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Di Genova C, Sampson A, Scott S, Cantoni D, Mayora-Neto M, Bentley E, Mattiuzzo G, Wright E, Derveni M, Auld B, Ferrara BT, Harrison D, Said M, Selim A, Thompson E, Thompson C, Carnell G, Temperton N. Production, Titration, Neutralisation, Storage and Lyophilisation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Lentiviral Pseudotypes. Bio Protoc 2021; 11:e4236. [PMID: 34859134 DOI: 10.21769/bioprotoc.4236] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 11/02/2022] Open
Abstract
This protocol details a rapid and reliable method for the production and titration of high-titre viral pseudotype particles with the SARS-CoV-2 spike protein (and D614G or other variants of concern, VOC) on a lentiviral vector core, and use for neutralisation assays in target cells expressing angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2). It additionally provides detailed instructions on substituting in new spike variants via gene cloning, lyophilisation and storage/shipping considerations for wide deployment potential. Results obtained with this protocol show that SARS-CoV-2 pseudotypes can be produced at equivalent titres to SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV) pseudotypes, neutralised by human convalescent plasma and monoclonal antibodies, and stored at a range of laboratory temperatures and lyophilised for distribution and subsequent application.
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Affiliation(s)
- Cecilia Di Genova
- Viral Pseudotype Unit (VPU Kent), Medway School of Pharmacy, University of Kent and Greenwich at Medway, Chatham Maritime, Kent, UK
| | - Alex Sampson
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, Cambridge University, Madingley Road, Cambridge, UK
| | - Simon Scott
- Viral Pseudotype Unit (VPU Kent), Medway School of Pharmacy, University of Kent and Greenwich at Medway, Chatham Maritime, Kent, UK
| | - Diego Cantoni
- Viral Pseudotype Unit (VPU Kent), Medway School of Pharmacy, University of Kent and Greenwich at Medway, Chatham Maritime, Kent, UK
| | - Martin Mayora-Neto
- Viral Pseudotype Unit (VPU Kent), Medway School of Pharmacy, University of Kent and Greenwich at Medway, Chatham Maritime, Kent, UK
| | - Emma Bentley
- Division of Virology, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire, UK
| | - Giada Mattiuzzo
- Division of Virology, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire, UK
| | - Edward Wright
- Viral Pseudotype Unit (VPU Sussex), School of Life Sciences, University of Sussex, Brighton, UK
| | - Mariliza Derveni
- Viral Pseudotype Unit (VPU Sussex), School of Life Sciences, University of Sussex, Brighton, UK
| | - Bethany Auld
- Viral Pseudotype Unit (VPU Sussex), School of Life Sciences, University of Sussex, Brighton, UK
| | - Bill T Ferrara
- School of Science, University of Greenwich, Chatham Maritime, Kent, UK
| | - Dale Harrison
- School of Science, University of Greenwich, Chatham Maritime, Kent, UK
| | - Mohamed Said
- School of Science, University of Greenwich, Chatham Maritime, Kent, UK
| | - Arwa Selim
- School of Science, University of Greenwich, Chatham Maritime, Kent, UK
| | - Elinor Thompson
- School of Science, University of Greenwich, Chatham Maritime, Kent, UK
| | | | - George Carnell
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, Cambridge University, Madingley Road, Cambridge, UK
| | - Nigel Temperton
- Viral Pseudotype Unit (VPU Kent), Medway School of Pharmacy, University of Kent and Greenwich at Medway, Chatham Maritime, Kent, UK
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Miller A, Leach A, Thomas J, McAndrew C, Bentley E, Mattiuzzo G, John L, Mirazimi A, Harris G, Gamage N, Carr S, Ali H, Van Montfort R, Rabbitts T. A super-potent tetramerized ACE2 protein displays enhanced neutralization of SARS-CoV-2 virus infection. Sci Rep 2021; 11:10617. [PMID: 34012108 PMCID: PMC8134500 DOI: 10.1038/s41598-021-89957-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/05/2021] [Indexed: 01/06/2023] Open
Abstract
Approaches are needed for therapy of the severe acute respiratory syndrome from SARS-CoV-2 coronavirus (COVID-19). Interfering with the interaction of viral antigens with the angiotensin converting enzyme 2 (ACE-2) receptor is a promising strategy by blocking the infection of the coronaviruses into human cells. We have implemented a novel protein engineering technology to produce a super-potent tetravalent form of ACE2, coupled to the human immunoglobulin γ1 Fc region, using a self-assembling, tetramerization domain from p53 protein. This high molecular weight Quad protein (ACE2-Fc-TD) retains binding to the SARS-CoV-2 receptor binding spike protein and can form a complex with the spike protein plus anti-viral antibodies. The ACE2-Fc-TD acts as a powerful decoy protein that out-performs soluble monomeric and dimeric ACE2 proteins and blocks both SARS-CoV-2 pseudovirus and SARS-CoV-2 virus infection with greatly enhanced efficacy. The ACE2 tetrameric protein complex promise to be important for development as decoy therapeutic proteins against COVID-19. In contrast to monoclonal antibodies, ACE2 decoy is unlikely to be affected by mutations in SARS-CoV-2 that are beginning to appear in variant forms. In addition, ACE2 multimeric proteins will be available as therapeutic proteins should new coronaviruses appear in the future because these are likely to interact with ACE2 receptor.
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Affiliation(s)
- Ami Miller
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | - Adam Leach
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | - Jemima Thomas
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | - Craig McAndrew
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | - Emma Bentley
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Hertfordshire, EN6 3QG, UK
| | - Giada Mattiuzzo
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Hertfordshire, EN6 3QG, UK
| | - Lijo John
- Department of LABMED, National Veterinary Institute (SVA), 751 89, Uppsala, Sweden
- Karolinska Institute, 17177, Stockholm, Sweden
| | - Ali Mirazimi
- Department of LABMED, National Veterinary Institute (SVA), 751 89, Uppsala, Sweden
- Karolinska Institute, 17177, Stockholm, Sweden
| | - Gemma Harris
- Research Complex at Harwell, Rutherford Appleton Laboratory, Oxon, OX11 0FA, UK
| | - Nadisha Gamage
- Membrane Protein Laboratory, Diamond Light Source, Harwell Science and Innovation Campus, Didcot, OX11 0DE, UK
| | - Stephen Carr
- Research Complex at Harwell, Rutherford Appleton Laboratory, Oxon, OX11 0FA, UK
| | - Hanif Ali
- Quadrucept Limited, 1010 Cambourne Road, Cambridge, CB23 6DW, UK
| | - Rob Van Montfort
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | - Terence Rabbitts
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK.
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3
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Leach A, Miller A, Bentley E, Mattiuzzo G, Thomas J, McAndrew C, Van Montfort R, Rabbitts T. Implementing a method for engineering multivalency to substantially enhance binding of clinical trial anti-SARS-CoV-2 antibodies to wildtype spike and variants of concern proteins. Sci Rep 2021; 11:10475. [PMID: 34006961 PMCID: PMC8131632 DOI: 10.1038/s41598-021-89887-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022] Open
Abstract
Infection by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes COVID-19 disease. Therapeutic antibodies are being developed that interact with the viral spike proteins to limit viral infection of epithelium. We have applied a method to dramatically improve the performance of anti-SARS-CoV-2 antibodies by enhancing avidity through multimerization using simple engineering to yield tetrameric antibodies. We have re-engineered six anti-SARS-CoV-2 antibodies using the human p53 tetramerization domain, including three clinical trials antibodies casirivimab, imdevimab and etesevimab. The method yields tetrameric antibodies, termed quads, that retain efficient binding to the SARS-CoV-2 spike protein, show up to two orders of magnitude enhancement in neutralization of pseudovirus infection and retain potent interaction with virus variant of concern spike proteins. The tetramerization method is simple, general and its application is a powerful methodological development for SARS-CoV-2 antibodies that are currently in pre-clinical and clinical investigation.
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Affiliation(s)
- Adam Leach
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | - Ami Miller
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
- Evotec, 114 Innovation Dr, Milton Park, Abingdon, OX14 4RZ, UK
| | - Emma Bentley
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Hertfordshire, EN6 3QG, UK
| | - Giada Mattiuzzo
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Hertfordshire, EN6 3QG, UK
| | - Jemima Thomas
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | - Craig McAndrew
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | - Rob Van Montfort
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | - Terence Rabbitts
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK.
