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Maybury EK, Affrin ZC, Popa C, Fowler M, Laliberte BD, Clarke SC. Nexplanonectomy-the surgical removal of an embolized implanted contraceptive device: a case report and review of the literature. J Med Case Rep 2024; 18:234. [PMID: 38698425 DOI: 10.1186/s13256-024-04547-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Nexplanon implants are a common hormonal contraceptive modality. Though rare, these devices can embolize into the injured wall of the basilic vein, through the right heart, and finally wedge itself into a pulmonary artery. With adherence to the arterial wall over time, it becomes less amenable to endovascular retrieval. Patients may present with symptoms mimicking a pulmonary embolism, or without any symptoms at all. In asymptomatic cases, endovascular retrieval and/or surgery is required when patients wish to begin having children prior to biological inactivity. The current literature showed as little as nine case reports detailing lung tissue removal in the aim of reversing a patient's implanted contraceptive device. CASE PRESENTATION A 22-year-old asymptomatic active-duty Caucasian female presented for elective outpatient Nexplanon removal. The suspicion of possible implant migration arose when it was discovered to be non-palpable in her left arm. After plain film x-rays failed to localize the implant, a chest x-ray and follow-up Computed Tomography (CT) scan revealed that the Nexplanon had migrated to a distal branch of the left pulmonary artery. Due to the patient's strong desires to begin having children, the decision was made for removal. Initial endovascular retrieval failed due to Nexplanon encapsulation within the arterial wall. Ultimately, the patient underwent a left video-assisted thoracoscopic surgery (VATS) for exploration and left lower lobe basilar S7-9 segmentectomy, which successfully removed the Nexplanon. CONCLUSIONS Implanted contraceptive devices can rarely result in migration to the pulmonary vasculature. These radiopaque devices are detectable on imaging studies if patients and clinicians are unable to palpate them. An endovascular approach should be considered first to spare lung tissue and avoid chest-wall incisions, but can be complicated by encapsulation and adherence to adjacent tissue. A VATS procedure with single-lung ventilation via a double-lumen endotracheal tube allows surgeons to safely operate on an immobilized lung while anesthesiologists facilitate single-lung ventilation. This patient's case details the uncommon phenomenon of Nexplanon migration, and the exceedingly rare treatment resolution of lung resection to remove an embolized device.
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Affiliation(s)
- Edward K Maybury
- Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA.
| | - Zachary C Affrin
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA
| | - Christian Popa
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA
| | - Max Fowler
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA
| | - Bryan D Laliberte
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA
| | - Sarah C Clarke
- Darnall Medical Library, Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA
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Salem AM, Davis J, Gopalan D, Rudd JHF, Clarke SC, Schofield PM, Bennett MR, Brown AJ, Obaid DR. Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain. Clin Imaging 2023; 101:69-76. [PMID: 37311397 DOI: 10.1016/j.clinimag.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) can identify high-risk coronary plaque types. However, the inter-observer variability for high-risk plaque features, including low attenuation plaque (LAP), positive remodelling (PR), and the Napkin-Ring sign (NRS), may reduce their utility, especially amongst less experienced readers. METHODOLOGY In a prospective study, we compared the prevalence, location and inter-observer variability of both conventional CT-defined high-risk plaques with a novel index based on quantifying the ratio of necrotic core to fibrous plaque using individualised X-ray attenuation cut-offs (the CT-defined thin-cap fibroatheroma - CT-TCFA) in 100 patients followed-up for 7 years. RESULTS In total, 346 plaques were identified in all patients. Seventy-two (21%) of all plaques were classified by conventional CT parameters as high-risk (either NRS or PR and LAP combined), and 43 (12%) of plaques were considered high-risk using the novel CT-TCFA definition of (Necrotic Core/fibrous plaque ratio of >0.9). The majority (80%) of the high-risk plaques (LAP&PR, NRS and CT-TCFA) were located in the proximal and mid-LAD and RCA. The kappa co-efficient of inter-observer variability (k) for NRS was 0.4 and for PR and LAP combined 0.4. While the kappa co-efficient of inter-observer variability (k) for the new CT-TCFA definition was 0.7. During follow-up, patients with either conventional high-risk plaques or CT-TCFAs were significantly more likely to have MACE (Major adverse cardiovascular events) compared to patients without coronary plaques (p value 0.03 & 0.03, respectively). CONCLUSION The novel CT-TCFA is associated with MACE and has improved inter-observer variability compared with current CT-defined high-risk plaques.
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Affiliation(s)
- Ahmed M Salem
- Cardiology Department, Swansea Bay University Health Board, UK; Institute of Life Sciences-2, Swansea University Medical School, UK
| | - Joel Davis
- Southampton General Hospital, Southampton, UK
| | | | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Sarah C Clarke
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Adam J Brown
- The School of Clinical Sciences at Monash Health, Melbourne, Australia
| | - Daniel R Obaid
- Cardiology Department, Swansea Bay University Health Board, UK; Institute of Life Sciences-2, Swansea University Medical School, UK.
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Kerling DA, Clarke SC, DeLuca JP, Evans MO, Kress AT, Nadeau RJ, Selig DJ. Systematic Review and Meta-Analysis of the Effect of Loop Diuretics on Antibiotic Pharmacokinetics. Pharmaceutics 2023; 15:pharmaceutics15051411. [PMID: 37242653 DOI: 10.3390/pharmaceutics15051411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Loop diuretics and antibiotics are commonly co-prescribed across many clinical care settings. Loop diuretics may alter antibiotic pharmacokinetics (PK) via several potential drug interactions. A systematic review of the literature was performed to investigate the impact of loop diuretics on antibiotic PK. The primary outcome metric was the ratio of means (ROM) of antibiotic PK parameters such as area under the curve (AUC) and volume of distribution (Vd) on and off loop diuretics. Twelve crossover studies were amenable for metanalysis. Coadministration of diuretics was associated with a mean 17% increase in plasma antibiotic AUC (ROM 1.17, 95% CI 1.09-1.25, I2 = 0%) and a mean decrease in antibiotic Vd by 11% (ROM 0.89, 95% CI 0.81-0.97, I2 = 0%). However, the half-life was not significantly different (ROM 1.06, 95% CI 0.99-1.13, I2 = 26%). The remaining 13 observational and population PK studies were heterogeneous in design and population, as well as prone to bias. No large trends were collectively observed in these studies. There is currently not enough evidence to support antibiotic dosing changes based on the presence or absence of loop diuretics alone. Further studies designed and powered to detect the effect of loop diuretics on antibiotic PK are warranted in applicable patient populations.
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Affiliation(s)
- David A Kerling
- Walter Reed National Military Medical Center, Internal Medicine, Bethesda, MD 20889, USA
| | - Sarah C Clarke
- Walter Reed National Military Medical Center, Internal Medicine, Bethesda, MD 20889, USA
| | - Jesse P DeLuca
- Walter Reed Army Institute of Research, Clinical Pharmacology Fellowship, Silver Spring, MD 20910, USA
| | - Martin O Evans
- Walter Reed Army Institute of Research, Clinical Pharmacology Fellowship, Silver Spring, MD 20910, USA
| | - Adrian T Kress
- Walter Reed Army Institute of Research, Clinical Pharmacology Fellowship, Silver Spring, MD 20910, USA
| | - Robert J Nadeau
- Walter Reed Army Institute of Research, Clinical Pharmacology Fellowship, Silver Spring, MD 20910, USA
| | - Daniel J Selig
- Walter Reed Army Institute of Research, Clinical Pharmacology Fellowship, Silver Spring, MD 20910, USA
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Abstract
The Getting It Right First Time (GIRFT) process is designed to improve the care of patients in the National Health Service (NHS) in England through in-depth review of services, benchmarking and presenting a data-driven evidence base to support change. Although it started as a pilot project targeting unwarranted variation in elective orthopaedic surgery, it rapidly became apparent that the approach of clinically led deep dives to review the activity in individual orthopaedic units was effective in improving standards of care and resulted in substantial cost savings that could be reinvested in the clinical service. GIRFT has now expanded to encompass 40 clinical specialties and is funded nationally by the NHS in England. The purpose of this article is to describe its application and benefit to cardiology.
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Affiliation(s)
- Simon Ray
- Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sarah C Clarke
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Yokoi H, McGovern M, Fetherston T, Clarke SC, Ravindra VM, Hooten KG, Ikeda DS. A history of neurosurgical capabilities in the United States Pacific Command: from World War II to present. Neurosurg Focus 2022; 53:E13. [DOI: 10.3171/2022.6.focus22247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022]
Abstract
Neurosurgery has benefited from innovations as a result of military conflict. The volume and complexity of injuries sustained on the battlefield require medical teams to triage, innovate, and practice beyond their capabilities in order to treat wartime injuries. The neurosurgeons who practiced in the Pacific Command (PACOM) during World War II, the Korean War, and the War in Vietnam built upon field operating room knowledge and influenced the logistics of treating battle-injured patients in far-forward environments. Modern-day battles are held on new terrain, and the military neurosurgeon must adapt. War in the PACOM uniquely presented significant obstacles due to geographic isolation, ultimately accelerating the growth and adaptability of military neurosurgery and medical evacuation. The advancements in infrastructure and resource mobilization made during PACOM conflicts continue to inform modern-day practices and provide insight for future conflicts. In this historical article, the authors review the development and evolution of neurosurgical care, forward surgical teams, and mobile field hospitals with surgical capabilities through US conflicts in the PACOM.
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Affiliation(s)
- Hana Yokoi
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Meaghan McGovern
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Sarah C. Clarke
- Darnall Medical Library, Walter Reed National Military Medical Center, Bethesda, Maryland; and
| | - Vijay M. Ravindra
- Department of Neurosurgery, Naval Medical Readiness Training Command, San Diego, California
| | - Kristopher G. Hooten
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Daniel S. Ikeda
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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Treibel TA, Kelion A, Ingram TE, Archbold RA, Myerson SG, Menezes LJ, Morgan-Hughes GJ, Schofield R, Keenan NG, Clarke SC, Keys A, Keogh B, Masani N, Ray S, Westwood M, Pearce K, Colebourn CL, Bull RK, Greenwood JP, Roditi GH, Lloyd G. United Kingdom standards for non-invasive cardiac imaging: recommendations from the Imaging Council of the British Cardiovascular Society. Heart 2022; 108:e7. [PMID: 35613713 DOI: 10.1136/heartjnl-2022-320799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heart and circulatory diseases affect more than seven million people in the UK. Non-invasive cardiac imaging is a critical element of contemporary cardiology practice. Progressive improvements in technology over the last 20 years have increased diagnostic accuracy in all modalities and led to the incorporation of non-invasive imaging into many standard cardiac clinical care pathways. Cardiac imaging tests are requested by a variety of healthcare practitioners and performed in a range of settings from the most advanced hospitals to local health centres. Imaging is used to detect the presence and consequences of cardiovascular disease, as well as to monitor the response to therapies. The previous UK national imaging strategy statement which brought together all of the non-invasive imaging modalities was published in 2010. The purpose of this document is to collate contemporary standards developed by the modality-specific professional organisations which make up the British Cardiovascular Society Imaging Council, bringing together common and essential recommendations. The development process has been inclusive and iterative. Imaging societies (representing both cardiology and radiology) reviewed and agreed on the initial structure. The final document therefore represents a position, which has been generated inclusively, presents rigorous standards, is applicable to clinical practice and deliverable. This document will be of value to a variety of healthcare professionals including imaging departments, the National Health Service or other organisations, regulatory bodies, commissioners and other purchasers of services, and service users, i.e., patients, and their relatives.
