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Wang L, Sheth V, Liu K, Panja P, Frickenstein AN, He Y, Yang W, Thomas AG, Jamei MH, Park J, Lyu S, Donahue ND, Chen WR, Bhattacharya R, Mukherjee P, Wilhelm S. Primary Human Breast Cancer-Associated Endothelial Cells Favor Interactions with Nanomedicines. Adv Mater 2024:e2403986. [PMID: 38663008 DOI: 10.1002/adma.202403986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/19/2024] [Indexed: 05/04/2024]
Abstract
Cancer nanomedicines predominately rely on transport processes controlled by tumor-associated endothelial cells to deliver therapeutic and diagnostic payloads into solid tumors. While the dominant role of this class of endothelial cells for nanoparticle transport and tumor delivery is established in animal models, the translational potential in human cells needs exploration. Using primary human breast cancer as a model, the differential interactions of normal and tumor-associated endothelial cells with clinically relevant nanomedicine formulations are explored and quantified. Primary human breast cancer-associated endothelial cells exhibit up to ≈2 times higher nanoparticle uptake than normal human mammary microvascular endothelial cells. Super-resolution imaging studies reveal a significantly higher intracellular vesicle number for tumor-associated endothelial cells, indicating a substantial increase in cellular transport activities. RNA sequencing and gene expression analysis indicate the upregulation of transport-related genes, especially motor protein genes, in tumor-associated endothelial cells. Collectively, the results demonstrate that primary human breast cancer-associated endothelial cells exhibit enhanced interactions with nanomedicines, suggesting a potentially significant role for these cells in nanoparticle tumor delivery in human patients. Engineering nanoparticles that leverage the translational potential of tumor-associated endothelial cell-mediated transport into human solid tumors may lead to the development of safer and more effective clinical cancer nanomedicines.
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Affiliation(s)
- Lin Wang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Vinit Sheth
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Kaili Liu
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Prasanta Panja
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Alex N Frickenstein
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Yuxin He
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Wen Yang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Abigail G Thomas
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Mohammad Hasan Jamei
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Jeesoo Park
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Shanxin Lyu
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Nathan D Donahue
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Wei R Chen
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Resham Bhattacharya
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Priyabrata Mukherjee
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Stefan Wilhelm
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, 73019, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Institute for Biomedical Engineering, Science and Technology (IBEST), Norman, OK, 73019, USA
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Sheth V, Chen X, Mettenbrink EM, Yang W, Jones MA, M’Saad O, Thomas AG, Newport RS, Francek E, Wang L, Frickenstein AN, Donahue ND, Holden A, Mjema NF, Green DE, DeAngelis PL, Bewersdorf J, Wilhelm S. Quantifying Intracellular Nanoparticle Distributions with Three-Dimensional Super-Resolution Microscopy. ACS Nano 2023; 17:8376-8392. [PMID: 37071747 PMCID: PMC10643044 DOI: 10.1021/acsnano.2c12808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Super-resolution microscopy can transform our understanding of nanoparticle-cell interactions. Here, we established a super-resolution imaging technology to visualize nanoparticle distributions inside mammalian cells. The cells were exposed to metallic nanoparticles and then embedded within different swellable hydrogels to enable quantitative three-dimensional (3D) imaging approaching electron-microscopy-like resolution using a standard light microscope. By exploiting the nanoparticles' light scattering properties, we demonstrated quantitative label-free imaging of intracellular nanoparticles with ultrastructural context. We confirmed the compatibility of two expansion microscopy protocols, protein retention and pan-expansion microscopy, with nanoparticle uptake studies. We validated relative differences between nanoparticle cellular accumulation for various surface modifications using mass spectrometry and determined the intracellular nanoparticle spatial distribution in 3D for entire single cells. This super-resolution imaging platform technology may be broadly used to understand the nanoparticle intracellular fate in fundamental and applied studies to potentially inform the engineering of safer and more effective nanomedicines.
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Affiliation(s)
- Vinit Sheth
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Xuxin Chen
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Evan M. Mettenbrink
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Wen Yang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Meredith A. Jones
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Ons M’Saad
- Department of Cell Biology, Yale School of Medicine, New Haven, Connecticut, 06510, USA
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, 06520, USA
- Panluminate, Inc. New Haven, Connecticut, 06516, USA
| | - Abigail G. Thomas
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Rylee S. Newport
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Emmy Francek
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Lin Wang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Alex N. Frickenstein
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Nathan D. Donahue
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Alyssa Holden
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Nathan F. Mjema
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Dixy E. Green
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73126, USA
| | - Paul L. DeAngelis
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73126, USA
| | - Joerg Bewersdorf
- Department of Cell Biology, Yale School of Medicine, New Haven, Connecticut, 06510, USA
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, 06520, USA
- Kavli Institute for Neuroscience, Yale School of Medicine, New Haven, Connecticut, 06510 USA
- Department of Physics, Yale University, New Haven, Connecticut, 06511, USA
| | - Stefan Wilhelm
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
- Institute for Biomedical Engineering, Science, and Technology (IBEST), Norman, Oklahoma, 73019, USA
- Stephenson Cancer Center, Oklahoma City, Oklahoma, 73104, USA
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Yang W, Frickenstein AN, Sheth V, Holden A, Mettenbrink EM, Wang L, Woodward AA, Joo BS, Butterfield SK, Donahue ND, Green DE, Thomas AG, Harcourt T, Young H, Tang M, Malik ZA, Harrison RG, Mukherjee P, DeAngelis PL, Wilhelm S. Controlling Nanoparticle Uptake in Innate Immune Cells with Heparosan Polysaccharides. Nano Lett 2022; 22:7119-7128. [PMID: 36048773 PMCID: PMC9486251 DOI: 10.1021/acs.nanolett.2c02226] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We used heparosan (HEP) polysaccharides for controlling nanoparticle delivery to innate immune cells. Our results show that HEP-coated nanoparticles were endocytosed in a time-dependent manner by innate immune cells via both clathrin-mediated and macropinocytosis pathways. Upon endocytosis, we observed HEP-coated nanoparticles in intracellular vesicles and the cytoplasm, demonstrating the potential for nanoparticle escape from intracellular vesicles. Competition with other glycosaminoglycan types inhibited the endocytosis of HEP-coated nanoparticles only partially. We further found that nanoparticle uptake into innate immune cells can be controlled by more than 3 orders of magnitude via systematically varying the HEP surface density. Our results suggest a substantial potential for HEP-coated nanoparticles to target innate immune cells for efficient intracellular delivery, including into the cytoplasm. This HEP nanoparticle surface engineering technology may be broadly used to develop efficient nanoscale devices for drug and gene delivery as well as possibly for gene editing and immuno-engineering applications.
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Affiliation(s)
- Wen Yang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Alex N. Frickenstein
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Vinit Sheth
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Alyssa Holden
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Evan M. Mettenbrink
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Lin Wang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Alexis A. Woodward
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Bryan S. Joo
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Sarah K. Butterfield
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Nathan D. Donahue
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Dixy E. Green
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
| | - Abigail G. Thomas
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Tekena Harcourt
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Hamilton Young
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Mulan Tang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Zain A. Malik
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Roger G. Harrison
- School of Chemical, Biological and Materials Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Priyabrata Mukherjee
- Department of Pathology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
| | - Paul L. DeAngelis
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
| | - Stefan Wilhelm
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
- Institute for Biomedical Engineering, Science, and Technology (IBEST), University of Oklahoma, Norman, Oklahoma, 73019, USA
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Abstract
Water-induced reordering in ultrathin ionic liquid films has been observed using in situ x-ray photoelectron spectroscopy. An ultrathin layer of 1-butyl-3-methylimidazolium tetrafluoroborate ([C4C1Im][BF4]) was deposited on a rutile TiO2 (1 1 0) single crystal and exposed to water vapour at a relative humidity of ~70% in an in situ cell. Water was found to adsorb onto the ionic liquid surface, causing a reordering of the ions at the interface. Water initially remained trapped on the ionic liquid surface as the in situ cell was evacuated. This could have negative implications for supported ionic liquid phase catalysis, where reactants and products move in and out of an ionic liquid containing the catalyst. This insight into the behaviour at the water/ionic liquid interface provides a basis for understanding interfacial behaviour in more complex gas/ionic liquid systems.
