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Croghan SM, Voborsky M, Roche AF, Condron C, O'Keeffe DA, McGuire BB. Design and utilisation of a novel, high-fidelity, low-cost, hybrid-tissue simulation model to facilitate training in robot-assisted partial nephrectomy. J Robot Surg 2024; 18:103. [PMID: 38427102 PMCID: PMC10907476 DOI: 10.1007/s11701-024-01857-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
Robot-assisted partial nephrectomy (RAPN) has rapidly evolved as the standard of care for appropriately selected renal tumours, offering key patient benefits over radical nephrectomy or open surgical approaches. Accordingly, RAPN is a key competency that urology trainees wishing to treat kidney cancer must master. Training in robotic surgery is subject to numerous challenges, and simulation has been established as valuable step in the robotic learning curve. However, simulation models are often both expensive and suboptimal in fidelity. This means that the number of practice repetitions for a trainee may limited by cost restraints, and that trainees may struggle to reconcile the skills obtained in the simulation laboratory with real-world practice in the operating room. We have developed a high-fidelity, low-cost, customizable model for RAPN simulation based on porcine tissue. The model has been utilised in teaching courses at our institution, confirming both feasibility of use and high user acceptability. We share the design of our model in this proof-of-concept report.
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Affiliation(s)
- Stefanie M Croghan
- Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland.
- Strategic Academic Recruitment Programme, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Miroslav Voborsky
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Adam F Roche
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Dara A O'Keeffe
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barry B McGuire
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
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O'Toole M, Doyle A, Collins N, Sullivan C, Mulhall C, Condron C, Doherty E, Eppich W. 'They mirror what they see': A constructivist grounded theory study of simulation culture in four professional domains in Ireland. Med Teach 2024:1-8. [PMID: 38340311 DOI: 10.1080/0142159x.2024.2311863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE In simulation-based education (SBE), educators integrate their professional experiences to prepare learners for real world practice and may embed unproductive stereotypical biases. Although learning culture influences educational practices, the interactions between professional culture and SBE remain less clear. This study explores how professional learning culture informs simulation practices in healthcare, law, teacher training and paramedicine. METHODS Using constructivist grounded theory, we interviewed 19 educators about their experiences in designing and delivering simulation-based communication training. Data collection and analysis occurred iteratively via constant comparison, memo-writing and reflexive analytical discussions to identify themes and explore their relationships. RESULTS Varied conceptualizations and enactments of SBE contributed to distinct professional learning cultures. We identified a unique 'simulation culture' in each profession, which reflected a hyper-real representation of professional practice shaped by three interrelated elements: purpose and rationale for SBE, professional values and beliefs, and educational customs and techniques. Dynamic simulation cultures created tensions that may help or hinder learning for later interprofessional practice. CONCLUSION The concept of simulation culture enhances our understanding of SBE. Simulation educators must be mindful of their uni-professional learning culture and its impacts. Sharing knowledge about simulation practices across professional boundaries may enhance interprofessional education and learners' professional practice.
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Affiliation(s)
- Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrea Doyle
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Naoise Collins
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Visual and Human Computing, Dundalk Institute of Technology, Dundalk, Ireland
| | - Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eva Doherty
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Doyle AJ, Sullivan C, O'Toole M, Tjin A, Simiceva A, Collins N, Murphy P, Anderson MJ, Mulhall C, Condron C, Nestel D, MacAulay R, McNaughton N, Coffey F, Eppich W. Training simulated participants for role portrayal and feedback practices in communication skills training: A BEME scoping review: BEME Guide No. 86. Med Teach 2024; 46:162-178. [PMID: 37552799 DOI: 10.1080/0142159x.2023.2241621] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Providing feedback is a key aspect of simulated participants' (SPs) educational work. In teaching contexts, the ability to provide feedback to learners is central to their role. Suboptimal feedback practices may deny learners the valuable feedback they need to learn and improve. This scoping review systematically maps the evidence related to SPs' role as educators and identifies how SPs prepare for their role and feedback practices. METHODS The authors conducted a scoping review and included a group of international stakeholders with experience and expertise in SP methodology. Five online databases were systematically searched and ERIC, MedEdPortal and MedEdPublish were hand searched to identify relevant studies. Inclusion/exclusion criteria were developed. Data screening and subsequently data charting were performed in pairs. The results of data charting were thematically analysed including categories relating to the Association of SP Educators (ASPE) Standards of Best Practice (SOBP). RESULTS From 8179 articles identified for the title and abstract screening, 98 studies were included. Studies reported the benefit of SPs' authentic role portrayal and feedback interactions for learners and on the reported learning outcomes. Data was heterogeneous with a notable lack of consistency in the detail regarding the scenario formats for communication skills training interventions, SP characteristics, and approaches to training for feedback and role portrayal. CONCLUSIONS The published literature has considerable heterogeneity in reporting how SPs are prepared for role portrayal and feedback interactions. Additionally, our work has identified gaps in the implementation of the ASPE SOBP, which promotes effective SP-learner feedback interactions. Further research is required to identify effective applications of SP methodology to prepare SPs for their role as educators.
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Affiliation(s)
- Andrea J Doyle
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anna Tjin
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anastasija Simiceva
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Naoise Collins
- Department of Visual & Human Centred Computing, Dundalk Institute of Technology, Co. Louth
| | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin Ireland
| | - Michael J Anderson
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Debra Nestel
- School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Australia
- Department of Surgery, University of Melbourne, Australia
| | - Robert MacAulay
- School of Medicine, University of California San Diego, United States of America
| | - Nancy McNaughton
- The Wilson Centre for Research in Education, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Frank Coffey
- DREEAM (Department of Research and Education in Emergency and Acute medicine, Nottingham University Hospitals' NHS Trust)
- School of Health Sciences, University of Nottingham, UK
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Gardner AK, Rodgers DL, Steinert Y, Davis R, Condron C, Peterson DT, Rohra A, Viggers S, Eppich WJ, Reedy G. Mapping the Terrain of Faculty Development for Simulation: A Scoping Review. Simul Healthc 2024; 19:S75-S89. [PMID: 38240621 DOI: 10.1097/sih.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT Understanding what interventions and approaches are currently being used to improve the knowledge, skills, and effectiveness of instructors in simulation-based education is an integral step for carving out the future of simulation. The current study is a scoping review on the topic, to uncover what is known about faculty development for simulation-based education.We screened 3259 abstracts and included 35 studies in this scoping review. Our findings reveal a clear image that the landscape of faculty development in simulation is widely diverse, revealing an array of foundations, terrains, and peaks even within the same zone of focus. As the field of faculty development in simulation continues to mature, we would hope that greater continuity and cohesiveness across the literature would continue to grow as well. Recommendations provided here may help provide the pathway toward that aim.
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Affiliation(s)
- Aimee K Gardner
- From the Baylor College of Medicine (A.K.G., R.D., A.R.), Houston, TX; Indiana University School of Medicine (D.L.R.), Indianapolis, IN; McGill University, Faculty of Medicine and Health Sciences (Y.S.), Montréal, Canada; Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, RCSI SIM Center for Simulation Education and Research (C.C., W.J.E.), Dublin, Ireland; The University of Alabama at Birmingham (D.T.P.), Birmingham, AL; Copenhagen Academy for Medical Education and Simulation (S.V.), Copenhagen, Denmark; and King's College London (G.R.), London, United Kingdom
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Condron C, Power M, Mathew M, Lucey SM. Gender Equality Training for Students in Higher Education: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e44584. [PMID: 37728987 PMCID: PMC10551779 DOI: 10.2196/44584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The principles of gender equality are integral to the goals, targets, and indicators of all sustainable development goals. Higher education institutes can be powerful agents for promoting gender equality, diversity, and inclusion not only in the higher education context but also in society as a whole. To address and overcome gender inequality in the higher education environment, experts posit that change needs to occur from day 1 of the student's academic experience. To this end, training is required. A preliminary review of the literature indicates that multiple gender equality-based training programs or initiatives for students have been designed and evaluated in second and third-level education settings. Examples of educational activities undertaken include delivery of didactic teaching, participation in a face-to-face collaboration project, site visits, case studies, and coaching. Yet, our initial search indicated that, to date, a comprehensive review collating the available evidence on gender equality training for third-level students has not yet been carried out. OBJECTIVE Our review seeks to identify and explore the existing literature on gender equality training interventions for third-level students, with a particular emphasis on training content, methodology, and outcome evaluation. METHODS This scoping review will be structured using the Arskey and O'Malley's 5-stage framework and will consider empirical research and other relevant published works that address gender equality training. Systematic searches will be carried out in 6 research databases and the gray literature using key search terms. Inclusion and exclusion criteria have been defined, and a data charting tool created to methodically extract information from selected literature. The free web software Rayyan will be used for primary screening where each reference will be screened in duplicate first by title, then abstract, and finally by full text. RESULTS This review forms part of the LIBRA (Balance) study and has received peer-reviewed grant funding from the Irish Higher Education Authority. LIBRA aims to use simulation-based education to develop a gender equality leadership training program for student leaders in higher education. The findings will be summarized in tabular form, and a narrative synthesis produced to inform curriculum development. CONCLUSIONS This review seeks to inform curriculum design by reporting on the gender equality-enabling skills and leadership skills necessary to foster gender equality. This paper should inform recommendations for training and catalyze future research in this rapidly evolving area. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44584.
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Affiliation(s)
- Claire Condron
- RCSI SIM, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Mide Power
- RCSI SIM, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Midhun Mathew
- RCSI SIM, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Daly M, Condron C, Mulhall C, Eppich W, O'Neill J. IMPROVING DIAGNOSTIC CLINICAL SKILLS IN CARDIOLOGY: CAN HYBRID SIMULATION WITH SCRIPTED HISTORIES, WEARABLE TECHNOLOGY AND QUANTITATIVE GRADING IMPROVE LEARNING AND PERFORMANCE? - THE ASSIMILATE EXCELLENCE STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Frerejean J, van Merriënboer JJG, Condron C, Strauch U, Eppich W. Critical design choices in healthcare simulation education: a 4C/ID perspective on design that leads to transfer. Adv Simul (Lond) 2023; 8:5. [PMID: 36823641 PMCID: PMC9951482 DOI: 10.1186/s41077-023-00242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/12/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Healthcare simulation education often aims to promote transfer of learning: the application of knowledge, skills, and attitudes acquired during simulations to new situations in the workplace. Although achieving transfer is challenging, existing theories and models can provide guidance. RECOMMENDATIONS This paper provides five general recommendations to design simulations that foster transfer: (1) emphasize whole-task practice, (2) consider a cognitive task analysis, (3) embed simulations within more comprehensive programs, (4) strategically combine and align simulation formats, and (5) optimize cognitive load. We illustrate the application of these five recommendations with a blueprint for an educational program focusing on simulation activities. CONCLUSIONS More evidence-informed approaches to healthcare simulation might require a paradigm shift. We must accept that a limited number of simulations is not enough to develop complex skills. It requires comprehensive programs that combine simulation sessions with workplace learning.