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Affiliation(s)
- Thomas A Treibel
- Cardiac Imaging, Saint Bartholomew's Hospital Barts Heart Centre, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Andrew Kelion
- Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - R Andrew Archbold
- General & Invasive Cardiology, Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Saul G Myerson
- Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Leon J Menezes
- Department of Nuclear Cardiology, Barts Health NHS Trust, London, London, UK
| | | | - Rebecca Schofield
- Department of Cardiology, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Niall G Keenan
- Department of Cardiology, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Sarah C Clarke
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Bruce Keogh
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Navroz Masani
- Department of Cardiology, Cardiff and Vale NHS Trust, Cardiff, Cardiff, UK
| | - Simon Ray
- Cardiology, University Hospitals of South Manchester, Manchester, UK
| | - Mark Westwood
- Department of Cardiac Imaging, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
| | - Keith Pearce
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - John Pierre Greenwood
- Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Giles H Roditi
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Guy Lloyd
- Department of Cardiac Imaging, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
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Aetesam‐ur‐Rahman M, Zhao TX, Paques K, Oliveira J, Khialani B, Kyranis S, Braganza DM, Clarke SC, Bennett MR, West NEJ, Hoole SP. Coronary Flow Variations Following Percutaneous Coronary Intervention Affect Diastolic Nonhyperemic Pressure Ratios More Than the Whole Cycle Ratios. J Am Heart Assoc 2022; 11:e023554. [PMID: 35470686 PMCID: PMC9238611 DOI: 10.1161/jaha.121.023554] [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] [Indexed: 01/09/2023]
Abstract
Background Post-percutaneous coronary intervention (PCI) fractional flow reserve ≥0.90 is an accepted marker of procedural success, and a cutoff of ≥0.95 has recently been proposed for post-PCI instantaneous wave-free ratio. However, stability of nonhyperemic pressure ratios (NHPRs) post-PCI is not well characterized, and transient reactive submaximal hyperemia post-PCI may affect their precision. We performed this study to assess stability and reproducibility of NHPRs post-PCI. Methods and Results Fifty-seven patients (age, 63.77±10.67 years; men, 71%) underwent hemodynamic assessment immediately post-PCI and then after a recovery period of 10, 20, and 30 minutes and repeated at 3 months. Manual offline analysis was performed to derive resting and hyperemic pressure indexes (Pd/Pa resting pressure gradient, mathematically derived instantaneous wave-free ratio, resting full cycle ratio, and fractional flow reserve) and microcirculatory resistances (basal microvascular resistance and index of microvascular resistance). Transient submaximal hyperemia occurring post-PCI was demonstrated by longer thermodilution time at 30 minutes compared with immediately post-PCI; mean difference of thermodilution time was 0.17 seconds (95% CI, 0.07-0.26 seconds; P=0.04). Basal microcirculatory resistance was also higher at 30 minutes than immediately post-PCI; mean difference of basal microvascular resistance was 10.89 mm Hg.s (95% CI, 2.25-19.52 mm Hg.s; P=0.04). Despite this, group analysis confirmed no significant differences in the values of resting whole cycle pressure ratios (Pd/Pa and resting full cycle ratio) as well as diastolic pressure ratios (diastolic pressure ratio and mathematically derived instantaneous wave-free ratio). Whole cardiac cycle NHPRs demonstrated the best overall stability post-PCI, and 1 in 5 repeated diastolic NHPRs crossed the clinical decision threshold. Conclusions Whole cycle NHPRs demonstrate better reproducibility and clinical precision post-PCI than diastolic NHPRs, possibly because of less perturbation from predominantly diastolic reactive hyperemia and left ventricular stunning. Registration URL: https://clinicaltrials.gov/ct2/show/NCT03502083; Unique identifier: NCT03502083 and URL: https://clinicaltrials.gov/ct2/show/NCT03076476; Unique identifier: NCT03076476.
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Affiliation(s)
| | - Tian X. Zhao
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | - Kitty Paques
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | - Joana Oliveira
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | - Bharat Khialani
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | - Stephen Kyranis
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | - Denise M. Braganza
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | - Sarah C. Clarke
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | - Martin R. Bennett
- Division of Cardiovascular MedicineUniversity of CambridgeUnited Kingdom
| | - Nick E. J. West
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | - Stephen P. Hoole
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
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Affiliation(s)
- Rebecca Dobson
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Sarah C Clarke
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Clarke SC, Shohfi EE, Han S. Federal Library Utilization of LibGuides to Disseminate COVID-19 Information. EBLIP 2022. [DOI: 10.18438/eblip30017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective – In winter 2019-2020, the world saw the emergence of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than a year later, the pandemic continues with the U.S. death toll surpassing 550,000. Over the last decade, librarians have increased their roles in infectious disease outbreak response. However, no existing literature exists on use of the widely-used library content management platform, LibGuides, to respond to infectious disease outbreaks. This research explores how Federal Libraries use LibGuides to distribute COVID-19 information throughout the ongoing COVID-19 pandemic.
Methods – Survey questions were created and peer-reviewed by colleagues. Survey questions first screened for participant eligibility and collected broad demographic information to assist in identifying duplicate responses from individual libraries, then examined the creation, curation, and maintenance of COVID-19 LibGuides. The survey was hosted in Max.gov, a Federal Government data collection and analysis tool. Invitations to participate in the survey were sent via email to colleagues and listservs and posted to personal social media accounts. The survey was made publicly available for three weeks. Collected data were exported into Excel to clean, quantify, and visualize results. Long form answers were manually reviewed and tagged thematically.
Results – Of the 78 eligible respondents, 42% (n = 33) reported that their library uses LibGuides to disseminate COVID-19 information; 45% of these respondents said they spent 10+ hours creating their COVID-19 LibGuide, and 60% of respondents spent <1 hour a week on maintenance and updates. Most LibGuides were created in early spring 2020 as the U.S. first saw an uptick in COVID-19 cases. For marketing purposes, respondents reported using web/internal announcements (75%) and email (50%) most frequently. All respondents reported inclusion of U.S. Government resources in their COVID-19 LibGuides, and a majority also included guidelines, international websites, and databases to inform their user communities.
Conclusion – Some Federal Libraries use LibGuides as a tool to share critical information, including as a tool for emergency response. Results show libraries tend to start from scratch and share the same resources, duplicating efforts. To improve efficiency in LibGuide curation and use of library staff time, one solution to consider is the creation of a LibGuides template that any Federal Library can use to quickly set up and adapt an emergency response LibGuide specifically for their users. Additionally, findings show that libraries are uncertain of archiving and preservation plans for their guides post-pandemic, suggesting a need for recommended best practices.
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Gladstone RA, Siira L, Brynildsrud OB, Vestrheim DF, Turner P, Clarke SC, Srifuengfung S, Ford R, Lehmann D, Egorova E, Voropaeva E, Haraldsson G, Kristinsson KG, McGee L, Breiman RF, Bentley SD, Sheppard CL, Fry NK, Corander J, Toropainen M, Steens A. International links between Streptococcus pneumoniae vaccine serotype 4 sequence type (ST) 801 in Northern European shipyard outbreaks of invasive pneumococcal disease. Vaccine 2022; 40:1054-1060. [PMID: 34996643 PMCID: PMC8820377 DOI: 10.1016/j.vaccine.2021.10.046] [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] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/01/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pneumococcal disease outbreaks of vaccine preventable serotype 4 sequence type (ST)801 in shipyards have been reported in several countries. We aimed to use genomics to establish any international links between them. METHODS Sequence data from ST801-related outbreak isolates from Norway (n = 17), Finland (n = 11) and Northern Ireland (n = 2) were combined with invasive pneumococcal disease surveillance from the respective countries, and ST801-related genomes from an international collection (n = 41 of > 40,000), totalling 106 genomes. Raw data were mapped and recombination excluded before phylogenetic dating. RESULTS Outbreak isolates were relatively diverse, with up to 100 SNPs (single nucleotide polymorphisms) and a common ancestor estimated around the year 2000. However, 19 Norwegian and Finnish isolates were nearly indistinguishable (0-2 SNPs) with the common ancestor dated around 2017. CONCLUSION The total diversity of ST801 within the outbreaks could not be explained by recent transmission alone, suggesting that harsh environmental and associated living conditions reported in the shipyards may facilitate invasion of colonising pneumococci. However, near identical strains in the Norwegian and Finnish outbreaks does suggest that transmission between international shipyards also contributed to those outbreaks. This indicates the need for improved preventative measures in this working population including pneumococcal vaccination.
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Affiliation(s)
- R A Gladstone
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
| | - L Siira
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - O B Brynildsrud
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - D F Vestrheim
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - P Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - S C Clarke
- Faculty of Medicine and Institute of Life Sciences, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Trust, Southampton, United Kingdom; Global Health Research Institute, University of Southampton, Southampton, United Kingdom; School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia; Centre for Translational Research, IMU Institute for Research, Development and Innovation (IRDI), Kuala Lumpur, Malaysia
| | | | - R Ford
- Papua New Guinea Institute of Medical Research, PO Box 60, Goroka 441, Eastern Highlands Province, Papua New Guinea
| | - D Lehmann
- Telethon Kids Institute, the University of Western Australia, Perth, WA, Australia
| | - E Egorova
- G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - E Voropaeva
- G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - G Haraldsson
- Department of Clinical Microbiology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland and Faculty of Medicine, University of Iceland
| | - K G Kristinsson
- Department of Clinical Microbiology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland and Faculty of Medicine, University of Iceland
| | - L McGee
- Centers for Disease Control and Prevention, Atlanta, USA
| | - R F Breiman
- Emory Global Health Institute, Atlanta, USA; Rollins School Public Health, Emory University, USA
| | - S D Bentley
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
| | - C L Sheppard
- Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, London, United Kingdom
| | - N K Fry
- Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, London, United Kingdom; Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, United Kingdom
| | - J Corander
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
| | - M Toropainen
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - A Steens
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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11
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Aetesam‐ur‐Rahman M, Brown AJ, Jaworski C, Giblett JP, Zhao TX, Braganza DM, Clarke SC, Agrawal BSK, Bennett MR, West NEJ, Hoole SP. Adenosine-Induced Coronary Steal Is Observed in Patients Presenting With ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2021; 10:e019899. [PMID: 34187187 PMCID: PMC8403291 DOI: 10.1161/jaha.120.019899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/21/2021] [Indexed: 12/22/2022]
Abstract
Background Adenosine is used to treat no-reflow in the infarct-related artery (IRA) during ST-segment-elevation myocardial infarction intervention. However, the physiological effect of adenosine in the IRA is variable. Coronary steal-a reduction of blood flow to the distal coronary bed-can occur in response to adenosine and this is facilitated by collaterals. We investigated the effects of adenosine on coronary flow reserve (CFR) in patients presenting with ST-segment-elevation myocardial infarction to better understand the physiological mechanism underpinning the variable response to adenosine. Methods and Results Pressure-wire assessment of the IRA after percutaneous coronary intervention was performed in 93 patients presenting with ST-segment-elevation myocardial infarction to calculate index of microvascular resistance, CFR, and collateral flow index by pressure. Modified collateral Rentrop grade to the IRA was recorded, as was microvascular obstruction by cardiac magnetic resonance imaging. Coronary steal (CFR <0.9), no change in flow (CFR=0.9-1.1), and hyperemic flow (CFR >1.1) after adenosine occurred in 19 (20%), 15 (16%), and 59 (63%) patients, respectively. Patients with coronary steal had higher modified Rentrop score to the IRA (1 [0, 1.75] versus 0 [0, 1], P<0.001) and a higher collateral flow index by pressure (0.25±0.10 versus 0.15±0.10, P=0.004) than the hyperemic group. The coronary steal group also had significantly higher index of microvascular resistance (61.68 [28.13, 87.04] versus 23.93 [14.67, 37.00], P=0.006) and had more disease (stenosis >50%) in the donor arteries (52.63% versus 22.03%, P=0.02) than the hyperemic group. Conclusions Adenosine-induced coronary steal may be responsible for a reduction in coronary flow reserve in a proportion of patients presenting with ST-segment-elevation myocardial infarction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03145194. URL: https://www.isrctn.com; Unique identifier: ISRCTN3176727.
