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Chetan MR, Charlton MH, Thompson C, Dias RP, Andrews RC, Narendran P. The Type 1 diabetes 'honeymoon' period is five times longer in men who exercise: a case-control study. Diabet Med 2019; 36:127-128. [PMID: 30117195 DOI: 10.1111/dme.13802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M R Chetan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M H Charlton
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Thompson
- Department of Diabetes, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - R P Dias
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Paediatric Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - R C Andrews
- Department of Diabetes, Taunton and Somerset NHS Foundation Trust, Taunton, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - P Narendran
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Charlton MH, Aleksis R, Saint-Leger A, Gupta A, Loza E, Ribas de Pouplana L, Kaula I, Gustina D, Madre M, Lola D, Jaudzems K, Edmund G, Randall CP, Kime L, O’Neill AJ, Goessens W, Jirgensons A, Finn PW. N-Leucinyl Benzenesulfonamides as Structurally Simplified Leucyl-tRNA Synthetase Inhibitors. ACS Med Chem Lett 2018; 9:84-88. [PMID: 29456792 DOI: 10.1021/acsmedchemlett.7b00374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/18/2018] [Indexed: 12/12/2022] Open
Abstract
N-Leucinyl benzenesulfonamides have been discovered as a novel class of potent inhibitors of E. coli leucyl-tRNA synthetase. The binding of inhibitors to the enzyme was measured by using isothermal titration calorimetry. This provided information on enthalpy and entropy contributions to binding, which, together with docking studies, were used for structure-activity relationship analysis. Enzymatic assays revealed that N-leucinyl benzenesulfonamides display remarkable selectivity for E. coli leucyl-tRNA synthetase compared to S. aureus and human orthologues. The simplest analogue of the series, N-leucinyl benzenesulfonamide (R = H), showed the highest affinity against E. coli leucyl-tRNA synthetase and also exhibited antibacterial activity against Gram-negative pathogens (the best MIC = 8 μg/mL, E. coli ATCC 25922), which renders it as a promising template for antibacterial drug discovery.
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Affiliation(s)
- Michael H. Charlton
- Oxford Drug Design Ltd., Oxford Centre for Innovation, New Road, Oxford, OX1 1BY. U.K
| | - Rihards Aleksis
- Latvian Institute of Organic Synthesis, Aizkraukles 21, Riga LV-1006, Latvia
| | - Adélaïde Saint-Leger
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac, 10, 08028 Barcelona, Catalonia, Spain
- ICREA, Pg. Lluís Company 23, 08010 Barcelona, Catalonia, Spain
| | - Arya Gupta
- Antimicrobial
Research Centre and School of Molecular and Cellular Biology, Faculty
of Biological Sciences, University of Leeds, Leeds, LS2 9JT, U.K
| | - Einars Loza
- Latvian Institute of Organic Synthesis, Aizkraukles 21, Riga LV-1006, Latvia
| | - Lluís Ribas de Pouplana
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac, 10, 08028 Barcelona, Catalonia, Spain
- ICREA, Pg. Lluís Company 23, 08010 Barcelona, Catalonia, Spain
| | - Ilze Kaula
- Latvian Institute of Organic Synthesis, Aizkraukles 21, Riga LV-1006, Latvia
| | - Daina Gustina
- Latvian Institute of Organic Synthesis, Aizkraukles 21, Riga LV-1006, Latvia
| | - Marina Madre
- Latvian Institute of Organic Synthesis, Aizkraukles 21, Riga LV-1006, Latvia
| | - Daina Lola
- Latvian Institute of Organic Synthesis, Aizkraukles 21, Riga LV-1006, Latvia
| | - Kristaps Jaudzems
- Latvian Institute of Organic Synthesis, Aizkraukles 21, Riga LV-1006, Latvia
| | - Grace Edmund
- Oxford Drug Design Ltd., Oxford Centre for Innovation, New Road, Oxford, OX1 1BY. U.K
| | - Christopher P. Randall
- Antimicrobial
Research Centre and School of Molecular and Cellular Biology, Faculty
of Biological Sciences, University of Leeds, Leeds, LS2 9JT, U.K
| | - Louise Kime
- Antimicrobial
Research Centre and School of Molecular and Cellular Biology, Faculty
of Biological Sciences, University of Leeds, Leeds, LS2 9JT, U.K
| | - Alex J. O’Neill
- Antimicrobial
Research Centre and School of Molecular and Cellular Biology, Faculty
of Biological Sciences, University of Leeds, Leeds, LS2 9JT, U.K
| | - Wil Goessens
- Erasmus University Medical Center Rotterdam, Department
of Medical Microbiology and Infectious Diseases, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Aigars Jirgensons
- Latvian Institute of Organic Synthesis, Aizkraukles 21, Riga LV-1006, Latvia
| | - Paul W. Finn