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Affiliation(s)
- Jimmy Frerejean
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. .,Simulation Center Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - Jeroen J. G. van Merriënboer
- grid.5012.60000 0001 0481 6099School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Claire Condron
- grid.4912.e0000 0004 0488 7120RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ulrich Strauch
- grid.412966.e0000 0004 0480 1382Simulation Center Maastricht University Medical Center+, Maastricht, the Netherlands ,grid.412966.e0000 0004 0480 1382Department of Intensive Care, Maastricht University Medical Center +, Maastricht, the Netherlands
| | - Walter Eppich
- grid.4912.e0000 0004 0488 7120RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Sullivan C, Condron C, Mulhall C, Almulla M, Kelly M, O'Leary D, Eppich W. Preparing for Pediatrics: Experiential Learning Helps Medical Students Prepare for Their Clinical Placement. Front Pediatr 2022; 10:834825. [PMID: 35311060 PMCID: PMC8931532 DOI: 10.3389/fped.2022.834825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the importance of effective communication skills in pediatrics, clinical placements may inadequately prepare undergraduate students to communicate with children. The integration of non-clinical interactions with healthy children within a pediatric curriculum has the potential to enhance learning. We designed and implemented a novel course involving experiential learning, including video-recorded consultations with simulated parents (SPs), team-based scenarios with a pediatric mannequin, interactions with healthy children through a pre-school visit and medical student led health workshops for primary school children. Medical students at the RCSI University of Medicine and Health Sciences took part in the course. We used a mixed methods approach to assess the impact of the course. We investigated medical students' perspectives through a pre- and post-intervention questionnaire and post-intervention focus group discussions (FGDs). We assessed participating children's health literacy at the start of the course. 144/279 (51.6%) of the fourth year medical student cohort on their pediatric rotation, consented to participate in the study. All 144 (100%) of consenting students completed the pre-intervention questionnaire. 59/144 (40.1%) of consenting students completed the post-intervention questionnaire. Results showed a statistically significant improvement in ratings (p < 0.05) for items related to managing a confrontational situation involving family members, completing a psychosocial assessment with an adolescent and effectiveness using evidence-based medicine (EBM) when motivating patients. There was a statistically significant decrease in how students rated their comfort at using EBM when motivating patients. Four themes relating to how students experienced the intervention were identified from eight FGDs (n = 35 students): Shaping Student Learning; Supporting Student Learning; Developing New Skills and Feeling More Prepared. 39/49 (79.6%) children completed a health literacy assessment. All questions had a high percentage of positive responses. Question 7, understanding your doctor, had the highest proportion of negative responses (27%). Ours is one of the first studies to design an educational intervention to enhance pediatrics teaching by combining interactions with healthy children outside of a clinical setting with more traditional simulation-based approaches. We conclude that this type of intervention supports students' learning of pediatric communication skills and enhances students' perceived preparation for clinical placement.
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Affiliation(s)
- Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Mohammad Almulla
- RCSI School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Maria Kelly
- REACH RCSI, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Daire O'Leary
- Department of Pediatrics, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Karp J, Voborsky M, Woodward C, McDermott C, Kirrane R, Gilmore R, Condron C. 72 Medical Student Attitudes Towards Point-of-Care Ultrasound in Undergraduate Medical Education. Simul Healthc 2021. [DOI: 10.54531/ryjx3157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Point-of-care ultrasound (PoCUS) is a bedside imaging modality that provides the operator with instant clinical patient information. PoCUS is a low-cost, radiation-free, portable diagnostic tool that is utilized in many specialities The aim of the study was to assess undergraduate medical students’ attitudes towards PoCUS through the implementation of a rudimentary proctored PoCUS workshop.Third-year medical students at the Royal College of Surgeons in Ireland participated in a 1-hour PoCUS workshop as part of their fundamental clinical skills training. Medical students attended the in-person workshop repeated over 8 weeks. Students were exposed to three ultrasound stations. The first was a CAE Vimedix ultrasound simulator utilizing augmented reality colourization and 3D modelling. The second station was learning and performing an extended FAST scan with a focus on bright mode image acquisition and free fluid recognition. The third station was the practical placement of peripheral/central IV-line insertion helping students to identify vasculature while also manipulating the ultrasound transducer as a procedural adjunct. Students were asked to complete a post-workshop survey to investigate their attitudes towards ultrasound teaching in undergraduate medical education. The survey consisted of 10 questions to assess attendee’s prior ultrasound knowledge, to provide constructive feedback regarding the workshop and how ultrasound can be incorporated into future undergraduate medical education.A total of 121 students completed the post-workshop survey. Of those who completed the survey, 94.2% of students had never used an ultrasound machine before and 100% had never performed PoCUS previously. Collectively, participants strongly agreed 100% that PoCUS should be incorporated into the undergraduate medical student curriculum at RCSI. In particular, 89.3% and 45.5% of students indicated that POTUS should be included in the third- and fourth-year medicine curriculum, respectively. 85.1% of students indicated that PoCUS education would be most valuable to supplement clinical placement followed by anatomy (62.8%), pathology (59.9%) and physiology (23.1%). 86.8% of the students were interested in learning more about PoCUS through an online format.PoCUS appears to be an additional valuable learning resource for undergraduate medical students. Of the students surveyed, it is apparent that there is strong support in favour of early ultrasound integration into the future medical school curriculum.
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Lawler T, Condron C, Scott M, Meshcherskaya G, Roche A, Horne S, Kirrane R, Voborsky M, Sullivan C, O’Conghaile C. 49 The Effective Management of Resources in a Busy Sim Centre. Simul Healthc 2021. [DOI: 10.54531/tjlc8913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The efficient working of a busy, multi-faceted Healthcare Simulation Centre that caters to many different stakeholders requires a repertoire of protocols and procedures. Standard Operating Procedures (SOPs) ensure all resources are managed as effectively as they can be so that teaching can be continuously delivered at the optimum level.The aim of this wide-ranging project was to devise a collection of SOPs and accompanying files that regulate the efficient management of resources in a Sim Centre.A template for SOPs was created, with entries for background, purpose, scope, procedures etc. ensuring each SOP would meet a universal standard for the department. They also must be approved by the Simulation Manager and reviewed annually. Accompanying documents, spreadsheets and online forms to facilitate that the processes outlined in the SOPs would also have to be created.The SOPs include maintenance and servicing of equipment, loaning of equipment, booking of equipment for teaching and self-directed practise, inventory, management of Simulation spaces and storage areas, stock-taking and ordering of consumables. A suite of instructional documents, data management spreadsheets and online forms have been prepared and are updated regularly in accordance with the procedures outlined in the SOPs. Much of what simulation staff do is learned on the job and losing that institutional knowledge can be devastating for a program. To combat this the SOPs capture the essential steps to efficiently run our centre. The SOPs are useful tools to communicate the correct way of carrying out an activity and are used to orientate and train new technical staff in our centre. Importantly, the SOPs are an integral part of our quality enhancement process, updated regularly, and used to communicate innovations and improvements amongst the wider centre user community. These SOPs and associated resources will be made available to the simulation community upon request.
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Forget P, Aguirre JA, Bencic I, Borgeat A, Cama A, Condron C, Eintrei C, Eroles P, Gupta A, Hales TG, Ionescu D, Johnson M, Kabata P, Kirac I, Ma D, Mokini Z, Guerrero Orriach JL, Retsky M, Sandrucci S, Siekmann W, Štefančić L, Votta-Vellis G, Connolly C, Buggy D. How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence. Cancers (Basel) 2019; 11:cancers11050592. [PMID: 31035321 PMCID: PMC6563034 DOI: 10.3390/cancers11050592] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 01/04/2023] Open
Abstract
The question of whether anesthetic, analgesic or other perioperative intervention during cancer resection surgery might influence long-term oncologic outcomes has generated much attention over the past 13 years. A wealth of experimental and observational clinical data have been published, but the results of prospective, randomized clinical trials are awaited. The European Union supports a pan-European network of researchers, clinicians and industry partners engaged in this question (COST Action 15204: Euro-Periscope). In this narrative review, members of the Euro-Periscope network briefly summarize the current state of evidence pertaining to the potential effects of the most commonly deployed anesthetic and analgesic techniques and other non-surgical interventions during cancer resection surgery on tumor recurrence or metastasis.
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Affiliation(s)
- Patrice Forget
- Anesthesiology and Perioperative Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Jose A Aguirre
- Anesthesiology, Balgrist University Hospital Zurich, 8091 Zurich, Switzerland.
| | - Ivanka Bencic
- University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb 10000, Croatia.
| | - Alain Borgeat
- Anesthesiology, Balgrist University Hospital Zurich, 8091 Zurich, Switzerland.
| | - Allessandro Cama
- Department of Pharmacy, Unit of General Pathology, Center on Aging Sciences and Translational Medicine (CeSI-MeT), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Claire Condron
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, 9 Dublin, Ireland.
| | - Christina Eintrei
- Department of Anesthesiology and Intensive Care, University of Linköping, 581 83 Linköping, Sweden.
| | - Pilar Eroles
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
- Biomedical Research, Network in Breast Cancer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Anil Gupta
- Physiology and Pharmacology, Karolinska Institutet, Perioperative Medicine and Intensive Care, Karolinska Hospital, 171 76 Stockholm, Sweden.
| | - Tim G Hales
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, UK.
| | - Daniela Ionescu
- Head Department of Anesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Outcome Research Consortium, Cleveland, OH 44195, USA.
| | - Mark Johnson
- Department of Anesthesia, Fiona Stanley Hospital, Perth, Western Australia. University College Dublin School of Medicine and Medical Science, 4 Dublin, Ireland.
| | - Pawel Kabata
- Department of Surgical Oncology, Medical University of Gdańsk, 80-210 Gdańsk, Poland.
| | - Iva Kirac
- Surgical Oncology, University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb 10000, Croatia.
| | - Daqing Ma
- Anesthetics, Pain Medicine & Intensive Care, Department of Surgery and Cancer, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK.
| | - Zhirajr Mokini
- San Gerardo University Hospital, Monza, Italy. Clinique Saint Francois, 36000 Chateauroux, France.
| | - Jose Luis Guerrero Orriach
- Institute of Biomedical Research in Malaga [IBIMA], Department of Cardio-Anaesthesiology, Virgen de la Victoria University Hospital, 2010 Malaga, Spain.
- Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, 29071 Malaga, Spain.
| | - Michael Retsky
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
| | - Sergio Sandrucci
- Visceral Sarcoma Unit, CDSS-University of Turin, 10124 Turin, Italy.
| | - Wiebke Siekmann
- Department of Anesthesiology and Intensive Care, Örebro University, 702 81 Örebro, Sweden.
| | - Ljilja Štefančić
- Intensive Care Unit, University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb 10000, Croatia.
| | - Gina Votta-Vellis
- Departments of Anesthesiology and Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL 60607, USA.
| | - Cara Connolly
- Mater Misericordiae University Hospital, Eccles st., D07 R2WY Dublin, Ireland.
| | - Donal Buggy
- Mater University Hospital, School of Medicine, University College Dublin, 4 Dublin, Ireland.
- Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Ireland and Outcomes Research Consortium, Cleveland Clinic, OH 44195, USA.
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Naqi SA, Salih AM, Hoban A, Ayoub F, Quirke M, Hill ADK, Condron C. Evaluation of simulation methods for teaching peripheral arterial examination to medical students. BMJ STEL 2019; 5:49-51. [DOI: 10.1136/bmjstel-2017-000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 11/04/2022]
Abstract
Physical examination is a critical component of medical practice yet the focus on efficient patient turnover has impacted the availability of patients with clinical findings willing to be examined by students and skills' teaching is not consistent across clinical rotations. This work evaluates simulation methodologies for teaching of the peripheral arterial examination and evaluates whether skills learnt are transferable to clinical practice.Second-year medical students were taught peripheral arterial examination on a SimMan 3G or with simulated patients (SPs). Both groups were assessed by Objective Structured Clinical Examination (OSCE) with outpatients who have been diagnosed with peripheral arterial disease.There was no difference in the pass rate at OSCE between the two groups. SimMan better facilitated repeated practice, group learning, peer teaching and discussion, which were highly valued by the students. Students felt that the SImMan tutorial did not facilitate development of spatial cognition or pattern recognition. They also felt less well prepared to deal with real patients in terms of having practised appropriate language, issuing instructions and attempting to reassure patients.Both methods of simulation teaching have distinct merits and the ideal approach maybe to use the SimMan in combination with SPs.
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Scully M, Gang C, Condron C, Bouchier-Hayes D, Cunningham AJ. Protective Role of Cyclooxygenase (COX)-2 in Experimental Lung Injury: Evidence of a Lipoxin A4-Mediated Effect. J Surg Res 2012; 175:176-84. [DOI: 10.1016/j.jss.2011.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 02/02/2011] [Accepted: 02/14/2011] [Indexed: 10/18/2022]
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14
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Bergin DA, Reeves EP, Meleady P, Henry M, McElvaney OJ, Carroll TP, Condron C, Chotirmall SH, Clynes M, O'Neill SJ, McElvaney NG. α-1 Antitrypsin regulates human neutrophil chemotaxis induced by soluble immune complexes and IL-8. J Clin Invest 2010; 120:4236-50. [PMID: 21060150 DOI: 10.1172/jci41196] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 09/15/2010] [Indexed: 12/19/2022] Open
Abstract
Hereditary deficiency of the protein α-1 antitrypsin (AAT) causes a chronic lung disease in humans that is characterized by excessive mobilization of neutrophils into the lung. However, the reason for the increased neutrophil burden has not been fully elucidated. In this study we have demonstrated using human neutrophils that serum AAT coordinates both CXCR1- and soluble immune complex (sIC) receptor-mediated chemotaxis by divergent pathways. We demonstrated that glycosylated AAT can bind to IL-8 (a ligand for CXCR1) and that AAT-IL-8 complex formation prevented IL-8 interaction with CXCR1. Second, AAT modulated neutrophil chemotaxis in response to sIC by controlling membrane expression of the glycosylphosphatidylinositol-anchored (GPI-anchored) Fc receptor FcγRIIIb. This process was mediated through inhibition of ADAM-17 enzymatic activity. Neutrophils isolated from clinically stable AAT-deficient patients were characterized by low membrane expression of FcγRIIIb and increased chemotaxis in response to IL-8 and sIC. Treatment of AAT-deficient individuals with AAT augmentation therapy resulted in increased AAT binding to IL-8, increased AAT binding to the neutrophil membrane, decreased FcγRIIIb release from the neutrophil membrane, and normalization of chemotaxis. These results provide new insight into the mechanism underlying the effect of AAT augmentation therapy in the pulmonary disease associated with AAT deficiency.
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Affiliation(s)
- David A Bergin
- 1Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
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15
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Chen G, Neilan TG, Chen H, Condron C, Kelly C, Hill ADK, Bouchier-Hayes DJ. Attenuation of lipopolysaccharide-mediated left ventricular dysfunction by glutamine preconditioning. J Surg Res 2009; 160:282-7. [PMID: 19628228 DOI: 10.1016/j.jss.2009.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 04/03/2009] [Accepted: 04/16/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Myocardial dysfunction is often seen during the inflammatory response to major surgery at 4 to 6h postoperatively. The aim of this study was to investigate the effect of glutamine pretreatment, as a means of preconditioning, on lipopolysaccharide-induced myocardial dysfunction. METHODS C57BL/6 mice were randomized into four groups: Control; lipopolysaccharide; glutamine plus lipopolysaccharide; and Quercetin, an inhibitor of heat shock protein synthesis plus glutamine and lipopolysaccharide. Left ventricular function was assessed at 6h following lipopolysaccharide (LPS) insult by invasive hemodynamics. Heat shock protein (HSP)72 in heart tissue was determined by Western immunoblot at 12h after glutamine administration. RESULTS Administration of lipopolysaccharide resulted in significant decrease in left ventricular end systolic pressure (LVESP) (69.1 +/- 2.52 mm Hg versus 106.3 +/- 3.36 mm Hg in controls), reduced dP/dtmax (4704.1 +/- 425.31 mm Hg/s versus 9389.8 +/- 999.4 mm Hg/s in controls), and the increase in left ventricular end diastolic pressure (LVEDP) (5.10 +/- 0.28 mm Hg versus 2.16 +/- 0.27 mm Hg in controls) (P < 0.05). Peritoneal injection of 25 g/kg of glutamine 12 h prior to lipopolysaccharide exposure induced HSP72 expression in heart tissues and attenuated lipopolysaccharide-induced left ventricular dysfunction: LVESP 85.94 +/- 3.8 mm Hg (P < 0.05), dP/dtmax 8331 +/- 425 mm Hg (P < 0.05), LVEDP 2.32 +/- 0.23 mm Hg (P < 0.01). Quercetin partially attenuated glutamine induced HSP72 expression and blocked the protective response of glutamine. CONCLUSION These data demonstrate that cardioprotection with glutamine is associated with induction of HSP72 and may be an approach to activating the preconditioning response in the heart in clinical practise.
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Affiliation(s)
- Gang Chen
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research CentreBeaumont Hospital, Dublin 9, Ireland.
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16
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McGuinness J, Byrne J, Condron C, McCarthy J, Bouchier-Hayes D, Redmond JM. Pretreatment with ω-3 fatty acid infusion to prevent leukocyte–endothelial injury responses seen in cardiac surgery. J Thorac Cardiovasc Surg 2008; 136:135-41. [DOI: 10.1016/j.jtcvs.2007.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Revised: 10/16/2007] [Accepted: 11/13/2007] [Indexed: 11/16/2022]
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Donnelly M, Condron C, Murray P, Bouchier-Hayes D. Modulation of the glycemic response using insulin attenuates the pulmonary response in an animal trauma model. ACTA ACUST UNITED AC 2007; 63:351-7. [PMID: 17693835 DOI: 10.1097/01.ta.0000251599.80602.d1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/25/2022]
Abstract
BACKGROUND Hyperglycemia has been shown to be an independent prognostic indicator of poor outcome in the traumatized patient. The role of insulin and the prevention of hyperglycemia in the trauma patient have as yet not been fully explored. We hypothesized that the systemic inflammatory response to trauma could be modified by modulating the glycemic response to trauma using insulin. METHODS A rodent model of end- organ (lung) injury in trauma was chosen. Two groups underwent bilateral femur fracture and 15% blood loss. The third group was anesthetized only. The treatment group immediately received subcutaneous insulin according to a sliding scale. The control groups received normal saline subcutaneously. The animals were maintained under anesthesia for 4 hours from injury. Blood samples were then taken. Bronchoalveolar lavage was performed for neutrophil content and total protein estimation. The left lower lobe was harvested for wet:dry lung weight ratios as a measure of end-organ tissue edema. RESULTS Measures of end-organ injury, wet:dry lung weight ratios, and bronchoalveolar lavage neutrophil content were significantly reduced in the insulin-treated animals compared with in the controls (p < 0.05). Neutrophil respiratory burst activity was increased in insulin-treated animals compared with in controls (p < 0.05). CONCLUSIONS Insulin reduces leukocyte lung sequestration and end-organ (lung) edema, indicating an endothelial protective effect in this injured-animal model without attenuating neutrophil function. This work confirms that modifying the glycemic response to trauma using insulin may have a role in reducing adult respiratory distress syndrome rates in injured patients and thereby lead to improved outcomes.
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18
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O'Neill JP, O'Neill B, Condron C, Walsh M, Bouchier-Hayes D. Anaplastic (undifferentiated) thyroid cancer: improved insight and therapeutic strategy into a highly aggressive disease. J Laryngol Otol 2006; 119:585-91. [PMID: 16102210 DOI: 10.1258/0022215054516197] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: This review article discusses the clinical and diagnostic implications of anaplastic thyroid cancer, recognizing the aggressive nature of the disease and extensive disease progression upon diagnosis. Standard treatment strategies (surgical, chemotherapy, radiation) are discussed, comparing adjuvant and neo-adjuvant regimens and the emergence of tumour resistance with expression of multidrug resistance pumps. We question the pathological evolution of anaplasia as a ‘de novo’ disease or a post malignant transformation or dedifferentiation and the therapeutic implications of p53 mutation. Future treatment options are reviewed with an emphasis on specific molecular targets responsible for the neoplastic phenotype.Method: An electronic search on Medline and Pubmed was performed under ‘anaplastic thyroid carcinoma’, ‘anaplastic thyroid carcinogenesis’, ‘anaplastic thyroid carcinoma treatment reviews’. Relevant papers were systematically reviewed from 1965 to present.
