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Walker NF, Schutz C, Ward A, Barr D, Opondo C, Shey M, Elkington PT, Wilkinson KA, Wilkinson RJ, Meintjes G. Elevated plasma matrix metalloproteinases associate with Mycobacterium tuberculosis blood stream infection and mortality in HIV-associated tuberculosis. medRxiv 2023:2023.12.12.23299845. [PMID: 38168355 PMCID: PMC10760259 DOI: 10.1101/2023.12.12.23299845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Mortality from HIV-associated tuberculosis (HIV-TB) is high, particularly among hospitalised patients. In 433 people living with HIV admitted to hospital with symptoms of TB, we investigated plasma matrix metalloproteinases (MMP) and matrix-derived biomarkers in relation to TB diagnosis, mortality and Mycobacterium tuberculosis (Mtb) blood stream infection (BSI). Compared to other diagnoses, MMP-8 was elevated in confirmed TB and in Mtb-BSI, positively correlating with extracellular matrix breakdown products. Baseline MMP-3, -7, -8, -10 and procollagen III N-terminal propeptide (PIIINP) associated with Mtb-BSI and 12-week mortality. These findings implicate MMP dysregulation in pathophysiology of advanced HIV-TB and support MMP inhibition as a host-directed therapeutic strategy for HIV-TB.
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Affiliation(s)
- N F Walker
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, WC1E 7HT, United Kingdom
| | - C Schutz
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
| | - A Ward
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
| | - D Barr
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Wellcome Liverpool Glasgow Centre for Global Health Research, University of Liverpool, Liverpool, L69 3BX, United Kingdom
- Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, G51 4TF
| | - C Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, WC1E 7HT, United Kingdom
| | - M Shey
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
| | - P T Elkington
- NIHR Biomedical Research Centre, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, United Kingdom
| | - K A Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
- The Francis Crick Institute, London, NW1 1AT, United Kingdom
| | - R J Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
- The Francis Crick Institute, London, NW1 1AT, United Kingdom
- Department of Infectious Diseases, Imperial College London, W12 0NN, United Kingdom
| | - G Meintjes
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
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Miller KD, Milne P, Baker S, Barr D, Haghani A, Loo B, Matteini P, Monson KD, Perez R, Rawn T, Rosi F, Schmitz J, Summer S, Yadlapalli S. Determination of Low-Level Pesticide Residues in Soft Drinks and Sports Drinks by Liquid Chromatography with Tandem Mass Spectrometry: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/91.1.181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A collaborative study was conducted on a method for the measurement of 11 low-level pesticide residues in soft drinks and sports drinks by liquid chromatography with tandem mass spectrometry. The pesticide residues determined in this study were alachlor, atrazine, butachlor, isoproturon, malaoxon, monocrotophos, methyl paraoxon, phorate, phorate sulfone, phorate sulfoxide, and 2,4-dichlorophenoxyacetic acid (2,4-D). Blind fortification solutions containing 3 different levels of pesticide residues were provided to 9 collaborating laboratories to create test samples at concentrations of 0, 0.1, and 0.5 g/L with a 10-fold concentration for phorate in a total of 6 matrixes (2 colas, 1 diet cola, 1 clear lemon-lime soft drink, 1 orange soft drink, and 1 sports drink). Good qualitative performance of the method was demonstrated for all pesticide residues. Reproducibility relative standard deviation (RSDR) ranged from 7 to 151 for alachlor, atrazine, butachlor, isoproturon, malaoxon, monocrotophos, methyl paraoxon, phorate, phorate sulfone, phorate sulfoxide, and 2,4-D at the 0.1 g/L level (1.0 g/L for phorate). At 0.5 g/L (5.0 g/L for phorate), RSDR ranged from 9 to 57 for alachlor, atrazine, butachlor isoproturon, malaoxon, monocrotophos, methyl paraoxon, phorate, phorate sulfone, phorate sulfoxide, and 2,4-D in all matrixes. Repeatability relative standard deviation (RSDr), applicable to the diet cola and sports drink, ranged from 0 to 124 for the 11 pesticide residues at the 0.1 g/L level (1.0 g/L for phorate). At 0.5 g/L (5.0 g/L for phorate), RSDr ranged from 4 to 26. Recoveries for the 11 pesticide residues in all matrixes ranged from 84 to 300 at the 0.1 g/L level (1.0 g/L for phorate) and from 66 to 127 at the 0.5 g/L (5.0 g/L for phorate) level. Coefficients of determination (r2) of the matrix-matched calibration curves were 0.95. It is recommended that the method be accepted by AOAC as Official First Action with a limit of quantification of 0.5 g/L for alachlor, atrazine, butachlor, isoproturon, malaoxon, methyl paraoxon, monocrotophos, phorate sulfone, phorate sulfoxide, and 2,4-D and 5.0 g/L for phorate.
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Affiliation(s)
| | - Paul Milne
- PepsiCo Inc, 100 Stevens Ave, Valhalla, NY 10595
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Vujovic N, Barr D, Bowen JJ, Byrne S, Chaloka V, Chellappa S, Heng S, Kelly LM, Kerlin K, Mistretta J, Nedeltcheva A, Qian J, Rahman N, Van Zee C, Scheer FA. 0118 Endogenous Circadian Rhythm In Diet-induced Thermogenesis In Humans. Sleep 2018. [DOI: 10.1093/sleep/zsy061.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Vujovic
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - D Barr
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - J J Bowen
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - S Byrne
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - V Chaloka
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - S Chellappa
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - S Heng
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - L M Kelly
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - K Kerlin
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - J Mistretta
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - A Nedeltcheva
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - J Qian
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - N Rahman
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - C Van Zee
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
| | - F A Scheer
- Harvard Medical School/Brigham and Women’s Hospital, Boston, MA
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Rutqvist J, Barr D, Birkholzer JT, Chijimatsu M, Kolditz O, Liu Q, Oda Y, Wang W, Zhang C. Results from an International Simulation Study on Coupled Thermal, Hydrological, and Mechanical Processes near Geological Nuclear Waste Repositories. NUCL TECHNOL 2017. [DOI: 10.13182/nt08-a3974] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. Rutqvist
- Lawrence Berkeley National Laboratory, Earth Sciences Division, MS 90-1116 Berkeley, California 94720
| | - D. Barr
- U.S. Department of Energy, Office of Repository Development, Las Vegas, Nevada
| | - J. T. Birkholzer
- Lawrence Berkeley National Laboratory, Earth Sciences Division, MS 90-1116 Berkeley, California 94720
| | | | - O. Kolditz
- University of Tübingen, Tübingen, Germany
| | | | - Y. Oda
- Japan Atomic Energy Agency, Tokai, Japan
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Abstract
BACKGROUND The Wellness-Fitness Initiative submaximal treadmill exercise test (WFI-TM) is recommended by the US National Fire Protection Agency to assess aerobic capacity (VO2 max) in firefighters. However, predicting VO2 max from submaximal tests can result in errors leading to erroneous conclusions about fitness. AIMS To investigate the level of agreement between VO2 max predicted from the WFI-TM against its direct measurement using exhaled gas analysis. METHODS The WFI-TM was performed to volitional fatigue. Differences between estimated VO2 max (derived from the WFI-TM equation) and direct measurement (exhaled gas analysis) were compared by paired t-test and agreement was determined using Pearson Product-Moment correlation and Bland-Altman analysis. Statistical significance was set at P < 0.05. RESULTS Fifty-nine men performed the WFI-TM. Mean (standard deviation) values for estimated and measured VO2 max were 44.6 (3.4) and 43.6 (7.9) ml/kg/min, respectively (P < 0.01). The mean bias by which WFI-TM overestimated VO2 max was 0.9ml/kg/min with a 95% prediction interval of ±13.1. Prediction errors for 22% of subjects were within ±5%; 36% had errors greater than or equal to ±15% and 7% had greater than ±30% errors. The correlation between predicted and measured VO2 max was r = 0.55 (standard error of the estimate = 2.8ml/kg/min). CONCLUSIONS WFI-TM predicts VO2 max with 11% error. There is a tendency to overestimate aerobic capacity in less fit individuals and to underestimate it in more fit individuals leading to a clustering of values around 42ml/kg/min, a criterion used by some fire departments to assess fitness for duty.
