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Brunton H, Caligiuri G, Cunningham R, Upstill-Goddard R, Bailey UM, Garner IM, Nourse C, Dreyer S, Jones M, Moran-Jones K, Wright DW, Paulus-Hock V, Nixon C, Thomson G, Jamieson NB, McGregor GA, Evers L, McKay CJ, Gulati A, Brough R, Bajrami I, Pettitt SJ, Dziubinski ML, Barry ST, Grützmann R, Brown R, Curry E, Pajic M, Musgrove EA, Petersen GM, Shanks E, Ashworth A, Crawford HC, Simeone DM, Froeling FEM, Lord CJ, Mukhopadhyay D, Pilarsky C, Grimmond SE, Morton JP, Sansom OJ, Chang DK, Bailey PJ, Biankin AV, Chang DK, Cooke SL, Dreyer S, Grimwood P, Kelly S, Marshall J, McDade B, McElroy D, Ramsay D, Upstill-Goddard R, Rebus S, Hair J, Jamieson NB, McKay CJ, Westwood P, Williams N, Duthie F, Biankin AV, Johns AL, Mawson A, Chang DK, Scarlett CJ, Brancato MAL, Rowe SJ, Simpson SH, Martyn-Smith M, Thomas MT, Chantrill LA, Chin VT, Chou A, Cowley MJ, Humphris JL, Mead RS, Nagrial AM, Pajic M, Pettit J, Pinese M, Rooman I, Wu J, Tao J, DiPietro R, Watson C, Steinmann A, Lee HC, Wong R, Pinho AV, Giry-Laterriere M, Daly RJ, Musgrove EA, Sutherland RL, Grimmond SM, Waddell N, Kassahn KS, Miller DK, Wilson PJ, Patch AM, Song S, Harliwong I, Idrisoglu S, Nourbakhsh E, Manning S, Wani S, Gongora M, Anderson M, Holmes O, Leonard C, Taylor D, Wood S, Xu C, Nones K, Fink JL, Christ A, Bruxner T, Cloonan N, Newell F, Pearson JV, Quinn M, Nagaraj S, Kazakoff S, Waddell N, Krisnan K, Quek K, Wood D, Samra JS, Gill AJ, Pavlakis N, Guminski A, Toon C, Asghari R, Merrett ND, Pavey D, Das A, Cosman PH, Ismail K, O’Connnor C, Lam VW, McLeod D, Pleass HC, Richardson A, James V, Kench JG, Cooper CL, Joseph D, Sandroussi C, Crawford M, Gallagher J, Texler M, Forest C, Laycock A, Epari KP, Ballal M, Fletcher DR, Mukhedkar S, Spry NA, DeBoer B, Chai M, Zeps N, Beilin M, Feeney K, Nguyen NQ, Ruszkiewicz AR, Worthley C, Tan CP, Debrencini T, Chen J, Brooke-Smith ME, Papangelis V, Tang H, Barbour AP, Clouston AD, Martin P, O’Rourke TJ, Chiang A, Fawcett JW, Slater K, Yeung S, Hatzifotis M, Hodgkinson P, Christophi C, Nikfarjam M, Mountain A, Eshleman JR, Hruban RH, Maitra A, Iacobuzio-Donahue CA, Schulick RD, Wolfgang CL, Morgan RA, Hodgin M, Scarpa A, Lawlor RT, Beghelli S, Corbo V, Scardoni M, Bassi C, Tempero MA, Nourse C, Jamieson NB, Graham JS. HNF4A and GATA6 Loss Reveals Therapeutically Actionable Subtypes in Pancreatic Cancer. Cell Rep 2020; 31:107625. [PMID: 32402285 PMCID: PMC9511995 DOI: 10.1016/j.celrep.2020.107625] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/05/2019] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) can be divided into transcriptomic subtypes with two broad lineages referred to as classical (pancreatic) and squamous. We find that these two subtypes are driven by distinct metabolic phenotypes. Loss of genes that drive endodermal lineage specification, HNF4A and GATA6, switch metabolic profiles from classical (pancreatic) to predominantly squamous, with glycogen synthase kinase 3 beta (GSK3β) a key regulator of glycolysis. Pharmacological inhibition of GSK3β results in selective sensitivity in the squamous subtype; however, a subset of these squamous patient-derived cell lines (PDCLs) acquires rapid drug tolerance. Using chromatin accessibility maps, we demonstrate that the squamous subtype can be further classified using chromatin accessibility to predict responsiveness and tolerance to GSK3β inhibitors. Our findings demonstrate that distinct patterns of chromatin accessibility can be used to identify patient subgroups that are indistinguishable by gene expression profiles, highlighting the utility of chromatin-based biomarkers for patient selection in the treatment of PDAC.
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Affiliation(s)
- Holly Brunton
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Giuseppina Caligiuri
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland
| | - Richard Cunningham
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland
| | - Rosie Upstill-Goddard
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland
| | - Ulla-Maja Bailey
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Ian M Garner
- Epigenetics Unit, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Craig Nourse
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Stephan Dreyer
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Marc Jones
- Stratified Medicine Scotland Innovation Centre, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Kim Moran-Jones
- Stratified Medicine Scotland Innovation Centre, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Derek W Wright
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland
| | - Viola Paulus-Hock
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Colin Nixon
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Gemma Thomson
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Nigel B Jamieson
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Grant A McGregor
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Lisa Evers
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland
| | - Colin J McKay
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Aditi Gulati
- CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
| | - Rachel Brough
- CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
| | - Ilirjana Bajrami
- CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
| | - Stephen J Pettitt
- CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
| | - Michele L Dziubinski
- Department of Molecular and Integrative Physiology, University of Michigan, 4304 Rogel Cancer Center Drive, Ann Arbor, MI 48109, USA
| | - Simon T Barry
- Bioscience, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - Robert Grützmann
- Department of Surgery, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Robert Brown
- Epigenetics Unit, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Edward Curry
- Epigenetics Unit, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | | | | | - Marina Pajic
- The Kinghorn Cancer Centre, 370 Victoria Street, Darlinghurst and Garvan Institute of Medical Research, Sydney, NSW 2010, Australia; St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth A Musgrove
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland
| | | | - Emma Shanks
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Alan Ashworth
- CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA
| | - Howard C Crawford
- Department of Molecular and Integrative Physiology, University of Michigan, 4304 Rogel Cancer Center Drive, Ann Arbor, MI 48109, USA
| | - Diane M Simeone
- Pancreatic Cancer Center, Perlmutter Cancer Center, NYU Langone Health, New York, NY 10016, USA
| | - Fieke E M Froeling
- Epigenetics Unit, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK; Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Christopher J Lord
- CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
| | - Debabrata Mukhopadhyay
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Jacksonville, FL 32224, USA
| | | | - Sean E Grimmond
- University of Melbourne Centre for Cancer Research, University of Melbourne, Melbourne 3010, VIC, Australia
| | - Jennifer P Morton
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Owen J Sansom
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - David K Chang
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G31 2ER, UK; South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Peter J Bailey
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK; Department of General Surgery, University of Heidelberg, Heidelberg 69120, Germany.
