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Rabbitt L, Curneen J, Hobbins A, Browne D, Joyce M, Lappin D, McEvoy JW, Gillespie P, Dennedy MC. A cost-analysis of managing secondary and apparent treatment-resistant hypertension in a specialist multidisciplinary hypertension clinic. J Hypertens 2024; 42:58-69. [PMID: 38009268 DOI: 10.1097/hjh.0000000000003535] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
OBJECTIVES A knowledge gap exists around the costs and budget impact of specialist hypertension clinics. This study reports on the cost of providing care in a multidisciplinary hypertension clinic staffed by nephrologist, endocrinologist and cardiologist, which manages patients with suspected secondary hypertension and/or apparent treatment-resistant hypertension. The aim of this study is to provide the evidence required to inform policy and planning care pathways for this patient group. METHODS A cost analysis from a healthcare provider perspective using micro-costing techniques was conducted to estimate the direct implementation costs of existing standard practice for the care pathway of patients attending the multidisciplinary hypertension clinic. Sixty-five patients originally recruited for a study of medication adherence in hypertension were included in the sample. RESULTS The total care-pathway cost per patient, taking into account clinic visits, clinical reviews, investigations and MDT discussion, was estimated to be €3277, on average. For the patient subgroups, the average cost was €5644 for patients diagnosed with primary aldosteronism and €1446 for patients diagnosed with essential hypertension. CONCLUSION There is significant cost associated with providing specialized hypertension care for patients with apparent treatment-resistant hypertension. Given the high rates of nonadherence in this population, it is likely that some of this cost could be avoided with better detection and management of medication adherence in this challenging population. Future studies should consider the cost-effectiveness of this or similar models of care by exploring the benefit to patients and the wider healthcare context of providing care of this type.
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Affiliation(s)
- Louise Rabbitt
- Discipline of Pharmacology and Therapeutics, School of Medicine, University of Galway
| | - James Curneen
- Department of Clinical Pharmacology and Therapeutics, St James' Hospital, Dublin
| | - Anna Hobbins
- Centre for Research in Medical Devices (CÚRAM, SFI 13/RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, Ireland
| | | | - Mary Joyce
- Centre for Endocrinology, Diabetes and Metabolism
| | - David Lappin
- Department of Nephrology, Saolta University Healthcare Group (SUHCG), Galway University Hospitals
| | - John William McEvoy
- Department of Cardiology, School of Medicine, University of Galway
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Paddy Gillespie
- Centre for Research in Medical Devices (CÚRAM, SFI 13/RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, Ireland
| | - Michael Conall Dennedy
- Discipline of Pharmacology and Therapeutics, School of Medicine, University of Galway
- Centre for Endocrinology, Diabetes and Metabolism
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2
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Gorey D, Lappin D, Murphy D, Reilly L, Mannion E, Kennedy G, Waldron D. MO126: A ‘Point Prevalence’ Pain Study over 2 Days in Three Dialysis Units in the West of IRELAND. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac066.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Point prevalence studies are observational studies, without intervention, and involve collecting data, in patients in multiple care units, at a specific time. It provides no information on outcomes but provides information on how common a problem is, and current management. This type of study can be an ongoing program consisting of multiple research collection days, each performing multiple, independent studies simultaneously. The point prevalence studies are purely observational, and no intervention is required by the study protocol.
The aim of the study is to understand prescribing patterns of analgesia to dialysis patients and incidence of pain among them.
METHOD
This project is a prospective, observational, multicentre, 2-day, point prevalence study of three chronic dialysis units on the prevalence of pain in all patients in receipt of dialysis. Data were gathered regarding analgesia prescribed to patients and whether patients reported pain to the haemodialysis (HD) staff.
RESULTS
A total of 164 patients were audited, with an average age of 67.8 years.
Approximately 19.5% of dialysis patients presenting reported pain. The average age of these patients was 70 years. The most common cause was MSK (34%) then cramps (31%), vascular access pain (16%), ‘other’ (13%) and vascular wounds (6%). Approximately 12.5% of those patients with pain were reviewed by a doctor.
Approximately 50% of the patients are prescribed analgesia. This varied amongst dialysis units with 52% and 26% of patients in the two public units prescribed analgesia and 70% of patients in the private unit. Types of analgesia prescribed to HD patients were paracetamol (75.46%), neuropathic agent (20.12%), codeine (6), tramadol (4), tapentadol (3), pure opioid (4), buphenorphine patch (3) and lidocaine patches (2).
CONCLUSION
This shows a significant impact of pain amongst dialysis patient presenting daily to dialysis units. A prospective research study is planned using a novel Pain App specifically developed for HD patients. This may be structured as a Cluster Clinical trial to compare and contrast outcomes in different centres.
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Affiliation(s)
- David Gorey
- Nephrology, University Hospital Galway, Galway, Ireland
| | - David Lappin
- Nephrology, University Hospital Galway, Galway, Ireland
| | - David Murphy
- Palliative Care, University Hospital Galway, Galway, Ireland
| | - Leona Reilly
- Palliative Care, University Hospital Galway, Galway, Ireland
| | - Eileen Mannion
- Palliative Care, University Hospital Galway, Galway, Ireland
| | - Grace Kennedy
- Palliative Care, University Hospital Galway, Galway, Ireland
| | - Dympna Waldron
- Palliative Care, University Hospital Galway, Galway, Ireland
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3
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Curneen JMG, Rabbitt L, Browne D, O'Donoghue DF, Alansari Y, Harhen B, Ghríofa AN, Ferguson J, McEvoy JW, Lappin D, Finn DP, O'Shea PM, Dennedy MC. Major disparities in patient-reported adherence compared to objective assessment of adherence using mass spectrometry: a prospective study in a tertiary-referral hypertension clinic. Br J Clin Pharmacol 2022. [PMID: 35199372 DOI: 10.1111/bcp.15292] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/02/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
AIM Many challenges exist in determining true rates of adherence to antihypertensive medications among individuals in a clinic setting. For the first time, we aimed to compare patient-reported antihypertensive adherence with objective evidence using mass spectrometry spot urinalysis in a tertiary referral clinic setting. METHODS A prospective observational single-centre cohort study was performed in a tertiary referral hypertension clinic, encompassing antihypertensive initiation and persistence. Patients were referred with apparent treatment-resistant hypertension or for suspected secondary causes. Participants completed a self-reported assessment of antihypertensive adherence and provided a spot urine sample. The presence of antihypertensive medications and/or their respective metabolites was evaluated using high performance liquid chromatography tandem mass spectrometry (LC-MS/MS). Patients were determined to be adherent if they demonstrated both self-reported adherence and objective mass spectrometry evidence. RESULTS Of all 105 eligible participants initially recruited, 73 (69.5%) met the eligibility criteria. Only 27.4% (95% CI 0.2-0.4) of participants demonstrated true adherence to their self-reported antihypertensives, despite 75.3% (0.6-0.8) reporting adherence. Greatest medication adherence was achieved with angiotensin II receptor blockers (ARBs) (61%), with calcium-channel blockers and mineralocorticoid antagonists demonstrating least adherence (38%). CONCLUSION In patients attending a tertiary hypertension clinic, the combined use of spot urine mass spectrometry and self-reporting identifies higher rates of non-adherence when compared to either modality alone. Both techniques should be combined for more accurate detection of medication adherence.
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Affiliation(s)
- James M G Curneen
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Louise Rabbitt
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Darragh Browne
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Darragh F O'Donoghue
- Department of Nephrology, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Yousef Alansari
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Brendan Harhen
- Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Ailbhe Ní Ghríofa
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - John Ferguson
- Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - John William McEvoy
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Cardiology, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - David Lappin
- Department of Nephrology, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland.,Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - David P Finn
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Paula M O'Shea
- Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Michael Conall Dennedy
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland
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4
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Sebastian KK, Alzayer H, Abraham E, Roche D, Reddan D, Lappin D. Cutaneous Absidia corymbifera in a Lupus Nephritis Patient. Cureus 2021; 13:e19512. [PMID: 34912648 PMCID: PMC8664401 DOI: 10.7759/cureus.19512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
A 28-year-old farmer with class IV lupus nephritis presented with a two-week history of a right shin lesion. The lesion was purple in color, fungating, and indurated with a focus of deep ulceration at the inferior pole and punctate, bleeding from its surface. Three months earlier, he was started on induction immunosuppression for a relapse of his lupus nephritis. Since the diagnosis of lupus nephritis, nine years previously, he had had six flares of his disease and had been treated at different time points with cyclophosphamide, rituximab, and high-dose corticosteroids, without adverse events. Laboratory investigations showed improving kidney function (chronic kidney disease [CKD] stage IV) with reducing proteinuria, on his current immunosuppressive regimen. The differential diagnosis for this lesion was calciphylaxis, pyoderma gangrenosum, vasculitic lesion, or an infection. Histology and microbiological analysis confirmed the presence of Absidia corymbifera. He was treated with a combination of isavuconazole, reduction of his immunosuppressive agents, excision of the lesion, and skin grafting.
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Affiliation(s)
| | - Husam Alzayer
- Department of Renal Medicine, Cork University Hospital, Cork, IRL
| | | | - Darren Roche
- Department of Dermatology, University Hospital Galway, Galway, IRL
| | - Donal Reddan
- Department of Nephrology, University Hospital Galway, Galway, IRL
| | - David Lappin
- Department of Nephrology, University Hospital Galway, Galway, IRL
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5
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AHMED A, O'Donoghue D, Satti Manshad M, Lappin D. SAT-373 PRIMARY MEMBRANOUS NEPHROPATHY MANAGEMENT WITH CALCINEURIN INHIBITORS AND ITS ASSOCIATED REMISSION AND LONG-TERM RELAPSE RATE: MEMBRANOUS G-COHORT STUDY. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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6
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Ahmed AR, Satti MM, Abdalla AE, Giblin L, Lappin D. The Prevalence and Management of Metabolic Acidosis of Chronic Kidney Disease. Ir Med J 2019; 112:1002. [PMID: 31651132] [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: 06/10/2023]
Abstract
Aim Emerging evidence supports initiating oral sodium bicarbonate (OSB) at a serum bicarbonate (HCO3) level of less than 22mmol/L. We look to identify the prevalence of metabolic acidosis of chronic kidney disease (MA-CKD) and its management with OSB at a regional university hospital. Methods Retrospective data was collected using the national electronic renal database (eMED) to identify chronic kidney disease (CKD) patients with MA-CKD over a one-year period. Results One-hundred and forty-four patients were identified with CKD, of which 131 (89%) were tested for HCO3. MA-CKD was present in 44 patients (34%), all had eGFR< 30ml/min/1.73m2, 7 (16%) were prescribed OSB, 7(16%) OSB was contraindicated, and 37 (84%) patients managed with dietary input only. Mean HCO3 level at initiation in OSB group was 18.3±1mmol/L compared to 19.4±1.4mmol/L in dietary input only group which was statistically significant (p<0.05). Conclusion A high burden of advanced CKD was found in the regional nephrology centre, with one third of patients demonstrating MA-CKD. Majority had dietary input only. Further awareness and consensus need to be established on the benefits of treating MA-CKD with OSB.
