll C, Sharma S, Agorogiannis E, Williams J, Choi J, Injarie A, Puvanachandra N, Watts P, Shafi A, Millar E, Long V, Kumar A, Hughes E, Ritchie A, Gonzalez-Martin J, Pradeep A, Anwar S, Warrior K, Muthusamy B, Pilling R, Benzimra J, Reddy A, Bush K, Pharoah D, Falzon K, O'Colmain U, Knowles R, Tadic V, Dick A, Rahi J, Solebo AL. 2 Pathways to detection of non-infectious childhood uveitis in the UK: findings from the UNICORN cohort study. BMJ Open Ophthalmol 2023; 8:A1. [PMID: 37797997 DOI: 10.1136/bmjophth-2023-biposa.2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Prompt detection of childhood uveitis is key to minimising negative impact. From an internationally unique inception cohort, we report pathways to disease detection.UNICORNS is a national childhood non-infectious uveitis study with longitudinal collection of a standardised clinical dataset and patient reported outcomes. Descriptive analysis of baseline characteristics are reported.Amongst 150 recruited children (51% female, 31% non-white ethnicity) age at detection ranged from 2-18yrs (median 10). In 69%, uveitis was diagnosed following onset of symptoms: time from first symptoms to uveitis detection ranged from 0-739days (median 7days), with longer time to detection for those presenting initially to their general practitioner. Non symptomatic children were detected through JIA/other disease surveillance (16%), routine optometry review (5%) or child visual health screening (1%). Commonest underlying diagnoses at uveitis detection were JIA (17%), TINU (9%, higher than pre-pandemic reported UK disease frequency) and sarcoid (1%). 60% had no known systemic disease at uveitis detection. At disease detection, in at least one eye: 34% had structural complications (associated with greater time to detection - 17 days versus 4 days for uncomplicated presentation).The larger relative proportions of children with non-JIA uveitis reported here increase the importance of improving awareness of childhood uveitis amongst the wider clinical communities. There is scope for improvement of pathways to detection. Forthcoming analysis on the full cohort (251 recruited to date across 33 hospitals and 4 nations) will provide nationally representative data on management and the determinants of visual and broader developmental/well-being outcomes.
Collapse
Affiliation(s)
- S Kellett
- University College London, Institute of Child Health, UK
| | - H Petrushkin
- University College London, Institute of Child Health, UK
| | - J Ashworth
- University College London, Institute of Child Health, UK
| | - A Connor
- University College London, Institute of Child Health, UK
| | - E McLoone
- University College London, Institute of Child Health, UK
| | - C Schmoll
- University College London, Institute of Child Health, UK
| | - S Sharma
- University College London, Institute of Child Health, UK
| | - E Agorogiannis
- University College London, Institute of Child Health, UK
| | - J Williams
- University College London, Institute of Child Health, UK
| | - J Choi
- University College London, Institute of Child Health, UK
| | - A Injarie
- University College London, Institute of Child Health, UK
| | | | - P Watts
- University College London, Institute of Child Health, UK
| | - A Shafi
- University College London, Institute of Child Health, UK
| | - E Millar
- University College London, Institute of Child Health, UK
| | - V Long
- University College London, Institute of Child Health, UK
| | - A Kumar
- University College London, Institute of Child Health, UK
| | - E Hughes
- University College London, Institute of Child Health, UK
| | - A Ritchie
- University College London, Institute of Child Health, UK
| | | | - A Pradeep
- University College London, Institute of Child Health, UK
| | - S Anwar
- University College London, Institute of Child Health, UK
| | - K Warrior
- University College London, Institute of Child Health, UK
| | - B Muthusamy
- University College London, Institute of Child Health, UK
| | - R Pilling
- University College London, Institute of Child Health, UK
| | - J Benzimra
- University College London, Institute of Child Health, UK
| | - A Reddy
- University College London, Institute of Child Health, UK
| | - K Bush
- University College London, Institute of Child Health, UK
| | - D Pharoah
- University College London, Institute of Child Health, UK
| | - K Falzon
- University College London, Institute of Child Health, UK
| | - U O'Colmain
- University College London, Institute of Child Health, UK
| | - R Knowles
- University College London, Institute of Child Health, UK
| | - V Tadic
- University College London, Institute of Child Health, UK
| | - A Dick
- University College London, Institute of Child Health, UK
| | - J Rahi
- University College London, Institute of Child Health, UK
| | - A L Solebo
- University College London, Institute of Child Health, UK
| |
Collapse
|
3
|
Kollia E, Razzouk H, Biswas S, Ashworth J. 1 Retreatment for reactivation of ROP following initial anti-VEGF injections. A 5-year retrospective study. BMJ Open Ophthalmol 2023; 8:A1. [PMID: 37798006 DOI: 10.1136/bmjophth-2023-biposa.1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
To present the retreatment rates and the characteristics of ROP reactivation, as well as the differences between bevacizumab and ranibizumab injections in premature babies treated in our department over the past 5 years.A retrospective analysis of babies with treated ROP was performed. 89 babies who required treatment from 2017 to 2022 were examined. We studied the severity of their disease with regards to their gestational age, treatment time and type and the need of further treatment. We also focused on the comparison of anti-VEGF agents for ROP.22 out of 89 babies (14 boys and 8 girls) with aggressive posterior retinopathy of prematurity (APROP) and mean gestational age of 25+3w received initially anti-VEGF injections. 16 of those (11 boys and 5 girls) required retreatment with diode laser. 9 out of these 16 babies were treated with ranibizumab (Lucentis) and 7 with bevacizumab (Avastin). It is also of note that only 2 out of 67 babies who initially received laser treatment needed a complementary laser session.The majority of babies with aggressive ROP who receive anti-VEGF agents will most probably require further laser treatment. At an equal level of retinal damage, it seems that their response to ranibizumab and bevacizumab is similar.
Collapse
Affiliation(s)
- E Kollia
- Manchester Royal Eye Hospital, UK
| | | | - S Biswas
- Manchester Royal Eye Hospital, UK
| | | |
Collapse
|
4
|
Shram MJ, Henningfield JE, Apseloff G, Gorodetzky CW, De Martin S, Vocci FL, Sapienza FL, Kosten TR, Huston J, Buchhalter A, Ashworth J, Lanier R, Folli F, Mattarei A, Guidetti C, Comai S, O'Gorman C, Traversa S, Inturrisi CE, Manfredi PL, Pappagallo M. The novel uncompetitive NMDA receptor antagonist esmethadone (REL-1017) has no meaningful abuse potential in recreational drug users. Transl Psychiatry 2023; 13:192. [PMID: 37286536 DOI: 10.1038/s41398-023-02473-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023] Open
Abstract
Esmethadone (REL-1017) is the opioid-inactive dextro-isomer of methadone and a low-affinity, low-potency uncompetitive NMDA receptor antagonist. In a Phase 2, randomized, double-blind, placebo-controlled trial, esmethadone showed rapid, robust, and sustained antidepressant effects. Two studies were conducted to evaluate the abuse potential of esmethadone. Each study utilized a randomized, double-blind, active-, and placebo-controlled crossover design to assess esmethadone compared with oxycodone (Oxycodone Study) or ketamine (Ketamine Study) in healthy recreational drug users. Esmethadone 25 mg (proposed therapeutic daily dose), 75 mg (loading dose), and 150 mg (Maximum Tolerated Dose) were evaluated in each study. Positive controls were oral oxycodone 40 mg and intravenous ketamine 0.5 mg/kg infused over 40 min. The Ketamine study included oral dextromethorphan 300 mg as an exploratory comparator. The primary endpoint was maximum effect (Emax) for Drug Liking, assessed using a bipolar 100-point visual analog scale (VAS). A total of 47 and 51 participants completed the Oxycodone Study and the Ketamine Study, respectively (Completer Population). In both studies, esmethadone doses ranging from therapeutic (25 mg) to 6 times therapeutic (150 mg) had a meaningful and statistically significantly (p < 0.001) lower Drug Liking VAS Emax compared with the positive control. Results were consistent for all secondary endpoints in both studies. In both studies, all doses of esmethadone were statistically equivalent to placebo on Drug Liking VAS Emax (p < 0.05). In the Ketamine Study, Drug Liking VAS Emax scores for esmethadone at all tested doses were significantly lower vs. dextromethorphan (p < 0.05) (exploratory endpoint). These studies indicate no meaningful abuse potential for esmethadone at all tested doses.