- Oxford Drug Design Ltd., Oxford Centre for Innovation, New Road, Oxford, OX1 1BY. U.K
- Department
of Applied Computing, University of Buckingham, Hunter Street, Buckingham, MK18 1EG, U.K
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Ebejer JP, Charlton MH, Finn PW. Are the physicochemical properties of antibacterial compounds really different from other drugs? J Cheminform 2016; 8:30. [PMID: 27274770 PMCID: PMC4891840 DOI: 10.1186/s13321-016-0143-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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] [Received: 02/01/2016] [Accepted: 05/25/2016] [Indexed: 01/12/2023] Open
Abstract
Background It is now widely recognized that there is an urgent need for new antibacterial drugs, with novel mechanisms of action, to combat the rise of multi-drug resistant bacteria. However, few new compounds are reaching the market. Antibacterial drug discovery projects often succeed in identifying potent molecules in biochemical assays but have been beset by difficulties in obtaining antibacterial activity. A commonly held view, based on analysis of marketed antibacterial compounds, is that antibacterial drugs possess very different physicochemical properties to other drugs, and that this profile is required for antibacterial activity. Results We have re-examined this issue by performing a cheminformatics analysis of the literature data available in the ChEMBL database. The physicochemical properties of compounds with a recorded activity in an antibacterial assay were calculated and compared to two other datasets extracted from ChEMBL, marketed antibacterials and drugs marketed for other therapeutic indications. The chemical class of the compounds and Gram-negative/Gram-positive profile were also investigated. This analysis shows that compounds with antibacterial activity have physicochemical property profiles very similar to other drug classes. Conclusions The observation that many current antibacterial drugs lie in regions of physicochemical property space far from conventional small molecule therapeutics is correct. However, the inference that a compound must lie in one of these “outlier” regions in order to possess antibacterial activity is not supported by our analysis. Electronic supplementary material The online version of this article (doi:10.1186/s13321-016-0143-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jean-Paul Ebejer
- InhibOx Limited, Oxford Centre for Innovation, New Road, Oxford, OX1 1BY UK ; Centre for Molecular Medicine and Biobanking, University of Malta, Msida, MSD 2080 Malta
| | - Michael H Charlton
- InhibOx Limited, Oxford Centre for Innovation, New Road, Oxford, OX1 1BY UK
| | - Paul W Finn
- InhibOx Limited, Oxford Centre for Innovation, New Road, Oxford, OX1 1BY UK ; University of Buckingham, Hunter Street, Buckingham, MK18 1EG UK
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Arena de Souza V, Scott DJ, Nettleship JE, Rahman N, Charlton MH, Walsh MA, Owens RJ. Comparison of the Structure and Activity of Glycosylated and Aglycosylated Human Carboxylesterase 1. PLoS One 2015; 10:e0143919. [PMID: 26657071 PMCID: PMC4676782 DOI: 10.1371/journal.pone.0143919] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/11/2015] [Indexed: 11/25/2022] Open
Abstract
Human Carboxylesterase 1 (hCES1) is the key liver microsomal enzyme responsible for detoxification and metabolism of a variety of clinical drugs. To analyse the role of the single N-linked glycan on the structure and activity of the enzyme, authentically glycosylated and aglycosylated hCES1, generated by mutating asparagine 79 to glutamine, were produced in human embryonic kidney cells. Purified enzymes were shown to be predominantly trimeric in solution by analytical ultracentrifugation. The purified aglycosylated enzyme was found to be more active than glycosylated hCES1 and analysis of enzyme kinetics revealed that both enzymes exhibit positive cooperativity. Crystal structures of hCES1 a catalytically inactive mutant (S221A) and the aglycosylated enzyme were determined in the absence of any ligand or substrate to high resolutions (1.86 Å, 1.48 Å and 2.01 Å, respectively). Superposition of all three structures showed only minor conformational differences with a root mean square deviations of around 0.5 Å over all Cα positions. Comparison of the active sites of these un-liganded enzymes with the structures of hCES1-ligand complexes showed that side-chains of the catalytic triad were pre-disposed for substrate binding. Overall the results indicate that preventing N-glycosylation of hCES1 does not significantly affect the structure or activity of the enzyme.