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Affiliation(s)
- A R Ahmed
- Nephrology Department, University Hospital Galway, Newcastle Road, Galway City H91YR1 Ireland
| | - M M Satti
- National University of Ireland Galway, Ireland
| | - A E Abdalla
- Nephrology Department, University Hospital Galway, Newcastle Road, Galway City H91YR1 Ireland
| | - L Giblin
- Nephrology Department, University Hospital Galway, Newcastle Road, Galway City H91YR1 Ireland
| | - D Lappin
- Nephrology Department, University Hospital Galway, Newcastle Road, Galway City H91YR1 Ireland
- National University of Ireland Galway, Ireland
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7
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Winter S, McDonagh G, Lappin D, Smith AJ. Assessing the efficacy and cost of detergents used in a primary care automated washer disinfector. Br Dent J 2019; 225:315-319. [PMID: 30141495 DOI: 10.1038/sj.bdj.2018.643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2018] [Indexed: 11/09/2022]
Abstract
Background Cleaning of re-usable medical devices is a critical control point in the decontamination cycle, although defined end-points of the process are controversial. Objective Investigate cleaning efficacy and cost of different detergent classes in an automated washer disinfector (AWD) designed for dental practice. Methods Loads comprised test soiled dental hand instruments in cassettes and extraction forceps. Residual protein assayed using the International standard method (ISO 15883-5:2005) 1% SDS elution with ortho-phthalaldehyde (OPA) or GBox technology (on instrument OPA analysis). Short (60 minutes) and long (97 minutes) AWD cycles were used with four different classes of detergents, tap water and reverse osmosis water. Results SDS elution analysis (N = 612 instruments) demonstrated four detergents with both wash cycles achieved equivalent cleanliness levels and below a threshold of 200 μg protein/instrument. GBox methodology (N = 575) using UK Department of Health threshold of 5 μg/instrument side demonstrated that tap water performed with the greatest efficacy for all types of instruments and cycle types. Conclusions Using International standard methodology, different detergent classes had equivalence in cleaning efficacy. Cheaper detergents used in this study performed with similar efficacy to more expensive solutions. Findings emphasise the importance of validating the detergent (type and concentration) for each AWD.
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Affiliation(s)
- S Winter
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ
| | - G McDonagh
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ
| | - D Lappin
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ
| | - A J Smith
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ
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8
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Rafey MF, Butt A, Coffey B, Reddington L, Devitt A, Lappin D, Finucane FM. Prolonged acidosis is a feature of SGLT2i-induced euglycaemic diabetic ketoacidosis. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190087. [PMID: 31600728 PMCID: PMC6765316 DOI: 10.1530/edm-19-0087] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022] Open
Abstract
SUMMARY We describe two cases of SGLT2i-induced euglycaemic diabetic ketoacidosis, which took longer than we anticipated to treat despite initiation of our DKA protocol. Both patients had an unequivocal diagnosis of type 2 diabetes, had poor glycaemic control with a history of metformin intolerance and presented with relatively vague symptoms post-operatively. Neither patient had stopped their SGLT2i pre-operatively, but ought to have by current treatment guidelines. LEARNING POINTS SGLT2i-induced EDKA is a more protracted and prolonged metabolic derangement and takes approximately twice as long to treat as hyperglycaemic ketoacidosis. Surgical patients ought to stop SGLT2i medications routinely pre-operatively and only resume them after they have made a full recovery from the operation. While the mechanistic basis for EDKA remains unclear, our observation of marked ketonuria in both patients suggests that impaired ketone excretion may not be the predominant metabolic lesion in every case. Measurement of insulin, C-Peptide, blood and urine ketones as well as glucagon and renal function at the time of initial presentation with EDKA may help to establish why this problem occurs in specific patients.
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Affiliation(s)
- Mohammed Faraz Rafey
- Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Arslan Butt
- Galway University Hospitals, Galway, Ireland
| | | | | | | | | | - Francis M Finucane
- Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
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9
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O'Shea PM, O'Donoghue D, Bashari W, Senanayake R, Joyce MB, Powlson AS, Browne D, O'Sullivan GJ, Cheow H, Mendichovszky I, Quill D, Lowery A, Lappin D, Gurnell M, Dennedy MC. 11 C-Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice. Clin Endocrinol (Oxf) 2019; 90:670-679. [PMID: 30721535 DOI: 10.1111/cen.13942] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/08/2019] [Accepted: 01/30/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To describe clinical practice experience of 11 C-Metomidate PET/CT as an adjunct to adrenal vein sampling (AVS) in the lateralization of aldosterone-producing adenomas (APA) in primary aldosteronism (PA). CONTEXT Accurate lateralization of APA in the setting of PA offers the potential for surgical cure and improved long-term cardiovascular outcomes. Challenges associated with AVS, the current gold standard lateralization modality, mean that only a small proportion of potentially eligible patients currently make it through to surgery. This has prompted consideration of alternative strategies for lateralization, including the application of novel molecular PET tracers such as 11 C-Metomidate. DESIGN Clinical Service Evaluation/Retrospective audit. PATIENTS Fifteen individuals with a confirmed diagnosis of PA, undergoing lateralization with 11 C-Metomidate PET/CT prior to final clinical decision on surgical vs medical management. MEASUREMENTS All patients underwent screening aldosterone renin ratio (ARR), followed by confirmatory testing with the seated saline infusion test, according to Endocrine Society Clinical Practice Guidelines. Adrenal glands were imaged using dedicated adrenal CT. 11 C-Metomidate PET/CT was undertaken due to equivocal or failed AVS. Management outcomes were assessed by longitudinal measurement of blood pressure, ARR, number of hypertensive medications following adrenalectomy or institution of medical therapy. RESULTS We describe the individual lateralization and clinical outcomes for 15 patients with PA. CONCLUSION 11 C-Metomidate PET/CT in conjunction with adrenal CT and AVS provided useful information which aided clinical decision-making for PA within a multidisciplinary hypertension clinic.
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Affiliation(s)
- Paula M O'Shea
- Department of Clinical Biochemistry, Galway University Hospital, Galway, Ireland
| | - Darragh O'Donoghue
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland, Galway, Ireland
| | - Waiel Bashari
- Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Russell Senanayake
- Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Mary B Joyce
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland, Galway, Ireland
| | - Andrew S Powlson
- Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Darragh Browne
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland, Galway, Ireland
| | | | - Heok Cheow
- Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge, UK
| | | | - Denis Quill
- Department of Surgery, Galway University Hospital, Galway, Ireland
| | - Aoife Lowery
- Department of Surgery, Galway University Hospital, Galway, Ireland
| | - David Lappin
- Department of Nephrology, Galway University Hospital, Galway, Ireland
| | - Mark Gurnell
- Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Michael C Dennedy
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland, Galway, Ireland
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10
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Rafi Ahmed A, Abdalla AE, Satti M, Qazi J, Lappin D. Hemodialysis Session Duration, Ultrafiltration Rate, Interdialytic Weight Gain and their Association with Albumin in Patients on Intermittent Hemodialysis in a Regional Dialysis Unit: A Cross-sectional Study. Cureus 2018; 10:e3794. [PMID: 30868008 PMCID: PMC6402734 DOI: 10.7759/cureus.3794] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim Several studies suggest that a low pre-dialysis serum albumin level (<40g/L) is associated with increased mortality in dialysis patients. The objective of this study was to assess if hemodialysis session duration (HSD), ultrafiltration rate (UFR) and interdialytic weight gain percentage (IDWG%) are associated with pre-dialysis serum albumin levels (markers of all-cause mortality), thus influencing mortality. Method This is a cross-sectional analytical study in which data were collected from a regional cohort of 59 prevalent chronic hemodialysis patients using a national electronic database (eMED). Continuous data were analyzed using a regression model to assess for an association between HSD, IDWG% and UFR with albumin levels. Results Fifty-six patients were included in the study. Multiple linear regression models demonstrated a cross-sectional association between longer HSD and higher serum albumin levels and a statistically significant positive correlation (r = 0.353; p < 0.05). No significant association of UFR (p = 0.169) and IDWG% (p = 0.549) with albumin was observed. Mean albumin was 38.07 ± 3.96 g/L in the HSD <240 min group compared to 40.50 ± 2.83g/L in the HSD ≥240 min group which was statistically significant (p < 0.05). Conclusion Longer HSD has a cross-sectional association with higher pre-dialysis serum albumin with patients having HSD ≥240 min demonstrating the highest levels of serum albumin. Our study suggests longer HSD may improve mortality in the dialysis population.