Collapse
Affiliation(s)
| | | | | | - Charles W Gorodetzky
- Relmada Therapeutics, Coral Gables, FL, USA
- Consultant in Pharmaceutical Medicine, Kansas City, MO, USA
| | - Sara De Martin
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Frank L Vocci
- Relmada Therapeutics, Coral Gables, FL, USA
- Friends Research Institute, Baltimore, MD, USA
| | - Frank L Sapienza
- Relmada Therapeutics, Coral Gables, FL, USA
- The Drug and Chemical Advisory Group LLC, Fairfax, VA, USA
| | - Thomas R Kosten
- Relmada Therapeutics, Coral Gables, FL, USA
- Baylor College of Medicine, MD Anderson Cancer Center, University of Houston, Houston, TX, USA
| | | | | | | | | | - Franco Folli
- Department of Health Science, University of Milan, Milan, Italy
| | - Andrea Mattarei
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Clotilde Guidetti
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Pediatric Hospital, IRCCS, Rome, Italy
| | - Stefano Comai
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | | | | | | | | | | |
Collapse
|
5
|
Moline M, Asakura S, Beuckman C, Landry I, Setnik B, Ashworth J, Henningfield JE. The abuse potential of lemborexant, a dual orexin receptor antagonist, according to the 8 factors of the Controlled Substances Act. Psychopharmacology (Berl) 2023; 240:699-711. [PMID: 36749354 PMCID: PMC10006052 DOI: 10.1007/s00213-023-06320-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/17/2023] [Indexed: 02/08/2023]
Abstract
RATIONALE Lemborexant (LEM) is a dual orexin receptor antagonist (DORA) approved in multiple countries including the USA, Japan, Canada, Australia, and several Asian countries for the treatment of insomnia in adults. As a compound with central nervous system activity, it is important to understand the abuse potential of LEM with respect to public health. OBJECTIVES This review discusses data for LEM relevant to each of the 8 factors of the United States Controlled Substances Act. RESULTS LEM did not demonstrate abuse potential in nonclinical testing and was associated with a low incidence of abuse-related adverse events in clinical study participants with insomnia disorder. Similar to other DORAs that have been evaluated (eg., almorexant, suvorexant (SUV), and daridorexant), LEM and the positive controls (zolpidem and SUV) also showed drug liking in a phase 1 abuse potential study that enrolled subjects who used sedatives recreationally. However, internet surveillance of SUV and the FDA Adverse Events Reporting System suggests that drugs in the DORA class display very low abuse-related risks in the community. Additionally, as described in FDA-approved labeling, it does not carry physical dependence and withdrawal risks. CONCLUSIONS LEM, similar to most other prescription insomnia medications, was placed into Schedule IV. However, LEM and other drugs in the DORA class may have a lower potential for abuse as suggested by real-world postmarketing data from federal surveys and internet surveillance, and thus may have lower risks to public health than Schedule IV benzodiazepines and nonbenzodiazepine hypnotics that potentiate GABA signaling.
Collapse
Affiliation(s)
- Margaret Moline
- Eisai Inc., 200 Metro Boulevard, Nutley, Jersey, NJ, 07110, USA.
| | | | | | | | - Beatrice Setnik
- Altasciences, Laval, Quebec, Canada and the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | | | - Jack E Henningfield
- Pinney Associates, Inc., Bethesda, MD, USA.,The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Hamdaoui D, Ashworth J, Thompson JD. A scoping review of clinical practices and adherence to UK national guidance related to the placement and position confirmation of adult nasogastric feeding tubes. Radiography (Lond) 2023; 29:178-183. [PMID: 36455415 DOI: 10.1016/j.radi.2022.10.032] [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: 08/23/2022] [Revised: 10/23/2022] [Accepted: 10/31/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The administration of nutrition or medication into the lungs or pleura via a misplaced nasogastric feeding tube is considered a never event. Despite guidance from the National Patient Safety Agency and NHS Improvement this never event is regularly reported. Confirmation of correct placement and correct use of nasogastric tubes requires appropriate actions and decisions by a multidisciplinary team. METHODS A scoping review identified 43 records that discussed and supported nasogastric tube misplacement as a Never Event. Searches were completed using Web of Science, CINAHL, Google Scholar, British Nursing Index (BNI), as well as selected journals. A further manual search revealed 22 publicly available NHS Trust policies related to nasogastric feeding tube procedures. Items generated between 2011 and 2020 were considered eligible. A thematic analysis was completed to assess adherence to guidance and the practices in place across the NHS. RESULTS Three key themes were identified as part of the review: referral and authorisation of radiography, examination description, and visualisation of the nasogastric tube tip. Large variations in practice were identified. While there is recognition of national guidance, records showed inconsistency and lacked the required detail to ensure patient safety. CONCLUSION Despite classification as a never event, it is apparent that there is still room for improvement and further guidance in ensuring patient safety with respect to nasogastric tube insertion. IMPLICATIONS FOR PRACTICE Practice requires further standardisation whilst also ensuring optimisation and safety. Guidance should address in depth imaging authorisation, language and exact standards of acceptability for imaging the full length of the nasogastric tube.
Collapse
Affiliation(s)
- D Hamdaoui
- Institute of Health and Social Care, London South Bank University, 103 Borough Road, London. SE1 0AA, UK.
| | - J Ashworth
- The School of Health and Society, University of Salford, M5 4WT, UK.
| | - J D Thompson
- University Hospitals of Morecambe Bay NHS Foundation Trust, Furness General Hospital, Dalton Ln, Barrow-in-Furness, LA14 4LF, UK.
| |
Collapse
|
7
|
da Silva Cardoso J, Curto C, Manuel-Vieira P, Ashworth J, Temudo T, Carrilho I. Primary headache with onset in childhood and adolescence: natural history and prognostic factors in a Portuguese population. Rev Neurol 2023; 76:9-14. [PMID: 36544371 PMCID: PMC10364019 DOI: 10.33588/rn.7601.2022356] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Headaches are the most frequent neurological disorder in the pediatric population, with great impact on quality of life. This study aims to characterize a cohort of patients followed at a pediatric neurology unit between January 1st 2013 and December 31st, 2021. MATERIALS AND METHODS We reviewed medical records and selected patients with primary headaches and a minimum follow-up of 12 months. RESULTS A total of 226 patients were included, 54.4% female, with an average age at headache onset of 9 ± 3.5 (3.1-16.5) years; 63.5% were prepubertal. A positive family history of headache was identified in 76.6% of cases and triggers in 63.6%. At first clinical assessment, 45.1% were classified as migraine without aura, 10.6% as migraine with aura, 3.5% tension-type, 8% mixed (tension and migraine), 1.3% other type and 31.4% were unclassifiable. The patients had a median follow-up of 2.4 (1.8-3.3) years. The diagnosis of tension-type headaches remained stable in 75% of the patients and resolved in 25%; 13% of the patients with migraine without aura changed into another type of headache and 17.4% resolved; 44.4% of the patients with migraine with aura turned into another type of headache and 11.1% resolved. Of the variables studied, only duration of headache episode had a significant association with headache remission, with odds ratio 0.16 (p = 0.03; 95% confidence interval: 0.032-0.84). CONCLUSIONS Our study shows that headache type in pediatric population changes over time, especially in those with migraine with aura. The duration of each headache episode was presented as a predictor of headache remission over time.
Collapse
Affiliation(s)
- J da Silva Cardoso
- Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - C Curto
- Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - P Manuel-Vieira
- Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - J Ashworth
- Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - T Temudo
- Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - I Carrilho
- Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal
| |
Collapse
|
8
|
Henningfield JE, Ashworth J, Heal DJ, Smith SL. Psychedelic drug abuse potential assessment for new drug applications and controlled substance scheduling: A United States perspective. J Psychopharmacol 2023; 37:33-44. [PMID: 36588452 DOI: 10.1177/02698811221140004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Psychedelics are an increasingly active area of research and pharmaceutical development. This includes abuse potential assessment to better understand their pharmacological mechanisms and effects and guide controlled substance regulation. Psychedelics pose challenges to abuse assessments to ensure valid, reliable, and generalizable outcomes and safe study conduct. FINDINGS Key nonclinical techniques, for example, receptor binding and functional assays in vitro, and nonclinical physical dependence determinations, are easily adaptable to psychedelics. However, the entactogens (weak reinforcers) and hallucinogens (non-reinforcers) require more flexible approaches than typically recommended by regulatory agencies. Phase 1 pharmacokinetic/pharmacodynamic safety studies and Phases 2/3 efficacy/safety trials with systematic monitoring of abuse-related adverse events are readily applicable to psychedelics. Human abuse trials require modification because supratherapeutic doses may not be safe and procedures, for example, personal monitors to manage serious adverse events, might bias outcomes. RECOMMENDATIONS Abuse-related studies for psychedelics requiring approval by Food and Drug Administration and other agencies should take into consideration existing knowledge that will vary from extensive, for example, psilocybin, to zero for novel hallucinogens and entactogens. Many abuse assessments can be reasonably applied to animals and humans without compromising scientific integrity. Modification of existing techniques and incorporating a broader range of nonclinical tests should ensure generalizable outcomes. Human abuse studies merit reconsideration and possible modification to ensure safety and validity for psychedelic drug evaluation. Other nonclinical and clinical methods can provide evaluations of the pharmacological equivalence of test drugs to known drugs of abuse to provide context to the abuse assessment and guide drug scheduling.
