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Tavabie OD, Abbott J, Abeysekera KWM, Balachandrakumar VK, Bennett K, Brennan P, Buchanan R, Dhaliwal A, Galanakis V, Hardy T, Harris R, Kronsten VT, Leighton J, Li W, Yin JL, Macken L, Marjot T, Maurice JB, McDowell H, Navaratnam J, Pohl K, Nayagam JS, Saunsbury E, Scott J, Sheth A, Sinharay R, Sheiybani G, Subhani M, Tavabie OD, Turner L, White H, Zakeri N, Balachandrakumar VK, Cook C, Hardy T, Harris R, Navaratnam J, Saunsbury E, Tavabie OD, Abbas N, Abbasi A, Abdul R, Abdulaziz M, Abduljabbar D, Abeysekera KWM, Adamson R, Adebayo D, Adhikarla AK, Adler M, Ahmad S, Ahmed S, Afifi M, Akram A, Al Radhi B, Al-Talib I, Alele J, Ali AM, Almusai S, Appleby V, Asmat H, Astbury S, Atkinson A, Badrulhisham F, Balachandrakumar VK, Ball A, Banfa M, Barn J, Begum S, Belfield K, Bendall O, Bhandari R, Bhatti P, Bradley M, Brennan P, Brown E, Bryce K, Burke L, Campbell R, Cargill T, Carroll G, Cartledge J, Chatterjee D, Chaundry R, Choudhry Z, Clare K, Cobbold J, Coburn R, Corvan F, Cox R, Craig D, Creamer J, Curran C, De Silva S, Dean L, Dillon J, Dunn R, Eckersley R, Eike G, Elagib A, Elkholi A, Elshaarawy O, Faloon S, Fan F, Fazili M, Fernandes D, Fox J, Foxton M, Gaba W, Gaikwad G, Gairola A, Galanakis V, Gallaher C, Gautam N, Germain L, Giles B, Gill C, Glover B, Glover J, Gomez D, Gomez M, Gordon V, Gormley S, Goulder J, Goyal S, Greenham O, Guthrie S, Hackett R, Haddadin Y, Hadjinicolaou A, Hall J, Haque T, Hardy T, Harris R, Hart C, Hasnain Nadir SM, Hassall J, Hasan S, Hawker-Bond G, Hawkyard J, Healey S, Hornby C, Hamza M, Humayun M, Hutchison J, Iftikhar Z, Ismail A, James J, Jopson L, Juthani D, Kaina P, Karim A, Karim SM, Kashyap V, Kassab M, Katarey D, Kenny L, Kerry G, Khan A, Khan A, Khan A, Khan MT, Khan T, Khatib A, Khattak MF, King JJ, Korani M, Kotha S, Kooner E, Lam WL, Lateef M, Leith D, Li W, Liaros A, Lourenco F, Lyles A, Mahenthiran M, Magee C, Maggs D, Mahalingam A, Mahmood R, Mandour MO, Manocha N, Mansour D, Marks D, Marjot T, Martin C, Martin H, Martin I, Martin K, Maruthan S, Masin R, Mason D, Matthews C, Mavrou A, Maxan E, Maxfield D, McAvoy E, McColl K, McCaughan H, McCorry R, McGoran J, McDonald S, McDowell H, McIlwane S, Meakin O, Mebarek L, Merrill H, Michail S, Modarres P, Mohamedali A, Mohammed Y, Mohammed Z, Mohan J, Monnier C, Moran E, Morrison G, Moroni F, Msaddi A, Mutar S, Navaratnam J, Neto-Pereira L, Nahed I, Ng J, Nwoguh C, O’Kane R, Omar S, Ososanya A, Parambil JV, Patel J, Pericleous M, Pervais Z, Phoolchund A, Pietrzycki J, Pillay L, Prabhu K, Putri YRF, Qazi U, Rafique KK, Raman K, Ranade V, Rastelli F, Ratcliffe E, Rattehalli D, Raza T, Razak A, Raghuraman A, Read G, Robins A, Rushbrook S, Salama M, St. Aimee L, Saravan R, Sarkar S, Saunsbury E, Serna S, Shahzad H, Shamsaldeen M, Sharip M, Shearer J, Sheikh A, Sheiybani G, Sheth A, Sherwin M, Shintre N, Singhal S, Sinha R, Sinharay R, Smith G, Smith R, Spicer J, Spoor J, Sreenivasan S, Srinivasa A, Srivastava A, Stagg G, Stanley J, Stevenson J, Stokes D, Stroud R, Subhani M, Suliman H, Sultana M, Summers N, Sutherland C, Swann R, Sykes L, Taha M, Tan KE, Tariq Z, Ming Tay JJ, Taylor A, Thakor A, Tsang J, Tyler Z, Unitt E, Volcek E, Wischhusen J, Watson I, Watters C, Wells G, Widlak M, Williams M, Woodland H, Wren L, Xyda S, Yeh J, Young A, Jie Yuan JS, Abbott J, Abeysekera KWM, Galanakis V, Li W, Sheth A, Sinharay R, Sheiybani G, Tavabie OD, Abbott J, Abeysekera KWM, Galanakis V, Li W, Sheth A, Sinharay R, Sheiybani G, Tavabie OD, Abeysekera KWM, Brennan P, Li W, Marjot T, Tavabie OD, Aithal G, Bernal W, Dillon J, Hogan B, McPherson S, Jones R, Rowe I, Snowdon V. Defining characteristics and outcomes for patients with non-alcoholic fatty liver disease admitted to hospital with decompensated cirrhosis. J Hepatol 2023; 79:e165-e167. [PMID: 37315808 DOI: 10.1016/j.jhep.2023.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023]
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Riaposova L, Kim SH, Hanyaloglu AC, Sykes L, MacIntyre DA, Bennett PR, Terzidou V. Prostaglandin F2α requires activation of calcium-dependent signalling to trigger inflammation in human myometrium. Front Endocrinol (Lausanne) 2023; 14:1150125. [PMID: 37547305 PMCID: PMC10400332 DOI: 10.3389/fendo.2023.1150125] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/06/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Preterm birth is one of the major causes of neonatal morbidity and mortality across the world. Both term and preterm labour are preceded by inflammatory activation in uterine tissues. This includes increased leukocyte infiltration, and subsequent increase in chemokine and cytokine levels, activation of pro-inflammatory transcription factors as NF-κB and increased prostaglandin synthesis. Prostaglandin F2α (PGF2α) is one of the myometrial activators and stimulators. Methods Here we investigated the role of PGF2α in pro-inflammatory signalling pathways in human myometrial cells isolated from term non-labouring uterine tissue. Primary myometrial cells were treated with G protein inhibitors, calcium chelators and/or PGF2α. Nuclear extracts were analysed by TranSignal cAMP/Calcium Protein/DNA Array. Whole cell protein lysates were analysed by Western blotting. mRNA levels of target genes were analysed by RT-PCR. Results The results show that PGF2α increases inflammation in myometrial cells through increased activation of NF-κB and MAP kinases and increased expression of COX-2. PGF2α was found to activate several calcium/cAMP-dependent transcription factors, such as CREB and C/EBP-β. mRNA levels of NF-κB-regulated cytokines and chemokines were also elevated with PGF2α stimulation. We have shown that the increase in PGF2α-mediated COX-2 expression in myometrial cells requires coupling of the FP receptor to both Gαq and Gαi proteins. Additionally, PGF2α-induced calcium response was also mediated through Gαq and Gαi coupling. Discussion In summary, our findings suggest that PGF2α-induced inflammation in myometrial cells involves activation of several transcription factors - NF-κB, MAP kinases, CREB and C/EBP-β. Our results indicate that the FP receptor signals via Gαq and Gαi coupling in myometrium. This work provides insight into PGF2α pro-inflammatory signalling in term myometrium prior to the onset of labour and suggests that PGF2α signalling pathways could be a potential target for management of preterm labour.
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Affiliation(s)
- Lucia Riaposova
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
| | - Sung Hye Kim
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
| | - Aylin C. Hanyaloglu
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Lynne Sykes
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
- The Parasol Foundation Centre for Women’s Health and Cancer Research, St Mary’s Hospital, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - David A. MacIntyre
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
| | - Phillip R. Bennett
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
| | - Vasso Terzidou
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
- Department of Obstetrics & Gynaecology, Chelsea and Westminster Hospital National Health Service (NHS) Trust, London, United Kingdom
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Tavabie OD, Abeysekera KWM, Brennan PN, Marjot T, Kronsten VT, Li W, Nayagam JS, Dhaliwal A, Hardy T, Maurice JB, Zakeri N, Abbas N, Abbasi A, Abbott J, Abdul R, Abdulaziz M, Abduljabbar D, Adamson R, Adebayo D, Adhikarla AK, Adler M, Afifi M, Ahmad S, Ahmed S, Aithal G, Akram A, Al Radhi B, Al-Talib I, Alele J, Ali AM, Almusai S, Appleby V, Asmat H, Astbury S, Atkinson A, Badrulhisham F, Balachandrakumar VK, Ball A, Banfa M, Barn J, Begum S, Belfield K, Bendall O, Bennett K, Bernal W, Bhandari R, Bhatti P, Bradley M, Brown E, Bryce K, Buchanan R, Burke L, Campbell R, Cargill T, Carroll G, Cartledge J, Chatterjee D, Chaundry R, Choudhry Z, Clare K, Cobbold J, Coburn R, Cook C, Corvan F, Cox R, Craig D, Creamer J, Curran C, De Silva S, Dean L, Dillon J, Dillon J, Dunn R, Eckersley R, Eike G, Elagib A, Elkholi A, Elshaarawy O, Faloon S, Fan F, Fazili M, Fernandes D, Fox J, Foxton M, Gaba W, Gaikwad G, Gairola A, Galanakis V, Gallaher C, Gautam N, Germain L, Giles B, Gill C, Glover B, Glover J, Gomez D, Gomez M, Gordon V, Gormley S, Goulder J, Goyal S, Greenham O, Guthrie S, Hackett R, Haddadin Y, Hadjinicolaou A, Hall J, Hamza M, Haque T, Harris R, Hart C, Hasan S, Hasnain Nadir SM, Hassall J, Hawker-Bond G, Hawkyard J, Healey S, Hogan B, Hornby C, Humayun MD, Hutchison J, Iftikhar Z, Ismail A, James J, Jones R, Jopson L, Juthani D, Kaina P, Karim A, Karim SM, Kashyap V, Kassab M, Katarey D, Kenny L, Kerry G, Khan A, Khan A, Khan A, Khan MT, Khan T, Khatib A, Khattak MF, King JJ, Kooner E, Korani M, Kotha S, Lam WL, Lateef M, Leighton J, Leith D, Liaros A, Liu Yin J, Lourenco F, Lyles A, Macken L, Magee C, Maggs D, Mahalingam A, Mahenthiran M, Mahmood R, Mandour MO, Manocha N, Mansour D, Marks D, Martin C, Martin H, Martin I, Martin K, Maruthan S, Masin R, Mason D, Matthews C, Mavrou A, Maxan E, Maxfield D, McAvoy E, McCaughan H, McColl K, McCorry R, McDonald S, McDowell H, McGoran J, McIlwane S, McPherson S, Meakin O, Mebarek L, Merrill H, Michail S, Modarres P, Mohamedali A, Mohammed Y, Mohammed Z, Mohan J, Monnier C, Moran E, Moroni F, Morrison G, Msaddi A, Mutar S, Nahed I, Navaratnam J, Neto-Pereira L, Ng J, Nwoguh C, O'Kane R, Omar S, Ososanya A, Parambil JV, Patel J, Pericleous M, Pervais Z, Phoolchund A, Pietrzycki J, Pillay L, Pohl K, Prabhu K, Putri YRF, Qazi U, Rafique KK, Raghuraman A, Raman K, Ranade V, Rastelli F, Ratcliffe E, Rattehalli D, Raza T, Razak A, Read G, Robins A, Rowe I, Rushbrook S, Salama M, Saravan R, Sarkar S, Saunsbury E, Scott J, Serna S, Shahzad H, Shamsaldeen M, Sharip M, Shearer J, Sheikh A, Sheiybani G, Sherwin M, Sheth A, Shintre N, Singhal S, Sinha R, Sinharay R, Smith G, Smith R, Snowdon V, Spicer J, Spoor J, Sreenivasan S, Srinivasa A, Srivastava A, St. Aimee L, Stagg G, Stanley J, Stevenson J, Stokes D, Stroud R, Subhani M, Suliman H, Sultana M, Summers N, Sutherland C, Swann R, Sykes L, Taha M, Tan KE, Tariq Z, Tay JJM, Taylor A, Thakor A, Tsang J, Turner L, Tyler Z, Unitt E, Volcek E, Watson I, Watters C, Wells G, White H, Widlak M, Williams M, Wischhusen J, Woodland H, Wren L, Xyda S, Yeh J, Young A, Yuan JSJ. Regional variation in characteristics of patients with decompensated cirrhosis admitted to hospitals in the UK. Lancet Gastroenterol Hepatol 2023; 8:604-606. [PMID: 37148900 DOI: 10.1016/s2468-1253(23)00114-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/08/2023]
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Bayar E, MacIntyre DA, Sykes L, Mountain K, Parks TP, Lee PP, Bennett PR. Safety, tolerability, and acceptability of Lactobacillus crispatus CTV-05 (LACTIN-V) in pregnant women at high-risk of preterm birth. Benef Microbes 2023; 14:45-56. [PMID: 36815494 DOI: 10.3920/bm2022.0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The vaginal microbiota is a determinant for the risk of preterm birth (PTB). Dominance of the vaginal niche by Lactobacillus crispatus associates with term delivery. This is the first observational clinical study of live vaginal biotherapeutics (Lactobacillus crispatus CTV-05 (LACTIN-V)) in pregnant women at high-risk of PTB. The primary aim was to explore safety, tolerability and acceptability of LACTIN-V in pregnancy. Women were offered a course of LACTIN-V at 14 weeks gestation for five consecutive days followed by weekly administration for six weeks. Participants were followed up at 15, 18-, 20-, 28- and 36-weeks' gestation and at delivery for assessment of adverse events, compliance and tolerability. Participants completed a questionnaire to gauge experience and acceptability. In total, 73 women were recruited, of whom eight withdrew, leaving a final cohort size of 61. Self-reported compliance to the course was high (56/60, 93%). Solicited adverse events were reported in 13 women (19%) including changes in vaginal discharge, odour, colour or consistency of urine, itching and vaginal bleeding. One unsolicited adverse event was reported as haematuria at 38 weeks gestation, but was judged to be unrelated to LACTIN-V. No serious adverse events occurred. One mild adverse event led to study withdrawal. Thirty-one women completed an experience and acceptability questionnaire. Women found LACTIN-V easy and comfortable to use and the majority (30/31, 97%) would use LACTIN-V in future pregnancies. Eight women (8/31, 26%) found the schedule of use difficult to remember. The rate of PTB <34 weeks in this cohort was 3.3% compared to 7% in a historical cohort of 2,190 women at similar background PTB risk. With satisfactory uptake and good compliance, we demonstrate that LACTIN-V is safe and accepted in pregnancy, with high tolerability. Further studies are needed to assess colonisation of Lactobacillus crispatus CTV-05 and clinical efficacy.
