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Fresquet M, Rhoden SJ, Jowitt TA, McKenzie EA, Roberts I, Lennon R, Brenchley PE. Autoantigens PLA2R and THSD7A in membranous nephropathy share a common epitope motif in the N-terminal domain. J Autoimmun 2019; 106:102308. [PMID: 31395435 PMCID: PMC7471840 DOI: 10.1016/j.jaut.2019.102308] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 12/11/2022]
Abstract
Patients with membranous nephropathy have autoantibodies against PLA2R (up to 80%), or THSD7A (up to 2%). We previously described the immunodominant epitope within PLA2R but epitopes in THSD7A are still unknown. To find anti-THSD7A sera for this study, we screened 1843 sera from biopsy-proven MN patients by ELISA and identified 22 sera as anti-THSD7A positive representing 1.2% of MN cases. Anti-THSD7A positive sera were further characterized by western blotting and slot blotting on THSD7A protein fragments and peptides. Real time interaction analyses and antibodies off-rate could be reliably determined using bio-layer interferometry. A signature motif in the N-terminal domain of THSD7A (T28mer) with sequence homology to the major PLA2R epitope (P28mer) was identified. B-cell epitope prediction analysis and homology modelling revealed this sequence to be antigenic and surface available suggesting it is accessible for the antibody to bind. All ten selected sera bound to the T28mer confirming this sequence as a dominant epitope in THSD7A. Reactivity to this sequence was lost following kallikrein protease cleavage within the predicted epitope. Importantly, cross-reactivity of both PLA2R and THSD7A autoantibodies was observed at the peptide but not the protein level. We propose that this common motif shared by both autoantigens could be an epitope involved in the initial B-cell triggering event in MN.
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Affiliation(s)
- M Fresquet
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - S J Rhoden
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - T A Jowitt
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - E A McKenzie
- Manchester Institute of Biotechnology, University of Manchester, UK
| | | | - R Lennon
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - P E Brenchley
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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Lo Ten Foe J, Kwee M*, Rooimans M, Oostra A, Veerman A, van Weel M, Pauli R, Shahidi N, Dokal I, Roberts I, Altay C, Gluckman E, Gibson R, Mathew C, Arwert F, Joenje H. Somatic Mosaicism in Fanconi Anemia: Molecular Basis and Clinical Significance. Eur J Hum Genet 2019. [DOI: 10.1159/000484749] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Aboagye E, Alger K, Archibald S, Bakar N, Barton N, Bergare J, Bloom J, Bragg R, Burke B, Burns M, Carroll L, Calatayud D, Cawthorne C, Cortezon-Tamarit F, Crean C, Crump M, Dilworth J, Domarkas J, Duckett S, Eggleston I, Elmore C, van Es E, Fekete M, Goodwin M, Green G, Grönberg G, Hayes C, Hayes M, Hollis S, Hueting R, Ivanov P, Johnston G, Kerr W, Kohler A, Knox G, Lawrie K, Lee R, Lewis W, Lin B, Lockley W, López-Torres E, Lv K, Maddocks S, Marsh B, Mendiola A, Mirabello V, Miranda C, Norcott P, O'Hagan D, Olaru A, Pascu S, Rayner P, Read D, Ridge K, Ritter T, Roberts I, Samuri N, Sarpaki S, Somers D, Taylor R, Tuttle T, Varcoe J, Willis C. Abstracts of the 25th
International Isotope Society (UK Group) symposium: Synthesis and applications of labelled compounds 2016. J Labelled Comp Radiopharm 2017. [DOI: 10.1002/jlcr.3523] [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: 11/07/2022]
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Sanchez Ramon A, Lopez Galvez M, Ortega Alonso E, Hernandez Rodriguez R, Portilla Blanco R, Roberts I, Zarzosa Martin E. Influence of metabolic control in patients with refractory diabetic macular edema treated with Ozurdex. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.01566] [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: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - I. Roberts
- Ophthalmology; Hospital Universitario de Burgos; Burgos Spain
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Ker K, Shakur H, Roberts I. Does tranexamic acid prevent postpartum haemorrhage? A systematic review of randomised controlled trials. BJOG 2016; 123:1745-52. [DOI: 10.1111/1471-0528.14267] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2016] [Indexed: 11/26/2022]
Affiliation(s)
- K Ker
- Clinical Trials Unit; London School of Hygiene & Tropical Medicine; London UK
| | - H Shakur
- Clinical Trials Unit; London School of Hygiene & Tropical Medicine; London UK