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Affiliation(s)
- B A Dolezal
- Department of Medicine and Physiology, Exercise Physiology Research Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA,
| | - D Barr
- Department of Health and Exercise Sciences, First Responder Health and Safety Laboratory, Skidmore College, Saratoga Springs, NY 12866, USA
| | - D M Boland
- Department of Medicine and Physiology, Exercise Physiology Research Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - D L Smith
- Department of Health and Exercise Sciences, First Responder Health and Safety Laboratory, Skidmore College, Saratoga Springs, NY 12866, USA
| | - C B Cooper
- Department of Medicine and Physiology, Exercise Physiology Research Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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Dragnev D, Barr D, Kulshrestha M, Shanmugalingam S. Sarcoid panuveitis associated with etanercept treatment, resolving with adalimumab. BMJ Case Rep 2013; 2013:bcr-2013-200552. [PMID: 24005973 DOI: 10.1136/bcr-2013-200552] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We presented a case of a 54-year-old woman, who developed sarcoidosis uveitis while on treatment with the tumour necrosis factor α (TNFα) antagonist etanercept for rheumatoid arthritis. Her condition improved, but did not recover completely after the medication was stopped. After starting her on another TNFα antagonist, adalimumab, the uveitis recovered completely. Etanercept and adalimumab are from the same class of medication, but have different effects on other mediators and cells, which may explain these discrepancies.
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Affiliation(s)
- D Dragnev
- Hywel Dda Health Board, Aberystwyth Eye Centre, Aberystwyth, UK.
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Mossoba MM, Seiler A, Steinhart H, Kramer JKG, Rodrigues-Saona L, Griffith AP, Pierceall R, van de Voort FR, Sedman J, Ismail AA, Barr D, Da Costa Filho PA, Li H, Zhang Y, Liu X, Bradley M. Regulatory Infrared Spectroscopic Method for the Rapid Determination of Total Isolated Trans Fat: A Collaborative Study. J AM OIL CHEM SOC 2010. [DOI: 10.1007/s11746-010-1648-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Barr D. What lies beneath this World Cup frenzy. West J Med 2010. [DOI: 10.1136/bmj.c2702] [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: 11/04/2022]
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Barr D, Gregson W, Sutton L, Reilly T. A practical cooling strategy for reducing the physiological strain associated with firefighting activity in the heat. Ergonomics 2009; 52:413-420. [PMID: 19401892 DOI: 10.1080/00140130802707675] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of this study was to establish whether a practical cooling strategy reduces the physiological strain during simulated firefighting activity in the heat. On two separate occasions under high ambient temperatures (49.6 +/- 1.8 degrees C, relative humidity (RH) 13 +/- 2%), nine male firefighters wearing protective clothing completed two 20-min bouts of treadmill walking (5 km/h, 7.5% gradient) separated by a 15-min recovery period, during which firefighters were either cooled (cool) via application of an ice vest and hand and forearm water immersion ( approximately 19 degrees C) or remained seated without cooling (control). There was no significant difference between trials in any of the dependent variables during the first bout of exercise. Core body temperature (37.72 +/- 0.34 vs. 38.21 +/- 0.17 degrees C), heart rate (HR) (81 +/- 9 vs. 96 +/- 17 beats/min) and mean skin temperature (31.22 +/- 1.04 degrees C vs. 33.31 +/- 1 degrees C) were significantly lower following the recovery period in cool compared with control (p < 0.05). Core body temperature remained consistently lower (0.49 +/- 0.02 degrees C; p < 0.01) throughout the second bout of activity in cool compared to control. Mean skin temperature, HR and thermal sensation were significantly lower during bout 2 in cool compared with control (p < 0.05). It is concluded that this practical cooling strategy is effective at reducing the physiological strain associated with demanding firefighting activity under high ambient temperatures.
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Affiliation(s)
- D Barr
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
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Atkinson G, Barr D, Chester N, Drust B, Gregson W, Reilly T, Waterhouse J. Bright Light and Thermoregulatory Responses to Exercise. Int J Sports Med 2008; 29:188-93. [DOI: 10.1055/s-2007-965161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- N. S. Schneider
- a Army Materials and Mechanics Research Center , Watertown, Massachusetts, 021 72
| | - C. R. Desper
- a Army Materials and Mechanics Research Center , Watertown, Massachusetts, 021 72
| | - J. L. Illinger
- a Army Materials and Mechanics Research Center , Watertown, Massachusetts, 021 72
| | - A. O. King
- a Army Materials and Mechanics Research Center , Watertown, Massachusetts, 021 72
| | - D. Barr
- b Tennessee Eastman Co. , Kingsport, Tennessee, 37662
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Ioannidis JPA, Trikalinos TA, Law M, Carr A, Carr A, Barr D, Cooper DA, Emery S, Grinspoon S, Ioannidis J, Lewis R, Law M, Lichtenstein K, Murray J, Pizzuti D, Powderly WG, Rozenbaum W, Schambelan M, Puls R, Emery S, Moore A, Miller J, Carr A, Belloso WH, Ivalo SA, Clara LO, Barcan LA, Stern LD, Galich AM, Perman MI, Losso M, Duran A, Toibaro J, Baker D, Vale R, McFarlane R, MacLeod H, Kidd J, Genn B, Carr A, Fielden R, Mallal S, French M, Cain A, Skett J, Maxwell D, Mijch A, Hoy J, Pierce A, McCormick C, De Graaf B, Falutz J, Vatistas J, Dion L, Montaner J, Harris M, Phillips P, Montessori V, Valyi M, Stewart W, Walmsley S, Casciaro L, Lundgren J, Andersen O, Gronholdt A, Beguinot I, Mercié P, Chêne G, Reynes J, Cotte L, Rozenbaum W, Nait-Ighil L, Slama L, Nguyen TH, Rousselle C, Viard JP, Roudière L, Maignan A, Burgard M, Mauss S, Schmutz G, Scholten S, Oka S, Fraser H, Ishihara M, Itoh K, Reiss P, van der Valk M, Leunissen P, Nievaard M, van EckSmit B, Kujik CC, Paton N, Peperstraete B, Karim F, Khim CY, Ong S, Gatell J, Martinez E, Milinkovic A, Churchill D, Timaeus C, Maher T, Perry N, Bray A, Moyle G, Baldwin C, Higgs C, Reynolds B, Carpenter C, Bausserman L, Fiore T, DiSpigno M, Cohen C, Hellinger J, Foy K, Hubka S, Riccio B, El-Sadr W, Raghavan S, Chowdury N, de Vries B, Miller S, Hammer S, Crawford M, Chang S, Dobkin J, Quagliarello B, Gallagher D, Punyanitya M, Kessler H, Tenorio A, Kjos S, Falloon J, Lane HC, Rock D, Ehler L, Lichtenstein K, McClain T, Murphy R, Milne P, Powderly W, Aberg J, Klebert M, Conklin M, Ward D, Green L, Stearn B. HIV Lipodystrophy Case Definition using Artificial Neural Network Modelling. Antivir Ther 2003. [DOI: 10.1177/135965350300800511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective A case definition of HIV lipodystrophy has recently been developed from a combination of clinical, metabolic and imaging/body composition variables using logistic regression methods. We aimed to evaluate whether artificial neural networks could improve the diagnostic accuracy. Methods The database of the case-control Lipodystrophy Case Definition Study was split into 504 subjects (265 with and 239 without lipodystrophy) used for training and 284 independent subjects (152 with and 132 without lipodystrophy) used for validation. Back-propagation neural networks with one or two middle layers were trained and validated. Results were compared against logistic regression models using the same information. Results Neural networks using clinical variables only (41 items) achieved consistently superior performance than logistic regression in terms of specificity, overall accuracy and area under the ROC curve. Their average sensitivity and specificity were 72.4 and 71.2%, as compared with 73.0 and 62.9% for logistic regression, respectively (area under the ROC curve, 0.784 vs 0.748). The discriminating performance of the neural networks was largely unaffected when built excluding 13 parameters that patients may not have readily available. The average sensitivity and specificity of the neural networks remained the same when metabolic variables were also considered (total 60 items) without a clear advantage against logistic regression (overall accuracy 71.8%). The performance of networks considering also body composition variables was similar to that of logistic regression (overall accuracy 78.5% for both). Conclusions Neural networks may offer a means to improve the discriminating performance for HIV lipodystrophy, when only clinical data are available and a rapid approximate diagnostic decision is needed. In this context, information on metabolic parameters is apparently not helpful in improving the diagnosis of HIV lipodystrophy, unless imaging and body composition studies are also obtained.
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Affiliation(s)
- John PA Ioannidis
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Thomas A Trikalinos
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Matthew Law
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
| | - Andrew Carr
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
- HIV, Immunology and Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Australia
| | - A Carr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - D Barr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - DA Cooper
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (Massachusetts General Hospital, Boston, Mass., USA)
| | - S Grinspoon
- (Massachusetts General Hospital, Boston, Mass., USA)
| | | | - R Lewis
- (Agouron Pharmaceuticals, San Diego, Calif., USA)
| | - M Law
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - K Lichtenstein
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - J Murray
- (US Department of Health and Human Services Food and Drug Administration, Washington, DC, USA)
| | - D Pizzuti
- (Bristol-Myers Squibb, Princeton, NJ, USA, representing the European Medicines Evaluation Agency Oversight Committee)
| | - WG Powderly
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - W Rozenbaum
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - M Schambelan
- (University of California, San Francisco, Calif., USA; to September 2000)
| | - R Puls
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Moore
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - J Miller
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Carr
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - WH Belloso
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - SA Ivalo
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LO Clara
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LA Barcan
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LD Stern
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - AM Galich
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - MI Perman
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - M Losso
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - A Duran
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - J Toibaro
- (Hospital J M Ramos Mejía, Buenos Aires)
| | | | | | | | | | | | | | - A Carr
- (St Vincent's Hospital, Sydney)
| | | | | | | | - A Cain
- (Royal Perth Hospital, Perth)
| | - J Skett
- (Royal Perth Hospital, Perth)
| | | | - A Mijch
- (Alfred Hospital and Monash University, Melbourne)
| | - J Hoy
- (Alfred Hospital and Monash University, Melbourne)
| | - A Pierce
- (Alfred Hospital and Monash University, Melbourne)
| | - C McCormick
- (Alfred Hospital and Monash University, Melbourne)
| | - B De Graaf
- (Alfred Hospital and Monash University, Melbourne)
| | - J Falutz
- (Montreal General Hospital, Montreal)
| | | | - L Dion
- (Montreal General Hospital, Montreal)
| | | | | | | | | | - M Valyi
- (St Paul's Hospital, Vancouver)
| | | | | | | | - J Lundgren
- (Hvidovre University Hospital, Copenhagen)
| | - O Andersen
- (Hvidovre University Hospital, Copenhagen)
| | | | | | - P Mercié
- (Hôpital Haut-Lévêque, Bordeaux)
| | - G Chêne
- (Hôpital Haut-Lévêque, Bordeaux)
| | - J Reynes
- (Hôpital Gui de Chauliac, Montpellier)
| | - L Cotte
- (Hôpital Gui de Chauliac, Montpellier)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - P Reiss
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M van der Valk
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - P Leunissen
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M Nievaard
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - B van EckSmit
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - C can Kujik
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - N Paton
- (Tan Tock Seng Hospital, Singapore)
| | | | - F Karim
- (Tan Tock Seng Hospital, Singapore)
| | - C Y Khim
- (Tan Tock Seng Hospital, Singapore)
| | - S Ong
- (Tan Tock Seng Hospital, Singapore)
| | - J Gatell
- (Hospital Clinic Provincial de Barcelona)
| | - E Martinez
- (Hospital Clinic Provincial de Barcelona)
| | | | | | | | | | | | - A Bray
- (Sussex Hospital, Brighton)
| | - G Moyle
- (Chelsea and Westminster Hospital, London)
| | - C Baldwin
- (Chelsea and Westminster Hospital, London)
| | - C Higgs
- (Chelsea and Westminster Hospital, London)
| | - B Reynolds
- (Chelsea and Westminster Hospital, London)
| | | | | | - T Fiore
- (Miriam Hospital, Providence, RI)
| | | | - C Cohen
- (Community Research Initiative of New England, Brookline, Mass.)
| | - J Hellinger
- (Community Research Initiative of New England, Brookline, Mass.)
| | - K Foy
- (Community Research Initiative of New England, Brookline, Mass.)
| | - S Hubka
- (Community Research Initiative of New England, Brookline, Mass.)
| | - B Riccio
- (Community Research Initiative of New England, Brookline, Mass.)
| | - W El-Sadr
- (Harlem Hospital Center, New York, NY)
| | | | | | | | - S Miller
- (Harlem Hospital Center, New York, NY)
| | - S Hammer
- (Columbia University, New York, NY)
| | | | - S Chang
- (Columbia University, New York, NY)
| | - J Dobkin
- (Columbia University, New York, NY)
| | | | | | | | - H Kessler
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - A Tenorio
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - S Kjos
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - J Falloon
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - HC Lane
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - D Rock
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - L Ehler
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | | | - T McClain
- (Denver Infectious Disease Consultants, Denver, Col.)
| | - R Murphy
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - P Milne
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - W Powderly
- (Washington University School of Medicine, St Louis, Mo.)