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Affiliation(s)
- E Bayar
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, United Kingdom
- March of Dimes European Prematurity Research Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, UK, United Kingdom
| | - D A MacIntyre
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, United Kingdom
- March of Dimes European Prematurity Research Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, UK, United Kingdom
- Tommy's National Centre for Miscarriage Research. Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, United Kingdom
| | - L Sykes
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, United Kingdom
- March of Dimes European Prematurity Research Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, UK, United Kingdom
- The Parasol Foundation Centre for Women's Health and Cancer Research, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY
| | - K Mountain
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, United Kingdom
- March of Dimes European Prematurity Research Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, UK, United Kingdom
| | - T P Parks
- Osel Inc., 320 Logue Ave # 114, Mountain View, CA 94043, USA
| | - P P Lee
- Osel Inc., 320 Logue Ave # 114, Mountain View, CA 94043, USA
| | - P R Bennett
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, United Kingdom
- March of Dimes European Prematurity Research Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, UK, United Kingdom
- Tommy's National Centre for Miscarriage Research. Imperial College London, Hammersmith Hospital Campus, Du Cane Road, W120NN London, United Kingdom
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Gimeno-Molina B, Muller I, Kropf P, Sykes L. The Role of Neutrophils in Pregnancy, Term and Preterm Labour. Life (Basel) 2022; 12:life12101512. [PMID: 36294949 PMCID: PMC9605051 DOI: 10.3390/life12101512] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Neutrophils are surveillance cells, and the first to react and migrate to sites of inflammation and infection following a chemotactic gradient. Neutrophils play a key role in both sterile inflammation and infection, performing a wide variety of effector functions such as degranulation, phagocytosis, ROS production and release of neutrophil extracellular traps (NETs). Healthy term labour requires a sterile pro-inflammatory process, whereas one of the most common causes of spontaneous preterm birth is microbial driven. Peripheral neutrophilia has long been described during pregnancy, and evidence exists demonstrating neutrophils infiltrating the cervix, uterus and foetal membranes during both term and preterm deliveries. Their presence supports a role in tissue remodelling via their effector functions. In this review, we describe the effector functions of neutrophils. We summarise the evidence to support their role in healthy pregnancy and labour and describe their potential contribution to microbial driven preterm birth.
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Affiliation(s)
- Belen Gimeno-Molina
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0HS, UK
- March of Dimes European Prematurity Research Centre, Imperial College London, London W12 0HS, UK
| | - Ingrid Muller
- Department of Infectious Diseases, Imperial College London, London W2 1NY, UK
| | - Pascale Kropf
- March of Dimes European Prematurity Research Centre, Imperial College London, London W12 0HS, UK
- Department of Infectious Diseases, Imperial College London, London W2 1NY, UK
| | - Lynne Sykes
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0HS, UK
- March of Dimes European Prematurity Research Centre, Imperial College London, London W12 0HS, UK
- The Parasol Foundation Centre for Women’s Health and Cancer Research, St. Mary’s Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Correspondence:
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Petrou L, Latvanen E, Seichepine F, Kim SH, Bennett PR, Sykes L, MacIntyre DA, Terzidou V, Ladame S. Lateral Flow Test (LFT) Detects Cell‐Free MicroRNAs Predictive of Preterm Birth Directly from Human Plasma. Advanced NanoBiomed Research 2022. [DOI: 10.1002/anbr.202200026] [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: 11/09/2022] Open
Affiliation(s)
- Loukia Petrou
- Department of Bioengineering Imperial College London W12 0BZ London UK
| | - Elmeri Latvanen
- Department of Bioengineering Imperial College London W12 0BZ London UK
| | | | - Sung Hye Kim
- March of Dimes European Preterm Birth Research Centre Imperial College London W12 0NN London UK
- Institute of Reproductive and Developmental Biology Imperial College London W12 0NN London UK
| | - Phillip R. Bennett
- March of Dimes European Preterm Birth Research Centre Imperial College London W12 0NN London UK
- Institute of Reproductive and Developmental Biology Imperial College London W12 0NN London UK
- Queen Charlotte's and Chelsea Hospital Imperial College NHS Trust W12 0HS London UK
- Department of Obstetrics & Gynaecology Chelsea and Westminster Hospital NHS Trust SW10 9NH London UK
| | - Lynne Sykes
- March of Dimes European Preterm Birth Research Centre Imperial College London W12 0NN London UK
- Institute of Reproductive and Developmental Biology Imperial College London W12 0NN London UK
- The Parasol Foundation Centre for Women's Health and Cancer Research St Mary's Hospital Imperial College NHS Trust W2 1NY London UK
| | - David A. MacIntyre
- March of Dimes European Preterm Birth Research Centre Imperial College London W12 0NN London UK
- Institute of Reproductive and Developmental Biology Imperial College London W12 0NN London UK
| | - Vasso Terzidou
- March of Dimes European Preterm Birth Research Centre Imperial College London W12 0NN London UK
- Institute of Reproductive and Developmental Biology Imperial College London W12 0NN London UK
- Department of Obstetrics & Gynaecology Chelsea and Westminster Hospital NHS Trust SW10 9NH London UK
| | - Sylvain Ladame
- Department of Bioengineering Imperial College London W12 0BZ London UK
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Akpalu A, Sykes L, Nkromah K, Attoh J, Osei-Yeboah C, Johnson L, Amponsah C, Laryea F, Anarfi O, Shaw A, Cullen L, Easton S, Fullbrook-Scanlon C, Gordon C, Spice C. Experiences of Multidisciplinary Working: Perspectives from the Wessex Ghana Stroke Partnership. West Afr J Med 2022; 39:641-645. [PMID: 35752973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Substantial gaps remain in our understanding of stroke in Africa as well as in stroke care, practice and policy on the continent. The effective organization of preventative, therapeutic and rehabilitative stroke services continue to be challenging in many African countries. METHODOLOGY In this article we define the nature, function and benefits of effective multidisciplinary team (MDT) working. The experiences and perspectives of members of the MDT were collated by focus group discussions as well as individual and country specific contributions. RESULTS The experiences and perspectives of multidisciplinary team members from the United Kingdom and Ghana implementing these practices at the first stroke unit in Korle Bu Teaching Hospital, Accra, with a transparent discussion of successes and challenges faced throughout development of the service, is presented. MDT working has improved outcomes for patients and families who use the services, including encouraging better shared treatment planning and compliance. More stroke rehabilitation services are provided than previously, including greater self-management education and better secondary prevention care. CONCLUSION It is hoped that this article will provide an inspirational model for others working to provide stroke care in low-resource settings in Africa and worldwide.
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Affiliation(s)
- A Akpalu
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Ghana
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
| | - L Sykes
- Hampshire Hospitals NHS Trust, Royal Hampshire County Hospital, Winchester, UK
| | - K Nkromah
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
| | - J Attoh
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
| | | | - L Johnson
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - C Amponsah
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
- University of Ghana School of Biomedical and Allied Health Sciences, Department of Speech and Language Therapy, Ghana
| | - F Laryea
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
| | - O Anarfi
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
- University of Health and Allied Sciences School of Medicine, Department of Psychological Medicine and Mental Health, Ghana
| | - A Shaw
- University of Winchester, Winchester, UK
| | - L Cullen
- NHS England Southeast, Southampton, UK
| | - S Easton
- Hampshire Hospitals NHS Trust, Royal Hampshire County Hospital, Winchester, UK
| | | | - C Gordon
- University of Central Lancashire, Faculty of Health and Social Care, Preston, UK
| | - C Spice
- Queen Alexandra Hospital, Southwick Hill, Portsmouth, UK
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Chan D, Bennett PR, Lee YS, Kundu S, Teoh TG, Adan M, Ahmed S, Brown RG, David AL, Lewis HV, Gimeno-Molina B, Norman JE, Stock SJ, Terzidou V, Kropf P, Botto M, MacIntyre DA, Sykes L. Microbial-driven preterm labour involves crosstalk between the innate and adaptive immune response. Nat Commun 2022; 13:975. [PMID: 35190561 PMCID: PMC8861006 DOI: 10.1038/s41467-022-28620-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 01/28/2022] [Indexed: 01/04/2023] Open
Abstract
There has been a surge in studies implicating a role of vaginal microbiota in spontaneous preterm birth (sPTB), but most are associative without mechanistic insight. Here we show a comprehensive approach to understand the causative factors of preterm birth, based on the integration of longitudinal vaginal microbiota and cervicovaginal fluid (CVF) immunophenotype data collected from 133 women at high-risk of sPTB. We show that vaginal depletion of Lactobacillus species and high bacterial diversity leads to increased mannose binding lectin (MBL), IgM, IgG, C3b, C5, IL-8, IL-6 and IL-1β and to increased risk of sPTB. Cervical shortening, which often precedes preterm birth, is associated with Lactobacillus iners and elevated levels of IgM, C3b, C5, C5a and IL-6. These data demonstrate a role for the complement system in microbial-driven sPTB and provide a scientific rationale for the development of live biotherapeutics and complement therapeutics to prevent sPTB. Gaining mechanistic insight into the microbiological and immunological factors that are associated with spontaneous preterm birth is important for the development of prevention strategies. Here authors show that the complement system in conjunction with specific vaginal microbial and associated immunological changes are contributing to this condition.