| | - Andrew V Biankin
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, Scotland; West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G31 2ER, UK; South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
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Hunziker L, Radovanovic D, Jeger R, Pedrazzini G, Cuculi F, Urban P, Erne P, Rickli H, Pilgrim T, Hess F, Simon R, Hangartner P, Hufschmid U, Hornig B, Altwegg L, Trummler S, Windecker S, Rueff T, Loretan P, Roethlisberger C, Evéquoz D, Mang G, Ryser D, Müller P, Jecker R, Kistler W, Hongler T, Stäuble S, Freiwald G, Schmid H, Stauffer J, Cook S, Bietenhard K, Roffi M, Wojtyna W, Schönenberger R, Simonin C, Waldburger R, Schmidli M, Federspiel B, Weiss E, Marty H, Weber K, Zender H, Poepping I, Hugi A, Koltai E, Iglesias J, Erne P, Heimes T, Jordan B, Pagnamenta A, Feraud P, Beretta E, Stettler C, Repond F, Widmer F, Heimgartner C, Polikar R, Bassetti S, Iselin H, Giger M, Egger P, Kaeslin T, Fischer A, Herren T, Eichhorn P, Neumeier C, Flury G, Girod G, Vogel R, Niggli B, Yoon S, Nossen J, Stoller U, Veragut U, Bächli E, Weber A, Schmidt D, Hellermann J, Eriksson U, Fischer T, Peter M, Gasser S, Fatio R, Vogt M, Ramsay D, Wyss C, Bertel O, Maggiorini M, Eberli F, Christen S. Twenty-Year Trends in the Incidence and Outcome of Cardiogenic Shock in AMIS Plus Registry. Circ Cardiovasc Interv 2019; 12:e007293. [DOI: 10.1161/circinterventions.118.007293] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lukas Hunziker
- Department of Cardiology, Bern University Hospital, Switzerland (L.H., T.P.)
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (D.R.)
| | - Raban Jeger
- Division of Cardiology, University Hospital Basel, Switzerland (R.J.)
| | | | - Florim Cuculi
- Heart Centre Lucerne, Luzerner Kantonsspital, Switzerland (F.C.)
| | - Philip Urban
- Cardiology Department, La Tour Hospital, Geneva, Switzerland (P.U.)
| | - Paul Erne
- Department of Biomedicine, University of Basel, Switzerland (P.E.)
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, Switzerland (H.R.)
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Switzerland (L.H., T.P.)
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Szirt R, Ullah I, Knott J, Sun P, Ison G, Ramsay D, Weaver J. Percutaneous Coronary Intervention for Chronic Total Occlusions – Evolution of Technique and Radiation Reduction Within a Dedicated Program. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.414] [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: 10/19/2022]
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Aviv RI, Huynh T, Huang Y, Ramsay D, Van Slyke P, Dumont D, Asmah P, Alkins R, Liu R, Hynynen K. An in vivo, MRI-integrated real-time model of active contrast extravasation in acute intracerebral hemorrhage. AJNR Am J Neuroradiol 2014; 35:1693-9. [PMID: 24763419 DOI: 10.3174/ajnr.a3939] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The "spot sign" or contrast extravasation is strongly associated with hematoma formation and growth. An animal model of contrast extravasation is important to test existing and novel therapeutic interventions to inform present and future clinical studies. The purpose of this study was to create an animal model of contrast extravasation in acute intracerebral hemorrhage. MATERIALS AND METHODS Twenty-eight hemispheres of Yorkshire male swine were insonated with an MR imaging-guided focused sonography system following lipid microsphere infusion and mean arterial pressure elevation. The rate of contrast leakage was quantified by using dynamic contrast-enhanced MR imaging and was classified as contrast extravasation or postcontrast leakage by using postcontrast T1. Hematoma volume was measured on gradient recalled-echo MR imaging performed 2 hours postprocedure. Following this procedure, sacrificed brain was subjected to histopathologic examination. Power level, burst length, and blood pressure elevation were correlated with leakage rate, hematoma size, and vessel abnormality extent. RESULTS Median (intracerebral hemorrhage) contrast extravasation leakage was higher than postcontrast leakage (11.3; 6.3-23.2 versus 2.4; 1.1-3.1 mL/min/100 g; P<.001). Increasing burst length, gradient recalled-echo hematoma (ρ=0.54; 95% CI, 0.2-0.8; P=.007), and permeability were correlated (ρ=0.55; 95% CI, 0.1-0.8; P=.02). Median permeability (P=.02), gradient recalled-echo hematoma (P=.02), and dynamic contrast-enhanced volumes (P=.02) were greater at 1000 ms than at 10 ms. Within each burst-length subgroup, incremental contrast leakage was seen with mean arterial pressure elevation (ρ=0.2-0.8). CONCLUSIONS We describe a novel MR imaging-integrated real-time swine intracerebral hemorrhage model of acute hematoma growth and contrast extravasation.
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Affiliation(s)
- R I Aviv
- From the Department of Medical Imaging (T.H., R.I.A., R.L.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Medical Imaging (T.H., K.H., R.I.A.), University of Toronto, Toronto, Ontario, Canada
| | - T Huynh
- From the Department of Medical Imaging (T.H., R.I.A., R.L.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Medical Imaging (T.H., K.H., R.I.A.), University of Toronto, Toronto, Ontario, Canada
| | - Y Huang
- Imaging Research (Y.H., K.H.), Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - D Ramsay
- Department of Pathology (D.R.), London Health Sciences Centre, London, Ontario, Canada
| | - P Van Slyke
- The Centre for Proteomic Studies (D.D., P.V.S.)
| | - D Dumont
- Departments of Medical Biophysics (K.H., D.D., R.A., P.A.) The Centre for Proteomic Studies (D.D., P.V.S.)
| | - P Asmah
- Departments of Medical Biophysics (K.H., D.D., R.A., P.A.)
| | - R Alkins
- Departments of Medical Biophysics (K.H., D.D., R.A., P.A.)
| | - R Liu
- From the Department of Medical Imaging (T.H., R.I.A., R.L.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - K Hynynen
- Departments of Medical Biophysics (K.H., D.D., R.A., P.A.) Medical Imaging (T.H., K.H., R.I.A.), University of Toronto, Toronto, Ontario, Canada Imaging Research (Y.H., K.H.), Sunnybrook Research Institute, Toronto, Ontario, Canada
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MESH Headings
- Aged
- Autopsy
- Blood/microbiology
- Brain/diagnostic imaging
- Brain/pathology
- Cerebellum/pathology
- Conjunctiva/pathology
- DNA, Bacterial/chemistry
- DNA, Bacterial/genetics
- DNA, Ribosomal/chemistry
- DNA, Ribosomal/genetics
- Endocarditis, Bacterial/diagnosis
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/pathology
- Exanthema/pathology
- Fatal Outcome
- Female
- Humans
- Kidney/diagnostic imaging
- Kidney/pathology
- Lung/diagnostic imaging
- Lung/pathology
- Neisseria sicca/isolation & purification
- Neisseriaceae Infections/diagnosis
- Neisseriaceae Infections/pathology
- RNA, Ribosomal, 16S/genetics
- Sequence Analysis, DNA
- Tomography, X-Ray Computed
- Ultrasonography
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Affiliation(s)
- R Sommerstein
- Department of Internal Medicine, Cantonal Hospital Zug, Zug, Switzerland.
