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Covshoff E, Blake L, Rose E, Bolade A, Rathouse R, Wilson A, Cotterell A, Pittrof R, Sethi F. Sexual and Reproductive Health Needs Assessment & Interventions in a Female Psychiatric Intensive Care Unit. Eur Psychiatry 2022. [PMCID: PMC9568154 DOI: 10.1192/j.eurpsy.2022.2088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction This quality improvement project was a collaboration between an adult, inpatient female psychiatric intensive care unit (PICU) in South London and the Sexual and Reproductive Health Rights, Inclusion and Empowerment (SHRINE) programme. SHRINE is a London-based programme delivering SRH care to any individual with serious mental illness, substance misuse and/or learning disability. Objectives The primary aim of this quality improvement project was to assess patients’ sexual and reproductive (SRH) needs, and the acceptability of providing SRH assessments in a female PICU setting. Secondary aims were to explore the barriers to access and the feasibility of providing SRH assessments and SHRINE interventions in the PICU. Methods A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on the PICU over a seven-month period. Within a quality improvement framework, a staff training needs assessment was performed, training delivered, a protocol developed, staff attitudes explored, and patient and carer engagement sought. Results 30% of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. 42% of women were assessed, representing a 3.5-fold increase in uptake. 21% of women initiated SRH interventions of which 14% had all their SRH needs met. Conclusions Results identified SRH needs for PICU admissions are greater than realised. Staff highlighted the acceptability and importance of SRH care, if interventions are appropriately timed and the patient’s individual risk profile considered. Providing a nurse-led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients. Disclosure No significant relationships.
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Lohman RJ, Iyer A, Fairlie TJ, Cotterell A, Gupta P, Reid RC, Vesey DA, Sweet MJ, Fairlie DP. Differential Anti-inflammatory Activity of HDAC Inhibitors in Human Macrophages and Rat Arthritis. ACTA ACUST UNITED AC 2015; 356:387-96. [DOI: 10.1124/jpet.115.229328] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/07/2015] [Indexed: 01/02/2023]
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Gupta G, Regmi A, Kumar D, Posner S, Posner MP, Sharma A, Cotterell A, Bhati CS, Kimball P, Massey HD, King AL. Safe Conversion From Tacrolimus to Belatacept in High Immunologic Risk Kidney Transplant Recipients With Allograft Dysfunction. Am J Transplant 2015; 15:2726-31. [PMID: 25988397 DOI: 10.1111/ajt.13322] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 02/08/2015] [Revised: 03/08/2015] [Accepted: 03/14/2015] [Indexed: 01/25/2023]
Abstract
There is no literature on the use of belatacept for sensitized patients or regrafts in kidney transplantation. We present our initial experience in high immunologic risk kidney transplant recipients who were converted from tacrolimus to belatacept for presumed acute calcineurin inhibitor (CNI) toxicity and/or interstitial fibrosis/tubular atrophy. Six (mean age = 40 years) patients were switched from tacrolimus to belatacept at a median of 4 months posttransplant. Renal function improved significantly from a peak mean estimated glomerular filtration rate (eGFR) of 23.8 ± 12.9 mL/min/1.73 m(2) prior to the switch to an eGFR of 42 ± 12.5 mL/min/1.73 m(2) (p = 0.03) at a mean follow-up of 16.5 months postconversion. No new rejection episodes were diagnosed despite a prior history of rejection in 2/6 (33%) patients. Surveillance biopsies performed in 5/6 patients did not show subclinical rejection. No development of donor-specific antibodies (DSA) was noted. In this preliminary investigation, we report improved kidney function without a concurrent increase in risk of rejection and DSA in six sensitized patients converted from tacrolimus to belatacept. Improvement in renal function was noted even in patients with chronic allograft fibrosis without evidence of acute CNI toxicity. Further studies with protocol biopsies are needed to ensure safety and wider applicability of this approach.