| | - J Aberg
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Klebert
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Conklin
- (Washington University School of Medicine, St Louis, Mo.)
| | - D Ward
- (Dupont Circle Physician's Group, Washington, DC)
| | - L Green
- (Dupont Circle Physician's Group, Washington, DC)
| | - B Stearn
- (Dupont Circle Physician's Group, Washington, DC)
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Abstract
In 1996, a citizens group in Nogales, Arizona, reported to the Arizona Department of Health their concerns about a possible excess prevalence of systemic lupus erythematosus (SLE) due to exposure to environmental contamination in the area. The authors conducted a two-phase study in which the objectives of phase I were to identify potential SLE cases and to determine the prevalence of SLE and the objectives of phase II were to identify potential risk factors associated with the development of SLE and to evaluate the possible association between SLE and environmental exposure to pesticides and inorganic compounds. Participants included 20 confirmed cases and 36 controls. The authors found the prevalence of SLE to be 103 cases per 100,000 population (95 percent confidence interval: 56, 149), two to seven times higher than the prevalence in the US population. They detected elevated levels of 1,1-dichloro-2,2-bis-(p-chorophenyl)ethylene and organophosphate metabolites among cases and controls. In both, levels were higher than the reference mean for the US population. The authors found no statistical association between elevated levels of pesticides and disease status. Their results show that the prevalence of SLE in Nogales is higher than the reported prevalence in the US population and that both cases and controls had past exposure to chlorinated pesticides and have ongoing exposure to organophosphates.
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Affiliation(s)
- L Balluz
- Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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16
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Barr D. Too smart for our own good. Res Initiat Treat Action 2001; 7:25-7. [PMID: 11548385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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17
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Abstract
We describe three patients in whom an isolated sixth nerve palsy was the only clinical symptom or sign of multiple sclerosis (MS). Data were collected prospectively over 6 years on these three patients, who showed no other signs of brainstem dysfunction or prior symptoms; in addition. Retrospective analysis of all patients with MS and all patients with sixth nerve palsy referred to a neuro-ophthalmology service between 1982 and 1998 showed isolated sixth nerve palsy to be the presenting sign of MS in only 0.5% of these patients. MS was the cause of isolated sixth nerve palsy in 0.8% of all patients and in 1.6% of those aged 18-50 years. Although it has been previously suggested that sixth nerve palsy is a not uncommon presenting sign of MS, our results suggest it is rare.
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Affiliation(s)
- D Barr
- Tennent Institute of Ophthalmology, Glasgow, UK
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18
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Gross PA, Asch S, Kitahata MM, Freedberg KA, Barr D, Melnick DA, Bozzette SA, Bozette SA. Performance measures for guidelines on preventing opportunistic infections in patients infected with human immunodeficiency virus. Clin Infect Dis 2000; 30 Suppl 1:S85-93. [PMID: 10770917 DOI: 10.1086/313845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/03/2022] Open
Abstract
This article serves as a complement to the 1999 US Public Health Service/Infectious Diseases Society of America guidelines on the prevention of opportunistic infections in persons infected with HIV, published in this issue of Clinical Infectious Diseases [1]. A number of performance measures to assess compliance with the guidelines and to aid in their implementation are proposed.
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Affiliation(s)
- P A Gross
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ 07601, USA
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19
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Barr D, Kupersmith M, Turbin R, Yang S, Iezzi R. Synkinesis following diabetic third nerve palsy. Arch Ophthalmol 2000; 118:132-4. [PMID: 10636432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- D Barr
- INN at Beth Israel North, New York, NY 10128, USA
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20
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Barr D, Kupersmith MJ, Pinto R, Turbin R. Arachnoid cyst of the cavernous sinus resulting in third nerve palsy. J Neuroophthalmol 1999; 19:249-51. [PMID: 10608679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A 67-year-old man exhibited long-standing left third nerve palsy. Magnetic resonance imaging revealed a cystic lesion in the left cavernous sinus with signal characteristics typical of arachnoid cyst. Intradural cavernous sinus arachnoid cyst has not reported previously. Pathogenetic mechanisms are discussed.
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Affiliation(s)
- D Barr
- Department of Neuro-Ophthalmology, Beth Israel Institute for Neurology and Neurosurgery, New York, New York, USA
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21
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Abstract
PURPOSE Intervention at the organizational rather than the individual level is gaining greater attention in worksite health promotion efforts. However, little research has been done on instruments to measure this domain. Therefore, the purpose of this study was to further test the utility of an existing organizational heart health support instrument by examining relationships among worksite structural characteristics and comparing these results to other survey findings. DESIGN One-time cross-sectional. SETTING New York State. SUBJECTS One hundred fifteen volunteer worksites in the New York State Healthy Heart Program, representing manufacturing, government, education, health care, and other industries. MEASURES A survey was conducted using HeartCheck, an organizational assessment of employee support for heart health. HeartCheck contains 175 items measuring organizational support for tobacco control, nutrition, physical activity, stress, screening, and administrative support structure. RESULTS On average, only 22% of all worksite resources assessed were present in the sample. Having a workforce greater than 250 provided a 12% increase in predicted overall worksite resources. A predominantly female workforce (> 75%) provided 10% higher levels of worksite stress resources. Worksites with unions had higher levels of resources for physical activity (10%), screening (13%), and general supportive structures (10%). The presence of manual labor diminished support for tobacco control resources (-13%). Finally, manufacturing worksites demonstrated a clear advantage for all types of worksite resources, except for stress. CONCLUSION A number of trends found in this study are consistent with earlier work. Industry type and size both predict worksite supports similar to previous studies. Other findings that appear to contradict previous work, including the relatively low level of support observed in this sample, can be explained by the comprehensive nature of the instrument. Overall, these findings demonstrate the utility of HeartCheck.
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Affiliation(s)
- B Fisher
- NYS Department of Health, Albany 12237-0679, USA
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23
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Barr D, Ashton JB. Meeting the healthcare needs of refugees and asylum seekers. BMJ 1999; 318:1291. [PMID: 10231283 PMCID: PMC1115673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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24
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Barr D, Hershow R, Furner S, Handler A, Levy P. Assessing prenatal hepatitis B screening in Illinois with an inexpensive study design adaptable to other jurisdictions. Am J Public Health 1999; 89:19-24. [PMID: 9987459 PMCID: PMC1508502 DOI: 10.2105/ajph.89.1.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study estimated, using an economical survey design adaptable to other jurisdictions, the proportion of birth admissions in Illinois hospitals in which mothers were not screened for hepatitis B surface antigen prior to delivery. It also identified factors associated with lack of screening. METHODS Based on a cluster sampling design, 1372 birth records were sampled, and data were abstracted by local personnel at 56 hospitals. Selected data elements were reabstracted on a subsample to evaluate recording errors. RESULTS Reabstracted data demonstrated 95% agreement among reviewers. Hepatitis B surface antigen screening was documented for 90.7% of mothers; 11% of responding hospitals accounted for 45% of nonscreened mothers. Risk factors for not being screened included no prenatal care, Medicaid or no insurance, and delivery at a hospital lacking a written hepatitis B surface antigen policy. CONCLUSIONS In Illinois, prenatal hepatitis B surface antigen screening rates were high and similar to those in other states. Births without screening or transferred information clustered in a few hospitals. The methods used here can economically identify underscreened populations by sampling a large number of hospitals within designated areas.