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Gräni C, Walder A, Vogt M, Ramsay D, Minder E. [Delirious psychiatric nurse with abdominal pain - a medical chameleon]. Praxis (Bern 1994) 2011; 100:311-315. [PMID: 21365564 DOI: 10.1024/1661-8157/a00454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Acute hepatic porphyrias stand for a group of rare genetic defects in the metabolism of heme biosynthesis, whereof acute intermittent porphyria is the most frequent one. Factors like drugs, infections, fasting, alcohol, or stress can provoke an acute crisis. The symptoms are very variable; however gastrointestinal and neuro-psychiatric symptoms are common. Furthermore darkening urine might be an important diagnostic sign. We describe the case of a 33-year-old psychiatric nurse presenting with stomach ache, hypertension, delirium and red spots in his underwear.
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Affiliation(s)
- Ch Gräni
- Medizinische Klinik, Zuger Kantonsspital, Baar.
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Lee S, Welman CJ, Ramsay D. Investigation of acute lower gastrointestinal bleeding with 16- and 64-slice multidetector CT. J Med Imaging Radiat Oncol 2009; 53:56-63. [PMID: 19453529 DOI: 10.1111/j.1754-9485.2009.02038.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We evaluated the usefulness of 16- and 64-slice multidetector CT (MDCT) in the detection of a bleeding site in acute lower gastrointestinal tract (GIT) haemorrhage by conducting a retrospective study of cases of presumed acute lower GIT haemorrhage imaged with CT in two teaching hospitals in an 11-month period. The patients underwent contrast enhanced CT using either a 16 or 64 MDCT. No oral contrast was used. One hundred milliliters of non-ionic intravenous contrast agent was injected at 4.5 mL/s, followed by a 60 mL saline flush at 4 mL/s through a dual head injector. Images were acquired in arterial phase with or without non-contrast and portal phase imaging with 16 x 1.5 mm or 64 x 0.625 mm collimation. Active bleeding was diagnosed by the presence of iodinated contrast extravasation into the bowel lumen on arterial phase images with attenuation greater than and distinct from the normal mucosal enhancement or focal pooling of increased attenuation contrast material within a bowel segment on portal-venous images. Further management and final diagnosis was recorded. Fourteen patients and 15 studies were reviewed. CT detected and localized a presumed bleeding site or potential causative pathology in 12 (80%) of the patients. Seven of these were supported by other investigations or surgery, while five were not demonstrated by other modalities. Eight patients had mesenteric angiography, of which only four corroborated the site of bleeding. CT did not detect the bleeding site in three patients, of which two required further investigation and definitive treatment. We propose that MDCT serves a useful role as the initial rapid investigation to triage patients presenting with lower GIT bleeding for further investigation and management.
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Affiliation(s)
- S Lee
- Department of Radiology, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
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French A, Weaver J, Ramsay D, Binnekamp M, Rees D, Prasan A, McCrohon J. Evaluation of Myocardial Salvage and Intramyocardial Haemorrhage on T2 Weighted Cardiac Magnetic Resonance Imaging after Reperfused STEMI. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.089] [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: 10/20/2022]
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Searle J, Mendelson R, Zelesco M, Sanford J, Cheng W, McKinstry C, Ramsay D. Non-invasive prediction of the degree of liver fibrosis in patients with hepatitis C using an ultrasound contrast agent. A pilot study. J Med Imaging Radiat Oncol 2008; 52:130-3. [PMID: 18373803 DOI: 10.1111/j.1440-1673.2008.01930.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
It has been shown that the severity of hepatic fibrosis in patients with hepatitis C can be predicted non-invasively by measuring intrahepatic circulatory time (IHCT) using a microbubble agent with spectral Doppler analysis. The aim of this study was to assess whether this technique is reproducible using a third-generation microbubble agent and contrast harmonic imaging, which are becoming the standard ultrasound techniques in all radiology departments. Twenty-three untreated patients with hepatitis C, who had undergone a recent liver biopsy, were studied prospectively. Based on their histological fibrosis score, patients were divided into four groups (fibrosis levels 1-4). Contrast harmonic imaging was carried out after an intravenous bolus of a microbubble agent (Optison; Amersham Health, Milwaukee, WI, USA). IHCT was calculated by measuring the difference between the hepatic vein and hepatic artery microbubble arrival times. The IHCT was compared with the degree of fibrosis. Significant differences were shown between the groups for IHCT. There were significant differences between fibrosis levels 1 and 3 and between fibrosis levels 1 and 4. This study has shown that calculation of IHCT using a third-generation microbubble agent and contrast harmonic imaging can differentiate mild fibrosis from more severe degrees of fibrosis in patients with hepatitis C.
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Affiliation(s)
- J Searle
- Department of Radiology, Cheltenham General Hospital, Cheltenham, UK
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Abstract
The following issues and requirements related to the implementation of a CT colonography (CTC) service are important: (i) policies are needed regarding the indications for CTC. Concomitant with this is the need for education of potential referrers and patients. Expectations of the procedure, particularly by general practitioners, may be unrealistic and indications for referral may otherwise be inappropriate. At present there is not general acceptance of CTC for screening asymptomatic persons; (ii) a flexible approach to CT protocols is useful, dependent on the indication for and clinical context of referral, the age and body habitus of the patient; (iii) attention to the issues related to the special skills required by the reporting radiologist. While there is a temptation to regard CTC interpretation as an extension of skills used in interpreting other cross-sectional images, there is a need to realise that there are skills required specific to CTC and there should be adequate provision for training; (iv) matters related to reporting, such as reporting format, and lesions that will be reported/not reported; and (v) informed consent from the patient. Information should be provided with regard to the limitations of CTC, the implications of a positive finding and radiation dosage.
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Affiliation(s)
- R Mendelson
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Box X2213 GPO, Perth, WA 6847, Australia.
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Abstract
A wide range of peptides and polypeptides can be appended to either the N- or C-terminus of G protein-coupled receptors without disrupting substantially ligand binding and signal transduction. Following fusion of fluorescent proteins, reporter gene constructs or G protein alpha subunits to the C-terminal tail of a receptor high content and G protein activation assays can be employed to identify agonist ligands. Further modification of the receptor fusions to introduce enhanced levels of constitutive activity and to physically destabilise the protein allows antagonist/inverse agonists screens to be developed in parallel. Equivalent C-terminal addition of pairs of complementary, non-functional, polypeptide fragments allows the application of enzyme complementation techniques. Introduction of N-terminal tags to receptors has also allowed the introduction of novel assay techniques based on a pH-sensitive cyanine dye. These have the capacity to overcome certain limitations of GPCR-fluorescent protein fusions.
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Affiliation(s)
- G Milligan
- Division of Biochemistry and Molecular Biology, Institute of Biomedical and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland UK.