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11
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Padmanabhan N, Lappin D, Waller D. The European Certificate in Nephrology: what is involved and how to prepare. Nephrol Dial Transplant 2018; 34:5187421. [PMID: 30452720 DOI: 10.1093/ndt/gfy344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/08/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Neal Padmanabhan
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, UK
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12
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Shantier M, Martin WP, Singh R, McDermott P, Gallen R, Suleiman S, Reddan DN, Giblin L, Lappin D, O'Meara YM, Griffin MD. Increased Weight Gain During the Long Interdialytic Period Is Associated with Minor Effects on Blood Pressure Control in Clinically Stable In-Centre Haemodialysis Patients. Nephron Clin Pract 2018; 141:87-97. [PMID: 30415243 DOI: 10.1159/000494221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Three-day-a-week chronic haemodialysis (cHD) involves 1 long (72 h) and 2 short (48 h) inter-dialytic periods (IDPs). We aimed to determine whether BP control following the long IDP is inferior to the short IDPs. METHODS All pre- and post-dialysis BP and weight measurements over a 4-week period were retrospectively analyzed among 135 clinically stable cHD patients at 2 academic centres with comparisons between measurements recorded following short and long IDPs. Subsequently, 23 clinically stable cHD patients underwent 24-h ambulatory blood pressure monitoring (ABPM) during the final day/night cycle of the long IDP and 1 short IDP within the same week. RESULTS In combined and separate analyses of the 2 retrospective cohorts, pre-dialysis BP parameters were not different following long and short IDPs despite greater inter-dialytic weight gain (IDWG) during the long IDP. Subgroup analyses of the total cohort showed no evidence for inferior BP control during the long IDP among those with high %IDWG. In the ABPM study, nocturnal hypertension and loss of nocturnal dipping were frequent. Furthermore, daytime systolic blood pressure (SBP) and pulse pressure were modestly higher during the last day/night cycle of the long compared with short IDP. CONCLUSION In stable cHD patients, the greater IDWG that occurred during the long IDP was not associated with overtly inferior BP control as reflected in pre-dialysis BP measurements. However, modestly higher daytime SBP was evident towards the end of the long IDP by 24 h ABPM. Thus, while fluid gain has well-documented associations with hypertension and adverse cardiovascular outcomes, the excess IDWG that occurs during the long IDP exerts relatively minor effects on BP control in patients on well-established dialysis regimens that are better identified by ambulatory monitoring.
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Affiliation(s)
- Mohamed Shantier
- Nephrology Services, Saolta University Healthcare Group, Galway, Ireland.,School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - William P Martin
- Nephrology Services, Saolta University Healthcare Group, Galway, Ireland
| | - Rajneet Singh
- Nephrology Services, Saolta University Healthcare Group, Galway, Ireland
| | - Paul McDermott
- Nephrology Services, Saolta University Healthcare Group, Galway, Ireland
| | - Rory Gallen
- Department of Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sami Suleiman
- Nephrology Services, Saolta University Healthcare Group, Galway, Ireland
| | - Donal N Reddan
- Nephrology Services, Saolta University Healthcare Group, Galway, Ireland
| | - Louise Giblin
- Nephrology Services, Saolta University Healthcare Group, Galway, Ireland
| | - David Lappin
- Nephrology Services, Saolta University Healthcare Group, Galway, Ireland
| | - Yvonne M O'Meara
- Department of Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Matthew D Griffin
- Nephrology Services, Saolta University Healthcare Group, Galway, Ireland, .,School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland,
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Smith A, Winter S, Lappin D, Sherriff A, McIvor I, Philp P, Suttner N, Holmes S, Stewart A. Reducing the risk of iatrogenic Creutzfeldt–Jakob disease by improving the cleaning of neurosurgical instruments. J Hosp Infect 2018. [DOI: 10.1016/j.jhin.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Cannata-Andía JB, Weinstein T, Slotki I, Ferreira A, Zoccali C, Lappin D. The European Certificate in Nephrology: towards harmonization and excellence in training. Clin Kidney J 2018; 12:167-171. [PMID: 30976392 PMCID: PMC6452178 DOI: 10.1093/ckj/sfy106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Indexed: 01/21/2023] Open
Abstract
Nephrology is a young medical specialty that has evolved and expanded during the last 4 decades of the past century, becoming recognized as one of the most innovative and challenging medical specialties. The training of nephrology takes place mainly in public hospitals, and there are important variations in the duration and assessment of training among the European countries. The Union of European Medical Specialties (UEMS) Renal Section and the European Renal Association–European Dialysis and Transplant Association have been working jointly since 2010 to harmonize European nephrology training and more recently to establish the European Certificate in Nephrology (ECN). The first two editions of the ECN were held in early 2017 and 2018. In total, 122 candidates from 26 countries have sat for the exam, with a success rate of 59% (72/122). To date, Switzerland has adopted the exam as their national training assessment and we expect that other countries will join Switzerland in the near future. Fostering the development and importance of the ECN requires that member states work to increase the academic and professional profile of the ECN within their countries. The ECN should be considered a ‘quality mark’ and a sign of high achievement in nephrology training in Europe. If holding the ECN becomes advantageous for employment or improving scientific careers, the number of candidates will increase and the sustainability of the ECN will be guaranteed. A recent, positive development is the pre-agreement between the UEMS Renal Section, UK Renal Association and Royal Colleges of the UK to adopt a unique pan-European exam beginning in 2020. However, any decision to commence the pan-European exam will depend, in part, on strong candidate enrolment for the ECN 2019 edition. Thus support of the national societies is crucial for the sustainability and growth of a European exam, because of their capacities to influence strategic policies in hospitals, universities and medical associations, with a longer-term aim to increase the professional recognition of the European exam.
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Affiliation(s)
- Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), REDinREN-ISCIII, Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Talia Weinstein
- Department of Nephrology, Tel Aviv Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Itzchak Slotki
- Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anibal Ferreira
- Department of Nephrology, Hospital Curry Cabral and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carmine Zoccali
- National Research Council (Italy), Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension and Renal and Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy
| | - David Lappin
- Department of Nephrology, Galway University Hospital and National University of Ireland, Galway, Ireland
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Ahmed AR, Lappin D. Oral alkali therapy and the management of metabolic acidosis of chronic kidney disease: A narrative literature review. World J Nephrol 2018; 7:117-122. [PMID: 30324086 PMCID: PMC6181870 DOI: 10.5527/wjn.v7.i6.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/05/2018] [Accepted: 08/30/2018] [Indexed: 02/06/2023] Open
Abstract
Chronic metabolic acidosis is a common complication seen in advanced chronic kidney disease (CKD). There is currently no consensus on its management in the Republic of Ireland. Recent trials have suggested that appropriate active management of metabolic acidosis through oral alkali therapy and modified diet can have a deterring impact on CKD progression. The potential benefits of treatment include preservation of bone health and improvement in muscle function; however, present data is limited. This review highlights the current evidence, available primarily from randomised control trials (RCTs) over the last decade, in managing the metabolic acidosis of CKD and outlines ongoing RCTs that are promising. An economic perspective is also briefly discussed to support decision-making.
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Affiliation(s)
- Adeel Rafi Ahmed
- Department of Nephrology, University Hospital Galway, Galway H91YR1, Ireland
| | - David Lappin
- Department of Nephrology, University Hospital Galway, Galway H91YR1, Ireland
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Kanmaz B, Lappin D, Buduneli N. Effects of smoking on non-surgical periodontal therapy in generalized aggressive periodontitis. Tob Induc Dis 2018. [DOI: 10.18332/tid/94529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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George MJ, Marks DJB, Rezk T, Breckenridge R, Sofat R, Martin J, MacAllister R, Touyz RM, Staessen JA, Bursztyn M, Lappin D, Barigou M, Hingorani A. Resistant Hypertension: Trials and Tribulations. Hypertension 2018; 71:772-780. [PMID: 29610269 DOI: 10.1161/hypertensionaha.118.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc J George
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Daniel J B Marks
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Tamer Rezk
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Ross Breckenridge
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Reecha Sofat
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - John Martin
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Raymond MacAllister
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Rhian M Touyz
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Jan A Staessen
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Michael Bursztyn
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - David Lappin
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Mohammed Barigou
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Aroon Hingorani
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
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Kennedy C, Connaughton DM, Murray S, Ormond J, Butler A, Phelan E, Young J, Durack L, Flavin J, O'Grady M, O'Kelly P, Lavin P, Leavey S, Lappin D, Giblin L, Casserly L, Plant WD, Conlon PJ. Home haemodialysis in Ireland. QJM 2018; 111:225-229. [PMID: 29272506 DOI: 10.1093/qjmed/hcx249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Home haemodialysis (HHD) has the potential to impact positively on patient outcomes and health resource management. There has been rejuvenated international interest in HHD in recent years. AIM We aimed to review the activity and outcomes of the Irish HHD Programme since inception (2009-16). DESIGN Retrospective review. METHODS Patient data were collected using the national electronic Renal Patient database (eMEDRenal version 3.2.1) and individual centre records. All data were recorded in a coded fashion on a Microsoft Excel Spread-sheet and analysed with Stata SE software. RESULTS One hundred and one patients completed training and commenced HHD; a further fourty-five patients were assessed for HHD suitability but did not ultimately dialyse at home. Twenty patients switched to nocturnal HHD when this resource became available. The switch from conventional in-centre dialysis to HHD led to an increase in the mean weekly hours on haemodialysis (HD) and a reduction in medication burden for the majority of patients. The overall rate of arteriovenous fistula (AVF) as primary vascular access was 62%. Most HHD complications were related to access function or access-related infection. Over the 7-years, 29 HHD patients were transplanted and 9 patients died. No deaths resulted directly from a HHD complication or technical issue. CONCLUSIONS Patient and technique survival rates compared favourably to published international reports. However, we identified several aspects that require attention. A small number of patients were receiving inadequate dialysis and require targeted education. Ongoing efforts to increase AVF and self-needling rates in HD units must continue. Psychosocial support is critical during the transition between dialysis modalities.