| | - I Roberts
- Clinical Trials Unit; London School of Hygiene & Tropical Medicine; London UK
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Tetali S, Edwards P, Murthy GVS, Roberts I. Road traffic injuries to children during the school commute in Hyderabad, India: cross-sectional survey. Inj Prev 2016; 22:171-5. [PMID: 26701985 PMCID: PMC4893121 DOI: 10.1136/injuryprev-2015-041854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/17/2015] [Accepted: 11/24/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND India is motorising rapidly. With increasing motorisation, road traffic injuries are predicted to increase. A third of a billion children travel to school every day in India, but little is known about children's safety during the school commute. We investigated road traffic injury to children during school journeys. METHODS We conducted a cross-sectional survey in Hyderabad using a two-stage stratified cluster sampling design. We used school travel questionnaires to record any road injury in the past 12 months that resulted in at least 1 day of school missed or required treatment by a doctor or nurse. We estimated the prevalence of road injury by usual mode of travel and distance to school. RESULTS The total sample was 5842 children, of whom 5789 (99.1%) children answered the question on road injury. The overall prevalence of self-reported road injury in the last 12 months during school journeys was 17% (95% CI 12.9% to 21.7%). A higher proportion of boys (25%) reported a road injury than girls (11%). There was a strong association between road injury, travel mode and distance to school. Children who cycled to school were more likely to be injured compared with children who walked (OR 1.5; 95% CI 1.2 to 2.0). Travel by school bus was safer than walking (OR 0.5; 95% CI 0.3 to 0.9). CONCLUSIONS A sixth of the children reported a road traffic injury in the past 12 months during school journeys in Hyderabad. Injury prevention interventions should focus on making walking and cycling safer for children.
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Affiliation(s)
- Shailaja Tetali
- Indian Instituteof Public Health, Hyderabad, India
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - P Edwards
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - G V S Murthy
- Indian Instituteof Public Health, Hyderabad, India
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - I Roberts
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Tamblyn JA, Norton A, Spurgeon L, Donovan V, Bedford Russell A, Bonnici J, Perkins K, Vyas P, Roberts I, Kilby MD. Prenatal therapy in transient abnormal myelopoiesis: a systematic review. Arch Dis Child Fetal Neonatal Ed 2016; 101:F67-71. [PMID: 25956670 DOI: 10.1136/archdischild-2014-308004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/15/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review current evidence regarding prenatal diagnosis and management of transient abnormal myelopoiesis (TAM) in fetuses with trisomy 21. A novel case of GATA1-positive TAM, in which following serial in utero blood transfusion clinical improvement and postnatal remission were observed, is included. SEARCH STRATEGY AND DATA COLLECTION A systematic search of electronic databases (inception to October 2014) and reference lists, hand-searching of journals and expert contact. All confirmed cases of prenatal TAM were included for analysis. Data on study characteristics, design and quality were obtained. RESULTS Of 73 potentially relevant citations identified, 22 studies were included, describing 39 fetuses. All studies included comprised single case or small cohort studies; overall quality was 'very low'. Fetal/neonatal outcome was poor; 12 stillbirths (30.8%), 4 neonatal deaths (10.2%) and 7 infant deaths (17.9%). In two cases, the pregnancy was terminated (5.1%). TAM was primarily detected in the third trimester (79.4%), and in 14 a retrospective diagnosis was made postpartum. Ultrasound features indicative of TAM included hepatomegaly±splenomegaly (79.5%), hydrops fetalis (30.8%), pericardial effusion (23.1%) and aberrant liquor volume (15.4%). When performed, liver function tests were abnormal in 91.6% of cases. CONCLUSIONS Prenatal TAM presents a challenging diagnosis, and prognosis is poor, with consistently high mortality. A low threshold to measure haematological and biochemical markers is advised when clinical features typical of TAM are detected in the context of trisomy 21. Larger prospective studies are warranted to accurately ascertain the role of GATA1 analysis and potential value of prenatal therapy.
