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Wong S, Derry F, Forbes A, Grimble G, Reilly J, Gandy J. PP105 ASSOCIATION OF NUTRITION RISK SCORE AND NUTRITIONAL INDICES IN PATIENTS WITH SPINAL CORD INJURIES - THE RESULT FOR A UK MULTI CENTRE STUDY. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1744-1161(10)70181-2] [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: 10/19/2022]
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Johnson MW, Rogers GB, Bruce KD, Lilley AK, von Herbay A, Forbes A, Ciclitira PJ, Nicholls RJ. Bacterial community diversity in cultures derived from healthy and inflamed ileal pouches after restorative proctocolectomy. Inflamm Bowel Dis 2009; 15:1803-11. [PMID: 19637361 DOI: 10.1002/ibd.21022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 05/11/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pouchitis is believed to occur as a reaction to dysbiosis. In this study we assessed differences between mucosal bacterial communities cultured from noninflamed and inflamed ileal pouches. METHODS Thirty-two ileal pouch patients, 22 with ulcerative colitis (UC) and 10 with familial adenomatous polyposis (FAP), underwent symptomatic, endoscopic, and histological assessment. The Objective Pouchitis Score (OPS) and the Pouch Disease Activity Index (PDAI) were used to diagnose pouchitis. Seven UC patients had pouchitis (UC+), 15 had a noninflamed pouch (UC-), 9 had a noninflamed pouch (FAP-), and 1 FAP patient had pouchitis (FAP+). Biopsies taken from the ileal mucosa of the pouch were cultured under aerobic and anaerobic conditions. Following standardized DNA extraction a polymerase chain reaction (PCR) was performed to generate 16S rRNA gene products. A "fingerprint" of the bacterial community within each sample was created using terminal-restriction fragment length polymorphism (T-RFLP) profiling. Species richness and evenness were determined using T-RF band lengths and relative band intensities. RESULTS From the 64 DNA samples, 834 bands were detected, of which 179 represented different species (operational taxonomic units [OTUs]). The average species richness for the FAP-, FAP+, UC-, and UC+ groups was 26, 35, 23.9, and 29.6 per patient, with the average species diversity within the groups of 10.6, 29, 8.3, and 11.4, respectively. Similar trends were observed when the anaerobic and aerobic-derived bacterial groups were analyzed separately. CONCLUSIONS No significant differences were found between the bacterial cultures derived from any of the clinical groups or between pouchitis and nonpouchitis patients.
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Affiliation(s)
- Matt W Johnson
- Gastroenterology Surgical Department, St. Mark's Hospital, Harrow, Middlesex, UK
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Mwakikunga BW, Forbes A, Sideras-Haddad E, Scriba M, Manikandan E. Self Assembly and Properties of C:WO(3) Nano-Platelets and C:VO(2)/V(2)O(5) Triangular Capsules Produced by Laser Solution Photolysis. Nanoscale Res Lett 2009; 5:389-397. [PMID: 20671779 PMCID: PMC2893700 DOI: 10.1007/s11671-009-9494-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 11/11/2009] [Indexed: 05/24/2023]
Abstract
Laser photolysis of WCl(6) in ethanol and a specific mixture of V(2)O(5) and VCl(3) in ethanol lead to carbon modified vanadium and tungsten oxides with interesting properties. The presence of graphene's aromatic rings (from the vibrational frequency of 1,600 cm(-1)) together with C-C bonding of carbon (from the Raman shift of 1,124 cm(-1)) present unique optical, vibrational, electronic and structural properties of the intended tungsten trioxide and vanadium dioxide materials. The morphology of these samples shows nano-platelets in WO(x) samples and, in VO(x) samples, encapsulated spherical quantum dots in conjunction with fullerenes of VO(x). Conductivity studies revealed that the VO(2)/V(2)O(5) nanostructures are more sensitive to Cl than to the presence of ethanol, whereas the C:WO(3) nano-platelets are more sensitive to ethanol than atomic C.
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Affiliation(s)
- BW Mwakikunga
- CSIR National Laser Centre, P. O. Box 395, Pretoria, 0001, South Africa
- DST/NRF Centre of Excellence in Strong Materials and School of Physics, University of the Witwatersrand, Johannesburg, South Africa
- Department of Physics, University of Malawi-The Polytechnic, Private Bag 303, Chichiri, Blantyre 3, Malawi
| | - A Forbes
- CSIR National Laser Centre, P. O. Box 395, Pretoria, 0001, South Africa
- School of Physics, University of Kwazulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - E Sideras-Haddad
- DST/NRF Centre of Excellence in Strong Materials and School of Physics, University of the Witwatersrand, Johannesburg, South Africa
- iThemba LABS, Private Bag 11, Wits 2050, Jan Smuts & Empire Rd., Johannesburg, South Africa
| | - M Scriba
- DST/CSIR National Centre for Nano-Structured Materials, P. O. Box 395, Pretoria, South Africa
| | - E Manikandan
- DST/CSIR National Centre for Nano-Structured Materials, P. O. Box 395, Pretoria, South Africa
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Abstract
There is ample evidence that iron is an essential trace element, but assessment of iron status and decisions on the amounts needed and the means of delivery in patients on parenteral nutrition (PN) have been unclear. Although iron requirements may diminish during acute illness, the frequent concurrence of blood loss and iron deficiency argue strongly for maintenance of levels of delivery in line with basal requirements. Maintenance of iron delivery has not been thought likely to present risk, but new data are questioning this. The needs of menstruating, pregnant, and lactating women are greater than those of adult men. The evidence favors an intravenous dose of around 1 mg of elemental iron per day in adult men and postmenopausal women. Doses of 1.5 mg/d [DOSAGE ERROR CORRECTED] in menstruating women and 2.0 mg/d [DOSAGE ERROR CORRECTED] for those in the later stages of pregnancy or lactating can be supported. A calibrated response is required in the growing child. Continued monitoring of iron status is recommended. Iron is an essential component for most PN regimens. The quantity of iron to be included should take account of predicted requirements.
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Abstract
Manifestations of SSc in the gastrointestinal (GI) tract are common, occurring in 50-90% of patients. They typically result from the fibrosis that characterizes this disease. Manifestations of SSc can affect many sites within the GI tract, and patients may experience substantial dysfunction in the processes of motility, digestion, absorption and excretion. Oesophageal dysfunction is the most common GI manifestation, but patients may also experience dysfunction of the stomach, small intestine, colon and rectum, each of which can be responsible for severe and distressing symptoms. At present, few specific therapeutic options are available for the treatment of these patients, but relief of symptoms is often possible with appropriate knowledge and support. It is therefore particularly important to identify, monitor and manage these patients carefully, with a view to minimizing further degeneration and maximizing quality of life.
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Affiliation(s)
- A Forbes
- Department of Gastroenterology and Nutrition, University College Hospital, London, UK.