Collapse
Affiliation(s)
- Jack E Henningfield
- PinneyAssociates, Inc, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - David J Heal
- DevelRx Ltd, BioCity, Nottingham, UK.,Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | | |
Collapse
|
9
|
Oldham A, Oxborrow N, Woolfson P, Jenkins P, Gadepalli C, Ashworth J, Saxena A, Rothera M, Hendriksz C, Tol G, Jovanovic A. MPS VII - Extending the classical phenotype. Mol Genet Metab Rep 2022; 33:100922. [PMID: 36299251 PMCID: PMC9589197 DOI: 10.1016/j.ymgmr.2022.100922] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022] Open
Abstract
Mucopolysaccharidosis VII (or Sly syndrome) is an autosomal recessive disorder characterised by a deficiency in the enzyme Beta-glucuronidase (GUSB). Partial degradation of glycosaminoglycans (GAGs); chondroitin sulfate (CS), dermatan sulfate (DS) and heparan sulfate (HS) results in the accumulation of these fragments in the lysosomes of many tissues, eventually leading to multisystem damage. In some cases, early diagnosis on clinical grounds alone can be difficult due to the extreme variability of the clinical presentation and disease progression. We present a case report of a 31-year-old male patient diagnosed with MPS VII at the age of 28, who multiple specialists saw without suspecting the diagnosis due to the unusual presentation. The patient presented with a history of developmental delay, scoliosis, kyphosis, corneal clouding, abnormal gait, short stature, hearing impairment, slightly coarse facial features and progressive deterioration of fine motor skills since childhood. The patient had inguinal hernia repair at around 12 months, bilateral hearing impairment with a left bone-anchored hearing aid, and spinal surgery. During spinal surveillance MPS VII was suspected by a spinal surgeon with interest in MPS, and the diagnosis confirmed with a deficiency in beta-glucuronidase in leucocytes and marginally elevated urinary GAGs. Next-generation sequencing identified two mutations in the GUSB gene (OMIM 611499), c.526C > T p.(Leu176Phe) and c.1820G > C p.(Gly607Ala). Although the patient exhibited features of the severe form of non-classical manifestations, his metabolic condition has remained reasonably stable, surviving into adulthood with only symptomatic treatment. We present the ever-expanding phenotypic spectrum of this ultra-rare disease.
Collapse
Affiliation(s)
- A. Oldham
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, United Kingdom,Corresponding author.
| | | | - P. Woolfson
- Cardiology Department, Salford Royal NHS Foundation Trust, United Kingdom
| | - P. Jenkins
- North West Congenital Heart Disease Partnership, Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, United Kingdom
| | - C. Gadepalli
- Department of Ear, Nose and Throat, Salford Royal NHS Foundation Trust, United Kingdom
| | - J. Ashworth
- Manchester Royal Eye Hospital, Manchester Foundation NHS Trust, United Kingdom
| | - A. Saxena
- Neurosurgery, Salford Royal NHS Foundation Trust, United Kingdom
| | - M. Rothera
- Royal Manchester Children's Hospital, United Kingdom
| | - C.J. Hendriksz
- University of Pretoria, Mark Holland Metabolic Unit, Salford Royal NHS Foundation Truist, Stott Lane, Salford, M6 8HD, United Kingdom
| | - G. Tol
- Salford Royal NHS Foundation Trust, United Kingdom
| | - A. Jovanovic
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, United Kingdom
| |
Collapse
|
10
|
Henningfield J, Gauvin D, Bifari F, Fant R, Shram M, Buchhalter A, Ashworth J, Lanier R, Pappagallo M, Inturrisi C, Folli F, Traversa S, Manfredi PL. REL-1017 (esmethadone; d-methadone) does not cause reinforcing effect, physical dependence and withdrawal signs in Sprague Dawley rats. Sci Rep 2022; 12:11389. [PMID: 35794162 PMCID: PMC9259683 DOI: 10.1038/s41598-022-15055-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
REL-1017 (esmethadone, d-methadone) is the opioid-inactive d-isomer of racemic d,l-methadone. REL-1017 may exert antidepressant effects via uncompetitive N-methyl-d-aspartate receptor (NMDAR) channel block. As REL-1017 is expected to exert central nervous system activity, full characterization of its abuse potential is warranted. We evaluated lack of reinforcing effect, physical dependence, and withdrawal of REL-1017 in Sprague Dawley rats. (1) Self-administration Study Rats were trained to self-administer oxycodone intravenously (IV) and then were subjected to 3-day substitution tests where saline, oxycodone, and REL-1017 were self-delivered IV by a fixed number of lever presses; (2) Drug Discontinuation Study Rats were treated for 30 days by oral gavage with vehicle, REL-1017, ketamine or morphine and evaluated for withdrawal with functional observational batteries (FOBs). In the self-administration study, rats treated with saline, vehicle, and all REL-1017 doses showed the typical “extinction burst” pattern of response, characterized by an initial rapid increase of lever-pressing followed by a rapid decrease over 3 days. Rats treated with oxycodone maintained stable self-injection, as expected for reinforcing stimuli. In the withdrawal study, REL-1017 did not engender either morphine or ketamine withdrawal signs over 9 days following abrupt discontinuation of drug exposure. REL-1017 showed no evidence of abuse potential and did not engender withdrawal symptomatology.
Collapse
|
11
|
Ashworth J, Thompson J, Mercer C. Learning to look: Evaluating the student experience of an interactive image appraisal activity. Radiography (Lond) 2019; 25:314-319. [DOI: 10.1016/j.radi.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 11/25/2022]
|
12
|
Merrison A, Brady S, Madden H, Ashworth J. EP.109Establishing a new psychology service for people living with amyotrophic lateral sclerosis. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Merrison A, Brady S, Grose N, Ashworth J, Majumdar A. EP.45Neuromuscular disease services crossing boundaries: a multi-disciplinary network approach in the United Kingdom. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
14
|
Appleyard T, Ashworth J, Bedson J, Yu D, Peat G. Trends in gabapentinoid prescribing in patients with osteoarthritis: a United Kingdom national cohort study in primary care. Osteoarthritis Cartilage 2019; 27:1437-1444. [PMID: 31276819 DOI: 10.1016/j.joca.2019.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate trends in gabapentinoid prescribing in patients with osteoarthritis (OA). METHODS Patients aged 40 years and over with a new OA diagnosis recorded between 1995 and 2015 were identified in the Clinical Practice Research Datalink (CPRD) and followed to first prescription of gabapentin or pregabalin, or other censoring event. We estimated the crude and age-standardised annual incidence rates of gabapentinoid prescribing, stratified by patient age, sex, geographical region, and time since OA diagnosis, and the proportion of prescriptions attributable to OA, or to other conditions representing licensed and unlicensed indications for a gabapentinoid prescription. RESULTS Of 383,680 newly diagnosed OA cases, 35,031 were prescribed at least one gabapentinoid. Irrespective of indication, the annual age-standardised incidence rate of first gabapentinoid prescriptions rose from 1.6 [95% confidence interval (CI): 1.3, 2.0] per 1000 person-years in 2000, to 27.6 (26.7, 28.4) in 2015, a trend seen across all ages and not explained by length of follow-up. Rates were higher among women, younger patients, and in Northern Ireland, Scotland and the North of England. Approximately 9% of first prescriptions could be attributed to OA, a further 13% to comorbid licensed or unlicensed indications. CONCLUSION Gabapentinoid prescribing in patients with OA increased dramatically between 1995 and 2015. In most cases, diagnostic codes for licensed or unlicensed indications were absent. Gabapentinoid prescribing may be attributable to OA in a significant proportion but evidence for their effectiveness in OA is lacking. Further research to investigate clinical decision making around prescribing these expensive and potentially harmful medicines is recommended.