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Affiliation(s)
- C Kennedy
- Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - D M Connaughton
- Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland
| | - S Murray
- Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland
| | - J Ormond
- Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland
| | - A Butler
- Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland
| | - E Phelan
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland
| | - J Young
- Department of Nephrology, Tallaght Hospital, Dublin, Ireland
| | - L Durack
- Department of Nephrology, University Hospital Galway, Galway, Ireland
| | - J Flavin
- Department of Nephrology, University Hospital Limerick, Limerick, Ireland
| | - M O'Grady
- Department of Nephrology, University Hospital Waterford, Waterford, Ireland
| | - P O'Kelly
- Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland
| | - P Lavin
- Department of Nephrology, Tallaght Hospital, Dublin, Ireland
| | - S Leavey
- Department of Nephrology, University Hospital Waterford, Waterford, Ireland
| | - D Lappin
- Department of Nephrology, University Hospital Galway, Galway, Ireland
| | - L Giblin
- Department of Nephrology, University Hospital Galway, Galway, Ireland
| | - L Casserly
- Department of Nephrology, University Hospital Limerick, Limerick, Ireland
| | - W D Plant
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland
- Health Service Executive Clinical Strategy and Programmes Division, National Renal Office, Ireland
| | - P J Conlon
- Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
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Winter S, Smith A, Lappin D, McDonagh G, Kirk B. Investigating steam penetration using thermometric methods in dental handpieces with narrow internal lumens during sterilizing processes with non-vacuum or vacuum processes. J Hosp Infect 2017; 97:338-342. [DOI: 10.1016/j.jhin.2017.07.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/27/2017] [Indexed: 02/06/2023]
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Winter S, Smith A, Lappin D, McDonagh G, Kirk B. Failure of non-vacuum steam sterilization processes for dental handpieces. J Hosp Infect 2017; 97:343-347. [PMID: 28903057 DOI: 10.1016/j.jhin.2017.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/06/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Dental handpieces are used in critical and semi-critical operative interventions. Although some dental professional bodies recommend that dental handpieces are sterilized between patient use there is a lack of clarity and understanding of the effectiveness of different steam sterilization processes. The internal mechanisms of dental handpieces contain narrow lumens (0.8-2.3 mm) which can impede the removal of air and ingress of saturated steam required to achieve sterilization conditions. AIM To identify the extent of sterilization failure in dental handpieces using a non-vacuum process. METHODS In-vitro and in-vivo investigations were conducted on widely used UK bench-top steam sterilizers and three different types of dental handpieces. The sterilization process was monitored inside the lumens of dental handpieces using thermometric (TM; dataloggers), chemical indicator (CI), and biological indicator (BI) methods. FINDINGS All three methods of assessing achievement of sterility within dental handpieces that had been exposed to non-vacuum sterilization conditions demonstrated a significant number of failures [CI: 8/3024 (fails/no. of tests); BI: 15/3024; TM: 56/56] compared to vacuum sterilization conditions (CI: 2/1944; BI: 0/1944; TM: 0/36). The dental handpiece most likely to fail sterilization in the non-vacuum process was the surgical handpiece. Non-vacuum sterilizers located in general dental practice had a higher rate of sterilization failure (CI: 25/1620; BI: 32/1620; TM: 56/56) with no failures in vacuum process. CONCLUSION Non-vacuum downward/gravity displacement, type N steam sterilizers are an unreliable method for sterilization of dental handpieces in general dental practice. The handpiece most likely to fail sterilization is the type most frequently used for surgical interventions.
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Affiliation(s)
- S Winter
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
| | - A Smith
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK.
| | - D Lappin
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
| | - G McDonagh
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
| | - B Kirk
- 3M Health Care, Loughborough, UK
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21
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McNicholas BA, Griffin TP, Donnellan S, Ryan L, Garrahy A, Coughlan R, Giblin L, Lappin D, Reddan D, Carey JJ, Griffin MD. ANCA-associated vasculitis: a comparison of cases presenting to nephrology and rheumatology services. QJM 2016; 109:803-809. [PMID: 27318367 DOI: 10.1093/qjmed/hcw100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 05/19/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis (AAV) is a disease characterized by inflammation of small vessels and detectable ANCA in the circulation. Patients may develop a broad spectrum of clinical features ranging from indolent sino-nasal disease and rashes to fulminant renal failure or acute life-threatening pulmonary haemorrhage. Consequently, patients with AAV present to a variety of specialties including nephrology and rheumatology, whose training and approaches to management of such patients may differ. There is little literature comparing patients presenting to different specialties and their outcomes. METHODS We compared two cohorts of patients with ANCA-positive AAV presenting to either the rheumatology or nephrology department at Galway University Hospitals from June 2002 to July 2011. A standardized data collection form was used to collect information regarding baseline demographics, manifestations of AAV, initial management, relapses and complications. RESULTS Forty-five patients were included in this study (15 rheumatology/30 nephrology). The nephrology cohort was older, had a higher C-reactive protein, Birmingham Vascular Activity Score and ANCA titer at presentation compared to the rheumatology group. Induction treatment varied between the cohorts with rheumatology patients most commonly receiving a combination of oral corticosteroids (73%) and methotrexate (60%) and nephrology patients receiving a combination of intravenous corticosteroids (93%) and cyclophosphamide (90%). Fifty-three percent of the rheumatology patients who completed induction therapy relapsed compared to 30% of the nephrology patients. CONCLUSION This study presents two different cohorts of patients with the same disease that were managed by two different disciplines. It highlights the heterogeneity of AAV and the importance of interdisciplinary communication and cooperation when managing these patients.
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Affiliation(s)
- B A McNicholas
- From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - T P Griffin
- From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
- Rheumatology Department, Galway University Hospitals, Saolta University Health Group, Galway, Ireland
| | - S Donnellan
- From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland
| | - L Ryan
- From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland
| | - A Garrahy
- From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland
| | - R Coughlan
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
- Rheumatology Department, Galway University Hospitals, Saolta University Health Group, Galway, Ireland
| | - L Giblin
- From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - D Lappin
- From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - D Reddan
- From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - J J Carey
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
- Rheumatology Department, Galway University Hospitals, Saolta University Health Group, Galway, Ireland
| | - M D Griffin
- From the Nephrology Department , Galway University Hospitals, Saolta University Health Group, Galway, Ireland
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
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Cummings J, Aisen P, Barton R, Bork J, Doody R, Dwyer J, Egan JC, Feldman H, Lappin D, Truyen L, Salloway S, Sperling R, Vradenburg G. Re-Engineering Alzheimer Clinical Trials: Global Alzheimer's Platform Network. J Prev Alzheimers Dis 2016; 3:114-120. [PMID: 28459045 PMCID: PMC5408881 DOI: 10.14283/jpad.2016.93] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Alzheimer's disease (AD) drug development is costly, time-consuming, and inefficient. Trial site functions, trial design, and patient recruitment for trials all require improvement. The Global Alzheimer Platform (GAP) was initiated in response to these challenges. Four GAP work streams evolved in the US to address different trial challenges: 1) registry-to-cohort web-based recruitment; 2) clinical trial site activation and site network construction (GAP-NET); 3) adaptive proof-of-concept clinical trial design; and 4) finance and fund raising. GAP-NET proposes to establish a standardized network of continuously funded trial sites that are highly qualified to perform trials (with established clinical, biomarker, imaging capability; certified raters; sophisticated management system. GAP-NET will conduct trials for academic and biopharma industry partners using standardized instrument versions and administration. Collaboration with the Innovative Medicines Initiative (IMI) European Prevention of Alzheimer's Disease (EPAD) program, the Canadian Consortium on Neurodegeneration in Aging (CCNA) and other similar international initiatives will allow conduct of global trials. GAP-NET aims to increase trial efficiency and quality, decrease trial redundancy, accelerate cohort development and trial recruitment, and decrease trial costs. The value proposition for sites includes stable funding and uniform training and trial execution; the value to trial sponsors is decreased trial costs, reduced time to execute trials, and enhanced data quality. The value for patients and society is the more rapid availability of new treatments for AD.
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Affiliation(s)
- J Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - P Aisen
- University of Southern California, Los Angeles, CA, USA
| | - R Barton
- Eli Lilly, Indianapolis, IN, USA
| | - J Bork
- Pintail Solutions, Indianapolis, IN, USA
| | - R Doody
- Baylor College of Medicine, Alzheimer's Disease and Memory Disorder Center, Baylor, TX, USA
| | - J Dwyer
- Global Alzheimer's Platform Foundation, USA
| | - J C Egan
- Eli Lilly, Indianapolis, IN, USA
| | - H Feldman
- University of British Columbia, Vancouver, BC, USA
| | - D Lappin
- FaegreBD Consulting, Washington, DC, USA
| | - L Truyen
- Johnson & Johnson, New Brunswick, NJ, USA
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Gleeson PJ, Wilson V, Cox TE, Sharma SD, Smith-Jackson K, Strain L, Lappin D, McHale T, Kavanagh D, Goodship THJ. Chromosomal rearrangement-A rare cause of complement factor I associated atypical haemolytic uraemic syndrome. Immunobiology 2016; 221:1124-30. [PMID: 27268256 DOI: 10.1016/j.imbio.2016.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 02/24/2016] [Revised: 03/30/2016] [Accepted: 05/08/2016] [Indexed: 10/21/2022]
Abstract
Chromosomal rearrangements affecting the genes encoding complement factor H and the factor H related proteins have been described in aHUS patients. To date such disorders have not been described in other aHUS associated genes. We describe here a heterozygous 875,324bp deletion encompassing the gene (CFI) encoding complement factor I and ten other genes. The index case presented with aHUS and did not recover renal function. No abnormalities were detected on Sanger sequencing of CFI but a low factor I level led to a multiplex ligation-dependent probe amplification assay being undertaken. This showed a complete heterozygous deletion of CFI. The extent of the deletion and the breakpoint was defined. In the Newcastle aHUS cohort we have identified and report here 32 different CFI variants in 56 patients but to date this is the only deletion that we have identified. This finding although rare does suggest that screening for chromosomal rearrangements affecting CFI should be undertaken in all aHUS patients particularly if the factor I level is unexplainably low.
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Affiliation(s)
- Patrick J Gleeson
- Departments of Nephrology and Histopathology, University Hospital Galway, Galway, Ireland
| | - Valerie Wilson
- Northern Molecular Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas E Cox
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Seema D Sharma
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Kate Smith-Jackson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa Strain
- Northern Molecular Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Lappin
- Departments of Nephrology and Histopathology, University Hospital Galway, Galway, Ireland
| | - Teresa McHale
- Departments of Nephrology and Histopathology, University Hospital Galway, Galway, Ireland
| | - David Kavanagh
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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Abstract
An otherwise healthy young man was transferred to our hospital after a diving incident. He had made an uncontrolled ascent from 10 m. On arrival he appeared well. No hypotensive episodes occurred during the transfer. He denied having arthralgias, back pain, dyspnoea or neurological symptoms. Laboratory investigations revealed acutely elevated creatinine (170 µmol/L) and creatine kinase (909 U/L). Radiology was consistent with a focus of pulmonary barotrauma and intrinsic renal disease. Creatine kinase is a marker of arterial gas embolism (AGE). We determined that our patient suffered acute kidney injury as a result of gas embolisation to his renal vasculature from an area of pulmonary barotrauma. Creatinine fell the following day in response to aggressive intravenous fluids. This is the first reported case of acute kidney injury secondary to AGE. Biochemical studies should be part of the routine assessment of patients involved in diving incidents.