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Keshaw H, Georgiou G, Blaker JJ, Forbes A, Knowles JC, Day RM. Assessment of Polymer/Bioactive Glass-Composite Microporous Spheres for Tissue Regeneration Applications. Tissue Eng Part A 2009; 15:1451-61. [DOI: 10.1089/ten.tea.2008.0203] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Hussila Keshaw
- Biomaterials and Tissue Engineering Group, Burdette Institute of Gastrointestinal Nursing, Kings College London, London, United Kingdom
| | - George Georgiou
- Division of Biomaterials and Tissue Engineering, Eastman Dental Institute, University College London, London, United Kingdom
| | - Jonny J. Blaker
- Biomaterials and Tissue Engineering Group, Burdette Institute of Gastrointestinal Nursing, Kings College London, London, United Kingdom
| | - Alastair Forbes
- Biomaterials and Tissue Engineering Group, Centre for Gastroenterology & Nutrition, University College London, London, United Kingdom
| | - Jonathan C. Knowles
- Division of Biomaterials and Tissue Engineering, Eastman Dental Institute, University College London, London, United Kingdom
| | - Richard M. Day
- Biomaterials and Tissue Engineering Group, Burdette Institute of Gastrointestinal Nursing, Kings College London, London, United Kingdom
- Biomaterials and Tissue Engineering Group, Centre for Gastroenterology & Nutrition, University College London, London, United Kingdom
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Bozzetti F, Forbes A. The ESPEN clinical practice Guidelines on Parenteral Nutrition: present status and perspectives for future research. Clin Nutr 2009; 28:359-64. [PMID: 19523723 DOI: 10.1016/j.clnu.2009.05.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 05/11/2009] [Indexed: 02/09/2023]
Abstract
The ESPEN Guidelines on Parenteral Nutrition (PN) reflect current scientific knowledge in the field of clinical nutrition in adults. They summarize the indications for PN and its anticipated outcomes in respect of the underlying disease, nutritional status and quality of life. They are companion documents to the ESPEN Guidelines on Enteral Nutrition and follow the same general format. They address the influence of the underlying disease on the patient's nutritional status, and that of malnutrition on the outcome of the disease. Contraindications to and complications of PN are considered, together with comparative analyses of the roles of the parenteral and enteral routes in different illness states. The quality and strength of the supporting literature has been graded according to the criteria of the Scottish Intercollegiate Guidelines Network (SIGN) and the Agency for Health Care Policy and Research. Hence, meta-analysis of randomised clinical trials (level of evidence Ia) or at least one randomised clinical trial (level of evidence Ib) translate to a Grade A recommendation. Levels of evidence IIa, IIb and III are attributed respectively to: at least one well-designed controlled trial without randomisation; at least one other type of well-designed, quasi-experimental study; or well-designed non-experimental descriptive studies such as comparative studies, correlation studies, case-control studies; each of these sustains a Grade B recommendation. Grade C recommendations reflect expert opinion and/or the clinical experience of respected authorities (level of evidence IV). Each of the 11 sets of PN Guidelines was devised by an international working group, the total faculty comprising no fewer than 87 experts from 16 European/Mediterranean countries, each group's contributions being co-ordinated by a designated chairman. Once each guideline had been approved by all the members of the relevant working group, this version was reviewed by at least two independent external reviewers (one selected from ESPEN's Education and Clinical Practice Committee, and at least one from outside the ESPEN committee structure). Following this review each guideline was hosted in draft form on the public pages of the ESPEN website for at least one month to permit the receipt of comments or suggestions from any interested party. At this point the Guidelines were reviewed and revised again by the original working group chairman and submitted to the Clinical Nutrition editorial process. At least 3 further reviewers were selected by the Journal's editorial office for each guideline, in line with the normal selection process. Final revisions were performed by the Chairmen of the working groups, and by ourselves as commissioning editors of the whole project. More than 300 evidence-based recommendations are now presented. Fewer than one sixth of the recommendations are Grade A, and disappointingly, but unsurprisingly, more than 50% are Grade C. The need for more and better controlled trials in the field remains apparent.
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Affiliation(s)
- Federico Bozzetti
- Department of Surgery, Hospital of Prato, Piazza dell'Ospedale 5, 59100 Prato, Italy.
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Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, Griffiths R, Kreyman G, Leverve X, Pichard C, ESPEN. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr 2009; 28:387-400. [PMID: 19505748 DOI: 10.1016/j.clnu.2009.04.024] [Citation(s) in RCA: 672] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 04/29/2009] [Indexed: 02/07/2023]
Abstract
Nutritional support in the intensive care setting represents a challenge but it is fortunate that its delivery and monitoring can be followed closely. Enteral feeding guidelines have shown the evidence in favor of early delivery and the efficacy of use of the gastrointestinal tract. Parenteral nutrition (PN) represents an alternative or additional approach when other routes are not succeeding (not necessarily having failed completely) or when it is not possible or would be unsafe to use other routes. The main goal of PN is to deliver a nutrient mixture closely related to requirements safely and to avoid complications. This nutritional approach has been a subject of debate over the past decades. PN carries the considerable risk of overfeeding which can be as deleterious as underfeeding. Therefore the authors will present not only the evidence available regarding the indications for PN, its implementation, the energy required, its possible complementary use with enteral nutrition, but also the relative importance of the macro- and micronutrients in the formula proposed for the critically ill patient. Data on long-term survival (expressed as 6 month survival) will also be considered a relevant outcome measure. Since there is a wide range of interpretations regarding the content of PN and great diversity in its practice, our guidance will necessarily reflect these different views. The papers available are very heterogeneous in quality and methodology (amount of calories, nutrients, proportion of nutrients, patients, etc.) and the different meta-analyses have not always taken this into account. Use of exclusive PN or complementary PN can lead to confusion, calorie targets are rarely achieved, and different nutrients continue to be used in different proportions. The present guidelines are the result of the analysis of the available literature, and acknowledging these limitations, our recommendations are intentionally largely expressed as expert opinions.
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Affiliation(s)
- Pierre Singer
- General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Tikva, Israel
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Mwakikunga BW, Sideras-Haddad E, Arendse C, Witcomb MJ, Forbes A. WO3 nano-spheres into W18O49 one-dimensional nano-structures through thermal annealing. J Nanosci Nanotechnol 2009; 9:3286-3294. [PMID: 19453005 DOI: 10.1166/jnn.2009.vc12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We elaborate the size controlled synthesis of nano-spheres and nano-crystals of WO3 by ultrasonic spray pyrolysis. The as-deposited particles are predominantly spherical in shape and tend to exhibit less agglomeration and a decrease in diameter as the process temperature is increased. Characterization was carried out using transmission (TEM) and scanning (SEM) electron microscopy, energy dispersive X-ray spectroscopy (EDS) and X-ray diffraction (XRD). One-dimensional nano-structures with the highest yield of WOx nano-wires were observed in a sample synthesized at 500 degrees C but only after thermal annealing of this sample at 500 degrees C for 17 hour in flowing argon. XRD revealed a high deficiency in oxygen in all samples suggesting that the nano-structures are transformed to sub-oxides of tungsten. Micro-diffraction patterns of a typical nano-wire reveal the monoclinic phase of W18O49.
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Affiliation(s)
- B W Mwakikunga
- CSIR National Centre for Nano-Structured Materials, P.O. Box 395, Pretoria 0001, South Africa
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Taylor SA, Punwani S, Rodriguez-Justo M, Bainbridge A, Greenhalgh R, De Vita E, Forbes A, Cohen R, Windsor A, Obichere A, Hansmann A, Rajan J, Novelli M, Halligan S. Mural Crohn disease: correlation of dynamic contrast-enhanced MR imaging findings with angiogenesis and inflammation at histologic examination--pilot study. Radiology 2009; 251:369-79. [PMID: 19276323 DOI: 10.1148/radiol.2512081292] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine mural perfusion dynamics in Crohn disease by using dynamic contrast material-enhanced magnetic resonance (MR) imaging and to correlate these with histopathologic markers of inflammation and angiogenesis. MATERIALS AND METHODS Ethical permission was given by the University College London Hospital ethics committee, and informed consent was obtained from all participants. Eleven consecutive patients with Crohn disease (eight female patients, three men; mean age, 39.5 years; range, 16.4-66.6 years) undergoing elective small-bowel resection were recruited between July 2006 and December 2007. Harvey-Bradshaw index, C-reactive protein (CRP) level, and disease chronicity were recorded. Preoperatively, dynamic contrast-enhanced MR imaging was performed through the section of bowel destined for resection, and slope of enhancement, time to maximum enhancement, enhancement ratio, the volume transfer coefficient K(trans), and the extracellular volume fraction v(e) were calculated for the affected segment. Ex vivo surgical specimens were imaged to facilitate imaging-pathologic correlation. Histopathologic sampling of the specimen was performed through the imaged tissue, and microvascular density (MVD) was determined, together with acute and chronic inflammation scores. Correlations between clinical, MR imaging, and histopathologic data were made by using the Kendall rank correlation and linear regression. RESULTS Disease chronicity was positively correlated with enhancement ratio (correlation coefficient, 0.82; P = .002). Slope of enhancement demonstrated a significant negative correlation with MVD (correlation coefficient, -0.86; P < .001). There was a negative correlation between CRP level and slope of enhancement (correlation coefficient, -0.77; P = .006). Neither acute nor chronic inflammation score correlated with any other parameter. CONCLUSION Certain MR imaging-derived mural hemodynamic parameters correlate with disease chronicity and angiogenesis in Crohn disease, but not with histologic and clinical markers of inflammation. Data support the working hypothesis that microvessel permeability increases with disease chronicity and that tissue MVD is actually inversely related to mural blood flow.