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Affiliation(s)
- J P O'Neill
- Department of Surgery and Otolaryngology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
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19
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Timlin M, Toomey D, Condron C, Power C, Street J, Murray P, Bouchier-Hayes D. Fracture Hematoma Is a Potent Proinflammatory Mediator of Neutrophil Function. ACTA ACUST UNITED AC 2005; 58:1223-9. [PMID: 15995474 DOI: 10.1097/01.ta.0000169866.88781.f1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with multiple skeletal injuries are susceptible to acute respiratory distress syndrome and multiple organ failure, which result from hyperactivation of the immune system. This study was designed to evaluate in vitro the proinflammatory properties of fracture hematoma (FH). METHODS FH was isolated from patients undergoing emergent open reduction and internal fixation for isolated closed fractures. Neutrophils (PMNs), isolated from healthy volunteers, were exposed to the FH supernatant and activation was examined (CD11b and CD18 adhesion receptor expression and respiratory burst). PMN phagocytosis, apoptosis, and transmigration across an endothelial barrier were also assessed. RESULTS FH increased PMN respiratory burst (control, 100; FH-treated, 186) and phagocytosis (control, 100; FH-treated, 172) but had no effect on adhesion receptor expression. Transendothelial migration of PMNs was unaffected, although FH was toxic to endothelial cells. In contrast, apoptosis of FH-treated PMNs was delayed (control, 46; FH-treated, 8). CONCLUSION These effects, although beneficial at the site of injury in the context of antibactericidal function, may cause PMN-mediated tissue injury systemically.
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Affiliation(s)
- Marcus Timlin
- Departments of Orthopaedics, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin, Ireland.
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20
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Robb W, Naughton P, Kelly J, Condron C, Walsh T, Bouchier-Hayes D. Epithelial progenitor cell release is augmented by oral taurine supplementation in patients with Barrett’s esophagus. J Surg Res 2004. [DOI: 10.1016/j.jss.2004.07.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Timlin M, Condron C, Toomey D, Power C, Thornes B, Kearns S, Street J, Murray P, Bouchier-Hayes D. N-acetylcysteine attenuates lung injury in a rodent model of fracture. ACTA ACUST UNITED AC 2004; 75:61-5. [PMID: 15022809 DOI: 10.1080/00016470410001708120] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Neutrophil-mediated lung injury is a cause of significant morbidity and mortality in patients with multiple injuries. We have shown previously that fracture hematoma can activate neutrophils and is thus a putative mediator of the systemic inflammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF) in those patients with severe skeletal trauma. Our aim was to establish a rodent model of fracture which caused lung injury and subsequently to administer a drug following fracture to attenuate the lung injury. The drug we chose was N-acetylcysteine, a potent antioxidant. ANIMALS AND METHODS Adult Sprague-Dawley rats were assigned to 4 groups: (1) general anesthetic only, (2) general anesthetic with bilateral femur fractures and nailing, (3) general anesthetic and N-acetylcysteine, (4) general anesthetic with bilateral femur fractures and nailing and N-acetylcysteine after the injury (n = 6 in each group). The dose of N-acetylcysteine was 0.5 mg/kg which was given intraperitoneally after injury to the treated groups. The rats were killed 24 hours after injury and some parameters of lung injury were evaluated--i.e., bronchoalveolar lavage (BAL), lung tissue myeloperoxidase levels (MPO) and wet/dry ratios of lung tissue. The results were analyzed, using one-way analysis of variance. RESULTS Bilateral femur fracture produced a significant lung injury, measured by increases in MPO (25-43 microg/g tissue) and BAL protein (460-605 microg/mL). This effect was attenuated by treatment with N-acetylcysteine (MPO 43-9 microg/mL, BAL protein 605-198 microg/mL). INTERPRETATION N-acetyl cysteine, if given after skeletal trauma, is of potential therapeutic benefit, in preventing SIRS, ARDS and MOF.
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Affiliation(s)
- Marcus Timlin
- Department of Orthopaedics, RCSI Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland.
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McCabe D, Bacon L, O'Regan K, Condron C, O'Donnell JR, Murphy PT. CD38 expression on B-cell chronic lymphocytic leukemic cells is strongly correlated with vascular endothelial growth factor expression. Leukemia 2004; 18:649-50. [PMID: 14749705 DOI: 10.1038/sj.leu.2403282] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Condron C, Toomey D, Casey RG, Shaffii M, Creagh T, Bouchier-Hayes D. Neutrophil bactericidal function is defective in patients with recurrent urinary tract infections. ACTA ACUST UNITED AC 2003; 31:329-34. [PMID: 14574538 DOI: 10.1007/s00240-003-0344-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2002] [Accepted: 06/04/2003] [Indexed: 10/26/2022]
Abstract
Urinary tract infection (UTI), most frequently caused by Escherichia coli, is one of the most common bacterial infections in humans. It is a host inflammatory response to bacterial invasion in which large numbers of neutrophils are recruited into the bladder in response to cytokines secreted by the infected bladder epithelium. We hypothesise that an impaired host neutrophil response leads to susceptibility to recurrent UTI (rUTI). Therefore, the neutrophil inflammatory response of patients with a history of rUTI was compared to healthy controls. No difference in neutrophil adhesion receptor expression or complement receptor expression following bacterial stimulus was detected between the two groups. However, the expression of the IgG receptor CD16, bacterial phagocytosis and reactive oxygen intermediate (ROI) production were significantly reduced in UTI patient neutrophils compared to controls. Neutrophils from rUTI patients have a significantly reduced bactericidal function when compared to healthy controls, with the former showing a reduced capacity for activation. This reduced neutrophil function may result in defective bacterial clearance and lead to susceptibility to recurrent infection.
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Affiliation(s)
- C Condron
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Center, Beaumont Hospital, Dublin 9, Ireland
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24
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Naughton P, Kelly J, Condron C, Tormey S, Broe P, Walsh T, Bouchier-Hayes D. 217 Increased bone marrow-derived endothelial cells in Barrett's metaplasia. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
The pathway involved in Fas-mediated neutrophil apoptosis remains to be fully elucidated. We examined whether this pathway involved either oxygen-dependent or calcium-dependent mechanisms. We also investigated whether taurine, a powerful antioxidant and regulator of intracellular calcium fluxes, could inhibit Fas-mediated neutrophil apoptosis. Neutrophils were stimulated with Fas monoclonal antibody in the presence or absence of taurine. Fas receptor ligation resulted in significant neutrophil apoptosis at 18 h. Engagement of the Fas receptor rapidly resulted in a significant decrease in intracellular calcium. Apoptosis was inhibited and intracellular calcium levels were maintained in the presence of calcium ionophore A23187 or taurine. Fas ligation did not result in an increase in intracellular reactive oxygen species. We have demonstrated that Fas-mediated neutrophil apoptosis occurs after a decrease in intracellular calcium and is reactive oxygen intermediate independent. Furthermore, the amino acid taurine attenuates this pathway of neutrophil apoptosis by calcium regulation. This newly identified role of taurine in the inhibition of Fas-mediated neutrophil apoptosis may have significant implications for future manipulation of host pro-inflammatory cell function.
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Affiliation(s)
- Claire Condron
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin, Ireland
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26
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Toomey D, Smyth G, Condron C, Kelly J, Byrne AM, Kay E, Conroy RM, Broe P, Bouchier-Hayes D. Infiltrating immune cells, but not tumour cells, express FasL in non-small cell lung cancer: No association with prognosis identified in 3-year follow-up. Int J Cancer 2003; 103:408-12. [PMID: 12471625 DOI: 10.1002/ijc.10836] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [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: 11/11/2022]
Abstract
Non-small cell lung cancer (NSCLC) remains a difficult disease to treat and independent prognostic markers other than tumour stage and histology have not emerged. The immune cell content of solid tumours has been associated with tumour regression and at times, tumour progression. The involvement of immune cells in prognosis of NSCLC is poorly described. Poor immune responses within solid tumours have been linked with tumour production of immunosuppressive cytokines. Tumour expression of FasL is thought to disarm responses through the transduction of a death signal in Fas-expressing T cells. The existence of the 'tumour counterattack' in vivo has been questioned. We undertook to measure T cell and macrophage infiltration of the tumour bed in NSCLC and report the association between immune cell content and prognosis in a limited, 3-year analysis of survival (n = 113). In addition we investigated FasL expression (n = 45). T cells and macrophages were found to frequently infiltrate lung tumours, albeit in small numbers. Generally there were more T cells infiltrating than macrophages. T cell and macrophage numbers were not associated with prognosis. Lung tumours were found not to express FasL, although occasional immune cells surrounding tumour cells were strongly positive. FasL expression was not associated with prognosis in this series. Thus, immune cells infiltrating NSCLC are not capable of suppressing tumour growth, nor are they associated with tumour progression. We report that lung tumours do not express the FasL, and that although some immune cells are FasL positive, this is not a reflection of general immune cell activation.
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Affiliation(s)
- Deirdre Toomey
- Department of Surgery, The Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin, Ireland.
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27
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Hanson RP, Gang C, Condron C, Winter DC, Kneafsey B, Bouchier-Hayes DJ. L-Arginine supplementation has multiple effects in the diabetic wound model. Ir J Med Sci 2002. [DOI: 10.1007/bf03170044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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Kiely PD, Wang JC, Kelly CJ, Condron C, Watson RGK, Bouchier-Hayes DJ. Diethylmaleate, a pro-oxidant, attenuates experimental ischaemia-reperfusion-induced lung injury. Br J Surg 2002; 89:482-5. [PMID: 11952592 DOI: 10.1046/j.0007-1323.2001.02050.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Systemic ischaemia-reperfusion (IR) injury is in part an oxidant injury mediated by neutrophils. Diethylmaleate (DEM), an intracellular pro-oxidant agent, has been shown to alleviate neutrophil-mediated tissue injury. The aim of this study was to evaluate whether DEM could have a protective effect on neutrophil-mediated lung injury in an animal model of lower-torso IR. METHODS Sprague-Dawley rats (seven per group) were randomized into three groups. The control group underwent midline laparotomy only; the IR group underwent laparotomy and clamping of the infrarenal abdominal aorta for 30 min followed by 2 h of reperfusion; and the third group was pretreated with DEM 6 mmol/kg intraperitoneally 1 h before the IR insult. RESULTS IR resulted in a significant increase in both microvascular leakage and pulmonary neutrophil infiltration as measured by bronchoalveolar lavage protein concentration and pulmonary myeloperoxidase activity respectively. Pretreatment with DEM significantly attenuated both microvascular leakage and neutrophil infiltration. CONCLUSION Preconditioning with DEM protected against IR-induced lung injury. This protective effect raises the possibility of using pro-oxidants to prevent inflammatory injury.