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Affiliation(s)
| | - Yvelynne Kelly
- Department of Nephrology, University College Hospital, Galway, Ireland
| | | | - David Lappin
- Department of Nephrology, University College Hospital, Galway, Ireland
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Archimandriti D, Somarakis G, Markatseli T, Migkos M, Lappin D, Voulgari P, Drosos A. AB0123 Antibodies to Porphyromonas Gingivalis in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Alfotawei R, Naudi KB, Lappin D, Barbenel J, Di Silvio L, Hunter K, McMahon J, Ayoub A. The use of TriCalcium Phosphate (TCP) and stem cells for the regeneration of osteoperiosteal critical-size mandibular bony defects, an in vitro and preclinical study. J Craniomaxillofac Surg 2014; 42:863-9. [PMID: 24485270 DOI: 10.1016/j.jcms.2013.12.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 10/02/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022] Open
Abstract
The investigation aims to assess the reconstruction of critical-size mandibular bone defects in rabbits using beta-Tricalcium Phosphate (β-TCP) scaffolding loaded with stem cells. A 20 mm-long mandibular osteoperiosteal continuity defect was created in 8 New Zealand rabbits and filled with β-TCP scaffolding. In 6 cases bone marrow stem cells (BMSCs) harvested, and enriched, from the posterior iliac crest of the same rabbit were seeded into the scaffolding, while a scaffold was used alone in two cases chosen at random. Radiographic analysis was carried out immediately following surgery and 4, 8 and 12 weeks postoperatively. Cone Beam CT (CBCT) scanning, biomechanical testing and histology assessments were carried out on the explanted mandibles three months postoperatively. The radiography showed minimal new bone formation in all the cases, with significant amounts of undegraded scaffold material visible. Sporadic areas of bone formation were seen, these did not bridge the gap of the created surgical defect. The mechanical properties of the regenerated bone were of an inferior quality when compared with that of the contralateral non-operated side. The addition of BMSCs to the biodegradable β-TCP scaffold did not improve reconstruction of the created mandibular defect. Despite successful aspiration and culture of BMSCs, the survival of these cells in vivo was questionable.
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Affiliation(s)
- Randa Alfotawei
- Biotechnology and Craniofacial Sciences (BACS) Research Group, Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Kurt Busuttil Naudi
- Biotechnology and Craniofacial Sciences (BACS) Research Group, Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom.
| | - David Lappin
- Biotechnology and Craniofacial Sciences (BACS) Research Group, Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Joseph Barbenel
- Biotechnology and Craniofacial Sciences (BACS) Research Group, Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Lucy Di Silvio
- Biotechnology and Craniofacial Sciences (BACS) Research Group, Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Keith Hunter
- Biotechnology and Craniofacial Sciences (BACS) Research Group, Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Jeremy McMahon
- Biotechnology and Craniofacial Sciences (BACS) Research Group, Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Ashraf Ayoub
- Biotechnology and Craniofacial Sciences (BACS) Research Group, Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
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Gümüş P, Buduneli E, Bıyıkoğlu B, Aksu K, Saraç F, Nile C, Lappin D, Buduneli N. Gingival crevicular fluid, serum levels of receptor activator of nuclear factor-κB ligand, osteoprotegerin, and interleukin-17 in patients with rheumatoid arthritis and osteoporosis and with periodontal disease. J Periodontol 2013; 84:1627-37. [PMID: 23327689 DOI: 10.1902/jop.2013.120595] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study is performed to evaluate gingival crevicular fluid (GCF) and serum levels of soluble receptor activator of nuclear factor-κB ligand (sRANKL), interleukin (IL)-17A, IL-17E, IL-17F, IL-17A/F, and osteoprotegerin (OPG) in women with rheumatoid arthritis (RA), osteoporosis (OPR), and those who are systemically healthy (SH), all with periodontal disease. METHODS GCF and serum samples were obtained before any periodontal intervention from 17 women with RA, 19 with OPR, and 13 who were SH with periodontitis. Full-mouth clinical periodontal measurements were recorded. sRANKL, OPG, and IL-17 levels were determined by enzyme-linked immunosorbent assay. RESULTS Clinical periodontal measurements were similar in the three study groups. Although the total amounts of GCF albumin, OPG, IL-17A, and IL-17A/F were similar in the study groups, there were statistically significant differences in GCF concentrations of sRANKL, OPG, IL-17A, IL-17E, IL-17F, and IL-17A/F. The sRANKL/OPG ratios were significantly higher in the RA group than in the OPR and SH groups (P <0.05). Serum sRANKL, sRANKL/OPG, and IL-17A/IL-17E ratios were significantly higher, whereas OPG concentrations were significantly lower in the RA group compared to other groups (P <0.05). Serum IL-17A concentrations were significantly higher in the RA and OPR groups than in the SH group (P <0.05). CONCLUSION Increased inflammatory mediator levels in patients with RA, despite the long-term use of various anti-inflammatory drugs, suggest that these patients may have a propensity to overproduce these inflammatory mediators.
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Affiliation(s)
- Pınar Gümüş
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
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Wilkinson C, Lappin D, Vellinga A, Heneghan HM, O’Hara R, Monaghan J. Spot urinary protein analysis for excluding significant proteinuria in pregnancy. J OBSTET GYNAECOL 2012; 33:24-7. [DOI: 10.3109/01443615.2012.711388] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Busuttil Naudi K, Ayoub A, McMahon J, Di Silvio L, Lappin D, Hunter KD, Barbenel J. Mandibular reconstruction in the rabbit using beta-tricalcium phosphate (β-TCP) scaffolding and recombinant bone morphogenetic protein 7 (rhBMP-7) - histological, radiographic and mechanical evaluations. J Craniomaxillofac Surg 2012; 40:e461-9. [PMID: 22507295 DOI: 10.1016/j.jcms.2012.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 11/18/2022] Open
Abstract
This investigation assesses the histological, radiographic and mechanical properties of regenerated bone in a unilateral critical-size osteoperiosteal mandibular continuity defect in the rabbit model, following the application of beta-tricalcium phosphate (β-TCP) scaffolding and recombinant human bone morphogenetic protein 7 (rhBMP-7). The study was carried out on nine cases; in six cases the critical-size defect was filled with rhBMP-7 in the β-TCP scaffolding, and in three cases the β-TCP was used alone. The cases were sacrificed 3 months post-operatively. Histologically the overall mean of the percentage of regenerated bone volume in the cases that received rhBMP-7 was 29.41% ± 6.25%, which was considerably greater than the 6.35% ± 3.08% in the cases treated with β-TCP alone. Mechanical testing of the cases treated with rhBMP-7 gave failure moments (55 mNm-2.040 Nm) that were consistently greater than those treated with β-TCP alone (0 mNm-48 mNm). In some cases the mechanical properties of the regenerated bone were comparable to those of untreated bone. RhBMP-7 in prefabricated β-TCP scaffolding appeared, radiographically and histologically, to be an effective method for bone regeneration in mandibular critical-size defects in the rabbit model. This points towards possible future clinical applications.
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Affiliation(s)
- Kurt Busuttil Naudi
- Biotechnology & Craniofacial Sciences Research Group, Glasgow Dental Hospital, UK.
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McCulloch E, Ramage G, Rajendran R, Lappin D, Jones B, Warn P, Kirkpatrick W, Patterson T, Williams C. The effect of antifungal treatments on laboratory diagnostic assays for invasive fungal infections. J Infect 2011. [DOI: 10.1016/j.jinf.2011.04.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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31
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Guy C, McCulloch E, Bicknell S, Macgregor G, Ramage G, Lappin D, Williams C. 148 The influence of moulds as an independent risk factor for decreasing lung function in cystic fibrosis. J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Naudi KB, Ayoub A, McMahon J, Lappin D, Di Silvio L. Bone regeneration in a critical-size mandibular defect using bone morphogenetic protein 7 on tricalcium phosphate scaffolding. Int J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.ijom.2009.03.460] [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: 11/27/2022]
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33
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Erridge C, Burdess A, Jackson AJ, Murray C, Riggio M, Lappin D, Milligan S, Spickett CM, Webb DJ. Vascular cell responsiveness to Toll-like receptor ligands in carotid atheroma. Eur J Clin Invest 2008; 38:713-20. [PMID: 18837796 DOI: 10.1111/j.1365-2362.2008.02010.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [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: 11/29/2022]
Abstract
BACKGROUND Atherosclerosis is potentiated by stimulation of Toll-like receptors (TLRs), which serve to detect pathogen associated molecular patterns (PAMPs). However little is known of which PAMPs may be present in atheroma, or capable of stimulating inflammatory signalling in vascular cells. MATERIALS AND METHODS DNA extracted from human carotid atheroma samples was amplified and sequenced using broad-range 16S gene specific primers to establish historical exposure to bacterial PAMPs. Responsiveness of primary human arterial and venous endothelial and smooth muscle cells to PAMPs specific for each of the TLRs was assessed by measurement of interleukin-8 secretion and E-selectin expression. RESULTS Extracts of atheromatous tissue stimulated little or no signalling in TLR-transfected HEK-293 cells. However, sequencing of bacterial DNA amplified from carotid atheroma revealed the presence of DNA from 17 different bacterial genera, suggesting historical exposure to bacterial lipopeptide, lipopolysaccharide and flagellin. All cells examined were responsive to the ligands of TLR3 and TLR4, poly inosine:cytosine and lipopolysaccharide. Arterial cells were responsive to a wider range of PAMPs than venous cells, being additionally responsive to bacterial flagellin and unmethylated cytosine-phosphate-guanosine DNA motifs, the ligands of TLR5 and TLR9, respectively. Cells were generally unresponsive towards the ligands of human TLR7 and TLR8, loxoribine and single stranded RNA. Only coronary artery endothelial cells expressed TLR2 mRNA and responded to the TLR2 ligand Pam(3)CSK(4). CONCLUSIONS Vascular cells are responsive to a relatively diverse range of TLR ligands and may be exposed, at least transiently, to ligands of TLR2, TLR4, TLR5 and TLR9 during the development of carotid atheroma.