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Affiliation(s)
- Muhammad Aetesam‐ur‐Rahman
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
- Division of Cardiovascular MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Adam J. Brown
- Department of CardiologyMonash UniversityMelbourneAustralia
| | | | - Joel P. Giblett
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
- Division of Cardiovascular MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Tian X. Zhao
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
- Division of Cardiovascular MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Denise M. Braganza
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | - Sarah C. Clarke
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | | | - Martin R. Bennett
- Division of Cardiovascular MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Nick E. J. West
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
| | - Stephen P. Hoole
- Department of Interventional CardiologyRoyal Papworth HospitalCambridgeUnited Kingdom
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Aetesam-Ur-Rahman M, Giblett JP, Khialani B, Kyranis S, Clarke SJ, Zhao TX, Braganza DM, Clarke SC, West NEJ, Bennett MR, Hoole SP. GLP-1 vasodilatation in humans with coronary artery disease is not adenosine mediated. BMC Cardiovasc Disord 2021; 21:223. [PMID: 33932990 PMCID: PMC8088691 DOI: 10.1186/s12872-021-02030-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 04/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Incretin therapies appear to provide cardioprotection and improve cardiovascular outcomes in patients with diabetes, but the mechanism of this effect remains elusive. We have previously shown that glucagon-like peptide (GLP)-1 is a coronary vasodilator and we sought to investigate if this is an adenosine-mediated effect. METHODS We recruited 41 patients having percutaneous coronary intervention (PCI) for stable angina and allocated them into four groups administering a specific study-related infusion following successful PCI: GLP-1 infusion (Group G) (n = 10); Placebo, normal saline infusion (Group P) (n = 11); GLP-1 + Theophylline infusion (Group GT) (n = 10); and Theophylline infusion (Group T) (n = 10). A pressure wire assessment of coronary distal pressure and flow velocity (thermodilution transit time-Tmn) at rest and hyperaemia was performed after PCI and repeated following the study infusion to derive basal and index of microvascular resistance (BMR and IMR). RESULTS There were no significant differences in the demographics of patients recruited to our study. Most of the patients were not diabetic. GLP-1 caused significant reduction of resting Tmn that was not attenuated by theophylline: mean delta Tmn (SD) group G - 0.23 s (0.27) versus group GT - 0.18 s (0.37), p = 0.65. Theophylline alone (group T) did not significantly alter resting flow velocity compared to group GT: delta Tmn in group T 0.04 s (0.15), p = 0.30. The resulting decrease in BMR observed in group G persisted in group GT: - 20.83 mmHg s (24.54 vs. - 21.20 mmHg s (30.41), p = 0.97. GLP-1 did not increase circulating adenosine levels in group GT more than group T: delta median adenosine - 2.0 ng/ml (- 117.1, 14.8) versus - 0.5 ng/ml (- 19.6, 9.4); p = 0.60. CONCLUSION The vasodilatory effect of GLP-1 is not abolished by theophylline and GLP-1 does not increase adenosine levels, indicating an adenosine-independent mechanism of GLP-1 coronary vasodilatation. TRIAL REGISTRATION The local research ethics committee approved the study (National Research Ethics Service-NRES Committee, East of England): REC reference 14/EE/0018. The study was performed according to institutional guidelines, was registered on http://www.clinicaltrials.gov (unique identifier: NCT03502083) and the study conformed to the principles outlined in the Declaration of Helsinki.
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Affiliation(s)
- Muhammad Aetesam-Ur-Rahman
- Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Joel P Giblett
- Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK
| | - Bharat Khialani
- Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK
| | - Stephen Kyranis
- Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK
| | - Sophie J Clarke
- Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK
| | - Tian X Zhao
- Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Denise M Braganza
- Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK
| | - Sarah C Clarke
- Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK
| | - Nick E J West
- Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Stephen P Hoole
- Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
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Haddow AD, Clarke SC. Inaccuracies in Google's Health-Based Knowledge Panels Perpetuate Widespread Misconceptions Involving Infectious Disease Transmission. Am J Trop Med Hyg 2021; 104:2293-2297. [PMID: 33901005 DOI: 10.4269/ajtmh.21-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/12/2021] [Indexed: 11/07/2022] Open
Abstract
Google health-based Knowledge Panels were designed to provide users with high-quality basic medical information on a specific condition. However, any errors contained within Knowledge Panels could result in the widespread distribution of inaccurate health information. We explored the potential for inaccuracies to exist within Google's health-based Knowledge Panels by focusing on a single well-studied pathogen, Ebola virus (EBOV). We then evaluated the accuracy of those transmission modes listed within the Google Ebola Knowledge Panel and investigated the pervasiveness of any misconceptions associated with inaccurate transmission modes among persons living in Africa. We found that the Google Ebola Knowledge Panel inaccurately listed insect bites or stings as modes of EBOV transmission. Our scoping review found 27 articles and reports that revealed that 9 of 11 countries where misconceptions regarding insect transmission of EBOV have been reported are locations of current (i.e., Democratic Republic of Congo and Guinea) or previous EBOV outbreaks. We found reports that up to 26.6% (155/582) of study respondents in Democratic Republic of Congo believed mosquito bite avoidance would prevent EBOV; in other locations of previous large-scale EBOV outbreaks (e.g., Guinea), up to 61.0% (304/498) of respondents believed insects were involved in EBOV transmission. Our findings highlight the potential for errors to exist within the health information contained in Google's health-based Knowledge Panels. Such errors could perpetuate misconceptions or misinformation, leading to mistrust of health workers and aid agencies and in turn undermining public health education or outbreak response efforts.
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Affiliation(s)
- Andrew D Haddow
- 1Virology Division, United States Army Medical Research Institute of Infectious Diseases, Frederick, Maryland
| | - Sarah C Clarke
- 2Darnall Medical Library, Walter Reed National Military Medical Center, Bethesda, Maryland
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Ladeiras-Lopes R, Baciu L, Grapsa J, Sohaib A, Vidal-Perez R, Bohm A, Silvola H, Gimenez MR, Muscoli S, Wallner M, Rakisheva A, Nagy VK, Cowie MR, Clarke SC, Achenbach S. Social media in cardiovascular medicine: a contemporary review. Eur Heart J Digit Health 2020; 1:10-19. [PMID: 36713964 PMCID: PMC9707982 DOI: 10.1093/ehjdh/ztaa004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/05/2020] [Indexed: 02/01/2023]
Abstract
Social media increasingly impact both the private and professional lives of the majority of the population, including individuals engaged in cardiovascular healthcare and research. Healthcare providers across the world use social media platforms such as Twitter or Facebook to find medical and scientific information, to follow scientific meetings, to discuss individual clinical cases with colleagues, and to engage with patients. While social media provide a means for fast, interactive and accessible communication without geographic boundaries, their use to obtain and disseminate information has limitations and the potential threats are not always clearly understood. Governance concerns include a lack of rigorous quality control, bias due to the pre-selection of presented content by filter algorithms, and the risk of inadvertent breach of patient confidentiality. This article provides information and guidance regarding the role and use of social media platforms in cardiovascular medicine, with an emphasis on the new opportunities for the dissemination of scientific information and continuing education that arise from their responsible use.
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Affiliation(s)
- Ricardo Ladeiras-Lopes
- Cardiology Department, Gaia Hospital Centre, Vila Nova de Gaia, Portugal,Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal,Corresponding author. Tel: +351 22 786 51 00,
| | | | | | - Afzal Sohaib
- Barts Heart Centre, London, UK,Barking, Havering and Redbridge University Hospitals, London, UK
| | - Rafael Vidal-Perez
- Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Allan Bohm
- Department of Acute Cardiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia,Academy - Research Organization, Bratislava, Slovakia
| | - Harri Silvola
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Maria Rubini Gimenez
- Heart Centre Leipzig, Leipzig, Germany,University Hospital of Basel, Basel, Switzerland
| | - Saverio Muscoli
- Department of Cardiology, Policlinico Universitario “Tor Vergata”, Rome, Italy
| | - Markus Wallner
- Lewis Katz School of Medicine, Temple University, Cardiovascular Research Center, Philadelphia, PA, USA,Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Amina Rakisheva
- Cardiology Department, Scientific and Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | | | - Martin R Cowie
- Digital Health Committee of the European Society of Cardiology, Imperial College London (Royal Brompton Hospital), London, UK
| | - Sarah C Clarke
- Media Committee of the European Society of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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15
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Affiliation(s)
- Sarah C Clarke
- Cardiac Unit, Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0AY, UK
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Giblett JP, Clarke S, Zhao T, McCormick LM, Braganza DM, Densem CG, O'Sullivan M, Adlam D, Clarke SC, Steele J, Fielding S, West NE, Villar SS, Hoole SP. The role of Glucagon-Like Peptide 1 Loading on periprocedural myocardial infarction During elective PCI (GOLD-PCI study): A randomized, placebo-controlled trial. Am Heart J 2019; 215:41-51. [PMID: 31277053 DOI: 10.1016/j.ahj.2019.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incretin hormone glucagon-like peptide 1 (GLP-1) has been shown to protect against lethal ischemia-reperfusion injury in animal models and against nonlethal ischemia reperfusion injury in humans. Furthermore, GLP-1 receptor agonists have been shown to reduce major adverse cardiovascular and cerebrovascular events (MACCE) in large-scale studies. We sought to investigate whether GLP-1 reduced percutaneous coronary intervention (PCI)-associated myocardial infarction (PMI) during elective PCI. METHODS The study was a randomized, double-blind controlled trial in which patients undergoing elective PCI received an intravenous infusion of either GLP-1 at 1.2 pmol/kg/min or matched 0.9% saline placebo before and during the procedure. Randomization was performed in 1:1 fashion, with stratification for diabetes mellitus. Six-hour cardiac troponin I (cTnI) was measured with a primary end point of PMI defined as rise ≫×5 upper limit of normal (280 ng/L). Secondary end points included cTnI rise and MACCE at 12 months. RESULTS A total of 192 patients were randomized with 152 (79%) male and a mean age of 68.1 ± 8.9 years. No significant differences in patient demographics were noted between the groups. There was no difference in the rate of PMI between GLP-1 and placebo (9 [9.8%] vs 8 [8.3%], P = 1.0) or in the secondary end points of difference in median cTnI between groups (9.5 [0-88.5] vs 20 [0-58.5] ng/L, P = .25) and MACCE at 12 months (7 [7.3%] vs 9 [9.4%], P = .61). CONCLUSIONS In this randomized, placebo-controlled trial, GLP-1 did not reduce the low incidence of PMI or abrogate biomarker rise during elective PCI, nor did it influence the 12-month MACCE rate which also remained low. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov Number: NCT02127996https://clinicaltrials.gov/ct2/show/NCT02127996.