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Duymun S, Reddy V, Bentley E, Bose-Kolanu A. Tissue Plasminogen Activator-Induced Angioedema Involving a Posterior Cerebral Artery Infarct: A Case Presentation. Am J Case Rep 2021; 22:e927137. [PMID: 33441533 PMCID: PMC7811978 DOI: 10.12659/ajcr.927137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patient: Female, 84-year-old Final Diagnosis: Angioedema Symptoms: Angioedema Medication:— Clinical Procedure: — Specialty: Critical Care Medicine • General and Internal Medicine
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Affiliation(s)
- Shahnaz Duymun
- Department of Medicine, Arnot Ogden Medical Center, Elmira, NY, USA
| | - Vidhya Reddy
- Department of Medicine, Arnot Ogden Medical Center, Elmira, NY, USA
| | - Emma Bentley
- Department of Medicine, Arnot Ogden Medical Center, Elmira, NY, USA
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Mekkaoui L, Bentley E, Ferrari M, Lamb K, Ward K, Karattil R, Akbar Z, Bughda R, Sillibourne J, Onuoha S, Mattiuzzo G, Takeuchi Y, Pule M. Optimised Method for the Production and Titration of Lentiviral Vectors Pseudotyped with the SARS-CoV-2 Spike. Bio Protoc 2021. [DOI: 10.21769/bioprotoc.4034] [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: 11/02/2022] Open
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Bentley E, Richardson S, Killip M, Hassall M, Garry R, Bernasconi V, Holst J, Page M, Mattiuzzo G. Evaluation of a serological reference panel for Lassa virus. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.11.041] [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: 10/22/2022] Open
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7
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Martin J, Klapsa D, Wilton T, Zambon M, Bentley E, Bujaki E, Fritzsche M, Mate R, Majumdar M. Tracking SARS-CoV-2 in Sewage: Evidence of Changes in Virus Variant Predominance during COVID-19 Pandemic. Viruses 2020; 12:E1144. [PMID: 33050264 PMCID: PMC7601348 DOI: 10.3390/v12101144] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 02/07/2023] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), responsible for the ongoing coronavirus disease (COVID-19) pandemic, is frequently shed in faeces during infection, and viral RNA has recently been detected in sewage in some countries. We have investigated the presence of SARS-CoV-2 RNA in wastewater samples from South-East England between 14th January and 12th May 2020. A novel nested RT-PCR approach targeting five different regions of the viral genome improved the sensitivity of RT-qPCR assays and generated nucleotide sequences at sites with known sequence polymorphisms among SARS-CoV-2 isolates. We were able to detect co-circulating virus variants, some specifically prevalent in England, and to identify changes in viral RNA sequences with time consistent with the recently reported increasing global dominance of Spike protein G614 pandemic variant. Low levels of viral RNA were detected in a sample from 11th February, 3 days before the first case was reported in the sewage plant catchment area. SARS-CoV-2 RNA concentration increased in March and April, and a sharp reduction was observed in May, showing the effects of lockdown measures. We conclude that viral RNA sequences found in sewage closely resemble those from clinical samples and that environmental surveillance can be used to monitor SARS-CoV-2 transmission, tracing virus variants and detecting virus importations.
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Affiliation(s)
- Javier Martin
- Division of Virology, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire EN6 3QG, UK; (D.K.); (T.W.); (E.B.); (E.B.); (M.M.)
| | - Dimitra Klapsa
- Division of Virology, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire EN6 3QG, UK; (D.K.); (T.W.); (E.B.); (E.B.); (M.M.)
| | - Thomas Wilton
- Division of Virology, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire EN6 3QG, UK; (D.K.); (T.W.); (E.B.); (E.B.); (M.M.)
| | - Maria Zambon
- Respiratory Virology & Polio Reference Service, Public Health England, London NW9 5EQ, UK;
| | - Emma Bentley
- Division of Virology, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire EN6 3QG, UK; (D.K.); (T.W.); (E.B.); (E.B.); (M.M.)
| | - Erika Bujaki
- Division of Virology, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire EN6 3QG, UK; (D.K.); (T.W.); (E.B.); (E.B.); (M.M.)
| | - Martin Fritzsche
- Division of Analytical and Biological Sciences, NIBSC, Potters Bar, Hertfordshire EN6 3QG, UK; (M.F.); (R.M.)
| | - Ryan Mate
- Division of Analytical and Biological Sciences, NIBSC, Potters Bar, Hertfordshire EN6 3QG, UK; (M.F.); (R.M.)
| | - Manasi Majumdar
- Division of Virology, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire EN6 3QG, UK; (D.K.); (T.W.); (E.B.); (E.B.); (M.M.)
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Osborne MS, Bentley E, Farrow A, Chan J, Murphy J. Impact of coronavirus disease 2019 on urgent referrals to secondary care otolaryngology: a prospective case series. J Laryngol Otol 2020; 134:1-4. [PMID: 32981533 PMCID: PMC7684200 DOI: 10.1017/s0022215120002091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE As the novel coronavirus disease 2019 changed patient presentation, this study aimed to prospectively identify these changes in a single ENT centre. DESIGN A seven-week prospective case series was conducted of urgently referred patients from primary care and accident and emergency department. RESULTS There was a total of 133 referrals. Referral rates fell by 93 per cent over seven weeks, from a mean of 5.4 to 0.4 per day. Reductions were seen in referrals from both primary care (89 per cent) and the accident and emergency department (93 per cent). Presentations of otitis externa and epistaxis fell by 83 per cent, and presentations of glandular fever, tonsillitis and peritonsillar abscess fell by 67 per cent. CONCLUSION Coronavirus disease 2019 has greatly reduced the number of referrals into secondary care ENT. The cause for this reduction is likely to be due to patients' increased perceived risk of the virus presence in a medical setting. The impact of this reduction is yet to be ascertained, but will likely result in a substantial increase in emergency pressures once the lockdown is lifted and the general public's perception of the coronavirus disease 2019 risk reduces.
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Affiliation(s)
- M S Osborne
- Department of ENT, New Cross Hospital, Wolverhampton, UK
| | - E Bentley
- Department of ENT, New Cross Hospital, Wolverhampton, UK
| | - A Farrow
- Department of ENT, New Cross Hospital, Wolverhampton, UK
| | - J Chan
- Department of ENT, Princess Royal Hospital, Telford, UK
| | - J Murphy
- Department of ENT, New Cross Hospital, Wolverhampton, UK
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Bentley E, Kellihan H, Longhurst C, Chun R. Effect of attire on client perceptions of veterinarians. Vet J 2020; 265:105550. [PMID: 33129551 DOI: 10.1016/j.tvjl.2020.105550] [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: 01/23/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
This study examined the effect that veterinarian attire and gender had on clients' perceptions of veterinarians in a large academic specialty hospital. Clients volunteered to answer a survey in the small animal waiting area over a 3-month period. The survey consisted of demographic information, information about the nature of their appointment with their pet, and questions regarding clients' levels of comfort with and the perceived trustworthiness of a Caucasian male and Caucasian female model in four different types of attire: surgical scrubs, surgical scrubs with white lab coat, business casual, and business casual with white lab coat. Relevant effects of interest were estimated using linear mixed models. Five hundred and five clients participated in the survey, yielding a total of 6217 completed survey questions. Clients perceived veterinarians wearing white lab coats as more competent and reported more comfort with those veterinarians (P < 0.0001). When comparing surgical scrubs with no white lab coat to business attire with no white lab coat, surgical scrubs resulted in higher perceived competence and comfort levels (P < 0.0001). Wearing a white lab coat over both surgical scrubs and business casual increased clients' perceived competency and comfort levels compared to not wearing a white lab coat.
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Affiliation(s)
- E Bentley
- School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA.
| | - H Kellihan
- School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA
| | - C Longhurst
- Biostatistics and Medical Informatics, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA
| | - R Chun
- School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA
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Bentley E, Ved R, Amato-Watkins A, Lang J, Zilani G, Bhatti I, Leach P. P104 One year failure rates for de novo ventriculo-peritonealshunts in under 3- month-old children. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.161] [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] [Indexed: 11/03/2022]
Abstract
ObjectivesHistorically VPS failure and infection rates are higher for neonates than for older children. We compared our one year VPS failure and infection rates in under 3-month-olds with those of older children.DesignA retrospective, single centre study comparing 1 year survival and infection rates of VPS in under 3-month-olds verses older children.Subjects58 children under 3 months of age underwent VPS insertion between January 2007 and December 2016.MethodsData was collected by three independent reviewers from electronic files and case notes. Data was analysed using descriptive statistics and one year shunt survival curves were produced.ResultsFor children under 3 months there was a 29.3% one-year shunt failure rate, of which 2 were shunt infections (3.4%). In patients greater than 3 months, the shunt malfunction rate was 23.4% and the infection rate was 4.3%. There were no shunt-related mortalities in either group.ConclusionsChildren under 3-months-old undergoing VPS insertion should not automatically expect an increased 1 year failure or infection rate compared with older children. Reasons for this may be increased sub-specialisation, improved neonatal care and use of antibiotic impregnated catheters.
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11
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Mayora-Neto M, Bentley E, Wright E, Temperton N, Ploemen I, Soema P, ten Have R, Masterson S, Michaelis M, Wass M, Scott S. Generation, lyophilisation and epitope modification of high titre filovirus pseudotyped lentiviruses for use in antibody neutralisation assays and ELISA. Access Microbiol 2019. [DOI: 10.1099/acmi.ac2019.po0373] [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: 11/18/2022] Open
Affiliation(s)
| | - Emma Bentley
- 2National Institute for Biological Standards and Control, Potters Bar, United Kingdom
| | | | | | | | | | | | | | | | - Mark Wass
- 5University of Kent, Canterbury, United Kingdom
| | - Simon Scott
- 1University of Kent, Chatham, United Kingdom
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Ved R, Bentley E, Amato-Watkins A, Lang J, Zilani G, Bhatti I, Leach P. One year failure rates for de-novo ventriculo-peritoneal shunts in under 3-month-old children. Br J Neurosurg 2019; 33:357-359. [PMID: 30732482 DOI: 10.1080/02688697.2018.1563286] [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] [Indexed: 10/27/2022]
Abstract
Introduction: Ventriculo-peritoneal shunts (VPS) are still the mainstay treatment for hydrocephalus in children. It is generally accepted that VPS failure and infection rates are higher for neonates than for older children. We compared our 1-year failure and infection rates in under 3-month-old children compared with older children in our department. Results: We identified 58 children under 3 months of age who underwent VPS insertion between January 2007 and December 2016. They had a 29.3% (17) shunt failure rate over the first year. There were two confirmed shunt infections (3.4%). Discussion: The 1-year shunt failure rate at our institution for VPS insertion in children over 3 months is 26.1% and the infection rate is 4.3% (9). The literature suggests that the outcome for VPS in younger children is worse than for older children. Our work shows similar outcomes for all children compared to those under 3 months at time of VPS insertion alone. Conclusion: Children under 3-months-old undergoing VPS insertion should not automatically expect an increased 1-year failure or infection rate compared with older children. The reasons for this may be as a result of increased subspecialisation, the more widespread use of antibiotic-impregnated catheters and improved neonatal care.