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Affiliation(s)
- G Gupta
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - A Regmi
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - D Kumar
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - S Posner
- Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - M P Posner
- Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - A Sharma
- Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - A Cotterell
- Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - C S Bhati
- Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - P Kimball
- Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - H D Massey
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - A L King
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA
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Suen JY, Cotterell A, Lohman RJ, Lim J, Han A, Yau MK, Liu L, Cooper MA, Vesey DA, Fairlie DP. Pathway-selective antagonism of proteinase activated receptor 2. Br J Pharmacol 2014; 171:4112-24. [PMID: 24821440 DOI: 10.1111/bph.12757] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/04/2014] [Accepted: 04/30/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Proteinase activated receptor 2 (PAR2) is a GPCR associated with inflammation, metabolism and disease. Clues to understanding how to block PAR2 signalling associated with disease without inhibiting PAR2 activation in normal physiology could be provided by studies of biased signalling. EXPERIMENTAL APPROACH PAR2 ligand GB88 was profiled for PAR2 agonist and antagonist properties by several functional assays associated with intracellular G-protein-coupled signalling in vitro in three cell types and with PAR2-induced rat paw oedema in vivo. KEY RESULTS In HT29 cells, GB88 was a PAR2 antagonist in terms of Ca(2+) mobilization and PKC phosphorylation, but a PAR2 agonist in attenuating forskolin-induced cAMP accumulation, increasing ERK1/2 phosphorylation, RhoA activation, myosin phosphatase phosphorylation and actin filament rearrangement. In CHO-hPAR2 cells, GB88 inhibited Ca(2+) release, but activated G(i/o) and increased ERK1/2 phosphorylation. In human kidney tubule cells, GB88 inhibited cytokine secretion (IL6, IL8, GM-CSF, TNF-α) mediated by PAR2. A rat paw oedema induced by PAR2 agonists was also inhibited by orally administered GB88 and compared with effects of locally administered inhibitors of G-protein coupled pathways. CONCLUSIONS AND IMPLICATIONS GB88 is a biased antagonist of PAR2 that selectively inhibits PAR2/G(q/11)/Ca(2+)/PKC signalling, leading to anti-inflammatory activity in vivo, while being an agonist in activating three other PAR2-activated pathways (cAMP, ERK, Rho) in human cells. These findings highlight opportunities to design drugs to block specific PAR2-linked signalling pathways in disease, without blocking beneficial PAR2 signalling in normal physiology, and to dissect PAR2-associated mechanisms of disease in vivo.
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Affiliation(s)
- J Y Suen
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia
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Scian MJ, Maluf DG, David KG, Archer KJ, Suh JL, Wolen AR, Mba MU, Massey HD, King AL, Gehr T, Cotterell A, Posner M, Mas V. MicroRNA profiles in allograft tissues and paired urines associate with chronic allograft dysfunction with IF/TA. Am J Transplant 2011; 11:2110-22. [PMID: 21794090 PMCID: PMC3184368 DOI: 10.1111/j.1600-6143.2011.03666.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Despite the advances in immunosuppression, renal allograft attrition over time remains unabated due to chronic allograft dysfunction (CAD) with interstitial fibrosis (IF) and tubular atrophy (TA). We aimed to evaluate microRNA (miRNA) signatures in CAD with IF/TA and appraise correlation with paired urine samples and potential utility in prospective evaluation of graft function. MiRNA signatures were established between CAD with IF/TA versus normal allografts by microarray. Validation of the microarray results and prospective evaluation of urine samples was performed using real-time quantitative-PCR (RT-qPCR). Fifty-six miRNAs were identified in samples with CAD-IF/TA. Five miRNAs were selected for further validation based on array fold change, p-value and in silico predicted mRNA targets. We confirmed the differential expression of these five miRNAs by RT-qPCR using an independent set of samples. Differential expression was detected for miR-142-3p, miR-204, miR-107 and miR-211 (p < 0.001) and miR-32 (p < 0.05). Furthermore, differential expression of miR-142-3p (p < 0.01), miR-204 (p < 0.01) and miR-211 (p < 0.05) was also observed between patient groups in urine samples. A characteristic miRNA signature for IF/TA that correlates with paired urine samples was identified. These results support the potential use of miRNAs as noninvasive markers of IF/TA and for monitoring graft function.