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9
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Kim SH, MacIntyre DA, Sykes L, Arianoglou M, Bennett PR, Terzidou V. Whole Blood Holding Time Prior to Plasma Processing Alters microRNA Expression Profile. Front Genet 2022; 12:818334. [PMID: 35096023 PMCID: PMC8795683 DOI: 10.3389/fgene.2021.818334] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
MicroRNAs (miRNAs) can exhibit aberrant expression under different physiological and pathological conditions. Therefore, differentially expressed circulating miRNAs have been a focus of biomarker discovery research. However, the use of circulating miRNAs comes with challenges which may hinder the reliability for their clinical application. These include varied sample collection protocols, storage times/conditions, sample processing and analysis methods. This study focused on examining the effect of whole blood holding time on the stability of plasma miRNA expression profiles. Whole blood samples were collected from healthy pregnant women and were held at 4°C for 30 min, 2 h, 6 h or 24 h prior to processing for plasma isolation. Plasma RNA was extracted and the expression of 179 miRNAs were analyzed. Unsupervised principal component analysis demonstrated that whole blood holding time was a major source of variation in miRNA expression profiles with 53 of 179 miRNAs showing significant changes in expression. Levels of specific miRNAs previously reported to be associated with pregnancy-associated complications such as hsa-miR-150-5p, hsa-miR-191-5p, and hsa-miR-29a-3p, as well as commonly used endogenous miRNA controls, hsa-miR-16-5p, hsa-miR-25-3p, and hsa-miR-223-3p were significantly altered with increase in blood holding time. Current protocols for plasma-based miRNA profiling for diagnostics describe major differences in whole blood holding periods ranging from immediately after collection to 26 h after. Our results demonstrate holding time can have dramatic effects on analytical reliability and reproducibility. This highlights the importance of standardization of blood holding time prior to processing for plasma in order to minimize introduction of non-biological variance in miRNA profiles.
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Affiliation(s)
- Sung Hye Kim
- Parturition Group, Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
| | - David A MacIntyre
- Parturition Group, Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
| | - Lynne Sykes
- Parturition Group, Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
| | - Maria Arianoglou
- Parturition Group, Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
| | - Phillip R Bennett
- Parturition Group, Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
| | - Vasso Terzidou
- Parturition Group, Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, United Kingdom
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10
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Rasheed ZBM, Lee YS, Kim SH, Teoh T, MacIntyre DA, Bennett PR, Sykes L. 15-Deoxy-Delta-12,14-prostaglandin J2 modulates pro-labour and pro-inflammatory responses in human myocytes, vaginal and amnion epithelial cells. Front Endocrinol (Lausanne) 2022; 13:983924. [PMID: 36213265 PMCID: PMC9533017 DOI: 10.3389/fendo.2022.983924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prematurity is the leading cause of childhood death under the age of five. The aetiology of preterm birth is multifactorial; however, inflammation and infection are the most common causal factors, supporting a potential role for immunomodulation as a therapeutic strategy. 15-Deoxy-Delta-12,14-prostaglandin J2 (15dPGJ2) is an anti-inflammatory prostaglandin and has been shown to delay lipopolysaccharide (LPS) induced preterm labour in mice and improve pup survival. This study explores the immunomodulatory effect of 15dPGJ2 on the transcription factors NF-κB and AP-1, pro-inflammatory cytokines, and contraction associated proteins in human cultured myocytes, vaginal epithelial cell line (VECs) and primary amnion epithelial cells (AECs). METHODS Cells were pre-incubated with 32µM of 15dPGJ2 and stimulated with 1ng/mL of IL-1β as an in vitro model of inflammation. Western immunoblotting was used to detect phosphorylated p-65 and phosphorylated c-Jun as markers of NF-κB and AP-1 activation, respectively. mRNA expression of the pro-inflammatory cytokines IL-6, IL-8, and TNF-α was examined, and protein expression of COX-2 and PGE2 were detected by western immunoblotting and ELISA respectively. Myometrial contractility was examined ex-vivo using a myograph. RESULTS 15dPGJ2 inhibited IL-1β-induced activation of NF-κB and AP-1, and expression of IL-6, IL-8, TNF-α, COX-2 and PGE2 in myocytes, with no effect on myometrial contractility or cell viability. Despite inhibiting IL-1β-induced activation of NF-κB, expression of IL-6, TNF-α, and COX-2, 15dPGJ2 led to activation of AP-1, increased production of PGE2 and increased cell death in VECs and AECs. CONCLUSION We conclude that 15dPGJ2 has differential effects on inflammatory modulation depending on cell type and is therefore unlikely to be a useful therapeutic agent for the prevention of preterm birth.
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Affiliation(s)
- Zahirrah BM. Rasheed
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Universiti Kebangsaan Malaysia (UKM) Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yun S. Lee
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Prematurity Research Centre, Imperial College London, London, United Kingdom
| | - Sung H. Kim
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Prematurity Research Centre, Imperial College London, London, United Kingdom
| | - Tg Teoh
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Prematurity Research Centre, Imperial College London, London, United Kingdom
- The Parasol Foundation Centre for Women’s Health and Cancer Research, St Mary’s Hospital, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - David A. MacIntyre
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Prematurity Research Centre, Imperial College London, London, United Kingdom
| | - Phillip R. Bennett
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Prematurity Research Centre, Imperial College London, London, United Kingdom
| | - Lynne Sykes
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- March of Dimes European Preterm Birth Prematurity Research Centre, Imperial College London, London, United Kingdom
- The Parasol Foundation Centre for Women’s Health and Cancer Research, St Mary’s Hospital, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
- *Correspondence: Lynne Sykes,
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11
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Pruski P, Correia GDS, Lewis HV, Capuccini K, Inglese P, Chan D, Brown RG, Kindinger L, Lee YS, Smith A, Marchesi J, McDonald JAK, Cameron S, Alexander-Hardiman K, David AL, Stock SJ, Norman JE, Terzidou V, Teoh TG, Sykes L, Bennett PR, Takats Z, MacIntyre DA. Direct on-swab metabolic profiling of vaginal microbiome host interactions during pregnancy and preterm birth. Nat Commun 2021; 12:5967. [PMID: 34645809 PMCID: PMC8514602 DOI: 10.1038/s41467-021-26215-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
The pregnancy vaginal microbiome contributes to risk of preterm birth, the primary cause of death in children under 5 years of age. Here we describe direct on-swab metabolic profiling by Desorption Electrospray Ionization Mass Spectrometry (DESI-MS) for sample preparation-free characterisation of the cervicovaginal metabolome in two independent pregnancy cohorts (VMET, n = 160; 455 swabs; VMET II, n = 205; 573 swabs). By integrating metataxonomics and immune profiling data from matched samples, we show that specific metabolome signatures can be used to robustly predict simultaneously both the composition of the vaginal microbiome and host inflammatory status. In these patients, vaginal microbiota instability and innate immune activation, as predicted using DESI-MS, associated with preterm birth, including in women receiving cervical cerclage for preterm birth prevention. These findings highlight direct on-swab metabolic profiling by DESI-MS as an innovative approach for preterm birth risk stratification through rapid assessment of vaginal microbiota-host dynamics.
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Affiliation(s)
- Pamela Pruski
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine Imperial College London, London, UK
| | - Gonçalo D S Correia
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine Imperial College London, London, UK
- National Phenome Centre, Imperial College London, London, UK
| | - Holly V Lewis
- March of Dimes Prematurity Research Centre at Imperial College London, London, UK
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - Katia Capuccini
- March of Dimes Prematurity Research Centre at Imperial College London, London, UK
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Paolo Inglese
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine Imperial College London, London, UK
- National Phenome Centre, Imperial College London, London, UK
| | - Denise Chan
- March of Dimes Prematurity Research Centre at Imperial College London, London, UK
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - Richard G Brown
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - Lindsay Kindinger
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Yun S Lee
- March of Dimes Prematurity Research Centre at Imperial College London, London, UK
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ann Smith
- Faculty of Health and Applied Sciences, University West of England, Bristol, UK
| | - Julian Marchesi
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine Imperial College London, London, UK
- March of Dimes Prematurity Research Centre at Imperial College London, London, UK
| | - Julie A K McDonald
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK
| | - Simon Cameron
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine Imperial College London, London, UK
- School of Biological Sciences, Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - Kate Alexander-Hardiman
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine Imperial College London, London, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Sarah J Stock
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Jane E Norman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Vasso Terzidou
- March of Dimes Prematurity Research Centre at Imperial College London, London, UK
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Chelsea & Westminster Hospital, NHS Trust, London, UK
| | - T G Teoh
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Lynne Sykes
- March of Dimes Prematurity Research Centre at Imperial College London, London, UK
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - Phillip R Bennett
- March of Dimes Prematurity Research Centre at Imperial College London, London, UK
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Zoltan Takats
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine Imperial College London, London, UK.
- National Phenome Centre, Imperial College London, London, UK.
- March of Dimes Prematurity Research Centre at Imperial College London, London, UK.
| | - David A MacIntyre
- March of Dimes Prematurity Research Centre at Imperial College London, London, UK.
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK.
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12
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Bell JS, James BD, Al-Chalabi S, Sykes L, Kalra PA, Green D. Community- versus hospital-acquired acute kidney injury in hospitalised COVID-19 patients. BMC Nephrol 2021; 22:269. [PMID: 34301204 PMCID: PMC8299737 DOI: 10.1186/s12882-021-02471-2] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background Acute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood. Methods Data was collected on all adult patients who returned a positive COVID-19 swab while hospitalised at a large UK teaching hospital between 1st March 2020 and 3rd June 2020. Patients were stratified into community- and hospital-acquired AKI based on the timing of AKI onset. Results Out of the 448 eligible patients with COVID-19, 118 (26.3 %) recorded an AKI during their admission. Significant independent risk factors for community-acquired AKI were chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure and respiratory rate. Similar risk factors were significant for hospital-acquired AKI including CKD and trough systolic blood pressure, peak heart rate, peak CRP and trough lymphocytes during admission. In addition, invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted odds ratio 9.1, p < 0.0001) while atrial fibrillation conferred a protective effect (adjusted odds ratio 0.29, p < 0.0209). Mortality was significantly higher for patients who had an AKI compared to those who didn’t have an AKI (54.3 % vs. 29.4 % respectively, p < 0.0001). On Cox regression, hospital-acquired AKI was significantly associated with mortality (adjusted hazard ratio 4.64, p < 0.0001) while community-acquired AKI was not. Conclusions AKI occurred in over a quarter of our hospitalised COVID-19 patients. Community- and hospital-acquired AKI have many shared risk factors which appear to converge on a pre-renal mechanism of injury. Hospital- but not community acquired AKI was a significant risk factor for death.
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Affiliation(s)
- Jack S Bell
- Salford Royal NHS Foundation Trust, Salford, UK.
| | | | - Saif Al-Chalabi
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Lynne Sykes
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Darren Green
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Emergency Assessment Unit, Salford Royal NHS Foundation Trust, Salford, UK
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13
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Pikovsky M, Tan MY, Ahmed A, Sykes L, Agha-Jaffar R, Yu CKH. Euglycaemic ketoacidosis in pregnant women with COVID-19: two case reports. BMC Pregnancy Childbirth 2021. [PMID: 34134652 DOI: 10.1186/s12884‐021‐03928‐w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Euglycaemic ketoacidosis (EKA) is an infrequent but serious condition which usually follows a period of starvation, severe vomiting or illness in individuals with or without diabetes. Ketoacidosis is associated with materno-fetal morbidity and mortality necessitating prompt diagnosis and management. Physiological increases in insulin resistance render pregnancy a diabetogenic state with increased susceptibility to ketosis. COVID-19 is associated with worse clinical outcomes in patients with diabetes and is an independent risk factor for ketoacidosis in normoglycaemic individuals. CASE PRESENTATIONS We describe two cases of SARS-CoV-2 positive pregnant women presenting with normoglycaemic metabolic ketoacidosis. Both cases were associated with maternal and fetal compromise, requiring aggressive fluid and insulin resuscitation and early delivery. CONCLUSION We discuss possible physiology and propose a management strategy for euglycaemic ketoacidosis in pregnancy.
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Affiliation(s)
- Margaret Pikovsky
- St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK
| | - Min Yi Tan
- St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK
| | - Amanda Ahmed
- St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK
| | - Lynne Sykes
- St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK.,March of Dimes Prematurity Research Centre, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0HS, UK
| | - Rochan Agha-Jaffar
- Endocrinology Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W1 2NY, UK
| | - Christina K H Yu
- St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK.