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Affiliation(s)
- D Barr
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago 60612, USA
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25
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Novak EJ, Blosch CM, Perkins JD, Davis CL, Barr D, McVicar JP, Griffin RS, Farrand AL, Wener M, Marsh CL. Recombinant human tumor necrosis factor receptor Fc fusion protein therapy in kidney transplant recipients undergoing OKT3 induction therapy. Transplantation 1998; 66:1732-5. [PMID: 9884268 DOI: 10.1097/00007890-199812270-00028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 11/26/2022]
Abstract
BACKGROUND Initial doses of OKT3 are associated with a cytokine-induced acute clinical syndrome (ACS). This study assessed the safety of a recombinant human tumor necrosis factor receptor fusion protein (TNFR:Fc) given to minimize OKT3-ACS symptoms in renal allograft recipients undergoing induction therapy. METHODS Sixteen patients were randomized into treatment or control groups. Treated patients received TNFR:Fc 1 hr before OKT3 on days 0 and 3. Patients were monitored after transplant for OKT3-ACS symptoms. Levels of cytokines, serum creatinine, and C-reactive protein were followed. RESULTS Patients receiving TNFR:Fc had lower OKT3-ACS symptoms as measured by a scoring system. There was a higher incidence of infection in treated patients (10/12) compared to controls (1/4) in the 3 months after transplant, but the etiology of this difference was unclear. There were no significant differences in cytokine profiles. CONCLUSIONS TNFR:Fc is well tolerated by renal transplant patients receiving OKT3 induction therapy and modestly decreases the symptoms associated with OKT3-ACS.
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Affiliation(s)
- E J Novak
- Department of Surgery, University of Washington, Seattle 98195, USA
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26
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Turbin RE, St Louis L, Barr D, Kupersmith MJ. Monocular band optic atrophy. J Neuroophthalmol 1998; 18:242-5. [PMID: 9858003] [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: 02/09/2023]
Abstract
Band or "bow tie" optic atrophy is characterized by well-described ophthalmoscopic findings in the optic nerve and nerve fiber layer and homonymous hemianopia. It is typically associated with compressive lesions of the pregeniculate postchiasmal visual pathway or, less commonly, congenital malformations affecting the postgeniculate radiations or cortex. A unique case with band optic atrophy is described because of the unilateral visual defect. The optic atrophy is strictly unilateral and without an obvious structural lesion that could explain the optic disc damage. However, incidental cerebral gray matter cortical heterotopia may mark a congenital insult that contributed to both of these abnormal findings.
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Affiliation(s)
- R E Turbin
- Institute for Neurology and Neurosurgery at Beth Israel North, New York Eye and Ear Infirmary, New York University School of Medicine, New York 10128, USA
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Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of a management training seminar, developed through a partnership among a college, a managed care company, and a state public health department, to increase the level of organizational support for employee heart health in selected companies. DESIGN Quasiexperimental. SETTING Worksites, including heavy and light industries, school districts, insurance companies, county health agencies, and health care centers. SUBJECTS Twenty western New York companies matched on size, industry type, and interest in worksite health promotion. INTERVENTION Seven training seminars held at a college for 1 year and directed primarily at human resource managers. Training was supplemented by the availability of student interns, faculty consulting, a vendors' fair, and various program planning aids. MEASURES Groups were assessed using HeartCheck, a measure of organizational support for employee heart health. RESULTS A fourfold difference in change for HeartCheck was observed by the experimental vs. comparison groups (p < .01), along with significantly greater increases on five of the instrument's six subscales (p < .05). The level of HeartCheck reached in the experimental group matched those seen in highly acclaimed commercially sponsored programs. CONCLUSION This study represents one of the first attempts to intervene at the organizational level within a worksite health promotion initiative. Positive results were observed that appear to be both meaningful and cost-effective.
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Affiliation(s)
- T Golaszewski
- Department of Health Science, SUNY College at Brockport, USA
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28
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McVicar JP, Kowdley KV, Emond MJ, Barr D, Marsh CL, Carithers RL, Perkins JD. Induction immunosuppressive therapy is associated with a low rejection rate after liver transplantation. Clin Transplant 1997; 11:328-33. [PMID: 9267724] [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: 02/05/2023]
Abstract
Despite advances in immunosuppression, allograft rejection occurs frequently after liver transplantation. The use of induction therapy with cytolytic antibodies may decrease the frequency of rejection in liver transplant recipients, but may also increase the rate of cytomegalovirus (CMV) infection. It has been our center's strategy to use induction therapy in our liver transplant recipients. To determine the outcome of our strategy, we retrospectively reviewed all liver transplants performed in the first 5 yr of our liver transplant program. The frequency of acute rejection in the first year after liver transplantation was only 34% in patients who received induction therapy. The type of induction therapy antibody did not affect the rejection rate. Clinically significant CMV infection (requiring treatment) occurred in 22% of patients. These results suggest that use of induction therapy with cytolytic antibodies does not lead to a high incidence of CMV infection and decreases the incidence of rejection after liver transplantation.
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Affiliation(s)
- J P McVicar
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
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29
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Barr D, Kay MA. Methods for delivery of genes to hepatocytes in vivo using recombinant adenovirus vectors. Methods Mol Med 1997; 7:205-212. [PMID: 24493428 DOI: 10.1385/0-89603-484-4:205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In many ways, the liver represents an ideal target organ for gene delivery. Anatomically, the sheer bulk cof its tissue mass and its dual blood supply are advantageous for intravascular injection of virus into either portal or systemic circulation. The portal vein provides a direct iv route into the liver. It also theoretically provides an indirect route by oral administration since the portal system drains the gut.
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Affiliation(s)
- D Barr
- Division of Transplantation, Department of Surgery, University of Washington, Seattle, WA
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30
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Lieber A, He CY, Polyak SJ, Gretch DR, Barr D, Kay MA. Elimination of hepatitis C virus RNA in infected human hepatocytes by adenovirus-mediated expression of ribozymes. J Virol 1996; 70:8782-91. [PMID: 8971007 PMCID: PMC190975 DOI: 10.1128/jvi.70.12.8782-8791.1996] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.8] [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: 02/03/2023] Open
Abstract
Hepatitis C virus (HCV), a positive-strand RNA virus, is the major infectious agent responsible for causing chronic hepatitis. Currently, there is no vaccine for HCV infection, and the only therapy for chronic hepatitis C is largely ineffective. To investigate new genetic approaches to the management of HCV infection, six hammerhead ribozymes directed against a conserved region of the plus strand and minus strand of the HCV genome were isolated from a ribozyme library, characterized, and expressed from recombinant adenovirus vectors. The expressed ribozymes individually or in combination were efficient at reducing or eliminating the respective plus- or minus-strand HCV RNAs expressed in cultured cells and from primary human hepatocytes obtained from chronic HCV-infected patients. This study demonstrates the potential utility of ribozyme therapy as a strategy for the treatment of hepatitis C virus infection.