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Affiliation(s)
- Stuart A Taylor
- Department of Specialist Radiology, University College London Hospitals National Health Service Foundation Trust, 235 Euston Road, London NW12BU, England.
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211
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Gosling C, Gabbe B, Forbes A. Coaches’ and health professionals’ perceptions of injury and injury risk factors in Australian age-group triathletes. J Sci Med Sport 2009. [DOI: 10.1016/j.jsams.2008.12.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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212
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Tonkin AM, Forbes A, Haas SJ. The evidence on trial: cholesterol lowering and cancer. Heart Asia 2009; 1:6-10. [PMID: 27325918 PMCID: PMC4898325 DOI: 10.1136/ha.2008.000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Accepted: 11/27/2008] [Indexed: 06/06/2023]
Affiliation(s)
- A M Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S J Haas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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213
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Mawdsley JE, Hollington P, Bassett P, Windsor AJ, Forbes A, Gabe SM. An analysis of predictive factors for healing and mortality in patients with enterocutaneous fistulas. Aliment Pharmacol Ther 2008; 28:1111-21. [PMID: 18671774 DOI: 10.1111/j.1365-2036.2008.03819.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most studies of enterocutaneous fistula report management and outcome. Few studies examine factors predicting healing and mortality. AIM To identify factors predicting healing and mortality in patients with ECF managed either with a definitive attempt at surgical closure or conservatively. METHODS The case notes of 277 patients with enterocutaneous fistula, treated at our institution over a 10 year period, were retrospectively reviewed. Patients were divided into those managed operatively or conservatively. Eleven factors were examined for their relationship to fistula healing and fistula-related mortality. RESULTS For patients treated operatively, successful enterocutaneous fistula closure related only to the complexity of the fistula (multiple fistula or presence of an internal abscess cavity) (P = 0.03), whereas fistula-related mortality related only to the presence of comorbidity (P = 0.02). In patients managed conservatively, a decreased likelihood of enterocutaneous fistula closure was associated with a high fistula output (P = 0.01), comorbidity (P = 0.03) and being referred from an external institution (P < 0.001). Fistula related-mortality in this group was related to a high output (P = 0.003) and an increased age (P = 0.001). CONCLUSION In patients managed operatively, fistula healing and fistula-related mortality are each associated with only one factor, whereas in patients managed conservatively healing and mortality are predicted by three and two factors, respectively.
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Affiliation(s)
- J E Mawdsley
- Lennard-Jones Intestinal Failure Unit, St Mark's Hospital, Harrow, London, UK.
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Forbes A. Is there a role for multidrug therapy in active Crohn's disease? Inflamm Bowel Dis 2008; 14 Suppl 2:S257-8. [PMID: 18816649 DOI: 10.1002/ibd.20668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Alastair Forbes
- Department of Gastroenterology and Clinical Nutrition, University College Hospital, London, UK
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Leslie K, Myles P, Chan M, Paech M, Peyton P, Forbes A, McKenzie D. Risk factors for severe postoperative nausea and vomiting in a randomized trial of nitrous oxide-based vs nitrous oxide-free anaesthesia. Br J Anaesth 2008; 101:498-505. [DOI: 10.1093/bja/aen230] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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216
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Mwakikunga BW, Forbes A, Sideras-Haddad E, Arendse C. Optimization, Yield Studies and Morphology of WO 3Nano-Wires Synthesized by Laser Pyrolysis in C 2H 2and O 2Ambients—Validation of a New Growth Mechanism. Nanoscale Res Lett 2008; 3:372. [PMCID: PMC3244893 DOI: 10.1007/s11671-008-9169-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/03/2008] [Indexed: 05/30/2023]
Abstract
Laser pyrolysis has been used to synthesize WO3nanostructures. Spherical nano-particles were obtained when acetylene was used to carry the precursor droplet, whereas thin films were obtained at high flow-rates of oxygen carrier gas. In both environments WO3nano-wires appear only after thermal annealing of the as-deposited powders and films. Samples produced under oxygen carrier gas in the laser pyrolysis system gave a higher yield of WO3nano-wires after annealing than the samples which were run under acetylene carrier gas. Alongside the targeted nano-wires, the acetylene-ran samples showed trace amounts of multi-walled carbon nano-tubes; such carbon nano-tubes are not seen in the oxygen-processed WO3nano-wires. The solid–vapour–solid (SVS) mechanism [B. Mwakikunga et al., J. Nanosci. Nanotechnol., 2008] was found to be the possible mechanism that explains the manner of growth of the nano-wires. This model, based on the theory from basic statistical mechanics has herein been validated by length-diameter data for the produced WO3nano-wires.
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Affiliation(s)
- BW Mwakikunga
- CSIR, National Centre for Nano-Structured Materials, P.O. Box 395, Pretoria, 0001, South Africa
- School of Physics, University of the Witwatersrand, Private Bag 3, P.O. Wits 2050, Johannesburg, South Africa
- Department of Physics and Biochemical Sciences, University of Malawi, The Polytechnic, Chichiri, Private Bag 303, Blantyre, 0003, Malawi
| | - A Forbes
- CSIR National Laser Centre, P.O. Box 395, Pretoria, 0001, South Africa
- School of Physics, University of Kwazulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - E Sideras-Haddad
- School of Physics, University of the Witwatersrand, Private Bag 3, P.O. Wits 2050, Johannesburg, South Africa
| | - C Arendse
- CSIR, National Centre for Nano-Structured Materials, P.O. Box 395, Pretoria, 0001, South Africa
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217
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Blaker JJ, Pratten J, Ready D, Knowles JC, Forbes A, Day RM. Assessment of antimicrobial microspheres as a prospective novel treatment targeted towards the repair of perianal fistulae. Aliment Pharmacol Ther 2008; 28:614-22. [PMID: 18565160 DOI: 10.1111/j.1365-2036.2008.03773.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND None of the proposed materials tested for the management of perianal fistulae has proven to be a definitive treatment. AIM To assess a new repair scaffold and drug delivery device conceived to target perianal fistula repair. METHODS Poly(D,L-lactide-co-glycolide) porous microspheres containing either antibacterial silver-releasing degradable phosphate glass or metronidazole were prepared using thermally induced phase separation. RESULTS Ion- and drug-release profiling of the microspheres revealed continued release of silver ions from microspheres filled with silver-doped phosphate glass and high encapsulation efficiency for metronidazole [78% and 82% for microspheres loaded with 2.5% and 1.3% (w/w), respectively]. Microbicidal activity was confirmed by growth inhibition of bacterial species (Staphylococcus aureus, Escherichia coli and Bacteroides fragilis), which characteristically dominate the colonization of perianal fistula tracts. Microspheres containing >3 mol% silver or metronidazole resulted in strong bacterial inhibition/kill against B. fragilis; the presence of one sphere containing >3 mol% silver had a potent inhibitory effect against all the microbes studied. Microspheres became rapidly integrated with host tissue following subcutaneous implantation into a rodent wound model. CONCLUSION The study demonstrates a novel scaffold for guided tissue regeneration providing local release of antimicrobial agents sufficient to counter bacterial colonization and warrants further investigation.
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Affiliation(s)
- J J Blaker
- Biomaterials and Tissue Engineering Group, Burdett Institute of Gastrointestinal Nursing, Kings College London, London, UK
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218
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Bernhardi EH, Forbes A, Bollig C, Esser MJD. Estimation of thermal fracture limits in quasi-continuous-wave end-pumped lasers through a time-dependent analytical model. Opt Express 2008; 16:11115-11123. [PMID: 18648425 DOI: 10.1364/oe.16.011115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 07/09/2008] [Indexed: 05/26/2023]
Abstract
A time-dependent analytical thermal model of the temperature and the corresponding induced thermal stresses on the pump face of quasi- continuous wave (qcw) end-pumped laser rods is derived. We apply the model to qcw diode-end-pumped rods and show the maximum peak pump power that can be utilized without fracturing the rod. To illustrate an application of the model, it is applied to a qcw pumped Tm:YLF rod and found to be in very good agreement with published experimental results. The results indicate new criteria to avoid fracture when operating Tm:YLF rods at low qcw pump duty cycles.