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14
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Pikovsky M, Tan MY, Ahmed A, Sykes L, Agha-Jaffar R, Yu CKH. Euglycaemic ketoacidosis in pregnant women with COVID-19: two case reports. BMC Pregnancy Childbirth 2021; 21:427. [PMID: 34134652 PMCID: PMC8207493 DOI: 10.1186/s12884-021-03928-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background Euglycaemic ketoacidosis (EKA) is an infrequent but serious condition which usually follows a period of starvation, severe vomiting or illness in individuals with or without diabetes. Ketoacidosis is associated with materno-fetal morbidity and mortality necessitating prompt diagnosis and management. Physiological increases in insulin resistance render pregnancy a diabetogenic state with increased susceptibility to ketosis. COVID-19 is associated with worse clinical outcomes in patients with diabetes and is an independent risk factor for ketoacidosis in normoglycaemic individuals. Case presentations We describe two cases of SARS-CoV-2 positive pregnant women presenting with normoglycaemic metabolic ketoacidosis. Both cases were associated with maternal and fetal compromise, requiring aggressive fluid and insulin resuscitation and early delivery. Conclusion We discuss possible physiology and propose a management strategy for euglycaemic ketoacidosis in pregnancy.
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Affiliation(s)
- Margaret Pikovsky
- St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK
| | - Min Yi Tan
- St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK
| | - Amanda Ahmed
- St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK
| | - Lynne Sykes
- St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK.,March of Dimes Prematurity Research Centre, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0HS, UK
| | - Rochan Agha-Jaffar
- Endocrinology Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W1 2NY, UK
| | - Christina K H Yu
- St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK.
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15
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James B, Sykes L, Flanagan E, Sinha S, Kalra P, Green D. Mortality risk by peak serum creatinine in hospital episodes complicated by acute kidney injury. Clin Med (Lond) 2021; 20:s109-s110. [PMID: 32409413 DOI: 10.7861/clinmed.20-2-s109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Lynne Sykes
- Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Smeeta Sinha
- Salford Royal NHS Foundation Trust, Salford, UK and University of Manchester, Manchester, UK
| | - Philip Kalra
- Salford Royal NHS Foundation Trust, Salford, UK and University of Manchester, Manchester, UK
| | - Darren Green
- Salford Royal NHS Foundation Trust, Salford, UK and University of Manchester, Manchester, UK
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16
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Zarasvand S, Bayar E, Adan M, Mountain K, Lewis H, Joash K, Teoh TG, Bennett PR, Das S, Sykes L. Rapid quality improvement in a preterm birth clinic care pathway during the COVID-19 pandemic. BMJ Open Qual 2021; 9:bmjoq-2020-001049. [PMID: 33372041 PMCID: PMC7771216 DOI: 10.1136/bmjoq-2020-001049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022] Open
Abstract
Background Preterm birth (PTB) occurs in 8% of births in the UK. At Imperial College Healthcare NHS Trust, our PTB prevention clinic manages the care of approximately 1000 women/year. Women referred to the clinic are seen from 12 weeks of pregnancy with subsequent appointments every 2–4 weeks to measure cervical length (CL) using transvaginal ultrasound (TVUS). Women with a history of cervical weakness or short cervix on TVUS are offered a cervical cerclage. Local problem During the COVID-19 outbreak, pregnant women were strongly advised to avoid social mixing and public transport. The National Health Service had to rapidly adopt remote consultation and redesign clinical pathways in order to reduce transmission, exposure and spread among women at high risk of PTB. Methods We focused on Specific, Measurable, Achievable, Realistic and Timebound aims and used a driver diagram to visualise our changes. We used a series of Plan Do Study Act cycles to evaluate and adapt change ideas through the UK’s national lockdown during the COVID-19 pandemic between 23 March and 29 May 2020. Results We reduced the number of face-to-face appointments by 54%. This was achieved by increasing remote telephone consultations from 0% to 64%, and by reducing the intensity of surveillance. The rate of regional anaesthetic was increased from 53% to 95% for cerclage placement in order to minimise the number of aerosol-generating procedures. Patient and staff satisfaction responses to these changes were used to tailor practices. No women tested positive for COVID-19 during the study period. Conclusions By using quality improvement methodology, we were able to safely and rapidly implement a new care pathway for women at high risk of PTB which was acceptable to patients and staff, and effective in reducing exposure of COVID-19.
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Affiliation(s)
- Sara Zarasvand
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
| | - Erna Bayar
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
| | - Malko Adan
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK.,March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
| | - Katherine Mountain
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
| | - Holly Lewis
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
| | - Karen Joash
- Imperial College Healthcare NHS Trust, London, UK
| | - T G Teoh
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
| | - Phillip R Bennett
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK.,March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
| | - Sabrina Das
- Imperial College Healthcare NHS Trust, London, UK
| | - Lynne Sykes
- Imperial College Healthcare NHS Trust, London, UK .,Imperial College London, London, UK.,March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
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17
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Rasheed ZBM, Lee YS, Kim SH, Rai RK, Ruano CSM, Anucha E, Sullivan MHF, MacIntyre DA, Bennett PR, Sykes L. Differential Response of Gestational Tissues to TLR3 Viral Priming Prior to Exposure to Bacterial TLR2 and TLR2/6 Agonists. Front Immunol 2020; 11:1899. [PMID: 32983111 PMCID: PMC7477080 DOI: 10.3389/fimmu.2020.01899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/15/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Infection/inflammation is an important causal factor in spontaneous preterm birth (sPTB). Most mechanistic studies have concentrated on the role of bacteria, with limited focus on the role of viruses in sPTB. Murine studies support a potential multi-pathogen aetiology in which a double or sequential hit of both viral and bacterial pathogens leads to a higher risk preterm labour. This study aimed to determine the effect of viral priming on bacterial induced inflammation in human in vitro models of ascending and haematogenous infection. Methods: Vaginal epithelial cells, and primary amnion epithelial cells and myocytes were used to represent cell targets of ascending infection while interactions between peripheral blood mononuclear cells (PBMCs) and placental explants were used to model systemic infection. To model the effect of viral priming upon the subsequent response to bacterial stimuli, each cell type was stimulated first with a TLR3 viral agonist, and then with either a TLR2 or TLR2/6 agonist, and responses compared to those of each agonist alone. Immunoblotting was used to detect cellular NF-κB, AP-1, and IRF-3 activation. Cellular TLR3, TLR2, and TLR6 mRNA was quantified by RT-qPCR. Immunoassays were used to measure supernatant cytokine, chemokine and PGE2 concentrations. Results: TLR3 (“viral”) priming prior to TLR2/6 agonist (“bacterial”) exposure augmented the pro-inflammatory, pro-labour response in VECs, AECs, myocytes and PBMCs when compared to the effects of agonists alone. In contrast, enhanced anti-inflammatory cytokine production (IL-10) was observed in placental explants. Culturing placental explants in conditioned media derived from PBMCs primed with a TLR3 agonist enhanced TLR2/6 agonist stimulated production of IL-6 and IL-8, suggesting a differential response by the placenta to systemic inflammation compared to direct infection as a result of haematogenous spread. TLR3 agonism generally caused increased mRNA expression of TLR3 and TLR2 but not TLR6. Conclusion: This study provides human in vitro evidence that viral infection may increase the susceptibility of women to bacterial-induced sPTB. Improved understanding of interactions between viral and bacterial components of the maternal microbiome and host immune response may offer new therapeutic options, such as antivirals for the prevention of PTB.
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Affiliation(s)
- Zahirrah B M Rasheed
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yun S Lee
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.,March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
| | - Sung H Kim
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.,March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
| | - Ranjit K Rai
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Camino S M Ruano
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.,INSERM U1016 Institut Cochin, Paris, France
| | - Eberechi Anucha
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Mark H F Sullivan
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - David A MacIntyre
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.,March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
| | - Phillip R Bennett
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.,March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
| | - Lynne Sykes
- Imperial College Parturition Research Group, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.,March of Dimes European Preterm Birth Research Centre, Imperial College London, London, United Kingdom
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18
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Abstract
Preterm birth is a global health concern and continues to contribute to substantial neonatal morbidity and mortality despite advances in obstetric and neonatal care. The underlying aetiology is multi-factorial and remains incompletely understood. In this review, the complex interplay between the vaginal microbiome in pregnancy and its association with preterm birth is discussed in depth. Advances in the study of bacteriology and an improved understanding of the human microbiome have seen an improved awareness of the vaginal microbiota in both health and in disease.
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Affiliation(s)
- Erna Bayar
- Imperial College Parturition Research Group, Institute for Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 0HS, UK
| | - Phillip R Bennett
- Imperial College Parturition Research Group, Institute for Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 0HS, UK.
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK.
| | - Denise Chan
- Imperial College Parturition Research Group, Institute for Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 0HS, UK
| | - Lynne Sykes
- Imperial College Parturition Research Group, Institute for Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 0HS, UK
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
| | - David A MacIntyre
- Imperial College Parturition Research Group, Institute for Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 0HS, UK
- March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
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19
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Ashworth E, Sykes L, Fothergill J, Kadioglu A. P141 Investigating an ajoene derivative as a new combination therapy with antibiotics against Pseudomonas aeruginosa infections. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30476-8] [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: 11/26/2022]
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20
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Bailey S, Hunt C, Brisley A, Howard S, Sykes L, Blakeman T. Implementation of clinical decision support to manage acute kidney injury in secondary care: an ethnographic study. BMJ Qual Saf 2020; 29:382-389. [PMID: 31796574 PMCID: PMC7241968 DOI: 10.1136/bmjqs-2019-009932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Over the past decade, acute kidney injury (AKI) has become a global priority for improving patient safety and health outcomes. In the UK, a confidential inquiry into AKI led to the publication of clinical guidance and a range of policy initiatives. National patient safety directives have focused on the mandatory establishment of clinical decision support systems (CDSSs) within all acute National Health Service (NHS) trusts to improve the detection, alerting and response to AKI. We studied the organisational work of implementing AKI CDSSs within routine hospital care. METHODS An ethnographic study comprising non-participant observation and interviews was conducted in two NHS hospitals, delivering AKI quality improvement programmes, located in one region of England. Three researchers conducted a total of 49 interviews and 150 hours of observation over an 18-month period. Analysis was conducted collaboratively and iteratively around emergent themes, relating to the organisational work of technology adoption. RESULTS The two hospitals developed and implemented AKI CDSSs using very different approaches. Nevertheless, both resulted in adaptive work and trade-offs relating to the technology, the users, the organisation and the wider system of care. A common tension was associated with attempts to maximise benefit while minimise additional burden. In both hospitals, resource pressures exacerbated the tensions of translating AKI recommendations into routine practice. CONCLUSIONS Our analysis highlights a conflicted relationship between external context (policy and resources), and organisational structure and culture (eg, digital capability, attitudes to quality improvement). Greater consideration is required to the long-term effectiveness of the approaches taken, particularly in light of the ongoing need for adaptation to incorporate new practices into routine work.