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Affiliation(s)
- MJ Scian
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645
| | - DG Maluf
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645
| | - KG David
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645
| | - KJ Archer
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645,
Virginia Commonwealth University, Department of Biostatistics P.O. Box 980032, 730 East Broad Street, Room 3006, Richmond, VA 23298-0032
| | - JL Suh
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645
| | - AR Wolen
- Virginia Commonwealth University, Department of Human and Molecular Genetics P.O. Box 980033, 1101 East Marshall Street, Richmond, Virginia 23298-0033
| | - MU Mba
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645
| | - HD Massey
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645
| | - AL King
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645
| | - T Gehr
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645
| | - A Cotterell
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645
| | - M Posner
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645
| | - V Mas
- Virginia Commonwealth University, Department of Surgery P.O. Box 980645, 1200 E. Broad Street, Richmond, VA 23219-0645,
Virginia Commonwealth University, Department of Pathology PO Box 980662, 1101 E. Marshall Street, Richmond, VA 23298-0662,Corresponding author: Virginia Commonwealth University, Department of Surgery P.O. Box 980645 1200 E. Broad Street, Richmond VA 23219-0645
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Scian MJ, Maluf D, Archer KJ, Whitehill BC, Suh LJ, King A, Gehr TW, Sharma A, Kapoor S, Cotterell A, Massey DH, Posner MP, Mas V. DISCERNING GENE EXPRESSION PROFILES INVOLVED IN LOSS OF GRAFT FUNCTION WITH IF/TA: UTILITY IN DIAGNOSIS AND DISEASE PROGRESSION. Transplantation 2010. [DOI: 10.1097/00007890-201007272-00027] [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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Cotterell A, Fisher R, Maluf D, Stravitz R, Sterling R, Luketic V, Sanyal A, Shiffman M, Posner M. L/I-3 Biliary complications in adult-to-adult living donor right lobe liver transplants. Clin Transplant 2006. [DOI: 10.1111/j.1399-0012.2006.00577_3_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Maluf D, Cotterell A, Clark B, Stravitz T, Kauffman HM, Fisher RA. Hepatic angiosarcoma and liver transplantation: case report and literature review. Transplant Proc 2005; 37:2195-9. [PMID: 15964377 DOI: 10.1016/j.transproceed.2005.03.060] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Indexed: 12/17/2022]
Abstract
Hepatic angiosarcoma is a rare malignant vascular tumor that accounts for up to 2% of all primary liver tumors. Accurate diagnosis of this tumor is difficult, especially if the patient has no history of exposure to specific carcinogens including thorotrast, arsenicals, and vinyl chloride monomer. Diagnosis of diffuse angiosarcoma by means of liver biopsy has been reported as treacherous and nondiagnostic. Herein, we present a case of a 61-year-old Caucasian male with history of cryptogenic cirrhosis, normal alpha-fetoprotein, and pretransplant abnormal liver MRI who underwent nondiagnostic liver biopsies followed by liver transplantation. High grade diffuse angiosarcoma was diagnosed in the explanted liver. The patient developed bone metastases at 8 months and is alive 1 year posttransplantation. Diffuse liver tissue infiltration seen pretransplant on CT scan or MRI, suggesting the possibility of diffuse liver lesions (HCC, angiosarcoma, etc) must be fully investigated with all techniques available including multiple open liver biopsies to avoid the sacrifice of a liver allograft in these patients.
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Affiliation(s)
- D Maluf
- Department of Transplantation, Virginia Commonwealth University, Medical College of Virginia Hospitals, 1101 E. Marshall Street, Richmond, VA 23298, USA
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Maluf D, Fisher RA, Maroney T, Cotterell A, Fulcher A, Tisnado J, Contos M, Luketic V, Stravitz R, Shiffman M, Sterling R, Posner M. Non-resective ablation and liver transplantation in patients with cirrhosis and hepatocellular carcinoma (HCC): safety and efficacy. Am J Transplant 2003; 3:312-7. [PMID: 12614287 DOI: 10.1034/j.1600-6143.2003.00041.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We investigated the efficacy of nonresective ablation techniques and the tumor-free survival of cirrhotic patients undergoing liver transplantation for hepatocellular carcinoma (HCC). In group 1, 11 HCC patients were treated with these techniques and transplanted. On the waiting list, patients were treated to complete ablation, judged by gadolinium-enhanced MRI and alpha-fetoprotein (AFP) levels. Group 1 was compared with a concurrent group of 10 liver transplant patients (group 2) with incidental HCC (stages T1 three patients, T2 seven patients). The group 1 patients received 36 procedures (4 alcohol ablations, 14 trans -hepatic artery chemo-embolizations, 15 trans -hepatic chemo-infusions, and 3 radio frequency ablations) for treatment of 13 liver masses. Tumor-node-metastasis (TNM) stage was reduced in eight patients (72.7%), unchanged in two patients and increased in one patient before transplantation. The mean waiting time for transplantation was 12.9 7.6 months. Both groups had a tumor-free survival of 100%, at 30 12 months post transplant. On pathology, 54.5% of explanted livers had residual viable HCC after tumor treatment, and 36.4% (4/11) explants had synchronous lesions. Non-resective ablation therapy is safe and effective in reducing the HCC progression in cirrhotic patients awaiting liver transplantation. The cancer-free survival rate in this treatment group is equal to that for incidental T1-T2 HCCs.
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Affiliation(s)
- D Maluf
- Division of Transplant Surgery, Department of Radiology, Medical College of Virginia of Virginia Commonwealth University, PO Box 980254, Richmond, VA 23298, USA
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