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Affiliation(s)
- E H Bernhardi
- Counsil for Scientific and Industrial Research, National Laser Centre, Pretoria, South Africa
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Pironi L, Forbes A, Joly F, Colomb V, Lyszkowska M, Van Gossum A, Baxter J, Thul P, Hébuterne X, Gambarara M, Gottrand F, Moreno Villares JM, Messing B, Goulet O, Staun M. Survival of patients identified as candidates for intestinal transplantation: a 3-year prospective follow-up. Gastroenterology 2008; 135:61-71. [PMID: 18471440 DOI: 10.1053/j.gastro.2008.03.043] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Revised: 02/14/2008] [Accepted: 03/20/2008] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS The US Medicare indications for intestinal transplantation are based on failure of home parenteral nutrition. The American Society of Transplantation also includes patients at high risk of death from their primary disease or with high morbidity intestinal failure. A 3-year prospective study evaluated the appropriateness of these indications. METHODS Survival on home parenteral nutrition or after transplantation was analyzed in 153 (97 adult, 56 pediatric) candidates for transplantation and 320 (262 adult, 58 pediatric) noncandidates, enrolled through a European multicenter cross-sectional survey performed in 2004. Kaplan-Meier and chi-square test statistics were used. RESULTS The 3-year survival was 94% (95% CI, 92%-97%) in noncandidates and 87% (95% CI, 81%-93%) in candidates not receiving transplants (P = .007). Survival was 80% (95% CI, 70%-89%), 93% (95% CI, 86%-100%), and 100% in parenteral nutrition failure, high-risk primary disease, and high-morbidity intestinal failure, respectively (P = .034). Fifteen candidates underwent transplantation. Six died, including all 3 of those who were in hospital, and 25% of those who were at home at time of transplantation (P = .086). Survival in the 10 patients receiving a first isolated small bowel transplant was 89% (95% CI, 70%-100%), compared with 85% (95% CI, 74%-96%) in the candidates with parenteral nutrition failure not receiving transplants because of central venous catheter complications, or 70% (95% CI, 53%-88%) in those with parenteral nutrition-related liver failure (P = .364). CONCLUSIONS The results confirm home parenteral nutrition as the primary therapeutic option for intestinal failure and support the appropriateness and potential life-saving role of timely intestinal transplantation for patients with parenteral nutrition failure.
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Affiliation(s)
- Loris Pironi
- Department of Clinical Medicine, University of Bologna, Italy.
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Fisher SA, Tremelling M, Anderson CA, Gwilliam R, Bumpstead S, Prescott NJ, Nimmo ER, Massey D, Berzuini C, Johnson C, Barrett JC, Cummings FR, Drummond H, Lees CW, Onnie CM, Hanson CE, Blaszczyk K, Inouye M, Ewels P, Ravindrarajah R, Keniry A, Hunt S, Carter M, Watkins N, Ouwehand W, Lewis CM, Cardon L, Lobo A, Forbes A, Sanderson J, Jewell DP, Mansfield JC, Deloukas P, Mathew CG, Parkes M, Satsangi J. Genetic determinants of ulcerative colitis include the ECM1 locus and five loci implicated in Crohn's disease. Nat Genet 2008; 40:710-2. [PMID: 18438406 PMCID: PMC2719289 DOI: 10.1038/ng.145] [Citation(s) in RCA: 333] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 03/14/2008] [Indexed: 12/11/2022]
Abstract
We report results of a nonsynonymous SNP scan for ulcerative colitis and identify a previously unknown susceptibility locus at ECM1. We also show that several risk loci are common to ulcerative colitis and Crohn's disease (IL23R, IL12B, HLA, NKX2-3 and MST1), whereas autophagy genes ATG16L1 and IRGM, along with NOD2 (also known as CARD15), are specific for Crohn's disease. These data provide the first detailed illustration of the genetic relationship between these common inflammatory bowel diseases.
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Affiliation(s)
- Sheila A Fisher
- Department of Medical and Molecular Genetics, King's College London School of Medicine, 8th Floor Guy's Tower, Guy's Hospital, London SE1 9RT, UK
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Myles P, Chan M, Leslie K, Peyton P, Paech M, Forbes A. Effect of nitrous oxide on plasma homocysteine and folate in patients undergoing major surgery. Br J Anaesth 2008; 100:780-6. [DOI: 10.1093/bja/aen085] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [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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Forbes A, Nyilas M, Loze J, Werner C, Johnson B, Owen R, Todorov S, Carson W. Efficacy and tolerability of aripiprazole in adolescents with schizophrenia. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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223
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Zempolich K, Fuhrman C, Milash B, Flinner R, Greven K, Ryu J, Forbes A, Kerlin K, Nichols RC, Gaffney DK. Changes in gene expression induced by chemoradiation in advanced cervical carcinoma: a microarray study of RTOG C-0128. Gynecol Oncol 2008; 109:275-9. [PMID: 18299147 DOI: 10.1016/j.ygyno.2008.01.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 01/15/2008] [Accepted: 01/22/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate gene expression patterns in patients with advanced cervix cancer before and during chemoradiation in a multi-institutional cooperative group setting. METHODS RTOG C0128 was designed as a Phase II trial of radiation therapy with concomitant chemotherapy and Celecoxib at 400 mg twice daily for one year. Tumor samples were obtained for microarray gene expression analysis before treatment and at the time of the first implant (paired sample). RNA was extracted, linearly amplified, and purity was assessed by gel electrophoresis. Each sample was hybridized against a universal RNA mixture on a customized spotted array consisting of >10,000 genes. Gene expression pre-treatment was compared with clinical characteristics. Changes in gene expression following radiation were assessed within the paired samples (same patient) and then compared across all paired samples. Data were normalized using the AROMA software, and clustering analysis was performed using Ward's method in Spotfire. Differences in paired samples were calculated with Significance Analysis of Microarrays (SAM). RESULTS From August 2001 to March 2004, 84 patients were accrued to the trial. Tissue was obtained prior to initiation of therapy from 34 patients (40%). FIGO stages of the patients providing tissue were IB (23%), II (57%), and IIIA-IVA (20%). RNA quality was sufficient in 22 pre-treatment and 14 post-treatment samples. Among pre-treatment samples, no significant differences in gene expression were observed by FIGO stage, age, or race. However, between comparison of histologic subtypes (adenocarcinoma, n=5; squamous cell carcinoma, n=17) demonstrated 45 genes differentially expressed with a false discovery rate of 0.018. Cluster analysis segregated unpaired samples into 2 groups: 18/22 comprising pre-treatment samples and 10/14 in group 2 representing post-treatment samples. In all 13 paired samples, gene expression after chemoradiation was significantly upregulated in 91 genes and downregulated in 251 genes (false discovery rate of 0.0018). Genes significantly upregulated included bax, cdk inhibitor 1, MMP2, and adhesion molecules PECAM1, VCAM1, and ICAM2. Genes significantly downregulated included topoisomerase II alpha, myc, H2AX, MSH2, RAD51, RAD53, PCNA, and cell cycle-regulating molecules chk1, CDK2, cyclinB1, cyclin D3, cdc2, and cdc25. CONCLUSIONS Microarray analysis was successfully performed in a multi-institutional cooperative group trial. Gene expression significantly correlated with histology, but not stage, age or race. Cluster analysis identified two groups of gene expression profiles correlating with pre or post-treatment acquisition of tissue. Notably, paired samples showed significant changes in gene expression following chemoradiation, including several downregulated radiation response genes. Further analysis comparing gene expression to clinical outcomes, acute and late toxicities awaits maturation of clinical data. Hopefully, this data will lead to the development of molecularly based therapies.