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Affiliation(s)
- Simon Bailey
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Carianne Hunt
- Liverpool Health Partners, University of Liverpool, Liverpool, Merseyside, UK
| | - Adam Brisley
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Susan Howard
- Emergency Admissions Unit, Salford Royal Hospitals NHS Trust, Salford, Salford, UK
| | - Lynne Sykes
- Emergency Admissions Unit, Salford Royal Hospitals NHS Trust, Salford, Salford, UK
| | - Thomas Blakeman
- Centre for Primary Care, University of Manchester, Manchester, UK
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21
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Ridout AE, Ibeto LA, Ross GN, Cook JR, Sykes L, David AL, Seed PT, Tribe RM, Bennett PR, Terzidou V, Shennan AH, Chandiramani M, Brown RG, Chatfield S, Sadeh D, Sadeh D. Cervical length and quantitative fetal fibronectin in the prediction of spontaneous preterm birth in asymptomatic women with congenital uterine anomaly. Am J Obstet Gynecol 2019; 221:341.e1-341.e9. [PMID: 31132343 DOI: 10.1016/j.ajog.2019.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/28/2019] [Revised: 05/11/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Congenital uterine anomalies are associated with late miscarriage and spontaneous preterm birth. OBJECTIVE Our aim was 1) to determine the rate of spontaneous preterm birth in each type of congenital uterine anomaly, and 2) to assess the performance of quantitative fetal fibronectin and cervical length measurement by transvaginal ultrasound in asymptomatic women with congenital uterine anomalies for the prediction of spontaneous preterm birth at <34 and <37 weeks of gestation. MATERIALS AND METHODS This was a retrospective cohort of women with congenital uterine anomalies asymptomatic for spontaneous preterm birth, from 4 tertiary referral centers in the United Kingdom (2001-2016). Congenital uterine anomalies were categorized into fusion (unicornuate, didelphic, and bicornuate uteri) or resorption defects (septate, with or without resection, and arcuate uteri), based on prepregnancy diagnosis. All women underwent serial transvaginal ultrasound cervical length assessment in the second trimester (16 to 24 weeks' gestation); a subgroup underwent quantitative fetal fibronectin testing from 18 weeks' gestation. We investigated the relationship between congenital uterine anomalies and predictive test performance for spontaneous preterm birth at <34 and <37 weeks' gestation. RESULTS A total of 319 women were identified as having congenital uterine anomalies in our high-risk population. Of the women, 7% (23/319) delivered spontaneously at <34 weeks' gestation and 18% (56/319) at <37 weeks' gestation. Rates of spontaneous preterm birth by type were as follows: 26% (7/27) for unicornuate, 21% (7/34) for didelphic, 16% (31/189) for bicornuate, 13% (7/56) for septate, and 31% (4/13) for arcuate. In all, 80% (45/56) of women who had spontaneous preterm birth at <37 weeks did not develop a short cervical length (<25 mm) during the surveillance period (16-24 weeks). The diagnostic accuracy of short cervical length had a low sensitivity (20.3) for predicting spontaneous preterm birth at <34 weeks. Cervical length had an area under the receiver operating curve of 0.56 (95% confidence interval, 0.48-0.64) and 0.59 (95% confidence interval, 0.55-0.64) for prediction of spontaneous preterm birth at <34 and <37 weeks, respectively. The area under the curve for cervical length to predict spontaneous preterm birth at <34 weeks was 0.48 for fusion defects (95% confidence interval, 0.39-0.57) but 0.78 (95% confidence interval, 0.66-0.91) for women with resorption defects. Overall quantitative fetal fibronectin had an area under the curve of 0.63 (95% confidence interval, 0.49-0.77) and 0.58 (95% confidence interval, 0.49- 0.68) for prediction of spontaneous preterm birth at <34 and <37 weeks, respectively. The area under the curve for prediction of spontaneous preterm birth at <37 weeks with quantitative fetal fibronectin for fusion defects was 0.52 (95% confidence interval, 0.41-0.63) but 0.79 (95% confidence interval, 0.63-0.95) for women with resorption defects. Results were similar when women with intervention were excluded. CONCLUSION The commonly used markers cervical length and quantitative fetal fibronectin have utility in prediction of spontaneous preterm birth in resorption congenital uterine defects but not in fusion defects. This is contrary to findings in other high-risk populations. These findings need to be accounted for when planning antenatal care, and have potential implications for predictive tests used in spontaneous preterm birth surveillance and intervention.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dana Sadeh
- UCL EGA Institute for Women's Health, University College London, London, UK
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22
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Sykes L, Asar O, Ritchie J, Raman M, Vassallo D, Alderson HV, O’Donoghue DJ, Green D, Diggle PJ, Kalra PA. The influence of multiple episodes of acute kidney injury on survival and progression to end stage kidney disease in patients with chronic kidney disease. PLoS One 2019; 14:e0219828. [PMID: 31318937 PMCID: PMC6638939 DOI: 10.1371/journal.pone.0219828] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 07/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background Acute kidney injury (AKI) and chronic kidney disease (CKD) are common syndromes associated with significant morbidity, mortality and cost. The extent to which repeated AKI episodes may cumulatively affect the rate of progression of all-cause CKD has not previously been investigated. In this study, we explored the hypothesis that repeated episodes of AKI increase the rate of renal functional deterioration loss in patients recruited to a large, all-cause CKD cohort. Methods Patients from the Salford Kidney Study (SKS) were considered. Application of KDIGO criteria to all available laboratory measurements of renal function identified episodes of AKI. A competing risks model was specified for four survival events: Stage 1 AKI; stage 2 or 3 AKI; dialysis initiation or transplant before AKI event; death before AKI event. The model was adjusted for patient age, gender, smoking status, alcohol intake, diabetic status, cardiovascular co-morbidities, and primary renal disease. Analyses were performed for patients’ first, second, and third or more AKI episodes. Results A total of 48,338 creatinine measurements were available for 2287 patients (median 13 measures per patient [IQR 6–26]). There was a median age of 66.8years, median eGFR of 28.4 and 31.6% had type 1 or 2 diabetes. Six hundred and forty three (28.1%) patients suffered one or more AKI events; 1000 AKI events (58% AKI 1) in total were observed over a median follow-up of 2.6 years [IQR 1.1–3.2]. In patients who suffered an AKI, a second AKI was more likely to be a stage 2 or 3 AKI than stage 1 [HR 2.04, p 0.01]. AKI events were associated with progression to RRT, with multiple episodes of AKI progressively increasing likelihood of progression to RRT [HR 14.4 after 1 episode of AKI, HR 28.4 after 2 episodes of AKI]. However, suffering one or more AKI events was not associated with an increased risk of mortality. Conclusions AKI events are associated with more rapid CKD deterioration as hypothesised, and also with a greater severity of subsequent AKI. However, our study did not find an association of AKI with increased mortality risk in this CKD cohort.
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Affiliation(s)
- Lynne Sykes
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Ozgur Asar
- Department of Biostatistics and Medical Informatics, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - James Ritchie
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Maharajan Raman
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Diana Vassallo
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Helen V. Alderson
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Donal J. O’Donoghue
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Darren Green
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- * E-mail:
| | - Peter J. Diggle
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Philip A. Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
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23
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Sykes L, Taleb H, Preece J, Williams D, Neef D, Oldham H, Dixon G. WS01-5 A novel class of quorum sensing inhibitors prevent biofilm formation and reduce virulence of respiratory pathogens and are progressing to preclinical development. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30121-3] [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: 11/25/2022]
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24
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Sykes L, Asar O, Ritchie J, Diggle P, Kalra PA. FO073THE EFFECT OF REPEATED ACUTE KIDNEY INJURY ON SURVIVAL AND PROGRESSION TO END STAGE KIDNEY DISEASE IN CKD. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz096.fo073] [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: 11/12/2022] Open
Affiliation(s)
- Lynne Sykes
- Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Osgur Asar
- Acibadem University Hospital Atakent, Istanbul, Turkey, Turkey
| | - James Ritchie
- Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Peter Diggle
- Lancaster University, Bailrigg, Lancaster, UK, Bailrigg, United Kingdom
| | - Phillip A Kalra
- Salford Royal NHS Foundation Trust, Manchester, United Kingdom
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25
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Sykes L, Taleb H, Rice P, Preece J, Williams D, Neef D, Dixon G. P104 A novel class of compounds that inhibit biofilm formation and reduce the virulence and motility of respiratory pathogens. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30398-4] [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: 11/26/2022]
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26
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Sykes L, Kalra PA, Green D. Comparison of impact on death and critical care admission of acute kidney injury between common medical and surgical diagnoses. PLoS One 2019; 14:e0215105. [PMID: 30973921 PMCID: PMC6459489 DOI: 10.1371/journal.pone.0215105] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background Acute Kidney Injury (AKI) is common and associated with increased morbidity and mortality. This retrospective analysis quantified and compared the association between AKI and the risk of death and admission to critical care in acute admissions of different aetiology. Methods Data were extracted anonymously from the Trust ‘data warehouse’ for admissions between 2011and 2017. We applied KDIGO AKI criteria to establish AKI stage. Odds ratios (OR) for death and critical care admission were calculated for patients with AKI stage 3 (compared to all other patients), and patients with any stage AKI (compared to non-AKI admissions). Analyses were performed using logistic regression, adjusted for age, pre-existing CKD, co-morbid index, and gender. Results There were 26,052 medical and 12,560 surgical patient episodes within sixteen common diagnoses with 3823 medical and 1520 surgical patients with AKI events. The likelihood of AKI was highest in sepsis (31.8%), and the likelihood of death in AKI 3 highest in femoral neck fracture (54.5%). AKI 3 has a OR for death for acute coronary syndrome of 12.8 and a OR of 24.6 in femoral neck fracture. Admission to critical care for any AKI in medical patients has a OR of 9.6, but increases to OR 37.2 for heart failure. Conclusion The clinical impact of AKI differs across medical and surgical diagnoses, but is a significant contributor to the risk for death and critical care admission. This body of work may indicate a benefit to a more diagnosis-specific stratified approach to AKI care.
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Affiliation(s)
- Lynne Sykes
- Emergency Assessment Unit, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
- * E-mail:
| | - Philip A. Kalra
- Renal department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
| | - Darren Green
- Emergency Assessment Unit, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
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27
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Sykes L, Sinha S, Hegarty J, Flanagan E, Doyle L, Hoolickin C, Edwards L, Ferris P, Lamerton E, Poulikakos D, Green D, Nipah R. Reducing acute kidney injury incidence and progression in a large teaching hospital. BMJ Open Qual 2018; 7:e000308. [PMID: 30555931 PMCID: PMC6267307 DOI: 10.1136/bmjoq-2017-000308] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 12/23/2017] [Revised: 09/13/2018] [Accepted: 10/12/2018] [Indexed: 11/04/2022] Open
Abstract
Acute kidney injury (AKI) is a common syndrome that is associated with significant mortality and cost. The Quality Improvement AKI Collaborative at Salford Royal Foundation Trust was established to review and improve both the recognition and management of AKI. This was a whole-system intervention to tackle AKI implemented as an alternative to employing separate AKI nurses. Our aims were to reduce the overall incidence of AKI by 10%, to reduce hospital-acquired AKI by 25% and to reduce the progression of AKI from stage 1 to stage 2 or 3 by 50%. From 2014 to 2016, several multifaceted changes were introduced. These included system changes, such as inserting an e-alert for AKI into the electronic patient record, an online educational package and face-to-face teaching for AKI, and AKI addition to daily safety huddles. On 10 Collaborative wards, development of an AKI care bundle via multidisciplinary team (MDT) plan, do, study, act testing occurred. Results showed a 15.6% reduction in hospital-wide-acquired AKI, with a 22.3% reduction on the collaborative wards. Trust-wide rates of progression of AKI 1 to AKI 2 or 3 showed normal variation, whereas there was a 48.5% reduction in AKI progression on the Collaborative wards. This implies that e-alerts were ineffective in isolation. The Collaborative wards' results were a product of the educational support, bundle and heightened awareness of AKI. A number of acute hospitals have demonstrated impactful successes in AKI reduction centred on a dedicated AKI nurse model plus e-alerting with supporting changes. This project adds value by highlighting another approach that does not require a new post with attendant rolling costs and risks. We believe that our approach increased our efficacy in acute care in our front-line teams by concentrating on embedding improved recognition and actions across the MDT.
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Affiliation(s)
- Lynne Sykes
- Emergency Admission Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Smeeta Sinha
- Renal Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Janet Hegarty
- Renal Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Emma Flanagan
- Information Management and Technology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Liam Doyle
- Quality Improvement, Salford Royal NHS Foundation Trust, Salford, UK
| | - Chedia Hoolickin
- Quality Improvement, Salford Royal NHS Foundation Trust, Salford, UK
| | - Lewis Edwards
- Quality Improvement, Salford Royal NHS Foundation Trust, Salford, UK
| | - Paul Ferris
- Intensive Care, Salford Royal NHS Foundation Trust, Salford, UK
| | | | | | - Darren Green
- Emergency Admission Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Robert Nipah
- Emergency Admissions Unit, Royal Preston Hospital, Preston, UK
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28
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Abstract
Acute kidney injury (AKI) is independently associated with significant morbidity and mortality, and is thus an important challenge facing physicians in modern healthcare. This narrative review assesses the impact of strategies employed to tackle AKI following the 2009 NCEPOD report on acute kidney injury (Sterwart et al. Acute kidney injury: adding insult to injury, pp 1-22, 2009). There is scarce and heterogeneous research into hard end points such as mortality and AKI progression for AKI interventions. This review found that e-alerts have varying effects on mortality and AKI progression, but decrease the incidence of contrast-induced AKI. The use of AKI bundles delivers statistically significant improvements in mortality and AKI progression. Similarly, AKI nurses generate statistically significant improvements on hospital acquired AKI and mortality. As yet there is no evidence base for the effects of education, sick day rules and smart phone apps. Overall, a combination of e-alerts and AKI bundles supported by education yielded the most effective and statistically significant results. Current practice revolves around reactive rather than preventative behaviour. This narrative review discusses reactive interventions and their impact on the progression and severity of AKI, and on mortality from it. Preventative behaviour, such as risk stratification and early intervention in the deteriorating patient, may be influential in decreasing AKI incidence.