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Affiliation(s)
- C Erridge
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK.
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Buduneli N, Buduneli E, Cinar S, Lappin D, Kinane DF. Immunohistochemical Evaluation of Ki-67 Expression and Apoptosis in Cyclosporin A-Induced Gingival Overgrowth. J Periodontol 2007; 78:282-9. [PMID: 17274717 DOI: 10.1902/jop.2007.060051] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study was planned to evaluate cell division rate and apoptosis by immunohistochemical and in situ hybridization techniques in cyclosporin A (CsA)-induced gingival overgrowth tissue samples to determine whether these processes played a role in the pathogenesis of this condition. METHODS Fourteen CsA-induced overgrowth tissues from renal transplant recipients, 10 control tissues from patients with plaque-induced gingivitis, and 14 control tissues from systemically and periodontally healthy subjects were evaluated. In patient groups, clinical periodontal recordings and tissue sampling were performed before initiation of any periodontal intervention. Numbers of Ki-67-positive cells/field and apoptotic cells/field in formalin-fixed/paraffin-embedded tissue sections were determined. Data were evaluated by one-way analysis of variance, post hoc Sidak test with modified Bonferroni correction, and Pearson correlation analysis. Three phenytoin- and five nifedipine-induced overgrowth tissues were also processed in the same way, and findings in these tissue specimens were evaluated as case series. RESULTS The number of keratinocytes was significantly greater in the CsA-induced gingival overgrowth group than in the healthy control group (P <0.05). Cells labeled by in situ end labeling, namely the apoptotic cells, were significantly fewer in the CsA group than in the gingivitis and healthy control groups (P <0.01). Overall, statistically significant positive correlations were found between the numbers of Ki-67-positive cells and probing depth and hyperplastic, bleeding, and plaque indices (P <0.01). Phenytoin and nifedipine samples exhibited obviously higher expression of Ki-67-positive cells than the CsA, gingivitis, and healthy control groups. CONCLUSION Our findings suggest that decreased apoptosis may have a more prominent role than increased cell division in the pathogenesis of CsA-induced gingival overgrowth.
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Affiliation(s)
- Nurcan Buduneli
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey.
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35
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Vardar-Sengül S, Buduneli N, Buduneli E, Kardeşler L, Baylas H, Atilla G, Lappin D, Kinane DF. Dietary supplementation of omega-3 fatty acid and circulating levels of interleukin-1beta, osteocalcin, and C-reactive protein in rats. J Periodontol 2006; 77:814-20. [PMID: 16671873 DOI: 10.1902/jop.2006.050214] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In this study, we evaluated the effects of two different regimes of dietary supplementation of omega-3 fatty acid on serum levels of interleukin-1 beta (IL-1beta), osteocalcin (OC), and C-reactive protein (CRP) in experimental periodontitis. METHODS Experimental periodontitis was induced by repeated injections of Escherichia coli lipopolysaccharide (LPS). Thirty-nine adult male Sprague-Dawley rats were divided into four study groups as follows: an LPS positive control group; a saline (negative) control group; and two different groups with omega-3 fatty acid dietary supplementation, one in which we gave the supplement subsequent to disease induction (TO3) and the other in which the agent was started prior to and continued subsequent to LPS injections (P + TO3). In the TO3 group, omega-3 fatty acid administration was performed for 14 days following induction of experimental periodontitis. In the P + TO3 group, omega-3 fatty acid was given for 14 days prior to the start of LPS injections and was continued for another 14 days subsequent to the induction of experimental periodontitis. On day 15 of the first LPS injection, serum samples were obtained and rats were sacrificed. Serum samples were analyzed for IL-1beta, OC, and CRP concentrations by enzyme-linked immunosorbent assay. Defleshed jaws were analyzed morphometrically for alveolar bone loss. Data were evaluated statistically by non-parametric tests. RESULTS LPS injection resulted in statistically significantly more bone loss compared to the saline control group (P <0.05). None of the omega-3 fatty acid administration groups showed evidence that this fatty acid was effective in preventing LPS-induced alveolar bone loss. TO3 and P + TO3 groups revealed significantly higher IL-1beta and OC levels than the LPS group (P <0.05). The study groups exhibited no significant differences in the serum CRP levels. CONCLUSIONS Omega-3 fatty acid administration does not seem to influence circulating levels of CRP. The significantly increased serum OC level observed in both omega-3 fatty acid regimes is curious and could have an effect on bone turnover, as could the further significant increase in serum IL-1beta, which could counteract any osteoblastic induction by OC through promotion of osteoclast activity. The lack of a therapeutic benefit of omega-3 fatty acid in this study, despite the effects on OC and IL-1beta, is difficult to explain, and further studies are required to more fully assess the potential role of this fatty acid in periodontal treatment.
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Affiliation(s)
- Saynur Vardar-Sengül
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey
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Vardar-Sengül S, Buduneli N, Buduneli E, Baylas H, Atilla G, Lappin D, Kinane DF. Effects of selective cyclooxygenase-2 inhibitor and omega-3 fatty acid on serum interleukin-1beta, osteocalcin, and C-reactive protein levels in rats. J Periodontol 2006; 77:657-63. [PMID: 16584347 DOI: 10.1902/jop.2006.050164] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effects of selective cyclooxygenase-2 inhibitor, celecoxib, and omega-3 fatty acid on serum levels of interleukin 1-beta (IL-1beta), osteocalcin (OC), and C-reactive protein (CRP) in experimental periodontitis. METHODS Experimental periodontitis in rats was induced by repeated injection of purified lipopolysaccharide (LPS) derived from Escherichia coli endotoxin. Forty-seven adult male Sprague-Dawley rats were divided into five study groups as follows: saline control, LPS, LPS + celecoxib, LPS + omega-3 fatty acid, and LPS + celecoxib + omega-3 fatty acid. Celecoxib and omega-3 fatty acid were given alone or in combination during 14 days of the experimental study period. At the end of the 2-week protocol, serum samples were obtained, and the rats were sacrificed. Serum samples were analyzed for IL-1beta, OC, and CRP concentrations by enzyme-linked immunosorbent assay. Defleshed jaws were analyzed morphometrically for alveolar bone loss. Data were evaluated statistically by non-parametric tests. RESULTS According to the morphometric measurements, the LPS and drug treatment groups showed significantly higher bone loss than the saline control group (P <0.05). Omega-3 fatty acid, both alone and in combination with celecoxib, revealed significantly higher IL-1beta levels than LPS and celecoxib groups (P <0.05). Individual and combined administration of celecoxib and omega-3 fatty acid significantly increased OC levels compared to the LPS group (P <0.05). There were no significant differences in serum CRP levels. CONCLUSIONS Celecoxib and/or omega-3 fatty acid administration does not significantly influence circulating levels of CRP. The significantly increased serum OC level observed after individual and combination administration suggests that celecoxib and omega-3 fatty acid may influence bone remodeling and thereby inhibit the progression of alveolar bone resorption. However, the failure to observe any significant inhibition of bone loss in celecoxib- and/or omega-3 fatty acid-treated rats compared to the LPS group suggests that their therapeutic effect may be reduced by other factors, such as increases in serum IL-1beta promoting osteoclast activity.
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Affiliation(s)
- Saynur Vardar-Sengül
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey
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Buduneli E, Buduneli N, Vardar-Sengül S, Kardeşler L, Atilla G, Lappin D, Kinane DF. Systemic Low-Dose Doxycycline and Alendronate Administration and Serum Interleukin-1Beta, Osteocalcin, and C-Reactive Protein Levels in Rats. J Periodontol 2005; 76:1927-33. [PMID: 16274312 DOI: 10.1902/jop.2005.76.11.1927] [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] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the effects of systemic administration of low-dose doxycycline and a bisphosphonate, alendronate, on serum levels of interleukin-1beta (IL-1beta), osteocalcin (OC), and C-reactive protein (CRP) in experimental periodontitis in rats. METHODS Experimental periodontitis was induced by repeated injection of purified lipopolysaccharide (LPS) derived from Escherichia coli endotoxin. Forty-seven adult male Sprague-Dawley rats were divided into five study groups and given LPS, LPS + doxycycline, LPS + alendronate, LPS + doxycycline + alendronate, and saline control. At the end of the 1-week protocol, blood samples were obtained, and the rats were sacrificed. Serum samples were analyzed for IL-1beta, OC, and CRP concentrations by enzyme-linked immunosorbent assay (ELISA). The jaws were defleshed, and alveolar bone loss was assessed morphometrically. Data were evaluated statistically by non-parametric tests. RESULTS Morphometric measurements revealed significantly more bone loss in the LPS group compared to the saline control group (P <0.05). Alendronate revealed slight inhibition on alveolar bone loss either alone or in combination with doxycycline (alveolar bone loss: 0.41 mm in alendronate and combined drug treatment groups versus 0.45 mm in LPS and doxycycline groups). Significantly higher IL-1beta levels were observed with alendronate either alone or in combination with doxycycline than in the LPS group (P <0.05). Combined administration of doxycycline and alendronate showed significantly higher levels of OC than all of the other groups (P <0.01). Serum CRP levels did not exhibit significant differences between the study groups. CONCLUSIONS Alendronate either alone or in combination with doxycycline provided slight inhibition on LPS-induced alveolar bone resorption. The significantly increased serum OC level observed in the combined drug treatment group suggests that combined administration of alendronate and doxycycline might increase bone remodeling and thereby inhibit the progression of alveolar bone resorption in rats.