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Affiliation(s)
- P D Kiely
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
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Abstract
The purpose of this study was to determine if prereatment with taurolidine, a known anti-endotoxin agent, would attenuate the hemodynamic and respiratory responses associated with endotoxin induced lung injury in a large animal model in a randomized controlled study under license from the Department of Health. All animals underwent a general anesthetic. Vascular catheters were placed in the femoral artery and in the femoral vein. A Swan-Ganz Catheter was inserted for measurement of pulmonary artery pressure. Animals were randomized into three groups: Control, with measurements taken at baseline and half hourly up to 90 min; Endotoxin, receiving 5microg/Kg E. coli endotoxin intravenously after baseline measurements; and Endotoxin + Taurolidine, receiving 5g of taurolidine via intraperitoneal infusion 1 h before endotoxin administration. Main outcome measures were mean systemic arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), arterial oxygen tension (pO2), serum endotoxin concentration, and pulmonary myeloperoxidase. Endotoxin induced a significant lung injury characterized by an increase in pulmonary artery pressure, hypoxia, and systemic hypotension. Pretreatment with intraperitoneal taurolidine significantly attenuated these hemodynamic and respiratory changes. Serum endotoxin concentration was also significantly reduced as was lung myeloperoxidase. The data suggest that taurolidine may have a therapeutic role in preventing the lung injury seen in endotoxemia.
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Affiliation(s)
- Bridget M Egan
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin
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Maher S, Toomey D, Condron C, Bouchier-Hayes D. Activation-induced cell death: the controversial role of Fas and Fas ligand in immune privilege and tumour counterattack. Immunol Cell Biol 2002; 80:131-7. [PMID: 11940113 DOI: 10.1046/j.1440-1711.2002.01068.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [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: 12/29/2022]
Abstract
Activation-induced cell death (AICD) is the process by which cells undergo apoptosis in a controlled manner through the interaction of a death factor and its receptor. Programmed cell death can be induced by a number of physiological and pathological factors including Fas (CD95)-Fas ligand (FasL/CD95L) interaction, tumour necrosis factor (TNF), ceramide, and reactive oxygen species (ROS). Fas is a 48-kDa type I transmembrane protein that belongs to the TNF/nerve growth factor receptor superfamily. FasL is a 40-kDa type II transmembrane protein that belongs to the TNF superfamily. The interaction of Fas with FasL results in a series of signal transductions which initiate apoptosis. The induction of apoptosis in this manner is termed AICD. Activation-induced cell death and Fas-FasL interactions have been shown to play significant roles in immune system homeostasis. In this review the involvement of Fas and Fas ligand in cell death, with particular reference to the T cell, and the mechanism(s) by which they induce cell death is described. The role of AICD in immune system homeostasis and the controversy surrounding the role of FasL in immune privilege, inflammation, and so-called tumour counterattack is also discussed.
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Affiliation(s)
- Stephen Maher
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, BeaumontHospital, Dublin, Ireland
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Finnegan N, Toomey D, Condron C, Redmond HP, Da Costa M, Bouchier-Hayes DJ. Potentiation of the therapeutic index of interleukin-2 immunotherapy by combination with taurine in a syngeneic murine tumour model. Ir J Med Sci 2002; 171:85-8. [PMID: 12173896 DOI: 10.1007/bf03168959] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Administration of interleukin-2 (IL-2) is limited by the induction of the vascular leak syndrome (VLS). AIMS To examine the effect of taurine on the toxicity and antitumour activity of IL-2 in a B16 melanoma pulmonary metastases model. METHODS B16 melanoma cells were injected into female C57BL/6 mice. Macroscopic melanoma pulmonary foci were established by day 10 in untreated mice. Treated mice were randomised into treatment by rIL-2 alone, rIL-2 plus taurine or taurine alone. Control animals received saline. Mice were sacrificed on day 18. Lung metastases were counted in a blinded fashion with the aid of a dissecting microscope. Wet to dry lung weight was measured following lung removal. In another experiment animals were treated as above (n = 15 per group) and survival following treatment monitored. RESULT Treatment with IL-2 and taurine significantly reduced lung nodules compared with IL-2 alone. Host survival was significantly enhanced. The wet to dry (w/d) ratios of lung weights in the group receiving IL-2/taurine were significantly less than IL-2 alone. Bronchoalveolar lavage protein fluid was reduced indicating reduced pulmonary injury. CONCLUSION These findings indicate that the combination of taurine with IL-2 augments the efficacy of this immunotherapy while reducing its associated dose-limiting toxicity.
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Affiliation(s)
- N Finnegan
- Department of Surgery, Royal College of Surgeons, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
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Murphy MA, Joyce WP, Condron C, Bouchier-Hayes D. A reduction in serum cytokine levels parallels healing of venous ulcers in patients undergoing compression therapy. Eur J Vasc Endovasc Surg 2002; 23:349-52. [PMID: 11991698 DOI: 10.1053/ejvs.2002.1597] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION vascular endothelial growth factor (VEGF) and tumour necrosis factor alpha (TNF(alpha)) have been specifically implicated in the tissue damage associated with chronic venous disease (CVD). Furthermore, production of both factors is known to be upregulated in vessel wall cells subject to hypertension. The aim of this study was to determine the local venous levels of VEGF and TNF(alpha) in limbs with venous ulcers before and after treatment with graduated compression. PATIENTS AND METHODS eight patients with venous ulcers and 8 patients with varicose veins only were included in the study. For ulcer patients, serum samples were taken from the superficial veins in lower limbs and repeated after 4 weeks of treatment with 4-layered graduated compression. Serum from the arms of the same patients served as controls. Determination of the concentrations of VEGF and TNF(alpha) proteins were performed with sandwich enzyme-linked immunosorbent assays. RESULTS both groups of patients had elevated levels of VEGF and TNF(alpha). In patients with venous ulcers there was a reduction in the levels of both cytokines to below control values with treatment. These changes correlated with healing of the ulcers as determined by reduction in ulcer size. CONCLUSION these data, for the first time, suggest a central role for both TNF(alpha) and VEGF in the pathogenesis of venous ulceration which may constitute a causative link between venous hypertension and tissue pathology.
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Affiliation(s)
- M A Murphy
- Royal College of Surgeons, Beaumont Hospital, Dublin, Ireland
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Toomey D, Smyth G, Condron C, Kay E, Conroy R, Foley D, Hong C, Hogan B, Toner S, McCormick P, Broe P, Kelly C, Bouchier-Hayes D. Immune function, telomerase, and angiogenesis in patients with primary, operable nonsmall cell lung carcinoma: tumor size and lymph node status remain the most important prognostic features. Cancer 2002. [PMID: 11745200 DOI: 10.1002/1097-0142(20011115)92:10<2648::aid-cncr1618>3.0.co;2-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Lung carcinoma usually is advanced at the time of presentation and frequently shows metastatic spread. In recent times, prognostic factors such as c-erbB-2 in patients with breast carcinoma have provided useful information and beneficial therapeutic targets. The objective of this study was to evaluate angiogenesis, immune function, and telomerase expression in patients with nonsmall cell lung carcinoma (NSCLC) to determine their prognostic significance. METHODS Immunohistochemistry was used to evaluate the expression of human telomerase reverse transcriptase (hTERT; n = 115 patients), interleukin-2r (IL-2r; n = 40 patients), microvessel density (MVD; n = 81 patients), and vascular endothelial growth factor (VEGF; n = 61 patients). Three-year survival follow-up information was available for most patients, and a comprehensive review of clinicopathologic features was carried out. RESULTS Fifty percent of tumors showed nuclear staining for hTERT, 55% of tumors showed some degree of lymphocyte IL-2r expression, 33% of tumors were recorded with an MVD that was higher than average, and VEGF staining was detected in 85% of tumors. None of the parameters measured had an impact on survival. hTERT expression was correlated with lymph node status. Lymph node status and tumor size were identified as independent prognostic factors. CONCLUSIONS This study failed to identify a marker of prognosis for patients with NSCLC other than tumor size and lymph node status in this population. Telomerase expression was associated with metastases, raising the possibility that this enzyme is involved in the metastatic process. Tumor cell VEGF expression was identified frequently: This growth factor may have potential as a target for antiangiogenic therapy. Lung carcinoma typically is the result of large numbers of mutations. Further understanding of the biologic implications of these mutations will lead to the development of effective prognostic markers and treatments for patients with NSCLC.
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Affiliation(s)
- D Toomey
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.
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Chen H, Chen G, Kelly C, Condron C, Casey R, Bouchier-Hayes D. Vascular 02. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.25_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Toomey D, Smyth G, Condron C, Kay E, Conroy R, Foley D, Hong C, Hogan B, Toner S, McCormick P, Broe P, Kelly C, Bouchier-Hayes D. Immune function, telomerase, and angiogenesis in patients with primary, operable nonsmall cell lung carcinoma: tumor size and lymph node status remain the most important prognostic features. Cancer 2001; 92:2648-57. [PMID: 11745200 DOI: 10.1002/1097-0142(20011115)92:10<2648::aid-cncr1618>3.0.co;2-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Lung carcinoma usually is advanced at the time of presentation and frequently shows metastatic spread. In recent times, prognostic factors such as c-erbB-2 in patients with breast carcinoma have provided useful information and beneficial therapeutic targets. The objective of this study was to evaluate angiogenesis, immune function, and telomerase expression in patients with nonsmall cell lung carcinoma (NSCLC) to determine their prognostic significance. METHODS Immunohistochemistry was used to evaluate the expression of human telomerase reverse transcriptase (hTERT; n = 115 patients), interleukin-2r (IL-2r; n = 40 patients), microvessel density (MVD; n = 81 patients), and vascular endothelial growth factor (VEGF; n = 61 patients). Three-year survival follow-up information was available for most patients, and a comprehensive review of clinicopathologic features was carried out. RESULTS Fifty percent of tumors showed nuclear staining for hTERT, 55% of tumors showed some degree of lymphocyte IL-2r expression, 33% of tumors were recorded with an MVD that was higher than average, and VEGF staining was detected in 85% of tumors. None of the parameters measured had an impact on survival. hTERT expression was correlated with lymph node status. Lymph node status and tumor size were identified as independent prognostic factors. CONCLUSIONS This study failed to identify a marker of prognosis for patients with NSCLC other than tumor size and lymph node status in this population. Telomerase expression was associated with metastases, raising the possibility that this enzyme is involved in the metastatic process. Tumor cell VEGF expression was identified frequently: This growth factor may have potential as a target for antiangiogenic therapy. Lung carcinoma typically is the result of large numbers of mutations. Further understanding of the biologic implications of these mutations will lead to the development of effective prognostic markers and treatments for patients with NSCLC.