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Affiliation(s)
- Lynne Sykes
- Emergency Assessment Unit, Salford Royal NHS Foundation Trust, MAHSC, Stott Lane, Salford, M6 8HD, UK.
- Division of Cardiovascular Sciences, University of Manchester, MAHSC, Manchester, UK.
| | - Rob Nipah
- Emergency Assessment Unit, Salford Royal NHS Foundation Trust, MAHSC, Stott Lane, Salford, M6 8HD, UK
- Division of Cardiovascular Sciences, University of Manchester, MAHSC, Manchester, UK
| | - Philip Kalra
- Division of Cardiovascular Sciences, University of Manchester, MAHSC, Manchester, UK
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, MAHSC, Salford, UK
| | - Darren Green
- Emergency Assessment Unit, Salford Royal NHS Foundation Trust, MAHSC, Stott Lane, Salford, M6 8HD, UK
- Division of Cardiovascular Sciences, University of Manchester, MAHSC, Manchester, UK
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, MAHSC, Salford, UK
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29
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Cook JR, Chatfield S, Chandiramani M, Kindinger L, Cacciatore S, Sykes L, Teoh T, Shennan A, Terzidou V, Bennett PR. Cerclage position, cervical length and preterm delivery in women undergoing ultrasound indicated cervical cerclage: A retrospective cohort study. PLoS One 2017; 12:e0178072. [PMID: 28570639 PMCID: PMC5453689 DOI: 10.1371/journal.pone.0178072] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 05/05/2017] [Indexed: 11/28/2022] Open
Abstract
Objective The objectives were to assess whether anatomical location of ultrasound (USS) indicated cervical cerclage and/or the degree of cervical shortening (cervical length; CL) prior to and following cerclage affects the risk of preterm birth (PTB). Method A retrospective cohort study of 179 women receiving cerclage for short cervix (≤25mm) was performed. Demographic data, CL before and after cerclage insertion, height of cerclage (distance from external os) and gestation at delivery were collected. Relative risk (RR) and odds ratio (OR) of preterm delivery were calculated according to the anatomical location of the cerclage within the cervix and the CL before and after cerclage as categorical and continuous variables. Partition tree analysis was used to identify the threshold cerclage height that best predicts PTB. Results 25% (n = 45) delivered <34 weeks and 36% (n = 65) delivered <37 weeks. Risk of PTB was greater with cerclage in the distal 10mm (RR2.37, 95% CI 1.45–3.87) or the distal half of a closed cervix (RR2.16, 95% CI 1.45–3.87). Increasing absolute cerclage height was associated with a reduction in PTB (OR 0.87, 95% CI 0.82–0.94). A cerclage height <14.5 mm best predicts PTB (70.8%). Increasing CL following cerclage was associated with a reduction in PTB (OR0.87, 95% CI 0.82–0.94). Conversely, the risk of PTB was increased where CL remained static or shortened further following cerclage (RR2.34, 95% CI 1.04–5.25). Conclusion The higher a cerclage was placed within a shortened cervix, the lower the subsequent odds of PTB. Women whose cerclage is placed in the distal 10mm of closed cervix or whose cervix fails to elongate subsequently, should remain under close surveillance as they have the highest risk of PTB.
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Affiliation(s)
- Joanna R. Cook
- Parturition Research Group, Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom
| | - Susan Chatfield
- Parturition Research Group, Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom
| | - Manju Chandiramani
- Parturition Research Group, Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom
- Women's Health Academic Centre, King’s Health Partners, King’s College, St Thomas' Hospital Campus, Westminster Bridge Road, London, United Kingdom
| | - Lindsay Kindinger
- Parturition Research Group, Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom
| | - Stefano Cacciatore
- Parturition Research Group, Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom
| | - Lynne Sykes
- Parturition Research Group, Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom
| | - Tiong Teoh
- Parturition Research Group, Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom
| | - Andrew Shennan
- Women's Health Academic Centre, King’s Health Partners, King’s College, St Thomas' Hospital Campus, Westminster Bridge Road, London, United Kingdom
| | - Vasso Terzidou
- Parturition Research Group, Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom
- * E-mail:
| | - Phillip R. Bennett
- Parturition Research Group, Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom
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Sykes L, Reed A, Lamerton E. SP833EVALUATING PHARMACIST MEDICATION INTERVENTIONS IN EMERGENCY ADMISSIONS WITH COMMUNITY ACQUIRED ACUTE KIDNEY INJURY IN A LARGE TEACHING HOSPITAL. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx159.sp833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sykes L, Nipah R, Ritchie J. SO044THE INTRODUCTION OF A NOVEL SMARTPHONE APP TO TACKLE ACUTE KIDNEY INJURY IN NORTH WEST ENGLAND. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx107.so044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sykes L, Thomson KR, Boyce EJ, Lee YS, Rasheed ZBM, MacIntyre DA, Teoh TG, Bennett PR. Sulfasalazine augments a pro-inflammatory response in interleukin-1β-stimulated amniocytes and myocytes. Immunology 2015; 146:630-44. [PMID: 26395271 DOI: 10.1111/imm.12534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 10/28/2014] [Revised: 08/26/2015] [Accepted: 09/04/2015] [Indexed: 12/26/2022] Open
Abstract
Preterm birth occurs in 10% of pregnancies and is a major cause of neonatal morbidity and mortality. The majority of cases of early preterm labour are associated with infection/inflammation, which places the fetal central nervous system at risk. Targeting immune activation is therefore an appealing therapeutic strategy for the prevention of preterm labour and neonatal brain injury. The expression of many labour-associated and inflammatory-response genes is controlled by the transcription factors nuclear factor-κB (NF-κB) and activator protein-1 (AP-1), which makes them therapeutic targets of interest. Sulfasalazine (SASP) has been shown to inhibit NF-κB and reduce lipopolysaccharide-induced cytokine concentrations in fetal membrane explants and reduce the rate of Escherichia coli-induced preterm labour in mice. Its effects upon AP-1 in the context of pregnancy are unknown. In this study the effect of SASP on interleukin-1β (IL-1β) -induced NF-κB and AP-1 activity, cytokine production and cyclo-oxygenase-2 (COX-2) expression was examined in amniocytes and myocytes. A supra-therapeutic concentration (5 mm) was required to inhibit IL-1β-induced NF-κB (P < 0·0001) in amniocytes and IL-1β-induced NF-κB (P < 0·01), AP-1 (P < 0·01) and COX-2 (P < 0·05) in myocytes. Despite inhibiting IL-1β-induced cytokines, a basal increase in IL-6 (P < 0·01), IL-8 (P < 0·0001) and tumour necrosis factor-α (TNF-α) (P < 0·001) was seen with 5 mm SASP in amniocytes, and significant cytotoxic effects were seen in myocytes. The therapeutic concentration of 0·015 mm had no inhibitory effects on pro-inflammatory mediators, but led to an augmented response to IL-1β-induced IL-6 (P < 0·01), IL-8 (P < 0·05) and TNF-α (P < 0·05) in amniocytes and IL-8 (P < 0·05) in myocytes. SASP is therefore an unlikely therapeutic candidate for the prevention of inflammation-induced preterm labour.
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Affiliation(s)
- Lynne Sykes
- Department of Surgery and Cancer, Parturition Research Group, Institute of Reproduction and Developmental Biology, Imperial College London, London, UK
| | - Kacie R Thomson
- Department of Surgery and Cancer, Parturition Research Group, Institute of Reproduction and Developmental Biology, Imperial College London, London, UK
| | - Emily J Boyce
- Department of Surgery and Cancer, Parturition Research Group, Institute of Reproduction and Developmental Biology, Imperial College London, London, UK
| | - Yun S Lee
- Department of Surgery and Cancer, Parturition Research Group, Institute of Reproduction and Developmental Biology, Imperial College London, London, UK
| | - Zahirrah B M Rasheed
- Department of Surgery and Cancer, Parturition Research Group, Institute of Reproduction and Developmental Biology, Imperial College London, London, UK
| | - David A MacIntyre
- Department of Surgery and Cancer, Parturition Research Group, Institute of Reproduction and Developmental Biology, Imperial College London, London, UK
| | - Tiong Ghee Teoh
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Phillip R Bennett
- Department of Surgery and Cancer, Parturition Research Group, Institute of Reproduction and Developmental Biology, Imperial College London, London, UK
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Migale R, Herbert BR, Lee YS, Sykes L, Waddington SN, Peebles D, Hagberg H, Johnson MR, Bennett PR, MacIntyre DA. Specific Lipopolysaccharide Serotypes Induce Differential Maternal and Neonatal Inflammatory Responses in a Murine Model of Preterm Labor. Am J Pathol 2015. [PMID: 26212908 DOI: 10.1016/j.ajpath.2015.05.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intrauterine inflammation is recognized as a key mediator of both normal and preterm birth but is also associated with neonatal neurological injury. Lipopolysaccharide (LPS) is often used to stimulate inflammatory pathways in animal models of infection/inflammation-induced preterm labor; however, inconsistencies in maternal and neonatal responses to LPS are frequently reported. We hypothesized that LPS serotype-specific responses may account for a portion of these inconsistencies. Four different Escherichia coli LPS serotypes (O111:B4, O55:B5, O127:B8, and O128:B12) were administered to CD1 mice via intrauterine injection at gestational day 16. Although control animals delivered at term 60 ± 15 hours postinjection (p.i.), those administered with O111:B4 delivered 7 ± 2 hours p.i., O55:B5 delivered 10 ± 3 hours p.i., O127:B8 delivered 16 ± 10 hours p.i., and O128:B12 delivered 17 ± 2 hours p.i. (means ± SD). A correlation between the onset of preterm labor and myometrial activation of the inflammatory transcription factor, activator protein 1, but not NF-κB was observed. Specific LPS serotypes induced differential activation of downstream contractile and inflammatory pathways in myometrium and neonatal pup brain. Our findings demonstrate functional disparity in inflammatory pathway activation in response to differing LPS serotypes. Selective use of LPS serotypes may represent a useful tool for targeting specific inflammatory response mechanisms in these models.
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Affiliation(s)
- Roberta Migale
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Bronwen R Herbert
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom; Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Yun S Lee
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Lynne Sykes
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Simon N Waddington
- Gene Transfer Technology Group, Institute for Women's Health, University College London, London, United Kingdom; Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of the Witswatersrand, Johannesburg, South Africa
| | - Donald Peebles
- UCL Centre for Perinatal Brain Protection & Repair, Institute for Women's Health, University College London, London, United Kingdom
| | - Henrik Hagberg
- Department of Clinical Sciences, Perinatal Center, University of Gothenburg, Gothenburg, Sweden; Division of Imaging Sciences and Biomedical Engineering, Centre for the Developing Brain, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Mark R Johnson
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom; Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Phillip R Bennett
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - David A MacIntyre
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.
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Abstract
Preterm birth occurs in 10-12% of pregnancies and is the primary cause of neonatal mortality and morbidity. Tocolytic therapies have long been the focus for the prevention of preterm labour, yet they do not significantly improve neonatal outcome. A direct causal link exists between infection-induced inflammation and preterm labour. As inflammation and infection are independent risk factors for poor neonatal outcome, recent research focus has been shifted towards exploring the potential for anti-inflammatory strategies. Nuclear factor kappa B (NFκB) is a transcription factor that controls the expression of many labour-associated genes including PTGS2 (COX2), prostaglandins (PGs) and the oxytocin receptor (OXTR) as well as key inflammatory genes. Targeting the inhibition of NFκB is therefore an attractive therapeutic approach for both the prevention of preterm labour and for reducing neonatal exposure to inflammation. While PGs are considered to be pro-labour and pro-inflammatory, the cyclopentenone PG 15-deoxy-Δ(12,14)PGJ2 (15d-PGJ2) exhibits anti-inflammatory properties via the inhibition of NFκB in human amniocytes, myocytes and peripheral blood mononuclear cells in vitro. 15d-PGJ2 also delays inflammation-induced preterm labour in the mouse and significantly increases pup survival. This review examines the current understanding of inflammation in the context of labour and discusses how anti-inflammatory PGs may hold promise for the prevention of preterm labour and improved neonatal outcome.
