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Yamaguchi E, Ffrench O'Carroll R, Chau A, Preston R. Successful antepartum de-labelling of local anaesthetic allergy in a parturient with a self-reported allergy to amide and ester local anaesthetics. Int J Obstet Anesth 2024; 58:103978. [PMID: 38508964 DOI: 10.1016/j.ijoa.2024.103978] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/22/2023] [Accepted: 01/06/2024] [Indexed: 03/22/2024]
Affiliation(s)
- E Yamaguchi
- Room 1Q72-4500 Oak Street, Vancouver BC, Canada.
| | | | - A Chau
- BC Women's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - R Preston
- BC Women's Hospital, University of British Columbia, Vancouver, BC, Canada
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2
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Patel V, Patel J, Gan J, Rahiminejad M, Preston R, Mak SM, Benedetti G. Reporting of coronary artery calcification on chest CT studies in patients with interstitial lung disease. Clin Radiol 2024; 79:e532-e538. [PMID: 38242805 DOI: 10.1016/j.crad.2023.11.028] [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] [Received: 04/26/2023] [Revised: 11/03/2023] [Accepted: 11/29/2023] [Indexed: 01/21/2024]
Abstract
AIM To evaluate the prevalence of coronary artery calcification (CAC) on non-contrast computed tomography (CT) of the thorax in patients with interstitial lung disease (ILD), assess consistency of CAC reporting and assess incidence of subsequent cardiac events. MATERIALS AND METHODS Patients with known interstitial lung disease who underwent a CT thorax over a 2-year period were retrospectively reviewed. Presence of CAC was assessed using a visual scale for CAC reporting and graded as mild, moderate, or severe by two cardiothoracic radiologists. CT reports were reviewed to determine if presence of CAC had been described. Electronic medical records were reviewed for any subsequent cardiothoracic events from the date of the CT thorax to present. RESULTS 254 patients were included in the analysis (54.7% men; mean age 59.9 yo). 43.7% had CAC on their CT thorax; however, in 87.3% of those, reports did not comment on its presence. 8 patients had cardiac events; 7 of them had CAC on CT although only in 1 case this was reported. Global CAC and LAD CAC Patients with cardiac events had a significantly higher global CAC (p=0.016) and LAD CAC (p=0.048) when compared to patients without. CONCLUSION We demonstrated a high prevalence of CAC in ILD patients and its significant association with adverse cardiac events. Unfortunately, CAC on CT thorax is still largely unreported. As per recent BSCI/BSCCT and BSTI guidelines, reporting of CAC should become part of routine practice, as may prompt prevention and impact on patients outcome.
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Affiliation(s)
- V Patel
- The Royal Marsden, Fulham Road, London, SW3 6JJ, UK
| | - J Patel
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - J Gan
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - M Rahiminejad
- National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - R Preston
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - S M Mak
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - G Benedetti
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
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3
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Neill D, Preston R, Newton WG, Tsang D. Constraining the Nuclear Symmetry Energy with Multimessenger Resonant Shattering Flares. Phys Rev Lett 2023; 130:112701. [PMID: 37001080 DOI: 10.1103/physrevlett.130.112701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/03/2022] [Accepted: 01/27/2023] [Indexed: 06/19/2023]
Abstract
Much effort is devoted to measuring the nuclear symmetry energy through neutron star (NS) and nuclear observables. Since matter in the NS core may be nonhadronic, observables like radii and tidal deformability may not provide reliable constraints on properties of nucleonic matter. By performing the first consistent inference using ensembles of core and crust equations of state from astrophysical and nuclear data, we demonstrate that coincident timing of a resonant shattering flare (RSF) and gravitational wave signal during binary NS inspiral probes the crust-core transition region and provides constraints on the symmetry energy comparable to terrestrial nuclear experiments. We show that nuclear masses, RSFs, and measurements of NS radii and tidal deformabilities constrain different density ranges of the equation of state, providing complementary probes.
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Affiliation(s)
- Duncan Neill
- Department of Physics, University of Bath, Claverton Down, Bath, United Kingdom
| | - Rebecca Preston
- Department of Physics and Astronomy, Texas A&M University-Commerce, Commerce, Texas, USA
| | - William G Newton
- Department of Physics and Astronomy, Texas A&M University-Commerce, Commerce, Texas, USA
| | - David Tsang
- Department of Physics, University of Bath, Claverton Down, Bath, United Kingdom
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Preston R, Meng QJ, Lennon R. The dynamic kidney matrisome - is the circadian clock in control? Matrix Biol 2022; 114:138-155. [PMID: 35569693 DOI: 10.1016/j.matbio.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/21/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023]
Abstract
The circadian clock network in mammals is responsible for the temporal coordination of numerous physiological processes that are necessary for homeostasis. Peripheral tissues demonstrate circadian rhythmicity and dysfunction of core clock components has been implicated in the pathogenesis of diseases that are characterized by abnormal extracellular matrix, such as fibrosis (too much disorganized matrix) and tissue breakdown (too little matrix). Kidney disease is characterized by proteinuria, which along with the rate of filtration, displays robust circadian oscillation. Clinical observation and mouse studies suggest the presence of 24 h kidney clocks responsible for circadian oscillation in kidney function. Recent experimental evidence has also revealed that cell-matrix interactions and the biomechanical properties of extracellular matrix have key roles in regulating peripheral circadian clocks and this mechanism appears to be cell- and tissue-type specific. Thus, establishing a temporally resolved kidney matrisome may provide a useful tool for studying the two-way interactions between the extracellular matrix and the intracellular time-keeping mechanisms in this critical niche tissue. This review summarizes the latest genetic and biochemical evidence linking kidney physiology and disease to the circadian system with a particular focus on the extracellular matrix. We also review the experimental approaches and methodologies required to dissect the roles of circadian pathways in specific tissues and outline the translational aspects of circadian biology, including how circadian medicine could be used for the treatment of kidney disease.
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Affiliation(s)
- Rebecca Preston
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PT, UK
| | - Qing-Jun Meng
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PT, UK.
| | - Rachel Lennon
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PT, UK; Department of Pediatric Nephrology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK.
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5
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Naylor RW, Watson E, Williamson S, Preston R, Davenport JB, Thornton N, Lowe M, Williams M, Lennon R. Basement membrane defects in CD151-associated glomerular disease. Pediatr Nephrol 2022; 37:3105-3115. [PMID: 35278129 PMCID: PMC9587066 DOI: 10.1007/s00467-022-05447-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND CD151 is a cell-surface molecule of the tetraspanin family. Its lateral interaction with laminin-binding integrin ɑ3β1 is important for podocyte adhesion to the glomerular basement membrane (GBM). Deletion of Cd151 in mice induces glomerular dysfunction, with proteinuria and associated focal glomerulosclerosis, disorganisation of GBM and tubular cystic dilation. Despite this, CD151 is not routinely screened for in patients with nephrotic-range proteinuria. We aimed to better understand the relevance of CD151 in human kidney disease. METHODS Next-generation sequencing (NGS) was used to detect the variant in CD151. Electron and light microscopy were used to visualise the filtration barrier in the patient kidney biopsy, and immunoreactivity of patient red blood cells to anti-CD151/MER2 antibodies was performed. Further validation of the CD151 variant as disease-causing was performed in zebrafish using CRISPR-Cas9. RESULTS We report a young child with nail dystrophy and persistent urinary tract infections who was incidentally found to have nephrotic-range proteinuria. Through targeted NGS, a novel, homozygous truncating variant was identified in CD151, a gene rarely reported in patients with nephrotic syndrome. Electron microscopy imaging of patient kidney tissue showed thickening of GBM and podocyte effacement. Immunofluorescence of patient kidney tissue demonstrated that CD151 was significantly reduced, and we did not detect immunoreactivity to CD151/MER2 on patient red blood cells. CRISPR-Cas9 depletion of cd151 in zebrafish caused proteinuria, which was rescued by injection of wild-type CD151 mRNA, but not CD151 mRNA containing the variant sequence. CONCLUSIONS Our results indicate that a novel variant in CD151 is associated with nephrotic-range proteinuria and microscopic haematuria and provides further evidence for a role of CD151 in glomerular disease. Our work highlights a functional testing pipeline for future analysis of patient genetic variants. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Richard W Naylor
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK
| | - Elizabeth Watson
- South West Genomic Laboratory Hub, Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Samantha Williamson
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Preston
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK
| | - J Bernard Davenport
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK
| | - Nicole Thornton
- International Blood Group Reference Laboratory, NHS Blood and Transplant, Filton, Bristol, UK
| | - Martin Lowe
- Division of Molecular and Cellular Function, School of Biological Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Maggie Williams
- South West Genomic Laboratory Hub, Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Rachel Lennon
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK.