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Affiliation(s)
- J A Tamblyn
- Centre for Women's & Children's Health, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Norton
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Spurgeon
- Centre for Women's & Children's Health, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - V Donovan
- Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, UK
| | - A Bedford Russell
- Department of Neonatal Paediatrics, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, UK
| | - J Bonnici
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - K Perkins
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - P Vyas
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - I Roberts
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - M D Kilby
- Centre for Women's & Children's Health, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, UK
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Barbour SJ, Espino-Hernandez G, Reich HN, Coppo R, Roberts IS, Feehally J, Herzenberg AM, Cattran DC, Bavbek N, Cook T, Troyanov S, Alpers C, Amore A, Barratt J, Berthoux F, Bonsib S, Bruijn J, D’Agati V, D’Amico G, Emancipator S, Emmal F, Ferrario F, Fervenza F, Florquin S, Fogo A, Geddes C, Groene H, Haas M, Hill P, Hogg R, Hsu S, Hunley T, Hladunewich M, Jennette C, Joh K, Julian B, Kawamura T, Lai F, Leung C, Li L, Li P, Liu Z, Massat A, Mackinnon B, Mezzano S, Schena F, Tomino Y, Walker P, Wang H, Weening J, Yoshikawa N, Zhang H, Coppo R, Troyanov S, Cattran D, Cook H, Feehally J, Roberts I, Tesar V, Maixnerova D, Lundberg S, Gesualdo L, Emma F, Fuiano L, Beltrame G, Rollino C, RC, Amore A, Camilla R, Peruzzi L, Praga M, Feriozzi S, Polci R, Segoloni G, Colla L, Pani A, Angioi A, Piras L, JF, Cancarini G, Ravera S, Durlik M, Moggia E, Ballarin J, Di Giulio S, Pugliese F, Serriello I, Caliskan Y, Sever M, Kilicaslan I, Locatelli F, Del Vecchio L, Wetzels J, Peters H, Berg U, Carvalho F, da Costa Ferreira A, Maggio M, Wiecek A, Ots-Rosenberg M, Magistroni R, Topaloglu R, Bilginer Y, D’Amico M, Stangou M, Giacchino F, Goumenos D, Kalliakmani P, Gerolymos M, Galesic K, Geddes C, Siamopoulos K, Balafa O, Galliani M, Stratta P, Quaglia M, Bergia R, Cravero R, Salvadori M, Cirami L, Fellstrom B, Kloster Smerud H, Ferrario F, Stellato T, Egido J, Martin C, Floege J, Eitner F, Lupo A, Bernich P, Menè P, Morosetti M, van Kooten C, Rabelink T, Reinders M, Boria Grinyo J, Cusinato S, Benozzi L, Savoldi S, Licata C, Mizerska-Wasiak M, Martina G, Messuerotti A, Dal Canton A, Esposito C, Migotto C, Triolo G, Mariano F, Pozzi C, Boero R, Bellur S, Mazzucco G, Giannakakis C, Honsova E, Sundelin B, Di Palma A, Ferrario F, Gutiérrez E, Asunis A, Barratt J, Tardanico R, Perkowska-Ptasinska A, Arce Terroba J, Fortunato M, Pantzaki A, Ozluk Y, Steenbergen E, Soderberg M, Riispere Z, Furci L, Orhan D, Kipgen D, Casartelli D, Galesic Ljubanovic D, Gakiopoulou H, Bertoni E, Cannata Ortiz P, Karkoszka H, Groene H, Stoppacciaro A, Bajema I, Bruijn J, Fulladosa Oliveras X, Maldyk J, Ioachim E. The MEST score provides earlier risk prediction in lgA nephropathy. Kidney Int 2016; 89:167-75. [DOI: 10.1038/ki.2015.322] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 01/12/2023]
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Tetali S, Edwards P, Murthy GVS, Roberts I. Development and validation of a self-administered questionnaire to estimate the distance and mode of children's travel to school in urban India. BMC Med Res Methodol 2015; 15:92. [PMID: 26510525 PMCID: PMC4625478 DOI: 10.1186/s12874-015-0086-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Received: 01/19/2015] [Accepted: 10/19/2015] [Indexed: 12/02/2022] Open
Abstract