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Affiliation(s)
- Z Henderson
- Jeremiah Horrocks Institute for Mathematics, Physics and Astronomy, University of Central Lancashire, Preston, PR1 2HE, United Kingdom
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Henderson ML, Thomas AG, Shaffer A, Massie AB, Luo X, Holscher CM, Purnell TS, Lentine KL, Segev DL. The National Landscape of Living Kidney Donor Follow-Up in the United States. Am J Transplant 2017; 17:3131-3140. [PMID: 28510355 PMCID: PMC5690895 DOI: 10.1111/ajt.14356] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 04/28/2017] [Accepted: 05/04/2017] [Indexed: 01/25/2023]
Abstract
In 2013, the Organ Procurement and Transplantation Network (OPTN)/ United Network for Organ Sharing (UNOS) mandated that transplant centers collect data on living kidney donors (LKDs) at 6 months, 1 year, and 2 years postdonation, with policy-defined thresholds for the proportion of complete living donor follow-up (LDF) data submitted in a timely manner (60 days before or after the expected visit date). While mandated, it was unclear how centers across the country would perform in meeting thresholds, given potential donor and center-level challenges of LDF. To better understand the impact of this policy, we studied Scientific Registry of Transplant Recipients data for 31,615 LKDs between January 2010 and June 2015, comparing proportions of complete and timely LDF form submissions before and after policy implementation. We also used multilevel logistic regression to assess donor- and center-level characteristics associated with complete and timely LDF submissions. Complete and timely 2-year LDF increased from 33% prepolicy (January 2010 through January 2013) to 54% postpolicy (February 2013 through June 2015) (p < 0.001). In an adjusted model, the odds of 2-year LDF increased by 22% per year prepolicy (p < 0.001) and 23% per year postpolicy (p < 0.001). Despite these annual increases in LDF, only 43% (87/202) of centers met the OPTN/UNOS-required 6-month, 1-year, and 2-year LDF thresholds for LKDs who donated in 2013. These findings motivate further evaluation of LDF barriers and the optimal approaches to capturing outcomes after living donation.
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Affiliation(s)
- M L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - A B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - X Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - T S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - K L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - D L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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Patel N, Horsfield MA, Banahan C, Thomas AG, Nath M, Nath J, Ambrosi PB, Chung EML. Detection of Focal Longitudinal Changes in the Brain by Subtraction of MR Images. AJNR Am J Neuroradiol 2017; 38:923-927. [PMID: 28364006 DOI: 10.3174/ajnr.a5165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 12/14/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE The detection of new subtle brain pathology on MR imaging is a time-consuming and error-prone task for the radiologist. This article introduces and evaluates an image-registration and subtraction method for highlighting small changes in the brain with a view to minimizing the risk of missed pathology and reducing fatigue. MATERIALS AND METHODS We present a fully automated algorithm for highlighting subtle changes between multiple serially acquired brain MR images with a novel approach to registration and MR imaging bias field correction. The method was evaluated for the detection of new lesions in 77 patients undergoing cardiac surgery, by using pairs of fluid-attenuated inversion recovery MR images acquired 1-2 weeks before the operation and 6-8 weeks postoperatively. Three radiologists reviewed the images. RESULTS On the basis of qualitative comparison of pre- and postsurgery FLAIR images, radiologists identified 37 new ischemic lesions in 22 patients. When these images were accompanied by a subtraction image, 46 new ischemic lesions were identified in 26 patients. After we accounted for interpatient and interradiologist variability using a multilevel statistical model, the likelihood of detecting a lesion was 2.59 (95% CI, 1.18-5.67) times greater when aided by the subtraction algorithm (P = .017). Radiologists also reviewed the images significantly faster (P < .001) by using the subtraction image (mean, 42 seconds; 95% CI, 29-60 seconds) than through qualitative assessment alone (mean, 66 seconds; 95% CI, 46-96 seconds). CONCLUSIONS Use of this new subtraction algorithm would result in considerable savings in the time required to review images and in improved sensitivity to subtle focal pathology.
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Affiliation(s)
- N Patel
- From the Department of Cardiovascular Sciences (N.P., M.A.H., M.N., J.N., E.M.L.C.), University of Leicester, Leicester Royal Infirmary, Leicester, UK.,Leicester National Institute of Health Research Cardiovascular Biomedical Research Unit (N.P., E.M.L.C.), Glenfield Hospital, Leicester, UK
| | - M A Horsfield
- From the Department of Cardiovascular Sciences (N.P., M.A.H., M.N., J.N., E.M.L.C.), University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - C Banahan
- Medical Physics (C.B., E.M.L.C.), University Hospitals of Leicester National Health Service Trust, Leicester, UK
| | - A G Thomas
- Departments of Radiology (A.G.T., P.B.A.)
| | - M Nath
- From the Department of Cardiovascular Sciences (N.P., M.A.H., M.N., J.N., E.M.L.C.), University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - J Nath
- From the Department of Cardiovascular Sciences (N.P., M.A.H., M.N., J.N., E.M.L.C.), University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - P B Ambrosi
- Departments of Radiology (A.G.T., P.B.A.).,Neuri Beaujon (P.B.A.), University Paris Diderot, Paris, France
| | - E M L Chung
- From the Department of Cardiovascular Sciences (N.P., M.A.H., M.N., J.N., E.M.L.C.), University of Leicester, Leicester Royal Infirmary, Leicester, UK .,Leicester National Institute of Health Research Cardiovascular Biomedical Research Unit (N.P., E.M.L.C.), Glenfield Hospital, Leicester, UK.,Medical Physics (C.B., E.M.L.C.), University Hospitals of Leicester National Health Service Trust, Leicester, UK
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Abstract
OBJECTIVE To describe the range of intracranial injuries encountered in 0-2-year-olds in cases of accidental head injury where the mechanism of trauma was well characterised and to assess the clinical consequences. DESIGN A retrospective review of imaging and clinical data. SETTING Two tertiary paediatric referral centres. PATIENTS All children aged 0-2 undergoing cranial CT as indicated by National Institute for Health and Clinical Excellence guidance for head injury from 2006 to 2011. After exclusion criteria, 149 patients were included. MAIN OUTCOME MEASURES Rates of skull fracture, intracranial haemorrhage, parenchymal injuries and ischaemic change per type of mechanism of injury. Rates of neurological sequelae on follow-up. RESULTS Skull fractures were demonstrated in 54 (36%) patients of whom 17 (11%) had thin underlying subdural haemorrhage (SDH). Extradural haemorrhage complicated one fracture and two cases of isolated subdural haematomas were seen without skull fracture. Radiologically evident brain parenchymal injuries were present in three patients, all with mechanisms of injury involving high levels of force; severe neurological sequelae were only seen in one patient, who had diffuse hypoxic-ischaemic damage at presentation and whose (accidental) mechanism of injury involved extensive acceleration/deceleration/translational forces. CONCLUSIONS Skull fractures and focal SDH are relatively common following minor trauma in this age group but in the vast majority of cases there are no long-term neurological sequelae. Conversely, diffuse brain injury with severe subsequent neurological impairment was only seen in patients with a correspondingly severe mechanism of injury.
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Affiliation(s)
- A G Thomas
- Radiology Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, , Leicester, UK
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Tunnicliffe LB, Thomas AG, Busfield JJC. Silica-rubber microstructure visualised in three dimensions by focused ion beam-scanning electron microscopy. J Microsc 2012; 246:77-82. [PMID: 22260177 DOI: 10.1111/j.1365-2818.2011.03589.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A focused ion beam-scanning electron microscope (FIB-SEM) technique for three-dimensional reconstruction and representation of material microstructures was applied to a silica-filled synthetic rubber for the first time. Backscattered electron imaging allowed differentiation between rubber matrix, silica filler and zinc oxide (used as an activator for the sulphur vulcanisation reaction). Subsequent image processing allowed three-dimensional isosurface model generation of the particulate structure within the rubber composite and separation of zinc oxide from the silica filler. The potential for development and application of this technique using finite element analysis modelling is also highlighted.