Collapse
Affiliation(s)
- T Appleyard
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
| | - J Ashworth
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
| | - J Bedson
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
| | - D Yu
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
| | - G Peat
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
| |
Collapse
|
15
|
Redwood A, Douzgou S, Waller S, Ramsden S, Roberts A, Bonin H, Lloyd IC, Ashworth J, Black GCM, Clayton-Smith J. Congenital cataracts in females caused by BCOR mutations; report of six further families demonstrating clinical variability and diverse genetic mechanisms. Eur J Med Genet 2019; 63:103658. [PMID: 31048080 DOI: 10.1016/j.ejmg.2019.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/10/2018] [Revised: 03/26/2019] [Accepted: 04/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pathogenic variants in the BCOR gene have been identified in males with X-linked recessive microphthalmia and in females with X-linked dominant oculofaciocardiodental (OFCD) syndrome. This latter condition has previously been regarded as rare but the increased availability of genetic testing in recent years has led to the identification of a greater number of patients. METHODS We report the clinical and molecular findings in a series of 10 patients with pathogenic BCOR variants from 5 families, all seen in a single institution over a two year period. RESULTS We emphasize the phenotypic variability in this cohort and the diverse genetic mechanisms involved which included point mutations and deletions of BCOR as well as the occurrence of gonadal and somatic mosaicism. CONCLUSION In this report we demonstrate the novel findings of four newly identified variants in BCOR associated with an OFCD phenotype, and suggest that the frequency of this condition in females presenting with congenital cataract, including unilateral cataract, is more common than anticipated. We demonstrate the utility of screening for genetic causes of congenital cataract. Although gonadal mosaicism in OFCD had previously been reported, we demonstrate the presence of somatic mosaicism where BCOR mutations may only be detected in DNA from tissues other than blood such as buccal cells.
Collapse
Affiliation(s)
- A Redwood
- University of Manchester Medical School, Manchester, United Kingdom
| | - S Douzgou
- Manchester Centre For Genomic Medicine, St Mary's Hospital, Manchester and University Hospitals NHS Foundation Trust Manchester Academic Health Sciences Centre, United Kingdom
| | - S Waller
- Manchester Centre For Genomic Medicine, St Mary's Hospital, Manchester and University Hospitals NHS Foundation Trust Manchester Academic Health Sciences Centre, United Kingdom
| | - S Ramsden
- Manchester Centre For Genomic Medicine, St Mary's Hospital, Manchester and University Hospitals NHS Foundation Trust Manchester Academic Health Sciences Centre, United Kingdom
| | - A Roberts
- Manchester Centre For Genomic Medicine, St Mary's Hospital, Manchester and University Hospitals NHS Foundation Trust Manchester Academic Health Sciences Centre, United Kingdom
| | - H Bonin
- Manchester Centre For Genomic Medicine, St Mary's Hospital, Manchester and University Hospitals NHS Foundation Trust Manchester Academic Health Sciences Centre, United Kingdom
| | - I C Lloyd
- Manchester Royal Eye Hospital, Oxford Rd, Manchester and Manchester University Hospitals NHS Foundation Trust Manchester Academic Health Sciences Centre, United Kingdom; Department of Clinical and Academic Ophthalmology, Great Ormond Street Hospital, London and UCL Academic Health Sciences Centre, United Kingdom
| | - J Ashworth
- Manchester Royal Eye Hospital, Oxford Rd, Manchester and Manchester University Hospitals NHS Foundation Trust Manchester Academic Health Sciences Centre, United Kingdom
| | - G C M Black
- Manchester Centre For Genomic Medicine, St Mary's Hospital, Manchester and University Hospitals NHS Foundation Trust Manchester Academic Health Sciences Centre, United Kingdom; Division of Evolution and Genomic Sciences School of Biological Sciences University of Manchester, United Kingdom
| | - J Clayton-Smith
- Manchester Centre For Genomic Medicine, St Mary's Hospital, Manchester and University Hospitals NHS Foundation Trust Manchester Academic Health Sciences Centre, United Kingdom; Division of Evolution and Genomic Sciences School of Biological Sciences University of Manchester, United Kingdom.
| |
Collapse
|
16
|
Meller RA, Wenner BA, Ashworth J, Gehman AM, Lakritz J, Firkins JL. Potential roles of nitrate and live yeast culture in suppressing methane emission and influencing ruminal fermentation, digestibility, and milk production in lactating Jersey cows. J Dairy Sci 2019; 102:6144-6156. [PMID: 31030922 DOI: 10.3168/jds.2018-16008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/05/2019] [Indexed: 12/11/2022]
Abstract
Concern over the carbon footprint of the dairy industry has led to various dietary approaches to mitigate enteric CH4 production. One approach is feeding the electron acceptor NO3-, thus outcompeting methanogens for aqueous H2. We hypothesized that a live yeast culture (LYC; Saccharomyces cerevisiae from Yea-Sacc 1026, Alltech Inc., Nicholasville, KY) would stimulate the complete reduction of NO3- to NH3 by selenomonads, thus decreasing the quantity of CH4 emissions per unit of energy-corrected milk production while decreasing blood methemoglobin concentration resulting from the absorbed intermediate, NO2-. Twelve lactating Jersey cows (8 multiparous and noncannulated; 4 primiparous and ruminally cannulated) were used in a replicated 4 × 4 Latin square design with a 2 × 2 factorial arrangement of treatments. Cattle were fed diets containing 1.5% NO3- (from calcium ammonium nitrate) or an isonitrogenous control diet (containing additional urea) and given a top-dress of ground corn without or with LYC, with the fourth week used for data collection. Noncannulated cows were spot measured for CH4 emission by mouth using GreenFeed (C-Lock Inc., Rapid City, SD). The main effect of NO3- decreased CH4 by 17% but decreased dry matter intake by 10% (from 19.8 to 17.8 kg/d) such that CH4:dry matter intake numerically decreased by 8% and CH4:milk net energy for lactation production was unaffected by treatment. Milk and milk fat production were not affected, but NO3- decreased milk protein from 758 to 689 g/d. Ruminal pH decreased more sharply after feeding for cows fed diets without NO3-. Acetate:propionate was greater for cows fed NO3-, particularly when combined with LYC (interaction effect). Blood methemoglobin was higher for cattle fed NO3- than for those fed the control diet but was low for both treatments (1.5 vs. 0.5%, respectively; only one measurement exceeded 5%), indicating minimal risk for NO2- accumulation at our feeding level of NO3-. Although neither apparent organic matter nor neutral detergent fiber digestibilities were affected, apparent N digestibility had an interaction for NO3- × LYC such that apparent N digestibility was numerically lowest for diets containing both NO3- and LYC compared with the other 3 diets. Under the conditions of this study, NO3- mitigated ruminal methanogenesis but also depressed dry matter intake and milk protein yield. Based on the fact that few interactions were detected, LYC had a minimal role in attenuating negative cow responses to NO3- supplementation.
Collapse
Affiliation(s)
- R A Meller
- Department of Animal Sciences, The Ohio State University, Columbus 43210
| | - B A Wenner
- Department of Animal Sciences, The Ohio State University, Columbus 43210
| | - J Ashworth
- Department of Animal Sciences, The Ohio State University, Columbus 43210
| | - A M Gehman
- Alltech, 3031 Catnip Hill Pike, Nicholasville, KY 40356
| | - J Lakritz
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus 43210
| | - J L Firkins
- Department of Animal Sciences, The Ohio State University, Columbus 43210.
| |
Collapse
|
17
|
Anderson R, Rust S, Ashworth J, Clayton-Smith J, Taylor RL, Clayton PT, Morris AAM. Lathosterolosis: A Relatively Mild Case with Cataracts and Learning Difficulties. JIMD Rep 2018; 44:79-84. [PMID: 30097991 DOI: 10.1007/8904_2018_127] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/03/2022] Open
Abstract
Lathosterolosis is a rare defect of cholesterol synthesis. Only four previous cases have been reported, two of whom were siblings. We report a fifth patient, with a relatively mild phenotype. He presented at 5 years of age with bilateral posterior cataracts, which were managed with lensectomies and intraocular lens implants. He also had learning difficulties, with a full-scale IQ of 64 at 11 years of age. His head circumference is between the 0.4th and 2nd centiles, and he has mild hypotonia and subtle dysmorphism (a high-arched palate, anteverted nostrils, long philtrum and clinodactyly of toes). The diagnosis was established after sequencing a panel of genes associated with cataracts, which revealed compound heterozygous SC5D mutations: c.479C>G p.(Pro160Arg) and c.630C>A p.(Asp210Glu). The plasma lathosterol concentration was markedly raised at 219.8 μmol/L (control range 0.53-16.0), confirming the diagnosis. The c.630C>A p.(Asp210Glu) mutation has been reported in one previous patient, who also had a relatively mild phenotype (Ho et al., JIMD Rep 12:129-134, 2014). The mutation leads to a relatively conservative amino acid substitution, consistent with some residual enzyme activity. Our patient's family did not notice any benefit from treatment with simvastatin. In summary, milder patients with lathosterolosis may present with learning difficulties, cataracts and very subtle dysmorphism. The diagnosis will be missed unless plasma sterols are analysed or relevant genes sequenced.