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Affiliation(s)
- A Lieber
- Department of Medicine, University of Washington, Seattle 98195, USA
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31
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Abstract
Two lines of prior research into the conditions under which people seek information are examined in light of two statistical definitions of diagnosticity. Five experiments are reported. In two, subjects selected information in order to test a hypothesis. In the remaining three, they selected information in order to convince someone else of the truth of a known hypothesis. A total of 567 university students served as subjects. The two primary conclusions were as follows: (1) When the task is highly structured by the environment, subjects select information diagnostically, and (2) when the task is less structured, so that subjects must seek relevant information not manifest, they select information pseudodiagnostically. Possible relations to other laboratory inference tasks and to clinical judgment are discussed.
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Affiliation(s)
- M E Doherty
- Department of Psychology, Bowling Green State University, OH 43403, USA.
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Abstract
Tumoral calcinosis is a rare systemic disorder characterized by para-articular ectopic soft-tissue calcification. This case report describes the ophthalmic features (palpebral conjunctival calcific nodules, the white limbal girdle of Vogt, disc drusen, and angioid streaks) in a 38-year-old Asian woman who had tumoral calcinosis associated with hyperphosphatemia. A morphologic study of the calcified nodules on the palpebral conjunctiva disclosed deposition of hydroxyapatite crystals in an extracellular matrix (deposit) containing alcianophilic mucopolysaccharides. Excision of the eyelid nodules was not followed by recurrence.
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Affiliation(s)
- F Ghanchi
- Tennent Institute of Ophthalmology, Western Infirmary, Glasgow, Scotland
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McVicar JP, Kowdley KV, Bacchi CE, Barr D, Marsh CL, Perkins JD, Carithers RL. The natural history of untreated focal allograft rejection in liver transplant recipients. Liver Transpl Surg 1996; 2:154-60. [PMID: 9346642 DOI: 10.1002/lt.500020212] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Focal rejection involves less than 20% of portal tracts in liver allograft biopsy results. The clinical significance of "focal" rejection on protocol liver biopsy results is unknown. The purpose of this study was to prospectively determine the incidence of clinically significant rejection in patients with focal rejection after orthotopic liver transplantation. Biopsy specimens from 165 consecutive transplantations in 149 patients were analyzed. After protocol biopsy specimens were obtained, patients with focal or mild rejection were observed. Fifty of 583 (8.6%) protocol biopsy results in 41 patients showed focal or mild rejection. None were treated on the basis of this histological finding. Six patients subsequently developed abnormal liver function tests and required treatment with additional immunosuppression. We conclude that focal or mild rejection is a relatively common finding on protocol liver biopsy results and only rarely progresses to a clinically significant problem. Patients with this finding can safely be observed without treatment.
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Affiliation(s)
- J P McVicar
- Department of Surgery, University of Washington, Seattle 98195, USA
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Koduri RS, Whitwam RE, Barr D, Aust SD, Tien M. Oxidation of 1,2,4,5-tetramethoxybenzene by lignin peroxidase of Phanerochaete chrysosporium. Arch Biochem Biophys 1996; 326:261-5. [PMID: 8611032 DOI: 10.1006/abbi.1996.0074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We have reinvestigated the lignin peroxidase-catalyzed oxidation of 1,2,4,5-tetramethoxybenzene (TMB) by using presteady-state and steady-state kinetic methods. Our presteady-state kinetic results show that the reaction of compound I with TMB obeyed second order kinetics with a rate constant of 1.1 x 10(7) M-1s-1. The reaction of compound II with TMB exhibits a hyperbolic concentration dependence with a Kd of 16 microM and K = 24 s-1. The stoichiometry of TMB oxidation during steady state is two TMB cation radicals formed per H2O2 consumed. These results clearly show that TMB is a good substrate for both compounds I and II of lignin peroxidase.
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Affiliation(s)
- R S Koduri
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park 16802, USA
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35
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Alpers CE, Davis CL, Barr D, Marsh CL, Hudkins KL. Identification of platelet-derived growth factor A and B chains in human renal vascular rejection. Am J Pathol 1996; 148:439-51. [PMID: 8579107 PMCID: PMC1861676] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Platelet-derived growth factor (PDGF) exists as a dimer composed of two homologous but distinct peptides termed PDGF-A and -B chains, and may exist as AA, AB, and BB isoforms. The PDGF-B chain has been implicated as a mediator of renal vascular rejection by virtue of up-regulated expression of its receptor, PDGF beta-receptor, in affected arteries. A role for PDGF-A chain in mediating intimal proliferation has been suggested in human atherosclerosis (Rekhter MD, Gordon D: Does platelet-derived growth factor-A chain stimulate proliferation of arterial mesenchymal cells in human atherosclerotic plaques? Circ Res 1994, 75:410), but no studies of this molecule in human renal allograft injury have been reported to date. We used two polyclonal antisera to detect expression of PDGF-A chain and one monoclonal antibody to detect PDGF-B chain by immunohistochemistry in fixed, paraffin-embedded tissue from 1) normal adult kidneys, 2) a series of renal transplant biopsies chosen to emphasize features of vascular rejection, and 3) allograft nephrectomies. Immunohistochemistry was correlated with in situ hybridization on adjacent, formalin fixed tissue sections from nephrectomies utilizing riboprobes made from PDGF-A and -B chain cDNA. PDGF-A chain is widely expressed by medial smooth muscle cells of normal and rejecting renal arterial vessels of all sizes by immunohistochemistry and in situ hybridization. PDGF-A chain is also expressed by a population of smooth muscle cells (shown by double immunolabeling with an antibody to alpha-smooth muscle actin) comprising the intima in chronic vascular rejection. In arteries demonstrating acute rejection, up-regulated expression of PDGF-A chain by endothelial cells was detected by both immunohistochemistry and in situ hybridization. In contrast, PDGF-B chain was identified principally in infiltrating monocytes within the rejecting arteries, similar to its localization in infiltrating monocytes in human atherosclerosis. Although less prominent than the case for PDGF-A chain, PDGF-B chain also was present in medial and intimal smooth muscle cells in both rejecting and nonrejecting renal arteries. PDGF-A and -B chains have now been localized at both the mRNA and protein levels to the intimal proliferative lesions of vascular rejection. These peptides, which are known stimuli for smooth muscle cell migration and proliferation in experimental vascular injury, may have similar stimulatory effects on smooth muscle cells in an autocrine and/or paracrine manner to promote further intimal expansion and lesion progression in this form of human vasculopathy.
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Affiliation(s)
- C E Alpers
- Department of Pathology, University of Washington, Seattle 98195, USA
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Kuhr CS, Barr D, Healey PJ, Perkins JD, McVicar JP, Marsh CL. Cystoscopic management of pancreatic allograft duct obstruction. Transplant Proc 1995; 27:2994-5. [PMID: 8539807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- C S Kuhr
- Department of Surgery, University of Washington School of Medicine, Seattle 98195, USA
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37
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Barr D, Smart T. Candidiasis at ICAAC. GMHC Treat Issues 1995; 9:13. [PMID: 11362914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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38
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Barr D, Gilden D. Expanded access for experimental AIDS drugs. GMHC Treat Issues 1995; 9:2. [PMID: 11362908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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39
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Barbeito MS, Abraham G, Best M, Cairns P, Langevin P, Sterritt WG, Barr D, Meulepas W, Sanchez-Vizcaíno JM, Saraza M. Recommended biocontainment features for research and diagnostic facilities where animal pathogens are used. First International Veterinary Biosafety Workshop. REV SCI TECH OIE 1995; 14:873-87. [PMID: 8593417 DOI: 10.20506/rst.14.3.880] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [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: 01/31/2023]
Abstract
Recommendations are presented for the minimum structural components, special utilities, installations, and other design and operational features which define a microbiologically-secure animal containment facility. These biocontainment parameters are expected to enable the safe housing and handling of livestock and poultry infected with pathogenic agents. Physical testing and certification requirements for commissioning such facilities are described. Such a facility will minimise personnel exposure to infectious agents, limit cross-contamination between experiments, minimise horizontal transmission between research animals, and reduce the likelihood of pathogenic agents being released to the outside environment.