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Affiliation(s)
- D Toomey
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.
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Toomey D, Condron C, Wu QD, Kay E, Harmey J, Broe P, Kelly C, Bouchier-Hayes D. TGF-beta1 is elevated in breast cancer tissue and regulates nitric oxide production from a number of cellular sources during hypoxia re-oxygenation injury. Br J Biomed Sci 2001; 58:177-83. [PMID: 11575741] [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: 02/21/2023]
Abstract
Cellular response to treatment is dependent on the metabolic preconditioning of individual cells, which is a reflection of environmental conditions. Within solid tumours there are areas of different oxygen tension, which, we hypothesise, may indicate that cells are exposed to conditions that change continually. Other characteristics of the solid-tumour microenvironment include the production of growth factors, one of which is transforming growth factor (TGF)-beta1. As part of this study, we measured TGF-beta1 and found it raised in the serum of breast cancer patients compared with controls (98.24+/-13.25 vs. 48.87+/-12.14 ng/mL; P < 0.05; n = 7), and in the conditioned medium of breast tumour explant tissue compared with matched normal tissue (21.1+/-5.3 vs. 4.7+/-1.2 ng TGF-beta1/gram of tissue; P < 0.05; n = 11). Nitric oxide (NO) is a cytotoxic molecule produced by a large number of cells and thought to have antimetastatic properties. In order to observe the effect of conditions within breast tumours on NO production, we exposed macrophages, endothelial cells and tumour cells to hypoxia re-oxygenation in vitro, both in the presence and absence of TGF-beta1. Hypoxia stimulated increased NO production in both macrophages (normoxia: 0.34+/-0.04 nmol/L nitrite vs. hypoxia: 1.04+/-0.18 nmol/L nitrite; P < 0.05) and endothelial cells (normoxia: 0.02+/-0.01 nmol/L nitrite vs. hypoxia: 0.21+/-0.07 nmol/L nitrite; P < 0.05). NO production in macrophages, endothelial cells and tumour cells was reduced significantly following hypoxia in the presence of TGF-beta1 in a concentration-dependent manner. These results suggest that, within breast tumours, tumour-derived TGF-beta1 in combination with environmental conditions may result in decreased local NO production, which could have implications for tumour growth.
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Affiliation(s)
- D Toomey
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin.
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Egan BM, Abdih H, Kelly CJ, Condron C, Bouchier-Hayes DJ. Effect of intravenous taurine on endotoxin-induced acute lung injury in sheep. Eur J Surg 2001; 167:575-80. [PMID: 11716442 DOI: 10.1080/110241501753171164] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To find out if pretreatment with taurine would reduce the severity of endotoxin-induced acute lung injury in a large animal model. DESIGN Randomised controlled study under licence from the Department of Health. SETTING Department of Surgical Research, Ireland. ANIMALS 15 male Suffolk sheep. INTERVENTIONS Vascular catheters were placed in the femoral artery and vein and a Swan-Ganz catheter in the external jugular vein under general anaesthetic. Animals were randomized into three groups: control with measurements taken at baseline and half hourly up to 90 minutes; endotoxin, given Escherichia coli endotoxin intravenously after baseline measurements and taurine given 300 mg/kg 1 hour before endotoxin was given. MAIN OUTCOME MEASURES Mean systemic arterial pressure, mean pulmonary arterial pressure, arterial oxygen tension (PO2), pulmonary myeloperoxidase activity, and neutrophil respiratory burst activity. RESULTS Endotoxin induced a severe lung injury characterised by a decrease in mean systemic blood pressure and an increase in pulmonary artery pressure, hypoxia, and an increase in pulmonary myeloperoxidase activity. Pretreatment with intravenous taurine significantly reduced these haemodynamic changes. It reduced pulmonary myeloperoxidase activity and peripheral neutropenia and increased neutrophil respiratory burst activity. CONCLUSIONS This data suggest that taurine may have a therapeutic role in preventing the lung injury seen in endotoxaemia.
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Affiliation(s)
- B M Egan
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin
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Abstract
Tumor cell extravasation plays a key role in tumor metastasis. However, the precise mechanisms by which tumor cells migrate through normal vascular endothelium remain unclear. In this study, using an in vitro transendothelial migration model, we show that human polymorphonuclear neutrophils (PMN) assist the human breast tumor cell line MDA-MB-231 to cross the endothelial barrier. We found that tumor-conditioned medium (TCM) downregulated PMN cytocidal function, delayed PMN apoptosis, and concomitantly upregulated PMN adhesion molecule expression. These PMN treated with TCM attached to tumor cells and facilitated tumor cell migration through different endothelial monolayers. In contrast, MDA-MB-231 cells alone did not transmigrate. FACScan analysis revealed that these tumor cells expressed high levels of intercellular adhesion molecule-1 (ICAM-1) but did not express CD11a, CD11b, or CD18. Blockage of CD11b and CD18 on PMN and of ICAM-1 on MDA-MB-231 cells significantly attenuated TCM-treated, PMN-mediated tumor cell migration. These tumor cells still possessed the ability to proliferate after PMN-assisted transmigration. These results indicate that TCM-treated PMN may serve as a carrier to assist tumor cell transendothelial migration and suggest that tumor cells can exploit PMN and alter their function to facilitate their extravasation.
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Affiliation(s)
- Q D Wu
- Department of Surgery, Cork University Hospital, University College Cork, Wilton, Cork, Ireland
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Kearns SR, Kelly CJ, Barry M, Abdih H, Condron C, Leahy A, Bouchier-Hayes D. Vitamin C reduces ischaemia-reperfusion-induced acute lung injury. Eur J Vasc Endovasc Surg 1999; 17:533-6. [PMID: 10375489 DOI: 10.1053/ejvs.1999.0833] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES to evaluate vitamin C supplementation in the prevention of ischaemia-reperfusion (I-R) induced acute lung injury. DESIGN Sprague-Dawley rats (n =6/group) were randomised into Control, I-R and I-R pretreated with vitamin C (3.3 g over 5 days). Ischaemia-reperfusion injury was induced by 30 minutes infrarenal aortic cross-clamping and 120 minutes reperfusion. METHODS pulmonary microvascular injury was measured by broncho-alveolar lavage protein concentration, pulmonary neutrophil infiltration by tissue myeloperoxidase activity and bronchoalveolar lavage neutrophil counts. In a second experiment (n =5/group) neutrophil respiratory burst activity was measured in Control and vitamin C groups. RESULTS ischaemia-reperfusion resulted in a significant increase in both microvascular leakage and pulmonary neutrophil infiltration as measured by bronchoalveolar lavage protein concentration and pulmonary myeloperoxidase activity respectively. Pretreatment with vitamin C significantly attenuated both microvascular leakage and neutrophil infiltration. Neutrophil respiratory burst activity was significantly reduced in the vitamin C group (13.02 m.c.f.+/-0.3) compared with Control (19.04 m.c.f.+/-1. 9),p <0.02. CONCLUSION these data suggest that oral vitamin C therapy protects against ischaemia-reperfusion-induced acute lung injury, possibly by attenuating neutrophil respiratory burst activity.
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Affiliation(s)
- S R Kearns
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
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Abstract
Although it is well recognized that interferon-gamma (IFN-gamma) is involved in the development of systemic inflammatory response syndrome, a condition characterized by loss of endothelial barrier function, whether or not IFN-gamma has any direct effect on endothelial cell (EC) death is unclear. Furthermore, which signal transduction pathway involved in IFN-gamma-induced EC apoptosis remains to be elucidated. To answer these questions, we investigated the effect of IFN-gamma on EC death (apoptosis versus necrosis) and the underlying signal transduction pathway responsible for IFN-gamma-induced EC apoptosis. IFN-gamma resulted in a dose-dependent increase in EC apoptosis after 24 h incubation (p < .05). However, IFN-gamma did not induce EC necrosis. Tumor necrosis factor-alpha (TNF-alpha), but not lipopolysaccharide (LPS), had a augmentative effect on IFN-gamma-induced EC apoptosis (p < .05), while both of them alone failed to induce EC apoptosis. These results indicate that exposure of EC to IFN-gamma can cause apoptosis rather than necrosis. Both calcium ionophore, A23187, and the protein kinase C (PKC) activator phorbol-myristate-acetate (PMA) had a synergistic effect on IFN-gamma-induced EC apoptosis (p < .05). However, neither the calcium chelator 1,2-bis 2-aminophenoxy ethane-N,N,N',N'-tetraacetic acid (BAPTA), nor the PKC inhibitor 1 -5-isoquinolinysulfonyl 2-methyl piperazine (H-7) attenuated IFN-gamma-induced EC apoptosis. Three specific tyrosine protein kinase (TPK) inhibitors, herbimycin A, tyrphostin, and genistein, significantly inhibited IFN-gamma-induced EC apoptosis in a dose-dependent fashion (p < .05). Furthermore, the activation of TPK in EC by IFN-gamma was completely abrogated by these TPK inhibitors. These findings suggest that the signal transduction pathway required for induction of EC apoptosis by IFN-gamma is TPK dependent and is independent of calcium and PKC.
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Affiliation(s)
- J H Wang
- The Royal College of Surgeons in Ireland, Department of Surgery, Beaumont Hospital, Dublin
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Abstract
White cell infiltration of solid tumors is an important prognostic indicator in malignant disease. Although macrophage infiltration is associated with good outcome in colorectal cancer, a high macrophage content is associated with poor prognosis in breast cancer. Suppressor macrophages prevent T cell activation in normal tissues such as mucosal linings exposed to continuous antigenic challenge. Interleukin 10 (IL-10), an immunosuppressive cytokine, inhibits macrophage co-stimulation of T cells. Suppressor macrophage numbers, T cell numbers and T cell activation status were assessed in cell suspensions obtained from fresh specimens of breast and colorectal tumours and matched normal tissues. IL-10 production by both malignant and matched normal tissue was also assessed. This study identified elevated numbers of suppressor macrophages in breast tumors compared to matched normal breast tissue. Colorectal tumors did not contain significant numbers of these cells. Although T cell numbers are increased in breast tumors, these cells do not appear to be fully activated, as assessed by major histocompatibility complex class II and Interleukin 2 receptor expression. In contrast, T cells in colorectal tumors exhibit greater expression levels of these markers. Breast tumors produce significantly higher levels of IL-10 than normal breast tissue whereas IL-10 levels in colorectal tumors are similar to normal colon tissue. Our findings of high suppressor macrophage numbers, high levels of IL-10 and poorly activated T cells in breast tumors compared to low suppressor macrophage numbers, low IL-10 and fully activated T cells in colorectal tumors may explain why high macrophage content is associated with poor prognosis in breast cancer and good prognosis in colorectal malignancy.