Collapse
Affiliation(s)
- R Anderson
- Willink Metabolic Unit, Manchester Academic Health Sciences Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - S Rust
- Paediatric Psychosocial Service, Manchester Academic Health Sciences Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - J Ashworth
- Paediatric Ophthalmology Department, Manchester Academic Health Sciences Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - J Clayton-Smith
- Genomic Medicine, Manchester Academic Health Sciences Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R L Taylor
- Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - P T Clayton
- Centre for Translational Omics, Genetics and Genomic Medicine, UCL Institute of Child Health, London, UK
| | - A A M Morris
- Willink Metabolic Unit, Manchester Academic Health Sciences Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK. .,Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| |
Collapse
|
18
|
O’Toole A, Bogaart C, Lu L, Ashworth J, Woolhouse ME. A68 Bats as a source of zoonotic spillover: Investigating viruses in enteric bat samples from Viet Nam. Virus Evol 2018. [PMCID: PMC5905510 DOI: 10.1093/ve/vey010.067] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- A O’Toole
- University of Edinburgh, Edinburgh, UK
- VIZIONS Consortium
| | - C Bogaart
- University of Edinburgh, Edinburgh, UK
- VIZIONS Consortium
| | - L Lu
- University of Edinburgh, Edinburgh, UK
- VIZIONS Consortium
| | - J Ashworth
- University of Edinburgh, Edinburgh, UK
- VIZIONS Consortium
| | - M E Woolhouse
- University of Edinburgh, Edinburgh, UK
- VIZIONS Consortium
| |
Collapse
|
19
|
Thompson M, Vowles K, Sowden G, Ashworth J, Levell J. A qualitative analysis of patient-identified adaptive behaviour changes following interdisciplinary Acceptance and Commitment Therapy for chronic pain. Eur J Pain 2018; 22:989-1001. [DOI: 10.1002/ejp.1184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 11/07/2022]
Affiliation(s)
- M. Thompson
- Faculty of Health and Applied Sciences; University of the West of England; Bristol UK
| | - K.E. Vowles
- Department of Psychology; University of New Mexico; Albuquerque USA
- IMPACT Pain Service; Staffordshire and Stoke-on-Trent NHS Partnership Trust; Stoke-on-Trent UK
| | - G. Sowden
- IMPACT Pain Service; Staffordshire and Stoke-on-Trent NHS Partnership Trust; Stoke-on-Trent UK
| | - J. Ashworth
- IMPACT Pain Service; Staffordshire and Stoke-on-Trent NHS Partnership Trust; Stoke-on-Trent UK
| | - J. Levell
- IMPACT Pain Service; Staffordshire and Stoke-on-Trent NHS Partnership Trust; Stoke-on-Trent UK
| |
Collapse
|
20
|
Sergouniotis P, Ellingford J, Hall G, Ramsden S, Biswas S, Ashworth J, Black G. Human case. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.01355] [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: 11/28/2022]
Affiliation(s)
- P. Sergouniotis
- Paediatric Ophthalmology; Manchester Royal Eye Hospital; Manchester United Kingdom
| | - J. Ellingford
- Saint Mary's Hospital; Manchester Centre for Genomic Medicine; Manchester United Kingdom
| | - G. Hall
- Saint Mary's Hospital; Manchester Centre for Genomic Medicine; Manchester United Kingdom
| | - S. Ramsden
- Saint Mary's Hospital; Manchester Centre for Genomic Medicine; Manchester United Kingdom
| | - S. Biswas
- Paediatric Ophthalmology; Manchester Royal Eye Hospital; Manchester United Kingdom
| | - J. Ashworth
- Paediatric Ophthalmology; Manchester Royal Eye Hospital; Manchester United Kingdom
| | - G. Black
- Saint Mary's Hospital; Manchester Centre for Genomic Medicine; Manchester United Kingdom
| |
Collapse
|
21
|
Ashworth J, Doran N, Burrows E, Morgan A, Majumdar A, Thomas-Unsworth S. Living well with a neuromuscular disease: A newly established course for patients and their families. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.229] [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]
|
22
|
Deng X, Peters B, Ettore MW, Ashworth J, Brunelle LA, Crowson CS, Moder KG, Snyder MR. Utility of Antinuclear Antibody Screening by Various Methods in a Clinical Laboratory Patient Cohort. J Appl Lab Med 2016; 1:36-46. [DOI: 10.1373/jalm.2016.020172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/27/2016] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundAntinuclear antibody (ANA)5 testing is routinely performed during evaluation of patients with a suspected connective tissue disease (CTD), yet the question of which method is most appropriate remains controversial. The purpose of this study was to evaluate the clinical utility of ANA testing by an enzyme immunoassay (EIA), an immunofluorescence assay (IFA), and a multiplex immunoassay (MIA) in a routine laboratory population.MethodsSamples (n = 1000) were collected from specimens submitted for ANA testing by EIA (Bio-Rad). All samples were subsequently analyzed by IFA (Zeus) and MIA (Bio-Rad). The sample cohort was weighted to represent the routine testing population. Diagnostic information was obtained by chart review.ResultsFor the diagnosis of a CTD, ROC curve analysis demonstrated no significant differences between IFA (area under the curve 0.81) and EIA (0.84) (P = 0.25), with overlay of a single point for the MIA. When normalized to a specificity of approximately 90%, the sensitivities of the MIA, EIA, and IFA were 67%, 67%, and 56%, respectively. By varying the clinical cutoff, the IFA could achieve the highest sensitivity of 94%; however, the corresponding specificity was only 43%. In contrast, a strongly positive EIA had a specificity of 97%, although, at this cutoff, the sensitivity was only 40%.ConclusionsAlthough the overall diagnostic performance of the IFA, EIA, and MIA were not statistically different, the clinical sensitivity and specificity varied dramatically based on the positive/negative cutoff. Knowledge about the performance characteristics of each method will significantly aid in the interpretation of ANA testing.
Collapse
Affiliation(s)
- Xiaoli Deng
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Brian Peters
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Michael W Ettore
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Judy Ashworth
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Lynn A Brunelle
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Kevin G Moder
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Melissa R Snyder
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| |
Collapse
|
23
|
Musleh M, Hall G, Lloyd IC, Gillespie RL, Waller S, Douzgou S, Clayton-Smith J, Kehdi E, Black GCM, Ashworth J. Diagnosing the cause of bilateral paediatric cataracts: comparison of standard testing with a next-generation sequencing approach. Eye (Lond) 2016; 30:1175-81. [PMID: 27315345 DOI: 10.1038/eye.2016.105] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/13/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeIn addition to environmental causes such as TORCH infection, trauma and drug or chemical exposure, childhood cataracts (CC) frequently have a genetic basis. They may be isolated or syndromic and have been associated with mutations in over 110 genes. We have recently demonstrated that next-generation sequencing (NGS), a high throughput sequencing technique that enables the parallel sequencing of multiple genes, is ideally suited to the investigation of bilateral CC. This study assesses the diagnostic outcomes of traditional routine investigations and compares this with outcomes of NGS testing.MethodsA retrospective review of the medical records of 27 consecutive patients with bilateral CC presenting in 2010-2012 was undertaken. The outcomes of routine investigations in these patients, including TORCH screen, urinalysis, karyotyping, and urinary and plasma organic amino acids, were collated. The success of routine genetic investigations undertaken over 10 years (2000-2010) was also assessed.ResultsBy April 2014, the underlying cause of bilateral CC had been identified in just one of 27 patients despite 44% (n=12) receiving a full 'standard' investigative work-up and 22% (n=6) investigations in addition to the standard work-up. Fifteen of these patients underwent NGS testing and nine (60%) of these received a diagnosis for their CC.ConclusionThe frequency of patients receiving a diagnosis for their CC after standard care and the time taken to diagnosis was disappointing. NGS testing improved diagnostic rates and time to diagnosis, as well as changing clinical management. These data serve as a baseline for future evaluation of novel diagnostic modalities.