Background Although some 300 million Indian children travel to school every day, little is known about how they get there. This information is important for transport planners and public health authorities. This paper presents the development of a self-administered questionnaire and examines its reliability and validity in estimating distance and mode of travel to school in a low resource urban setting. Methods We developed a questionnaire on children’s travel to school. We assessed test re-test reliability by repeating the questionnaire one week later (n = 61). The questionnaire was improved and re-tested (n = 68). We examined the convergent validity of distance estimates by comparing estimates based on the nearest landmark to children’s homes with a ‘gold standard’ based on one-to-one interviews with children using detailed maps (n = 50). Results Most questions showed fair to almost perfect agreement. Questions on usual mode of travel (κ 0.73- 0.84) and road injury (κ 0.61- 0.72) were found to be more reliable than those on parental permissions (κ 0.18- 0.30), perception of safety (κ 0.00- 0.54), and physical activity (κ -0.01- 0.07). The distance estimated by the nearest landmark method was not significantly different than the in-depth method for walking , 52 m [95 % CI -32 m to 135 m], 10 % of the mean difference, and for walking and cycling combined, 65 m [95 % CI -30 m to 159 m], 11 % of the mean difference. For children who used motorized transport (excluding private school bus), the nearest landmark method under-estimated distance by an average of 325 metres [95 % CI −664 m to 1314 m], 15 % of the mean difference. Conclusions A self-administered questionnaire was found to provide reliable information on the usual mode of travel to school, and road injury, in a small sample of children in Hyderabad, India. The ‘nearest landmark’ method can be applied in similar low-resource settings, for a reasonably accurate estimate of the distance from a child’s home to school. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0086-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shailaja Tetali
- Indian Institute of Public Health, Plot No # 1, ANV Arcade, Amar Co-op Society, Madhapur, Kavuri Hills, Hyderabad, 500033, India. .,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Phil Edwards
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - G V S Murthy
- Indian Institute of Public Health, Plot No # 1, ANV Arcade, Amar Co-op Society, Madhapur, Kavuri Hills, Hyderabad, 500033, India. .,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - I Roberts
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Stanworth SJ, Manno D, Shakur H, Coats T, Edwards P, Gilmore I, Jairath V, Veitch A, Roberts I. Extending evidence for the use of tranexamic acid from traumatic haemorrhage to other patients with major bleeding: do we need more than one haemorrhage protocol? The case of gastrointestinal bleeding. Transfus Med 2015; 25:198-200. [PMID: 26084425 DOI: 10.1111/tme.12215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/15/2015] [Indexed: 12/15/2022]
Affiliation(s)
- S J Stanworth
- Department of Haematology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust/NHSBT, Oxford, UK
| | - D Manno
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - H Shakur
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - T Coats
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - P Edwards
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - I Gilmore
- Department of Medicine, University of Liverpool, Liverpool, UK
| | - V Jairath
- John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - A Veitch
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - I Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Tranexamic acid (TXA) reduces blood loss by inhibiting the enzymatic breakdown of fibrin. It is often used in surgery to decrease bleeding and the need for blood transfusion. In 2011, results from a multi-center, randomized, and placebo-controlled trial (CRASH-2 trial) showed that TXA (1 g loading dose over 10 min followed by an infusion of 1 g over 8 h) safely reduces mortality in bleeding trauma patients. Initiation of TXA treatment within 3 h of injury reduces the risk of hemorrhage death by about one-third, regardless of baseline risk. Because it does not have any serious adverse effects, TXA can be administered to a wide spectrum of bleeding trauma patients. Limiting its use to the most severely injured or those with a diagnosis of 'hyperfibrinolysis' would result in thousands of avoidable deaths. A clinical trial (CRASH-3 trial) of TXA in patients with traumatic brain injury is now in progress.