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Affiliation(s)
- M S Barbeito
- United States Department of Agriculture, Agricultural Research Service, Beltsville, MD 20705, USA
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Winter TC, Freeny PC, Nghiem HV, Hommeyer SC, Barr D, Croghan AM, Coldwell DM, Althaus SJ, Mack LA. Hepatic arterial anatomy in transplantation candidates: evaluation with three-dimensional CT arteriography. Radiology 1995; 195:363-70. [PMID: 7724754 DOI: 10.1148/radiology.195.2.7724754] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.7] [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: 01/26/2023]
Abstract
PURPOSE To assess the utility of three-dimensional (3D) hepatic helical computed tomographic (CT) arteriography as a replacement for conventional angiography in the evaluation of the arterial anatomy of patients being considered for liver transplantation. MATERIALS AND METHODS Three-dimensional CT arteriograms were obtained in 115 patients. Seventeen patients also underwent conventional angiography, and 16 patients who did not undergo angiography underwent hepatic transplantation. RESULTS Among the 3D CT arteriograms, 106 delineated the major arteries that supplied the liver. Nine were considered technical failures. In the 17 patients with angiographic correlation, there was only one marked disagreement with 3D CT arteriography. In the 16 patients with surgical correlation, no marked discrepancies were found. CONCLUSION In transplantation candidates, successful 3D CT arteriography was as accurate as angiography in the assessment of hepatic arterial anatomy. It was also safer, more convenient, and more easily tolerated. Conventional CT plus 3D CT arteriography was only 25% as expensive as the cost of conventional CT and conventional angiography.
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Affiliation(s)
- T C Winter
- Department of Radiology, University of Washington Medical Center, Seattle 98195, USA
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Barr D, Tubb J, Ferguson D, Scaria A, Lieber A, Wilson C, Perkins J, Kay MA. Strain related variations in adenovirally mediated transgene expression from mouse hepatocytes in vivo: comparisons between immunocompetent and immunodeficient inbred strains. Gene Ther 1995; 2:151-5. [PMID: 7719932] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
High efficiency gene transfer and gene expression in hepatocytes in vivo can be achieved using recombinant adenoviral vectors. However, the persistence of gene expression in different experimental animal models has been variable. To determine if similar differences could be observed in a single species, persistence of gene expression was studied in inbred strains of mice using a recombinant adenoviral vector that expresses human alpha 1-antitrypsin. Marked variability in the persistence of gene expression ranging from several weeks (C3H/HeJ and Balb/c) to more than 3 months [C57Bl/6, B10.A(2R) and B10.BR] was observed when this vector was transduced in different strains of inbred mice. This variability did not correlate with H-2 type. To evaluate the role of T and B cell immunity in the persistence of gene expression, congenic C3H-scid and Balb/c-scid mice were studied and found to have indefinite gene expression from transduced hepatocytes. These animals unlike their immunocompetent counter-parts were able to undergo secondary transduction of hepatocytes with a different recombinant adenoviral vector. These findings suggest that as yet unidentified genetic loci influence the persistence of adenovirus-mediated hepatic gene expression in vivo, and these effects are mediated at least in part, by the antigen specific immune system.
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Affiliation(s)
- D Barr
- Department of Surgery, University of Washington, Seattle 98195
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Affiliation(s)
- T S Keener
- Department of Radiology, University of Washington Medical Center, Seattle 98195, USA
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Kuhr CS, Davis CL, Barr D, McVicar JP, Perkins JD, Bachi CE, Alpers CE, Marsh CL. Use of ultrasound and cystoscopically guided pancreatic allograft biopsies and transabdominal renal allograft biopsies: safety and efficacy in kidney-pancreas transplant recipients. J Urol 1995; 153:316-21. [PMID: 7815571 DOI: 10.1097/00005392-199502000-00005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The use of allograft biopsies to guide treatment after solid organ transplantation is a valuable tool in the detection and treatment of rejection. Prior development and use of the cystoscopically guided pancreatic allograft biopsy have allowed for more accurate and timely diagnosis of pancreatic allograft dysfunction, possibly contributing to our 1-year pancreas graft, renal allograft and patient survival rates of 87.1%, 88.5% and 96.8%, respectively. We reviewed our experience, examining efficacy and complication rates of pancreas and kidney biopsies in 31 cadaveric pancreas or combined kidney and pancreas transplants performed between June 1990 and February 1992 with at least 1 year of followup. There were 94 pancreas, 54 kidney and 53 duodenal mucosal biopsies in 29 evaluable patients. This biopsy technique uses a 24.5F side-viewing nephroscope to view the cystoduodenostomy, with the duodenum acting as a portal for biopsy needles into the pancreas. Pancreatic tissue is obtained with either an 18 gauge, 500 mm. Menghini aspiration/core needle or an 18 gauge, 500 mm. Roth core needle. Percutaneous renal allograft biopsies are performed independently or simultaneously with the pancreas biopsies using a 16 gauge spring loaded needle. Pancreas biopsies were prompted by clinical indications of rejection (decreased urinary amylase, increased serum amylase or increased serum creatinine) or by protocol (10, 21 and 40 days postoperatively). Among the biopsies 30% were required by protocol, of which 10 (36%) revealed abnormal pathological findings and 5 (18%) showed evidence of occult cellular rejection. Renal biopsies demonstrated rejection in 69% of the cases. Of simultaneous pancreas/kidney biopsies 33% revealed concomitant rejection. A total of 88 Menghini needles with 170 passes was used in 73 biopsy attempts, yielding 126 tissue cores with a 16% complication rate. A total of 41 Roth needles was used with 73 passes in 34 biopsy attempts, yielding 55 tissue cores with a complication rate of 21%. Complications included self-limited bleeding from the biopsy site in 13% of the cases, bleeding requiring clot evacuation and fulguration in 1% and asymptomatic hyperamylasemia in 12%. Renal biopsy complications included 1 arteriovenous fistula (2%). We conclude that ultrasound and cystoscopically guided pancreatic allograft biopsy and percutaneous renal allograft biopsies are safe and essential methods of obtaining tissue for histological diagnosis without serious sequelae. The Menghini and Roth needles in cystoscopically guided pancreatic allograft biopsy have similar yield and complication rates in obtaining pancreatic tissue, although they require different performance techniques. In some cases both needles are necessary and are complementary in obtaining adequate tissue.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- C S Kuhr
- Department of Surgery (Division of Transplantation), University of Washington, Seattle 98195
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Finger WR, Barr D. Acceptability of IUDs is increasing. Netw Res Triangle Park N C 1992; 13:27-30. [PMID: 12286082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Zimmerman DW, Sarr MG, Smith CD, Nicholson CP, Dalton RR, Barr D, Perkins JD, DiMagno EP. Cyclic interdigestive pancreatic exocrine secretion: is it mediated by neural or hormonal mechanisms? Gastroenterology 1992; 102:1378-84. [PMID: 1372576] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Cyclic interdigestive exocrine pancreatic secretion and duodenal motility are closely linked. However, the mechanisms controlling this association are not well understood. The aim of this study was to determine whether a neural or hormonal mechanism controls the temporal association of interdigestive secretion and duodenal motility. In five dogs, the pancreas was autotransplanted to the pelvis with anastomosis of the pancreatic duct orifice to the bladder. Electrodes were positioned to monitor motility patterns of the in situ duodenum. After 10 days, dogs were studied on four occasions during fasting. Pancreatic output of amylase activity continued to cycle, but the periodicity of enzyme peaks (mean +/- SE) was different from the period of the duodenal migrating motor complex (MMC) (60 +/- 3 vs. 125 +/- 7 minutes; P less than 0.05). When grouped according to phase of duodenal MMC, amylase output per 10 minutes during phase I was significantly less than the outputs during phase II or III (135 +/- 52, 214 +/- 78, and 228 +/- 73 x 10(3) U; P less than 0.05). However, there was no temporal relationship of the cyclic output of amylase to duodenal phase III. No differences were found when amylase output was analyzed for the 30 minutes before phase III compared with the 30 minutes after phase III (687 +/- 253 vs. 378 +/- 110 x 10(3) U; P greater than 0.05). Plasma motilin concentrations varied with duodenal MMC, but no relationship existed between plasma motilin or plasma pancreatic polypeptide and peaks in amylase output. This study suggests that the close temporal coordination of interdigestive pancreatic exocrine secretion and duodenal motility is controlled primarily by a neural mechanism.