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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Aziz W, Morgan H, Demir OM, Sinha A, Rua T, Rajani R, Chang AL, Woo E, Mak SM, Benedetti G, Villa A, Preston R, Navin R, O'Kane K, Hunter L, Ismail T, Carr-White G, Beckley-Hoelscher N, Peacock J, Marber M, Razavi R, Perera D. Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT). Heart 2022; 108:1972-1978. [PMID: 36288924 PMCID: PMC9726962 DOI: 10.1136/heartjnl-2022-320990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/10/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Many patients presenting with suspected acute coronary syndrome (ACS) have high-sensitivity cardiac troponin (hs-cTn) concentrations between rule-in and rule-out thresholds and hence need serial testing, which is time consuming. The Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT) assessed the utility of coronary CT angiography (CCTA) in patients with suspected ACS, non-ischaemic ECG and intermediate initial hs-cTn concentration. METHODS Patients were randomised to CCTA-guided management versus standard of care (SOC). The primary outcome was hospital length of stay (LOS). Secondary outcomes included cost of in-hospital stay and major adverse cardiac events (MACE) at 12 months of follow-up. Data are mean (SD); for LOS harmonic means, IQRs are shown. RESULTS 250 (aged 55 (14) years, 25% women) patients were randomised. Harmonic mean (IQR) LOS was 7.53 (6.0-9.6) hours in the CCTA arm and 8.14 (6.3-9.8) hours in the SOC arm (p=0.13). Inpatient cost was £1285 (£2216) and £1108 (£3573), respectively, p=0.68. LOS was shorter in the CCTA group in patients with <25% stenosis, compared with SOC; 6.6 (5.6-7.8) hours vs 7.5 (6.1-9.4) hours, respectively; p=0.021. More referrals for cardiology outpatient clinic review and cardiac CT-related outpatient referrals occurred in the SOC arm (p=0.01). 12-month MACE rates were similar between the two arms (7 (5.6%) in the CCTA arm and 8 (6.5%) in the SOC arm-log-rank p=0.78). CONCLUSIONS CCTA did not lead to reduced hospital LOS or cost, largely because these outcomes were influenced by the detection of ≥25% grade stenosis in a proportion of patients. TRIAL REGISTRATION NUMBER NCT03583320.
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Affiliation(s)
- Waqar Aziz
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Holly Morgan
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Ozan M Demir
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Aish Sinha
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Tiago Rua
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ai-Lee Chang
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Eric Woo
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sze Mun Mak
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Adriana Villa
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Rebecca Preston
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Roshan Navin
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Kevin O'Kane
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Laura Hunter
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Tevfik Ismail
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | | | - Janet Peacock
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Michael Marber
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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Grigoryan K, Demetrescu C, Kasouridis I, Abiola O, Masci PG, Oguz D, Benedetti G, SzeMun M, Parwani P, Preston R, Chiribiri A, Hancock J, Patterson T, Redwood S, Prendergast B, Grapsa J. Multimodality Imaging in Valvular Structural Interventions. Card Fail Rev 2022; 8:e31. [PMID: 36644647 PMCID: PMC9820006 DOI: 10.15420/cfr.2022.10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
Structural valvular interventions have skyrocketed in the past decade with new devices becoming available and indications for patients who would previously have been deemed inoperable. Furthermore, while echocardiography is the main imaging tool and the first line for patient screening, cardiac magnetic resonance and CT are now essential tools in pre-planning and post-procedural follow-up. This review aims to address imaging modalities and their scope in aortic, mitral and tricuspid structural valvular interventions, including multimodality imaging. Pulmonary valve procedures, which are mostly carried out in patients with congenital problems, are discussed. This article presents a guide on individualised imaging approcahes on each of the available interventional procedures.
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Affiliation(s)
- Karine Grigoryan
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Camelia Demetrescu
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Ioannis Kasouridis
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Olukayode Abiola
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Pier Giorgio Masci
- Department of Cardiac Magnetic Resonance, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Didem Oguz
- Department of Cardiology, Massachusetts General Hospital, Harvard Medical SchoolBoston, Massachusetts, US
| | - Giulia Benedetti
- Department of Radiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Mak SzeMun
- Department of Radiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University HealthCalifornia, US
| | - Rebecca Preston
- Department of Radiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Amedeo Chiribiri
- Department of Cardiac Magnetic Resonance, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Jane Hancock
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Tiffany Patterson
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Simon Redwood
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Bernard Prendergast
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas’ NHS Foundation TrustLondon, UK
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McCurdie F, Mak SM, Mak D, Benedetti G, Preston R. Cavitating and cystic lung lesions: A pictorial review. Clin Radiol 2022. [DOI: 10.1016/j.crad.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wenlock RD, Tausan M, Mann R, Garr W, Preston R, Arnold A, Hoban J, Webb L, Quick C, Beckett A, Loveson K, Glaysher S, Elliott S, Malone C, Cogger B, Easton L, Robson SC, Hassan-Ibrahim MO, Sargent C. Nosocomial or not? A combined epidemiological and genomic investigation to understand hospital-acquired COVID-19 infection on an elderly care ward. Infect Prev Pract 2021; 3:100165. [PMID: 34485893 PMCID: PMC8397489 DOI: 10.1016/j.infpip.2021.100165] [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: 02/05/2021] [Accepted: 07/23/2021] [Indexed: 10/27/2022] Open
Abstract
Background COVID-19 has the potential to cause outbreaks in hospitals. Given the comorbid and elderly cohort of patients hospitalized, hospital-acquired COVID-19 infection is often fatal. Pathogen genome sequencing is becoming increasingly important in infection prevention and control (IPC). Aim To inform the understanding of in-hospital SARS-CoV-2 transmission in order to improve IPC practices and to inform the future development of virological testing for IPC. Methods Patients detected COVID-19 positive by polymerase chain reaction on Ward A in April and May 2020 were included with contact tracing to identify other potential cases. Genome sequencing was undertaken for a subgroup of cases. Epidemiological, genomic, and cluster analyses were performed to describe the epidemiology and to identify factors contributing to the outbreak. Findings Fourteen cases were identified on Ward A. Contact tracing identified 16 further patient cases; in addition, eight healthcare workers (HCWs) were identified as being COVID-19 positive through a round of asymptomatic testing. Genome sequencing of 16 of these cases identified viral genomes differing by two single nucleotide polymorphisms or fewer, with further cluster analysis identifying two groups of infection (a five-person group and a six-person group). Conclusion Despite the temporal relationship of cases, genome sequencing identified that not all cases shared transmission events. However, 11 samples were found to be closely related and these likely represented in-hospital transmission. This included three HCWs, thereby confirming transmission between patients and HCWs.