Collapse
Affiliation(s)
- M Musleh
- Manchester Centre for Genomic Medicine, Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester Academic Health Science Centre (MAHSC), Saint Mary's Hospital, Manchester, UK
| | - G Hall
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, MAHSC, Saint Mary's Hospital, Manchester, UK
| | - I C Lloyd
- Department of Ophthalmology, Manchester Royal Eye Hospital, Central Manchester Foundation Trust and Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UK
| | - R L Gillespie
- Manchester Centre for Genomic Medicine, Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester Academic Health Science Centre (MAHSC), Saint Mary's Hospital, Manchester, UK
| | - S Waller
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, MAHSC, Saint Mary's Hospital, Manchester, UK
| | - S Douzgou
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, MAHSC, Saint Mary's Hospital, Manchester, UK
| | - J Clayton-Smith
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, MAHSC, Saint Mary's Hospital, Manchester, UK
| | - E Kehdi
- Department of Ophthalmology, Manchester Royal Eye Hospital, Central Manchester Foundation Trust and Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UK
| | - G C M Black
- Manchester Centre for Genomic Medicine, Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester Academic Health Science Centre (MAHSC), Saint Mary's Hospital, Manchester, UK.,Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, MAHSC, Saint Mary's Hospital, Manchester, UK
| | - J Ashworth
- Department of Ophthalmology, Manchester Royal Eye Hospital, Central Manchester Foundation Trust and Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UK
| |
Collapse
|
24
|
Abrines Jaume N, Abbiss M, Wray J, Ashworth J, Brown KL, Cairns J. CHILDSPLA: a collaboration between children and researchers to design and animate health states. Child Care Health Dev 2015; 41:1140-51. [PMID: 26227090 DOI: 10.1111/cch.12280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/14/2015] [Accepted: 06/28/2015] [Indexed: 11/27/2022]
Abstract
AIM The children's health state preferences learnt from animation (CHILDSPLA) project developed an interactive application presented on a touch screen device using an animated character to collect information from children about their health. BACKGROUND The underlying hypothesis was that health information could be directly collected from children as young as 4 years old by the use of animated characters. This paper describes in detail how children were involved in the development of the application, and recounts both the challenges and benefits of that process. A child psychologist and an animation filmmaker worked closely with children to design a character and to animate it to represent different health states. Children were recruited from a local primary school (n = 38) and a paediatric specialist hospital (n = 36). Diverse interactive activities were organized to help children give feedback and guide the design process. The activities for each session were adjusted to the children's needs, based on the experience of previous sessions. RESULTS The character and the animations were modified according to the feedback provided by the children. CONCLUSIONS Developing the CHILDSPLA app in collaboration with children was a worthwhile and enriching experience, despite the required iteration and extension of the design process, as it enabled us to adjust the tool to the children's needs.
Collapse
Affiliation(s)
| | - M Abbiss
- Animation, Royal College of Art, London, UK
| | - J Wray
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - J Ashworth
- Animation, Royal College of Art, London, UK
| | - K L Brown
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - J Cairns
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
25
|
Ashworth J. SP0075 Clinical Approaches to Opioid use in Chronic Pain. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6549] [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]
|
26
|
Sindrup S, Konder R, Lehmann R, Meier T, Winkel M, Ashworth J, Baron R, Jensen T. Randomized controlled trial of the combined monoaminergic and opioid investigational compound GRT9906 in painful polyneuropathy. Eur J Pain 2011; 16:849-59. [DOI: 10.1002/j.1532-2149.2011.00069.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2011] [Indexed: 11/11/2022]
Affiliation(s)
- S.H. Sindrup
- Department of Neurology; Odense University Hospital; Odense; Denmark
| | | | - R. Lehmann
- Clinical Research Berlin-Buch GmbH; Berlin; Germany
| | - T. Meier
- Department of Anesthesiology; University Hospital Lübeck; Lübeck; Germany
| | | | | | - R. Baron
- Department of Neurology; Christian-Albrechts-University; Kiel; Germany
| | - T.S. Jensen
- Pain Research Center; Aarhus University Hospital; Aarhus; Denmark
| |
Collapse
|
27
|
Vowles K, Ashworth J, Beachill D, Packham J, Sowden G, Stanyer N. Preliminary outcomes of an abbreviated interdisciplinary programme of Acceptance and Commitment Therapy for chronic pain. The Journal of Pain 2011. [DOI: 10.1016/j.jpain.2011.02.301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
28
|
Evans G, Bevan A, Evans A, Kinsey T, Steel A, Ashworth J. Pilot study to examine the association between angiotensin-converting enzyme genotype and fluid retention in humans. Br J Sports Med 2010. [DOI: 10.1136/bjsm.2010.078972.48] [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]
|
29
|
Abstract
Congenital and infantile cataracts produce deprivation amblyopia and can thus cause lifelong visual impairment. Successful management is dependent on early diagnosis and referral for surgery when indicated. Accurate optical rehabilitation and postoperative supervision are essential.The timing of surgery and its relationship to the duration of deprivation is important. Unilateral congenital cataract surgery within 6 weeks of birth produces the best outcomes. The equivalent 'latent' period for bilateral visual deprivation may be longer at around 10 weeks. Visual deprivation has a significant impact on the development of fixation stability. Major form deprivation, even after early surgery, leads to nystagmus. This is mostly manifest latent nystagmus (MLN). The latent period for fixation stability may be as short as 3 weeks. Preoperative congenital nystagmus (CN) can convert to more benign MLN after surgery. Infantile IOL implantation is becoming increasingly accepted. A satisfactory long-term refractive result requires that allowance be made for childhood axial growth and myopic shift. In a series of 25 infants (33 eyes) implanted before 12 months of age, the mean myopic shift at 12 months was 4.83 D. This increased to 5.3 D in infants implanted before 10 weeks. The initial desired refractive outcome following IOL implantation is thus hypermetropia, with the degree dependent on the age of the child. Glaucoma or ocular hypertension is a common complication following paediatric cataract surgery. Microphthalmia and surgery in early infancy are risk factors. Tonometry results may be influenced by the increased corneal thickness seen in aphakic and pseudophakic children. The long-term prognosis of eyes with aphakic glaucoma is not necessarily poor but intraocular pressure control may require three or more medications. Surgical intervention appears to be necessary in over a quarter of eyes. Posterior capsule opacification (PCO) is common in infants undergoing primary lens implantation. Primary capsulotomy and anterior vitrectomy reduce the risk of PCO. In the absence of anterior vitrectomy, primary posterior capsulotomy does not prevent visual axis opacification. Further developments will continue to be driven by clinical research. The prevention of capsule opacification and cellular proliferation may in future be achieved by the use of devices to specifically target epithelial cells at surgery.
Collapse
Affiliation(s)
- I C Lloyd
- Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK.
| | | | | | | |
Collapse
|
30
|
Affiliation(s)
- E Hindle
- Hope Hospital, Stott Lane, Salford, UK.
| | | | | |
Collapse
|
31
|
Durnian JM, Wong V, Ashworth J, Mallucci C, Marsh IB. Bilateral ptosis and gaze palsies following radioactive seed treatment of tectal plate tumours. Eye (Lond) 2006; 20:1479-81. [PMID: 16680102 DOI: 10.1038/sj.eye.6702369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
32
|
|
33
|
Lutz S, Ashworth J, Spence C, Connor S. The use of radiotherapy in hospice patients: A population-based study from the National Hospice Outcomes Project. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8074] [Citation(s) in RCA: 6] [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: 11/20/2022] Open
Affiliation(s)
- S. Lutz
- Blanchard Valley Regional Cancer Ctr, Findlay, OH; National Hospice and Palliative Care Organization, Alexandria, VA
| | - J. Ashworth
- Blanchard Valley Regional Cancer Ctr, Findlay, OH; National Hospice and Palliative Care Organization, Alexandria, VA
| | - C. Spence
- Blanchard Valley Regional Cancer Ctr, Findlay, OH; National Hospice and Palliative Care Organization, Alexandria, VA
| | - S. Connor
- Blanchard Valley Regional Cancer Ctr, Findlay, OH; National Hospice and Palliative Care Organization, Alexandria, VA
| |
Collapse
|
34
|
Whitlow BJ, Tamizian O, Ashworth J, Kerry S, Penna LK, Arulkumaran S. Validation of traction force indicator in ventouse devices. Int J Gynaecol Obstet 2005; 90:35-8. [PMID: 15921684 DOI: 10.1016/j.ijgo.2005.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 02/24/2005] [Accepted: 03/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether the traction force indicator in a ventouse device gave an accurate estimation of the force applied. METHODS The study was carried out at the Derby City Hospital. An estimate of measurement errors was made by analyzing the standard deviation of the residuals for 30 Kiwi OmniCup devices (Clinical Innovations, Abingdon, Oxfordshire, England) and a standard industrial spring balance. RESULTS The measurement errors for the traction forces were very small and acceptable for the OmniCup. The overall estimate of measurement errors was 0.45 kg (1.35 lb). CONCLUSION The overall measurement error for the traction force indicator of the OmniCup was found to be very small. Injuries associated the ventouse, such as cephalohematomas and subgaleal hemorrhages, may be minimized if the recommended limits for a safe traction force are not exceeded.