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12
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Gaulin C, Ramsay D, Ringuette L, Ismaïl J. First documented outbreak of Listeria monocytogenes in Quebec, 2002. Can Commun Dis Rep 2003; 29:181-6. [PMID: 14603730] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- C Gaulin
- Ministère de la Santé et des Services sociaux, Direction de la protection de la santé publique, Quebec City
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13
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Yusoff IF, Mendelson RM, Edmunds SEJ, Ramsay D, Cullingford GL, Fletcher DR, Zimmerman AMJ. Preoperative assessment of pancreatic malignancy using endoscopic ultrasound. Abdom Radiol (NY) 2003; 28:556-62. [PMID: 14580100 DOI: 10.1007/s00261-002-0072-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [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: 10/26/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) has been regarded as the most accurate modality for locoregional staging of pancreatic malignancy. However, several recent studies have questioned this. The current study assessed the accuracy of EUS in determining preoperative resectability of pancreatic neoplasia. METHODS A retrospective review was performed of patients with pancreatic malignancy who had preoperative EUS and underwent surgery. EUS-predicted resectability was compared with surgical resectability. Where available, accuracies of vascular and nodal staging were also assessed. RESULTS Forty-five patients were identified (mean age 60 years, age range = 36-79 years). All patients underwent surgical exploration; vascular staging was available in 32 cases and 17 cases underwent surgical resection. The sensitivity, specificity, and accuracy of EUS in determining unresectability were 66%, 100%, and 78% respectively. Overall EUS stage concurred with surgical stage in 56%, greater than surgical stage in 4%, and less than surgical stage in 40%. Vascular staging on EUS had a sensitivity of 69% and a specificity of 100%. Accuracy of nodal staging was 71%. CONCLUSION EUS had a high specificity for assessing unresectable pancreatic malignancy. This technique should be used to avoid unnecessary surgical exploration of incurable lesions. However, EUS had only a moderate sensitivity, and a proportion of patients staged preoperatively as having resectable disease will not be surgically resectable.
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Affiliation(s)
- I F Yusoff
- Faculty of Dentistry and Medicine, University of Western Australia, Australia
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14
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Rajesh A, Ramsay D, Jeyapalan K. Case of the month: a pain in the neck. Br J Radiol 2002; 75:1003-4. [PMID: 12515711 DOI: 10.1259/bjr.75.900.751003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- A Rajesh
- Glenfield Hospital NHS Trust, Leicester LE3 9QP, UK
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15
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Abstract
In pneumopericardium, a rare but potentially life threatening differential diagnosis of chest pain with a broad variety of causes, rapid diagnosis and adequate treatment are crucial. In upright posteroanterior chest radiography, the apical limit of a radiolucent rim, outlining both the left ventricle and the right atrium, lies at the level of the pulmonary artery and ascending aorta, reflecting the anatomical limits of the pericardium. The band of gas surrounding the heart may outline the normally invisible parts of the diaphragm, producing the continuous left hemidiaphragm sign in an upright lateral chest radiograph. If haemodynamic conditions are stable, the underlying condition should be treated and the patient should be monitored closely. Acute haemodynamic deterioration should prompt rapid further investigation and cardiac tamponade must be actively ruled out. Spontaneous pneumopericardium in a 20 year old man is presented, and its pathophysiology described.
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Affiliation(s)
- L Brander
- Department of Intensive Care Medicine, University Hospital, Bern, Switzerland.
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16
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Ramsay D, Gibson P, Edmunds S, Mendelson R. Pancreatic islet cell tumours presenting as recurrent acute pancreatitis: imaging features in three cases. Australas Radiol 2001; 45:520-3. [PMID: 11903191 DOI: 10.1046/j.1440-1673.2001.00971.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present three cases of recurrent pancreatitis that occurred in patients with small islet cell tumours of the pancreas which were obstructing the main pancreatic duct. This is a very uncommon presentation of pancreatic islet cell tumours. The radiological findings in these cases are shown and the implications for imaging of 'idiopathic' relapsing pancreatitis are discussed.
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Affiliation(s)
- D Ramsay
- Department of Interventional and Diagnostic Radiology, The Royal Perth Hospital, Western Australia
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17
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Abstract
STUDY DESIGN Case report and literature review of cervical flexion myelopathies. OBJECTIVE To increase awareness that prolonged extreme neck flexion, in association with profound muscular relaxation, can produce a severe cervical myelopathy. SUMMARY OF BACKGROUND DATA Similar case reports of cervical myelopathies have been documented in the neurosurgical literature after intraoperative prolonged neck flexion, and after forcible prolonged neck flexion during a robbery. To the authors' best knowledge, this is the first report of a cervical flexion myelopathy after a medication overdose, and the only clinical-pathologic correlation. METHODS Retrospective case report with clinical, radiographic, and postmortem data available for analysis. RESULTS A transverse myelopathy at the sixth cervical level developed in a 25-year-old woman after an overdose of valproic acid in a suicide attempt. She was found in the sitting position, with her neck in extreme flexion, where she had been for an estimated 18 hours. Magnetic resonance imaging showed that her cervical cord was enlarged, maximally at C6, with prominent paraspinal soft tissue swelling. The patient died of pulmonary embolism and pneumonia. Pathologic findings included transverse spinal cord necrosis at C6; central gray matter necrosis extended to several segments below this. CONCLUSION Prolonged extreme neck flexion, in association with profound muscular relaxation, can produce a severe myelopathy that is at least partly related to compromise of the spinal cord's microcirculation.
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Affiliation(s)
- K L Kaye
- Departments of Clinical Neurological Sciences and Pathology, London Health Sciences Centre, London, Ontario, Canada
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18
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Abstract
Natriuretic peptides play an important role in water and salt homeostasis and in the regulation of the cardiovascular system. In recent years, exogenous administration of natriuretic peptides has primarily been used to improve our understanding of the role of natriuretic peptides. Also, it became evident that natriuretic peptides may be used therapeutically. Because of their peptide character, they cannot be administered orally and, therefore, may be used for short-term intravenous therapy only. In recent years, inhibitors of neutral endopeptidase, which degrades natriuretic peptides to inactive metabolites, have been investigated. This review focuses on the potential benefits of increasing natriuretic peptide levels, either through exogenous administration or inhibiting the degradation of endogenous natriuretic peptides.
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Affiliation(s)
- H P Brunner-La Rocca
- Department of Internal Medicine, Division of Cardiology, University Hospital, Ramistrasse 100, 8091, Zurich, Switzerland.
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19
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McVey M, Ramsay D, Kellett E, Rees S, Wilson S, Pope AJ, Milligan G. Monitoring receptor oligomerization using time-resolved fluorescence resonance energy transfer and bioluminescence resonance energy transfer. The human delta -opioid receptor displays constitutive oligomerization at the cell surface, which is not regulated by receptor occupancy. J Biol Chem 2001; 276:14092-9. [PMID: 11278447 DOI: 10.1074/jbc.m008902200] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.2] [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: 11/06/2022] Open
Abstract
Oligomerization of the human delta-opioid receptor and its regulation by ligand occupancy were explored following expression in HEK293 cells using each of co-immunoprecipitation of differentially epitope-tagged forms of the receptor, bioluminescence resonance energy transfer and time-resolved fluorescence resonance energy transfer. All of the approaches identified constitutively formed receptor oligomers, and the time-resolved fluorescence studies confirmed the presence of such homo-oligomers at the cell surface. Neither the agonist ligand [d-Ala(2),d-Leu(5)]enkephalin nor the inverse agonist ligand ICI174864 were able to modulate the oligomerization status of this receptor. Interactions between co-expressed delta-opioid receptors and beta(2)-adrenoreceptors were observed in co-immunoprecipitation studies. Such hetero-oligomers could also be detected using bioluminescence resonance energy transfer although the signal obtained was substantially smaller than for homo-oligomers of either receptor type. Signal corresponding to the delta-opioid receptor-beta(2)-adrenoreceptor hetero-oligomer was increased in the presence of agonist for either receptor. However, substantial levels of this hetero-oligomer were not detected at the cell surface using time-resolved fluorescence resonance energy transfer. These studies demonstrate that, following transient transfection of HEK293 cells, constitutively formed oligomers of the human delta-opioid receptor can be detected by a variety of approaches. However, these are not regulated by ligand occupancy. They also indicate that time-resolved fluorescence resonance energy transfer represents a means to detect such oligomers at the cell surface in populations of intact cells.