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Affiliation(s)
- R D Wenlock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Tausan
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - R Mann
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - W Garr
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - R Preston
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Arnold
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - J Hoban
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - L Webb
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - C Quick
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Beckett
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK
| | - K Loveson
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK
| | - S Glaysher
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - S Elliott
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - C Malone
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - B Cogger
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - L Easton
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - S C Robson
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK.,School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK
| | | | - C Sargent
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Nazir MS, Preston R, Chiribiri A, Sheikh N. Multimodal Imaging for Diagnosis of Anomalous Coronary Artery With Subsequent Myocardial Infarction. JACC Case Rep 2021; 3:1310-1314. [PMID: 34471884 PMCID: PMC8387804 DOI: 10.1016/j.jaccas.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/21/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
Chest pain in young adults is not always benign, and clinical suspicion should prompt further investigations. Multimodal imaging with computed tomography coronary angiography and cardiovascular magnetic resonance can be used to identify anomalous coronary arteries, determine adverse imaging features, and guide subsequent clinical decision making. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom
- Department of Cardiology, St Thomas’ Hospital, London, United Kingdom
| | - Rebecca Preston
- Department of Radiology, St Thomas’ Hospital, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom
| | - Nabeel Sheikh
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom
- Department of Cardiology, St Thomas’ Hospital, London, United Kingdom
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Liang G, Bhiladvala C, Preston R. Nutritional preferences of women during labour: a survey study. Int J Obstet Anesth 2021; 48:103209. [PMID: 34391026 DOI: 10.1016/j.ijoa.2021.103209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/30/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Affiliation(s)
- G Liang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - C Bhiladvala
- Department of Anesthesia, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - R Preston
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesia, British Columbia Women's Hospital, Vancouver, BC, Canada.
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12
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Patterson T, Hurrell H, Lee J, Esposito G, Dutta U, Grapsa J, Aroney N, Ahmed-Jushuf F, Allen C, Rajani R, Preston R, Young C, Lucchese G, Parmar K, Hunt B, Prendergast BD, Redwood SR. Coagulation derangement and risk factors for valve thrombosis following transcatheter aortic valve implantation. Open Heart 2021; 8:openhrt-2020-001496. [PMID: 34127530 PMCID: PMC8204180 DOI: 10.1136/openhrt-2020-001496] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/01/2021] [Accepted: 04/12/2021] [Indexed: 11/03/2022] Open
Abstract
Aims Durability of transcatheter aortic valve implantation (TAVI) is key to its expansion. We sought to identify incidence of valve thrombosis and predictors of valve thrombosis in our single centre with associated coagulation testing pre-TAVI and post-TAVI. Methods and results This single-centre observational study comprised patients undergoing transfemoral TAVI discussed in the Heart Team meeting. Patients were followed up with echocardiography at 120 days to identify incidence of elevated transvalvular gradient and multivariable analysis was performed to identify factors associated with an increased odds of developing valve thrombosis. In addition, 11 patients underwent baseline, day 1 and day 120 post-TAVI coagulation testing. Between August 2017 and August 2019, 437 consecutive patients underwent transfemoral TAVI. Of these patients, 207/437 (47.4%) had 3-month follow-up echo data available and were analysed. Of these patients, 26/207 (12.6%) had elevated transvalvular gradients. These patients tended to be younger (80±14 vs 83±6 years; p=0.047) with a lower ejection fraction (49±13 vs 54%±11%; p=0.021), with a greater proportion of the population experiencing atrial fibrillation (14/21, 54% vs 68/181, 38%; p=0.067). Following multivariable analysis, there remained a trend towards higher eccentricity index associated with elevated gradients. Baseline (pre-TAVI) elevation of thrombin antithrombin levels (56±63; reference range 1.0–4.1 ng/L) and PF 1+2 (791±632; reference range 69–229 ng/mL) normalised at 120 days post-TAVI Conclusion This study demonstrated that in the cohort of patients undergoing transfemoral TAVI in our centre: younger age, poor ejection fraction, atrial fibrillation and increased baseline eccentricity of the aortic valve annulus were present to a greater extent in patients exhibiting elevated transvalvular gradients at 3-month follow-up. Further work is required to delineate the extent of coagulation derangement and confirm predictors of thrombosis.
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Affiliation(s)
- Tiffany Patterson
- Cardiovascular Division, School of Life Science and Medicine, King's College London, London, UK
| | - Harriet Hurrell
- Cardiovascular Division, School of Life Science and Medicine, King's College London, London, UK
| | - Jack Lee
- Division of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Giulia Esposito
- Cardiovascular Division, School of Life Science and Medicine, King's College London, London, UK
| | - Utkarsh Dutta
- Cardiovascular Division, School of Life Science and Medicine, King's College London, London, UK
| | - Julia Grapsa
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Aroney
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fiyyaz Ahmed-Jushuf
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher Allen
- Cardiovascular Division, School of Life Science and Medicine, King's College London, London, UK
| | - Ronak Rajani
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rebecca Preston
- Department of Radiology and Cardiac CT, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher Young
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gianluca Lucchese
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kiran Parmar
- Department of Haematology and Thrombosis, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Beverley Hunt
- Department of Haematology and Thrombosis, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Simon R Redwood
- Cardiovascular Division, School of Life Science and Medicine, King's College London, London, UK
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13
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Hajhosseiny R, Rashid I, Bustin A, Munoz C, Cruz G, Nazir MS, Grigoryan K, Ismail TF, Preston R, Neji R, Kunze K, Razavi R, Chiribiri A, Masci PG, Rajani R, Prieto C, Botnar RM. Clinical comparison of sub-mm high-resolution non-contrast coronary CMR angiography against coronary CT angiography in patients with low-intermediate risk of coronary artery disease: a single center trial. J Cardiovasc Magn Reson 2021; 23:57. [PMID: 33993890 PMCID: PMC8127202 DOI: 10.1186/s12968-021-00758-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/06/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The widespread clinical application of coronary cardiovascular magnetic resonance (CMR) angiography (CMRA) for the assessment of coronary artery disease (CAD) remains limited due to low scan efficiency leading to prolonged and unpredictable acquisition times; low spatial-resolution; and residual respiratory motion artefacts resulting in limited image quality. To overcome these limitations, we have integrated highly undersampled acquisitions with image-based navigators and non-rigid motion correction to enable high resolution (sub-1 mm3) free-breathing, contrast-free 3D whole-heart coronary CMRA with 100% respiratory scan efficiency in a clinically feasible and predictable acquisition time. OBJECTIVES To evaluate the diagnostic performance of this coronary CMRA framework against coronary computed tomography angiography (CTA) in patients with suspected CAD. METHODS Consecutive patients (n = 50) with suspected CAD were examined on a 1.5T CMR scanner. We compared the diagnostic accuracy of coronary CMRA against coronary CTA for detecting a ≥ 50% reduction in luminal diameter. RESULTS The 50 recruited patients (55 ± 9 years, 33 male) completed coronary CMRA in 10.7 ± 1.4 min. Twelve (24%) had significant CAD on coronary CTA. Coronary CMRA obtained diagnostic image quality in 95% of all, 97% of proximal, 97% of middle and 90% of distal coronary segments. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were: per patient (100%, 74%, 55%, 100% and 80%), per vessel (81%, 88%, 46%, 97% and 88%) and per segment (76%, 95%, 44%, 99% and 94%) respectively. CONCLUSIONS The high diagnostic image quality and diagnostic performance of coronary CMRA compared against coronary CTA demonstrates the potential of coronary CMRA as a robust and safe non-invasive alternative for excluding significant disease in patients at low-intermediate risk of CAD.