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Affiliation(s)
- L B Tunnicliffe
- Department of Materials, Queen Mary University of London, London, UK
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Abstract
BACKGROUND The threshold amount of gluten in 'gluten-free' products that can be tolerated by people with coeliac disease is unclear. AIM To investigate the threshold amount of gluten and the threshold concentration of gluten in food products that can be tolerated by people with coeliac disease. DESIGN Systematic review of studies published between 1966 and May 2007. METHODS The data sources used were MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and reference lists of retrieved articles. We included studies that evaluated the amount of dietary gluten or the concentrations of gluten in food products that can be tolerated by people with coeliac disease whatever their design, method or language of publication. RESULTS Thirteen studies (three randomized controlled, one cohort, two crossover, and seven cross-sectional) met the inclusion criteria. The daily amount of tolerable gluten varied widely between studies. Whilst some patients tolerated an average of 34-36 mg of gluten per day, other patients who consumed about 10 mg of gluten per day developed mucosal abnormalities. The effect of the consumption of 'gluten-free' products with different degrees of gluten contamination was also inconsistent. CONCLUSIONS The amount of tolerable gluten varies among people with coeliac disease. Although there is no evidence to suggest a single definitive threshold, a daily gluten intake of <10 mg is unlikely to cause significant histological abnormalities.
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Affiliation(s)
- A K Akobeng
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Central Manchester and Manchester Children's University Hospitals, Manchester, UK.
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Kumarasinghe AR, Flavell WR, Thomas AG, Mallick AK, Tsoutsou D, Chatwin C, Rayner S, Kirkham P, Warren S, Patel S, Christian P, O'Brien P, Grätzel M, Hengerer R. Electronic properties of the interface between p-CuI and anatase-phase n-TiO2 single crystal and nanoparticulate surfaces: A photoemission study. J Chem Phys 2007; 127:114703. [PMID: 17887866 DOI: 10.1063/1.2772249] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present a study of the growth of the p-type inorganic semiconductor CuI on n-type TiO2 anatase single crystal (101) surfaces and on nanoparticulate anatase surfaces using synchrotron radiation photoemission spectroscopy. Core level photoemission data obtained using synchrotron radiation reveal that both the substrate (TiO2) and the overlayer (CuI) core levels shift to a lower binding energy to different degrees following the growth of CuI on TiO2. Valence band photoemission data show that the valence band maximum of the clean substrate differs from that of the dosed surface which may be interpreted qualitatively as due to the introduction of a new density of states within the band gap of TiO2 as a result of the growth of CuI. The valence band offset for the heterojunction n-TiO2p-CuI has been measured using photoemission for both nanoparticulate and single crystal TiO2 surfaces, and the band energy alignment for these heterojunction interfaces is presented. With the information obtained here, it is suggested that the interface between p-CuI and single crystal anatase-phase n-TiO2 is a type-II heterojunction interface, with significant band bending. The measured total band bending matches the work function change at the interface, i.e., there is no interface dipole. In the case of the nanoparticulate interface, an interface dipole is found, but band bending within the anatase nanoparticles remains quite significant. We show that the corresponding depletion layer may be accommodated within the dimension of the nanoparticles. The results are discussed in the context of the functional properties of dye-sensitized solid state solar cells.
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Affiliation(s)
- A R Kumarasinghe
- School of Physics and Astronomy, The University of Manchester, Sackville Street Building, P.O. Box 88, Manchester M60 1QD, United Kingdom
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11
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Abstract
BACKGROUND Prevention of relapse is a major issue in the management of Crohn's disease. Corticosteroids and 5-ASA preparations are not effective for the maintenance of remission. Methotrexate, infliximab, 6-mercaptopurine and its prodrug, azathioprine may be effective in maintaining remission, but these drugs may cause significant adverse events. OBJECTIVES To conduct a systematic review to evaluate the efficacy of enteral nutrition for the maintenance of remission in Crohn's disease. SEARCH STRATEGY MEDLINE (1966 to January 2007), EMBASE (1984 to January 2007) the Cochrane Central Register of Controlled Trials from the Cochrane Library (Issue 4, 2006) and the IBD/FBD Review Group Specialized Trials Register were searched. The articles cited in each publication were hand searched. SELECTION CRITERIA Randomised controlled trials which compared enteral nutrition with no intervention, placebo or with any other intervention were eligible for inclusion. DATA COLLECTION AND ANALYSIS Data extraction and assessment of methodological quality of included studies were independently performed by two authors. The main outcome measure was the occurrence of clinical or endoscopic relapse as defined by the primary studies. Odds ratios and 95% confidence intervals were calculated for dichotomous outcomes. MAIN RESULTS Two studies were identified that met the inclusion criteria and were included in the review. Statistical pooling of the results of these studies was not possible because the control interventions, and the way outcomes were assessed differed greatly between the two studies. In one study (Takagi 2006), patients who received half of their total daily calorie requirements as elemental diet and the remaining half by normal diet had a significantly lower relapse rate compared to patients who received unrestricted normal diet (9 of 26 versus 16 of 25; OR 0.3, 95% CI 0.09 to 0.94). In the other study (Verma 2001), elemental and polymeric feeds (providing between 35 and 50% of patients' pretrial calorie intake in addition to unrestricted normal food) were equally effective for maintenance of remission and allowing withdrawal of steroid therapy (8 of 19 versus 6 of 14; OR 0.97, 95% CI 0.24 to 3.92). AUTHORS' CONCLUSIONS The available evidence suggests that supplementary enteral nutritional may be effective for maintenance of remission in Crohn's disease. Whilst larger studies are needed to confirm these findings, enteral nutritional supplementation could be considered as an alternative or as an adjunct to maintenance drug therapy in Crohn's disease.
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Affiliation(s)
- A K Akobeng
- Central Manchester and Manchester Children's University Hospitals, Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Charlestown Road, Blackley, Manchester, UK, M9 7AA.
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Abstract
BACKGROUND Anti-TNF-alpha agents have been shown to be effective for the induction of remission in Crohn's disease. The role of TNF-alpha blocking agents in ulcerative colitis is, however, unclear and recent studies have yielded conflicting results. OBJECTIVES To evaluate the efficacy of TNF-alpha antibody for induction of remission in ulcerative colitis, and to determine adverse events associated with TNF-alpha antibody treatment. SEARCH STRATEGY We searched MEDLINE (1966 to 2005), EMBASE (1984 to 2005), the Cochrane Central Register of Controlled Trials (Issue 3, 2004) and the IBD/FBD Review Group Specialized Trials Register. We hand-searched the articles cited in each publication. SELECTION CRITERIA Only randomised controlled trials in which patients with active ulcerative colitis (defined by a combination of clinical, radiographic, endoscopic and histologic criteria) were randomly allocated to receive a TNF-alpha blocking agent in the treatment arm, and to receive placebo or another treatment in the comparison arm were included. DATA COLLECTION AND ANALYSIS Data extraction and assessment of methodological quality of each study were independently performed by two reviewers. Any disagreement among reviewers was resolved by consensus. The main outcome measure was the occurrence of remission as defined by the primary studies. Other endpoints were clinical, histological or endoscopic improvement as defined by the primary studies; improvement in quality of life as measured by a validated quality of life tool and the occurrence of adverse events. MAIN RESULTS Seven randomised controlled trials were identified that satisfied the inclusion criteria. In patients with moderate to severe ulcerative colitis whose disease was refractory to conventional treatment using corticosteroids and/or immunosuppressive agents, infliximab (three intravenous infusions at 0, 2, and 6 weeks) was more effective than placebo in inducing clinical remission (Relative Risk (RR) 3.22, 95% CI 2.18 to 4.76); inducing endoscopic remission (RR 1.88, 95% CI 1.54 to 2.28); and in inducing clinical response (RR 1.99, 95% CI 1.65 to 2.41) at 8 weeks. A single infusion of infliximab was also more effective than placebo in reducing the need for colectomy within 90 days after infusion (RR 0.44, 95% CI 0.22 to 0.87). AUTHORS' CONCLUSIONS In patients with moderate to severe ulcerative colitis whose disease is refractory to conventional treatment using corticosteroids and/or immunosuppressive agents, infliximab is effective in inducing clinical remission, inducing clinical response, promoting mucosal healing, and reducing the need for colectomy at least in the short term. Serious adverse events attributable to infliximab were not common in the included studies but physicians should be aware of and be prepared to deal with potential adverse events such as anaphylactic reactions and infections.