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Kim VL, Williams NP, Ostridge KK, Naghibi MM, Coombs NA, Devaster JM, Aris E, Clarke SC, Tuck AC, Wootton SA, Bourne SC, Staples KJ, Wilkinson TM. S37 The persistence of eosinophilic inflammation in copd over time – aeris cohort. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McNeil HC, Clarke SC. Serotype prevalence of Streptococcus pneumoniae in Malaysia - the need for carriage studies. Med J Malaysia 2016; 71:134-138. [PMID: 27495888] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pneumococcal disease, caused by the bacterium Streptococcus pneumoniae, is a major burden to global health. Although the World Health Organisation (WHO) strongly recommends the inclusion of pneumococcal conjugate vaccines in national immunisation programmes (NIP's) worldwide, this has not occurred in many countries in the WHO South East Asia and Western Pacific regions - particularly longstanding middle-income countries. It is widely accepted that carriage of S. pneumoniae is a precursor to developing any pneumococcal disease. The reduction in pneumococcal disease from vaccine serotypes (VT) following widespread implementation of the pneumococcal conjugate vaccine (PCV) is believed to be through the direct immunogenic protective effect of immunised individuals as well as indirectly through herd immunity diminishing the incidence of disease in nonimmunised individuals. In Malaysia, pneumococcal disease is not included in national surveillance programmes and although PCVs have been licensed, they have not been included in the NIP. Hence, the vaccine is only available privately and the majority of the population is not able to afford it. There is an urgent need to develop surveillance programmes in Malaysia to include pneumococcal serotype data from carriage and invasive disease so that it may help guide national vaccine policy prior to a decision being taken on the inclusion of PCVs in the NIP.
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Affiliation(s)
- H C McNeil
- University of Southampton Malaysia Campus, No.3, Persiaran Canselor, 1, Kota Ilmu, Educity, Iskandar, 79200 Nusajaya, Johor, Malaysia.
| | - S C Clarke
- University of Southampton, Faculty of Medicine and Institute of Life Sciences and Global Health Research Institute, United Kingdom
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Hoole SP, Clarke SC. Navigating Optimal Revascularization for Unprotected Left Main Disease in Changing Interventional Seas. JACC Cardiovasc Interv 2016; 9:1008-10. [PMID: 27198681 DOI: 10.1016/j.jcin.2016.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/14/2016] [Accepted: 03/18/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Stephen P Hoole
- Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Sarah C Clarke
- Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
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Abstract
The threat of bioterrorism remains a reality worldwide and, although of low probability, an attack would be a high-consequence event. Microbes are available to individuals with appropriate contacts and even many low-grade bacterial pathogens can severely affect health. Toxins provide bacteria with a system of defence that is often detrimental to humans and their versatility makes them potential tools of bioterrorism. It should be remembered that the aim of terrorism is not always to kill but rather to strike fear into peoples lives. Therefore, agents such as botulinum and cholera toxin could be used, which may not cause significant mortality but would cause widespread panic and potentially high morbidity. Importantly, no state can ever be fully prepared for a response and it is probable that no state ever could be. It is for this reason that biological agents are so attractive as weapons.
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Affiliation(s)
- S C Clarke
- Scottish Meningococcus and Pneumococcus Reference Laboratory, Glasgow, UK.
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21
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Hoole SP, Jaworski C, Brown AJ, McCormick LM, Agrawal B, Clarke SC, West NEJ. Serial assessment of the index of microcirculatory resistance during primary percutaneous coronary intervention comparing manual aspiration catheter thrombectomy with balloon angioplasty (IMPACT study): a randomised controlled pilot study. Open Heart 2015; 2:e000238. [PMID: 26019882 PMCID: PMC4442245 DOI: 10.1136/openhrt-2015-000238] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/13/2015] [Accepted: 03/31/2015] [Indexed: 01/26/2023] Open
Abstract
Objective Utilising a novel study design, we evaluated serial measurements of the index of microcirculatory resistance (IMR) in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) to assess the impact of device therapy on microvascular function, and determine what proportion of microvascular injury is related to the PPCI procedure, and what is an inevitable consequence of STEMI. Design 41 patients undergoing PPCI for STEMI were randomised to balloon angioplasty (BA, n=20) or manual thrombectomy (MT, n=21) prior to stenting. Serial IMR measurements, corrected for collaterals, were recorded at baseline and at each stage of the procedure. Microvascular obstruction (MVO) and infarct size at 24 h and 3 months were measured by troponin and cardiac MRI (CMR). Results IMR did not change significantly following PPCI, but patients with lower IMR values (<32, n=30) at baseline had a significant increase in IMR following PPCI (baseline: 21.2±7.9 vs post-stent: 33.0±23.7, p=0.01) attributable to prestent IRA instrumentation (baseline: 21.7±8.0 vs post-BA or MT: 36.9±25.9, p=0.006). Post-stent IMR correlated with early MVO on CMR (p=0.01). There was no significant difference in post-stent IMR, presence of early MVO or final infarct size between patients with BA and patients treated with MT. Conclusions Patients with STEMI and less microcirculatory dysfunction may be susceptible to acute iatrogenic microcirculatory injury from prestent coronary devices. MT did not appear to be superior to BA in maintaining microcirculatory integrity when the guide wire partially restores IRA flow during PPCI. Trial registration number ISRCTN31767278.
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Affiliation(s)
- Stephen P Hoole
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK
| | - Catherine Jaworski
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK
| | - Adam J Brown
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK
| | - Liam M McCormick
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK
| | - Bobby Agrawal
- Department of Radiology, Papworth Hospital, Cambridge, UK
| | - Sarah C Clarke
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK
| | - Nick E J West
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK
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Coughtrie AL, Whittaker RN, Begum N, Anderson R, Tuck A, Faust SN, Jefferies JM, Yuen HM, Roderick PJ, Mullee MA, Moore MV, Clarke SC. Evaluation of swabbing methods for estimating the prevalence of bacterial carriage in the upper respiratory tract: a cross sectional study. BMJ Open 2014; 4:e005341. [PMID: 25358677 PMCID: PMC4216860 DOI: 10.1136/bmjopen-2014-005341] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Bacterial carriage in the upper respiratory tract is usually asymptomatic but can lead to respiratory tract infection (RTI), meningitis and septicaemia. We aimed to provide a baseline measure of Streptococcus pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae and Neisseria meningitidis carriage within the community. Self-swabbing and healthcare professional (HCP) swabbing were compared. DESIGN Cross-sectional study. SETTING Individuals registered at 20 general practitioner practices within the Wessex Primary Care Research Network South West, UK. PARTICIPANTS 10,448 individuals were invited to participate; 5394 within a self-swabbing group and 5054 within a HCP swabbing group. Self-swabbing invitees included 2405 individuals aged 0-4 years and 3349 individuals aged ≥5 years. HCP swabbing invitees included 1908 individuals aged 0-4 years and 3146 individuals aged ≥5 years. RESULTS 1574 (15.1%) individuals participated, 1260 (23.4%, 95% CI 22.3% to 24.5%) undertaking self-swabbing and 314 (6.2%, 95% CI 5.5% to 6.9%) undertaking HCP-led swabbing. Participation was lower in young children and more deprived practice locations. Swab positivity rates were 34.8% (95% CI 32.2% to 37.4%) for self-taken nose swabs (NS), 19% (95% CI 16.8% to 21.2%) for self-taken whole mouth swabs (WMS), 25.2% (95% CI 20.4% to 30%) for nasopharyngeal swabs (NPS) and 33.4% (95% CI 28.2% to 38.6%) for HCP-taken WMS. Carriage rates of S. aureus were highest in NS (21.3%). S. pneumoniae carriage was highest in NS (11%) and NPS (7.4%). M. catarrhalis carriage was highest in HCP-taken WMS (28.8%). H. influenzae and P. aeruginosa carriage were similar between swab types. N. meningitidis was not detected in any swab. Age and recent RTI affected carriage of S. pneumoniae and H. influenzae. Participant costs were lower for self-swabbing (£41.21) versus HCP swabbing (£69.66). CONCLUSIONS Higher participation and lower costs of self-swabbing as well as sensitivity of self-swabbing favour this method for use in large population-based respiratory carriage studies.
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Affiliation(s)
- A L Coughtrie
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - R N Whittaker
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - N Begum
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - R Anderson
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - A Tuck
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - S N Faust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
- Southampton NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton Foundation NHS Trust, Southampton, UK
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton, UK
| | - J M Jefferies
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton, UK
| | - H M Yuen
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - P J Roderick
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - M A Mullee
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
- NIHR Research Design Service South Central, University Hospital Southampton Foundation NHS Trust, Southampton, UK
| | - M V Moore
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - S C Clarke
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton, UK
- Public Health England, Southampton, UK
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Shakrin NNSM, Balasubramaniam SD, Yusof HA, Mastuki MF, Masri SN, Taib NM, Nordin SA, Jamal F, Clarke SC, Desa MNM. Evaluation of PCR-based approach for serotype determination of Streptococcus pneumoniae. Trop Biomed 2013; 30:338-344. [PMID: 23959499] [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: 06/02/2023]
Abstract
Determination of Streptococcus pneumoniae serotypes is essential for epidemiological surveillance. Therefore accurate, reliable and cost effective serotyping method is crucial. In this study, we determined the serotypes of 41 pneumococcal isolates recovered from human anterior nares by multiplex Polymerase Chain Reaction (PCR) utilizing published primers. The data was then compared with conventional serology using latex agglutination (LA) and the Quellung reaction. Based on the PCR-approach, 8 different serogroups/serotypes were detected with one isolate classified as non-typeable (cpsA-negative). In reference to the serology-based data, the results were in agreement except for one isolate. For the latter isolate, the LA and Quellung tests failed to show a reaction but the PCR-approach and sequencing identified the isolate as serogroup 15B/C. Based on this experimental setting, we found that the PCR-approach for pneumococcal serotypes determination is reliable to serve as the alternative for determining the pneumococcal serotyping.