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Affiliation(s)
- Eralp Buduneli
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey
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Dolan V, Murphy M, Sadlier D, Lappin D, Doran P, Godson C, Martin F, O'Meara Y, Schmid H, Henger A, Kretzler M, Droguett A, Mezzano S, Brady HR. Expression of gremlin, a bone morphogenetic protein antagonist, in human diabetic nephropathy. Am J Kidney Dis 2005; 45:1034-9. [PMID: 15957132 DOI: 10.1053/j.ajkd.2005.03.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [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: 01/23/2023]
Abstract
BACKGROUND We report the induction of gremlin, a bone morphogenetic protein antagonist, in cultured human mesangial cells exposed to high glucose and transforming growth factor beta (TGF-beta) levels in vitro and kidneys from diabetic rats in vivo. METHODS Gremlin expression was assessed in human diabetic nephropathy by means of in situ hybridization, immunohistochemistry, and real-time polymerase chain reaction and correlated with clinical and pathological indices of disease. RESULTS Gremlin was not expressed in normal human adult kidneys. Conversely, abundant gremlin expression was observed in human diabetic nephropathy. Although some gremlin expression was observed in occasional glomeruli, gremlin expression was most prominent in areas of tubulointerstitial fibrosis, where it colocalized with TGF-beta expression. Gremlin messenger RNA levels correlated directly with renal dysfunction, determined by means of serum creatinine level, but not with proteinuria level. There was a strong correlation between gremlin expression and tubulointerstitial fibrosis score. CONCLUSION In aggregate, these results indicate that the developmental gene gremlin reemerges in the context of tubulointerstitial fibrosis in diabetic nephropathy and suggests a role for TFG-beta as an inducer of gremlin expression in this context.
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Affiliation(s)
- Vincent Dolan
- Department of Medicine, The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Mater Misericordiae University Hospital, Dublin, Ireland.
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Buduneli N, Buduneli E, Kardeşler L, Lappin D, Kinane DF. Plasminogen activator system in smokers and non-smokers with and without periodontal disease. J Clin Periodontol 2005; 32:417-24. [PMID: 15811061 DOI: 10.1111/j.1600-051x.2005.00694.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The present study assessed levels of plasminogen activator (PA) system proteins in gingival crevicular fluid (GCF) and serum of chronic gingivitis, chronic periodontitis patients and periodontally healthy subjects and evaluated how smoking influenced these levels. METHODS Twenty chronic gingivitis; 20 chronic periodontitis patients and 20 periodontally healthy volunteers were consecutively recruited according to the inclusion criteria so that exactly half of the subjects in each category were smokers. GCF samples from four sites together with serum samples were obtained from each subject. GCF levels of tissue type PA (t-PA), urokinase type PA (u-PA), PA inhibitor-1 (PAI-1) and PA inhibitor-2 (PAI-2) and serum concentrations of cotinine, u-PA and PAI-1 were analysed by enzyme-linked immunosorbent assay. RESULTS The only statistically significant difference between smokers and non-smokers was a lower GCF PAI-2 concentrations in healthy smokers compared with healthy non-smokers (p<0.01). Gingivitis and periodontitis patients had higher GCF concentrations of PAI-2 than healthy subjects (p<0.002 and p<0.02 respectively). The ratio of u-PA:PAI-1 and t-PA:PAI-1 were significantly higher in GCF of smokers with periodontitis compared with "healthy" smokers, whereas the ratio of t-PA:PAI-2 was significantly lower in smokers with periodontal disease (p<0.05). CONCLUSIONS GCF levels of the PA system proteins are increased in chronic gingivitis and periodontitis compared with healthy gingiva. Smoking had only subtle effects on the GCF PA system proteins with the exception of PAI-2, and the balance of activators and inhibitors. These findings suggest one mechanism whereby smoking may exert detrimental effects on the periodontal tissues.
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Affiliation(s)
- Nurcan Buduneli
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey.
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40
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Buduneli N, Buduneli E, Ciotanar S, Atilla G, Lappin D, Kinane D. Plasminogen activators and plasminogen activator inhibitors in gingival crevicular fluid of cyclosporin A-treated patients. J Clin Periodontol 2004; 31:556-61. [PMID: 15191592 DOI: 10.1111/j.1600-051x.2004.00517.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The plasminogen activator (PA) system plays many roles in the inflammatory process and tissue remodelling and repair and is considered to play a significant role in periodontal tissue destruction and healing. The aim of this study was to evaluate the role of the PA system in cyclosporin A (CsA)-induced gingival overgrowth in renal transplant patients. METHODS Eighteen renal transplant patients exhibiting moderate to severe CsA-induced gingival overgrowth, 10 other renal transplant patients receiving CsA therapy but showing no sign of CsA-induced gingival overgrowth (CsA-H), 16 chronic gingivitis patients (CG) and 16 systemically and periodontally healthy control subjects (H) were included in the study. Gingival crevicular fluid (GCF) samples were obtained from four randomly selected sites in each subject with the exception of the CsA-induced gingival overgrowth group, where four GCF samples were harvested from sites with severe overgrowth (CsA GO+) and from four sites without any gingival overgrowth (CsA GO-). The GCF levels of albumin, tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA), plasminogen activator inhibitor 1 (PAI-1) and plasminogen activator inhibitor 2 (PAI-2) were analysed by enzyme-linked immunosorbent assay. The results were tested for statistical differences. RESULTS In CsA GO+ sites t-PA levels were significantly elevated in comparison with gingivitis and healthy sites, while PAI-2 levels in these sites showed statistically significant differences only with CsA-H and gingivitis sites (p<0.05). The levels of t-PA and PAI-2 were significantly higher in CsA GO- sites compared with those of CsA-H, gingivitis and healthy sites (p<0.05). The levels of u-PA and PAI-1 failed to show significant differences between the study groups. CONCLUSIONS The findings of the present study indicate alterations in GCF t-PA and PAI-2 levels in CsA-induced gingival overgrowth and might suggest involvement of the plasminogen activating system in the pathogenesis of this side-effect of CsA therapy. However, to what extent these molecules contribute to the pathogenesis of CsA-induced gingival overgrowth remains to be determined.
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Affiliation(s)
- Nurcan Buduneli
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey.
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Stenson C, Mitchell S, Lappin D, Brady HR, Godson C. Biphasic regulation of leukocyte trafficking by lipoxins. Adv Exp Med Biol 2003; 507:543-9. [PMID: 12664638 DOI: 10.1007/978-1-4615-0193-0_83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Catherine Stenson
- Centre for Molecular Inflammation and Vascular Research, Department of Medicine and Therapeutics, Mater Misericordiae Hospital, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland
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Grey M, Townsend N, Lappin D, Roberts I, Stanford R, Sheldon M, Tate D, Short C, Lucas G. IgA myeloma of donor origin arising 7 years after allogeneic renal transplant. Br J Haematol 2000; 108:592-4. [PMID: 10759718 DOI: 10.1046/j.1365-2141.2000.01913.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the case of a 38-year-old man who developed IgA myeloma of donor origin 7 years after allogeneic renal transplant. The diagnosis of multiple myeloma was unequivocal and based on positive results from serum electrophoresis, skeletal survey and bone marrow investigations. The donor origin of the myeloma cells was confirmed by DNA fingerprinting. We believe this is the first reported case of disseminated multiple myeloma of donor origin developing after allogeneic renal transplant and, as such, gives some insight into the natural history and biology of the disease.
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Affiliation(s)
- M Grey
- University Department of Clinical Haematology, Manchester Royal Infirmary, UK
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Affiliation(s)
- J Eustace
- Department of Nephrology, Meath Hospital, Dublin, Ireland
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Abstract
OBJECTIVE Previous work indicates that large numbers of B and T cells accumulate in the periodontal soft tissues although we know little about cellular synthetic activity and proliferation in this site. The aim of this study was to examine lymphocytic cell synthetic activity and proliferation in periodontitis gingiva and compare this to a known site of leucocyte proliferation, namely the oropharyngeal tonsils. MATERIALS AND METHODS Messenger RNA (mRNA) and 28S ribosomal (28S rRNA) expressing cells in formalin-fixed/paraffin-embedded gingival and tonsillar tissue sections were detected by in situ hybridisation (ISH) using poly-deoxyribothymidine and 28S probes respectively. In addition S-phase proliferating and cycling cells were also detected by ISH with histone probes and by Ki-67 immunohistochemistry. Ten gingival biopsy samples were obtained from adult periodontitis patients and five tonsillar biopsies from tonsillectomy patients. RESULTS Both mRNA and 28S rRNA-expressing cells were detected in all the samples tested. Plasma cells showed the strongest signal for the two probes and slight to moderate staining could be seen in epithelium, fibroblasts and endothelial cells. In contrast, gingival lymphocytes were either weakly stained or were unstained for these probes of synthetic activity. In tonsils, most lymphocytes in germinal centres showed moderate staining and mantol zone cells were much more weakly stained. In gingival samples, histone mRNA-expressing and cycling (Ki-67) cells were detected in 4/10, 10/10 cases respectively. These positive cells were mainly basal and suprabasal epithelial cells and a few mononuclear cells, whereas most germinal centre lymphocytes (B cells) were positive for this probe. The number of Ki67 positive cells was greater than histone mRNA bearing cells both in gingiva and tonsillar tissue. In contrast, mantol zone cells (mainly T cells) were sparsely stained by probes of cell proliferation. CONCLUSION These results indicate that local proliferation of B cells does not occur in periodontitis gingiva in contrast with tonsillar tissue, although plasma cells showed strong synthetic activity in both tissues. T cells did not appear to proliferate greatly nor undergo active synthesis in either of these tissues. These findings substantiate previous hypotheses that specific leucocytes predominate in the gingival tissue through selective homing rather than by local proliferation.