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Affiliation(s)
- K Zempolich
- University of Utah and Huntsman Cancer Institute, USA
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Biancone L, Michetti P, Travis S, Escher JC, Moser G, Forbes A, Hoffmann JC, Dignass A, Gionchetti P, Jantschek G, Kiesslich R, Kolacek S, Mitchell R, Panes J, Soderholm J, Vucelic B, Stange E. European evidence-based Consensus on the management of ulcerative colitis: Special situations. J Crohns Colitis 2008; 2:63-92. [PMID: 21172196 DOI: 10.1016/j.crohns.2007.12.001] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Accepted: 12/30/2007] [Indexed: 02/08/2023]
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Katumba G, Makiwa G, Baisitse TR, Olumekor L, Forbes A, Wäckelgård E. Solar selective absorber functionality of carbon nanoparticles embedded in SiO2, ZnO and NiO matrices. ACTA ACUST UNITED AC 2008. [DOI: 10.1002/pssc.200776823] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Coggon D, Miller BG, Colvin AP, Hutchison PA, Tait H, Dempsey S, Lewis D, Soutar CA, Sim MR, Kelsall H, McKenzie D, Leder K, Ross J, Ikin J, Forbes A, Baste V, Riise T, Moen BE, Venables KM, Carpenter LM. Military mini-symposium. Occup Environ Med 2007. [DOI: 10.1136/oem.64.12.e30] [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: 11/04/2022]
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Bell AJG, Price AB, Forbes A, Ciclitira PJ, Nicholls RJ. Pre-pouch ileitis. Aliment Pharmacol Ther 2007; 26:963-4; author reply 964. [PMID: 17767481 DOI: 10.1111/j.1365-2036.2007.03436.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 01/25/2023]
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Mansfield JC, Parkes M, Hawthorne AB, Forbes A, Probert CSJ, Perowne RC, Cooper A, Zeldis JB, Manning DC, Hawkey CJ. A randomized, double-blind, placebo-controlled trial of lenalidomide in the treatment of moderately severe active Crohn's disease. Aliment Pharmacol Ther 2007; 26:421-30. [PMID: 17635377 DOI: 10.1111/j.1365-2036.2007.03385.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Therapy targeted at tumour necrosis factor-alpha has an established role in Crohn's disease. Lenalidomide, an analogue of thalidomide, is an oral immunomodulatory agent with powerful antitumour necrosis factor-alpha properties. It is licensed for myeloma and myelodysplastic syndrome. Based upon reports of thalidomide efficacy, lenalidomide was evaluated in Crohn's disease. AIM To evaluate the efficacy and safety of lenalidomide in subjects with moderately severe active Crohn's disease. METHODS In a multicentre, double-blind, placebo-controlled parallel group study 89 subjects were randomized to lenalidomide 25 mg daily, 5 mg daily or placebo. Subjects were treated for 12 weeks. The primary end point was a 70-point reduction in Crohn's Disease Activity Index. RESULTS The overall clinical response rate was not significantly different between the three groups: lenalidomide 25 mg 26%, lenalidomide 5 mg 48% and placebo 39%. Lenalidomide was generally well tolerated with only one serious adverse event, a deep vein thrombosis, being attributed to treatment. CONCLUSION Lenalidomide, an oral agent with antitumour necrosis factor-alpha properties, was not effective in active Crohn's disease in contrast to reports of benefit from thalidomide. The reasons for this lack of efficacy are speculative, other physiological activities may offset its action on inflammatory cytokines, or its antitumour necrosis factor-alpha action without apoptosis may be insufficient for activity in Crohn's disease.
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Affiliation(s)
- J C Mansfield
- Department of Gastroenterology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Lewis CM, Whitwell SCL, Forbes A, Sanderson J, Mathew CG, Marteau TM. Estimating risks of common complex diseases across genetic and environmental factors: the example of Crohn disease. J Med Genet 2007; 44:689-94. [PMID: 17660460 PMCID: PMC2752174 DOI: 10.1136/jmg.2007.051672] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Progress has been made in identifying mutations that confer susceptibility to complex diseases, with the prospect that these genetic risks might be used in determining individual disease risk. AIM To use Crohn disease (CD) as a model of a common complex disorder, and to develop methods to estimate disease risks using both genetic and environmental risk factors. METHODS The calculations used three independent risk factors: CARD15 genotype (conferring a gene dosage effect on risk), smoking (twofold increased risk for smokers), and residual familial risk (estimating the effect of unidentified genes, after accounting for the contribution of CARD15). Risks were estimated for high-risk people who are siblings, parents and offspring of a patient with CD. RESULTS The CD risk to the sibling of a patient with CD who smokes and carries two CARD15 mutations is approximately 35%, which represents a substantial increase on the population risk of 0.1%. In contrast, the risk to a non-smoking sibling of a patient with CD who carries no CARD15 mutations is 2%. Risks to parents and offspring were lower. CONCLUSIONS High absolute risks of CD disease can be obtained by incorporating information on smoking, family history and CARD15 mutations. Behaviour modification through smoking cessation may reduce CD risk in these people.
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Affiliation(s)
- C M Lewis
- Department of Medical and Molecular Genetics, Division of Genetics and Molecular Medicine, King's College London School of Medicine, London, UK.
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Abstract
BACKGROUND Shoulder pain is a common problem and although there are many accepted standard forms of conservative therapy for shoulder disorders including non-steroidal anti-inflammatory drugs, glucocorticosteroid injections, oral glucocorticosteroid medication, manipulation under anaesthesia, physical therapy, hydrodilatation (distension arthrography) and surgery, evidence of their efficacy is not well established. OBJECTIVES To review the efficacy of common interventions for shoulder pain. SEARCH STRATEGY We searched the Cochrane Musculoskeletal Group trials register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, and Science Citation Index) up to May 1998, and hand searched major textbooks, bibliographies of relevant literature, the fugitive literature, and the subject indices of relevant journals including: American College of Rheumatology;British College of Rheumatologists; the Biennial Conference of the Manipulative Physiotherapy Association of Australia;International Federation of Manual Therapists conference proceedings; British Orthopaedic Association;and American Orthopaedic Association. SELECTION CRITERIA Each identified study was assessed for possible inclusion by two independent reviewers based on the blinded methods sections. The determinants for inclusion were that the trial include an intervention of interest (non-steroidal anti-inflammatory drugs, intra-articular or subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, or surgery); that treatment allocation was randomized; and that the outcome assessment was blinded. DATA COLLECTION AND ANALYSIS Methodological quality was assessed by two independent, blinded reviewers. Data relating to selection criteria, outcome measurement and treatment effect was extracted from the blinded trials. Range of motion scores were entered as degrees of restriction to movement, and all pain and overall effect scores were transformed to 100 point scales. For continuous outcome measures, where standard deviation was not reported it was either calculated from the raw data or converted from standard error of the mean. If neither of these were reported, authors were contacted in an effort to obtain the missing values. Effect sizes were calculated and combined in a pooled analysis if study population, endpoint and intervention were comparable. MAIN RESULTS Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5 - 22) out of possible score of 40. Selection criteria varied widely even for the same diagnostic label. There was no uniformity in outcome measures used and their measurement properties were rarely reported. Effect sizes for individual trials were small (-1.4 to 3.0). The results of only three studies investigating "rotator cuff tendonitis" could be pooled. Benefit of subacromial steroid injection over placebo for improving range of abduction (weighted difference between means (WMD) 35 degrees , 95% CI 14 to 55) was the only positive finding. AUTHORS' CONCLUSIONS There is little evidence to support or refute the efficacy of common interventions for shoulder pain. As well as, the need for further well designed clinical trials, more research is needed to establish a uniform method of defining shoulder disorders and developing outcome measures which are valid, reliable and responsive in these study populations.
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Affiliation(s)
- S Green
- Monash University, Australasian Cochrane Centre, Monash Medical Centre, Locked Bag 29, Clayton, Victoria, Australia, 3168.