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Affiliation(s)
- N N S M Shakrin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
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Brown AJ, Joshi FR, Cacciottolo P, Hoole SP, Braganza DM, Schofield PM, West NEJ, Clarke SC. 060 CORONARY ROTATIONAL ATHERECTOMY USING BURR-TO-ARTERY RATIOS OF LESS THAN 0.5 IS ASSOCIATED WITH LOW LEVELS OF COMPLICATIONS, HIGH PROCEDURAL SUCCESS RATES AND FAVOURABLE 12-MONTH OUTCOMES. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.60] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Calvert PA, Obaid DR, O'Sullivan M, Shapiro LM, McNab DC, Densem CG, Hoole SP, Schofield PM, Braganza DM, Clarke SC, West NE, Bennett MR. 053 LONGTERM NATURAL HISTORY OF RADIOFREQUENCY INTRAVASCULAR ULTRASOUND IDENTIFIED CORONARY PLAQUES. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Clarke SC, Davies WR. Conference, conscience and climate: take flight. Heart 2012; 99:15-6. [PMID: 23250781 DOI: 10.1136/heartjnl-2012-302410] [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: 11/03/2022] Open
Affiliation(s)
- Sarah C Clarke
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
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Kydd AC, Gopalan D, Clarke SC, Rusk RA. Mitral annular caseous necrosis: insights from multimodality imaging. Eur Heart J 2012; 34:971. [PMID: 23014865 DOI: 10.1093/eurheartj/ehs325] [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: 11/12/2022] Open
Affiliation(s)
- Anna C Kydd
- Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, UK.
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Gladstone RA, Jefferies JM, Faust SN, Clarke SC. Sampling methods for the study of pneumococcal carriage: a systematic review. Vaccine 2012; 30:6738-44. [PMID: 22981760 DOI: 10.1016/j.vaccine.2012.08.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 08/20/2012] [Accepted: 08/31/2012] [Indexed: 10/27/2022]
Abstract
Streptococcus pneumoniae is an important pathogen worldwide. Accurate sampling of S. pneumoniae carriage is central to surveillance studies before and following conjugate vaccination programmes to combat pneumococcal disease. Any bias introduced during sampling will affect downstream recovery and typing. Many variables exist for the method of collection and initial processing, which can make inter-laboratory or international comparisons of data complex. In February 2003, a World Health Organisation working group published a standard method for the detection of pneumococcal carriage for vaccine trials to reduce or eliminate variability. We sought to describe the variables associated with the sampling of S. pneumoniae from collection to storage in the context of the methods recommended by the WHO and those used in pneumococcal carriage studies since its publication. A search of published literature in the online PubMed database was performed on the 1st June 2012, to identify published studies that collected pneumococcal carriage isolates, conducted after the publication of the WHO standard method. After undertaking a systematic analysis of the literature, we show that a number of differences in pneumococcal sampling protocol continue to exist between studies since the WHO publication. The majority of studies sample from the nasopharynx, but the choice of swab and swab transport media is more variable between studies. At present there is insufficient experimental data that supports the optimal sensitivity of any standard method. This may have contributed to incomplete adoption of the primary stages of the WHO detection protocol, alongside pragmatic or logistical issues associated with study design. Consequently studies may not provide a true estimate of pneumococcal carriage. Optimal sampling of carriage could lead to improvements in downstream analysis and the evaluation of pneumococcal vaccine impact and extrapolation to pneumococcal disease control therefore further in depth comparisons would be of value.
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Affiliation(s)
- R A Gladstone
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
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Jauneikaite E, Jefferies JM, Hibberd ML, Clarke SC. Prevalence of Streptococcus pneumoniae serotypes causing invasive and non-invasive disease in South East Asia: a review. Vaccine 2012; 30:3503-14. [PMID: 22475858 DOI: 10.1016/j.vaccine.2012.03.066] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is a major cause of bacterial infections resulting in significant morbidity and mortality worldwide. Currently, up to 13 serotypes are included in pneumococcal conjugate vaccines (PCVs). However, the serotype formulation of these vaccines was initially designed to protect children against serotypes most commonly causing invasive disease in North America, and may not reflect the serotype distribution across the world. Data regarding pneumococcal epidemiology from the other parts of the world, in particular South East Asia, has not been reviewed. METHODS This systematic literature review analyses published serotype data regarding S. pneumoniae isolates from South East Asian countries (defined as countries belonging to the Association of South East Asian Nations, ASEAN): Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam up to 3rd of March 2012. RESULTS Analysis of data from six ASEAN countries, from which information on pneumococcal serotypes was available, showed that the most common disease causing serotypes (in rank order) were 19F, 23F, 14, 6B, 1, 19A and 3. Serotype distribution of pneumococcal isolates was similar across the ASEAN region. Serotype level data was more commonly reported for pneumococcal isolates causing invasive pneumococcal disease than for those from non-invasive disease. Studies from Malaysia, Thailand and Singapore contributed the largest proportion of pneumococcal isolates, and serotype data, when compared to other ASEAN countries. CONCLUSION This review demonstrates that the majority of IPD causing serotypes in SE Asia are included in currently licensed PCVs. However, PCV's are included in the routine childhood immunisation schedule of only one of the ten countries included in this analysis. Our findings demonstrate the scarcity of information available on serotype prevalence and distribution of pneumococci in SE Asia.
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Affiliation(s)
- E Jauneikaite
- Infectious Disease Epidemiology Group, Sir Henry Wellcome Laboratories, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
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Calvert PA, Obaid DR, O'Sullivan M, Shapiro LM, McNab D, Densem CG, Schofield PM, Braganza D, Clarke SC, Ray KK, West NE, Bennett MR. Association Between IVUS Findings and Adverse Outcomes in Patients With Coronary Artery Disease. JACC Cardiovasc Imaging 2011; 4:894-901. [DOI: 10.1016/j.jcmg.2011.05.005] [Citation(s) in RCA: 385] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/15/2011] [Accepted: 05/05/2011] [Indexed: 01/28/2023]
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Calvert PA, Liew TV, Gorenne I, Clarke M, Costopoulos C, Obaid DR, O'Sullivan M, Shapiro LM, McNab DC, Densem CG, Schofield PM, Braganza D, Clarke SC, Ray KK, West NEJ, Bennett MR. Leukocyte telomere length is associated with high-risk plaques on virtual histology intravascular ultrasound and increased proinflammatory activity. Arterioscler Thromb Vasc Biol 2011; 31:2157-64. [PMID: 21680897 DOI: 10.1161/atvbaha.111.229237] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Leukocyte telomere length (LTL), a marker of cellular senescence, is inversely associated with cardiovascular events. However, whether LTL reflects plaque extent or unstable plaques, and the mechanisms underlying any association are unknown. METHODS AND RESULTS One hundred seventy patients with stable angina or acute coronary syndrome referred for percutaneous coronary intervention underwent 3-vessel virtual histology intravascular ultrasound; 30 372 mm of intravascular ultrasound pullback and 1096 plaques were analyzed. LTL was not associated with plaque volume but was associated with calcified thin-capped fibroatheroma (OR, 1.24; CI, 1.01-1.53; P=0.039) and total fibroatheroma numbers (OR, 1.19; CI, 1.02-1.39; P=0.027). Monocytes from coronary artery disease patients showed increased secretion of proinflammatory cytokines. To mimic leukocyte senescence, we disrupted telomeres and binding and expression of the telomeric protein protection of telomeres protein-1, inducing DNA damage. Telomere disruption increased monocyte secretion of monocyte chemoattractant protein-1, IL-6, and IL-1β and oxidative burst, similar to that seen in coronary artery disease patients, and lymphocyte secretion of IL-2 and reduced lymphocyte IL-10. CONCLUSIONS Shorter LTL is associated with high-risk plaque morphology on virtual histology intravascular ultrasound but not total 3-vessel plaque burden. Monocytes with disrupted telomeres show increased proinflammatory activity, which is also seen in coronary artery disease patients, suggesting that telomere shortening promotes high-risk plaque subtypes by increasing proinflammatory activity.
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Affiliation(s)
- Patrick A Calvert
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
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Benavides MT, Horn RL, Feldheim KA, Shivji MS, Clarke SC, Wintner S, Natanson L, Braccini M, Boomer JJ, Gulak SJB, Chapman DD. Global phylogeography of the dusky shark Carcharhinus obscurus: implications for fisheries management and monitoring the shark fin trade. ENDANGER SPECIES RES 2011. [DOI: 10.3354/esr00337] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Calvert PA, Obaid DR, West NEJ, Shapiro LM, McNab DC, Densem CG, Schofield PM, Braganza D, Clarke SC, O'Sullivan M, Ray KK, Bennett MR. VIRTUAL HISTOLOGY INTRAVASCULAR ULTRASOUND FINDINGS PREDICT ADVERSE OUTCOME IN PATIENTS WITH CORONARY ARTERY DISEASE: THE VIVA (VH-IVUS IN VULNERABLE ATHEROSCLEROSIS) STUDY. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)62055-x] [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: 10/18/2022]
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Jefferies JMC, Tee WSN, Clarke SC. Molecular analysis of Streptococcus pneumoniae clones causing invasive disease in children in Singapore. J Med Microbiol 2011; 60:750-755. [PMID: 21330410 DOI: 10.1099/jmm.0.030007-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Streptococcus pneumoniae remains a leading cause of serious paediatric disease. However, there are few published epidemiological data regarding invasive pneumococcal disease (IPD) in many countries in South East Asia, including Singapore. Baseline data for IPD are essential to inform policy regarding pneumococcal conjugate vaccine (PCV) use in Singapore. To our knowledge, this is the first study to use multilocus sequence typing (MLST) to investigate clonal relationships among Singaporean IPD isolates. We characterized 86 invasive pneumococci isolated from Singaporean children between 2001 and 2006 using serotyping and MLST. The objectives were to compare Singaporean MLST data to worldwide data and to assess serotype distribution in relation to current PCV formulations. We observed 50 sequence types (STs), a high proportion of which (n = 16) were novel STs. Despite the presence of these novel STs, serotype distribution was similar to that observed elsewhere. Serotypes 14, 6B, 19A and 19F accounted for 85 % of IPD cases. PCV7, PCV10 and PCV13 covered 85 %, 86 % and 97 % of IPD isolates, respectively. We have demonstrated a pressing need for larger studies to determine the molecular epidemiology and antibiotic susceptibility of circulating pneumococcal clones from both carriage and disease in Singapore.