Collapse
Affiliation(s)
- B J Whitlow
- Colchester Hospital, Turner Road, Colchester CO4 5JL, UK.
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
Linear epidermal naevus (LEN) in the genital area is quite rare. It may present at birth or appear later on in life, in infancy or childhood and occasionally for the first time in adult life. There are several variants of epidermal naevi (EN), which, to the less experienced, can be mistaken for warts. When extensive, it can be associated with abnormalities in other organ systems (epidermal naevus syndrome). The definitive treatment of LEN is surgical ablation with excision of underlying dermis, but this frequently leads to scarring. Laser therapy is an alternative treatment modality and good results have been shown. We report an unusual case of LEN in the genital area in a 60-year-old man presenting as genital warts.
Collapse
Affiliation(s)
- M Mahto
- Department of Genitourinary Medicine, Stepping Hill Hospital, Poplar Grove, Stockport SK2 7JE, UK.
| | | | | |
Collapse
|
36
|
O'Driscoll J, Muston GC, McGrath JA, Lam HM, Ashworth J, Christiano AM. A recurrent mutation in the loricrin gene underlies the ichthyotic variant of Vohwinkel syndrome. Clin Exp Dermatol 2002; 27:243-6. [PMID: 12072018 DOI: 10.1046/j.1365-2230.2002.01031.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Vohwinkel syndrome (VS) is a family of genodermatoses which exhibits extensive clinical and genetic heterogeneity. Here, we studied a pedigree originating from the UK with typical features of the ichthyotic variant of VS and identified a recurrent insertion mutation in the loricrin gene resulting in a mutant polypeptide with an unusual C terminus. Functional studies in transgenic mice have shown that the accumulation of mutant loricrin in the nucleus appears to interfere with the later stages of epidermal differentiation, thereby explaining the clinical manifestations of ichthyosis, keratoderma and pseudoainhum. Our findings extend the body of evidence implicating mutations in the loricrin gene as the underlying cause of VS.
Collapse
|
37
|
Sherratt MJ, Wess TJ, Baldock C, Ashworth J, Purslow PP, Shuttleworth CA, Kielty CM. Fibrillin-rich microfibrils of the extracellular matrix: ultrastructure and assembly. Micron 2001; 32:185-200. [PMID: 10936461 DOI: 10.1016/s0968-4328(99)00082-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fibrillin-rich microfibrils are a unique class of extensible connective tissue macromolecules. Their critical contribution to the establishment and maintenance of diverse extracellular matrices was underlined by the linkage of their principal structural component fibrillin to Marfan syndrome, a heritable connective tissue disorder with pleiotropic manifestations. Microscopy and preparative techniques have contributed substantially to the understanding of microfibril structure and function. The supramolecular organisation of microfibrillar assemblies in tissues has been examined by tissue sectioning and X-ray diffraction methods. Published findings are discussed and new information reported on the organisation of microfibrils in the ciliary zonular fibrils by environmental scanning electron microscopy. This review summarises microscopy and X-ray diffraction studies that are informing current understanding of the ultrastructure of fibrillin-rich microfibrils.
Collapse
Affiliation(s)
- M J Sherratt
- School of Biological Sciences, 2.205 Stopford Building, University of Manchester M13 9PT, Manchester, UK.
| | | | | | | | | | | | | |
Collapse
|
38
|
Farrar CW, Jack AS, Lyon C, Cowan RA, Griffiths CE, Ashworth J. A 62-year-old man presenting with widespread nodulo-ulcerative cutaneous lesions. Clin Exp Dermatol 2001; 26:115-9. [PMID: 11260199 DOI: 10.1046/j.1365-2230.2001.00745.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C W Farrar
- Department of Dermatology Unit, Hope Hospital, Salford, M6 8HD, UK
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
BACKGROUND Chronic idiopathic urticaria is a disabling condition that does not always respond to antihistamine drugs and other agents are sometimes needed to control disease activity. Warfarin has demonstrated efficacy in single unblinded case studies [1] but has been dismissed by others [2]. OBJECTIVE We investigated the effect of warfarin treatment in eight patients with chronic idiopathic urticaria unresponsive to antihistamines in an open study. Six of the eight patients responded to treatment and three had a dramatic response. These three were included in a double-blind placebo-controlled trial of warfarin therapy to confirm significant benefit from treatment. METHODS The three warfarin responders had their stable warfarin dose encapsulated and placebo capsules were provided. A double-blind placebo-controlled crossover trial was performed on each patient. Visual analogue scores recorded disease activity. RESULTS Comparison of visual analogue scores showed a significant benefit while on warfarin with a reduction in pruritus and angio-oedema. CONCLUSION This is the first double-blind placebo-controlled study to show a response of chronic idiopathic urticaria to warfarin. The mechanisms of action are unclear and require further study.
Collapse
Affiliation(s)
- R Parslew
- Royal Liverpool University Hospital, Department of Dermatology, Prescot Street, Liverpool, UK
| | | | | | | |
Collapse
|
40
|
Hayman R, Brocklesby J, Warren A, Ashworth J, Johnson I, Baker P. Evidence for a circulating factor in pre-eclampsia. A role for vascular endothelial growth factor? BJOG 1998. [DOI: 10.1111/j.1471-0528.1998.tb09981_29.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Abstract
UNLABELLED Desflurane is a potentially useful anesthetic for ambulatory surgery, but it has had limited evaluation in spontaneously breathing patients. After the induction of anesthesia with propofol and laryngeal mask insertion, 90 patients were randomized to receive isoflurane (0.25%-1%), propofol (50-200 microg x kg(-1) x min(-1)), or desflurane (1.4%-6%) for anesthetic maintenance. Respiratory complications were uncommon; only six patients coughed (three who received isoflurane, one who received propofol, and two who received desflurane), and no anesthetic produced significant respiratory depression. Purposeful movement was significantly more common with propofol (19 patients; 63%) compared with isoflurane (7 patients; 23%) or desflurane (2 patients; 6.7%), but no patient had recall. Emergence times were similar in the isoflurane, propofol, and desflurane groups (5.1 +/- 2.3, 5.6 +/- 3.1, and 4.4 +/- 1.4 min, respectively). Later recovery end points and pain and sedation visual analog scale scores did not differ among groups. Overall, 85 patients (94%) were free from postoperative nausea and vomiting. Desflurane produced few respiratory complications in spontaneously breathing ambulatory patients but offered no improvement in emergence or recovery compared with isoflurane. Propofol also did not reduce recovery times or side effects; however, it was more difficult to maintain an adequate depth of anesthesia. We conclude that neither desflurane nor propofol offered any major advantages over the older anesthetic, isoflurane, under the conditions of our study. IMPLICATIONS The new inhaled anesthetic desflurane is acceptable in spontaneously breathing outpatients despite its known ability to irritate the airway. The i.v. anesthetic propofol was associated with more patient movement (without awareness) during surgery. Neither anesthetic conferred any clinically significant advantages over the older inhaled drug, isoflurane.
Collapse
Affiliation(s)
- J Ashworth
- Department of Anaesthesia, North Staffordshire Hospital, Stoke-on-Trent, United Kingdom
| | | |
Collapse
|
42
|
Abstract
PURPOSE Mohs micrographic surgery has been advocated as the optimal management of nonmelanoma skin cancer in the periocular region. It is a technique that is ideally suited to the removal of skin tumours with a contiguous growth pattern such as basal cell carcinoma and squamous cell carcinoma, allowing examination of 100% of the surgical margin. As a result of this total margin control, the technique offers an unsurpassed curve rate combined with maximal preservation of normal tissue. Following excision of a periocular tumour by a Mohs surgeon, the resulting defect usually requires reconstruction. Our objective was to determine whether the size of defect produced by Mohs surgery and the type of reconstruction required differed from the results we would have expected from standard surgery with a 3 mm excision margin. METHODS A Mohs surgery service with a combined dermatological and oculoplastic approach was set up in Manchester in 1994. We reviewed 60 of our patients who underwent Mohs surgery and compared the size of defect produced as well as the type of reconstruction required with the results we would have predicted for standard excisional surgery with a 3 mm margin. RESULTS Although a minority of patients required larger reconstructions than would have been anticipated (20%), many had smaller reconstructions than we had predicted (37%). This latter group often had important structures preserved, and therefore had the benefit of less extensive reconstructive surgery. CONCLUSIONS Excision of a periocular tumour by Mohs surgery may occasionally identify extensive subclinical tumour extension and so produce an unexpectedly large defect for reconstruction. Many patients, however, require less extensive reconstructive surgery than would have been predicted. This produces benefits in terms not only of improved cosmesis and eyelid function, but also reduced operating theatre costs.