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Affiliation(s)
- D W Zimmerman
- Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota
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Barr D, van Heerden JA, Mucha P. The diagnostic challenge of postoperative acute appendicitis. World J Surg 1991; 15:526-8; discussion 529. [PMID: 1891940 DOI: 10.1007/bf01675654] [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: 12/29/2022]
Abstract
During the period 1979 to 1989, 0.1% of all cases of acute appendicitis at our institution occurred soon after another operative procedure. The interval between primary operation and appendectomy was 5 to 31 days (mean, 14 days). Signs and symptoms did not differ from those of classical acute appendicitis. Duration of symptoms ranged from 12 hours to 8 days (mean, 2.4 days). Perforation was present in 3 patients, suppurative appendicitis in 1 patient, and acute inflammation in 4 patients. Two of the perforations were associated with abscess formation. Morbidity related to the appendiceal condition included hepatic abscesses, septic shock, and prolonged ileus. There was no mortality. Hospitalization ranged from 6 to 80 days (mean, 12.5 days).
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Affiliation(s)
- D Barr
- Section of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota 55905
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Nicholson CP, Barr D, Oeltjen MR, Munn SR, DiMagno EP, Carpenter HA, Sarr MG, Perkins JD. The effect of somatostatin 201-995 on the early course of porcine pancreaticoduodenal allotransplantation. Transplant Proc 1991; 23:1587-8. [PMID: 1703346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C P Nicholson
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Nicholson CP, Barr D, Oeltjen MR, Munn SR, DiMagno EP, Carpenter HA, Sarr MG, Perkins JD. The effect of somatostatin 201-995 on the early course of porcine pancreaticoduodenal allotransplantation. Transplantation 1991; 51:31-6. [PMID: 1670973 DOI: 10.1097/00007890-199101000-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study was undertaken to determine the effects of somatostatin 201-995 (SMS) on the maintenance dose of intravenous cyclosporine and on graft blood flow, exocrine secretion, and rejection after porcine pancreaticoduodenal allotransplantation (PDA). For seven days, 12 pigs (6 control, 6 SMS-treated) were studied to determine the effects of SMS on serum CsA concentrations. Twenty-six pigs (14 control, 12 SMS) with streptozocin-induced diabetes underwent PDA. Blood flow was measured through graft celiac and superior mesenteric arteries 15 and 60 min after reperfusion. SMS (75 micrograms s.c.) was given after the 15-min blood-flow measurement in the SMS group. Sixteen pigs (8 control, 8 SMS) were followed postoperatively with daily measurements of serum glucose and amylase concentrations, and urine amylase and trypsin activities. All pigs were immunosuppressed with azathioprine, prednisone, and i.v. CsA. SMS pigs also received SMS (75 micrograms s.c.) every 8 hr. SMS had no effect on maintenance dose of CsA or on serum amylase, urine amylase, or urine trypsin activities. Mean days to rejection were also not affected. Intraoperative graft blood flow was significantly decreased by SMS, but incidence of graft thrombosis was unchanged. These results suggest that in the porcine PDA model, SMS does not appear to inhibit exocrine secretion and potentially may adversely affect the early course of PDA by decreasing graft blood flow.
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Affiliation(s)
- C P Nicholson
- Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905
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Carpenter HA, Engen DE, Munn SR, Barr D, Marsh CL, Ludwig J, Perkins JD. Histologic diagnosis of rejection by using cystoscopically directed needle biopsy specimens from dysfunctional pancreatoduodenal allografts with exocrine drainage into the bladder. Am J Surg Pathol 1990; 14:837-46. [PMID: 2389814] [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: 12/31/2022]
Abstract
To determine the histologic features of rejection and to identify nonrejection causes of human pancreatic allograft dysfunction, we analyzed 31 needle biopsy specimens (17 pancreatic, 14 duodenal) obtained under cystoscopic direction from 15 dysfunctional pancreatoduodenal allografts with exocrine drainage into the bladder. Eight allografts undergoing rejection showed the most common histologic features of rejection to be diffuse mixed inflammatory infiltrates of pancreatic acinar tissue and duodenum wall. Diffuse infiltration of pancreatic acinar tissue by neutrophils was the earliest histologic change in rejection. Seven dysfunctional allografts not undergoing rejection ("nonrejection") showed a normal pancreas or various changes including acinar dilation with inspissation of secretions, fibrosis, cytomegalovirus inclusions, and enzymatic necrosis. The histologic changes in the duodenum paralleled those in the pancreas in both rejection and nonrejection allografts. We conclude that the histologic features of rejection in pancreatoduodenal allografts are distinctive. The changes seen in biopsy specimens accurately reflect the state of the graft and can be used to diagnose rejection and to identify other causes of graft dysfunction. Biopsy samples from the duodenum as well as the pancreas are diagnostically useful. The biopsy findings can be used to guide the clinical management of rejection and in the development of other noninvasive tests for rejection.
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Affiliation(s)
- H A Carpenter
- Division of Pathology, Mayo Clinic, Rochester, Minnesota 55905
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Barr D, Munn SR, Carpenter HA, Perkins JD. A prospective comparison of two preservation solutions in human pancreaticoduodenal transplantation. Transplant Proc 1990; 22:529-31. [PMID: 1691542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- D Barr
- Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905
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