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Affiliation(s)
- J M C Jefferies
- Southampton NIHR Biomedical Research Unit in Respiratory Medicine, Southampton, UK.,HPA Microbiology Services, Southampton, UK.,Molecular Microbiology Group, Sir Henry Wellcome Laboratories, Division of Infection, Inflammation and Immunity, University of Southampton School of Medicine, Southampton, UK
| | - W S N Tee
- Department of Pathology and Laboratory Medicine, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229889, Singapore
| | - S C Clarke
- Southampton NIHR Biomedical Research Unit in Respiratory Medicine, Southampton, UK.,HPA Microbiology Services, Southampton, UK.,Molecular Microbiology Group, Sir Henry Wellcome Laboratories, Division of Infection, Inflammation and Immunity, University of Southampton School of Medicine, Southampton, UK
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Adams NG, Adekambi T, Afeltra J, Aguado J, Aires de Sousa M, Akiyoshi K, Al Hasan M, Ala-Kokko T, Albert M, Alfandari S, Allen D, Allerberger F, Almyroudis N, Alp E, Amin R, Anderson-Berry A, Andes DR, Andremont A, Andreu A, Angelakis M, Antachopoulos C, Antoniadou A, Arabatzis M, Arlet G, Arnez M, Arnold C, Asensio A, Asseray N, Ausiello C, Avni T, Ayling R, Baddour L, Baguelin M, Bányai K, Barbour A, Basco LK, Bauer D, Bayston R, Beall B, Becker K, Behr M, Bejon P, Belliot G, Benito-Fernandez J, Benjamin D, Benschop K, Berencsi G, Bergeron MG, Bernard K, Berner R, Beyersmann J, Bille J, Bizzini A, Bjarnsholt T, Blanc D, Blanco J, Blot S, Bohnert J, Boillat N, Bonomo R, Bonten M, Bordon JM, Borel N, Boschiroli ML, Bosilkovski M, Bosso JA, Botelho-Nevers E, Bou G, Bretagne S, Brouqui P, Brun-Buisson C, Brunetto M, Bucher H, Buchheidt D, Buckling A, Bulpa P, Cambau E, Canducci F, Cantón R, Capobianchi M, Carattoli A, Carcopino X, Cardona-Castro N, Carling PC, Carrat F, Castilla J, Castilletti C, Cavaco L, Cavallo R, Ceccherini-Silberstein F, Centrón D, Chappuis F, Charrel R, Chen M, Chevaliez S, Chezzi C, Chomel B, Chowers M, Chryssanthou E, Ciammaruconi A, Ciccozzi M, Cid J, Ciofu O, Cisneros D, Ciufolini MG, Clark C, Clarke SC, Clayton R, Clementi M, Clemons K, Cloeckaert A, Cloud J, Coenye T, Cohen Bacri S, Cohen R, Coia J, Colombo A, Colson P, Concerse P, Cordonnier C, Cormican M, Cornaglia G, Cornely O, Costa S, Cots F, Craxi A, Creti R, Crnich C, Cuenca Estrella M, Cusi MG, d'Ettorre G, da Cruz Lamas C, Daikos G, Dannaoui E, De Barbeyrac B, De Grazia S, de Jager C, de Lamballerie X, de Marco F, del Palacio A, Delpeyroux F, Denamur E, Denis O, Depaquit J, Deplano A, Desenclos JC, Desjeux P, Deutch S, Di Luca D, Dianzani F, Diep B, Diestra K, Dignani C, Dimopoulos G, Divizia M, Doi Y, Dornbusch HJ, Dotis J, Drancourt M, Drevinek P, Dromer F, Dryden M, Dubreuil L, Dubus JC, Dumitrescu O, Dumke R, DuPont H, Edelstein M, Eggimann P, Eis-Huebinger AM, El Atrouni WI, Entenza J, Ergonul O, Espinel-Ingroff A, Esteban J, Etienne J, Fan XG, Fenollar F, Ferrante P, Ferrieri P, Ferry T, Feuchtinger T, Finegold S, Fingerle V, Fitch M, Fitzgerald R, Flori P, Fluit A, Fontana R, Fournier PE, François M, Francois P, Freedman DO, Friedrich A, Gallego L, Gallinella G, Gangneux JP, Gannon V, Garbarg-Chenon A, Garbino J, Garnacho-Montero J, Gatermann S, Gautret P, Gentile G, Gerlich W, Ghannoum M, Ghebremedhin B, Ghigo E, Giamarellos-Bourboulis E, Girgis R, Giske C, Glupczynski Y, Gnarpe J, Gomez-Barrena E, Gorwitz RJ, Gosselin R, Goubau P, Gould E, Gradel K, Gray J, Gregson D, Greub G, Grijalva CG, Groll A, Groschup M, Gutiérrez J, Hackam DG, Hall WA, Hallett R, Hansen S, Harbarth S, Harf-Monteil C, Hasanjani RMR, Hasler P, Hatchette T, Hauser P, He Q, Hedges A, Helbig J, Hennequin C, Herrmann B, Hezode C, Higgins P, Hoesli I, Hoiby N, Hope W, Houvinen P, Hsu LY, Huard R, Humphreys H, Icardi M, Imoehl M, Ivanova K, Iwamoto T, Izopet J, Jackson Y, Jacobsen K, Jang TN, Jasir A, Jaulhac B, Jaureguy F, Jefferies JM, Jehl F, Johnstone J, Joly-Guillou ML, Jonas M, Jones M, Joukhadar C, Kahl B, Kaier K, Kaiser L, Kato H, Katragkou A, Kearns A, Kern W, Kerr K, Kessin R, Kibbler C, Kimberlin D, Kittang B, Klaassen C, Kluytmans J, Ko WC, Koh WJ, Kostrzewa M, Kourbeti I, Krause R, Krcmery V, Krizova P, Kuijper E, Kullberg BJ, Kumar G, Kunin CM, La Scola B, Lagging M, Lagrou K, Lamagni T, Landini P, Landman D, Larsen A, Lass-Floerl C, Laupland K, Lavigne JP, Leblebicioglu H, Lee B, Lee CH, Leggat P, Lehours P, Leibovici L, Leon L, Leonard N, Leone M, Lescure X, Lesprit P, Levy PY, Lew D, Lexau CA, Li SY, Li W, Lieberman D, Lina B, Lina G, Lindsay JA, Livermore D, Lorente L, Lortholary O, Lucet JC, Lund B, Lütticken R, MacLeod C, Madhi S, Maertens J, Maggi F, Maiden M, Maillard JY, Maira-Litran T, Maltezou H, Manian FA, Mantadakis E, Maragakis L, Marcelin AG, Marchaim D, Marchetti O, Marcos M, Markotic A, Martina B, Martínez J, Martinez JL, Marty F, Maurin M, McGee L, Mediannikov O, Meersseman W, Megraud F, Meletiadis J, Mellmann A, Meyer E, Meyer W, Meylan P, Michalopoulos A, Micol R, Midulla F, Mikami Y, Miller RF, Miragaia M, Miriagou V, Mitchell TJ, Miyakis S, Mokrousov I, Monecke S, Mönkemüller K, Monno L, Monod M, Morales G, Moriarty F, Morosini I, Mortensen E, Mubarak K, Mueller B, Mühlemann K, Muñoz Bellido JL, Murray P, Muscillo M, Mylotte J, Naessens A, Nagy E, Nahm MH, Nassif X, Navarro D, Navarro F, Neofytos D, Nes I, Ní Eidhin D, Nicolle L, Niederman MS, Nigro G, Nimmo G, Nordmann P, Nougairède A, Novais A, Nygard K, Oliveira D, Orth D, Ortiz JR, Osherov N, Österblad M, Ostrosky-Zeichner L, Pagano L, Palamara AT, Pallares R, Panagopoulou P, Pandey P, Panepinto J, Pappas G, Parkins M, Parola P, Pasqualotto A, Pasteran F, Paul M, Pawlotsky JM, Peeters M, Peixe L, Pepin J, Peralta G, Pereyre S, Perfect JR, Petinaki E, Petric M, Pettigrew M, Pfaller M, Philipp M, Phillips G, Pichichero M, Pierangeli A, Pierard D, Pigrau C, Pilishvili T, Pinto F, Pistello M, Pitout J, Poirel L, Poli G, Poppert S, Posfay-Barbe K, Pothier P, Poxton I, Poyart C, Pozzetto B, Pujol M, Pulcini C, Punyadeera C, Ramirez M, Ranque S, Raoult D, Rasigade JP, Re MC, Reilly JS, Reinert R, Renaud B, Rice L, Rich S, Richet H, Rigouts L, Riva E, Rizzo C, Robotham J, Rodicio MR, Rodriguez J, Rodriguez-Bano J, Rogier C, Roilides E, Rolain JM, Rooijakkers S, Rooney P, Rossi F, Rotimi V, Rottman M, Roux V, Ruhe J, Russo G, Sadowy E, Sagel U, Said SI, Saijo M, Sak B, Sa-Leao R, Sanders EAM, Sanguinetti M, Sarrazin C, Savelkoul P, Scheifele D, Schmidt WP, Schønheyder H, Schönrich G, Schrenzel J, Schubert S, Schwarz K, Schwarz S, Sefton A, Segondy M, Seifert H, Seng P, Senneville E, Sexton D, Shafer RW, Shalit I, Shankar N, Shata TM, Shields J, Sibley C, Sicinschi L, Siljander T, Simitsopoulou M, Simoons-Smit AM, Sissoko D, Sjögren J, Skiada A, Skoczynska A, Skov R, Slack M, Sogaard M, Sola C, Soriano A, Sotto A, Sougakoff W, Sougakoff W, Souli M, Spelberg B, Spelman D, Spiliopoulou I, Springer B, Stefani S, Stein A, Steinbach WJ, Steinbakk M, Strakova L, Strenger V, Sturm P, Sullivan P, Sutton D, Symmons D, Tacconelli E, Tamalet C, Tang JW, Tang YW, Tattevin P, Thibault V, Thomsen RW, Thuny F, Tong S, Torres C, Townsend R, Tristan A, Trouillet JL, Tsai HC, Tsitsopoulos P, Tuerlinckx D, Tulkens P, Tumbarello M, Tureen J, Turnidge JD, Turriziani O, Tutuian R, Uçkay I, Upton M, Vabret A, Vamvakas EC, van den Boom D, Van Eldere J, van Leeuwen W, van Strijp J, Van Veen S, Vandamme P, Vandenesch F, Vayssier M, Velin D, Venditti M, Venter M, Venuti A, Vergnaud G, Verheij T, Verhofstede C, Viscoli C, Vizza CD, Vogel U, Waller A, Wang YF, Warn P, Warris A, Wauters G, Weidmann M, Weill FX, Weinberger M, Welch D, Wellinghausen N, Wheat J, Widmer A, Wild F, Willems R, Willinger B, Winstanley C, Witte W, Wolff M, Wong F, Wootton M, Wyllie D, Xu W, Yamamoto S, Yaron S, Yildirim I, Zaoutis T, Zazzi M, Zbinden R, Zehender GG, Zemlickova H, Zerbini ML, Zhang L, Zhang Y, Zhao YD, Zhu Z, Zimmerli W. ACKNOWLEDGEMENT OF REVIEWERS. Clin Microbiol Infect 2011. [DOI: 10.1111/j.1469-0691.2010.03428.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Calvert PA, Obaid DR, West NEJ, Shapiro LM, McNab D, Densem CG, Schofield PM, Braganza D, Clarke SC, O'Sullivan M, Ray KR, Bennett MR. 106 Which virtual histology intravascular ultrasound properties discriminate better between stable angina pectoris and troponin positive acute coronary syndrome: assessment of plaques or analysis of the whole coronary artery vasculature? Heart 2010. [DOI: 10.1136/hrt.2010.196089.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Calvert PA, Obaid DR, Malhotra A, West NEJ, Shapiro LM, McNab D, Densem CG, Schofield PM, Braganza D, Clarke SC, Ray KR, O'Sullivan M, Bennett MR. 107 Plaque composition and plaque volume in non-stented vessels determines serum biomarker levels after stenting in stable angina: a VH-IVUS study. Heart 2010. [DOI: 10.1136/hrt.2010.196089.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jefferies JMC, Tocheva AS, Rubery H, Bennett J, Garland J, Christodoulides M, Faust SN, Smith A, Mitchell TJ, Clarke SC. Identification of novel pneumolysin alleles from paediatric carriage isolates of Streptococcus pneumoniae. J Med Microbiol 2010; 59:808-814. [PMID: 20339017 DOI: 10.1099/jmm.0.018663-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pneumolysin (Ply) is a major virulence factor of Streptococcus pneumoniae and is produced by all known clinical isolates of pneumococci. Pneumolysin toxoids are being considered as vaccine candidates. We investigated the diversity of pneumolysin among 194 nasopharyngeal pneumococci characterized by serotyping and multilocus sequence typing (MLST). Eight Ply protein alleles were identified, four of which were novel. The 4 novel alleles varied at 10 different amino acid positions, from a total of 147, 3 of these substitutions have been previously reported in different combinations. The protein allele correlated closely with MLST. It is critical that the presence of pneumolysin variants is considered with regards to the potential use of Ply in future vaccine formulations, as variation in Ply amino acid sequence may influence the immunogenicity of vaccines based on the presence of an individual Ply allele.