Collapse
|
43
|
Abstract
PURPOSE The hydroxyapatite orbital implant has been introduced as a buried, integrated implant for use in the anophthalmic patient. The second stage of the procedure involves drilling the implant and inserting a motility peg that allows direct coupling of the artificial eye to the implant. Other authors have advocated an assessment of implant vascularity by imaging prior to drilling. We aimed to see whether our practice of drilling after a predetermined time interval without assessment of implant vascularity would result in a higher complication rate. We also aimed to determine how successful the drilling procedure was in improving both the motility and the stability of the artificial eye. METHODS The notes of 41 consecutive patients who underwent drilling were studied to determine the time interval between implantation with a hydroxyapatite sphere and drilling, the nature of any complications and any further surgical procedures undertaken. A postal questionnaire was sent to all patients asking them to grade the motility of their implant before and after drilling, and to state whether or not there had been any improvement in the stability of their artificial eye. RESULTS The most frequent complication encountered was extrusion of the motility peg, which occurred in 3 patients. A total of 5 patients required redrilling. There was an 80% response rate to the questionnaire. Ninety-one per cent of patients felt that there had been an improvement in the motility of their artificial eye and 76% felt that the stability of their artificial eye had been improved. CONCLUSION Pegging of the hydroxyapatite implant improves both the motility and the stability of the artificial eye in the majority of cases. Complications are infrequent and minor. If sufficient time is allowed after implantation for full implant vascularity to occur, it is not necessary to perform imaging studies. This practice does not result in an increase in complications, and significantly reduces the expense of the procedure.
Collapse
|
44
|
Wess TJ, Purslow PP, Sherratt MJ, Ashworth J, Shuttleworth CA, Kielty CM. Calcium determines the supramolecular organization of fibrillin-rich microfibrils. J Cell Biol 1998; 141:829-37. [PMID: 9566980 PMCID: PMC2132742 DOI: 10.1083/jcb.141.3.829] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/1997] [Revised: 03/09/1998] [Indexed: 02/07/2023] Open
Abstract
Microfibrils are ubiquitous fibrillin-rich polymers that are thought to provide long-range elasticity to extracellular matrices, including the zonular filaments of mammalian eyes. X-ray diffraction of hydrated bovine zonular filaments demonstrated meridional diffraction peaks indexing on a fundamental axial periodicity (D) of approximately 56 nm. A Ca2+-induced reversible change in the intensities of the meridional Bragg peaks indicated that supramolecular rearrangements occurred in response to altered concentrations of free Ca2+. In the presence of Ca2+, the dominant diffracting subspecies were microfibrils aligned in an axial 0.33-D stagger. The removal of Ca2+ caused an enhanced regularity in molecular spacing of individual microfibrils, and the contribution from microfibrils not involved in staggered arrays became more dominant. Scanning transmission electron microscopy of isolated microfibrils revealed that Ca2+ removal or addition caused significant, reversible changes in microfibril mass distribution and periodicity. These results were consistent with evidence from x-ray diffraction. Simulated meridional x-ray diffraction profiles and analyses of isolated Ca2+-containing, staggered microfibrillar arrays were used to interpret the effects of Ca2+. These observations highlight the importance of Ca2+ to microfibrils and microfibrillar arrays in vivo.
Collapse
Affiliation(s)
- T J Wess
- Department of Biological and Molecular Sciences, University of Stirling, Stirling FK9 4LA, United Kingdom.
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
Twenty-one node-negative breast cancer patients were interviewed shortly after completing adjuvant chemotherapy and asked about side effects they had experienced, expectation of side effects, and strategies for coping with the side effects. Eighteen of the women were interviewed 6 months later to determine their feelings about the chemotherapy experience and ending treatment and what side effects persisted or developed after chemotherapy. Hair loss, fatigue, treatment-related problems, nausea and infections/low blood counts were the most frequently described problems during the first interviews. Patients used coping strategies suggested by physicians and nurses. Six months later, hair problems, fatigue, weight gain, menopausal problems, emotional problems and nail problems were most often reported. Most patients (16/18) did not expect to be experiencing chemotherapy-related problems 6 months after ending treatment. Fatigue interfered with daily lives and weight gain caused concern. A total of 35% of participants experienced fear or anxiety at the end of chemotherapy, but most (62%) recalled at least some positive feelings 6 months later. Given the same circumstances, all but two would make the same decision to undergo adjuvant chemotherapy. Support groups would be especially useful for patients completing chemotherapy who would lose continued frequent support from clinic personnel.
Collapse
Affiliation(s)
- A Beisecker
- Kansas Cancer Institute, University of Kansas Medical Center, Kansas City 66160-7312, USA
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Misra M, Reaveley DA, Ashworth J, Muller B, Seed M, Brown EA. Six-month prospective cross-over study to determine the effects of 1.1% amino acid dialysate on lipid metabolism in patients on continuous ambulatory peritoneal dialysis. Perit Dial Int 1997; 17:279-86. [PMID: 9237290] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the effect of 1.1% amino acid dialysate (AAD) (Nutrineal, Baxter, Castlebar, Ireland) on lipid metabolism in hyperlipidemic patients on continuous ambulatory peritoneal dialysis (CAPD). DESIGN Patients were alternately assigned to receive AAD in the first (group A), or the second (group B), 6 months of a prospective cross-over study. SETTING University teaching hospital. PATIENTS Eighteen stable CAPD patients with a serum cholesterol 5.5 mmol/L or greater. INTERVENTIONS One post prandial exchange of AAD during a 24-hour period for 6 months. MAIN OUTCOME MEASURES A significant change in serum lipid levels. RESULTS Patients in group A (n = 10) received a single daily exchange of AAD in place of their post prandial dextrose exchange for the first 6 months, and then crossed over to the dextrose phase. Patients in group B (n = 8) continued their usual dextrose dialysis for the first 6 months and then crossed over to receive AAD in the latter 6 months. Measurements of serum lipids and lipoproteins along with other biochemical parameters were made at regular intervals. Although a downward trend in mean serum total cholesterol was seen on AAD in group A, no significant change in total cholesterol, low-density lipoprotein cholesterol, or high-density lipoprotein cholesterol was observed in any group. Mean serum triglycerides fell on AAD in both groups, but were not statistically significant. Serum lipoprotein(a) [Lp(a)] and apolipoprotein B were elevated in both groups but did not change on AAD or with time. No change was observed in serum apoprotein A1 levels. Serum Lp(a) was not correlated to dialysate protein excretion. No change in mean serum albumin was observed, in either group, on AAD. KT/V urea, total weekly creatinine clearance, net ultrafiltration, and dialysate protein excretion remained unchanged on AAD. CONCLUSIONS The use of AAD, although clinically safe and without side effects, had no effect on the dyslipidemia in our group of CAPD patients.
Collapse
Affiliation(s)
- M Misra
- Department of Medicine (Nephrology), Charing Cross Hospital, London, U.K
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
Facial inflammatory dermatoses can be difficult to diagnose in their early stages; skin biopsy may help but often shows indeterminate features. The aims of our study were to identify patients presenting with a facial dermatosis requiring skin biopsy, in whom the initial histological features were classified as "non-specific", to determine the eventual diagnostic outcome, and to attempt to identify subtle early histologic features. We located 79 such cases with indeterminate histology from 45,000 dermatopathology reports 1972-1987. The original biopsies were assessed and scored using a check-list of 20 features and the patients' case-records up to 1992 were examined. Follow-up information was available in 64 cases and an eventual clinical diagnosis was made in 54 (84%) of these; the commonest diagnoses were rosacea (26%), chronic discoid lupus erythematosus (24%) and seborrheic or unclassified dermatitis (17%). Histological differences were seen in the original biopsies of these three diagnostic categories, although none was predictive. We conclude that clinical follow-up leads to the diagnosis of most facial rashes initially showing "non-specific" histology.
Collapse
Affiliation(s)
- L E Rhodes
- Dept. of Dermatology, Royal Liverpool University Hospital, UK
| | | | | |
Collapse
|
48
|
Ashworth J. The Shock Trauma Center at the University of Maryland Medical Center: an interview with John Ashworth. Interview by Vivian Smith. Md Med J 1994; 43:1065-7. [PMID: 7815911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
49
|
Affiliation(s)
- J Ashworth
- Department of Dermatology, Royal Liverpool University Hospital, UK
| |
Collapse
|
50
|
Affiliation(s)
- J J Jones
- Department of Pharmacy, Royal Liverpool University Hospital, United Kingdom
| | | |
Collapse
|