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MESH Headings
- Blotting, Western
- Cell Line
- Cell Membrane/chemistry
- Enkephalin, Leucine/analogs & derivatives
- Enkephalin, Leucine/chemistry
- Enkephalins/chemistry
- Epitopes
- Humans
- Immunoblotting
- Ligands
- Luminescent Measurements
- Narcotic Antagonists/chemistry
- Plasmids/metabolism
- Precipitin Tests
- Protein Binding
- Receptors, Adrenergic, beta-2/metabolism
- Receptors, Opioid, delta/chemistry
- Receptors, Opioid, delta/metabolism
- Signal Transduction
- Spectrometry, Fluorescence/methods
- Time Factors
- Transfection
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Affiliation(s)
- M McVey
- Molecular Pharmacology Group, Division of Biochemistry and Molecular Biology, Institute of Biomedical and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland
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20
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Wilmshurst JM, Bye A, Rittey C, Adams C, Hahn AF, Ramsay D, Pamphlett R, Pollard JD, Ouvrier R. Severe infantile axonal neuropathy with respiratory failure. Muscle Nerve 2001; 24:760-8. [PMID: 11360259 DOI: 10.1002/mus.1067] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We describe 5 infants (4 male, 1 female) with a severe intractable form of motor-sensory axonal neuropathy. All became ventilator-dependent, 4 have since died and 1 remains static. Diaphragmatic paralysis was an early feature with generalized neuropathy evolving rapidly. Nerve conduction studies and biopsies were consistent with axonal disease. This disorder could be a new condition or part of the spectrum of inherited neuropathies of the axonal degenerative type. It may be that there is a "switching-off" in the infant's Schwann cell-axonal interactions in utero or in the early postnatal period, resulting in severe progressive deterioration and then a static period without recovery.
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Affiliation(s)
- J M Wilmshurst
- Institute for Neuromuscular Research, Children's Hospital at Westmead, P.O. Box 3515, Parramatta, NSW 2124, Australia
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21
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Bruneau A, Lummis W, Ramsay D. Food poisoning associated with the ingestion of fiddleheads--Quebec 1999. Can Commun Dis Rep 2000; 26:165-9; discussion 169-70. [PMID: 11211700] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- A Bruneau
- Unité Maladies Infectieuses, santé publique Montréal-Centre, Montreal
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22
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Massell C, Coffin MF, Mann P, Mosher S, Frohlich C, Duncan CS, Karner G, Ramsay D, Lebrun JF. Neotectonics of the Macquarie Ridge Complex, Australia-Pacific plate boundary. ACTA ACUST UNITED AC 2000. [DOI: 10.1029/1999jb900408] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Alexiades-Armenakas M, Ramsay D, Kopf AW. The appropriateness of curettage and electrodesiccation for the treatment of basal cell carcinomas. Arch Dermatol 2000; 136:800. [PMID: 10871955 DOI: 10.1001/archderm.136.6.800] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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24
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Pilon P, Dion R, Jochem K, Rodrigue H, Vézina C, Desroches F, Ramsay D, Marquis V. Ciguatera food poisoning linked to the consumption of imported barracuda--Montreal, Quebec, 1998. Can Commun Dis Rep 2000; 26:73-6. [PMID: 10893819] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- P Pilon
- Unité Maladies infectieuses, Direction de la santé publique de Montréal-Centre, Quebec
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25
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Cairncross G, Swinnen L, Bayer R, Rosenfeld S, Salzman D, Paleologos N, Kaminer L, Forsyth P, Stewart D, Peterson K, Hu W, Macdonald D, Ramsay D, Smith A. Myeloablative chemotherapy for recurrent aggressive oligodendroglioma. Neuro Oncol 2000; 2:114-9. [PMID: 11303620 PMCID: PMC1919513 DOI: 10.1093/neuonc/2.2.114] [Citation(s) in RCA: 20] [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: 11/12/2022] Open
Abstract
The objective of this study was to ascertain the duration of tumor control and the toxicities of dose-intense myeloablative chemotherapy for patients with recurrent oligodendrogliomas. Patients with previously irradiated oligodendrogliomas, either pure or mixed, that were contrast enhancing, measurable, and behaving aggressively at recurrence were eligible for this study. Only complete responders or major partial responders (75 % reduction in tumor size) to induction chemotherapy--either intensive-dose procarbazine, lomustine, and vincristine or cisplatin plus etoposide-could receive high-dose thiotepa (300 mg/m2/day for 3 days) followed by hematopoietic reconstitution using either bone marrow or peripheral blood stem cells. Thirty-eight patients began induction chemotherapy and 20 (10 men, 10 women; median age 46 years; median Karnofsky score 80) received high-dose thiotepa. For the high-dose group, the median event-free, progression-free, and overall survival times from recurrence were 17, 20, and 49 months, respectively. Tumor control in excess of 2 years was observed in 6 patients (30%). Four patients (20%) are alive and tumor free 27 to 77 months (median, 42 months) from the start of induction therapy; however, fatal treatment-related toxicities also occurred in 4 patients (20%). Three patients died as a result of a progressive encephalopathy which, in 2 instances, was accompanied by a wasting syndrome; 1 patient died as a consequence of an intracerebral (intratumoral) hemorrhage. Fatal toxicities occurred in patients with pretreatment Karnofsky scores of 60 or 70. High-dose thiotepa to consolidate response was a disappointing treatment strategy for patients with recurrent aggressive oligodendroglial neoplasms, although several patients had durable responses. Moreover, as prescribed, high-dose thiotepa had significant toxic effects in previously irradiated patients, especially those with poorer performance status.
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Affiliation(s)
- G Cairncross
- Department of Oncology, University of Western Ontario and London Regional Cancer Centre, Canada
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26
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Affiliation(s)
- D Ramsay
- Department of Clinical Radiology, Leicester Royal Infirmary NHS Trust, Infirmary Close, UK
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27
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Abstract
This article describes the services and programs of a community mental health center in Frederick, Maryland. Way Station was founded in 1978 by a small group of individuals who were committed to helping individuals with mental illness. Way Station follows the Club House philosophy which is based on treating the clients with mutual respect, understanding and accountability. Both the staff and clients work together in pursuit of rehabilitation goals in a very warm and accepting environment. In order to learn more about this exceptional mental health community, fifty staff members and clients were interviewed. Their thoughts and feelings are discussed in this article.