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Affiliation(s)
- Lynne Sykes
- Parturition Research GroupDepartment of Surgery and Cancer, Institute of Reproduction and Developmental Biology, Imperial College London, London W12 0NN, UKSt Mary's HospitalImperial College Healthcare NHS Trust, London W1 2NY, UK
| | - David A MacIntyre
- Parturition Research GroupDepartment of Surgery and Cancer, Institute of Reproduction and Developmental Biology, Imperial College London, London W12 0NN, UKSt Mary's HospitalImperial College Healthcare NHS Trust, London W1 2NY, UK
| | - Tiong Ghee Teoh
- Parturition Research GroupDepartment of Surgery and Cancer, Institute of Reproduction and Developmental Biology, Imperial College London, London W12 0NN, UKSt Mary's HospitalImperial College Healthcare NHS Trust, London W1 2NY, UK
| | - Phillip R Bennett
- Parturition Research GroupDepartment of Surgery and Cancer, Institute of Reproduction and Developmental Biology, Imperial College London, London W12 0NN, UKSt Mary's HospitalImperial College Healthcare NHS Trust, London W1 2NY, UK
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Harryparsad A, Dullabh H, Sykes L, Herbst D. The effects of hydrochloric acid on all-ceramic restorative materials: an in-vitro study. SADJ 2014; 69:106-111. [PMID: 24974480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of this in-vitro study was to assess the long-term effects of hydrochloric acid on the surface roughness of three all-ceramic restorative materials CEREC VITABLOC Mark II CAD, IPS Empress CAD and IPS e.max CAD. MATERIALS AND METHODS Six cylindrical specimens (10mm diameter, 3mm height) of each material type were prepared, using the CEREC CAD/CAM machine. The unpolished samples were immersed in 15ml hydrochloric acid (pH 2) at 37 degrees C. Before immersion (baseline) and at periods of 7.5 hours, 45 hours and 91 hours, the specimens were removed from the acid and two randomised areas (10 microm X 10 microm) were selected and tested on each. The atomic force microscope (Bruker Dimension icon) was used to assess surface roughness and surface area at baseline and after each exposure time. The materials were compared over time with respect to surface roughness and surface area (baseline, 1 month, 6 months, 1 year) in a repeated measures analysis of variance (ANOVA). RESULTS Sample groups differed significantly for roughness (p < 0.0001) and surface area (p < 0.0001). For both parameters a significant interaction also existed between material and time (surface roughness: p = 0.0085; surface area: p = 0.0014). CEREC VITABLOC Mark II CAD and IPS Empress CAD had substantially higher levels of roughness and surface area than IPS e.max CAD, which was also affected to a lesser extent over time. CONCLUSION The results showed that IPS e.max CAD was least affected by long-term exposure to hydrochloric acid.
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Kandola MK, Sykes L, Lee YS, Johnson MR, Hanyaloglu AC, Bennett PR. EP2 receptor activates dual G protein signaling pathways that mediate contrasting proinflammatory and relaxatory responses in term pregnant human myometrium. Endocrinology 2014; 155:605-17. [PMID: 24265450 DOI: 10.1210/en.2013-1761] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Prostaglandin (PG) E2 (PGE(2)) plays a central role in the regulation of smooth muscle contractions. Classically, PGE(2) stimulates contractions via EP1 and EP3 receptors, whereas EP2 and EP4 maintain quiescence. Labor involves a change from myometrial quiescence to contractions with a shift from anti- to proinflammatory pathways. EP2, a Gαs-coupled receptor, is known to mediate its actions via cAMP signaling. However, we have recently shown that EP2 also activates the proinflammatory PG G/H synthase-2 (PGHS-2). Here, we identify the mechanism underlying the ability of EP2 to maintain uterine quiescence and activate a proinflammatory/prolabor response in term-pregnant human myometrium. Human myometrial biopsies for in vivo and in vitro studies were taken at cesarean section at term, before or after the onset of labor. Activation of EP2 increased intracellular levels of cAMP and reduced contractility. Contrastingly, EP2 stimulation increased levels of PGHS-2, membrane-associated PGE synthase-1, and PGE(2). This was entirely dependent on EP2-mediated activation of calcium signaling. Both calcium signaling and up-regulation of PGHS-2 were insensitive to the Gαi inhibitor pertussis toxin but inhibited by small interfering RNA knockdown of Gαq/11. There were no differences in EP2 mRNA or protein levels between upper or lower segment myometrium or between pre- and postlabor myometrium. However, in myocytes taken after the onset of labor, cAMP signaling was markedly attenuated, whereas activation of calcium and PGHS-2 was preserved. Overall, the dual coupling of EP2 to Gαs-cAMP and Gαq/11-calcium pathways underlies its ability to mediate contrasting functions in term pregnancy and the "switching" to a prolabor receptor.
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Affiliation(s)
- Mandeep K Kandola
- Parturition Research (M.K.K., L.S., Y.S.L., M.R.J., P.R.B.) and G-Protein Coupled Receptor (GPCR) Signaling Groups (A.C.H.), Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, London W12 0NN, United Kingdom
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Herbst D, Dullabh H, Sykes L, Vorster C. Evaluation of surface characteristics of titanium and cobalt chromium implant abutment materials. SADJ 2013; 68:350-356. [PMID: 24660402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Micro-organism adhesion and plaque formation is affected by surface free energy (SFE), surface roughness, hydrophilicity, surface chemistry, surface charge and the presence of proteins. AIMS The aim of this study was to assess and compare surface characteristics of surgical grade cobalt chromium alloy (CCM) and of commercially pure titanium (cpTi). METHOD Nine metallic cylinders were machined to precise standards from each material. Surface roughness was measured at four different points on each sample and the average Ra value was calculated for each material. Contact angles were obtained using the sessile-drop method and applied in calculating the SFE. Surface hardness was evaluated by means of a Vickers hardness micro-indentation. RESULTS Surface roughness was similar for both metals, but total SFE values and Vickers surface hardness scores showed significant differences (p < 0.0001). CONCLUSION SFE analysis showed CCM to be more hydrophobic and that oral bacteria might therefore be less adherent than to cpTi. The mean Vickers Hardness scores of the cpTi were significantly lower (p < 0.0001), suggesting that CCM may be more resistant to surface modifications and surface roughening, thus remaining smoother with less plaque accumulation than cpTi. This study demonstrated that CCM might be a suitable alternative implant abutment material.
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Sykes L, Herbert BR, Macintyre DA, Hunte E, Ponnampalam S, Johnson MR, Teoh TG, Bennett PR. The CRTH2 agonist Pyl A prevents lipopolysaccharide-induced fetal death but induces preterm labour. Immunology 2013; 139:352-65. [PMID: 23374103 DOI: 10.1111/imm.12085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/07/2013] [Accepted: 01/25/2013] [Indexed: 01/22/2023] Open
Abstract
We have previously demonstrated that the anti-inflammatory prostaglandin 15-deoxy-Δ 12,14-prostaglandin J(2) (15dPGJ(2)) delays inflammation-induced preterm labour in the mouse and improves pup survival through the inhibition of nuclear factor-κB (NF-κB) by a mechanism yet to be elucidated. 15dPGJ(2) is an agonist of the second prostaglandin D(2) receptor, chemoattractant receptor homologous to the T helper 2 cell (CRTH2). In human T helper cells CRTH2 agonists induce the production of the anti-inflammatory interleukins IL-10 and IL-4. We hypothesized that CRTH2 is involved in the protective effect of 15dPGJ(2) in inflammation-induced preterm labour in the murine model. We therefore studied the effects of a specific small molecule CRTH2 agonist on preterm labour and pup survival. An intrauterine injection of lipopolysaccharide (LPS) was administered to CD1 mice at embryonic day 16, ± CRTH2 agonist/vehicle controls. Mice were killed at 4.5 hr to assess fetal wellbeing and to harvest myometrium and pup brain for analysis of NF-κB, and T helper type 1/2 interleukins. To examine the effects of the CRTH2 agonist on LPS-induced preterm labour, mice were allowed to labour spontaneously. Direct effects of the CRTH2 agonist on uterine contractility were examined ex vivo on contracting myometrial strips. The CRTH2 agonist increased fetal survival from 20 to 100% in LPS-treated mice, and inhibited circular muscle contractility ex vivo. However, it augmented LPS-induced labour and significantly increased myometrial NF-κB, IL-1β, KC-GRO, interferon-γ and tumour necrosis factor-α. This suggests that the action of 15dPGJ(2) is not via CRTH2 and therefore small molecule CRTH2 agonists are not likely to be beneficial for the prevention of inflammation-induced preterm labour.
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Affiliation(s)
- Lynne Sykes
- Department of Surgery and Cancer, Parturition Research Group, Institute of Reproduction and Developmental Biology, Imperial College London, London, UK.
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Sykes L, Lee Y, Khanjani S, Macintyre DA, Yap XJ, Ponnampalam S, Teoh TG, Bennett PR. Chemoattractant receptor homologous to the T helper 2 cell (CRTH2) is not expressed in human amniocytes and myocytes. PLoS One 2012; 7:e50734. [PMID: 23226366 PMCID: PMC3511345 DOI: 10.1371/journal.pone.0050734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 10/23/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND 15-deoxy-Δ 12,14- Prostaglandin J2 (15dPGJ2) inhibits Nuclear factor kappa B (NF-κB) in human myocytes and amniocytes and delays inflammation induced preterm labour in the mouse. 15dPGJ2 is a ligand for the Chemoattractant Receptor Homologous to the T helper 2 cell (CRTH2), a G protein-coupled receptor, present on a subset of T helper 2 (Th2) cells, eosinophils and basophils. It is the second receptor for Prostaglandin D2, whose activation leads to chemotaxis and the production of Th2-type interleukins. The cellular distribution of CRTH2 in non-immune cells has not been extensively researched, and its identification at the protein level has been limited by the lack of specific antibodies. In this study we explored the possibility that CRTH2 plays a role in 15dPGJ2-mediated inhibition of NF-κB and would therefore represent a novel small molecule therapeutic target for the prevention of inflammation induced preterm labour. METHODS The effect of a small molecule CRTH2 agonist on NF-κB activity in human cultured amniocytes and myocytes was assessed by detection of p65 and phospho-p65 by immunoblot. Endogenous CRTH2 expression in amniocytes, myocytes and peripheral blood mononuclear cells (PBMCs) was examined by PCR, western analysis and flow cytometry, with amniocytes and myocytes transfected with CRTH2 acting as a positive control in flow cytometry studies. RESULTS The CRTH2 agonist had no effect on NF-κB activity in amniocytes and myocytes. Although CRTH2 mRNA was detected in amniocytes and myocytes, CRTH2 was not detectable at the protein level, as demonstrated by western analysis and flow cytometry. 15dPGJ2 inhibited phospho-65 in PBMC'S, however the CRTH2 antagonist was not able to attenuate this effect. In conclusion, CRTH2 is not expressed on human amniocytes or myocytes and plays no role in the mechanism of 15dPGJ2-mediated inhibition of NF-κB.
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MESH Headings
- Amniotic Fluid/cytology
- Amniotic Fluid/drug effects
- Amniotic Fluid/metabolism
- Animals
- Cells, Cultured
- Female
- Gene Expression Regulation/drug effects
- Genetic Vectors/genetics
- Humans
- Interleukin-1beta/pharmacology
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/metabolism
- Muscle Cells/cytology
- Muscle Cells/drug effects
- Muscle Cells/metabolism
- NF-kappa B/antagonists & inhibitors
- NF-kappa B/metabolism
- Peptides/pharmacology
- Pregnancy
- Prostaglandin D2/analogs & derivatives
- Prostaglandin D2/pharmacology
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptors, Immunologic/agonists
- Receptors, Immunologic/genetics
- Receptors, Immunologic/metabolism
- Receptors, Prostaglandin/agonists
- Receptors, Prostaglandin/genetics
- Receptors, Prostaglandin/metabolism
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Affiliation(s)
- Lynne Sykes
- Parturition Research Group, Department of Surgery and Cancer, Imperial College London, London, England.