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Affiliation(s)
- D Toomey
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin
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Clarke G, Ryan E, O’Keane JC, Crowe J, McMathuna P, Moriarty D, Ettarh R, Sheahan K, Hyland J, O’Donoghue DP, Baird AW, Clarke G, Ryan E, Gormley G, Keane JCO, Crowe J, MacMathuna P, Wang JH, Wu QD, Redmond HP, Condron C, Bouchier-Hayes D, Nally K, Newton F, O’Connell J, O’Sullivan GC, Morgan J, Collins JK, Shanahan F, Goode C, O’Connell J, O’Sullivan GC, Collins JK, Shanahan F, Winter DC, Taylor CT, Skelly MM, O’Donoghue DP, O’Sullivan GC, Baird AW, Harvey BJ, Varghese JC, Farrell MA, McGrath FP, Murray FE, Osborne H, Lee MJ, Ryan E, Sullivan A, O’Keane JC, Crowe J, Ryan AE, O’Keane JC, Crowe J, Donovan AN, McCormick PA, Kenny B, Somers S, Bohan A, Gibney RG, Marcaccio M, Malone DE, Doyle M, Delaney CP, Gorey TF, McEntee GP, O’Sullivan GC, Clarke A, Stuart R, Kelly J, Kiely MD, Collins JK, Shanahan F, O’Sullivan M, Lovett E, Mahmud N, Kelleher D, O’Morain CA, Larkin CJ, Watson RGP, Sloan JM, Ardill JES, Johnston CF, Buchanan KD, Heaney A, Collins JSA, Watson GRP, Kalin RM, Heaney A, Collins JSA, Tham TCK, Watson RGP, McFarland RJ, Bamford KB, Cróinín TÓ, Clyne M, Drumm B, Rowland M, Kumar D, O’Connor P, Daly LE, Drumm B, O’Toole DL, Long A, Murphy AM, O’Neill L, Weir DG, Kelleher D, Heaney A, Collins JSA, Watson RGP, Hopkins AM, Moynagh P, O’Donoghue DP, Baird AW, Brennan C, Harmey J, Stapleton PP, Redmond HP, Bouchier-Hayes D, Rasheed AM, Chen G, Kelly C, Bouchier-Hayes DJ, Leahy A, Gallagher M, Grace A, Xin Y, Leader M, Kay E, Whelan A, Pattison U, Willoughby R, Wallace E, Weir D, Feighery C, Bennett MW, O’Connell J, O’Sullivan GC, Brady C, Roche D, Collins JK, Shanahan F, Mahmud N, Molloy A, McPartlin J, Scott JM, Weir DG, Acheson AG, Lee J, Khosraviani K, Irwin ST, McDaid J, McCormick PA, Docherty JR, O’Grady A, Kay E, Mabruk M, Grace A, Leader M, Lee J, Acheson AG, Irwin ST, Larkin CJ, Johnston C, Curry W, Ardill J, Cunningham R, Buchanan KD, Watson RGP, McDougall NI, Coyle PV, Callender ME, Ouinn AM, Warner R, Stevens FM, Chakravarthi PIS, Kearns M, Bourke M, Hassan A, McWeeney J, Stevens FM, McCarthy CF, Casey M, O’Donoghue J, Eustace-Ryan AM, O’Regan P, Feighery L, Jackson J, Cronin N, Shanahan F, Quane K, Feighery C, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, O’Sulhvan M, Harman I, Breslin NP, Clayton N, O’Morain CA, Hogan S, Donovan B, Hayes D, Kiely M, Eustace-Ryan AM, O’Regan P, Goulding CA, Albloushi SS, O’Connor J, Courtney MG, Murray FE, Albloushi SS, Goulding CA, Kay E, Royston D, Leader M, Courtney MG, Murray FE, Albloushi SS, Kay E, Goulding CA, Grace A, O’Connor J, Shattock AG, Courtney MG, Murray FE, Albloushi SS, Stack A, Kay E, Goulding CA, Carmody M, Murray FE, Courtney MG, Barrett S, Ryan E, O’Keane JC, Crowe J, Hennigan A, Delaney CP, Young L, Shields CJ, O’Keane C, Gorey TF, Fitzpatrick JM, Rasheed AM, Wang JH, Kelly C, Bouchier-Hayes DJ, Leahy A, Doyle MM, Stephens RB, Daly PA, Bennett MW, O’Connell J, O’Sullivan GC, Brady C, Roche D, Collins JK, Shanahan F, Briggs GM, McCrory D, Briggs GM, McCrory D, O’Neill S, O’Grady H, Grant DC, Barry K, Traynor O, Hyland JMP, O’Toole GC, Grant DC, Barry MK, Hyland JMP, Johnston SD, Ritchie CM, Robinson TJ, Johnston SD, Kirby JM, Mackle EM, Robinson TJ, Haider N, Aherne N, McNichol F, Hamilton D, Neary P, Hegarty S, Connor JO, Watson RGK, Drudy D, Alwan A, Fenelon L, O’Farrelly C, Hyland J, Byrne B, Madrigal L, Carton J, Collins C, O’Donoghue D, O’Farrelly C, Gannon N, Hickey A, O’Boyle CA, Byrne R, Albloushi S, Murray F. Irish society of gastroenterology. Ir J Med Sci 1998. [DOI: 10.1007/bf02937896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shannon FJ, Boyle TJ, Grant DC, Clyne OJ, Hyland JMP, Mulligan ED, Purcell T, Lawlor P, Reynolds JV, Byrne PJ, Hennessy TPJ, Duff M, Hill ADK, Shering SG, McDermott EW, O’Higgins NJ, Harte M, Corrigan J, Khurana S, Manning F, Kierce B, Corbally M, McNamara DA, Dimitriadis E, Kay E, Redmond HP, Harmey J, Bouchier-Hayes DJ, Chen G, Kelly C, Chen H, Leahy A, Bouchier-Hayes J, Winter DC, Nally K, O’Callaghan J, Harvey BJ, Shanahan F, O’Sullivan GC, Wang H, Wu QD, Redmond HP, Condron C, Bouchier-Hayes D. Waterford surgical October club and surgical section, Royal Academy of Medicine Joint Surgical Symposium. Ir J Med Sci 1998. [DOI: 10.1007/bf02937558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
This study was designed to test the hypothesis that the antioxidant taurine may modulate human endothelial cell (EC) death (apoptosis versus necrosis). Sodium arsenite (80 microM) alone and in combination with tumor necrosis factor-alpha (25 ng/mL) caused EC apoptosis after 24 h of treatment. Taurine (.5 mg/mL) added at 0 and 6 h could significantly attenuate EC apoptosis, and oxidative state in response to lipopolysaccharide and tumor necrosis factor-alpha stimulation. EC necrosis was induced by activated neutrophils (PMNs). Taurine reduced PMN-mediated EC necrosis in a dose-dependent manner. Moreover, treatment of ECs with a calcium ionophore, A23187 (1.0-4.0 microM), resulted in both EC apoptosis and necrosis. Taurine significantly abrogated A23187-mediated intracellular calcium elevation and EC death. These data indicate that taurine, possibly through its antioxidant activity and regulation of intracellular calcium flux, can prevent EC dysfunction and cell death, which may have implications for the application of this amino acid in the amelioration of acute lung injury during systemic inflammatory response syndrome.
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Affiliation(s)
- J H Wang
- Royal College of Surgeons in Ireland, Department of Surgery, Beaumont Hospital, Dublin, Ireland
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Watson RW, Redmond HP, Wang JH, Condron C, Bouchier-Hayes D. Neutrophils undergo apoptosis following ingestion of Escherichia coli. J Immunol 1996; 156:3986-92. [PMID: 8621940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Apoptosis is a distinct mechanism by which eukaryotic cells die. Neutrophils (PMN) play a fundamental role in the systemic inflammatory response syndrome. Clearance of PMN during resolution of the acute inflammatory process occurs by apoptosis, but factors inducing this process are unknown. The aims of this study were to determine whether PMN ingestion of Escherichia coli would result in PMN apoptosis and whether the mechanism was related to the respiratory burst. PMN from 10 healthy volunteers were cultured with different ratios of PMN:E. coli (1:0 to 1:25) for 12 h. Apoptosis was then assessed by propidium iodide DNA staining, morphology, gel electrophoresis, and Fc gamma RIII expression. There was a significant induction of PMN apoptosis on incubation with E. coli at a ratio of 1:10 and 1:25 PMN:E. coli as well as decreases in Fc gamma RIII. This correlated with increased ingestion of FITC-labeled E. coli and intracellular reactive oxygen intermediates after a 2-h coculture. To clarify the role of reactive oxygen intermediates in E. coli-induced PMN apoptosis, we assessed the effects of the antioxidants catalase, DMSO, glutathione, and N-acetylcysteine. There was a significant decrease in E. coli-induced PMN apoptosis on incubation with DMSO (1.0%), glutathione (25 mM), and N-acetylcysteine (25 mM) compared with control PMN:E. coli. This study demonstrates for the first time that E. coli induces PMN apoptosis through an oxygen-dependent mechanism. The removal of effete PMN by the process of apoptosis rather than necrosis may be teleologically beneficial during Gram-negative septicemia.
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Affiliation(s)
- R W Watson
- Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin
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Watson RW, Redmond HP, Wang JH, Condron C, Bouchier-Hayes D. Neutrophils undergo apoptosis following ingestion of Escherichia coli. The Journal of Immunology 1996. [DOI: 10.4049/jimmunol.156.10.3986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Apoptosis is a distinct mechanism by which eukaryotic cells die. Neutrophils (PMN) play a fundamental role in the systemic inflammatory response syndrome. Clearance of PMN during resolution of the acute inflammatory process occurs by apoptosis, but factors inducing this process are unknown. The aims of this study were to determine whether PMN ingestion of Escherichia coli would result in PMN apoptosis and whether the mechanism was related to the respiratory burst. PMN from 10 healthy volunteers were cultured with different ratios of PMN:E. coli (1:0 to 1:25) for 12 h. Apoptosis was then assessed by propidium iodide DNA staining, morphology, gel electrophoresis, and Fc gamma RIII expression. There was a significant induction of PMN apoptosis on incubation with E. coli at a ratio of 1:10 and 1:25 PMN:E. coli as well as decreases in Fc gamma RIII. This correlated with increased ingestion of FITC-labeled E. coli and intracellular reactive oxygen intermediates after a 2-h coculture. To clarify the role of reactive oxygen intermediates in E. coli-induced PMN apoptosis, we assessed the effects of the antioxidants catalase, DMSO, glutathione, and N-acetylcysteine. There was a significant decrease in E. coli-induced PMN apoptosis on incubation with DMSO (1.0%), glutathione (25 mM), and N-acetylcysteine (25 mM) compared with control PMN:E. coli. This study demonstrates for the first time that E. coli induces PMN apoptosis through an oxygen-dependent mechanism. The removal of effete PMN by the process of apoptosis rather than necrosis may be teleologically beneficial during Gram-negative septicemia.