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Affiliation(s)
- I Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
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Perel P, Prieto-Merino D, Shakur H, Roberts I. Development and validation of a prognostic model to predict death in patients with traumatic bleeding, and evaluation of the effect of tranexamic acid on mortality according to baseline risk: a secondary analysis of a randomised controlled trial. Health Technol Assess 2014; 17:1-45, v-vi. [PMID: 23782457 DOI: 10.3310/hta17240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Severe bleeding accounts for about one-third of in-hospital trauma deaths. Patients with a high baseline risk of death have the most to gain from the use of life-saving treatments. An accurate and user-friendly prognostic model to predict mortality in bleeding trauma patients could assist doctors and paramedics in pre-hospital triage and could shorten the time to diagnostic and life-saving procedures such as surgery and tranexamic acid (TXA). OBJECTIVES The aim of the study was to develop and validate a prognostic model for early mortality in patients with traumatic bleeding and to examine whether or not the effect of TXA on the risk of death and thrombotic events in bleeding adult trauma patients varies according to baseline risk. DESIGN Multivariable logistic regression and risk-stratified analysis of a large international cohort of trauma patients. SETTING Two hundred and seventy-four hospitals in 40 high-, medium- and low-income countries. PARTICIPANTS We derived prognostic models in a large placebo-controlled trial of the effects of early administration of a short course of TXA [Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2) trial]. The trial included 20,127 trauma patients with, or at risk of, significant bleeding, within 8 hours of injury. We externally validated the model on 14,220 selected trauma patients from the Trauma Audit and Research Network (TARN), which included mainly patients from the UK. We examined the effect of TXA on all-cause mortality, death due to bleeding and thrombotic events (fatal and non-fatal myocardial infarction, stroke, deep-vein thrombosis and pulmonary embolism) within risk strata in the CRASH-2 trial data set and we estimated the proportion of premature deaths averted by applying the odds ratio (OR) from the CRASH-2 trial to each of the risk strata in TARN. INTERVENTIONS For the stratified analysis according baseline risk we considered the intervention TXA (1 g over 10 minutes followed by 1 g over 8 hours) or matching placebo. MAIN OUTCOME MEASURES For the prognostic models we included predictors for death in hospital within 4 weeks of injury. For the stratified analysis we reported ORs for all causes of death, death due to bleeding, and fatal and non-fatal thrombotic events associated with the use of TXA according to baseline risk. RESULTS A total of 3076 (15%) patients died in the CRASH-2 trial and 1705 (12%) in the TARN data set. Glasgow Coma Scale score, age and systolic blood pressure were the strongest predictors of mortality. Discrimination and calibration were satisfactory, with C-statistics > 0.80 in both CRASH-2 trial and TARN data sets. A simple chart was constructed to readily provide the probability of death at the point of care, while a web-based calculator is available for a more detailed risk assessment. TXA reduced all-cause mortality and death due to bleeding in each stratum of baseline risk. There was no evidence of heterogeneity in the effect of TXA on all-cause mortality (p-value for interaction = 0.96) or death due to bleeding (p= 0.98). There was a significant reduction in the odds of fatal and non-fatal thrombotic events with TXA (OR = 0.69, 95% confidence interval 0.53 to 0.89; p= 0.005). There was no evidence of heterogeneity in the effect of TXA on the risk of thrombotic events (p= 0.74). CONCLUSIONS This prognostic model can be used to obtain valid predictions of mortality in patients with traumatic bleeding. TXA can be administered safely to a wide spectrum of bleeding trauma patients and should not be restricted to the most severely injured. Future research should evaluate whether or not the use of this prognostic model in clinical practice has an impact on the management and outcomes of trauma patients.
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Affiliation(s)
- P Perel
- London School of Hygiene and Tropical Medicine, London, UK
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Maroz A, Stachorski L, Emmrich S, Reinhardt K, Xu J, Shao Z, Käbler S, Dertmann T, Hitzler J, Roberts I, Vyas P, Juban G, Hennig C, Hansen G, Li Z, Orkin S, Reinhardt D, Klusmann JH. GATA1s induces hyperproliferation of eosinophil precursors in Down syndrome transient leukemia. Leukemia 2013; 28:1259-70. [PMID: 24336126 PMCID: PMC4047213 DOI: 10.1038/leu.2013.373] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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] [Received: 08/07/2013] [Revised: 12/01/2013] [Accepted: 12/03/2013] [Indexed: 02/06/2023]
Abstract
Transient leukemia (TL) is evident in 5–10% of all neonates with Down syndrome (DS) and associated with N-terminal truncating GATA1-mutations (GATA1s). Here we report that TL cell clones generate abundant eosinophils in a substantial fraction of patients. Sorted eosinophils from patients with TL and eosinophilia carried the same GATA1s-mutation as sorted TL-blasts, consistent with their clonal origin. TL-blasts exhibited a genetic program characteristic of eosinophils and differentiated along the eosinophil lineage in vitro. Similarly, ectopic expression of Gata1s, but not Gata1, in wild-type CD34+-hematopoietic stem and progenitor cells induced hyperproliferation of eosinophil promyelocytes in vitro. While GATA1s retained the function of GATA1 to induce eosinophil genes by occupying their promoter regions, GATA1s was impaired in its ability to repress oncogenic MYC and the pro-proliferative E2F transcription network. ChIP-seq indicated reduced GATA1s occupancy at the MYC promoter. Knockdown of MYC, or the obligate E2F-cooperation partner DP1, rescued the GATA1s-induced hyperproliferative phenotype. In agreement, terminal eosinophil maturation was blocked in Gata1Δe2 knockin mice, exclusively expressing Gata1s, leading to accumulation of eosinophil precursors in blood and bone marrow. These data suggest a direct relationship between the N-terminal truncating mutations of GATA1 and clonal eosinophilia in DS patients.