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Abstract
Pregnancy is characterized by a complex interplay of inflammatory events regulated by both the innate and acquired immune systems. Similarly, parturition can be viewed as the activation of "pro-labour" inflammatory pathways, which drive cervical ripening and myometrial activation. Premature activation of these pathways, for example, by infection, can lead to preterm labour and birth. Nuclear factor κβ is a key modulator of these pathways and functions by regulating the expression of prostaglandins, chemokines and pro-inflammatory cytokines involved in both term and preterm labour. Future design of therapeutics that target key mediators of inflammation and immune activation would therefore be a rational approach for preventing preterm labour and immune-mediated neonatal brain damage.
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Affiliation(s)
- David A MacIntyre
- Department of Surgery and Cancer, Parturition Research Group, Institute of Reproduction and Developmental Biology, Imperial College London, London, UK
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Sykes L, Owen CP. Students' guide to complete denture construction. SADJ 2010; 65:436-437. [PMID: 21180295] [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: 05/30/2023]
Affiliation(s)
- L Sykes
- Department of Prosthodontics, University of the Witwatersrand, Johannesburg, South Africa.
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Connor A, Sykes L, Roberts ISD, Weston CE. [Acute phosphate nephropathy after the use of sodium phosphate preparation]. Praxis (Bern 1994) 2009; 98:608-611. [PMID: 19472147 DOI: 10.1024/1661-8157.98.11.608] [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: 05/27/2023]
Affiliation(s)
- A Connor
- Department of Renal Medicine, Dorset County Hospital, Dorchester DT1 2JY.
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Abstract
OBJECTIVE Vitamin D is essential for skeletal health and prolonged deficiency results in infantile rickets and adult osteomalacia. The aim of this study is to determine the vitamin D status in pregnancy and to evaluate the effects of daily and of single-dose vitamin D supplementation. DESIGN A prospective randomized study at St Mary's Hospital London. PATIENTS A total of 180 women (Indian Asian, Middle Eastern, Black and Caucasian) were recruited at 27 weeks gestation and randomized into three treatment groups: a single oral dose of 200,000 IU vitamin D, a daily supplement of 800 IU vitamin D from 27 weeks until delivery and a no treatment group. MEASUREMENTS Vitamin D (25-hydroxyvitamin D), PTH and corrected calcium levels in mothers at 27 weeks and at delivery and cord 25-hydroxyvitamin D and corrected calcium levels. RESULTS The final maternal 25-hydroxyvitamin D levels were significantly higher in the supplemented group [daily dose (median) 42 (IQR 31-76) nmol/l, stat dose (median) 34 (IQR 30-46) nmol/l vs. median 27 (IQR 27-39) nmol/l in the no treatment; P < 0.0001] and significantly fewer women with secondary hyperparathyroidism in the supplemented group (10% in daily dose vs. 12% in stat dose vs. 27% in the no treatment; P < 0.05). Cord 25-hydroxyvitamin D levels were significantly higher with supplementation [daily dose median 26 (IQR 17-45) nmol/l, stat dose median 25 (IQR 18-34) nmol/l vs. median 17 (IQR 14-22) nmol/l in no treatment; P = 0.001]. CONCLUSION Single or daily dose improved 25-hydroxyvitamin D levels significantly. However, even with supplementation, only a small percentage of women and babies were vitamin D sufficient. Further research is required to determine the optimal timing and dosing of vitamin D in pregnancy.
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Affiliation(s)
- C K H Yu
- Department of Obstetrics and Gynaecology, Imperial College School of Medicine, St Mary's Hospital, Paddington, London, UK.
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Abstract
OBJECTIVE To investigate which knee kinematic characteristics show the greatest differences between stroke patients with minimal residual disability and age-matched healthy volunteers as a first step towards the development of a sensitive, objective measure of performance of movement for use in the clinical setting. DESIGN A comparative study. SETTING A movement analysis laboratory. SUBJECTS Ten patients between 6 and 12 months post stroke aged between 65 and 74 years and 10 age-matched healthy volunteers. All patients had made a good recovery and were able to complete all of the functional tasks. INTERVENTIONS Each subject had reflective markers placed on anatomical landmarks and was filmed performing three movement tasks: sit-to-stand, walking, and step on block. MAIN OUTCOME MEASURES Knee kinematic characteristics involving timing, joint angle and angular velocity at key points during each task. RESULTS Significant differences were found between patients and volunteers for only some of the timing and joint angle characteristics but for all angular velocity characteristics for which the mean differences ranged from 31.85 degrees/s for sit-to-stand (p = 0.013) to 82.5 degrees/s (p = 0.014) for the swing phase of gait. CONCLUSIONS These preliminary findings suggest that angular velocity of the knee during functional tasks might have potential as a sensitive, objective measure of performance of movement after stroke for patients with minimal residual disability.
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Affiliation(s)
- J D Richards
- Geriatric Medicine, St George's Hospital, London, UK
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45
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Abstract
BACKGROUND Although achieving quality of movement after stroke is an important aim of physiotherapy it is rarely measured objectively or described explicitly. OBJECTIVE To test whether physiotherapists agree on a composite measure of quality of movement. SETTING; A movement analysis laboratory SUBJECTS Ten stroke patients and 10 healthy age-matched volunteers. DESIGN Prospective correlational. PROCEDURE All subjects were videofilmed performing three trials of six standardized functional tasks. Two videotapes were made, each with a different randomized order of appearance of the trials. Ten senior physiotherapists independently rated the videotapes twice using a 100-mm visual analogue scale. ANALYSIS Analysis of variance models were fitted to transformed data. Estimates of components of variance were calculated and presented as a percentage of the total variance for differences, within subjects (intra-subject), between raters (inter-rater) and within raters (intra-rater). An acceptable percentage was set at less than 10%. RESULTS The percentage of intra-subject variance ranged from 1% (pick up box and walking) to 9% (step on block). The percentage of inter-rater variance ranged from 18% (pick up pencil) to 38% (sit to stand). The percentage of intra-rater variance was less than 1% for all tasks. CONCLUSIONS Although physiotherapists disagreed with each other on quality of movement they were more consistent in their own scoring.
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Affiliation(s)
- V M Pomeroy
- The Stroke Association's Therapy Research Unit, University of Manchester, UK.
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Pomeroy VM, Dean D, Sykes L, Faragher EB, Yates M, Tyrrell PJ, Moss S, Tallis RC. The unreliability of clinical measures of muscle tone: implications for stroke therapy. Age Ageing 2000; 29:229-33. [PMID: 10855905 DOI: 10.1093/ageing/29.3.229] [Citation(s) in RCA: 26] [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: 11/14/2022] Open
Abstract
BACKGROUND the central tenet of the neurofacilitatory approach to stroke therapy is that muscle tone needs to be normal before normal movement can occur. A reliable clinical measure of the full spectrum of muscle tone is needed to test: (i) the purported relationship between muscle tone, other motor impairments and disability, and (ii) the effectiveness of stroke therapy to restore movement. AIM the purpose of the study was to test the inter-rater reliability of clinical categorization of muscle tone (spastic/normal/flaccid) and also a visual analogue scale with anchor points of 'lowest tone possible' (score 0) and 'highest tone possible' (score 100). METHODS four independent raters assessed tone of elbow flexors and knee extensors of 14 stroke rehabilitation inpatients using the categorical scale. Six independent raters assessed tone of elbow flexors and knee extensors of 25 chronic stroke patients and two healthy volunteers using the visual analogue scale. All assessment orders were randomized. RESULTS both scales were unreliable, with K coefficients for the categorical scale ranging from -0.046 to 0.56 for the categorical scale, and intra-class correlation coefficients for the visual analogue scale of 0.595 for elbow flexors and 0.451 for knee extensors. Assessment order effects for the visual analogue scale were non-significant for elbow flexors (P= 0.545) and knee extensors (P= 0.911). CONCLUSIONS these results, and those of earlier studies, suggest that clinical measures of muscle tone are consistently unreliable. Systematic investigation of the therapy rationale for planning and evaluating treatment is required before relevant clinical measures can be developed.
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Affiliation(s)
- V M Pomeroy
- Department of Geriatrc Medicine, Hope Hospital, Salford, Manchester, UK.
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47
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Gauthier S, Rockwood K, Gélinas I, Sykes L, Teunisse S, Orgogozo JM, Erkinjuntti T, Erzigkeit H, Gleeson M, Kittner B, Pontecorvo M, Feldman H, Whitehouse P. Outcome measures for the study of activities of daily living in vascular dementia. Alzheimer Dis Assoc Disord 1999; 13 Suppl 3:S143-7. [PMID: 10609694] [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: 02/14/2023]
Abstract
Decline in functional abilities is a major component of the dementia syndrome. The definition of dementia in the International Classification of Diseases (10th rev.) requires a cognitive impairment sufficient to impair personal activities of daily living (ADL). The Diagnostic and Statistical Manual of Mental Disorders (4th ed.) also requires cognitive deficits sufficiently severe to cause impairment in occupational or social functioning and must represent a decline from a higher level of functioning. However, the term disability is more appropriate than impairment to describe a loss in activities, as opposed to a loss of elementary functions, and is consistent with World Health Organization definitions of impairment, disability, and handicap. There is no doubt that ADL outcomes are required in therapeutic drug studies on vascular dementia, and there is a good rationale and some evidence for the use of ADL scales developed for therapeutic research in Alzheimer disease, favoring scales devoid of items sensitive to physical disabilities. Similarly, ADL-related clinical milestones could be used for longer-term studies aiming predominantly at slowing progression of disease in both early and later stages of dementia. Slower decline in ADL and delay in reaching ADL-related clinical milestones should be considered as valid outcomes by regulatory bodies in the process of dementia drug approval.
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Affiliation(s)
- S Gauthier
- McGill Centre for Studies in Aging, Verdun, Quebec, Canada
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48
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Sykes L, Essop R. A feeding adaptation by an infant with a cleft palate. SADJ 1999; 54:369-70. [PMID: 10860048] [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: 02/16/2023]
Abstract
One of the primary problems in the management and care of infants born with cleft palates is that of achieving an adequate seal of the cleft to allow proper swallowing to take place. This article describes an interesting case in which a 14-month-old baby, who had received no surgical or prosthodontic treatment for her cleft palate, had developed her own 'obturation' mechanism to enable her to swallow efficiently.
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Affiliation(s)
- L Sykes
- Department of Prosthetic Dentistry, School of Oral Health Sciences, University of the Witwatersrand, Johannesburg
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49
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Sykes L. Oral management of irradiated head and neck cancer patients. SADJ 1999; 54:59-62. [PMID: 10518910] [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: 04/13/2023]
Affiliation(s)
- L Sykes
- Department of Prosthetic Dentistry, University of the Witwatersrand, Johannesburg
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50
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Sykes L, Ross ER, Powell ES, Edwards J. Objective measurement of use of the reciprocating gait orthosis (RGO) and the electrically augmented RGO in adult patients with spinal cord lesions. Prosthet Orthot Int 1996; 20:182-90. [PMID: 8985998 DOI: 10.3109/03093649609164441] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of the study was to measure objectively the home use of the reciprocating gait orthosis (RGO) and the electrically augmented (hybrid) RGO. It was hypothesised that RGO use would increase following provision of functional electrical stimulation (FES). Five adult subjects participated in the study with spinal cord lesions ranging from C2 (incomplete) to T6. Selection criteria included active RGO use and suitability for electrical stimulation. Home RGO use was measured for up to 18 months by determining the mean number of steps taken per week. During this time patients were supplied with the hybrid system. Three alternatives for the measurement of steps taken were investigated: a commercial digital pedometer, a magnetically actuated counter and a heel contact switch linked to an electronic counter. The latter was found to be the most reliable system and was used for all measurements. Additional information on RGO use was acquired using three patient diaries administered throughout the study and before and after the provision of the hybrid system. Testing of the original hypothesis was complicated by problems in finding a reliable measurement tool and difficulties with data collection. However, the results showed that overall use of the RGO, whether with or without stimulation, is low. Statistical analysis of the step counter results was not realistic. No statistically significant change in RGO use was found between the patient diaries. The study suggests that the addition of electrical stimulation does not increase RGO use. The study highlights the problem of objectively measuring orthotic use in the home.
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Affiliation(s)
- L Sykes
- North Western Orthotic Unit, Hope Hospital, Salford, UK
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