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Lawson MM, Thomas AG, Akobeng AK. Tumour necrosis factor alpha blocking agents for induction of remission in ulcerative colitis. Cochrane Database Syst Rev 2006. [PMID: 16856078 DOI: 10.1002/14651858.cd005112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Anti-TNF-alpha agents have been shown to be effective for the induction of remission in Crohn's disease. The role of TNF-alpha blocking agents in ulcerative colitis is, however, unclear and recent studies have yielded conflicting results. OBJECTIVES To evaluate the efficacy of TNF-alpha antibody for induction of remission in ulcerative colitis, and to determine adverse events associated with TNF-alpha antibody treatment. SEARCH STRATEGY We searched MEDLINE (1966 to 2005), EMBASE (1984 to 2005), the Cochrane Central Register of Controlled Trials (Issue 3, 2004) and the IBD/FBD Review Group Specialized Trials Register. We hand-searched the articles cited in each publication. SELECTION CRITERIA Only randomised controlled trials in which patients with active ulcerative colitis (defined by a combination of clinical, radiographic, endoscopic and histologic criteria) were randomly allocated to receive a TNF-alpha blocking agent in the treatment arm, and to receive placebo or another treatment in the comparison arm were included. DATA COLLECTION AND ANALYSIS Data extraction and assessment of methodological quality of each study were independently performed by two reviewers. Any disagreement among reviewers was resolved by consensus. The main outcome measure was the occurrence of remission as defined by the primary studies. Other endpoints were clinical, histological or endoscopic improvement as defined by the primary studies; improvement in quality of life as measured by a validated quality of life tool and the occurrence of adverse events. MAIN RESULTS Seven randomised controlled trials were identified that satisfied the inclusion criteria. In patients with moderate to severe ulcerative colitis whose disease was refractory to conventional treatment using corticosteroids and/or immunosuppressive agents, infliximab (three intravenous infusions at 0, 2, and 6 weeks) was more effective than placebo in inducing clinical remission (Relative Risk (RR) 3.22, 95% CI 2.18 to 4.76); inducing endoscopic remission (RR 1.88, 95% CI 1.54 to 2.28); and in inducing clinical response (RR 1.99, 95% CI 1.65 to 2.41) at 8 weeks. A single infusion of infliximab was also more effective than placebo in reducing the need for colectomy within 90 days after infusion (RR 0.44, 95% CI 0.22 to 0.87). AUTHORS' CONCLUSIONS In patients with moderate to severe ulcerative colitis whose disease is refractory to conventional treatment using corticosteroids and/or immunosuppressive agents, infliximab is effective in inducing clinical remission, inducing clinical response, promoting mucosal healing, and reducing the need for colectomy at least in the short term. Serious adverse events attributable to infliximab were not common in the included studies but physicians should be aware of and be prepared to deal with potential adverse events such as anaphylactic reactions and infections.
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Sullivan PB, Morrice JS, Vernon-Roberts A, Grant H, Eltumi M, Thomas AG. Does gastrostomy tube feeding in children with cerebral palsy increase the risk of respiratory morbidity? Arch Dis Child 2006; 91:478-82. [PMID: 16446283 PMCID: PMC2082795 DOI: 10.1136/adc.2005.084442] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2005] [Indexed: 01/02/2023]
Abstract
BACKGROUND Children with severe neurological impairment may have significant oral motor dysfunction and are at increased risk of nutritional deficiencies, poor growth, and aspiration pneumonia. Gastrostomy tube feeding is increasingly being used for nutritional support in these children. AIM To examine the occurrence of respiratory morbidity before and after gastrostomy feeding tube insertion in children with severe neurological disabilities. METHODS This study was nested in a longitudinal, prospective, uncontrolled, multicentre cohort study designed to investigate the outcomes of gastrostomy tube feeding in 57 children with severe neurological disabilities. Parents completed a questionnaire prior to (visit 1) and 6 and 12 months (visits 2 and 3) following the gastrostomy, detailing number of chest infections requiring antibiotics and/or hospital admission. RESULTS Mean number of chest infections requiring antibiotics was 1.8 on visit 1 and 0.9 on visit 3. Hospital admissions for chest infections fell significantly from 0.5 to 0.09. CONCLUSION This study provides no evidence for an increase in respiratory morbidity following insertion of a feeding gastrostomy in children with cerebral palsy.
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Affiliation(s)
- P B Sullivan
- Department of Paediatrics, University of Oxford, Oxford, UK.
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15
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Abstract
AIMS To compare the height, weight, and body mass index (BMI) of children presenting with dyspeptic symptoms and Helicobacter pylori infection, to those with dyspepsia but without the infection. METHODS A retrospective chart review of 257 children was performed. 13C urea breath test was performed to detect H pylori infection; weight and height were recorded and BMI was calculated. Weight, height, and BMI SD scores were determined using the 1990 UK normative data. The Index of Multiple Deprivation 2004 (IMD 2004) scores, which measure deprivation at small area level, were calculated from the patients' postcodes. RESULTS Ninety seven of the 257 children were H pylori positive. The mean age at diagnosis and presenting symptoms of H pylori positive and negative patients were similar. The mean IMD 2004 scores for children with H pylori infection were significantly higher compared to H pylori negative patients, suggesting that children with the infection came from relatively more deprived areas. The mean weight and height SD score were significantly lower for children with H pylori infection compared to those without. However, this difference was no longer significant after adjusting for socioeconomic deprivation and ethnic differences between the groups. CONCLUSION Children with dyspepsia and H pylori infection were shorter and lighter than patients with similar symptoms but no infection. The differences in anthropometry may be due to socioeconomic and ethnic factors rather than H pylori infection.
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Affiliation(s)
- M R Sood
- Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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16
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Abstract
BACKGROUND Crohn's disease in childhood is a chronic relapsing condition. Fifteen to forty per cent of children with Crohn's disease have growth retardation (Griffiths 1993a). Some treatment modalities including corticosteroids have been implicated in growth failure but it is thought mainly to be secondary to uncontrolled disease activity (Motil 1993; Markowitz 1993). Growth is fundamental to the practice of pediatrics, so by taking growth as the primary outcome measure we address issues important to both patients, their families and pediatricians. OBJECTIVES To evaluate the effectiveness of the different modalities available for the treatment of childhood Crohn's disease with regard to the reversal of growth failure and the promotion of normal growth. SEARCH STRATEGY Searches were made of the following databases using the Collaborative Review Group Search Strategy: EMBASE (1984-2004), MEDLINE (1966-2004), The Cochrane Central Register of Controlled Trials, The Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialized Trials Register and the Science Citation Index. Abstracts from the major gastrointestinal research meetings and references from published articles were also reviewed. SELECTION CRITERIA Randomized controlled trials pertaining to children less than 18 years of age with Crohn's disease were selected. Those with growth as an outcome measure were included in the review. DATA COLLECTION AND ANALYSIS Data extraction and assessment of the methodological quality of each trial was independently reviewed by two reviewers. Only one good quality randomized controlled trial was included in the review and therefore no statistical analysis was possible. MAIN RESULTS Three randomized controlled trials were identified. One was of good methodological quality (Markowitz 2000). This study looked at the use of 6-mercaptopurine (6-MP) as a steroid sparing agent. No difference in linear growth was observed between the intervention and placebo groups, although the total steroid dose received over the 18 month follow up period was reduced in the group receiving 6-MP. The two remaining randomized controlled trials (Sanderson 1987; Thomas 1993a) consider the use of enteral feeding versus corticosteroids for induction of remission, with height velocity standard deviation score at 6 months as an outcome measure. Although of less rigorous methodological quality, the results of these studies are discussed in detail in the review. In both studies height velocity standard deviation scores were significantly increased in the enteral feeding group compared with the corticosteroid group. AUTHORS' CONCLUSIONS In addition to these randomized controlled trials, a body of lower quality evidence does exist relevant to two other important interventions; the use of supplemental enteral nutrition (Morin 1980; Belli 1988; Israel 1995) and the judicious use of surgical interventions in pre-pubertal children with refractory disease (Alperstein 1985; Lipson 1990; McLain 1990). Newer treatments, such as infliximab, are now becoming more widely used and may offer advantages in promoting growth. These effects are as yet unstudied. This review highlights the need for large, multi centre studies of the different treatment options in paediatric Crohn's disease and the importance of standardised measurements of growth, such as height velocity standard deviation scores and height standard deviation scores as outcome measures.