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Affiliation(s)
- Victoria Arena de Souza
- UK OPPF-UK, The Research Complex at Harwell, Rutherford Appleton Laboratory Harwell Oxford, Oxfordshire, United Kingdom
- Division of Structural Biology, Henry Wellcome Building for Genomic Medicine, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, United Kingdom
| | - David J. Scott
- The Research Complex at Harwell, Rutherford Appleton Laboratory Harwell Oxford, Oxfordshire, United Kingdom
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, Leicestershire, United Kingdom
| | - Joanne E. Nettleship
- UK OPPF-UK, The Research Complex at Harwell, Rutherford Appleton Laboratory Harwell Oxford, Oxfordshire, United Kingdom
- Division of Structural Biology, Henry Wellcome Building for Genomic Medicine, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
| | - Nahid Rahman
- UK OPPF-UK, The Research Complex at Harwell, Rutherford Appleton Laboratory Harwell Oxford, Oxfordshire, United Kingdom
- Division of Structural Biology, Henry Wellcome Building for Genomic Medicine, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
| | - Michael H. Charlton
- Chroma Therapeutics Ltd., 93 Innovation Drive Milton Park, Abingdon, United Kingdom
| | - Martin A. Walsh
- The Research Complex at Harwell, Rutherford Appleton Laboratory Harwell Oxford, Oxfordshire, United Kingdom
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, United Kingdom
- * E-mail: (MAW); (RJO)
| | - Raymond J. Owens
- UK OPPF-UK, The Research Complex at Harwell, Rutherford Appleton Laboratory Harwell Oxford, Oxfordshire, United Kingdom
- Division of Structural Biology, Henry Wellcome Building for Genomic Medicine, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
- * E-mail: (MAW); (RJO)
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Charlton MH, Brotherton DH, Owen J, Clark VL, Testar RJ, Davies SJ, Moffat DFC. Monocyte and macrophage selective anti-inflammatory kinase inhibitors. Med Chem Commun 2012. [DOI: 10.1039/c2md20158e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Needham LA, Davidson AH, Bawden LJ, Belfield A, Bone EA, Brotherton DH, Bryant S, Charlton MH, Clark VL, Davies SJ, Donald A, Day FA, Krige D, Legris V, McDermott J, McGovern Y, Owen J, Patel SR, Pintat S, Testar RJ, Wells GMA, Moffat D, Drummond AH. Drug targeting to monocytes and macrophages using esterase-sensitive chemical motifs. J Pharmacol Exp Ther 2011; 339:132-42. [PMID: 21778281 DOI: 10.1124/jpet.111.183640] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The therapeutic and toxic effects of drugs are often generated through effects on distinct cell types in the body. Selective delivery of drugs to specific cells or cell lineages would, therefore, have major advantages, in particular, the potential to significantly improve the therapeutic window of an agent. Cells of the monocyte-macrophage lineage represent an important target for many therapeutic agents because of their central involvement in a wide range of diseases including inflammation, cancer, atherosclerosis, and diabetes. We have developed a versatile chemistry platform that is designed to enhance the potency and delivery of small-molecule drugs to intracellular molecular targets. One facet of the technology involves the selective delivery of drugs to cells of the monocyte-macrophage lineage, using the intracellular carboxylesterase, human carboxylesterase-1 (hCE-1), which is expressed predominantly in these cells. Here, we demonstrate selective delivery of many types of intracellularly targeted small molecules to monocytes and macrophages by attaching a small esterase-sensitive chemical motif (ESM) that is selectively hydrolyzed within these cells to a charged, pharmacologically active drug. ESM versions of histone deacetylase (HDAC) inhibitors, for example, are extremely potent anticytokine and antiarthritic agents with a wider therapeutic window than conventional HDAC inhibitors. In human blood, effects on monocytes (hCE-1-positive) are seen at concentrations 1000-fold lower than those that affect other cell types (hCE-1-negative). Chemical conjugates of this type, by limiting effects on other cells, could find widespread applicability in the treatment of human diseases where monocyte-macrophages play a key role in disease pathology.