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Affiliation(s)
- R Ved
- a Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK
| | - E Bentley
- a Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK
| | - A Amato-Watkins
- a Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK
| | - J Lang
- a Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK
| | - G Zilani
- a Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK
| | - I Bhatti
- a Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK
| | - P Leach
- a Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK
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Bentley E, Wright E, Hassall M, Myhill S, Rigsby P, Wilkinson D, Stone L, Page M, Mattiuzzo G. Use of Pseudotyped viruses for the production of reference materials as part of emerging viral outbreak preparedness. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.035] [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: 10/27/2022] Open
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Chou B, Choe J, Park H, Mehl C, Bentley E, Jones G. Linear Accelerator-Based Frameless Stereotactic Radiosurgery for Trigeminal Neuralgia with Optical Surface Monitoring: A Community Cancer Center Experience. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Singer-Berk M, Knickelbein KE, Vig S, Liu J, Bentley E, Nunnery C, Reilly C, Dwyer A, Drögemüller C, Unger L, Gerber V, Lassaline M, Bellone RR. Genetic risk for squamous cell carcinoma of the nictitating membrane parallels that of the limbus in Haflinger horses. Anim Genet 2018; 49:457-460. [PMID: 29999543 DOI: 10.1111/age.12695] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/29/2022]
Abstract
Squamous cell carcinoma (SCC) is the most common cancer affecting the equine eye, with a higher incidence documented in Haflinger horses. Recently, a missense variant in the gene damage specific DNA binding protein 2 (DDB2, p.Thr338Met) on ECA12 was identified as a risk factor for the development of limbal SCC in Haflinger horses. SCC also occurs on the nictitating membrane; therefore, investigating the role of this missense variant in nictitating membrane SCC is warranted. In this study, a common ancestor was identified among Haflinger horses affected with limbal SCC or with nictitating membrane SCC, thus supporting a recessive risk factor for the development of cancer at both ocular locations. Analysis of genotype data from Haflinger horses with and without nictitating membrane SCC revealed that the same region on ECA12 associated with limbal SCC was also associated with nictitating membrane SCC (P < 2.04 × 10-5 ). Fine mapping of this locus using 25 cases and 49 controls supported the hypothesis that DDB2:c.1013C>T, p.Thr338Met, is a risk factor for nictitating membrane SCC, as 88% of our cases were homozygous for this variant and no other polymorphism was more strongly associated (P = 4.13 × 10-14 ). These data indicate that the genetic risk is the same for the development of both limbal and nictitating membrane SCC in Haflinger horses and validates utilization of genetic testing of the DDB2 variant for both clinical management and the guidance of mating decisions.
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Affiliation(s)
- M Singer-Berk
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - K E Knickelbein
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA.,Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA, 95616, USA
| | - S Vig
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - J Liu
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - E Bentley
- Department of Surgical Services, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - C Nunnery
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - C Reilly
- Insight Veterinary Specialty Pathology, 6902A Bennett Ave., Austin, TX, 78752, USA
| | - A Dwyer
- Genesee Valley Equine Clinic, LLC, Scottsville, NY, 14546, USA
| | - C Drögemüller
- Institute of Genetics, Vetsuisse Faculty, University of Bern, Hochschulstrasse 6, Bern, Switzerland
| | - L Unger
- Department of Clinical Veterinary Medicine, Swiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern and Agroscope, Hochschulstrasse 6, Bern, Switzerland
| | - V Gerber
- Department of Clinical Veterinary Medicine, Swiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern and Agroscope, Hochschulstrasse 6, Bern, Switzerland
| | - M Lassaline
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - R R Bellone
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA.,Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
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16
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Shah K, Bentley E, Tyler A, Richards KSR, Wright E, Easterbrook L, Lee D, Cleaver C, Usher L, Burton JE, Pitman JK, Bruce CB, Edge D, Lee M, Nazareth N, Norwood DA, Moschos SA. Field-deployable, quantitative, rapid identification of active Ebola virus infection in unprocessed blood. Chem Sci 2017; 8:7780-7797. [PMID: 29163915 PMCID: PMC5694917 DOI: 10.1039/c7sc03281a] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/20/2017] [Indexed: 01/01/2023] Open
Abstract
The West African Ebola virus outbreak underlined the importance of delivering mass diagnostic capability outside the clinical or primary care setting in effectively containing public health emergencies caused by infectious disease. Yet, to date, there is no solution for reliably deploying at the point of need the gold standard diagnostic method, real time quantitative reverse transcription polymerase chain reaction (RT-qPCR), in a laboratory infrastructure-free manner. In this proof of principle work, we demonstrate direct performance of RT-qPCR on fresh blood using far-red fluorophores to resolve fluorogenic signal inhibition and controlled, rapid freeze/thawing to achieve viral genome extraction in a single reaction chamber assay. The resulting process is entirely free of manual or automated sample pre-processing, requires no microfluidics or magnetic/mechanical sample handling and thus utilizes low cost consumables. This enables a fast, laboratory infrastructure-free, minimal risk and simple standard operating procedure suited to frontline, field use. Developing this novel approach on recombinant bacteriophage and recombinant human immunodeficiency virus (HIV; Lentivirus), we demonstrate clinical utility in symptomatic EBOV patient screening using live, infectious Filoviruses and surrogate patient samples. Moreover, we evidence assay co-linearity independent of viral particle structure that may enable viral load quantification through pre-calibration, with no loss of specificity across an 8 log-linear maximum dynamic range. The resulting quantitative rapid identification (QuRapID) molecular diagnostic platform, openly accessible for assay development, meets the requirements of resource-limited countries and provides a fast response solution for mass public health screening against emerging biosecurity threats.