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Abstract
BACKGROUND Children with cerebral palsy (CP) can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding ability and, eventually, to under-nutrition. It can also result in aspiration of food into the lungs. Feeding time may be considerably increased and, instead of being an enjoyable experience, mealtimes may be distressing for both the child and carer. Increasingly for children unable to maintain a normal nutritional state feeding by mouth, gastrostomy or jejunostomy tubes are being used to provide the digestive system with nutrients. A gastrostomy tube is a feeding tube inserted surgically through the abdominal wall directly into the stomach. A jejunostomy feeding tube is inserted into the jejunum, part of the small intestine, either directly or via a previous gastrostomy. Although gastrostomy or jejunostomy placement may greatly facilitate feeding of children with CP, many carers find it very difficult to accept this intervention emotionally. The treatment is also relatively costly. For all of these reasons, its effectiveness requires assessment. OBJECTIVES To assess the effects of nutritional supplementation given via gastrostomy or jejunostomy in children with feeding difficulties due to cerebral palsy. SEARCH STRATEGY We searched the Cochrane Library's register of controlled trials (CENTRAL) up to Issue 4, 2003, MEDLINE 1977 - December 2003, EMBASE 1980 - December 2003, CINAHL 1982 - December 2003, LILACS 1980 - end 2003, ASLIB 1983 - 2003 and Dissertation Abstracts 1980 - 2003. SELECTION CRITERIA Only randomised controlled trials which compared delivery of nutrition via a gastrostomy or jejunostomy tube compared with oral feeding alone for children up to the age of 16 were considered for this review. DATA COLLECTION AND ANALYSIS Selection of trials, data extraction and assessment of trial quality were undertaken independently by two reviewers. MAIN RESULTS No trials were identified that met the inclusion criteria for this review. REVIEWERS' CONCLUSIONS On the basis of this systematic review, considerable uncertainty about the effects of gastrostomy for children with cerebral palsy remains. A well designed and conducted randomised controlled trial should be undertaken to resolve the current uncertainties about medical management for children with cerebral palsy and physical difficulties in eating.
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Rojas C, Thomas AG, Majer P, Tsukamoto T, Lu XM, Vornov JJ, Wozniak KM, Slusher BS. Glutamate carboxypeptidase II inhibition as a novel therapeutic target. Adv Exp Med Biol 2003; 524:205-13. [PMID: 12675241 DOI: 10.1007/0-306-47920-6_25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- C Rojas
- Guilford Pharmaceuticals Inc., 6611 Tributary Street, Baltimore, Maryland 21224 USA
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Campbell DI, Beath SV, deVille de Goyet J, Thomas AG, Booth IW, Milford D, McKiernan PJ, Kelly DA. Severe intestinal lymphangiectasia complicated by nephrotic syndrome treated by small bowel, liver, and kidney transplantation. J Pediatr Gastroenterol Nutr 2003; 36:278-82. [PMID: 12548067 DOI: 10.1097/00005176-200302000-00022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- D I Campbell
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP, UK.
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Akobeng AIL, Clayton PE, Miller V, Hall CM, Thomas AG. Low serum concentrations of insulin-like growth factor-I in children with active Crohn disease: effect of enteral nutritional support and glutamine supplementation. Scand J Gastroenterol 2002; 37:1422-7. [PMID: 12523592 DOI: 10.1080/003655202762671521] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Dept. of Paediatric Gastroenterology, Central Manchester Hospital, Manchester, UK.
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Affiliation(s)
- A I L Akobeng
- Dept. of Paediatric Gastroenterology, Central Manchester Hospital, Manchester, UK.
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Thomas AG, Brodine SK, Shaffer R, Shafer MA, Boyer CB, Putnam S, Schachter J. Chlamydial infection and unplanned pregnancy in women with ready access to health care. Obstet Gynecol 2001; 98:1117-23. [PMID: 11755563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To apply urine-based ligase chain reaction for Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) detection and standard urine-based pregnancy testing for Navy-enlisted women, and to compare the prevalence and epidemiologic correlates of these adverse reproductive outcomes. METHODS Participants were surveyed and urine was collected for pregnancy testing using standard laboratory methods and detection of C. trachomatis and N. gonorrhoeae infection by ligase chain reaction. Self-administered surveys facilitated collection of demographics, sexual behavior, including contraceptive use, sexual partners, sexually transmitted disease, and pregnancy history. RESULTS Among 299 of 314 participants, the prevalence of chlamydial infection was 4.7% and of pregnancy was 9.7%, with 48.3% of the pregnancies unplanned. Chlamydia trachomatis infection was univariately associated with having a new sex partner within the last 6 months, more sexual partners, single marital status, condom use, drinking until passing out or vomiting in the past 30 days (alcohol misuse), and current pregnancy. Unplanned pregnancy was univariately associated with young age, single marital status, inconsistent condom use, having a new sex partner within the last 6 months, and more recent sexual partners. Among the pregnant women, four (13.8%) were infected with C. trachomatis. CONCLUSION The high rates of chlamydial infection and unplanned pregnancy found in this population of employed young women with ready access to health care and health education underscore the challenge of enhancing reproductive health via compliance with effective contraceptive and sexually transmitted disease prevention methods. This is a challenge that remains unmet.
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Affiliation(s)
- A G Thomas
- Graduate School of Public Health, Department of Epidemiology and Biostatistics, San Diego State University, California, USA.
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Thomas AG, Liu W, Olkowski JL, Tang Z, Lin Q, Lu XC, Slusher BS. Neuroprotection mediated by glutamate carboxypeptidase II (NAALADase) inhibition requires TGF-beta. Eur J Pharmacol 2001; 430:33-40. [PMID: 11698060 DOI: 10.1016/s0014-2999(01)01239-0] [Citation(s) in RCA: 32] [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: 11/16/2022]
Abstract
Inhibition of glutamate carboxypeptidase (GCP) II (EC 3.4.17.21), also termed N-acetylated alpha-linked acidic dipeptidase (NAALADase), has been shown to protect against ischemic injury presumably via decreasing glutamate and increasing N-acetyl-aspartyl-glutamate (NAAG). NAAG is a potent and selective mGlu3 receptor agonist. Activation of glial mGlu3 receptors has been shown to protect against NMDA toxicity by releasing transforming growth factors, TGF-betas. We hypothesized that GCP II inhibition could be neuroprotective also via TGF-betas, due to increased NAAG. To verify this, Enzyme-Linked Immunosorbent Assays (ELISAs) were performed on media from both control and ischemic cultures treated with the GCP II inhibitor, 2-(phosphonomethyl)-pentanedioic acid (2-PMPA). We found that 2-PMPA attenuated ischemia-induced declines in TGF-beta. To further assess the role of TGF-betas in 2-PMPA-mediated neuroprotection, a neutralizing antibody to TGF-beta (TGF-beta Ab) was used. In both in vitro and in vivo models of cerebral ischemia, TGF-beta Ab reversed the neuroprotection by 2-PMPA. Antibodies to other growth factors had no effect. Data suggests that neuroprotection by GCP II inhibition may be partially mediated by promoting TGF-beta release.
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Affiliation(s)
- A G Thomas
- Guilford Pharmaceuticals Inc., 6611 Tributary Street, Baltimore, MD 21224, USA
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Thomas AG, Olkowski JL, Slusher BS. Neuroprotection afforded by NAAG and NAALADase inhibition requires glial cells and metabotropic glutamate receptor activation. Eur J Pharmacol 2001; 426:35-8. [PMID: 11525768 DOI: 10.1016/s0014-2999(01)01198-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
N-acetylated-alpha-linked-acidic-dipeptidase (NAALADase or glutamate carboxypeptidase II) cleaves the neuropeptide N-acetyl-aspartyl-glutamate (NAAG) to glutamate and N-acetyl-aspartate (NAA). Previously, NAAG and 2-(phosphonomethyl)-pentanedioic acid (2-PMPA), a potent and selective NAALADase inhibitor, were found to be neuroprotective in neuronal/glial co-cultures and in animals following transient middle cerebral artery occlusion. In this report, we examined the involvement of glial cells and metabotropic glutamate (mGlu) receptors in neuroprotection mediated by NAAG and 2-PMPA in an in vitro model of metabolic inhibition. Neuroprotection of neuronal/glial co-cultures by both NAAG and 2-PMPA, against metabolic inhibition, was significantly higher than neuroprotection in the absence of glia. Similarly, (2S,2'R,3'R)-2-(2',3'-dicarboxycyclopropyl)glycine (DCG IV), a selective group II mGlu receptor agonist, was less neuroprotective in the absence of glia. Selective group II mGlu receptor antagonists and (S)-alpha-methyl-4-carboxyphenylglycine (MCPG), a non-selective mGlu receptor antagonist, reduced the protection afforded by both NAAG and 2-PMPA when using neuronal/glial co-cultures. In contrast, groups I and III mGlu receptor antagonists did not affect NAAG or 2-PMPA neuroprotection. These results underscore the critical involvement of glia and group II mGlu receptors in NAAG and 2-PMPA-mediated neuroprotection.