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Affiliation(s)
- J M C Jefferies
- Health Protection Agency South East Regional Microbiology Laboratory, Southampton University Hospitals NHS Trust, Southampton SO16 6YD, UK.,Molecular Microbiology & Infection, Division of Infection, Inflammation and Immunity, University of Southampton School of Medicine, Southampton General Hospital, Southampton SO16 6YD, UK
| | - A S Tocheva
- Molecular Microbiology & Infection, Division of Infection, Inflammation and Immunity, University of Southampton School of Medicine, Southampton General Hospital, Southampton SO16 6YD, UK
| | - H Rubery
- Wellcome Trust Clinical Research Facility, University of Southampton, Southampton University Hospitals NHS Trust, Southampton SO16 6YD, UK
| | - J Bennett
- Wellcome Trust Clinical Research Facility, University of Southampton, Southampton University Hospitals NHS Trust, Southampton SO16 6YD, UK
| | - J Garland
- Wellcome Trust Clinical Research Facility, University of Southampton, Southampton University Hospitals NHS Trust, Southampton SO16 6YD, UK
| | - M Christodoulides
- Molecular Microbiology & Infection, Division of Infection, Inflammation and Immunity, University of Southampton School of Medicine, Southampton General Hospital, Southampton SO16 6YD, UK
| | - S N Faust
- Wellcome Trust Clinical Research Facility, University of Southampton, Southampton University Hospitals NHS Trust, Southampton SO16 6YD, UK.,Molecular Microbiology & Infection, Division of Infection, Inflammation and Immunity, University of Southampton School of Medicine, Southampton General Hospital, Southampton SO16 6YD, UK
| | - A Smith
- Infection Research Group, Glasgow Dental Hospital & School, Glasgow G2 3JZ, UK
| | - T J Mitchell
- Division of Infection & Immunity, Glasgow Biomedical Research Centre, University of Glasgow, Glasgow G12 8TA, UK
| | - S C Clarke
- Hampshire & Isle of Wight Health Protection Unit, Fusion 2, Parkway, Solent Business Park, Whiteley PO15 7AB, UK.,Molecular Microbiology & Infection, Division of Infection, Inflammation and Immunity, University of Southampton School of Medicine, Southampton General Hospital, Southampton SO16 6YD, UK
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Hoole SP, Khan SN, White PA, Heck PM, Kharbanda RK, Densem CG, Clarke SC, Shapiro LM, Schofield PM, O'Sullivan M, Dutka DP. Remote ischaemic pre-conditioning does not attenuate ischaemic left ventricular dysfunction in humans. Eur J Heart Fail 2009; 11:497-505. [DOI: 10.1093/eurjhf/hfp040] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [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)
- Stephen P. Hoole
- Department of Cardiovascular Medicine; Addenbrooke's Hospital; ACCI, Level 6, Box 110, Hills Road Cambridge CB23 3RE UK
- Department of Cardiology; Papworth Hospital; Papworth Everard Cambridge CB3 8RE UK
| | - Sadia N. Khan
- Department of Cardiovascular Medicine; Addenbrooke's Hospital; ACCI, Level 6, Box 110, Hills Road Cambridge CB23 3RE UK
- Department of Cardiology; Papworth Hospital; Papworth Everard Cambridge CB3 8RE UK
| | - Paul A. White
- Department of Cardiology; Papworth Hospital; Papworth Everard Cambridge CB3 8RE UK
- Department of Medical Physics and Clinical Engineering; Addenbrooke's Hospital; Hills Road Cambridge CB2 0QQ UK
| | - Patrick M. Heck
- Department of Cardiovascular Medicine; Addenbrooke's Hospital; ACCI, Level 6, Box 110, Hills Road Cambridge CB23 3RE UK
- Department of Cardiology; Papworth Hospital; Papworth Everard Cambridge CB3 8RE UK
| | - Rajesh K. Kharbanda
- Department of Cardiovascular Medicine; Addenbrooke's Hospital; ACCI, Level 6, Box 110, Hills Road Cambridge CB23 3RE UK
| | - Cameron G. Densem
- Department of Cardiology; Papworth Hospital; Papworth Everard Cambridge CB3 8RE UK
| | - Sarah C. Clarke
- Department of Cardiology; Papworth Hospital; Papworth Everard Cambridge CB3 8RE UK
| | - Leonard M. Shapiro
- Department of Cardiology; Papworth Hospital; Papworth Everard Cambridge CB3 8RE UK
| | - Peter M. Schofield
- Department of Cardiology; Papworth Hospital; Papworth Everard Cambridge CB3 8RE UK
| | - Michael O'Sullivan
- Department of Cardiology; Papworth Hospital; Papworth Everard Cambridge CB3 8RE UK
| | - David P. Dutka
- Department of Cardiovascular Medicine; Addenbrooke's Hospital; ACCI, Level 6, Box 110, Hills Road Cambridge CB23 3RE UK
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Hoole SP, Heck PM, Sharples L, Khan SN, Duehmke R, Densem CG, Clarke SC, Shapiro LM, Schofield PM, O'Sullivan M, Dutka DP. Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study: a prospective, randomized control trial. Circulation 2009; 119:820-7. [PMID: 19188504 DOI: 10.1161/circulationaha.108.809723] [Citation(s) in RCA: 338] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Myocyte necrosis as a result of elective percutaneous coronary intervention (PCI) occurs in approximately one third of cases and is associated with subsequent cardiovascular events. This study assessed the ability of remote ischemic preconditioning (IPC) to attenuate cardiac troponin I (cTnI) release after elective PCI. METHODS AND RESULTS Two hundred forty-two consecutive patients undergoing elective PCI with undetectable preprocedural cTnI were recruited. Subjects were randomized to receive remote IPC (induced by three 5-minute inflations of a blood pressure cuff to 200 mm Hg around the upper arm, followed by 5-minute intervals of reperfusion) or control (an uninflated cuff around the arm) before arrival in the catheter laboratory. The primary outcome was cTnI at 24 hours after PCI. Secondary outcomes included renal dysfunction and major adverse cardiac and cerebral event rate at 6 months. The median cTnI at 24 hours after PCI was lower in the remote IPC compared with the control group (0.06 versus 0.16 ng/mL; P=0.040). After remote IPC, cTnI was <0.04 ng/mL in 44 patients (42%) compared with 24 in the control group (24%; P=0.01). Subjects who received remote IPC experienced less chest discomfort (P=0.0006) and ECG ST-segment deviation (P=0.005) than control subjects. At 6 months, the major adverse cardiac and cerebral event rate was lower in the remote IPC group (4 versus 13 events; P=0.018). CONCLUSIONS Remote IPC reduces ischemic chest discomfort during PCI, attenuates procedure-related cTnI release, and appears to reduce subsequent cardiovascular events.
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Affiliation(s)
- Stephen P Hoole
- Department of Cardiology, Papworth Hospital, Papworth Everard, UK
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42
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Hoole SP, Heck PM, White PA, Khan SN, O'Sullivan M, Clarke SC, Dutka DP. Remote ischemic preconditioning stimulus does not reduce microvascular resistance or improve myocardial blood flow in patients undergoing elective percutaneous coronary intervention. Angiology 2008; 60:403-11. [PMID: 19106155 DOI: 10.1177/0003319708328921] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Remote ischemic preconditioning (RIPC) may limit myocardial infarction by improving microvascular function and maintaining myocardial blood flow. We hypothesized that a RIPC stimulus would reduce coronary microvascular resistance and improve coronary blood flow during elective percutaneous coronary intervention (PCI). METHOD We prospectively recruited 54 patients with multi-vessel disease (MVD = 32) or single vessel disease awaiting elective PCI. Patients with MVD had non-target vessel (NTV) index of micro-circulatory resistance (IMR) determined, before and after target vessel (TV) PCI (cardiac RIPC). The effect of arm RIPC on serial microvascular resistance (R(p)) was assessed in patients with single vessel disease. RESULTS TV balloon occlusion did not alter the NTV IMR: 16.5 (12.4) baseline vs. 17.6 (11.6) post cardiac RIPC, P = 0.65 or hyperaemic transit time. Arm RIPC did not alter R( p) in patients with single vessel disease: Rp, mmHg.cm(-1).s( -1): 3.5 (1.9) baseline vs. 4.1 (3.0) post arm RIPC, P = 0.19 and coronary flow velocity remained constant. CONCLUSION RIPC stimuli during elective PCI do not affect coronary microvascular resistance or coronary flow in humans.
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Affiliation(s)
- Stephen P Hoole
- Department of Cardiovascular Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, United Kingdom
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Bogaert D, Sluijter M, Toom NLD, Mitchell TJ, Goessens WHF, Clarke SC, de Groot R, Hermans PWM. Dynamics of pneumococcal colonization in healthy Dutch children. Microbiology (Reading) 2006; 152:377-385. [PMID: 16436426 DOI: 10.1099/mic.0.28394-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A recent study of pneumococcal colonization in 3198 healthy children of 1-19 years of age in The Netherlands showed pneumococcal colonization in 19 % of the children, with a peak incidence of 55 % at the age of 2 years; an age-related serotype distribution was also found. In the present study, the genetic background and resistance profiles of 578 pneumococcal isolates from the latter study were characterized by means of chromosomal genotyping and susceptibility testing. In contrast to the age-related serotype distribution observed previously, the genetic background of the strains was not age related. Few strains were found showing close homology (>95 %) with the international clones Spain(9V)-3 (ten isolates showed homology), England(14)-9 (four isolates), Tennessee(23F)-4 (two isolates), CSR(14)-10 (one isolate) and Sweden(15A)-25 (one isolate). In total, 19 % of strains showed resistance to one or more antibiotics. Resistance to cotrimoxazole, tetracycline, erythromycin and penicillin was found in 12.9, 5.6, 5.0 and 2.7 % of isolates, respectively. Multidrug resistance was found in 1.9 % of strains. In conclusion, pneumococcal colonization isolates from healthy Dutch children represent a heterogeneous, mostly antibiotic susceptible, genetic population.