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Affiliation(s)
- M Royeen
- School of Pharmacy and Allied Health Professions, Creighton University, Department of Occupational Therapy, Omaha, NE
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28
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Affiliation(s)
- A Daudia
- Department of General Surgery, Leicester Royal Infirmary NHS Trust, Infirmary Square
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29
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Gaulin CD, Ramsay D, Cardinal P, D'Halevyn MA. [Epidemic of gastroenteritis of viral origin associated with eating imported raspberries]. Can J Public Health 1999. [PMID: 10910564 DOI: 10.1007/bf03404097] [Citation(s) in RCA: 49] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several episodes of food poisoning affected the region of Quebec City in July and August 1997. In the first two episodes, the analysis of two cohorts (A and B) demonstrated that the consumption of a raspberry mousse with raspberry sauce increased the risk of contracting gastroenteritis (A, RR = 2.6 p = 0.001; B, RR = 4.7 p = 0.02). More than 200 people were sick after eating a raspberry dessert. The common ingredient of all those desserts was raspberries imported from Bosnia. Viral studies on the raspberry sauce (2) and stool samples (5) using the genome amplification method by PCR indicated the presence of genomic material compatible with a virus of the Caliciviruses family. Southern hybridization and sequence analysis showed that the nucleotide sequences found in the raspberry sauce and in the stool samples were identical. It is important to maintain active surveillance to detect and limit the spread of this kind of outbreak.
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Affiliation(s)
- C D Gaulin
- Centre de santé publique de Québec, Beauport
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30
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Abstract
Renal artery stenosis is an important and potentially curable cause of hypertension. Captopril renography is now recognized to have a high sensitivity and specificity in its diagnosis. Ultimately, however, the result is of little benefit if it does not lead to a change in patient management. To assess how patient management was changed following the result of a captopril renogram, we reviewed the notes of 95 patients who had undergone this test over a 5 year period to identify renal artery stenosis. Of these patients, significant renal artery stenosis was suggested in 16 (17%), of whom only 9 (56%) underwent a change in management (7 proceeding to angiography with or without angioplasty, 2 having alterations in medication). In the 67 patients who had a negative renogram, 16 (24%) had an alteration in management (13 angiography, 3 altered drug treatment). Finally, of the 12 patients who had a non-diagnostic renogram, 7 (60%) had a management change (3 angiography, 4 altered drug therapy). Our results suggest that, despite evidence from the literature that captopril renography is both sensitive and specific for renal artery stenosis, clinicians still rely on other factors when determining who has significant stenosis and, therefore, who should proceed to a further investigation or have a change in medication. Ultimately, this reduces the clinical value of the test at present.
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Affiliation(s)
- D Ramsay
- Department of Clinical Radiology, Leicester Royal Infirmary NHS Trust, Infirmary Close, UK
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31
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Abstract
Side effects in the treatment of mycosis fungoides with topical nitrogen mustard include allergic contact dermatitis, hyperpigmentation, urticaria, and erythema multiforme-like dermatitis. We reviewed biopsy specimens from 10 patients with mycosis fungoides who were treated with topical nitrogen mustard for 10-76 months. There was no history of oral psoralen with long-wave UV radiation treatment, radiotherapy, or systemic chemotherapy. Control biopsies taken from erythematous or poikilodermatous patches on the trunk or proximal extremities showed epidermal and dermal changes associated with cytologic atypia that were not present before treatment. These changes included slight epidermal hyperplasia with foci of flat rete ridges, atypical keratinocytes with large nuclei, mostly in the lower portion of the epidermis; suprabasal mitotic figures; a few dyskeratotic cells, focal vacuolar alteration of the epidermal basal layer; increased number of slightly enlarged junctional melanocytes; melanophages in the papillary dermis; dilated blood vessels lined by plump, atypical endothelial cells; and large fibroblasts with atypical nuclei. These atypical histologic changes resemble, in part, those described in association with systemic chemotherapeutic agents, such as etoposide, busulfan, and bleomycin. We conclude that topical nitrogen mustard should be added to the list of chemotherapeutic agents that can produce atypical histologic changes in the skin.
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Affiliation(s)
- V B Reddy
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
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32
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Abstract
Observation of cortisol and behavioral responses to routine inoculation was conducted at 18 months for infants in a longitudinal sample whose stress responses had been observed at 2, 4, and 6 months of age. At 18 months, infants showed an increase in cortisol level over base to the perturbation. The magnitude of this response did not differ from the 6-month response. Moreover, level of cortisol response at 18 months was related to level of cortisol response at 6 months, but not at 2 or 4 months of age. In light of previous findings for a decline in cortisol response between 2 and 6 months had for the emergence of consistent individual differences in cortisol response by 4 to 6 months, the present findings indicate that a developmental shift in adrenocortical functioning has occurred by 6 months of age.
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Affiliation(s)
- M Lewis
- Institute for the Study of Child Development, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick 08903-0019, USA
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34
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Fukuyama K, Matsuzawa K, Hubbard SL, Dirks P, Rulka JT, Maisuzawa K, Hubbard SL, Rutka JT, Del Maestro RF, Vaithilingam IS, McDonald W, Weiss JB, Mikkelsen T, Kohn E, Nclson K, Rosenblum ML, Guha A, Shamah S, Stiles C, Dooley NP, Baltuch GH, Roslworowski M, Villemure JG, Yong VW, Baltuch G, Rostworowski M, Couldwell WT, Hinton DR, Weiss MH, Law R, Couldwell WT, Hinton DR, Law R, Weiss MH, Piepmeier JM, Pedersen PE, Greer CA, Dirks PB, Hubbard SL, Taghian A, Budach W, Freeman J, Gioioso D, Suit HD, Turner J, Barron G, Zia P, Wong CS, Van Dyk J, Milosevic M, Laperriere NJ, Myles ST, Lauryssen C, Shaw EG, Scheithauer BW, Suman V, Katzmann J, Preul M, Shenouda G, Langleben A, Arnold D, Watling C, van Meyel D, Ramsay D, Cairncross G, Bahary JP, Wainer I, Pollak M, Leyland-Jones B, Tsatoumas A, Choi A, Rosenfeld SS, Gillespie GY, Gladson CL, Drake JM, Hoffman HJ, Humphreys RP, Holowka S, Fullon DS, Urtasun RC, Hamilton MG, Beals S, Joganic E, Spetzler R, Buckner JC, Schaefer PL, Dinapolit RP, O'Fallon JR, Burch PA, Chandler CL, Hopkins K, Coakham HB, Bullimore J, Kemshead JT, Bernstein M, Laperriere N, MeKenzie S, Glen J, Lee D, Macdonald D, Sneed PK, Gulin PG, Larson DA, McDermott MW, Prados MD, Wara WM, Weaver KA, Gaspar L, Zamorano L, Garcia L, Shamsa F, Warmelink C, Yakar D, Espinosa JA, Souhami L, Caron JL, Olivier A, Podgorsak EB, Lindquist C, Loeffler JS, Lunsford LD, Newton HB, Kotur MD, Papp AC, Prior TW, Roosen N, Chopra R, Windham J, Parliament M, Franko A, Mielke B, Feindel W, Tampieri D, Mechtler LL, Wilheim-Leitch S, Shin K, Kinkel WR, Hammoud MA, Sawaya R, Shi W, Thall PP, Leeds N, Patel M, Truax B, Kinkel P, Cheng TM, O'Ncill BP, Piepgras DG, Frost PJ, Simpson WJS, Payne DG, Pintilie M, Ramsay DA, Bonnin J, Macdonald DR, Assis L, Villemurel JG, Choi S, Leblancl R, Olivieri A, Bertrandl G, Hazel J, Grand W, Plunkett R, Munschauer F, Ostrow P, Mcchtler L, Meckling S, Dold O, Forsyth P, Brasher P, Hagen N, Hudson LP, Cooke AL, Muller PJ, Tucker W, Moulton R, Cusimano M, Bilbao J, Pahapill PA, Sibala C, West C, Fisher B, Pexman W, Taylor J, Lee T, McKenzie SW, Zengmin T, Zonghui L, Kirby S, Fisher BJ, Stewart DJ, Roa W, McClean B, Buckney S, Halls S, Richardson S, Wilson BC, Whitton AC, Borr RD, Rhydderch H, Case T, Feeny D, Furlong W, Torrance GW. Abstracts of the 6th Canadian Neuro-Oncology Meeting May 18–21, 1994 Lake Louise, Alberta. J Neurooncol 1994. [DOI: 10.1007/bf01306460] [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: 11/29/2022]