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Affiliation(s)
- A G Thomas
- Guilford Pharmaceuticals Inc., 6611 Tributary Street, Baltimore, MD 21224, USA
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Richardson G, Griffiths AM, Miller V, Thomas AG. Quality of life in inflammatory bowel disease: a cross-cultural comparison of English and Canadian children. J Pediatr Gastroenterol Nutr 2001; 32:573-8. [PMID: 11429519 DOI: 10.1097/00005176-200105000-00016] [Citation(s) in RCA: 28] [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: 02/06/2023]
Abstract
BACKGROUND Any disease and its treatment has an important impact on health-related quality of life for affected individuals. There have been few previous studies on the quality of life for children with inflammatory bowel disease (IBD). METHODS A cross-cultural comparison was performed to determine whether the concerns of children with IBD in the United Kingdom are ranked similarly to those of children with IBD in Canada. An item reduction questionnaire, developed from interviews with Canadian children with IBD, was scored by 53 British children with IBD for importance and frequency, as a questionnaire had been scored previously by 117 Canadian children. RESULTS There was a significant correlation between the mean scores (r = 0.831, P < 0.001) and ranks (r = 0.801, P < 0.001) for the 96 questions, and 43 of the 50 highest-ranking concerns corresponded for both populations. Confidence interval analysis showed a significant difference between the mean values for 21 of the 96 items; 20 of these 21 were ranked higher in the United Kingdom than they had been in Canada, suggesting that the frequency and/or degree of concern was greater for the British children with IBD. CONCLUSIONS Health-related concerns of British children with Crohn disease and ulcerative colitis correlate closely with those of Canadian children with those diseases. Further studies are needed to determine the sensitivity of individual questions, the most appropriate wording of these questions, and the optimal length for a proposed instrument to assess quality of life in children with IBD.
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Affiliation(s)
- G Richardson
- Booth Hall Children's Hospital, Charlestown Road, Blackley, Manchester M9 7AA, U.K
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Thomas AG, Vornov JJ, Olkowski JL, Merion AT, Slusher BS. N-Acetylated alpha-linked acidic dipeptidase converts N-acetylaspartylglutamate from a neuroprotectant to a neurotoxin. J Pharmacol Exp Ther 2000; 295:16-22. [PMID: 10991955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
We previously reported that inhibition of the brain enzyme N-acetylated alpha-linked acidic dipeptidase (NAALADase; glutamate carboxypeptidase II) robustly protects cortical neurons from ischemic injury. Since NAALADase hydrolyzes N-acetylaspartylglutamate (NAAG) to glutamate we hypothesized that inhibiting NAALADase would both decrease glutamate and increase NAAG. Increasing NAAG is potentially important because NAAG is a metabotropic glutamate receptor agonist and an N-methyl-D-aspartate (NMDA) partial antagonist, both of which have previously been shown to be neuroprotective. To understand the likely effects of endogenous NAAG in the central nervous system, we have now investigated the activity of NAAG in primary cortical cultures while manipulating NAALADase activity. Under hydrolyzing conditions, when NAALADase was active, NAAG had toxic effects that were blocked by NMDA and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)/kainate receptor antagonists and by NAALADase inhibition. NAAG's toxic effects were presumably due to the liberation of glutamate. Under nonhydrolyzing conditions, when NAALADase was inhibited, NAAG demonstrated neuroprotective effects against both NMDA toxicity and metabolic inhibition. In the case of NMDA-induced toxicity, NAAG provided neuroprotection through its partial antagonist activity at the NMDA receptor. In the case of metabolic inhibition, NAAG had an additional neuroprotective effect mediated through its agonist properties at the type II metabotropic glutamate receptor. These results indicate that NAAG might play an important role in the central nervous system, under certain pathological conditions, as a neurotoxin or as a neuroprotectant, depending on the activity of NAALADase.
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Affiliation(s)
- A G Thomas
- Guilford Pharmaceuticals Inc., Baltimore, Maryland, USA
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Affiliation(s)
- M Yadav
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Blackley, Manchester, United Kingdom
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Abstract
Children with neurological impairment frequently have difficulties in consuming sufficient energy and other nutrients to maintain adequate nutritional status. Under-nutrition is a significant contributory factor to growth failure. Eating may be distressing and time-consuming for the child and carer. Aspiration of feeds is common and may predispose to chronic chest infections. Gastro-oesophageal reflux is also common and may contribute to significant morbidity. This paper discusses some of the issues involved in the nutritional management of neurologically impaired children.
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Affiliation(s)
- A G Thomas
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Manchester, UK
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Yadav M, Akobeng AK, Thomas AG. Breast-feeding and childhood obesity. J Pediatr Gastroenterol Nutr 2000; 30:345-6. [PMID: 10749426 DOI: 10.1097/00005176-200003000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M Yadav
- Department of Paediatric Gastroentrology, Booth Hall Children's Hospital, Manchester, United Kingdom
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Sadler GR, Thomas AG, Yen JY, Dhanjal SK, Marie Ko C, Tran CH, Wang K. Breast cancer education program based in Asian grocery stores. J Cancer Educ 2000; 15:173-177. [PMID: 11019767 DOI: 10.1080/08858190009528688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Culturally and linguistically compatible university students were trained as community health educators to provide breast cancer education and screening information to shoppers at Asian grocery stores. Information about early detection of breast cancer was shared with 8,877 women, who reported speaking 40 different languages. Baseline surveys were completed by 1,202 women; 779 took part in the follow-up survey. The survey questions assessed baseline knowledge, attitudes, and screening behaviors regarding breast cancer, tested the efficacy of the intervention, and sought barriers to accessing screening services. Screening adherence at baseline was low, but reported screening compliance had increased by follow-up. This study confirms the cost-effectiveness of student health educators and Asian grocery store sites as venues to reach the diverse age, ethnic, and socioeconomic segments of the Asian community, while demonstrating the community's receptiveness to the dissemination of health information and introducing bilingual students to health education and research careers.
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Affiliation(s)
- G R Sadler
- University of California, San Diego Cancer Center, San Diego School of Medicine, La Jolla 92093-0658, USA.
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Sadler GR, Thomas AG, Gebrekristos B, Dhanjal SK, Mugo J. Black cosmetologists promoting health program: pilot study outcomes. J Cancer Educ 2000; 15:33-37. [PMID: 10730801 DOI: 10.1080/08858190009528650] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND African Americans suffer a disproportionate burden of illness and premature mortality. METHODS A health education program delivered via cosmetologists was pilot tested as a supplement to other programs seeking to reach this community with information designed to remedy this inequality. Eight cosmetologists were randomized to either an active or a passive educational intervention arm, with the active arm (experimental arm) focused on breast cancer early detection. RESULTS Both cosmetologists and clients found this an acceptable intervention. Nearly all women in the study demonstrated that they had heard the mainstream messages about the value of breast cancer early detection, but a considerable proportion appeared not to realize breast cancer's high level of morbidity and mortality within their own community. CONCLUSION The results suggest this approach is worthy of further evaluation.