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Papadia C, Sherwood RA, Kalantzis C, Wallis K, Volta U, Fiorini E, Forbes A. Plasma citrulline concentration: a reliable marker of small bowel absorptive capacity independent of intestinal inflammation. Am J Gastroenterol 2007; 102:1474-82. [PMID: 17459021 DOI: 10.1111/j.1572-0241.2007.01239.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [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: 12/11/2022]
Abstract
OBJECTIVES Postabsorptive plasma citrulline concentration has been proposed as a reliable marker of small bowel absorptive capacity in short bowel patients. The aim of this study was to address the potentially confounding impact of intestinal inflammation. METHODS Fifty-five patients were selected according to diagnosis, small bowel length, and degree of bowel inflammation. (a) Crohn's disease (CD) with massive small bowel resection leaving </=50 cm (N = 6), (b) CD with 50-150 cm remaining (N = 9), (c) CD with no resection but active inflammation (high C-reactive protein [CRP] and Crohn's Disease Activity Index [CDAI] >220) (N = 7), (d) CD without resection or active inflammation (normal CRP and CDAI <150) (N = 9), (e) mesenteric infarction (MI) with resection leaving </=50 cm (N = 6), (f) MI leaving 50-150 cm (N = 6), (g) active celiac disease (N = 6), (h) healthy volunteers (N = 6). Postabsorptive fasting plasma citrulline was measured using reverse-phase, high performance liquid chromatography. Absorptive capacity and permeability were also measured after oral sugar-mix ingestion (5 g lactulose, 1 g L-rhamnose, 0.5 g D-xylose). RESULTS The plasma citrulline strongly correlated with small bowel length (P < 0.0001) and xylose absorption (P < 0.001). No correlation was found with CDAI, permeability, CRP, albumin, sedimentation rate, white cell count, or platelet count. Citrulline was significantly higher (P < 0.0004) in CD and MI patients with a remnant small bowel length of 50-150 cm (mean 21.0 micromol/L) than in those with length </=50 cm (mean 9.2 micromol/L). CONCLUSIONS Plasma citrulline concentration is a simple and reliable surrogate for small bowel absorptive capacity and is not influenced by intestinal inflammation.
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Affiliation(s)
- Cinzia Papadia
- Department of Gastroenterology, University College Hospital, London, United Kingdom
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Affiliation(s)
- A Windsor
- Department of Colorectal Surgery, University College London Hospitals, UK
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Steinhart AH, Forbes A, Mills EC, Rodgers-Gray BS, Travis SPL. Systematic review: the potential influence of mesalazine formulation on maintenance of remission in Crohn's disease. Aliment Pharmacol Ther 2007; 25:1389-99. [PMID: 17539978 DOI: 10.1111/j.1365-2036.2007.03324.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the effectiveness of pH 6-/pH 7-dependent and controlled-release mesalazines in maintaining medically and surgically induced Crohn's disease remission. METHODS A systematic search identified 13 randomized controlled trials (RCTs). The rate of symptomatic relapse (Crohn's disease activity index >150, or an increase in baseline by at least 60-100 points) was extracted from each randomized controlled trial. Pooled odds ratios (OR), the number needed to treat (NNT), and percentage therapeutic benefit (absolute risk reduction) were calculated. RESULTS Treatment with pH 7-dependent mesalazine significantly reduced the risk of relapse in patients with either surgically [OR 0.28; 95% confidence interval (CI) 0.12-0.65; P = 0.0032] or medically induced remission (OR 0.38; 95% CI 0.17-0.85; P = 0.0113). However, treatment with controlled-release mesalazine and pH 6-dependent mesalazine failed to show any significant advantage over placebo. The NNT to maintain surgically or medically induced remission was lowest for pH 7-dependent mesalazine (NNT = 4 and 5, respectively; NNT = 15 and 16 for controlled-release mesalazine and NNT = 11 and 23 for pH 6-dependent mesalazine). Therapeutic benefit was highest for pH 7-dependent mesalazine (surgical = 30.6%, medical = 22.8%). This compared with 6.9% (surgical) and 6.4% (medical) for controlled-release mesalazine, and 9.8% and 4.4%, respectively, for pH 6-dependent mesalazine. CONCLUSION Further trials of pH 7-dependent mesalazine formulations are warranted in the maintenance of remission in Crohn's disease.
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Affiliation(s)
- A H Steinhart
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Parkes M, Barrett JC, Prescott NJ, Tremelling M, Anderson CA, Fisher SA, Roberts RG, Nimmo ER, Cummings FR, Soars D, Drummond H, Lees CW, Khawaja SA, Bagnall R, Burke DA, Todhunter CE, Ahmad T, Onnie CM, McArdle W, Strachan D, Bethel G, Bryan C, Lewis CM, Deloukas P, Forbes A, Sanderson J, Jewell DP, Satsangi J, Mansfield JC, Cardon L, Mathew CG. Sequence variants in the autophagy gene IRGM and multiple other replicating loci contribute to Crohn's disease susceptibility. Nat Genet 2007; 39:830-2. [PMID: 17554261 PMCID: PMC2628541 DOI: 10.1038/ng2061] [Citation(s) in RCA: 867] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 05/11/2007] [Indexed: 02/06/2023]
Abstract
A genome-wide association scan in individuals with Crohn's disease by the Wellcome Trust Case Control Consortium detected strong association at four novel loci. We tested 37 SNPs from these and other loci for association in an independent case-control sample. We obtained replication for the autophagy-inducing IRGM gene on chromosome 5q33.1 (replication P = 6.6 x 10(-4), combined P = 2.1 x 10(-10)) and for nine other loci, including NKX2-3, PTPN2 and gene deserts on chromosomes 1q and 5p13.
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Affiliation(s)
- Miles Parkes
- Inflammatory Bowel Disease Research Group, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 2QQ, UK.
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Willoughby T, Meeks S, Huddleston A, Kupelian P, Forbes A. TH-C-M100J-03: Lung Localization and Initial Shifts Based On Implanted Markers. Med Phys 2007. [DOI: 10.1118/1.2761651] [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: 11/07/2022] Open
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Prescott NJ, Fisher SA, Franke A, Hampe J, Onnie CM, Soars D, Bagnall R, Mirza MM, Sanderson J, Forbes A, Mansfield JC, Lewis CM, Schreiber S, Mathew CG. A nonsynonymous SNP in ATG16L1 predisposes to ileal Crohn's disease and is independent of CARD15 and IBD5. Gastroenterology 2007; 132:1665-71. [PMID: 17484864 DOI: 10.1053/j.gastro.2007.03.034] [Citation(s) in RCA: 239] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 03/18/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS A genome-wide association scan of nonsynonymous DNA polymorphisms identified association of a threonine-to-alanine substitution (T300A) in the autophagy-related 16-like gene ATG16L1 with Crohn's disease. We investigated this association in independent U.K. cohorts of Crohn's disease and ulcerative colitis. METHODS The T300A variant (rs2241880) was genotyped in an independent sample of 727 Crohn's disease and 877 ulcerative colitis cases, and in 579 controls. We then performed an extension analysis combining these data with the U.K. data from the initial study to give a total of 1236 U.K. Crohn's disease cases and 1235 controls to estimate disease risk and test for interaction with the CARD15 and IBD5 risk loci and for association with disease subtypes. RESULTS The association of T300A was replicated in the independent sample of 727 Crohn's disease cases (P = .001), and was strongly associated in the extended analysis of 1236 Crohn's cases (P = 2.4 x 10(-6)). The 300A/A genotype conferred a 1.65-fold risk of Crohn's disease, with a 2.2-fold risk of ileal disease. Analysis of the interaction of ATG16L1 with CARD15 and IBD5 indicated that all 3 loci contribute independently to disease risk. Homozygosity for the risk allele at all 3 loci conferred a combined risk of 20.4 (95% confidence interval: 8.71, 47.7) for Crohn's disease. The ATG16L1 risk genotype showed a modest but significant association with ulcerative colitis (P = .026). CONCLUSIONS The association of ATG16L1 with Crohn's disease and possibly with ulcerative colitis supports a role for autophagy in the pathogenesis of inflammatory bowel disease.