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Affiliation(s)
- Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK.
| | - Imran Rashid
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
| | - Aurélien Bustin
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
| | - Camila Munoz
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
| | - Gastao Cruz
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
| | - Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Karine Grigoryan
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rebecca Preston
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK
| | - Karl Kunze
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
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14
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Marriot C, Mak D, Mak SM, Preston R, Benedetti G. A guide for general radiologists: the heart of the CT scan. Clin Radiol 2020. [DOI: 10.1016/j.crad.2020.11.060] [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: 11/16/2022]
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15
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Muthuswamy K, Amlani A, Mak D, Benedetti G, Preston R, Mak SM. Dual-energy CTPA: an aid for radiology registrars. Clin Radiol 2020. [DOI: 10.1016/j.crad.2020.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Mak SM, Mak D, Hodson D, Preston R, Retter A, Camporota L, Benedetti G. Pulmonary ischaemia without pulmonary arterial thrombus in COVID-19 patients receiving extracorporeal membrane oxygenation: a cohort study. Clin Radiol 2020; 75:795.e1-795.e5. [PMID: 32778329 PMCID: PMC7368894 DOI: 10.1016/j.crad.2020.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 01/19/2023]
Abstract
AIM To evaluate the incidence of pulmonary ischaemia in COVID-19 patients on extracorporeal membrane oxygenation (ECMO), and its correlation with pulmonary artery thrombosis. MATERIALS AND METHODS Computed tomography (CT) thorax of all patients receiving ECMO with proven COVID-19 pneumonitis between March and May 2020 were analysed for the presence and extension of pulmonary thromboembolic disease. RESULTS Fifty-one patients were reviewed. The mean (range) age of 45 (26–66) years; 38/51 (74.5%) were men. All patients had severe COVID-19 pneumonitis, and 18/51 (35.3%) had macroscopic thrombosis (15 with associated ischaemia); however, 13/51 (25.5%) patients had ischaemia without associated thrombus. CONCLUSION The majority of patients with COVID-19 who received ECMO had areas of ischaemia within consolidated lungs, almost half of these without subtending pulmonary artery thrombosis. Although the prognostic significance of these findings is unclear, they are highly suggestive of lung ischaemia due to isolated microvascular immune thrombosis. High incidence of pulmonary artery thrombosis in COVID-19 ECMO patients. Lung ischaemia seen in patients with and without visible pulmonary artery thrombus. Ischaemia with no visible thrombus suggest microvascular thrombosis.
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Affiliation(s)
- S M Mak
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 9RT, UK.
| | - D Mak
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 9RT, UK
| | - D Hodson
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 9RT, UK
| | - R Preston
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 9RT, UK
| | - A Retter
- Department of Critical Care Medicine, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 9RT, UK
| | - L Camporota
- Department of Critical Care Medicine, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 9RT, UK
| | - G Benedetti
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 9RT, UK
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17
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Preston R, Naylor RW, Stewart G, Bierzynska A, Saleem MA, Lowe M, Lennon R. A role for OCRL in glomerular function and disease. Pediatr Nephrol 2020; 35:641-648. [PMID: 31811534 PMCID: PMC7056711 DOI: 10.1007/s00467-019-04317-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Lowe syndrome and Dent-2 disease are caused by mutations in the OCRL gene, which encodes for an inositol 5-phosphatase. The renal phenotype associated with OCRL mutations typically comprises a selective proximal tubulopathy, which can manifest as Fanconi syndrome in the most extreme cases. METHODS Here, we report a 12-year-old male with nephrotic-range proteinuria and focal segmental glomerulosclerosis on renal biopsy. As a glomerular pathology was suspected, extensive investigation of tubular function was not performed. RESULTS Surprisingly, whole exome sequencing identified a genetic variant in OCRL (c1467-2A>G) that introduced a novel splice mutation leading to skipping of exon 15. In situ hybridisation of adult human kidney tissue and zebrafish larvae showed OCRL expression in the glomerulus, supporting a role for OCRL in glomerular function. In cultured podocytes, we found that OCRL associated with the linker protein IPIP27A and CD2AP, a protein that is important for maintenance of the podocyte slit diaphragm. CONCLUSION Taken together, this work suggests a previously under-appreciated role for OCRL in glomerular function and highlights the importance of investigating tubular function in patients with persistent proteinuria.
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Affiliation(s)
- Rebecca Preston
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
| | - Richard W Naylor
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
| | - Graham Stewart
- Renal Department, Ninewells Hospital, Dundee, DD1 9SY, UK
| | | | - Moin A Saleem
- Children's and Academic Renal Unit, University of Bristol, Bristol, UK
| | - Martin Lowe
- Division of Molecular and Cellular Function, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, M13 9PT, UK.
| | - Rachel Lennon
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, M13 9PT, UK.
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester Academic Health Science Centre, Manchester University Hospital NHS Foundation Trust, Manchester, UK.
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18
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Shippam W, Preston R, Douglas J, Chau A. Redefining endpoints with apnoeic oxygenation in pregnancy – better the devil you know than the devil you don't? Anaesthesia 2019; 74:1621-1622. [DOI: 10.1111/anae.14882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- W. Shippam
- British Columbia Women's Hospital Vancouver Canada
| | - R. Preston
- British Columbia Women's Hospital Vancouver Canada
| | - J. Douglas
- British Columbia Women's Hospital Vancouver Canada
| | - A. Chau
- British Columbia Women's Hospital Vancouver Canada
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19
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Aziz W, Claridge S, Ntalas I, Gould J, de Vecchi A, Razeghi O, Toth D, Mountney P, Preston R, Rinaldi CA, Razavi R, Niederer S, Rajani R. Emerging role of cardiac computed tomography in heart failure. ESC Heart Fail 2019; 6:909-920. [PMID: 31400060 PMCID: PMC6816076 DOI: 10.1002/ehf2.12479] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 11/27/2022] Open
Abstract
Despite medical advancements, the prognosis of patients with heart failure remains poor. While echocardiography and cardiac magnetic resonance imaging remain at the forefront of diagnosing and monitoring patients with heart failure, cardiac computed tomography (CT) has largely been considered to have a limited role. With the advancements in scanner design, technology, and computer processing power, cardiac CT is now emerging as a valuable adjunct to clinicians managing patients with heart failure. In the current manuscript, we review the current applications of cardiac CT to patients with heart failure and also the emerging areas of research where its clinical utility is likely to extend into the realm of treatment, procedural planning, and advanced heart failure therapy implementation.
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Affiliation(s)
- Waqar Aziz
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Simon Claridge
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Ntalas
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Adelaide de Vecchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel Toth
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Peter Mountney
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rebecca Preston
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher A Rinaldi
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ronak Rajani
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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20
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Shippam W, Preston R, Douglas J, Taylor J, Albert A, Chau A. High-flow nasal oxygen vs. standard flow-rate facemask pre-oxygenation in pregnant patients: a randomised physiological study. Anaesthesia 2019; 74:450-456. [DOI: 10.1111/anae.14567] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 12/18/2022]
Affiliation(s)
- W. Shippam
- British Columbia Women's Hospital; Vancouver BC Canada
| | - R. Preston
- British Columbia Women's Hospital; Vancouver BC Canada
| | - J. Douglas
- University of British Columbia; Vancouver BC Canada
| | - J. Taylor
- British Columbia Women's Hospital; Vancouver BC Canada
| | - A. Albert
- Women's Health Research Institute; Vancouver BC Canada
| | - A. Chau
- British Columbia Women's Hospital; Vancouver BC Canada
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21
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Hondorp S, Preston R, Schroeder E, de Voest M, Sohn M, Schram J. Association of pre-operative behavioral measures with antidepressant medications one year after bariatric surgery. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.418] [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]
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22
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Rajkumar CA, Claridge S, Jackson T, Behar J, Johnson J, Sohal M, Amraoui S, Nair A, Preston R, Gill J, Rajani R, Rinaldi CA. Diagnosis and management of iatrogenic cardiac perforation caused by pacemaker and defibrillator leads. Europace 2018; 19:1031-1037. [PMID: 27353321 DOI: 10.1093/europace/euw074] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 11/10/2015] [Accepted: 02/29/2016] [Indexed: 12/28/2022] Open
Abstract
Aims Cardiac perforations caused by pacemaker or implantable cardioverter-defibrillator (ICD) leads are uncommon but potentially fatal events. The optimal approach to such cases is unclear. The aim of this study was to identify the optimal imaging modality and management strategy for cardiac perforation. Methods and results All patients presenting to a single institution with cardiac perforation >24 h since implant between 2011 and 2015 were identified retrospectively. Assessment of the diagnostic performance of pre-extraction chest radiography, transthoracic echocardiography (TTE), and computed tomography (CT) was carried out by blinded review. The method of lead extraction and any associated complications were examined. Eighteen cases of cardiac perforation were identified from 426 lead extraction procedures. Sixteen patients had abnormal electrical parameters at device interrogation. In all cases, the perforating lead was an active fixation model, and in four cases, this was an ICD coil. The accuracy of CT imaging for the diagnosis of cardiac perforation was 92.9%, with sensitivity and specificity of 100 and 85.7%, respectively. This was superior to both TTE (accuracy 62.7%, sensitivity and specificity 41.2 and 84.2%, respectively) and chest radiography (accuracy 61.1%, sensitivity and specificity 27.7 and 94.4%, respectively). Transvenous lead extraction (TLE) was performed in 17 patients, and a hybrid surgical approach in 1 patient. Of those who underwent TLE, there was 100% complete procedural success as per Heart Rhythm Society definitions. Conclusion In the setting of cardiac perforation, CT is the imaging modality of choice. Transvenous lead extraction can be recommended as a safe, efficacious, and versatile intervention.