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Affiliation(s)
- G R Sadler
- Department of Surgery, University of California at San Diego School of Medicine, University of California at San Diego Cancer Center, LaJolla 92093-0658, USA
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Akobeng AK, Miller V, Stanton J, Elbadri AM, Thomas AG. Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn's disease. J Pediatr Gastroenterol Nutr 2000; 30:78-84. [PMID: 10630444 DOI: 10.1097/00005176-200001000-00022] [Citation(s) in RCA: 128] [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: 12/29/2022]
Abstract
BACKGROUND Glutamine is traditionally considered a nonessential amino acid but may be conditionally essential in patients with catabolic conditions. Glutamine-supplemented foods in these patients have been shown to prevent deterioration of gut permeability, protect against the development of intestinal mucosal atrophy, and improve nitrogen balance. Animal models of inflammatory bowel disease suggest that glutamine-enriched enteral diets may lead to less severe intestinal damage, less weight loss, improved nitrogen balance, and reduced disease activity. The purpose of the current study was to compare the efficacy of a glutamine-enriched polymeric diet with a standard low-glutamine polymeric diet in the treatment of active Crohn's disease. METHODS Eighteen children with active Crohn's disease were randomly assigned to receive a 4-week course of either a standard polymeric diet with a low glutamine content (4% of amino acid composition; group S) or a glutamine-enriched polymeric diet (42% of amino acid composition; Group G). The two diets were isocaloric and isonitrogenous with an identical essential amino acid profile. Remission rates were analysed on an intent-to-treat basis. Changes in clinical and laboratory parameters of disease activity were also compared after 4 weeks of nutritional treatment. RESULTS Two of the children, both in group G, were withdrawn from the trial because of nontolerance of the diet. There was no difference between the two groups in proportion of patients achieving remission (intent-to-treat basis): 5 (55.5%) of 9 in group S versus 4 (44.4%) of 9 in group G (p = 0.5). Improvement in mean paediatric Crohn's disease activity index (PCDAI) was significantly more in group S (p = 0.002) but changes in orosomucoid level, platelet count, and weight were not different between the groups. CONCLUSIONS The findings suggest that a glutamine-enriched polymeric diet offers no advantage over a standard low-glutamine polymeric diet in the treatment of active Crohn's disease. Rather, it appears to be less effective in improving PCDAI. The reported beneficial effects of glutamine seen in many catabolic states must be viewed with caution when extrapolating to the management of Crohn's disease.
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Affiliation(s)
- A K Akobeng
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Manchester Children's Hospitals NHS Trust, United Kingdom
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Slusher BS, Vornov JJ, Thomas AG, Hurn PD, Harukuni I, Bhardwaj A, Traystman RJ, Robinson MB, Britton P, Lu XC, Tortella FC, Wozniak KM, Yudkoff M, Potter BM, Jackson PF. Selective inhibition of NAALADase, which converts NAAG to glutamate, reduces ischemic brain injury. Nat Med 1999; 5:1396-402. [PMID: 10581082 DOI: 10.1038/70971] [Citation(s) in RCA: 227] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe here a new strategy for the treatment of stroke, through the inhibition of NAALADase (N-acetylated-alpha-linked-acidic dipeptidase), an enzyme responsible for the hydrolysis of the neuropeptide NAAG (N-acetyl-aspartyl-glutamate) to N-acetyl-aspartate and glutamate. We demonstrate that the newly described NAALADase inhibitor 2-PMPA (2-(phosphonomethyl)pentanedioic acid) robustly protects against ischemic injury in a neuronal culture model of stroke and in rats after transient middle cerebral artery occlusion. Consistent with inhibition of NAALADase, we show that 2-PMPA increases NAAG and attenuates the ischemia-induced rise in glutamate. Both effects could contribute to neuroprotection. These data indicate that NAALADase inhibition may have use in neurological disorders in which excessive excitatory amino acid transmission is pathogenic.
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Affiliation(s)
- B S Slusher
- Guilford Pharmaceuticals, Department of Research, Baltimore, Maryland 21224, USA.
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McClelland JL, Thomas AG, McCandliss BD, Fiez JA. Understanding failures of learning: Hebbian learning, competition for representational space, and some preliminary experimental data. Prog Brain Res 1999; 121:75-80. [PMID: 10551021 DOI: 10.1016/s0079-6123(08)63068-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- J L McClelland
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Philadelphia, PA, USA.
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Affiliation(s)
- A K Akobeng
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Blackley, Manchester, United Kingdom
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Abstract
Folates have been shown to be neurotoxic and convulsive. Endogenously, folates exist in the brain in a polyglutamated form with 1-7 terminal glutamates (approx. 1 microM). The brain enzyme N-acetylated alpha-linked acidic dipeptidase (NAALADase) has been shown to remove sequentially the gamma-linked glutamates from folic acid polyglutamates. We report that, at high concentrations (300 microM-30 mM), a folic acid hexaglutamate analog is dose-dependently toxic to dissociated rat cortical cultures and that this toxicity is reversed by 2-PMPA, a potent and selective NAALADase inhibitor. These data suggest a new mechanism for folic acid toxicity.
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Affiliation(s)
- A G Thomas
- Guilford Pharmaceuticals, 6611 Tributary Street, Baltimore, MD 21224, USA
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Affiliation(s)
- A G Thomas
- Department of Gastroenterology, Booth Hall Children's Hospital, Blackley, Manchester M9 7AA, UK
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Akobeng AK, Clayton PT, Miller V, Super M, Thomas AG. An inborn error of bile acid synthesis (3beta-hydroxy-delta5-C27-steroid dehydrogenase deficiency) presenting as malabsorption leading to rickets. Arch Dis Child 1999; 80:463-5. [PMID: 10208955 PMCID: PMC1717927 DOI: 10.1136/adc.80.5.463] [Citation(s) in RCA: 25] [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: 11/04/2022]
Abstract
Deficiency of 3beta-hydroxy-delta5-C27-steroid dehydrogenase (3beta-HSDH), the enzyme that catalyses the second reaction in the principal pathway for the synthesis of bile acids, has been reported to present with prolonged neonatal jaundice with the biopsy features of neonatal hepatitis. It has also been shown to present between the ages of 4 and 46 months with jaundice, hepatosplenomegaly, and steatorrhoea (a clinical picture resembling progressive familial intrahepatic cholestasis). This paper reports two children with 3beta-HSDH deficiency who developed rickets during infancy and did not develop clinically evident liver disease until the age of 3 years. Bile acid replacement resulted in considerable clinical and biochemical improvement. The importance of thorough investigation of fat soluble vitamin deficiencies in infancy is emphasised.
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Affiliation(s)
- A K Akobeng
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, University of Manchester, Charlestown Road, Blackley, Manchester M9 7AA, UK
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Abstract
BACKGROUND Focus group meetings were held with two groups, each containing 12 children with Crohn's disease aged 8 to 12 and 12 to 17 years. The children were asked broad questions about how Crohn's disease and its treatment affected their lives. To explore these areas in more detail, an 88-item questionnaire was developed and read to an additional 16 of 20 children with Crohn's disease selected at random from outpatients. At first, many of the children denied that Crohn's disease affected their lives at all, but it soon became apparent that many were frustrated or angry about physical symptoms, lack of understanding about Crohn's disease, unpleasant investigations, treatment, and hospitalisation. METHODS The questionnaire covered six domains of health-related quality of life including symptoms and treatment, social, emotional, family, educational, and future aspects. RESULTS Elemental diet was the preferred treatment, although surgery was more effective in controlling symptoms. Children receiving steroids had more depressive symptoms. Absenteeism from school and inability to engage in school sports, swimming, and running were frequent problems. There were also difficulties with taking holidays and staying at friends' houses. Worry was reported in 14 of 16 children, anger and frustration and feeling fed up in 12 of 16. CONCLUSIONS In addition to being a symptomatically disabling condition, Crohn's disease has a great impact on the health-related quality of life of affected children. Future studies of treatment in children with inflammatory bowel disease should include an attempt to assess the impact on the child's health-related quality of life.
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Affiliation(s)
- A K Akobeng
- Booth Hall Children's Hospital, Blackley, Manchester, United Kingdom
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Abstract
BACKGROUND Few investigators have reported on the quality of life of family members of children with inflammatory bowel disease. Psychological symptoms have been reported in parents and siblings, but the problems that which give rise to these symptoms are seldom examined. In this pilot study, some of the issues that affect the quality of life of parents and siblings of children with inflammatory bowel disease were examined. METHODS Focus group meetings were held separately with 20 parents and 7 siblings of children with inflammatory bowel disease. The participants were encouraged to identify voluntarily problems related to the disease that affected their lives, and the discussions were tape recorded. Each participant subsequently wrote down the three most important concerns. RESULTS Thirteen (65%) parents were very concerned about the effect of the disease on the child's future jobs, marriage, independence) and 11 (55%) were worried about problems the ill child was encountering at school. Other issues of most concern to parents included side effects of medication (n = 7), limited job prospects (n = 3), persistent feelings of guilt (n = 3), and restricted family lifestyle (n = 1 ). Most siblings (57%) were concerned about their parents' keeping information about the illness from them, and three (43%) of them were also concerned about others bullying the ill child at school. Other issues of concern to siblings included fear about the disease and treatment (n = 3), parents overprotecting the ill child, and feelings of jealousy (n = 1). CONCLUSION Families of children with inflammatory bowel disease experience many problems that may affect their quality of life. Resources should be made available to help families with these concerns.