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Affiliation(s)
- Kavit Shah
- Westminster Genomic Services , Department of Biomedical Sciences , Faculty of Science and Technology , University of Westminster , 115 New Cavendish Str , London W1W 6UW , UK
- BGResearch Ltd. , 6 The Business Centre, Harvard Way, Harvard Industrial Estate , Kimbolton , Huntingdon PE28 0NJ , UK
| | - Emma Bentley
- Department of Biomedical Sciences , Faculty of Science and Technology , University of Westminster , 115 New Cavendish Str , London W1W 6UW , UK
| | - Adam Tyler
- BioGene Ltd. , 8 The Business Centre, Harvard Way, Harvard Industrial Estate , Kimbolton , Huntingdon PE28 0NJ , UK
| | - Kevin S R Richards
- Public Health England , National Infection Service , High Containment Microbiology Department , Porton Down , Salisbury , Wiltshire SP4 0JG , UK
| | - Edward Wright
- Department of Biomedical Sciences , Faculty of Science and Technology , University of Westminster , 115 New Cavendish Str , London W1W 6UW , UK
| | - Linda Easterbrook
- Public Health England , National Infection Service , High Containment Microbiology Department , Porton Down , Salisbury , Wiltshire SP4 0JG , UK
| | - Diane Lee
- Fluorogenics LIMITED , Building 227, Tetricus Science Park, Dstl Porton Down , Salisbury , Wiltshire SP4 0JQ , UK
| | - Claire Cleaver
- Fluorogenics LIMITED , Building 227, Tetricus Science Park, Dstl Porton Down , Salisbury , Wiltshire SP4 0JQ , UK
| | - Louise Usher
- Westminster Genomic Services , Department of Biomedical Sciences , Faculty of Science and Technology , University of Westminster , 115 New Cavendish Str , London W1W 6UW , UK
| | - Jane E Burton
- Public Health England , National Infection Service , High Containment Microbiology Department , Porton Down , Salisbury , Wiltshire SP4 0JG , UK
| | - James K Pitman
- Public Health England , National Infection Service , High Containment Microbiology Department , Porton Down , Salisbury , Wiltshire SP4 0JG , UK
| | - Christine B Bruce
- Public Health England , National Infection Service , High Containment Microbiology Department , Porton Down , Salisbury , Wiltshire SP4 0JG , UK
| | - David Edge
- BioGene Ltd. , 8 The Business Centre, Harvard Way, Harvard Industrial Estate , Kimbolton , Huntingdon PE28 0NJ , UK
| | - Martin Lee
- Fluorogenics LIMITED , Building 227, Tetricus Science Park, Dstl Porton Down , Salisbury , Wiltshire SP4 0JQ , UK
| | - Nelson Nazareth
- BioGene Ltd. , 8 The Business Centre, Harvard Way, Harvard Industrial Estate , Kimbolton , Huntingdon PE28 0NJ , UK
| | - David A Norwood
- Diagnostic Systems Division and Virology Division , United States Army Medical Research Institute of Infectious Diseases , Fort Detrick , MD 21701-5011 , USA
| | - Sterghios A Moschos
- Westminster Genomic Services , Department of Biomedical Sciences , Faculty of Science and Technology , University of Westminster , 115 New Cavendish Str , London W1W 6UW , UK
- Department of Biomedical Sciences , Faculty of Science and Technology , University of Westminster , 115 New Cavendish Str , London W1W 6UW , UK
- Department of Applied Sciences , Faculty of Health and Life Sciences , Northumbria University , C4.03 Ellison Building, Ellison Place , Newcastle Upon Tyne , Tyne and Wear NE1 8ST , UK . ; Tel: +44(0) 191 215 6623
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17
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Bentley E, Mattiuzzo G, Wash R, Binter S, Friedrich M, Goulding D, Kellam P, Page M, Wright E. 20.078 Ebolavirus pseudotypes as antigen surrogates for serological studies. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.306] [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: 10/20/2022] Open
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18
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Grehan K, Bentley E, Mather S, Kinsley R, Carnell G, Scott S, Wright E, Temperton N. Exploiting viral pseudotypes for emerging virus research. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.024] [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: 10/20/2022] Open
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19
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Bellone R, Liu J, Vig S, Reilly CM, Lassaline M, Michau TM, Bentley E, Petersen JL. P6048 Investigating a single nucleotide polymorphism in DDB2 as a risk factor for squamous cell carcinomas of the nictitans in the Haflinger and Belgian horse breeds. J Anim Sci 2016. [DOI: 10.2527/jas2016.94supplement4172a] [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: 11/13/2022] Open
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20
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De Benedictis P, Minola A, Rota Nodari E, Aiello R, Zecchin B, Salomoni A, Foglierini M, Agatic G, Vanzetta F, Lavenir R, Lepelletier A, Bentley E, Weiss R, Cattoli G, Capua I, Sallusto F, Wright E, Lanzavecchia A, Bourhy H, Corti D. Development of broad-spectrum human monoclonal antibodies for rabies post-exposure prophylaxis. EMBO Mol Med 2016; 8:407-21. [PMID: 26992832 PMCID: PMC4818751 DOI: 10.15252/emmm.201505986] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/08/2016] [Accepted: 02/15/2016] [Indexed: 12/25/2022] Open
Abstract
Currently available rabies post-exposure prophylaxis (PEP) for use in humans includes equine or human rabies immunoglobulins (RIG). The replacement of RIG with an equally or more potent and safer product is strongly encouraged due to the high costs and limited availability of existing RIG. In this study, we identified two broadly neutralizing human monoclonal antibodies that represent a valid and affordable alternative to RIG in rabies PEP. Memory B cells from four selected vaccinated donors were immortalized and monoclonal antibodies were tested for neutralizing activity and epitope specificity. Two antibodies, identified as RVC20 and RVC58 (binding to antigenic site I and III, respectively), were selected for their potency and broad-spectrum reactivity. In vitro, RVC20 and RVC58 were able to neutralize all 35 rabies virus (RABV) and 25 non-RABV lyssaviruses. They showed higher potency and breath compared to antibodies under clinical development (namely CR57, CR4098, and RAB1) and commercially available human RIG. In vivo, the RVC20-RVC58 cocktail protected Syrian hamsters from a lethal RABV challenge and did not affect the endogenous hamster post-vaccination antibody response.
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MESH Headings
- Animals
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/isolation & purification
- Antibodies, Neutralizing/administration & dosage
- Antibodies, Neutralizing/immunology
- Antibodies, Neutralizing/isolation & purification
- Antibodies, Viral/administration & dosage
- Antibodies, Viral/immunology
- Antibodies, Viral/isolation & purification
- Disease Models, Animal
- Humans
- Immunization, Passive/methods
- Immunologic Factors/administration & dosage
- Immunologic Factors/immunology
- Immunologic Factors/isolation & purification
- Mesocricetus
- Post-Exposure Prophylaxis/methods
- Rabies/prevention & control
- Rabies virus/immunology
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Paola De Benedictis
- FAO and National Reference Centre for Rabies, National Reference Centre and OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy
| | | | - Elena Rota Nodari
- FAO and National Reference Centre for Rabies, National Reference Centre and OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy
| | - Roberta Aiello
- FAO and National Reference Centre for Rabies, National Reference Centre and OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy
| | - Barbara Zecchin
- FAO and National Reference Centre for Rabies, National Reference Centre and OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy
| | - Angela Salomoni
- FAO and National Reference Centre for Rabies, National Reference Centre and OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy
| | - Mathilde Foglierini
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland
| | | | | | - Rachel Lavenir
- Institut Pasteur, Unit of Lyssavirus Dynamics and Host Adaptation National Reference Centre for Rabies World Health Organization Collaborating Centre for Reference and Research on Rabies, Paris Cedex 15, France
| | - Anthony Lepelletier
- Institut Pasteur, Unit of Lyssavirus Dynamics and Host Adaptation National Reference Centre for Rabies World Health Organization Collaborating Centre for Reference and Research on Rabies, Paris Cedex 15, France
| | - Emma Bentley
- Viral Pseudotype Unit, Faculty of Science and Technology, University of Westminster, London, UK
| | - Robin Weiss
- Division of Infection and Immunity, University College London, London, UK
| | - Giovanni Cattoli
- FAO and National Reference Centre for Rabies, National Reference Centre and OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy
| | - Ilaria Capua
- FAO and National Reference Centre for Rabies, National Reference Centre and OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy
| | - Federica Sallusto
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Edward Wright
- Viral Pseudotype Unit, Faculty of Science and Technology, University of Westminster, London, UK
| | - Antonio Lanzavecchia
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland Institute of Microbiology, ETH Zurich, Zurich, Switzerland
| | - Hervé Bourhy
- Institut Pasteur, Unit of Lyssavirus Dynamics and Host Adaptation National Reference Centre for Rabies World Health Organization Collaborating Centre for Reference and Research on Rabies, Paris Cedex 15, France
| | - Davide Corti
- Humabs BioMed SA, Bellinzona, Switzerland Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland
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Abstract
In an experimental model of transplant rejection, renal transplants were performed on 6 mixed-breed dogs. Capecitabine (CPC) was administered as an oral immunosuppressive agent. All recipients received systemic CPC, cyclosporine (CSA), prednisolone, and famotidine throughout the study. Two dogs developed superficial keratitis, which was characterized by multifocal geographic erosions, superficial corneal epithelial pigmentation, and corneal neovascularization. These clinical signs correlated with the dose of CPC given, whereas other drug doses remained unchanged. After euthanasia, routine histologic sections were stained with hematoxylin and eosin and with alcian blue periodic acid-Schiff for light microscopic evaluation. Ocular histopathologic abnormalities were limited to neovascularization and inflammatory infiltrate of the anterior corneal stroma and abnormal basal cell morphology, disorganization, thinning, and pigmentation of the corneal epithelium. The purpose of this communication is to describe the clinical and histopathologic evidence of CPC corneal toxicity in dogs.
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Affiliation(s)
- M Zarfoss
- Department of Surgical and Sciences, College of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA
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22
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Salek RM, Maguire ML, Bentley E, Rubtsov DV, Hough T, Cheeseman M, Nunez D, Sweatman BC, Haselden JN, Cox RD, Connor SC, Griffin JL. A metabolomic comparison of urinary changes in type 2 diabetes in mouse, rat, and human. Physiol Genomics 2006; 29:99-108. [PMID: 17190852 DOI: 10.1152/physiolgenomics.00194.2006] [Citation(s) in RCA: 314] [Impact Index Per Article: 17.4] [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: 11/22/2022] Open
Abstract
Type 2 diabetes mellitus is the result of a combination of impaired insulin secretion with reduced insulin sensitivity of target tissues. There are an estimated 150 million affected individuals worldwide, of whom a large proportion remains undiagnosed because of a lack of specific symptoms early in this disorder and inadequate diagnostics. In this study, NMR-based metabolomic analysis in conjunction with multivariate statistics was applied to examine the urinary metabolic changes in two rodent models of type 2 diabetes mellitus as well as unmedicated human sufferers. The db/db mouse and obese Zucker (fa/fa) rat have autosomal recessive defects in the leptin receptor gene, causing type 2 diabetes. 1H-NMR spectra of urine were used in conjunction with uni- and multivariate statistics to identify disease-related metabolic changes in these two animal models and human sufferers. This study demonstrates metabolic similarities between the three species examined, including metabolic responses associated with general systemic stress, changes in the TCA cycle, and perturbations in nucleotide metabolism and in methylamine metabolism. All three species demonstrated profound changes in nucleotide metabolism, including that of N-methylnicotinamide and N-methyl-2-pyridone-5-carboxamide, which may provide unique biomarkers for following type 2 diabetes mellitus progression.