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Affiliation(s)
| | - Simon Claridge
- Department of Imaging Sciences, King's College London, London, UK
| | - Tom Jackson
- Department of Imaging Sciences, King's College London, London, UK
| | - Jonathan Behar
- Department of Imaging Sciences, King's College London, London, UK
| | - Jonathan Johnson
- Department of Imaging Sciences, King's College London, London, UK
| | - Manav Sohal
- Department of Imaging Sciences, King's College London, London, UK
| | - Sana Amraoui
- Department of Cardiology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Arjun Nair
- Department of Cardiac Computed Tomography, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Rebecca Preston
- Department of Cardiac Computed Tomography, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Jaswinder Gill
- Department of Cardiology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Ronak Rajani
- Department of Cardiology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Department of Cardiac Computed Tomography, Guy's and St Thomas NHS Foundation Trust, London, UK
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23
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Ness AR, Wills AK, Waylen A, Al-Ghatam R, Jones TEM, Preston R, Ireland AJ, Persson M, Smallridge J, Hall AJ, Sell D, Sandy JR. Centralization of cleft care in the UK. Part 6: a tale of two studies. Orthod Craniofac Res 2018; 18 Suppl 2:56-62. [PMID: 26567856 PMCID: PMC4670710 DOI: 10.1111/ocr.12111] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/30/2022]
Abstract
Objectives We summarize and critique the methodology and outcomes from a substantial study which has investigated the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after the UK government started to implement the centralization of cleft care in response to an earlier survey in 1998, the Clinical Standards Advisory Group (CSAG). Setting and Sample Population A UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Data were collected from children born in the UK with a unilateral cleft lip and palate between 1 April 2005 and 31 March 2007. Materials and Methods We discuss and contextualize the outcomes from speech recordings, hearing, photographs, models, oral health and psychosocial factors in the current study. We refer to the earlier survey and other relevant studies. Results We present arguments for centralization of cleft care in healthcare systems, and we evidence this with improvements seen over a period of 15 years in the UK. We also make recommendations on how future audit and research may configure. Conclusions Outcomes for children with a unilateral cleft lip and palate have improved after the introduction of a centralized multidisciplinary service, and other countries may benefit from this model. Predictors of early outcomes are still needed, and repeated cross-sectional studies, larger longitudinal studies and adequately powered trials are required to create a research-led evidence-based (centralized) service.
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Affiliation(s)
- A R Ness
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK.,School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A K Wills
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - R Al-Ghatam
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - T E M Jones
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,Musgrove Park Hospital, Taunton, UK
| | - R Preston
- Cleft Lip and Palate Association, London, UK
| | - A J Ireland
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - M Persson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - J Smallridge
- South Thames' Cleft Unit, Guy's and St Thomas Hospital, London, UK.,Cleft Net East Cleft Network, Addenbrooke's Hospital, Cambridge, UK
| | - A J Hall
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D Sell
- Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - J R Sandy
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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Persson M, Sandy JR, Waylen A, Wills AK, Al-Ghatam R, Ireland AJ, Hall AJ, Hollingworth W, Jones T, Peters TJ, Preston R, Sell D, Smallridge J, Worthington H, Ness AR. A cross-sectional survey of 5-year-old children with non-syndromic unilateral cleft lip and palate: the Cleft Care UK study. Part 1: background and methodology. Orthod Craniofac Res 2018; 18 Suppl 2:1-13. [PMID: 26567851 PMCID: PMC4670715 DOI: 10.1111/ocr.12104] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2015] [Indexed: 11/28/2022]
Abstract
Objectives We describe the methodology for a major study investigating the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after an initial survey, detailed in the Clinical Standards Advisory Group (CSAG) report in 1998, had informed government recommendations on centralization. Setting and Sample Population This is a UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Children born between 1 April 2005 and 31 March 2007 were seen in cleft centre audit clinics. Materials and Methods Consent was obtained for the collection of routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) and anthropometric measures (height, weight, head circumference). The methodology for each clinical measure followed those of the earlier survey as closely as possible. Results We identified 359 eligible children and recruited 268 (74.7%) to the study. Eleven separate records for each child were collected at the audit clinics. In total, 2666 (90.4%) were collected from a potential 2948 records. The response rates for the self-reported questionnaires, completed at home, were 52.6% for the Health and Lifestyle Questionnaire and 52.2% for the Satisfaction with Service Questionnaire. Conclusions Response rates and measures were similar to those achieved in the previous survey. There are practical, administrative and methodological challenges in repeating cross-sectional surveys 15 years apart and producing comparable data.
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Affiliation(s)
- M Persson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - J R Sandy
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A K Wills
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - R Al-Ghatam
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,Dental & Maxillofacial Centre, Royal Medical Services, West Riffa, Kingdom of Bahrain
| | - A J Ireland
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A J Hall
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Centre for Child & Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - W Hollingworth
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - T Jones
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,Musgrove Park Hospital, Taunton, UK
| | - T J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - R Preston
- Cleft Lip and Palate Association, London, UK
| | - D Sell
- Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - J Smallridge
- South Thames' Cleft Unit, Guy's and St Thomas Hospital, London, UK.,Cleft Net East Cleft Network, Addenbrooke's Hospital, Cambridge, UK
| | - H Worthington
- School of Dentistry, University of Manchester, Manchester, UK
| | - A R Ness
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
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Behar JM, Rajani R, Pourmorteza A, Preston R, Razeghi O, Niederer S, Adhya S, Claridge S, Jackson T, Sieniewicz B, Gould J, Carr-White G, Razavi R, McVeigh E, Rinaldi CA. Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy. Heart Rhythm 2017; 14:1364-1372. [PMID: 28479514 PMCID: PMC5575356 DOI: 10.1016/j.hrthm.2017.04.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Indexed: 01/26/2023]
Abstract
Background Optimal lead positioning is an important determinant of cardiac resynchronization therapy (CRT) response. Objective The purpose of this study was to evaluate cardiac computed tomography (CT) selection of the optimal epicardial vein for left ventricular (LV) lead placement by targeting regions of late mechanical activation and avoiding myocardial scar. Methods Eighteen patients undergoing CRT upgrade with existing pacing systems underwent preimplant electrocardiogram-gated cardiac CT to assess wall thickness, hypoperfusion, late mechanical activation, and regions of myocardial scar by the derivation of the stretch quantifier for endocardial engraved zones (SQUEEZ) algorithm. Cardiac venous anatomy was mapped to individualized American Heart Association (AHA) bull’s-eye plots to identify the optimal venous target and compared with acute hemodynamic response (AHR) in each coronary venous target using an LV pressure wire. Results Fifteen data sets were evaluable. CT-SQUEEZ–derived targets produced a similar mean AHR compared with the best achievable AHR (20.4% ± 13.7% vs 24.9% ± 11.1%; P = .36). SQUEEZ-derived guidance produced a positive AHR in 92% of target segments, and pacing in a CT-SQUEEZ target vein produced a greater clinical response rate vs nontarget segments (90% vs 60%). Conclusion Preprocedural CT-SQUEEZ–derived target selection may be a valuable tool to predict the optimal venous site for LV lead placement in patients undergoing CRT upgrade.