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Affiliation(s)
- R W Watson
- Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin
| | - H P Redmond
- Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin
| | - J H Wang
- Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin
| | - C Condron
- Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin
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Campbell F, Redmond H, Condron C, Bouchier-Hayes D. 137 O - Induction of a heat shock response protects tumour cells from monocyte mediated lysis. Eur J Cancer 1996. [DOI: 10.1016/0959-8049(96)84894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wang JH, Redmond HP, Watson RW, Condron C, Bouchier-Hayes D. Induction of heat shock protein 72 prevents neutrophil-mediated human endothelial cell necrosis. Arch Surg 1995; 130:1260-5. [PMID: 7492272 DOI: 10.1001/archsurg.1995.01430120014002] [Citation(s) in RCA: 41] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine the hypothesis that induction of heat shock proteins in human endothelial cells (ECs) by either heat shock or sodium arsenite could prevent subsequent EC necrosis induced by activated human polymorphonuclear neutrophil leukocytes (PMNs). DESIGN Cultures of ECs were exposed to heat shock (42 degrees C, 30 to 60 minutes) or sodium arsenite (40 to 320 mumol/L) for 6 hours to induce the expression of a heat shock protein of 72-kd molecular weight (HSP-72). Activated PMNs were subsequently added to these ECs for 24 hours to evaluate the ability of HSP-72 to prevent activated PMN-mediated EC necrosis. RESULTS Neither EC necrosis nor apoptosis was induced by heat shock. Sodium arsenite (40 to 80 mumol/L) did not induce EC necrosis, although 320-mumol/L sodium arsenite caused a significant increase in EC necrosis. Sodium arsenite (80 to 320 mumol/L) also induced dose-dependent EC apoptosis. Endothelial cells exposed to heat shock and sodium arsenite (40 and 80 mumol/L) significantly attenuated subsequent EC necrosis induced by activated PMNs. However, sodium arsenite at 320 mumol/L aggravated activated PMN-mediated EC necrosis. Expression of HSP-72 was detected after ECs were treated both with heat shock and sodium arsenite (40 to 320 mumol/L) for 6 hours. CONCLUSION Induction of HSP-72 in ECs by a thermal or nonthermal mechanism could prevent activated PMN-mediated EC necrosis, which may favor increased vascular permeability during systemic inflammatory response syndrome.
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Affiliation(s)
- J H Wang
- Royal College of Surgeons in Ireland, Department of Surgery, Beaumont Hospital, Dublin, Ireland
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Feeney T, O’Muire O, Gilmartin JJ, Manning P, Sinclair H, Clancy L, O’Connell F, Springall DR, Polak JM, Thomas VE, Fuller RW, Pride NB, Lyons RA, Leonard C, Faul J, Tormey VJ, Poulter LW, Burke CM, Pathmakanthan S, Barry MC, Wang JH, Kelly CJ, Burke PE, Sheehan SJ, Redmond HP, Bouchier-Hayes D, Abdih H, Watson RWG, Burke P, Egan JJ, Barber L, Lomax J, Fox A, Craske J, Yonan N, Rahman AN, Deiraniya AK, Carroll KB, Turner A, Woodcock AA, McNeill K, Bookless B, Gould K, Corris P, Higgenbottam T, Webb A, Woodcock A, McManus K, Miller D, Allen M, Ilstrup D, Deschamps C, Trastek V, Pairolero P, Cotter TP, Vaughan C, Kealy WP, Duggan PF, Curtain A, Bredin CP, Waite A, Maguire CP, Ryan J, O’Neill D, Coakley D, Walsh JB, Kilgallen I, O’Neill S, Ryan M, O’Connor CM, McDonnell T, Lowry RC, Buick JB, Magee TRA, O’Riordan D, Hayes J, O’Connor C, FitzGerald MX, Cosgrave C, Costello C, Deegan PC, McNicholas WT, Nugent AM, Lyons J, Gleadhill I, MacMahon J, Stevenson EC, Heaney LG, Shields MD, Cadden IS, Taylor R, Ennis M, Kharitonov SA, O’Connor J, Owens WA, O’Kane H, Cleland J, Gladstone DJ, Sarsam M, Graham ANJ, Anikin V, McGuigan JA, Curry RC, Varghese G, Keelan P, Rutherford R, O’Keeffe D, McCarthy P, Gilmartin JJ, Moore H, Balbernie E, Gilmartin JJ, Coakley R, Keane M, Costello R, Byrne P, McKeogh D, McLoughlin P, Finlay G, Concannon D, McKeown D, Kelly P, Tanner WA, Bouchier-Hayes DJ, Arumugasamy M, Yacoub K, O’Leary G, Stokes K, Geraghty J, Osborne H, O’Dwyer R, Gilliland R, Saleem SM, Aherne T, Power CK, Burke CH, Byrne A, Murphy JFA, Sharkey R, Mulloy E, Sharkey K, Long M, Birchall MA, Moorat A, Henderson J, Jacques L, Cahill P, Condron C, Royston D, Murphy J, Neill SO. Irish Thoracic Society. Ir J Med Sci 1995. [DOI: 10.1007/bf02973289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Calleary J, Tansey C, McCormack J, Kapur S, Doyle J, Flynn J, Curran AJ, Smyth D, Kane B, Toner M, Timon CVI, Cronin KJ, O’Donoghue J, Darmanin FX, McCann J, Campbell F, Redmond HP, Condron C, Bouchier-Hayes D, Aizaz K, MacGowan SW, O’Donnell AF, Luke DA, McGovern E, Morrin M, Khan F, Delaney PV, Lavelle SM, Kanagaratnam B, Cuervas-Mons V, Gauthier A, Gips C, Santos RMD, Molino GP, Theodossi A, Tsiftsis DD, Boyle CJO, Boyle TJ, Kerin MJ, Courtney DM, Quill DS, Given HF, O’Brien DF, Kelly EJ, Kelly J, Richardson D, Fanning NF, Brennan R, Horgan PG, Keane FBV, Reid S, Walsh C, Patock R, Hall J, Evoy D, Magd-Eldin M, Curran D, Keeling P, Ade-Ajayi N, Spitz L, Kiely E, Drake D, Klein N, O’Hanlon DM, Karat D, Callanan K, Crisp W, Griffin SM, Murchan PM, Mancey-Jones B, Sedman P, Mitchell CJ, Macfie J, Scott D, Raimes S, O’Boyle CJ, Maher D, Willsher PC, Robertson JFR, Hilaly M, Blarney RW, Shering SG, Mitrovic S, Rahim A, McDermott EW, O’Higgins NJ, Murphy CA, Morgan D, Elston CW, Ellis IO, O’Sullivan MP, O’Riordain MG, Stack JP, Barry MK, Ennis JT, Fitzpatrick JM, Gorey TF, Kollis J, Mullet H, Smith DF, Zbar A, Murray MJ, McDermott EWM, Smyth PPA, Kapucouglu N, Holmes S, Holland P, McCollum PT, da Silva A, de Cossart L, Hamilton D, Kelly CJ, Stokes K, Broe P, Crinnion J, Grace PA, Morton N, Ross N, Naidu S, Gervaz P, Holdsworth RJ, Stonebridge PA, O’Donnell A, Carson K, Phelan D, McBrinn S, McCarthy D, Javadpour H, McCarthy J, Neligan M, Caldwell MTP, McGrath JP, Byrne PJ, Walsh TN, Lawlor P, Timon C, Stuart RC, Murray K, Carney A, Johnston JG, Egan B, O’Connell PR, Donoghue J, Pollock A, Hyde D, Hourihan D, Tanner WA, Donohue J, Fanning N, Horgan P, Mahmood A, Dave K, Stewart J, Cole A, Hartley R, Brennan TG, O’Donoghue JM, O’Sullivan ST, Beausang E, Panchal J, O’Shaughnessy M, O’Grady P, Watson RWG, Johnstone D, O’Donnell J, McCarthy E, Flynn N, O’Dwyer T, Curran C, Duggan S, Tierney S, Qian Z, Lipsett PA, Pitt HA, Lillemoe KD, Kollias J, Morgan DAL, Young IS, Regan MC, Geraghty JG, Suilleabhain CBO, Rodrick ML, Horgan AF, Mannick JA, Lederer JA, Hennessy TPJ, Canney M, Feeley K, Connolly CE, Abdih H, Finnegan N, Da Costa M, Shafii M, Martin AJ, Mulcahy D, Dolan M, Stephens M, McManus F, Walsh M, O’Brien DP, Phillips JP, Carroll TA, O’Brien D, Rawluk D, Sullivan T, Herbert K, Kerins M, O’Donnell M, Lawlor D, McHugh M, Edwards G, Rice J, McCabe JP, Sparkes J, Hayes S, Corcoran M, Bredin H, O’Keeffe D, Candon J, Mulligan ED, Lynch TH, Mulvin D, Vingers L, Smith JM, Corby H, Barry K, Eardley I, Frick J, Goldwasser B, Wiklund P, Rogers E, Weaver R, Scardino PT, Kumar R, Puri P, Adeyoju AB, Lynch T, Corr J, McDermott TED, Grainger R, Thornhill J, Butler M, Keegan D, Hegarty N, McCarthy P, Mirza AH, O’Sullivan M, Neary P, O’Connor TPF, McCormack D, Cunningham K, Cassidy N, Sullivan T, Mulhall K, Murphy M, Puri A, Dhaif B, Carey PD, Delicata RJ, Abbasakoor F, Stephens RB, Hussey AJ, Garrihy B, Nolan DJ, McAnena OJ, Fitzgerald R, Watson D, Coventry BJ, Malycha P, Ward SC, Kwok SPY, Lau WY, Bergman JW, Hacking GEB, Metreweli C, Li AKC, Madhavan P, Donohoe J, O’Donohue M, McNamara DA, O’Donohoe MK. Sir Peter Freyer Memorial Lecture and Surgical Symposium 15th and 16th September, 1995. Ir J Med Sci 1995. [DOI: 10.1007/bf02969896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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