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Affiliation(s)
- R M Salek
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
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23
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Kaplan KJ, O'Dell J, Dragovic LJ, McKeon MC, Bentley E, Telmet KL. An update on the Kevorkian-Reding 93 physician-assisted deaths in Michigan: is Kevorkian a savior, serial-killer or suicidal martyr? Omega (Westport) 2003; 40:209-29. [PMID: 12578006 DOI: 10.2190/gj87-uaxj-2fhw-t72d] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This report presents an update of the Kevorkian-Reding physician-assisted (or physician-aided) deaths to include the ninety-three publicly acknowledged cases as of November 25, 1998. These deaths are divided into ten distinct time phases. The following trends emerge. Over two-thirds of the decedents are women, the ratio of females to males varying widely with phase. The proportion of women seems to be the highest when Kevorkian is free to act as he wants and lowest when he seems to be acting under legal or political restraints. Based on autopsy results, only 29.0 percent of the cases are terminal, this percentage being higher among men (37.9%) than among women (25.4%). However, 66.7% of the decedents were disabled, no significant difference emerging between men and women. Further, five out of the six decedents showing no apparent anatomical sign of disease at autopsy were women. Over 80 percent of the physician-assisted deaths are cremated, approximately twice as high a proportion as that emerging for suicides in Michigan and four times as high as cremations occurring with regard to overall deaths. Finally, death by carbon monoxide decreases dramatically with time phase while the use of the contraption dubbed the "suicide machine" increases, suggesting an increasing routinization over time. Finally, during the ninth and tenth phases, Kevorkian's aims and his own suicidality emerge more clearly involving 1) harvesting organs and 2) threat of starving himself in prison if he is convicted. Phase 10 can be seen as an escalation from assisted death to overt euthanasia, repeating the same need for a demonstration (Thomas Youk) that was first exhibited in Phase I (Janet Adkins).
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Affiliation(s)
- K J Kaplan
- Michael Reese Hospital and Medical Center, 2929 S. Ellis Avenue, Chicago, IL 61616-3390, USA
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24
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Abstract
BACKGROUND The taking of multiple colorectal biopsies is in widespread use although there is little research into their benefit for the pathological diagnosis of inflammatory bowel disease. There is also still debate about appropriate morphological criteria for interpreting these biopsies. AIMS To determine the effect of single versus multiple biopsies on the accuracy of diagnosis and to study the accuracy and reproducibility of the different criteria used in the diagnosis of multiple biopsies by expert and non-expert pathologists. METHOD Thirteen expert and 12 non-expert international diagnostic histopathologists attended a workshop. Sixty cases with full follow up were viewed, blinded, in two rounds. Diagnoses were made on rectal biopsies and then full colonoscopic series. RESULTS Experts correctly identified 24% of Crohn's disease cases (non-experts, 12%) from the rectal biopsies. This improved to 64% (non-experts, 60%) with the full series. The accuracy of the diagnosis of ulcerative colitis also improved slightly with the full series from 64% to 74% overall. Experts had a similar (moderate) level of agreement and accuracy to non-experts. For Crohn's disease, the likelihood ratios (LR) for the most important individual features were 12.4 for granulomas and 3.3 for focal or patchy inflammation. Features favouring ulcerative colitis were diffuse crypt architectural irregularity (LR, 3.4), general crypt epithelial polymorphs (LR, 3.7), and reduced crypt numbers (LR, 2.9). CONCLUSIONS A full colonoscopic series gave more accurate diagnosis than a rectal biopsy. Accurate pathologists used the same evidence based criteria for multiple biopsies as for single biopsies.
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Affiliation(s)
- E Bentley
- Division of Pathology, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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25
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Kendrick D, Fielding K, Bentley E, Miller P, Kerslake R, Pringle M. The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomised (unblinded) controlled trial. Health Technol Assess 2002; 5:1-69. [PMID: 11701101 DOI: 10.3310/hta5300] [Citation(s) in RCA: 61] [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: 11/22/2022] Open
Abstract
OBJECTIVES To test the hypotheses that: (1) Lumbar spine radiography in primary care patients with low back pain is not associated with improved patient outcomes, including pain, disability, health status, sickness absence, reassurance, and patient satisfaction or belief in the value of radiography. (2) Lumbar spine radiography in primary care patients with low back pain is not associated with changes in patient management, including medication use, and the use of primary and secondary care services, physical therapies and complementary therapies. (3) Participants choosing their treatment group (i.e. radiography or no radiography) do not have better outcomes than those randomised to a treatment group. (4) Lumbar spine radiography is not cost-effective compared with usual care without lumbar spine radiography. DESIGN A randomised unblinded controlled trial. SETTING Seventy-three general practices in Nottingham, North Nottinghamshire, Southern Derbyshire, North Lincolnshire and North Leicestershire. Fifty-two practices recruited participants to the trial. SUBJECTS Randomised arm: 421 participants with low back pain, with median duration of 10 weeks. Patient preference arm: 55 participants with low back pain, with median duration of 11 weeks. INTERVENTION Lumbar spine radiography and usual care versus usual care without radiography. MAIN OUTCOME MEASURES Roland adaptation of the Sickness Impact Profile, visual analogue pain scale, health status scale, EuroQol, use of primary and secondary care services, and physical and complementary therapies, sickness absence, medication use, patient satisfaction, reassurance and belief in value of radiography at 3 and 9 months post-randomisation. RESULTS Participants randomised to receive an X-ray were more likely to report low back pain at 3 months (odds ratio (OR) = 1.56; 95% confidence interval (CI), 1.02 to 2.40) and had a lower overall health status score (p = 0.02). There were no differences in health or functional status at 9 months. A higher proportion of participants consulted the general practitioner (GP) in the 3 months following an X-ray (OR = 2.72; 95% CI, 1.80 to 4.10). There were no differences in use of any other services, medication use or sickness absence at 3 or 9 months. No serious spinal pathology was identified in either group. The commonest X-ray reports were of discovertebral degeneration and normal findings. Many patients did not perceive their information needs were met within the consultation. Satisfaction with care was greater in the group receiving radiography at 9 months. Participants randomised to receive an X-ray were not less worried, or more reassured about serious disease causing their low back pain. Satisfaction was associated with meeting participants' information needs and reduced belief in the necessity for investigations for low back pain, including X-rays and blood tests. In both groups, at 3 and 9 months 80% of participants would choose to have an X-ray if the choice was available. Participants in the patient preference group achieved marginally better outcomes than those randomised to a treatment group, but the clinical significance of these differences is unclear. Lumbar spine radiography was associated with a net economic loss at 3 and 9 months. CONCLUSIONS Lumbar spine radiography in primary care patients with low back pain of at least 6 weeks duration is not associated with improved functioning, severity of pain or overall health status, and is associated with an increase in GP workload. Participants receiving X-rays are more satisfied with their care, but are not less worried or more reassured about serious disease causing their low back pain. CONCLUSIONS - RECOMMENDATIONS FOR FURTHER RESEARCH: Further work is required to develop and test an educational package that educates patients and GPs about the utility of radiography and provides strategies for identifying and meeting the information needs of patients, and the needs of patients and GPs to be reassured about missing serious disease. Guidelines on the management of low back pain in primary care should be consistent about not recommending lumbar spine radiography in patients with low back pain in the absence of red flags for serious spinal pathology, even if the pain has persisted for at least 6 weeks.
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Affiliation(s)
- D Kendrick
- Division of General Practice, School of Community Health Sciences, Nottingham, UK
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26
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Abstract
An 8-week-old springer spaniel presented with a large central corneal opacity of the left globe, which was accompanied by cords of tissue spanning from the iris collarette to the posterior cornea. A posterior cortical cataract was noted in the right eye. At the owner's request the puppy was humanely destroyed, and a necropsy was performed. Upon sectioning the left globe in the vertical plane, a circle of pigmented strands of tissue was observed spanning the anterior chamber from the iris to the posterior aspect of the cornea. The right globe appeared normal when inspected grossly. Histologically, a membrane of pigmented tissue covered the posterior aspect of the broad central corneal leukoma of the left globe. This membrane and the cords traversing the anterior chamber were composed of vascular uveal tissue. Descemet's membrane and the corneal endothelium were reduced or absent in the zone of corneal opacity. Other than the changes associated with cataract, the right globe was histologically normal. The clinical and histological findings in the left globe were identical with those described for Peters>> anomaly in human beings.
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Affiliation(s)
- H L Swanson
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive West, Madison, WI 53706, USA
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27
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Bentley E, Abrams GA, Covitz D, Cook CS, Fischer CA, Hacker D, Stuhr CM, Reid TW, Murphy CJ. Morphology and immunohistochemistry of spontaneous chronic corneal epithelial defects (SCCED) in dogs. Invest Ophthalmol Vis Sci 2001; 42:2262-9. [PMID: 11527939] [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: 02/21/2023] Open
Abstract
PURPOSE To determine the morphologic features of the epithelium and extracellular matrix in spontaneous chronic corneal epithelial defects (SCCED) in dogs. METHODS Forty-eight superficial keratectomy specimens were obtained after confirmation of the presence of a superficial corneal erosion for longer than 3 weeks with no discernible underlying cause. Histologic samples were examined by light microscopy, scanning electron microscopy, and transmission electron microscopy. Immunolocalization of laminin, collagen IV, fibronectin, and collagen VII was performed. RESULTS Epithelial cells adjacent to the defect were poorly attached to the underlying extracellular matrix. A prominent superficial stromal hyaline acellular zone composed of collagen fibrils in the area of the erosion was present in most specimens. Samples exhibited a varying degree of fibroplasia, vascularization, and leukocytic infiltrate. Laminin, collagen IV, and collagen VII were usually either not present or were present only in discontinuous segments on the surface of the erosion. Fibronectin usually coated the surface of the erosion, either as a continuous sheet or in discontinuous segments. Transmission electron microscopy of 15 samples revealed that the basement membrane was either absent in the area of the erosion or was present only in discontinuous segments. Scanning electron microscopy of eight of nine samples confirmed the absence of continuous basement membrane. Epithelial and extracellular matrix components in the peripheral cornea appeared normal. CONCLUSIONS Most canine patients with spontaneous chronic corneal epithelial defects do not have a normal basement membrane structure in the region of the epithelial defect and have other abnormalities in the subjacent extracellular matrix that may reflect a part of the underlying pathophysiology of chronic and recurrent erosions.