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Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Ronak Rajani
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amir Pourmorteza
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Rebecca Preston
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Orod Razeghi
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - Steve Niederer
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - Shaumik Adhya
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Claridge
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tom Jackson
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ben Sieniewicz
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gerry Carr-White
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Reza Razavi
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - Elliot McVeigh
- Departments of Bioengineering, Medicine, and Radiology, University of California San Diego, La Jolla, California
| | - Christopher Aldo Rinaldi
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Behar J, Behar J, Providência R, Cronbach P, Siddiqui S, Brough C, Ara F, Newham W, Ng F, Ayala-Paredes F, Withers K, Hayward C, Chin H, Fearn S, Omerod J, Gamble J, Foley P, Bostock J, Claridge S, Jackson T, Sohal M, Razavi R, Betts T, Herring N, Rinaldi C, Pourmorteza A, McVeigh E, Niederer S, Claridge S, Jackson T, Sohal M, Preston R, Carr-White G, Razavi R, Rajani R, Rinaldi C, Boveda S, Defaye P, Barra S, Babu G, Ang R, Algalarrondo V, Bouzeman A, Ahsan S, Deharo JC, Sporton S, Segal O, Klug D, Lambiase P, Sadoul N, Agarwal S, Piot O, Chow A, Périer M, Fauchier L, Babuty D, Lowe M, Leclercq C, Bordachar P, Marijon E, Wilson D, Panfilo D, Greenhut S, Stegemann B, Morgan J, Nicolson W, Li A, Behr E, Ng G, Raman G, Belchambers S, Rao A, Wright D, John I, Crockford C, Kaba R, Begg G, Tayebjee M, Leong K, Hu M, Kanapeckaite L, Roney C, Lim P, Harding S, Peters N, Varnava A, Kanagaratnam P, Roux JF, Badra M, White J, Lencioni M, Carolan-Rees G, Patrick H, Griffith M, Patel H, Spiesshoefer J, Morley-Smith A, Patel K, Rosen S, DiMario C, Lyon A, Cowie M. Devices & Sudden death. Europace 2015; 17:v10-v13. [PMCID: PMC4892105 DOI: 10.1093/europace/euv331] [Citation(s) in RCA: 1] [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: 09/05/2023] Open
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Pai S, Koretomo R, Tamaki S, Berg J, Marbury T, Galloway C, Preston R. FP658JTZ-951, A NOVEL HIF-PHD INHIBITOR, DEMONSTRATES INCREASES IN HEMOGLOBIN, IRON MOBILIZATION, REPRODUCIBLE PHARMACOKINETICS, AND SAFETY FOLLOWING ONCE DAILY ADMINISTRATION FOR 15 DAYS IN PATIENTS WITH ANEMIA RECEIVING HEMODIALYSIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv182.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Eliwan HO, Watson RWG, Aslam S, Regan I, Philbin B, O'Hare FM, O'Neill A, Preston R, Blanco A, Grant T, Nolan B, Smith O, Molloy EJ. Neonatal brain injury and systemic inflammation: modulation by activated protein C ex vivo. Clin Exp Immunol 2015; 179:477-84. [PMID: 25204207 DOI: 10.1111/cei.12453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 01/04/2023] Open
Abstract
Infection and inflammation can be antecedents of neonatal encephalopathy (NE) and increase the risk of neurological sequelae. Activated protein C (APC) has anti-coagulant and anti-inflammatory effects and provides neuroprotection in brain and spinal cord injury. We examined neutrophil and monocyte responses to lipopolysaccharide (LPS) in infants with NE compared with healthy adult and neonatal controls, and also studied the effect of APC. Whole blood was incubated with LPS and APC and Toll-like receptor (TLR)-4 (LPS recognition), CD11b expression (activation) and intracellular reactive oxygen intermediate (ROI; function) release from neutrophils and monocytes was examined by flow cytometry serially from days 1 to 7. We found a significant increase in neutrophil ROI in infants with NE on day 3 following LPS compared to neonatal controls and this augmented response was reduced significantly by APC. Neutrophil and monocyte CD11b expression was increased significantly on day 1 in infants with NE compared to neonatal controls. LPS-induced neutrophil TLR-4 expression was increased significantly in infants with NE on days 3 and 7 and was reduced by APC. LPS-induced monocyte TLR-4 was increased significantly in infants with NE on day 7. Neutrophil and monocyte activation and production of ROIs may mediate tissue damage in infants with NE. APC modified LPS responses in infants with NE. APC may reduce the inflammatory responses in NE and may ameliorate multi-organ dysfunction. Further study of the immunomodulatory effects of protein C may be warranted using mutant forms with decreased bleeding potential.
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Affiliation(s)
- H O Eliwan
- Paediatrics, National Maternity Hospital, Dublin, Ireland; UCD School of Medicine and Medical Science and Conway Institute for Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; National Children Research Centre, Dublin, Ireland; Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rajani R, Webb J, Marciniak A, Preston R. Comparative efficacy testing — Fractional flow reserve by coronary computed tomography for the evaluation of patients with stable chest pain. Int J Cardiol 2015; 183:173-7. [DOI: 10.1016/j.ijcard.2015.01.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/05/2015] [Accepted: 01/24/2015] [Indexed: 10/24/2022]
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Starsmore L, Lams B, Agarwal S, Nair A, Preston R, Barrett N, Glover G, Ioannou N, Langrish C, Wyncoll D, Meadows C. S9 Acute Inflammatory Presentation Associates With Survival In Interstitial Lung Disease And Extracorporeal Membrane Oxygenation-requiring Severe Respiratory Failure: A Single Centre Case Series. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yalakki Jagadeesh L, Kirkham B, Lams B, Preston R, Gullick N, Agarwal S. 112. Disease Characteristics in Patients with Rheumatoid Arthritis and Lung Disease. Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu102.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sarwar KN, Huda MSB, Van de Velde V, Hopkins L, Luck S, Preston R, McGowan BM, Carroll PV, Powrie JK. The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab 2013; 98:2362-7. [PMID: 23585661 DOI: 10.1210/jc.2013-1249] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Incidental pituitary hemorrhage, without full pituitary apoplexy, is a recognized radiological finding, but little information exists on its clinical behavior, with most reports describing surgically treated macroprolactinoma or nonfunctioning adenoma. OBJECTIVE Our aim was to characterize the prevalence, natural history, and risk factors associated with pituitary hemorrhage in a large clinic prolactinoma population. DESIGN The design consisted of a retrospective analysis of a clinic population. SETTING The setting was a tertiary endocrine center in a large teaching hospital. PATIENTS We studied three hundred sixty-eight patients with prolactinoma. The presence of hemorrhage was documented on magnetic resonance imaging. MAIN OUTCOME MEASURE The main outcome measures were the prevalence, risk factors, and natural history of pituitary hemorrhage. RESULTS Pituitary hemorrhage was found in 25 patients, giving an overall prevalence of 6.8%, and was significantly higher in macroprolactinoma (20.3%) compared to microprolactinoma (3.1%, P < .0001). Three patients had classical pituitary apoplexy. The majority of patients in the hemorrhage group had macroprolactinomas (16/25 [64%]) and were women (22/25 [88%]). The proportion of women with macroprolactinoma was higher in the hemorrhage group (14/16 macroprolactinomas [87.5%]) than in the nonhemorrhage group (36/63 macroprolactinomas [57.1%], P = .02). The majority of pituitary hemorrhages (92%) were treated conservatively with dopamine agonist therapy for hyperprolactinemia. Eighty-seven percent of patients had complete resolution of their hemorrhage within 26.6 ± 23.3 (mean ± SD) months. The presence of macroprolactinoma (odds ratio 9.00 [95%CI 3.79-23.88], P < .001) and being female (odds ratio 8.03 [95%confidence interval 1.22-52.95], P = .03) were independently associated with hemorrhage. CONCLUSIONS These data show that incidental hemorrhage in prolactinoma is not uncommon. It is more likely to occur in macroprolactinoma, where 1 in 5 develop hemorrhage, and is particularly common in women with macroprolactinoma. The majority are asymptomatic and resolve spontaneously.