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35
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Ramsay D, Coid DR. Assessment of the structures and functions of Fife core dementia teams. J Manag Med 1993; 8:65-71. [PMID: 10172129 DOI: 10.1108/02689239410059651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A research partnership was formed between Fife Regional Council's Social Work Department, Fife Health Board and the Dementia Services Development Centre and Social Work Research Centre of Stirling University, to investigate the multi-disciplinary dementia teams which operate in Fife. The primary method of data collection was a series of group interviews with the six dementia teams: the teams were autonomous coalitions of professionals from various agencies and organizations who met together voluntarily. The informal nature of the teams has permitted them to operate without a defined set of purposes or objectives, enabling the participants to work together with a degree of pragmatism according to professional values and agency policies. There was wide agreement within the teams that the coordination of multi-agency services to clients was much improved and inter-personal relations between different professionals had become much better developed since the operation of teams.
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Abstract
A 53-year-old man presented with a paraganglioma of the cauda equina that caused significant hemodynamic instability during removal. The clinical implications of this phenomenon are discussed.
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Affiliation(s)
- B Toyota
- Department of Neurosurgery, Victoria Hospital Corporation, London, Ontario, Canada
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37
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Brousseau P, Simard P, Dewailly E, Meisels M, Ramsay D, Joly J. Impact of the ring-billed gull (Larus delawarensis) on the microbiological quality of recreational water. Appl Environ Microbiol 1993; 59:1228-30. [PMID: 8489231 PMCID: PMC202265 DOI: 10.1128/aem.59.4.1228-1230.1993] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We evaluated the impact of the ring-billed gull (Larus delawarensis) on the microbiological quality of water. We measured fecal coliforms, Salmonella spp., and Aeromonas spp. in the gull droppings and the number of fecal coliforms in the water prior to and after attracting these birds to the beach with food. Gulls can contribute to the bacteriological degradation of recreational water.
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Liegner KB, Shapiro JR, Ramsay D, Halperin AJ, Hogrefe W, Kong L. Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection. J Am Acad Dermatol 1993; 28:312-4. [PMID: 8436647 DOI: 10.1016/0190-9622(93)70043-s] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [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: 01/30/2023]
Abstract
Erythema migrans recurred in a patient 6 months after a course of treatment with minocycline for Lyme disease. Polymerase chain reaction on heparinized peripheral blood at that time demonstrated the presence of Borrelia burgdorferi-specific DNA. The patient was seronegative by Lyme enzyme-linked immunosorbent assay but showed suspicious bands on Western blot. Findings of a Warthin-Starry stain of a skin biopsy specimen of the eruption revealed a Borrelia-compatible structure. Reinfection was not believed to have occurred. Further treatment with minocycline led to resolution of the erythema migrans.
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Affiliation(s)
- K B Liegner
- Department of Medicine, Northern Westchester Hospital Center, Mount Kisco, NY
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39
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Carter H, Gorman D, Ramsay D, Turvey T. The dependent elderly: a comparative survey of institutional care in Fife. Health Bull (Edinb) 1992; 50:433-40. [PMID: 1483869] [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: 12/27/2022]
Abstract
Dependency levels were assessed in 441 elderly people in long term geriatric hospital care, 488 living in private nursing homes and 637 in the local authority residential homes in Fife. Results indicated that the most dependent were in hospital care, the most able in residential homes with private nursing homes accommodating elderly people with intermediate dependency levels. While each care setting cares for severely dependent elderly people, up to 29% of those in residential homes, 24% of those in nursing homes and 6% of hospital residents were considered by care staff to be fully independent. The implications of this in relation to the future provision and pattern of long term care for the frail elderly in Fife are considerable.
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40
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Ramsay D, Thrasher TN. Homeostatic mechanisms in the regulation of plasma osmolality. Acta Physiol Pol 1989; 40:275-81. [PMID: 2701837] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- D Ramsay
- Department of Physiology, University of California, San Francisco
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41
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Barthe C, Joly JR, Ramsay D, Boissinot M, Benhamou N. Common epitope on the lipopolysaccharide of Legionella pneumophila recognized by a monoclonal antibody. J Clin Microbiol 1988; 26:1016-23. [PMID: 2454935 PMCID: PMC266507 DOI: 10.1128/jcm.26.5.1016-1023.1988] [Citation(s) in RCA: 17] [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: 01/01/2023] Open
Abstract
Serogroup-specificity of Legionella pneumophila is related to lipopolysaccharide (LPS), and few cross-reactions between serogroups have been observed with rabbit or monkey antisera. C57BL/6 mice were sequentially immunized with crude outer membrane fractions of L. pneumophila serogroups 1, 5, and 7, Legionella bozemanii, and Legionella micdadei. Spleen cells from these mice were then fused with the Sp2-0/Ag14 mouse myeloma cell line. Outer membrane-rich fractions and LPS were prepared from L. pneumophila serogroups 1 to 8 and other Legionella and non-Legionella species. Immunoblots of these extracts were performed with monoclonal antibody obtained from these fusions. One of these monoclonal antibodies recognized an epitope common to all tested serogroups of L. pneumophila and attached to the major constituent of the outer membrane, LPS. This antibody did not react with other Legionella species and numerous gram-negative rods other than Pseudomonas fluorescens CDC93. This monoclonal antibody may be useful in preliminary identification of L. pneumophila as an alternative to direct fluorescent-antibody testing.
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Affiliation(s)
- C Barthe
- Département de Microbiologie, Faculté de Médecine, Université Laval, Quebec, Canada
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42
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Abstract
Psychosocial oncology has become an area of considerable interest over the past ten to fifteen years. There has been little written about the development of psychiatric services or the profile of such services to this population. This paper describes the historical evolution of a psychiatric consultation service in a cancer hospital and provides a statistical analysis of the patient population and services provided. The special need for continuity of care and a comprehensive biopsychosocial approach is elaborated and clinical examples are reported. Finally, directions for the future development of this kind of service are suggested.