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Affiliation(s)
- E Bentley
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 53706, USA
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Murphy CJ, Marfurt CF, McDermott A, Bentley E, Abrams GA, Reid TW, Campbell S. Spontaneous chronic corneal epithelial defects (SCCED) in dogs: clinical features, innervation, and effect of topical SP, with or without IGF-1. Invest Ophthalmol Vis Sci 2001; 42:2252-61. [PMID: 11527938] [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] Open
Abstract
PURPOSE To delineate the clinical features and alterations in innervation and substance P (SP) content in spontaneous chronic corneal epithelial defects (SCCED) in dogs and to conduct a preliminary investigation evaluating the efficacy of topical SP, with or without insulin-like growth factor (IGF)-1, in the treatment of this disorder. METHODS Complete ophthalmic examinations, including Cochet-Bonnet aesthesiometry, were performed in 45 canine patients that had spontaneous corneal epithelial defects of at least 3 weeks' duration and with no identifiable cause. Eighteen patients had superficial keratectomies performed, and the corneal nerves were labeled immunohistochemically with antibodies against protein gene product (PGP)-9.5, SP, vasoactive intestinal peptide (VIP), and tyrosine hydroxylase (TH). Relative fiber densities were assessed qualitatively and quantitatively. Corneal epithelial cell and tear SP contents were determined in affected and normal dogs by an enzyme immunoassay. A preliminary open-label treatment trial of topical SP, with and without IGF-1, was conducted in 21 dogs. RESULTS The duration of the erosion before admittance into the study was a mean of 9.22 weeks (range, 3-52). The average patient was middle aged (mean, 9.25 +/- 1.85 years [SD]); no sex predisposition of the disease was identified. Boxers, golden retrievers, and keeshonds were overrepresented when compared with the normal hospital population. Corneal sensation was normal. Marked alterations in corneal innervation were identified in affected dogs with abnormal increased SP and calcitonin gene-related peptide (CGRP)-immunoreactive nerve plexuses identified surrounding the periphery of the epithelial defect. The SP content of epithelial cells surrounding the defect increased, whereas the tear SP content remained unchanged. Of the canine patients treated with SP, with or without IGF-1, 70% to 75% had complete healing of the defect. CONCLUSIONS This idiopathic spontaneous corneal disease in dogs shares clinical features with chronic epithelial defects in humans. The presence of marked alterations in peptidergic innervation and positive response to topical therapy with SP suggest that SP plays a critical role in corneal wound-healing processes.
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Affiliation(s)
- C J Murphy
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 53706, USA.
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Smith LJ, Shih A, Bentley E, Miller PE. Morphine or lidocaine infusion as a pre-emptive analgesic for intraocular surgery in dogs. Vet Anaesth Analg 2001; 28:97-98. [PMID: 28404350 DOI: 10.1046/j.1467-2987.2001.temp.doc.x-i12] [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: 11/20/2022]
Affiliation(s)
- L J Smith
- University of Wisconsin, Madison, Wisconsin, USA
| | - A Shih
- University of Wisconsin, Madison, Wisconsin, USA
| | - E Bentley
- University of Wisconsin, Madison, Wisconsin, USA
| | - P E Miller
- University of Wisconsin, Madison, Wisconsin, USA
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Kendrick D, Fielding K, Bentley E, Kerslake R, Miller P, Pringle M. Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ 2001; 322:400-5. [PMID: 11179160 PMCID: PMC26570 DOI: 10.1136/bmj.322.7283.400] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To test the hypothesis that radiography of the lumbar spine in patients with low back pain is not associated with improved clinical outcomes or satisfaction with care. DESIGN Randomised unblinded controlled trial. SETTING 73 general practices in Nottingham, north Nottinghamshire, southern Derbyshire, north Lincolnshire, and north Leicestershire. 52 practices recruited participants to the trial. SUBJECTS 421 patients with low back pain of a median duration of 10 weeks. INTERVENTION Radiography of the lumbar spine. MAIN OUTCOME MEASURES Roland adaptation of the sickness impact profile, visual analogue scale for pain, health status, EuroQol, satisfaction with care, use of primary and secondary care services, and reporting of low back pain at three and nine months after randomisation. RESULTS The intervention group were more likely to report low back pain at three months (relative risk 1.26, 95% confidence interval 1.00 to 1.60) and had a lower overall health status score and borderline higher Roland and pain scores. A higher proportion of participants consulted their doctor in the three months after radiography (1.62, 1.33 to 1.97). Satisfaction with care was greater in the group receiving radiography at nine but not three months after randomisation. Overall, 80% of participants in both groups at three and nine months would have radiography if the choice was available. An abnormal finding on radiography made no difference to the outcome, as measured by the Roland score. CONCLUSIONS Radiography of the lumbar spine in primary care patients with low back pain of at least six weeks' duration is not associated with improved patient functioning, severity of pain, or overall health status but is associated with an increase in doctor workload. Guidelines on the management of low back pain in primary care should be consistent about not recommending radiography of the lumbar spine in patients with low back pain in the absence of indicators for serious spinal disease, even if it has persisted for at least six weeks. Patients receiving radiography are more satisfied with the care they received. The challenge for primary care is to increase satisfaction without recourse to radiography.
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Affiliation(s)
- D Kendrick
- Division of General Practice, School of Community Health Sciences, University Park, Nottingham NG7 2RD.
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31
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Campbell SM, Roland MO, Bentley E, Dowell J, Hassall K, Pooley JE, Price H. Research capacity in UK primary care. Br J Gen Pract 1999; 49:967-70. [PMID: 10824340 PMCID: PMC1313581] [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: 02/16/2023] Open
Abstract
BACKGROUND Moves towards a 'primary care-led' National Health Service (NHS) and towards evidence-based care have focused attention upon the need for evaluative research relating to the structure, delivery, and outcome of primary health care in the United Kingdom (UK). This paper describes work carried out to inform the Department of Health Committee on Research and Development (R&D) in Primary Care (Mant Committee). AIM To describe the extent and nature of current research capacity in primary care in the UK and to identify future needs and priorities. METHOD Funding data were requested from NHS National Programmes, NHS Executive Regional Offices, the Department of Health (DoH), Scottish Office, Medical Research Council, and some charities. A postal survey was sent to relevant academic departments, and appropriate academic journals were reviewed from 1992 to 1996. In addition, interviews were conducted with academic and professional leaders in primary care. RESULTS Overall, total annual primary care R&D spend by the NHS and the DoH was found to be 7% of the total spend, although annual primary care R&D spend differs according to funding source. Journals relating to primary care do not, with some notable exceptions (e.g. British Journal of General Practice, Family Practice), have high academic status, and research into primary care by academic departments is, with perhaps the exception of general practice, on a small scale. The research base of most primary care professions is minimal, and significant barriers were identified that will need addressing if research capacity is to be expanded. CONCLUSION There are strong arguments for the development of primary care research in a 'primary care-led' NHS in the UK. However, dashes for growth or attempts to expand capacity from the present infrastructure must be avoided in favour of endeavours to foster a sustainable, long-term research infrastructure capable of responding meaningfully to identified needs.
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Affiliation(s)
- S M Campbell
- National Primary Care Research and Development Centre, University of Manchester
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Bentley E, Miller PE, Murphy CJ, Schoster JV. Combined cycloablation and gonioimplantation for treatment of glaucoma in dogs: 18 cases (1992-1998). J Am Vet Med Assoc 1999; 215:1469-72. [PMID: 10579044] [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
OBJECTIVE To evaluate a combined cycloablative and gonioimplantation technique for treatment of glaucoma in dogs. DESIGN Retrospective study. ANIMALS 18 adult dogs with glaucoma. PROCEDURE Medical records of dogs that received a valved gonioimplant and a cyclodestructive procedure (cyclocryoablation or diode laser cyclophotocoagulation) during a 6-year period were reviewed. Retention of vision and intraocular pressure control were assessed, as well as number and nature of complications. RESULTS 19 eyes of 18 dogs received a valved gonioimplant and either cyclocryoablation (n = 12) or diode laser cyclophotocoagulation (7). At > or = 1 year after surgery, 11 of 19 eyes had vision and 14 of 19 eyes had intraocular pressure < 25 mm Hg. Two dogs (2 eyes) were lost to follow-up 3 and 6 months after surgery. Despite the alternative route for aqueous humor flow created by the gonioimplant, 7 eyes had increased intraocular pressure (27 to 61 mm Hg) < 24 hours after surgery. Other complications included excessive intraocular fibrin, focal retinal detachment, corneal ulcer, retinal hemorrhage, cataract, and implant migration. CONCLUSIONS AND CLINICAL RELEVANCE Combined cycloablation and gonioimplantation appears to be a promising technique for retention of vision and control of intraocular pressure in dogs with glaucoma.