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Affiliation(s)
- D Bogaert
- Department of Pediatrics, Erasmus MC-Sophia, Room Ee 1500, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands
| | - M Sluijter
- Department of Pediatrics, Erasmus MC-Sophia, Room Ee 1500, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands
| | - N Lemmens-den Toom
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - T J Mitchell
- Division of Infection and Immunity, Institute of Biomedical and Life Sciences, University of Glasgow, Glasgow, UK
| | - W H F Goessens
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - S C Clarke
- Scottish Meningococcus and Pneumococcus Reference Laboratory, Stobhill Hospital, Glasgow, UK
| | - R de Groot
- Department of Pediatrics, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - P W M Hermans
- Department of Pediatrics, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
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Kirschenlohr HL, Griffin JL, Clarke SC, Rhydwen R, Grace AA, Schofield PM, Brindle KM, Metcalfe JC. Proton NMR analysis of plasma is a weak predictor of coronary artery disease. Nat Med 2006; 12:705-10. [PMID: 16732278 DOI: 10.1038/nm1432] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Accepted: 12/14/2005] [Indexed: 11/09/2022]
Abstract
Multivariate analysis of 1H-NMR spectra of blood sera was reported previously to predict angiographically defined advanced coronary artery disease (CAD) with >90% accuracy and specificity. The analysis depended mainly on the major lipid regions of the spectra, but many variables, including gender and drug treatment, affect lipid composition and are potential confounders. We have determined the predictive power of the same methodology for angiographically defined CAD using plasma samples from groups of male patients, classified by statin treatment, who had normal coronary arteries (NCAs) or CAD. Predictions for NCA and CAD groups were only 80.3% correct for patients not treated with statins and 61.3% for treated patients, compared with random correct predictions of 50%. A confidence limit of >99% was achieved for 36.2% of predictions for untreated groups and 6.2% for treated groups. Detection of CAD by 1H-NMR with >99% confidence was therefore very weak compared with angiography.
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Affiliation(s)
- Heide L Kirschenlohr
- Department of Biochemistry, University of Cambridge, Building O, Downing Site, Tennis Court Road, Cambridge CB2 1QW, UK
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Smith AJ, Jefferies J, Clarke SC, Dowson C, Edwards GFS, Mitchell TJ. Distribution of epidemic antibiotic-resistant pneumococcal clones in Scottish pneumococcal isolates analysed by multilocus sequence typing. Microbiology (Reading) 2006; 152:361-365. [PMID: 16436424 DOI: 10.1099/mic.0.28419-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sequence types of pneumococci isolated in Scotland between 1996 and 2003 were compared with those of globally prevalent antibiotic-resistant clones. Multilocus sequence typing was performed on 252 invasive pneumococcal isolates referred to the Scottish Meningococcus and Pneumococcus Reference Laboratory. Isolates were not preselected for antimicrobial resistance, patient age or disease caused. Sequence types were compared with globally significant antimicrobial-resistant clones identified by the Pneumococcal Molecular Epidemiology Network (PMEN). Sequence types identical with three of the 26 PMEN clones were present in the Scottish collection; the clones were the Spain9V-3 clone (sequence type 156, seven isolates), the England14-9 clone (sequence type 9, eight isolates) and the Utah35B-24 clone (sequence type 377, one isolate). Many Scottish isolates related to PMEN clones had lower antimicrobial MICs than those described for the corresponding PMEN type strain. A number of single- (SLVs) and double-locus variants (DLVs) were present. Fifteen SLVs related to PMEN sequence types 37, 67, 90, 81, 156, 236 and 377 were detected. The collection contained 10 DLVs related to PMEN sequence types 37, 156, 173 and 338. The majority of SLVs and DLVs were penicillin- or erythromycin-sensitive variants of the resistant PMEN type strains. Capsule switching in isolates related to the PMEN clones was also detected. The highest levels of penicillin resistance were detected in sequence type 320 (serotype 19F), which is not a PMEN clone. These data suggest that PMEN clones are not widely distributed in disease-causing isolates in Scotland.
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Affiliation(s)
- A J Smith
- Infection Research Group, Level 9, Glasgow Dental Hospital, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
| | - J Jefferies
- Division of Infection and Immunity, Institute of Biomedical and Life Sciences, University of Glasgow, UK
| | - S C Clarke
- Scottish Meningococcus and Pneumococcus Reference Laboratory, Stobhill Hospital, Glasgow, UK
- Division of Infection and Immunity, Institute of Biomedical and Life Sciences, University of Glasgow, UK
| | - C Dowson
- Department of Biological Sciences, University of Warwick, UK
| | - G F S Edwards
- Scottish Meningococcus and Pneumococcus Reference Laboratory, Stobhill Hospital, Glasgow, UK
| | - T J Mitchell
- Division of Infection and Immunity, Institute of Biomedical and Life Sciences, University of Glasgow, UK
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Sullivan CB, Jefferies JMC, Diggle MA, Clarke SC. Automation of MLST Using Third-Generation Liquid-Handling Technology. Mol Biotechnol 2006; 32:219-26. [PMID: 16632888 DOI: 10.1385/mb:32:3:219] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 11/11/2022]
Abstract
The molecular characterization of bacterial pathogens of clinical significance is increasingly important. Methods, such as multilocus sequence typing (MLST), allow bacterial strains to be characterized during case clusters, for antibiotic-resistant strains to be monitored, and for the impact of new vaccines to be assessed. Our laboratory performs MLST on Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. We have developed high-throughput automated methods to allow MLST to be performed in a time scale useful in a clinical setting. Here we describe the automation of MLST on a third-generation liquid-handling robot.
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Affiliation(s)
- C B Sullivan
- Scottish Meningococcus and Pneumococcus Reference Laboratory, Glasgow, UK
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Mosedale DE, Smith DJ, Aitken S, Schofield PM, Clarke SC, McNab D, Goddard H, Gale CR, Martyn CN, Bethell HWL, Barnard C, Hayns S, Nugent C, Panicker A, Grainger DJ. Circulating levels of MCP-1 and eotaxin are not associated with presence of atherosclerosis or previous myocardial infarction. Atherosclerosis 2005; 183:268-74. [PMID: 15894320 DOI: 10.1016/j.atherosclerosis.2004.11.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Revised: 11/01/2004] [Accepted: 11/17/2004] [Indexed: 11/21/2022]
Abstract
The chemokines are a family of signalling proteins that participate in regulation of the immune system and have been implicated in the pathogenesis of vascular diseases. Deleting the gene encoding the chemokine MCP-1 in mouse models of atherosclerosis reduces lipid lesion formation and circulating chemokines are upregulated in man immediately following myocardial infarction (MI) or coronary angioplasty. We have therefore investigated whether circulating levels of two chemokines (MCP-1 and eotaxin) differ between subjects with and without atherosclerosis. We have used three different methods of measuring the presence and extent of atherosclerosis in human subjects: duplex ultrasonography of the carotid arteries and clinical diagnosis of coronary heart disease on individuals from the general population and coronary angiography on patients with suspected heart disease. There was no difference in the levels of circulating MCP-1 or eotaxin, measured by ELISA, between subjects with and without atherosclerosis. Furthermore, any increase in circulating MCP-1 following acute MI must be short-lived, since chemokine levels were not different in subjects who had had an MI previously compared to those who had not. We conclude that although there may be a transient increase in circulating chemokine levels following coronary angioplasty, there is no difference in the levels of circulating MCP-1 or eotaxin in subjects with and without atherosclerosis.
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Affiliation(s)
- David E Mosedale
- Department of Medicine, University of Cambridge, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
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Abstract
A serotype 1 disease-causing pneumococcus possessing a truncated xanthine phosphoribosyltransferase (xpt) housekeeping gene is described. The deletion is within the gene region used for multi-locus sequence typing (MLST) and may have occurred through genetic transformation or capsule switch between clones. The identification of this deletion in a clinical isolate therefore warrants highlighting due to potential errors that may ensue in isolate characterization and due to the fact that deletions may occur in other genes in this or other species characterized by MLST.
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Affiliation(s)
- M A Diggle
- Scottish Meningococcus and Pneumococcus Reference Laboratory, House on the Hill, Stobhill Hospital, Balornock Road, Glasgow G21 3UW, UK 2Division of Infection and Immunity, Institute of Biomedical and Life Sciences, Joseph Black Building, University of Glasgow, Glasgow G12 8QQ, UK
| | - S C Clarke
- Scottish Meningococcus and Pneumococcus Reference Laboratory, House on the Hill, Stobhill Hospital, Balornock Road, Glasgow G21 3UW, UK 2Division of Infection and Immunity, Institute of Biomedical and Life Sciences, Joseph Black Building, University of Glasgow, Glasgow G12 8QQ, UK
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Clarke SC, Reid JA, Thom L, Diggle MA, McChlery S, Scott K, Edwards GFS. Erythromycin resistance among invasive pneumococci in Scotland, 1994-2003. Br J Biomed Sci 2005; 62:28-30. [PMID: 15816209 DOI: 10.1080/09674845.2005.11732684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- S C Clarke
- Scottish Meningococcus and Pneumococcus Reference Laboratory, Glasgow, UK.
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McChlery SM, Scott KJ, Clarke SC. Clonal analysis of invasive pneumococcal isolates in Scotland and coverage of serotypes by the licensed conjugate polysaccharide pneumococcal vaccine: possible implications for UK vaccine policy. Eur J Clin Microbiol Infect Dis 2005; 24:262-7. [PMID: 15902532 DOI: 10.1007/s10096-005-1313-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 7-valent pneumococcal conjugate vaccine (PCV7) has gained licensure and has proven successful in the USA for preventing pneumococcal disease and reducing the incidence of antibiotic-resistant pneumococcal strains. The ability, therefore, to accurately monitor the likely effect of the introduction of PCV7 vaccine on invasive pneumococcal disease in the UK is essential. Serotyping and multilocus sequence typing was performed on invasive isolates of Streptococcus pneumoniae (n=645) from Scotland during 2003. The information gained from this was used to evaluate serotype coverage by the vaccine and the relationship between serotypes. In the present study, invasive pneumococcal disease in Scotland was caused by 33 different serotypes, consisting of 150 sequence types. Overall, 48.4% of the isolates were of serotypes included in the PCV7. Pneumococci were most frequently associated with sequence types 9, 124, and 162. PCV7 would provide protection in 71.8% of infants under 5 years of age against the serotypes in the vaccine. There was limited evidence of the potential for capsule switch among currently circulating invasive pneumococci. The successful implementation of a suitable vaccination programme should lead to a reduction in invasive pneumococcal disease in the UK as well as a reduction in antibiotic resistance of pneumococcal strains.
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Affiliation(s)
- S M McChlery
- Scottish Meningococcus and Pneumococcus Reference Laboratory, Glasgow, UK
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