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Abstract
The biological activity of a series of structurally diverse 3-isothiazolones (1) has been assessed by evaluating the minimum inhibitory concentration required to inhibit the growth of E. Coli. The structure and electronic properties of these derivatives have been calculated using both semi-empirical and ab initio molecular orbital methods. Multi-linear regression analysis shows no correlation between the experimental activity of the 3-isothiazolones and either the calculated geometries, electronic properties, or the frontier orbital energies of these derivatives, but a reasonable relationship is found with other parameters including their calculated solvation energies, suggesting that diffusion may play an important role in their mode of action.
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Affiliation(s)
- John O Morley
- Chemistry Department, University of Wales Swansea, Singleton Park, Swansea, UKSA2 8PP
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Affiliation(s)
- John O. Morley
- Chemistry Department, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP, United Kingdom, and Evotec OAI, 111 Milton Park, Abingdon, Oxfordshire, OX14 4SD, United Kingdom
| | - Owen J. Guy
- Chemistry Department, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP, United Kingdom, and Evotec OAI, 111 Milton Park, Abingdon, Oxfordshire, OX14 4SD, United Kingdom
| | - Michael H. Charlton
- Chemistry Department, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP, United Kingdom, and Evotec OAI, 111 Milton Park, Abingdon, Oxfordshire, OX14 4SD, United Kingdom
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Abstract
Virtual screening methods using structure-based, pharmacophore-based and descriptor based protocols may be used to identify ligands for the G-protein coupled receptor target family. A complementary approach is the synthesis and screening of compound libraries designed using privileged motifs and/or based on validated hit molecules. A virtual screening approach based on molecular docking performed with GOLD using a templated homology model and a consensus scoring procedure can identify vasopressin 1a receptor antagonists. In a separate project a library design and synthesis approach based around validated hit GPCR ligands led to the identification of potent oxytocin antagonists. Subsequent optimisation of the initial library compounds has provided compounds that are now being evaluated in the clinic for the treatment of preterm labour.
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Affiliation(s)
- Mark Ashton
- Evotec OAI, 151 Milton Park, Abingdon, Oxfordshire OX14 4SD, UK.
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Buchanan JG, Charlton MH, Mahon MF, Robinson JJ, Ruggiero GD, Williams IH. Experimental and computational studies of ?-lactones: Structure and bonding in the three-membered ring. J PHYS ORG CHEM 2002. [DOI: 10.1002/poc.526] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Robinson JJ, Buchanan JG, Kinsman RG, Mahon MF, Williams IH, Charlton MH. Evidence for α-lactone intermediates in addition of aqueous bromine to disodium dimethyl-maleate and -fumarate. Chem Commun (Camb) 2001. [DOI: 10.1039/b100335f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Morley JO, Charlton MH. Molecular Modeling Studies on the Structure and Electronic Properties of Bis(Thiophosphorylamines) and Their Zinc Complexes. J Phys Chem A 1998. [DOI: 10.1021/jp9819238] [Citation(s) in RCA: 9] [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: 11/28/2022]
Affiliation(s)
- John O. Morley
- Chemistry Department, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP, and Research Centre, Zeneca Specialties, Hexagon house, Blackley, Manchester, M9 8ZS, United Kingdom
| | - Michael H. Charlton
- Chemistry Department, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP, and Research Centre, Zeneca Specialties, Hexagon house, Blackley, Manchester, M9 8ZS, United Kingdom
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Buttar D, Charlton MH, Docherty R, Starbuck J. Theoretical investigations of conformational aspects of polymorphism. Part 1: o-acetamidobenzamide. ACTA ACUST UNITED AC 1998. [DOI: 10.1039/a706978b] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- John O. Morley
- Contribution from the Chemistry Department, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP, U.K., and Research Centre, Zeneca Specialties, Hexagon house, Blackley, Manchester, M9 8ZS, U.K
| | - Richard M. Morley
- Contribution from the Chemistry Department, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP, U.K., and Research Centre, Zeneca Specialties, Hexagon house, Blackley, Manchester, M9 8ZS, U.K
| | - Robert Docherty
- Contribution from the Chemistry Department, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP, U.K., and Research Centre, Zeneca Specialties, Hexagon house, Blackley, Manchester, M9 8ZS, U.K
| | - Michael H. Charlton
- Contribution from the Chemistry Department, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP, U.K., and Research Centre, Zeneca Specialties, Hexagon house, Blackley, Manchester, M9 8ZS, U.K