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Affiliation(s)
- E Bentley
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison 53706-1102, USA
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Jones JM, Bentley E, Meisler MH, Darling SM. Genetic mapping of the voltage-gated shaker potassium channel beta subunit Kcnab1 to mouse chromosome 3. Mamm Genome 1998; 9:260. [PMID: 9501317 DOI: 10.1007/s003359900740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- J M Jones
- Department of Human Genetics, University of Michigan, Ann Arbor 48109-0618, USA
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Abstract
Loci conferring susceptibility to schizophrenia, coeliac disease, and orofacial clefting have been assigned to the 6p23-p25 region of human chromosome 6. To facilitate the identification of candidate genes we have sublocalized and ordered 39 ESTs assigned to this interval by radiation hybrid mapping. This was achieved by generating PAC contigs containing the ESTs, genetic markers, and random STSs. For full integration into previously published data a single YAC contig spanning 6p23-p25 was used to unambiguously order the PAC contigs and ESTs along the chromosome. The majority of the ESTs (31/39) were positioned in the 6p23-p24 interval at the proximal half of the map, and of these 8 are located within a single PAC clone. The order of known genes in this region is cen-CD83-ZNF40-EDN1-(GCNT2, CAPZB)-TFAP2-BMP6-DSP-tel.
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Affiliation(s)
- M G Olavesen
- Division of Medical Molecular Genetics, UMDS, Guy's Hospital, London, United Kingdom
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36
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Bentley E, Mackie I, Fuller SS. The rationale, organisation and evaluation of a campaign to increase the use of sugar-free paediatric medicines. Community Dent Health 1997; 14:36-40. [PMID: 9114548] [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: 02/04/2023]
Abstract
OBJECTIVE To conduct and evaluate a dental health education campaign to encourage the use of sugar-free rather than sugar-containing medicines. DESIGN Meetings were organised for general medical practitioners, pharmacists and health visitors where the campaign was explained and discussed. Leaflets were given to parents by the health professionals. The campaign targeted the use of children's medicines from several aspects, namely when recommended, prescribed, sold and used. SETTING The campaign was conducted in the North West Region. SUBJECTS The campaign was directed at parents of young children, and health professionals, namely, general medical practitioners, pharmacists and health visitors. OUTCOME MEASURES Evaluation was by means of questionnaires, sales figures and prescriptions of medicines. RESULTS There was an increase in the proportion of sugar-free paracetamol prescribed in five out of six districts. The frequency of sugar intakes as an important cause of dental caries was not understood by many health professionals. CONCLUSIONS Continued education for health professionals is needed in order to show the importance of the frequency of sugar intakes and to dispel some prevalent dental health misconceptions.
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Affiliation(s)
- E Bentley
- Department of Dental Medicine and Surgery, University Dental Hospital of Manchester, UK
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Richardson JD, Cross T, Lee D, Shively E, Bentley E, Weiss D, Brock K, Petrocelli J, Miller FB, Polk HC. Impact of level III verification on trauma admissions and transfer: comparisons of two rural hospitals. J Trauma 1997; 42:498-502; discussion 502-3. [PMID: 9095118 DOI: 10.1097/00005373-199703000-00018] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To study the impact of Level III verification and other changes in rural hospitals on trauma delivery and to examine factors affecting transfer to a Level I trauma center. SETTING Two rural Kentucky hospitals and a Level I trauma center. METHOD OF REVIEW Concurrent review of all trauma patients in 1988 and re-review of the same parameters in 1995. FINDINGS In 1988, both hospitals had similar management practices in trauma care. A significant number of patients were transferred for (a) patient choice, (b) serious and/or multiple trauma, (c) specialty care in non-life threatening situations, and (d) to exclude a potentially serious problem seen on radiologic evaluation (usually questionable cervical spine or widened mediastinum). Both hospitals had major changes in trauma delivery. One hospital received Level III verification, and the other had changes that lessened the general surgeon's involvement with initial evaluation and treatment. A re-review in 1995 disclosed major changes at both institutions. Transfers to exclude radiologic abnormalities had virtually disappeared. The Level III status had increased the surgical involvement in that hospital; there was actually an increase in patients transferred to the Level I hospital and an increase in patient acuity. More operations were performed locally, and the care was more efficiently delivered. The other hospital had a large increase in transfers and decreased admissions locally as general surgical involvement decreased. CONCLUSIONS The factors related to patient transfer for trauma care are complex and require careful elucidation to improve care. The development of a Level III trauma service appeared to increase the number of seriously injured patients treated in the rural hospital and the efficiency of the care delivered.
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Affiliation(s)
- J D Richardson
- Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA
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Bentley E, Inglis JD, Gossler A, Stephenson DA, Darling SM. D5Ucl1 and Els1 are closely linked to W on mouse chromosome 5 but lie distal to the W19H deletion. Mamm Genome 1996; 7:691-3. [PMID: 8703124 DOI: 10.1007/s003359900207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- E Bentley
- Department of Anatomy and Developmental Biology, University College London, Gower Street, London WC1E 6BT, UK
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39
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Affiliation(s)
- E Bentley
- Department of Dental Medicine and Surgery, University Dental Hospital of Manchester
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Abstract
To facilitate the characterization of genetic expression in human adult testis, expressed sequence tag analysis of cDNAs from this tissue has been undertaken. Over 180 kb of DNA sequence has been determined and used to search the GenBank database. The results from the first 359 cDNA clones analyzed indicate that the sequences could be sorted into several categories with a high proportion being novel. Twenty-five clones (7%) showed 100% identity with human genes, 11 (3%) with prokaryotic sequences, 21 (5%) with between 60 and 95% similarity to human genes, 27 (8%) with between 60 and 95% similarity to genes from other species, and 33 (9%) with matches to human repeat sequences. Two hundred forty-two (67%) showed no significant matches and thus are likely to represent novel transcripts. In comparison to similar studies on human brain tissue and a hepatoma cell line, the findings indicate that the matches in the testis transcript population appear to be identifying a different spectrum of gene sequences.
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Affiliation(s)
- N A Affara
- Department of Pathology, University of Cambridge, United Kingdom
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41
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Mackie IC, Bentley E. Sugar-containing or sugar-free paediatric medicines: does it really matter? Dent Update 1994; 21:192-4. [PMID: 7875348] [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: 01/27/2023]
Abstract
The long-term use of sugar-containing medicines has long been considered a cause of dental caries in children. Several studies have examined the role of prescription medicines in dental decay, but what about those that can be bought over the counter and that are used infrequently? In this paper practitioners are advised on how to encourage parents to use sugar-free medicines for the sake of their children's teeth.
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Affiliation(s)
- I C Mackie
- University of Manchester Dental Hospital, UK
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42
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Bentley E. Dental health. I. Views about preventive dental care for infants. Health Visit 1994; 67:88-89. [PMID: 8194971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A study to investigate attitudes of health visitors and parents to preventive dental health care for young children revealed that while the majority of parents agreed early dental visits were important, few had taken their child to the dentist before the age of one year. Where dental health is poor it is vital that the health visitor continues to give parents appropriate dietary advice and to recommend early visits to the dentist, writes Elaine Bentley.
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Foster K, Crossey PA, Cairns P, Hetherington JW, Richards FM, Jones MH, Bentley E, Affara NA, Ferguson-Smith MA, Maher ER. Molecular genetic investigation of sporadic renal cell carcinoma: analysis of allele loss on chromosomes 3p, 5q, 11p, 17 and 22. Br J Cancer 1994; 69:230-4. [PMID: 8297719 PMCID: PMC1968700 DOI: 10.1038/bjc.1994.44] [Citation(s) in RCA: 81] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
To investigate the role of tumour-suppressor genes on the short arm of chromosome 3 in the mechanism of tumorigenesis in non-familial renal cell carcinoma, we analysed 55 paired blood-tumour DNA samples for allele loss on chromosome 3p and in the region of known or putative tumour-suppressor genes on chromosomes 5, 11, 17 and 22. Sixty-four per cent (35/55) of informative tumours showed loss of heterozygosity (LOH) of at least one locus on the short arm of chromosome 3, compared with only 13% at the p53 tumour-suppressor gene and 6% at 17q21. LOH at chromosome 5q21 and 22q was uncommon (2-3%). Detailed analysis of the regions of LOH on chromosome 3p suggested that, in addition to the VHL gene in chromosome 3p25-p26, mutations in one or more tumour-suppressor genes in chromosome 3p13-p24 may be involved in the pathogenesis of sporadic renal cell carcinoma (RCC). We also confirmed previous suggestions that chromosome 3p allele loss is not a feature of papillary RCC (P < 0.05).