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Affiliation(s)
- Natalie J Prescott
- Department of Medical and Molecular Genetics, King's College London School of Medicine, Guy's Hospital, London, UK
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Tremelling M, Cummings F, Fisher SA, Mansfield J, Gwilliam R, Keniry A, Nimmo ER, Drummond H, Onnie CM, Prescott NJ, Sanderson J, Bredin F, Berzuini C, Forbes A, Lewis CM, Cardon L, Deloukas P, Jewell D, Mathew CG, Parkes M, Satsangi J. IL23R variation determines susceptibility but not disease phenotype in inflammatory bowel disease. Gastroenterology 2007; 132:1657-64. [PMID: 17484863 PMCID: PMC2696256 DOI: 10.1053/j.gastro.2007.02.051] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 02/08/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Identification of inflammatory bowel disease (IBD) susceptibility genes is key to understanding pathogenic mechanisms. Recently, the North American IBD Genetics Consortium provided compelling evidence for an association between ileal Crohn's disease (CD) and the IL23R gene using genome-wide association scanning. External replication is a priority, both to confirm this finding in other populations and to validate this new technique. We tested for association between IL23R and IBD in a large independent UK panel to determine the size of the effect and explore subphenotype correlation and interaction with CARD15. METHODS Eight single nucleotide polymorphism markers in IL23R tested in the North American study were genotyped in 1902 cases of Crohn's disease (CD), 975 cases of ulcerative colitis (UC), and 1345 controls using MassARRAY. Data were analyzed using chi(2) statistics, and subgroup association was sought. RESULTS A highly significant association with CD was observed, with the strongest signal at coding variant Arg381Gln (allele frequency, 2.5% in CD vs 6.2% in controls [P = 1.1 x 10(-12)]; odds ratio, 0.38; 95% confidence interval, 0.29-0.50). A weaker effect was seen in UC (allele frequency, 4.6%; odds ratio, 0.73; 95% confidence interval, 0.55-0.96). Analysis accounting for Arg381Gln suggested that other loci within IL23R also influence IBD susceptibility. Within CD, there were no subphenotype associations or evidence of interaction with CARD15. CONCLUSIONS This study shows an association between IL23R and all subphenotypes of CD with a smaller effect on UC. This extends the findings of the North American study, providing clear evidence that genome-wide association scanning can successfully identify true complex disease genes.
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Affiliation(s)
- Mark Tremelling
- IBD Research Group, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Fraser Cummings
- Gastroenterology Unit, Radcliffe Infirmary, University of Oxford, Oxford, England
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Sheila A. Fisher
- Division of Genetics and Molecular Medicine, Guy’s, King’s College and St Thomas’ School of Medicine, London, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - John Mansfield
- Faculty of Medical Sciences, University of Newcastle, Newcastle upon Tyne, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Rhian Gwilliam
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Andrew Keniry
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Elaine R. Nimmo
- Department of Gastroenterology, University of Edinburgh, and Gastrointestinal Unit, Western General Hospital, Edinburgh, Scotland
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Hazel Drummond
- Department of Gastroenterology, University of Edinburgh, and Gastrointestinal Unit, Western General Hospital, Edinburgh, Scotland
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Clive M. Onnie
- Department of Medical and Molecular Genetics, King’s College London School of Medicine, Guy’s Hospital, London, United Kingdom
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Natalie J. Prescott
- Department of Medical and Molecular Genetics, King’s College London School of Medicine, Guy’s Hospital, London, United Kingdom
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Jeremy Sanderson
- Division of Genetics and Molecular Medicine, Guy’s, King’s College and St Thomas’ School of Medicine, London, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Francesca Bredin
- IBD Research Group, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Carlo Berzuini
- IBD Research Group, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Alastair Forbes
- Department of Medical and Molecular Genetics, King’s College London School of Medicine, Guy’s Hospital, London, United Kingdom
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Cathryn M. Lewis
- Division of Genetics and Molecular Medicine, Guy’s, King’s College and St Thomas’ School of Medicine, London, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Lon Cardon
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Panos Deloukas
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Derek Jewell
- Gastroenterology Unit, Radcliffe Infirmary, University of Oxford, Oxford, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Christopher G. Mathew
- Division of Genetics and Molecular Medicine, Guy’s, King’s College and St Thomas’ School of Medicine, London, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Miles Parkes
- IBD Research Group, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England
- Centre for Gastroenterology and Nutrition, University College, London, England
| | - Jack Satsangi
- Department of Gastroenterology, University of Edinburgh, and Gastrointestinal Unit, Western General Hospital, Edinburgh, Scotland
- Centre for Gastroenterology and Nutrition, University College, London, England
- Address requests for reprints to: Jack Satsangi, FRCP, Gastrointestinal Unit, Division of Medical Sciences, School of Molecular and Clinical Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, England. fax: (44) 0131-537-1085.
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Fisher SA, Mirza MM, Onnie CM, Soars D, Lewis CM, Prescott NJ, Mathew CG, Sanderson J, Forbes A, Todhunter C, Donaldson P, Mansfield J. Combined evidence from three large British Association studies rejects TUCAN/CARD8 as an IBD susceptibility gene. Gastroenterology 2007; 132:2078-80. [PMID: 17484911 DOI: 10.1053/j.gastro.2007.03.086] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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241
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Grosset D, Taurah L, Burn DJ, MacMahon D, Forbes A, Turner K, Bowron A, Walker R, Findley L, Foster O, Patel K, Clough C, Castleton B, Smith S, Carey G, Murphy T, Hill J, Brechany U, McGee P, Reading S, Brand G, Kelly L, Breen K, Ford S, Baker M, Williams A, Hearne J, Qizilbash N, Chaudhuri KR. A multicentre longitudinal observational study of changes in self reported health status in people with Parkinson's disease left untreated at diagnosis. J Neurol Neurosurg Psychiatry 2007; 78:465-9. [PMID: 17098846 PMCID: PMC2117846 DOI: 10.1136/jnnp.2006.098327] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The issue of when to start treatment in Parkinson's disease (PD) remains controversial. Some favour treatment at diagnosis while others opt for a "wait and watch" policy. The effect of the latter policy on the self reported health status of people with PD is unknown. AIMS To record self reported health status through longitudinal use of a validated PD specific questionnaire (PDQ-39) in untreated PD patients in multiple centres in the UK. To compare patients who were left untreated with those who were offered treatment during follow-up. METHODS A multicentre, prospective, "real life" observational audit based study addressing patient reported outcomes in relation to self reported health status and other sociodemographic details. RESULTS 198 untreated PD were assessed over a mean period of 18 months. During two follow-up assessments, the self reported health status scores in all eight domains of the PDQ-39 and the overall PDQ-39 summary index worsened significantly (p<0.01) in patients left untreated. In a comparative group in whom treatment was initiated at or soon after diagnosis, there was a trend towards improvement in self reported health status scores after treatment was started. CONCLUSIONS This study addresses for the first time self reported health status, an indicator of health related quality of life, in untreated PD. The findings may strengthen the call for re-evaluation of the policy to delay treatment in newly diagnosed patients with PD.
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Affiliation(s)
- D Grosset
- Institute of Neurological Sciences, Glasgow, UK
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Abstract
BACKGROUND The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. This is an update of an earlier review published in The Cochrane Library in Issue 3, 2004. OBJECTIVES To determine whether nursing-led inpatient units are effective in preparing patients for discharge from hospital compared to usual inpatient care. SEARCH STRATEGY We searched The Cochrane Library, the Specialized Register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, MEDLINE, CINAHL, EMBASE, BNI and HMIC databases. Citation searches were undertaken on the science and social science citation indices. Authors were contacted to identify additional data. The initial search was done in January 2001. The register search was updated in October 2006, the other database searches were updated in November 2006 and the citation search was run in January 2007. SELECTION CRITERIA Controlled trials and interrupted time series designs that compared the NLU to usual inpatient care managed by doctors. Patients over 18 years of age following an acute hospital admission for a physical health condition. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed study quality. MAIN RESULTS Ten random or quasi-random controlled trials reported on a total of 1896 patients. There was no statistically significant effect on inpatient mortality (OR 1.10, 95% CI 0.56 to 2.16) or mortality to longest follow up (OR 0.92, 95% CI 0.65 to 1.29) but higher quality studies showed a larger non-significant increase in inpatient mortality (OR 1.52, 95% CI 0.86 to 2.68). Discharge to institutional care was reduced for the NLU (OR 0.44 95% CI 0.22 to 0.89) and functional status at discharge increased (SMD 0.37, 95% CI 0.20 to 0.54) but there was a near significant increase in inpatient stay (WMD 5.13 days 95% CI -0.5 days to 10.76 days). Early readmissions were reduced (OR 0.52 95% CI 0.34 to 0.80). One study compared a NLU for the chronically critically ill with ICU care. Mortality (OR 0.62 95% CI 0.35 to 1.10) and length of inpatient stay differ did not differ (WMD 2 days, 95% CI 10.96 to -6.96 days). Early readmissions were reduced (OR 0.33 95% CI 0.12 to 0.94). Costs of care on the NLU were higher for UK studies but lower for US based studies. AUTHORS' CONCLUSIONS There is some evidence that patients discharged from a NLU are better prepared for discharge but it is unclear if this is simply a product of an increased length of inpatient stay. No statistically significant adverse effects were noted but the possibility of increased early mortality cannot be discounted. More research is needed.