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Affiliation(s)
- K Takahashi
- Department of Adult Dental Care, Glasgow Dental Hospital and School, Scotland, UK
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Gulati P, Guc D, Lemercier C, Lappin D, Whaley K. Expression of the components and regulatory proteins of the classical pathway of complement in normal and diseased synovium. Rheumatol Int 1994; 14:13-9. [PMID: 7939135 DOI: 10.1007/bf00302666] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We studied the synthesis of the classical pathway complement components in synovial membrane. Ribonucleic acid was extracted from the synovial membranes of patients with rheumatoid arthritis (RA) or osteoarthritis (OA), as well as from normal synovial membrane. Northern blot and dot blot analysis showed that the mRNAs for all classical pathway complement components (C1qA chain, C1qB chain, C1qC chain, C1r, C1s, C4 and C2) and the fluid-phase regulatory components (C1-inhibitor, C4-bp and factor I) were present in all three types of synovial membrane. Thus, all the components of the classical pathway were expressed in normal and diseased synovium. In an attempt to determine which components were synthesised by each cell type, monocytes (mononuclear phagocytes), human umbilical vein endothelial cells (HUVEC), synovial membrane fibroblasts (from normal, OA and RA synovial membrane) and peripheral blood lymphocytes were cultured in vitro and secretion rates of individual components were measured and total cellular RNA was analysed by Northern blotting. Monocytes secreted C1q, C1r, C1s, C4, C2, C1-inhibitor and C4-bp but not factor I. Fibroblasts secreted C1r, C1s, C2, C3, C1-inhibitor and factor I but not C1q, C4 or C4-bp. HUVEC secreted C1s, C2, C1-inhibitor and factor I but not C1q, C1r, C4 or C4-bp. Lymphocytes did not secrete any of these components. In three instances mRNA was detected in the absence of secreted protein: mRNAs for the C1qA and C1qC chains were detected in HUVEC, whereas the mRNA for the C1qB chain was not, and C4 mRNA was detected in both fibroblasts and HUVEC.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Gulati
- Department of Immunology, Leicester Royal Infirmary, UK
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46
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Gulati P, Lemercier C, Guc D, Lappin D, Whaley K. Regulation of the synthesis of C1 subcomponents and C1-inhibitor. Behring Inst Mitt 1993:196-203. [PMID: 8172568] [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: 01/29/2023]
Abstract
We have investigated the synthesis of C1q, C1r, C1s and C1-inhibitor in HepG2 cells, human umbilical vein endothelial cells (HUVEC), fibroblasts (skin and synovial membrane), chondrocytes and monocytes. C1q was only synthesised by monocytes, although the mRNAs for the C1qA and C1qC chains were expressed in HUVEC. C1r, C1s and C1-inhibitor were synthesised by all cell types. The secretion rates of C1r and C1s were approximately equimolar in fibroblasts and chondrocytes whereas the secretion rate for C1s exceeded that for C1r in the other cell types. Molar ratios of C1s to C1r were approximately 2:1 for HepG2 cells, 5:1 for monocytes and 10:1 for HUVEC. Stimulation with interferon-gamma resulted in increased expression of all four proteins. The C1s:C1r ratio did not alter in chondrocytes or fibroblasts, but approached unity in HepG2, monocytes and HUVEC, due to relatively greater stimulation of C1r gene expression.
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Affiliation(s)
- P Gulati
- Department of Immunology, Leicester Royal Infirmary, UK
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Guc D, Gulati P, Lemercier C, Lappin D, Birnie GD, Whaley K. Expression of the components and regulatory proteins of the alternative complement pathway and the membrane attack complex in normal and diseased synovium. Rheumatol Int 1993; 13:139-46. [PMID: 8310205 DOI: 10.1007/bf00301260] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We have studied synthesis of the complement components and regulatory proteins of the alternative pathway and the membrane attack complex in synovial membrane. RNA was extracted from synovial tissue of patients with rheumatoid arthritis (RA) or osteoarthritis (OA) as well as from normal synovial membrane. Dot blot analysis showed the presence of mRNAs for all the complement components and regulatory proteins (C3, factor B, factor D, C5, C6, C7, C9, factor H, factor I, S-protein, SP-40, 40, DAF, MCP, CR1, CD59), except for properdin, C8 alpha, C8 beta and C8 gamma in all three types of synovial membrane studied. In an attempt to determine which components were synthesised by each cell type, monocytes (mononuclear phagocytes), human umbilical vein endothelial cells (HUVEC), synovial membrane fibroblasts (from normal, OA and RA synovial membrane) and peripheral blood lymphocytes were cultured in vitro and secretion rates of individual components were measured and total cellular RNA analysed by northern blotting. Monocytes secreted properdin, C3, and factor H but not factor B, factor I, C5, C6, C7, C8 or C9. Fibroblasts and endothelial cells secreted factor B, factor H and factor I, but not properdin, C5, C6, C7, C8 or C9. Lymphocytes did not secrete any of these components. mRNAs encoding C3, factor B, factor H, S-protein, SP-40, 40, MCP and DAF were detected in all three other cell types (monocytes, fibroblasts and HU-VEC), but factor I and CD59 mRNAs were not detected in monocytes. C5, C6, C7, C8 alpha, C8 beta, CD8 gamma and C9 mRNAs were not detected in any of the cell types studied.(ABSTRACT TRUNCATED AT 250 WORDS)
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MESH Headings
- Arthritis, Rheumatoid/metabolism
- Arthritis, Rheumatoid/pathology
- Arthritis, Rheumatoid/physiopathology
- Base Sequence
- Blotting, Northern
- Cells, Cultured
- Complement C3/analysis
- Complement C3/genetics
- Complement C3/metabolism
- Complement C5/analysis
- Complement C5/genetics
- Complement C5/metabolism
- Complement C6/analysis
- Complement C6/genetics
- Complement C6/metabolism
- Complement C7/analysis
- Complement C7/genetics
- Complement C7/metabolism
- Complement C9/analysis
- Complement C9/genetics
- Complement C9/metabolism
- Complement Factor H/analysis
- Complement Factor H/genetics
- Complement Factor H/metabolism
- Complement Membrane Attack Complex/analysis
- Complement Membrane Attack Complex/metabolism
- Complement Membrane Attack Complex/physiology
- Complement Pathway, Alternative/physiology
- Endothelium, Vascular/chemistry
- Endothelium, Vascular/cytology
- Endothelium, Vascular/physiology
- Fibroblasts/chemistry
- Fibroblasts/cytology
- Fibroblasts/physiology
- Humans
- Leukocytes/chemistry
- Leukocytes/pathology
- Leukocytes/physiology
- Membrane Glycoproteins/analysis
- Membrane Glycoproteins/genetics
- Membrane Glycoproteins/metabolism
- Molecular Sequence Data
- Monocytes/chemistry
- Monocytes/pathology
- Monocytes/physiology
- Oligonucleotide Probes
- Osteoarthritis/metabolism
- Osteoarthritis/pathology
- Osteoarthritis/physiopathology
- RNA, Messenger/analysis
- RNA, Messenger/genetics
- Synovial Membrane/chemistry
- Synovial Membrane/pathology
- Synovial Membrane/physiology
- Vitronectin
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Affiliation(s)
- D Guc
- Beatson Institute for Cancer Research, Glasgow, UK
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48
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Affiliation(s)
- K Whaley
- Department of Immunology, Leicester Royal Infirmary, UK
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49
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Moffat GJ, Lappin D, Birnie GD, Whaley K. Complement biosynthesis in human synovial tissue. Clin Exp Immunol 1989; 78:54-60. [PMID: 2805423 PMCID: PMC1534611] [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: 01/02/2023] Open
Abstract
Molecular biological and immunochemical techniques have been used to study the synthesis of complement components by synovial tissue from patients with rheumatoid arthritis or osteoarthritis and by normal synovial tissue from a patient undergoing patellectomy. Using Northern and dot-blot analyses, mRNAs coding for C1-inhibitor, C2, C3, C4 and factor B have been detected, but not for C5. Quantitative analyses of the data have not shown any significant differences in the steady state levels of any of the mRNAs in synovium from rheumatoid arthritis and osteoarthritis patients. When synovial membrane fragments from rheumatoid arthritis, osteoarthritis patients or normal synovium were cultured in vitro, synthesis of C1-inhibitor, C2, C3, C4 and factor B detected by ELISA and C2, C3 and factor B were shown to be functionally active. This study thus provides conclusive evidence that synthesis of complement components occurs locally within normal and inflamed synovial tissue. The local synthesis of complement within normal synovial joints may be of importance in their defence against infection, whereas in inflamed joints it may contribute to the inflammatory response.
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Affiliation(s)
- G J Moffat
- Department of Pathology, Western Infirmary, Glasgow, Scotland
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50
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Lappin D, Whaley K. Regulation of C1-inhibitor synthesis by interferons and other agents. Behring Inst Mitt 1989:180-92. [PMID: 2478116] [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: 01/01/2023]
Abstract
C1-inhibitor (C1-inh) is synthesised and secreted by at least four cell types: hepatocytes, mononuclear phagocytes, fibroblasts and umbilical vein endothelial cells. The production of this protein by monocytes/macrophages and Hep G2 cells has been studied in great detail. Environmental factors alter C1-inh synthesis by these cells. A number of agents which inhibit monocyte C1-inh production (such as histamine, PGE2 C5a des arg and serum treated immune complexes) bind to membrane receptors, activate adenylate cyclase, elevate intracellular cAMP and activate cAMP-dependent protein kinase. Elevation of monocyte cAMP levels is associated with decreased C1-inh secretion by these cells and reduced C1-inh mRNA levels. These changes can be seen within 8 hours of exposure. Stimulation of monocyte C1-inh synthesis occurs after the addition of agents which induce the formation of sodium ion and calcium ion channels, activate the phosphatidyl inositol cycle and activate protein kinase C (immune-complexes, carbamylcholine and phenylephrine). Agents which act directly on protein kinase C (phorbol myristate acetate) also stimulate C1-inh synthesis. Amongst the most potent stimulators of monocyte and Hep G2 C1-inh synthesis are the interferons (Ifns) Ifn alpha, Ifn beta and Ifn gamma. These are known to bind to specific receptors on cells (Ifn alpha and beta binding to Type I Ifn receptors and Ifn-gamma binding to type II Ifn receptors). At least two mechanisms by which Ifn receptor-ligand interaction elicit their effects exist. These are: 1) binding of an activated receptor transducer/regulatory component to specific DNA sequences on Ifn sensitive genes; 2) the activation of protein kinase C and binding of its regulatory components to specific DNA sequences. Ifn alpha, beta and gamma cause a dose related increase in monocyte and Hep G2 cell C1-inh mRNA abundance and protein synthesis. Ifn-gamma is the most potent of the interferons on monocyte C1-inh synthesis. Ifn alpha and beta being less effective but equipotent. These cytokines elicit their maximum effect on monocyte C1-inh synthesis after 1-2 hours treatment. This rapid stimulation of monocyte C1-inh synthesis suggests that this increases the transcription of the C1-inh gene. After removal of Ifns from monocytes the elevated C1-inh mRNA levels subside towards control levels of expression in Ifn alpha and beta-treated cells but remain elevated in Ifn-gamma-treated monocytes. This binding suggests that Ifn-gamma alters the stability of C1-inh mRNA.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- D Lappin
- University Department of Pathology, Western Infirmary, Glasgow, U.K
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