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Affiliation(s)
- K N Sarwar
- Department of Endocrinology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London SE1 9RT, United Kingdom
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Yalakki Jagadeesh L, Lams B, Preston R, Gullick N, Kirkham B, Agarwal S. AB0177 Patterns and severity of lung disease in patients with rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rajani R, Wang Y, Uss A, Perera D, Redwood S, Thomas M, Chambers JB, Preston R, Carr-White GS, Liatsis P. Virtual fractional flow reserve by coronary computed tomography - hope or hype? EUROINTERVENTION 2013; 9:277-84. [DOI: 10.4244/eijv9i2a44] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kathirgamanathan A, Douglas MJ, Tyler J, Saran S, Gunka V, Preston R, Kliffer P. Speed of spinal vs general anaesthesia for category-1 caesarean section: a simulation and clinical observation-based study. Anaesthesia 2013; 68:753-9. [DOI: 10.1111/anae.12290] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - M. J. Douglas
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - J. Tyler
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - S. Saran
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - V. Gunka
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - R. Preston
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - P. Kliffer
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
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Cecelja M, Hussain T, Greil G, Botnar R, Preston R, Moayyeri A, Spector TD, Chowienczyk P. Multimodality imaging of subclinical aortic atherosclerosis: relation of aortic stiffness to calcification and plaque in female twins. Hypertension 2013; 61:609-14. [PMID: 23339166 DOI: 10.1161/hypertensionaha.111.00024] [Citation(s) in RCA: 32] [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] [Indexed: 01/08/2023]
Abstract
Aortic stiffness, an important predictor of cardiovascular events, may relate to aortic calcification rather than noncalcified atherosclerotic plaque. The aim of this study was to determine the relation of aortic stiffness to aortic plaque and aortic calcification in asymptomatic postmenopausal women. One hundred female twins (mean age±standard deviation 64±7 years) underwent computed tomography and magnetic resonance imaging (black-blood sequence) of the aorta. The topographical relation of plaque on magnetic resonance images and calcification on computed tomography images was assessed on magnetic resonance/computed tomography fused images. Carotid-femoral pulse wave velocity was used as a measure of aortic stiffness. Aortic plaque was identified in 87% and calcification in 65% of subjects, both increased with age and were higher in the abdominal compared with thoracic aorta (P<0.0001). Plaque correlated with calcification (R=0.68; P<0.0001), but was also detected in 58% of women who had no calcification. Pulse wave velocity (adjusted for age and blood pressure) increased across quartiles of calcification (P<0.01) but not plaque score (P=0.56). Shared genetic factors accounted for >99% of the correlation (0.35) between PWV and calcification. In conclusion, there is a high prevalence of subclinical atherosclerosis within the aorta in asymptomatic middle-aged women. Aortic stiffening relates to aortic calcification, but not to atherosclerotic plaque burden, and the association of aortic stiffness with calcification is driven by common genes.
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Affiliation(s)
- Marina Cecelja
- Department of Clinical Pharmacology, St. Thomas' Hospital, London, UK
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Clarke REJ, Padayachee ST, Preston R, McMahon Z, Gordon M, Graham C, Crook MA, Wierzbicki AS. Effectiveness of alternative strategies to define index case phenotypes to aid genetic diagnosis of familial hypercholesterolaemia. Heart 2012; 99:175-80. [DOI: 10.1136/heartjnl-2012-302917] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Clarke R, MacMahon Z, Padayachee T, Preston R, Graham C, Crook M, Wierzbicki A. (2) The role of improved phenotypic confirmation of familial hypercholesterolemia in enhancing the use of genetic testing. Atherosclerosis 2012. [DOI: 10.1016/j.atherosclerosis.2012.06.026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rajani R, Barden E, Al-Fakih K, Preston R, Carr-White G. An unusual cause of intractable cough. Eur Heart J Cardiovasc Imaging 2012; 13:848. [PMID: 22588210 DOI: 10.1093/ehjci/jes106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ronak Rajani
- Department of Cardiac Computed Tomography, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
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Preston R, Jakubek J, Prokopovich D, Uher J. Development of SiPM-based scintillator tile detectors for a multi-layer fast neutron tracker. EPJ Web of Conferences 2012. [DOI: 10.1051/epjconf/20123502004] [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: 11/14/2022] Open
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Abstract
Acute chest pain is a common presenting complaint of patients attending emergency room departments. Despite this, it can often be challenging to completely exclude a diagnosis of acute coronary syndrome following an initial standard clinical and biochemical evaluation. As a result of this, patients are often admitted to hospital until the treating clinician is satisfied that this diagnosis can be excluded. This process imparts a significant health economic burden by not only increasing hospital bed occupancy rates but also by the unnecessary layering of diagnostic investigations. With the rapid advances in coronary computed tomography angiography (CTA), there has been considerable interest in whether coronary CTA may be a viable alternative to this current standard care. We review the current literature and supporting evidence for utilising coronary CTA in the evaluation of patients presenting with acute chest pain in terms of its diagnostic accuracy, safety, cost-effectiveness and prognostic implications.
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Affiliation(s)
- R Rajani
- Department of Cardiac Computed Tomography, St Thomas' Hospital, London, UK.
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Koschier F, Gallo MA, Feng X, Baxter GE, Preston R, Stevens K, Powers W. Toxicological studies on 2,4,6-tribromoanisole. Food Chem Toxicol 2011; 49:2074-80. [PMID: 21645578 DOI: 10.1016/j.fct.2011.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 11/24/2022]
Abstract
TBA, or 2,4,6-tribromoanisole, is a musty-smelling metabolite of 2,4,6-tribromophenol that is used as a flame retardant and an antifungal agent for wooden pallets and packaging materials. The compound can impart its peculiar, often offensive, odor on product packaging to the concern of consumers for the safety of the package contents. These studies were conducted to evaluate the safety of TBA to humans ingesting products tainted with TBA. In addition to the 28-day oral study, a bacterial reverse mutation study was conducted, and confirmed that TBA was not mutagenic. To evaluate oral safety, TBA was evaluated in single dose and 5-day and 4-week repeated dose oral toxicity studies in rats. The test article, administered in single gavage doses of 2000, 5000 and 7500 mg/kg body weight (bw), in 5 daily repeated doses of 1000, 2000 or 3000 mg/kg bw/day or in 28 daily oral gavage doses of 0 001, 0.01, 100, and 1000 mg/kg bw/day did not result in any deaths. Also, the single and repeat dose studies resulted in no significant differences between control and treated groups on body weight gain, food consumption, clinical observations, blood biochemical values, and hematology findings. Treatment-related adverse findings were only detected in male rats during repeated dose studies and were associated with high plasma concentrations of TBA. The test article-related finding of hyaline droplets in the cortical tubular epithelium of kidneys was associated with increases in α(2 μ)-globulin content in the kidneys as indicated by the intensity of immunohistochemical staining. These findings were correlated with an increased weight of kidneys in males administered 1000mg/kgbw/day for 28days. Chemical induction of hyaline droplets containing α(2μ)-globulin in the renal proximal tubule is a process unique to the male rat and is not relevant for human risk assessment. Findings of increased liver weight with minimal centrilobular to diffuse hepatocellular hypertrophy in males treated with TBA at 1000mg/kg bw/day for 28days were considered to be an adaptive metabolic response to xenobiotic administration. The increased volume of urine, noted in both males and females treated with 1000mg/kg bw/day was considered adaptive and necessary to excrete the high xenobiotic burden resulting from TBA administration. TBA appeared to be highly bioavailable since high concentrations of TBA were detected in plasma, at 1, 4 and 8h after administration of TBA at 100 and 1000mg/kg bw for 1 and 28days. Levels were dose-related but did not clarify the course of TBA elimination with time after administration. These studies indicate that TBA, administered orally to rats, produced male rat-specific, treatment-related toxicity at the highest orally administered dose in repeated dose (5-day at 3000mg/kg bw and 28-day at 1000mg/kg bw) studies. Therefore, the NOAEL for the 28-day oral study was determined to be 1000mg/kg bw/day for the rat.