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Affiliation(s)
- K Foster
- Department of Pathology, Cambridge University, UK
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Crossey PA, Foster K, Richards FM, Phipps ME, Latif F, Tory K, Jones MH, Bentley E, Kumar R, Lerman MI. Molecular genetic investigations of the mechanism of tumourigenesis in von Hippel-Lindau disease: analysis of allele loss in VHL tumours. Hum Genet 1994; 93:53-8. [PMID: 8270255 DOI: 10.1007/bf00218913] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.5] [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: 01/29/2023]
Abstract
Von Hippel-Lindau (VHL) disease is a dominantly inherited familial cancer syndrome characterised by the development of retinal and central nervous system haemangioblastomas, renal cell carcinoma (RCC), phaeochromocytoma and pancreatic tumours. The VHL disease gene maps to chromosome 3p25-p26. To investigate the mechanism of tumourigenesis in VHL disease, we analysed 24 paired blood/tumour DNA samples from 20 VHL patients for allele loss on chromosome 3p and in the region of tumour suppressor genes on chromosomes 5, 11, 13, 17 and 22. Nine out of 24 tumours showed loss of heterozygosity (LOH) at at least one locus on chromosome 3p and in each case the LOH included the region to which the VHL gene has been mapped. Chromosome 3p allele loss was found in four tumour types (RCC, haemangioblastoma, phaeochromocytoma and pancreatic tumour) suggesting a common mechanism of tumourigenesis in all types of tumour in VHL disease. The smallest region of overlap was between D3S1038 and D3S18, a region that corresponds to the target region for the VHL gene from genetic linkage studies. The parental origin of the chromosome 3p25-p26 allele loss could be determined in seven tumours from seven familial cases; in each tumour, the allele lost had been inherited from the unaffected parent. Our results suggest that the VHL disease gene functions as a recessive tumour suppressor gene and that inactivation of both alleles of the VHL gene is the critical event in the pathogenesis of VHL neoplasms. Four VHL tumours showed LOH on other chromosomes (5q21, 13q, 17q) indicating that homozygous VHL gene mutations may be required but may not be sufficient for tumourigenesis in VHL disease.
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Affiliation(s)
- P A Crossey
- Cambridge University Department of Pathology, UK
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Maher ER, Bentley E, Payne SJ, Latif F, Richards FM, Chiano M, Hosoe S, Yates JR, Linehan M, Barton DE. Presymptomatic diagnosis of von Hippel-Lindau disease with flanking DNA markers. J Med Genet 1993; 29:902-5. [PMID: 1362224 PMCID: PMC1016210 DOI: 10.1136/jmg.29.12.902] [Citation(s) in RCA: 20] [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: 11/04/2022]
Abstract
Von Hippel-Lindau (VHL) disease is a dominantly inherited cancer syndrome characterised by the development of retinal, cerebellar, and spinal haemangioblastomas, renal cell carcinoma, and phaeochromocytoma. The gene for VHL disease has been mapped to chromosome 3p25-p26 and flanking markers identified. We have investigated the usefulness of currently available DNA markers for the presymptomatic diagnosis of VHL disease. In the first part of this investigation, genetic linkage data from two previously published studies were updated and reanalysed to provide accurate estimates of sex specific recombination fractions and to confirm that there is no evidence of locus heterogeneity. In the second part of this study, 14 families containing 23 asymptomatic subjects at 50% prior risk of VHL disease were investigated with closely linked DNA markers (RAF1, D3S18, D3S732). Seventeen subjects were informative with one or more markers, six of whom were informative at markers flanking the VHL disease gene. By combining age related and DNA based risk information the carrier risk for 11 subjects was reduced to < 2%.
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Affiliation(s)
- E R Maher
- Cambridge University, Department of Pathology
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Sargent CA, Affara NA, Bentley E, Pelmear A, Bailey DM, Davey P, Dow D, Leversha M, Aplin H, Besley GT. Cloning of the X-linked glycerol kinase deficiency gene and its identification by sequence comparison to the Bacillus subtilis homologue. Hum Mol Genet 1993; 2:97-106. [PMID: 8499912 DOI: 10.1093/hmg/2.2.97] [Citation(s) in RCA: 26] [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: 01/31/2023] Open
Abstract
cDNA clones from a human adult testis cDNA library were isolated and sequenced as part of a programme to produce expressed sequence tags (ESTs). ESTs were used routinely to search DNA and protein sequence databases. One clone (142) showed 60% identity to the Bacillus subtilis glycerol kinase gene at both the DNA and amino acid sequence levels. Analysis of DNA from somatic cell hybrids carrying deleted X chromosomes, has shown that clone 142 detects homologous sequences between Xp21.2-p22.1 (the interval containing the locus responsible for glycerol kinase deficiency--GKD). These sequences are deleted in two patients with GKD. Clone 142 also detects homologous sequences on Xq and at several autosomal loci. The sequences of clone 142 and two further cDNA clones isolated from a human foetal brain cDNA library are presented.
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Affiliation(s)
- C A Sargent
- Cambridge University, Department of Pathology, UK
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Maher ER, Bentley E, Yates JR, Latif F, Lerman M, Zbar B, Affara NA, Ferguson-Smith MA. Mapping of the von Hippel-Lindau disease locus to a small region of chromosome 3p by genetic linkage analysis. Genomics 1991; 10:957-60. [PMID: 1680799 DOI: 10.1016/0888-7543(91)90185-h] [Citation(s) in RCA: 59] [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: 12/28/2022]
Abstract
Genetic linkage studies were performed in 22 families with von Hippel-Lindau (VHL) disease by using polymorphic DNA markers from distal chromosome 3p. Linkage was detected between VHL disease and the markers D3S18 (Zmax = 6.6 at theta = 0.0, confidence interval (CI) 0.00-0.06), RAF1 (Zmax = 5.9 at theta = 0.06, CI 0.01-0.16), and THRB (Zmax 3.4 at theta = 0.11). Multipoint linkage analysis localized the VHL disease gene within a small region (approximately 8 cM) of 3p25-p26 between RAF1 and (D3S191, D3S225) and close to the D3S18 locus. There was no evidence of locus heterogeneity, and families with and without pheochromocytoma showed linkage to D3S18. The identification of DNA markers flanking the VHL disease gene allows reliable presymptomatic and prenatal diagnosis to be offered to informative families.
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Affiliation(s)
- E R Maher
- Department of Pathology, University of Cambridge, United Kingdom
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Maher ER, Bentley E, Yates JR, Barton D, Jennings A, Fellows IW, Ponder MA, Ponder BA, Benjamin C, Harris R. Mapping of von Hippel-Lindau disease to chromosome 3p confirmed by genetic linkage analysis. J Neurol Sci 1990; 100:27-30. [PMID: 1982450 DOI: 10.1016/0022-510x(90)90008-b] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Genetic linkage studies were performed in 12 British families with von Hippel-Lindau disease (VHL) using RFLPs at three loci (DNF15S2, THRB, RAF1) on the short arm of chromosome 3. Linkage was detected between the VHL disease locus and RAF1 with a maximum lod score of 3.88 at a recombination fraction of 0.05 (confidence interval 0.003-0.18). Multipoint linkage analysis suggested that the most likely location for the VHL disease locus is telomeric to THRB. These results confirm earlier reports localizing the VHL gene to the short arm of chromosome 3, and provide no evidence for genetic heterogeneity.
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Affiliation(s)
- E R Maher
- Department of Pathology, Cambridge University, U.K
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Bentley E, Chandrasoma P, Radin R, Cohen H. Generalized juvenile polyposis with carcinoma. Am J Gastroenterol 1989; 84:1456-9. [PMID: 2683746] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Generalized juvenile polyposis usually is not associated with an increased risk for gastrointestinal carcinoma. A subgroup of patients, however, have juvenile polyps with adenomatous features. A case report of juvenile polyposis, together with adenocarcinoma of the colon and review of the literature, are presented to emphasize the potential for malignancy in this subgroup of patients and to guide appropriate evaluation.
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Affiliation(s)
- E Bentley
- Department of Medicine, University of Southern California School of Medicine, Los Angeles County-USC Medical Center
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Abstract
This study assesses the effect of oral iron therapy on the upper gastrointestinal tract and fecal occult blood testing. Fourteen healthy volunteers completed a checklist of gastrointestinal symptoms, underwent endoscopy and biopsy of the stomach and duodenum, and supplied a fresh stool sample for Hemoccult and HemoQuant testing. They then took ferrous sulfate 325 mg per os tid for two weeks and had the same evaluation repeated. Gastrointestinal symptoms were rated by the patients on a scale of 0-3, endoscopic findings were numerically scored (0-4), and the biopsies were graded blindly. Thirteen other healthy volunteers took ferrous sulfate 325 mg per os tid for one week and had Hemoccult testing of stool at days 0 and 7. All subjects developed dark stools, and significant nausea and diarrhea were noted (0.1 +/- 0.1 to 0.9 +/- 0.3, P less than 0.05 for both symptoms). Only 1/27 had a questionably trace-positive Hemoccult test (two observers disagreed) and no significant difference was seen in HemoQuant testing (1.4 +/- 0.5 to 1.8 +/- 0.7 mg Hb/g). A significant increase was seen in endoscopic abnormalities in the stomach (0.1 +/- 0.1 to 1.5 +/- 0.3, P = 0.003), consisting of erythema, small areas of subepithelial hemorrhage, and, in two subjects, erosions. Biopsies showed no significant change after iron therapy. We conclude that (1) oral ferrous sulfate rarely causes Hemoccult-positive stools, and patients with positive Hemoccult tests on iron therapy require further evaluation; and (2) oral iron may cause mild endoscopic abnormalities in the stomach which are of uncertain clinical significance.
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Affiliation(s)
- L A Laine
- Department of Medicine and Pathology, LAC-USC Medical Center-USC School of Medicine 90033
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