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Affiliation(s)
- P D Griffiths
- King's College London, School of Nursing and Midwifery, Room 3.29b JCMB, Waterloo Road, London, UK, SE1 8WA.
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Culkin A, Gabe SM, Bjarnason I, Grimble G, Madden AM, Forbes A. A double-blind, randomized, controlled crossover trial of glutamine supplementation in home parenteral nutrition. Eur J Clin Nutr 2007; 62:575-83. [PMID: 17440526 DOI: 10.1038/sj.ejcn.1602754] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Studies suggest clinical benefit of glutamine-supplemented parenteral nutrition. The aim was to determine if the inclusion of 10 g of glutamine as part of the nitrogen source of home parenteral nutrition (HPN) reduces infectious complications. SUBJECTS/METHODS Thirty-five patients on HPN were recruited and 22 completed the study. Patients were randomized to receive either standard HPN or glutamine-supplemented HPN. Patients were assessed at randomization, 3 and 6 months later then they were crossed over to the alternative HPN and reassessed at 3 and 6 months. Assessments included plasma amino acid concentrations, intestinal permeability and absorption, nutritional status, oral and parenteral intake, quality of life, routine biochemistry and haematology. RESULTS No difference was seen between the groups at randomization. No difference was detected between the treatment phases for infective complications (55% in the standard treatment phase and 36% in the glutamine-supplemented phase P=0.67). There were no differences in nutritional status, intestinal permeability, plasma glutamine concentrations or quality of life. CONCLUSION Although limited by the sample size, the study has shown that glutamine as part of the nitrogen source of parenteral nutrition can be given to patients on HPN for 6 months without any adverse effects.
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Affiliation(s)
- A Culkin
- Department of Nutrition and Dietetics, St Mark's Hospital, Harrow, Middlesex, UK.
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244
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Affiliation(s)
- C Banks
- Centre for Gastroenterology, University College London, UK
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245
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Pearce AV, Fisher SA, Prescott NJ, Onnie CM, Pattni R, Green P, Forbes A, Mansfield J, Sanderson J, Schreiber S, Lewis CM, Mathew CG. Investigation of association of the DLG5 gene with phenotypes of inflammatory bowel disease in the British population. Int J Colorectal Dis 2007; 22:419-24. [PMID: 16944184 DOI: 10.1007/s00384-006-0151-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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] [Accepted: 05/02/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Mutations in the DLG5 gene are associated with an increased risk of inflammatory bowel disease (IBD) in some European populations. Initial investigation of a British IBD population showed evidence of association of one of three DLG5 variants, R30Q, in a family-based collection but not in a case-control cohort. We have now examined the association of the R30Q polymorphism in a large cohort of British IBD cases, tested for interaction between the DLG5 and CARD15 genes and assessed possible association of DLG5 with clinical features of Crohn's disease (CD) and ulcerative colitis (UC). MATERIALS AND METHODS DLG5 R30Q and the CARD15 polymorphisms, Arg702Trp, Gly908Arg and Leu1007fs were genotyped in 1,148 IBD cases and 749 controls. DLG5 R30Q was also analysed in cases stratified by CARD15 genotype, disease subtype and smoking history. RESULTS/FINDINGS No significant difference in frequencies of the R30Q variant was observed between IBD cases (9.9%) and controls (10.1%) or in cases analysed separately as CD and UC. There was also no significant difference in the frequency of R30Q between CD cases carrying risk-associated CARD15 alleles and those that did not. The frequency of R30Q was higher in CD cases with ileal disease than cases without (p=0.042) and higher in CD cases who had smoked than in nonsmokers (p=0.009). INTERPRETATION/CONCLUSION The R30Q variant in the DLG5 gene does not appear to be associated with an overall increase in the risk of disease in a British IBD cohort, but differences in its frequency in subgroups of CD patients warrant further investigation.
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Affiliation(s)
- Alexandra V Pearce
- Department of Medical & Molecular Genetics, King's College London School of Medicine, 8th Floor Guy's Tower, Guy's Hospital, London SE1 9RT, UK
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Nyilas M, Auby P, Mallikaarjun S, Forbes A, Carson W. Aripiprazole in child and adolescent psychiatric disorders: Safety, tolerability, and pharmacokinetics. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sivagnanam P, Koutsoumpas A, Forbes A. Respiratory symptoms in patients with inflammatory bowel disease and the impact of dietary salicylates. Dig Liver Dis 2007; 39:232-9. [PMID: 16979961 DOI: 10.1016/j.dld.2006.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 07/29/2006] [Accepted: 08/04/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Respiratory symptoms are over-represented in inflammatory bowel disease. There are similarities between the epidemiology of inflammatory bowel disease and that of respiratory conditions for which an adverse influence of salicylate has been identified. Natural salicylates exist within our diet. AIMS To determine whether a lower intake of dietary salicylates is associated with less active inflammatory bowel disease and fewer concurrent respiratory symptoms. PATIENTS AND METHODS Respiratory status, inflammatory bowel disease activity, quality of life, and dietary habits were established in 73 patients with Crohn's disease and 69 with ulcerative colitis, using a self-administered questionnaire and peak expiratory flow rate readings. Harvey-Bradshaw and Simple Birmingham/Royal Free Colitis indices, an internally validated respiratory score, and estimated weekly dietary salicylate intake, were calculated for each patient. RESULTS There was at least one respiratory symptom in 63.4% of patients. The commonest underlying respiratory diagnosis was asthma. Respiratory impairment was similar in ulcerative colitis and Crohn's disease; 56.3% of Crohn's disease patients with an active respiratory diagnosis had other extra-intestinal manifestations. The dietary salicylate intake was independent of respiratory status, but inversely correlated with ulcerative colitis activity (dietary salicylate intake 37.0mg versus 21.4mg for low and higher Simple Birmingham/Royal Free Colitis index, respectively; p<0.02). A similar association was not seen in Crohn's disease. CONCLUSIONS Respiratory impairment is common in inflammatory bowel disease. Higher intake of dietary salicylates is associated with less active colitis and possibly causally so.
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Affiliation(s)
- P Sivagnanam
- Imperial College School of Medicine, South Kensington, London, UK
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Abstract
PURPOSE OF REVIEW The past 12 months have seen advances in the safe use of intravenous nutrition and its place in the therapeutic armamentarium. RECENT FINDINGS Complications of intravenous nutrition and proposed optimal strategies to avoid them are considered, with particular attention to the hazards of hyperglycaemia. Intravenous nutrition in certain specified conditions is addressed, including its minor role in advanced malignancy. New details on the effects of amended lipid emulsions are presented, together with a meta-analysis of growth hormone and glutamine. SUMMARY Parenteral nutrition needs attention to detail if it is to be employed safely and effectively. Special care should be taken to maintain blood glucose in the normal range. There are currently insufficient data to warrant wholesale switching to novel lipid emulsions or the global use of glutamine or growth hormone.
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Affiliation(s)
- Alastair Forbes
- Department of Gastroenterology and Clinical Nutrition, University College Hospital, London, UK.
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Abstract
BACKGROUND Glucagon-like peptide 2 (GLP-2) is an important peptide growth factor secreted from the human intestine. The trophic properties of GLP-2 are very specific to the gut where it is pivotal in the regulation of mucosal morphology, function and integrity. AIMS This review details the current understanding of the molecular biology of GLP-2, its mechanisms of action and physiological properties. A major focus is the discussion of recent clinical data evaluating the use of GLP-2 as a therapeutic agent. METHODS Relevant articles were identified using Medline searches and from the reference lists of key papers. RESULTS AND CONCLUSIONS In the treatment of short bowel syndrome, GLP-2 has been shown to be highly effective in improving fluid absorption. In Crohn's disease, GLP-2 is superior to placebo in the induction of remission. Early data also suggest that the effects of GLP-2 on bone metabolism can provide a new treatment approach for patients with osteoporosis. In the future, the positive effects of GLP-2 on intestinal barrier function, splanchnic perfusion and mucosal healing could be utilized to expand its therapeutic application to other causes of intestinal injury. However, important safety aspects need to be considered when using this potent growth-promoting agent for a long term.
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Affiliation(s)
- K Wallis
- Division of Medicine, Imperial College, Hammersmith Hospital, London, UK
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