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Affiliation(s)
- F Koschier
- Johnson & Johnson Consumer & Personal Products Worldwide, 199 Grandview Road, Skillman, NJ 08558-1303, United States.
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Abstract
The long-term effects of cranial external beam radiotherapy are emerging as survival rates for cerebral tumours improve. Cerebral cavernoma are a recognized consequence of cranial irradiation. Endocrinologists managing the life-long complications of hypopituitarism associated with irradiation need to be aware and vigilant of the risks of cavernoma formation, in particular in the population with a history of childhood irradiation. We present three cases of young patients who were diagnosed with cerebral cavernoma many years after childhood irradiation treatment and review the current literature on this condition. We discuss implications for endocrine practice as rising numbers of patients survive childhood cancer and irradiation and are now attending adult endocrine services for long-term management of secondary hypopituitarism.
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Affiliation(s)
- Y Liu
- Department of Endocrinology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
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Collins P, Rosano G, Casey C, Daly C, Gambacciani M, Hadji P, Kaaja R, Mikkola T, Palacios S, Preston R, Simon T, Stevenson J, Stramba-Badiale M. Management of cardiovascular risk in the perimenopausal women: a consensus statement of European cardiologists and gynecologists. Climacteric 2009; 10:508-26. [DOI: 10.1080/13697130701755213] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bailey J, Veitch C, Crossland L, Preston R. Developing research capacity building for Aboriginal & Torres Strait Islander health workers in health service settings. Rural Remote Health 2006; 6:556. [PMID: 17187447] [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: 05/13/2023] Open
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander health workers (hereafter called health workers) can play a major role in facilitating culturally appropriate health care delivery and program development through the acquisition of improved skills in the planning, monitoring and evaluation of these programs (RCB). However, many Aboriginal and Torres Strait Islander people and communities remain concerned about research and related activities. Health workers are well placed to assist communities to not only embrace research, but to be active players and promoters of relevant, appropriate and acceptable research. One means of achieving the twin goals of RCB and community acceptance and involvement in research, is through health workers undertaking research of health priority issues and evaluation of activities, such as program delivery, that are of direct relevance to their community's aim of improving or enhancing service delivery. This article outlines the development and content of a community-based RCB framework for health workers. The focus is on the major issues that enhance a proactive service delivery model using culturally appropriate research methods. Development process: The RCB framework described here was developed, over a period of time, through community workshops and consultations aimed at deriving general consensus on the key issues and components of a culturally-appropriate, community-based training process. The framework has subsequently been reviewed by Aboriginal and Torres Strait Islander community representatives from across Australia. The overall aim of the framework is to supplement current (institutionally-based) education and training resources for health workers with community-based research training modules. These modules can be tailored to provide research and evaluation skills relevant to health workers taking a more proactive role in facilitating health and wellbeing programs in their own communities. The use of collaborative consultation and participatory methods are intended to be a two-way education process. Course content: A visual pathway is used that encompasses the impact of health and practice in the community for health workers at a grass-roots level. This enables elements of the RCB process to be divided into a series of connected modules. These are: (i 'assessing' Existing Services; (ii) methods and measures for Identifying Need at various levels; (iii) important issues in Program Development; (iv) how the former contributes to Service Improvement; (v) resultant Outcomes that will impact on community and service provision; and (vi) Evaluation Methods and applying findings to service delivery. CONCLUSIONS Active participation by the Aboriginal and Torres Strait Islander community is fundamental for effective research practices and outcomes. The aim is to provide health workers and community members with a working knowledge of research ethics and methods so that they can assist, monitor and steer the development of culturally appropriate research activities that will lead to provision of the highest quality services 'back' to the community. This RCB framework will enable health workers to be more proactive, self-reliant and self-sufficient within their community and healthcare settings.
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Affiliation(s)
- J Bailey
- Rural Health Research Unit, School of Medicine, James Cook University, Douglas, Queensland, Australia.
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Däbritz J, Hänfler J, Preston R, Stieler J, Oettle H. Detection of Ki-ras mutations in tissue and plasma samples of patients with pancreatic cancer using PNA-mediated PCR clamping and hybridisation probes. Br J Cancer 2005; 92:405-12. [PMID: 15655549 PMCID: PMC2361834 DOI: 10.1038/sj.bjc.6602319] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In the present study, we combined the PCR-clamping approach with melting curve analysis using mutant specific hybridisation probes and wild-type specific peptide nucleic acids (PNAs) to determine the genotypes of the most frequent point mutation in codon 12 of the proto-oncogene Ki-ras in tissue and plasma samples of patients with pancreatic cancer. The sensitivity of our assay was 1–5 × 10−5. The melting curve analysis of tissue samples of four patients revealed two valine mutations, one none-valine mutation and one wild-type sequence. Ki-ras alterations were found in 28% of DNAs (18 out of 64) of nonrelated plasma samples of 10 patients with ductal adenocarcinoma of the pancreas. The valine mutation was the predominantly detected gene alteration (83%). Out of ten patients investigated, four patients (40%) became positive during clinical observation with respect to Ki-ras mutation. All four patients exhibited progressive disease and high levels of tumour marker CA 19-9. In conclusion, the one-step procedure discribed may be a useful clinical tool for analysing Ki-ras point mutations in tissue and plasmas samples. In addition, this method can be adapted for simultanous detection of multiple mutations and quantitation.
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Affiliation(s)
- J Däbritz
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik und Poliklinik m.S. Hämatologie und Onkologie, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J Hänfler
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik und Poliklinik m.S. Hämatologie und Onkologie, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik und Poliklinik m.S. Hämatologie und Onkologie, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail:
| | - R Preston
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik und Poliklinik m.S. Hämatologie und Onkologie, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J Stieler
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik und Poliklinik m.S. Hämatologie und Onkologie, Augustenburger Platz 1, 13353 Berlin, Germany
| | - H Oettle
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik und Poliklinik m.S. Hämatologie und Onkologie, Augustenburger Platz 1, 13353 Berlin, Germany
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Kearvell R, Kuan R, Preston R, Tanner P, Buck H, Hedges R. Acute radiation toxicity assessment of a 3-D conformal head and neck radiation treatment technique. ACTA ACUST UNITED AC 2005; 48:358-63. [PMID: 15344987 DOI: 10.1111/j.0004-8461.2004.01319.x] [Citation(s) in RCA: 3] [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] [Indexed: 11/26/2022]
Abstract
Patients undergoing radiation treatment for head and neck cancer have many critical structures within or adjacent to the treatment area. Avoiding these critical structures is more efficient and easier using 3-D conformal planning. At Sir Charles Gairdner Hospital an investigation into the acute radiation toxicity was undertaken when the head and neck treatment technique was changed from the conventional 2-D plan to the conformal 3-D plan. Although the primary target volume (PTV), fraction size and overall dose remain the same for the two techniques, differing beam configurations mean that treatment fields enter and exit through different parts of the head and neck. Ten patients were initially assessed to gain a baseline appearance of their head and neck region, and then graded weekly according to the toxicity criteria during treatment and at 4, 8 and 12 weeks after treatment. The results of the assessment indicate that there is no increase in toxicity as a result of treating using the conformal head and neck technique.
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Affiliation(s)
- R Kearvell
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, Western Australia 6009, Australia.
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Phillips I, Casewell M, Cox T, De Groot B, Friis C, Jones R, Nightingale C, Preston R, Waddell J. Antibiotic use in animals. J Antimicrob Chemother 2004; 53:885; author reply 886. [PMID: 15028664 DOI: 10.1093/jac/dkh149] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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