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Affiliation(s)
- D Ramsay
- Princess Margaret Hospital, Toronto, Ontario
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Affiliation(s)
- D B Drachman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
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44
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Boissinot M, Ramsay D, Barthe C, Joly JR. Antigenic variability of the outer membrane antigens of Legionella pneumophila serogroups 1 to 8. Can J Microbiol 1987; 33:607-13. [PMID: 2444323 DOI: 10.1139/m87-106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 01/01/2023]
Abstract
The outer membrane proteins of Legionella pneumophila serogroups 1 to 8 were prepared from broken cells by selective solubilization using sodium lauryl sarcosinate. The isolated proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and transferred to nitrocellulose sheets. Rabbit antisera against each of the eight serogroups of L. pneumophila were obtained by immunizing each animal with live bacteria. The transferred proteins were revealed using these antisera and peroxidase-labeled swine anti-rabbit immunoglobulins. Antigenic determinants common to all eight serogroups were found in at least three outer membrane antigens (19, 29, and 45 kilodaltons (kDa)). However, cross-absorption experiments revealed that these three antigens were immunologically related, but not identical among serogroups. The antigenic relationships observed with two of these three antigens correlated well with cross-reactions observed in immunofluorescence. When a monoclonal antibody directed against L. pneumophila serogroup 1 lipopolysaccharide was used to reveal a blot of serogroup 1 outer membrane antigens, the 29- and 45-kDa bands appeared. This demonstrates a strong association between lipopolysaccharide and outer membrane proteins.
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Affiliation(s)
- M Boissinot
- Département de Microbiologie, Faculté de Médecine, Université Laval, Québec, Canada
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45
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Wieczorek R, Suhrland M, Ramsay D, Reed ML, Knowles DM. Leu-M1 antigen expression in advanced (tumor) stage mycosis fungoides. Am J Clin Pathol 1986; 86:25-32. [PMID: 3088980 DOI: 10.1093/ajcp/86.1.25] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The authors describe two patients with clinically and histopathologically documented advanced (tumor) stage mycosis fungoides. In each case the large, pleomorphic neoplastic cells lacked the monoclonal antibody-defined cell surface antigens commonly associated with immature and mature T-cells, i.e., T11, Leu-1, T3, T4, T6, T8, and T10, but expressed various T-cell-associated activation antigens, such as HLA-DR, Tac, and T21. Leu-M1, a monocyte-associated antigen, was not expressed by the small, cerebriform neoplastic cells in the plaque stage lesions of either patient. However, Leu-M1 was expressed by most of the large, pleomorphic neoplastic cells present in the nodular lesions of both patients. The pattern of Leu-M1 antigen expression was identical to that previously reported in the Reed-Sternberg cells of Hodgkin's disease. Identification of these two patients suggests using caution in the interpretation of the results of immunophenotypic analysis of cutaneous lymphoid neoplasms and that Leu-M1 should not be used as a diagnostic indicator of Hodgkin's disease or a histiocytic-derived neoplasm. These studies also suggest that Leu-M1 may be preferentially expressed on a subpopulation of activated, rapidly proliferating, and/or dedifferentiated neoplastic T-cells that proliferate in the advanced (tumor) stages of mycosis fungoides.
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Joly JR, McKinney RM, Tobin JO, Bibb WF, Watkins ID, Ramsay D. Development of a standardized subgrouping scheme for Legionella pneumophila serogroup 1 using monoclonal antibodies. J Clin Microbiol 1986; 23:768-71. [PMID: 3517064 PMCID: PMC362834 DOI: 10.1128/jcm.23.4.768-771.1986] [Citation(s) in RCA: 171] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A panel of monoclonal antibodies to Legionella pneumophila serogroup 1 and a subclassification scheme were developed in a collaborative project among three laboratories. The seven most useful monoclonal antibodies were selected from three previously developed panels on the basis of indirect fluorescent antibody patterns with 83 strains of L. pneumophila serogroup 1 that were obtained from widely distributed geographic locations. The isolates were divided into 10 major subgroups on the basis of reactivity patterns that can be readily reproduced in any laboratory and are not subject to major inconsistencies of interpretation of staining intensity. A standard protocol for the indirect fluorescent antibody procedure was also developed.
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Fiset L, Ramsay D, Milgrom P, Weinstein P. Effects of lidocaine with epinephrine on fear related arousal among dental phobics. Anesth Prog 1986; 33:225-9. [PMID: 3465257 PMCID: PMC2177493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The effects of 2% lidocaine containing 72 μg epinephrine on fear related arousal were tested using a cross-over design on dental patients fearful of injections and other dental procedures. Heart rate and body movement in the dental operatory were monitored, and subjects' self-reported upset in the Epinephrine condition than in the No-Epinephrine condition (F = 4.8, p = .04), but the clinical significance was negligible. No interaction between initial fear levels and the drug condition could be established. Results suggest that pre-existing dental fear levels may produce greater self-report, behavioral or physiological arousal in the dental operatory than exogenous epinephrine.
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Singer LM, Brodzinsky DM, Ramsay D, Steir M, Waters E. Mother-infant attachment in adoptive families. Child Dev 1985; 56:1543-51. [PMID: 4075872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Data from 2 separate samples using the Strange Situation paradigm were combined to assess the quality of attachment relationships in adoptive and nonadoptive mother-infant pairs. Infants were between 13 and 18 months at the time of observation. Results indicated no differences in mother-infant attachment between nonadopted and intraracial adopted subjects or between intraracial and interracial adopted subjects. Interracial adoptive mother-infant pairs did show a higher incidence of insecure attachment in comparison to nonadoptive pairs. Mothers of interracial adopted infants also were less comfortable having others care for their babies and perceived less emotional support from extended family and friends for their decision to adopt a child prior to the actual adoption than did other mothers. No relation was found, however, between quality of mother-infant attachment and either perceived social support, infant developmental quotient, infant temperament, number of foster homes experienced by the infant, or infant's age at the time of adoption placement. It was suggested that the higher incidence of psychological problems found among adoptees in middle childhood and adolescence cannot be explained in terms of insecure attachment relationships during the infancy years.
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Joly JR, Ramsay D. Use of monoclonal antibodies in the diagnosis and epidemiologic studies of legionellosis. Clin Lab Med 1985; 5:561-74. [PMID: 3899482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The routine use of monoclonal antibodies against L. pneumophila and other Legionellaceae has not yet reached the clinical microbiology laboratory. Most of these antibodies are still under evaluation and are not available commercially. However, it is obvious that some of them will be available in the next few years. Because of the numerous subtypes and serogroups of L. pneumophila already identified, extreme caution must be used before they are adopted routinely by a given laboratory. Testing against a large number of strains will have to be performed, and even then unidentified subtypes may not be recognized. Monoclonal antibodies against species-specific antigens of Legionella may prove to be the most useful for routine work, but once again a large number of strains will have to be tested before they are adopted. Under certain circumstances and especially in epidemiologic studies, well-chosen anti-L. pneumophila serogroup 1 monoclonal antibodies that define different subtypes may prove to be invaluable. This is currently the area in which the use of monoclonal antibodies against L. pneumophila is best defined.
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