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Affiliation(s)
- A K Akobeng
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Manchester, United Kingdon
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Affiliation(s)
- A K Akobeng
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, University of Manchester, Blackley, United Kingdom
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Brennan BM, Gill M, Pennells L, Eden OB, Thomas AG, Clayton PE. Insulin-like growth factor I, IGF binding protein 3, and IGFBP protease activity: relation to anthropometric indices in solid tumours or leukaemia. Arch Dis Child 1999; 80:226-30. [PMID: 10325701 PMCID: PMC1717861 DOI: 10.1136/adc.80.3.226] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To measure the serum concentrations of insulin-like growth factor I (IGF-I) and IGF binding protein 3 (IGFBP-3), and the level of IGFBP-3 protease activity in 38 children presenting with malignancies, and to assess their relation with auxological parameters and nutritional status. METHODS Height, weight, skinfold thickness, and mid-upper arm circumference (MUAC) were recorded using standard techniques. IGF-I and IGFBP-3 were measured using specific radioimmunoassays. Serum IGFBPs were also visualised on western ligand blot. IGFBP-3 protease activity was assessed by the extent of fragmentation of recombinant [125I]-IGFBP-3, compared with that induced by pregnancy serum. Anthropometric and radioimmunoassay data were expressed as standard deviation scores (SDS). RESULTS The median (range) IGF-I SDS was significantly reduced in all patients (-1.1 (-5.1 to 1.2)) and lower in children who were malnourished (-2.5 (-3.9 to 0.1)). IGFBP-3 SDS was within the normal range for 31 of 38 patients but IGFBP-3 protease activity was raised in all patients. Neither IGFBP-3 concentration nor protease activity was affected by nutritional status. IGF-I correlated with MUAC (r = 0.41) and subscapular skinfold thickness SDS (r = 0.38), but not with weight, height, weight for height, or triceps skinfold thickness. CONCLUSIONS IGF-I is low in children with malignancies, and even lower in those who are malnourished. IGFBP-3 concentrations were normal in most patients but interpretation is complicated by the presence of raised IGFBP-3 protease activity, which could lead to overestimating concentrations of intact peptide. IGF-I appears to relate to arm anthropometry as an index of nutritional status but not height, weight, or weight for height, as would be expected in normal children.
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Affiliation(s)
- B M Brennan
- Department of Paediatric Oncology, Manchester Children's Hospitals, UK
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Affiliation(s)
- A K Akobeng
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Manchester, United Kingdom
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Sarin YK, Khurana M, Natu MV, Thomas AG, Singh T. Item analysis of published MCQs. Indian Pediatr 1998; 35:1103-5. [PMID: 10216545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- Y K Sarin
- Christian Medical College, Ludhiana, India
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Abstract
Feeding difficulty and malnutrition are common in disabled children. Intake may be reduced because of anorexia, chewing and swallowing difficulties, or vomiting. Feeding is often time consuming, unpleasant, and may result in aspiration. Malnutrition may result in impaired growth and neurodevelopment, and impaired cardiorespiratory, gastrointestinal, and immune functions. Multidisciplinary assessment is recommended and should include a feeding history, oral-motor examination, and nutritional assessment. The energy requirements of most disabled children are less than those for a normal child of the same age but may be increased by spasticity, athetosis, convulsions, and recurrent infections. Micronutrient deficiencies may occur even in children receiving nutritionally complete feeds if the volume is reduced because of low energy requirements. Oral intake may be improved by a change of posture, special seating, feeding equipment, oral desensitization, mashing or pureeing of lumpy food, thickening of liquids, use of calorie supplements, and treatment of reflux/esophagitis. Non-oral feeding should be considered when oral feeding is unsafe, not enjoyable, inadequate, or very time consuming. Long-term support requires a gastrostomy. This is less obtrusive than a nasogastric tube, less likely to become displaced, less traumatic, and is associated with improved quality of life, but is also associated with significant morbidity. If there is symptomatic reflux a fundoplication may be required, but this is associated with significant mortality and substantial morbidity.
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Affiliation(s)
- E Trier
- Booth Hall Children's Hospital, Manchester, UK
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Thomas AG, Mam MK, John B, George K. Pattern of hand injuries. Indian Pediatr 1998; 35:763-5. [PMID: 10216569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- A G Thomas
- Department of Orthopedic Surgery, Christian Medical College, Punjab, India
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Marchiano DA, Thomas AG, Lapinski R, Balwan K, Patel J. Intraoperative blood loss and gestational age at pregnancy termination. Prim Care Update Ob Gyns 1998; 5:204-205. [PMID: 10838389 DOI: 10.1016/s1068-607x(98)00144-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To establish the relationship of measured intraoperative blood loss to gestational age at pregnancy termination, and to determine which factors, if any, affect the risk of bleeding.Methods: A single-operator series of 363 consecutive women undergoing pregnancy termination between 5 and 24 weeks gestational age, as dated by ultrasound, was prospectively evaluated. All pregnancies under 13 weeks gestation were terminated by mechanical dilation and suction curettage without preoperative cervical ripening. All pregnancies between 13 and 24 weeks gestation were terminated by preoperative osmotic cervical dilation with laminaria tents and subsequent uterine evacuation by a combination of suction curettage, sharp curettage, and Bierer forceps extraction. All patients over 12 weeks gestation received a postoperative oxytocin infusion. Whenever possible, amniotic fluid and blood were collected and measured separately. Patients were excluded from the data analysis for pregnancy demise, PPROM, Potter's syndrome, or inability to separate blood establish their relationship. After adjustment for gestational age, the results were analyzed to determine if blood loss was related to maternal age, smoking history, body habitus, or operative indication.Results: A curvilinear relationship between blood loss and gestational age was observed. Mean blood loss at 24 weeks exceeded 800 mL. After adjustment for gestational age, no factors significantly affected blood loss at dilation and aspiration of first trimester pregnancies. In those patients undergoing dilation and evacuation in the second trimester, both simple and stepwise regression analyses showed obesity (BMI >/=32.3) to be significantly associated with increased blood loss (P <.05). Neither age, parity, previous cesarean section, nor smoking history were significantly associated with increased blood loss at dilation and evacuation.Conclusions: With advancing gestational age, intraoperative blood loss increases in curvilinear fashion. Termination providers should be advised that, although blood loss is unaffected by many factors, obese patients are at risk for increased bleeding at dilation and evacuation of pregnancies beyond 12 weeks gestation.
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Affiliation(s)
- DA Marchiano
- Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai Medical Center, New York, New York, USA
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Abstract
OBJECTIVE To determine what percentage of patients have none of the five nonorganic behavioral processes known as Waddell signs, and the relational pattern between Waddell signs and somatic complaints, disturbed functional performance, negative treatment attitudes, physical pathology, depression, generalized anxiety, and MMPI-2 validity scales. DESIGN Case series survey. SETTING A referral-based multidisciplinary pain center affiliated with a state medical school. PATIENTS Seventy-five consecutive patients with chronic back pain. INTERVENTION Medical evaluation and completion of self-report inventories. MAIN OUTCOME MEASURE Total number of Waddell signs, physical pathology, and pain intensity ratings were assessed by a physician during an initial medical evaluation. Degree of disturbed functional performance and psychological symptoms were assessed by self-report measures at the initial evaluation. RESULTS Sixty-four percent of the patients had no Waddell signs. Total number of Waddell signs yielded positive and statistically significant correlations (p < or = .05) with depression, disturbed functional performance, somatic complaints, and pain intensity ratings. Correlations of slightly smaller and statistically nonsignificant magnitudes were revealed for Waddell signs with generalized anxiety, negative treatment attitudes, and physical pathology. Waddell signs were unrelated to age, duration of pain, gender, number of lumbar surgeries, and MMPI-2 validity scales. CONCLUSIONS Taken together, multiple Waddell signs and some of their correlates present various factors that might interfere with optimal response to treatment.
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Affiliation(s)
- D M Novy
- Department of Anesthesiology, University of Texas-Houston Health Science Center, 77030, USA
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Affiliation(s)
- M V Suresh-Babu
- Department of Gastroenterology, Booth Hall Children's Hospital, Manchester, United Kingdom
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