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Malone JF, Murray CM, Charlton MH, Docherty R, Lavery AJ. X[mdash ]H[middot][middot][middot][pi ] (phenyl) interactions Theoretical and crystallographic observations. ACTA ACUST UNITED AC 1997. [DOI: 10.1039/a700669a] [Citation(s) in RCA: 234] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Charlton MH, Docherty R, Hutchings MG. Quantitative structure–sublimation enthalpy relationship studied by neural networks, theoretical crystal packing calculations and multilinear regression analysis. ACTA ACUST UNITED AC 1995. [DOI: 10.1039/p29950002023] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Charlton MH, Docherty R, McGeein DJ, Morley JO. Theoretical investigation of the structure and spectra of donor–acceptor azobenzenes. ACTA ACUST UNITED AC 1993. [DOI: 10.1039/ft9938901671] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
A 5-year experience with 562 carotid endarterectomies, using electroencephalogram (EEG) monitoring and selective shunting, was reviewed. EEG changes occurred in 102 patients (18%). The frequency of EEG changes, as related to cerebral vascular symptoms, was as follows: transient ischemic attacks, seven per cent (19/259); completed strokes, 37% (36/98); vertebral basilar insufficiency, 24% (32/135); asymptomatic, 21% (15/71). Patients with contralateral carotid occlusion exhibited EEG changes in 37% (28/76) of operations. Fifteen patients suffered perioperative strokes (2.6%). Nine of the 15 were associated with a technical problem of either thrombosis of the internal carotid artery (five) or emboli (four). Technical problems were more common when shunts were used (five per cent) than when they were not (0.9%). Patients who suffered strokes prior to surgery were more at risk to develop a perioperative stroke (three per cent) than those not suffering prior strokes (0.3%). The EEG did not change in three patients who had lacunar infarcts prior to surgery and who awoke with a worsened deficit. Our series does not clearly establish the advantages of EEG monitoring, which is expensive (+375/patient) and may not detect ischemia in all areas of the brain. However, the use of shunts may introduce a risk of stroke due to technical error that is equal or greater than the risk of stroke due to hemodynamic ischemia. Since the need for protection is unpredictable by angiographic or clinical criteria, the benefit of EEG monitoring may be in reducing the incidence of shunting in those patients whose tracing remains normal after clamping. The decision to shunt, however, when there is electrical dysfunction after carotid clamping should be based not only on the EEG but also on the clinical signs and computed tomography (CT) scan. Our data does not show a net benefit in selective shunting unless the patient has sustained a stroke prior to surgery.
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Abstract
EEG monitoring and carotid back pressure were performed on 100 patients undergoing elective carotid endarterectomy. Shunts were inserted selectively in those patients who showed change in EEG after a trial period of carotid clamping (15%). No patient in the series awoke with a neurologic deficit. Back pressures were significantly lower in the shunted group and these pressures roughly correlated with EEG changes. Only one patient with a back pressure of greater than 40 mmHg had EEG changes and this patient had a recent mild stroke. EEG changes were most frequent in patients with contralateral carotid occlusions and in asymptomatic significant stenoses. EEG is a more discriminating indicator for shunt insertion than back pressure, although a pressure greater than 40 mmHg is safe in patients without recent stroke.
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Hanley JA, Charlton MH. EEG in the operating room: artifacts and unusual waveforms. Am J EEG Technol 1982; 22:135-41. [PMID: 10258497] [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: 02/12/2023]
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Charlton MH. Presenile dementia. N Y State J Med 1975; 75:1493-5. [PMID: 1057065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Charlton MH. Hippocrates and Asklepois; rise and fall of ancient scientific neurology. N Y State J Med 1975; 75:117-9. [PMID: 1089221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Charlton MH. Muscular dystrophy, 1865 (Wilhelm Griesinger). Am J Dis Child 1973; 125:893-8. [PMID: 4581905] [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: 01/11/2023]
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Charlton MH. Clinical aspects. Minimal brain dysfunction and the hyperkinetic child. N Y State J Med 1972; 72:2058-60. [PMID: 4505330] [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: 01/11/2023]
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Charlton MH. Minimal brain dysfunction: clinical aspects. Electroencephalogr Clin Neurophysiol 1970; 29:412-3. [PMID: 4097226] [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: 01/08/2023]
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Charlton MH, Mellinger JF. Infantile spasms and hypsarrhythmia. Electroencephalogr Clin Neurophysiol 1970; 29:413. [PMID: 4097228] [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: 01/08/2023]
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