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Affiliation(s)
- A Maroz
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - L Stachorski
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - S Emmrich
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - K Reinhardt
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - J Xu
- 1] Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA [2] Howard Hughes Medical Institute, Harvard Medical School, Boston, MA, USA [3] Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Z Shao
- 1] Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA [2] Howard Hughes Medical Institute, Harvard Medical School, Boston, MA, USA [3] Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - S Käbler
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - T Dertmann
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - J Hitzler
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - I Roberts
- Oxford University Department of Paediatrics, Childrens Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, UK
| | - P Vyas
- 1] MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK [2] Department of Haematology, Oxford University Hospital, NHS Trust, Oxford, UK
| | - G Juban
- 1] MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK [2] Department of Haematology, Oxford University Hospital, NHS Trust, Oxford, UK
| | - C Hennig
- Department of Pediatric Pneumology, Hannover Medical School, Hannover, Germany
| | - G Hansen
- Department of Pediatric Pneumology, Hannover Medical School, Hannover, Germany
| | - Z Li
- Division of Genetics, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Orkin
- 1] Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA [2] Howard Hughes Medical Institute, Harvard Medical School, Boston, MA, USA [3] Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - D Reinhardt
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - J-H Klusmann
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
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15
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Abstract
Worldwide, trauma is responsible for more than 10,000 deaths each day with hundreds of thousands seriously injured. Current trauma resuscitation strategies are based on supporting haemostasis, maintaining circulating volume and rapidly identifying sites of blood loss. Approaches include hypotensive/hypovolaemic resuscitation, avoidance of colloids and crystalloids, early blood product based resuscitation, early imaging to identify sites of blood loss and damage control surgery. In this paper, we focus on ways to minimise blood loss and preserve the circulating volume. These include minimal movement of the patient, splinting fractures, use of tourniquets, application of local haemostatic dressings/agents, keeping the patient warm and giving tranexamic acid to improve clot strength. The recent CRASH-2 trial provided unequivocal evidence that tranexamic acid reduces mortality in bleeding trauma patients. This will be discussed in detail. When employed as part of a package of care in a well-rehearsed trauma system, these interventions to preserve the remaining circulating volume have the potential to save lives and allow patients to survive until timely definitive haemostasis can occur.
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Affiliation(s)
- A Chesters
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
| | - I Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - T Harris
- Queen Mary, University of London and Bart's Health NHS Trust, London, UK
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16
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Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, Cook L, Kawahara T, Perel P, Prieto-Merino D, Ramos M, Cairns J, Guerriero C. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess 2013; 17:1-79. [PMID: 23477634 DOI: 10.3310/hta17100] [Citation(s) in RCA: 332] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Among trauma patients who survive to reach hospital, exsanguination is a common cause of death. A widely practicable treatment that reduces blood loss after trauma could prevent thousands of premature deaths each year. The CRASH-2 trial aimed to determine the effect of the early administration of tranexamic acid on death and transfusion requirement in bleeding trauma patients. In addition, the effort of tranexamic acid on the risk of vascular occlusive events was assessed. OBJECTIVE Tranexamic acid (TXA) reduces bleeding in patients undergoing elective surgery. We assessed the effects and cost-effectiveness of the early administration of a short course of TXA on death, vascular occlusive events and the receipt of blood transfusion in trauma patients. DESIGN Randomised placebo-controlled trial and economic evaluation. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial co-ordinating centre staff) were masked to treatment allocation. All analyses were by intention to treat. A Markov model was used to assess cost-effectiveness. The health outcome was the number of life-years (LYs) gained. Cost data were obtained from hospitals, the World Health Organization database and UK reference costs. Cost-effectiveness was measured in international dollars ($) per LY. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results to model assumptions. SETTING Two hundred and seventy-four hospitals in 40 countries. PARTICIPANTS Adult trauma patients (n = 20,211) with, or at risk of, significant bleeding who were within 8 hours of injury. INTERVENTIONS Tranexamic acid (loading dose 1 g over 10 minutes then infusion of 1 g over 8 hours) or matching placebo. MAIN OUTCOME MEASURES The primary outcome was death in hospital within 4 weeks of injury, and was described with the following categories: bleeding, vascular occlusion (myocardial infarction, stroke and pulmonary embolism), multiorgan failure, head injury and other. RESULTS Patients were allocated to TXA (n = 10,096) and to placebo (n = 10,115), of whom 10,060 and 10,067 patients, respectively, were analysed. All-cause mortality at 28 days was significantly reduced by TXA [1463 patients (14.5%) in the TXA group vs 1613 patients (16.0%) in the placebo group; relative risk (RR) 0.91; 95% confidence interval (CI) 0.85 to 0.97; p = 0.0035]. The risk of death due to bleeding was significantly reduced [489 patients (4.9%) died in the TXA group vs 574 patients (5.7%) in the placebo group; RR 0.85; 95% CI 0.76 to 0.96; p = 0.0077]. We recorded strong evidence that the effect of TXA on death due to bleeding varied according to the time from injury to treatment (test for interaction p < 0.0001). Early treatment (≤ 1 hour from injury) significantly reduced the risk of death due to bleeding [198 out of 3747 patients (5.3%) died in the TXA group vs 286 out of 3704 patients (7.7%) in the placebo group; RR 0.68; 95% CI 0.57 to 0.82; p < 0.0001]. Treatment given between 1 and 3 hours also reduced the risk of death due to bleeding [147 out of 3037 patients (4.8%) died in the TXA group vs 184 out of 2996 patients (6.1%) in the placebo group; RR 0.79; 95% CI 0.64 to 0.97; p = 0.03]. Treatment given after 3 hours seemed to increase the risk of death due to bleeding [144 out of 3272 patients (4.4%) died in the TXA group vs 103 out of 3362 patients (3.1%) in the placebo group; RR 1.44; 95% CI1.12 to 1.84; p = 0.004]. We recorded no evidence that the effect of TXA on death due to bleeding varied by systolic blood pressure, Glasgow Coma Scale score or type of injury. Administering TXA to bleeding trauma patients within 3 hours of injury saved an estimated 755 LYs per 1000 trauma patients in the UK. The cost of giving TXA to 1000 patients was estimated at $30,830. The incremental cost of giving TXA compared with not giving TXA was $48,002. The incremental cost per LY gained of administering TXA was $64. CONCLUSIONS Early administration of TXA safely reduced the risk of death in bleeding trauma patients and is highly cost-effective. Treatment beyond 3 hours of injury is unlikely to be effective. Future work [the Clinical Randomisation of an Antifibrinolytic in Significant Head injury-3 (CRASH-3) trial] will evaluate the effectiveness and safety of TXA in the treatments of isolated traumatic brain injury (http://crash3.lshtm.ac.uk/). TRIAL REGISTRATION Current Controlled Trials ISRCTN86750102, ClinicalTrials.gov NCT00375258 and South African Clinical Trial Register DOH-27-0607-1919. FUNDING The project was funded by the Bupa Foundation, the J P Moulton Charitable Foundation and the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 10. See HTA programme website for further project information.
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Affiliation(s)
- I Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK.
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17
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Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. Br J Surg 2013; 100:1271-9. [DOI: 10.1002/bjs.9193] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Tranexamic acid (TXA) reduces blood transfusion in surgery but the extent of the reduction in blood loss and how it relates to the dose of TXA is unclear.
Methods
A systematic review of randomized trials was performed. Data were extracted on blood loss from trials comparing intravenous TXA with no TXA or placebo in surgical patients. A Bayesian linear regression was used to describe the relationship between the reduction in blood loss with TXA and the extent of bleeding as measured by the mean blood loss in the control group. A meta-analysis of the log-transformed data was conducted to quantify the effect of TXA on blood loss, stratified by type of surgery, timing of TXA administration and trial quality. Meta-regression was used to explore the effect of TXA dosage.
Results
Data from 104 trials were examined. Although the absolute reduction in blood loss with TXA increased as surgical bleeding increased, the percentage reduction was similar. TXA reduced blood loss by 34 per cent (pooled ratio 0·66, 95 per cent confidence interval 0·65 to 0·67; P < 0·001). The percentage reduction in blood loss with TXA differed by type of surgery, timing of TXA administration and trial quality, but the differences were small. The effect of TXA on blood loss did not vary over the range of doses assessed (5·5–300 mg/kg).
Conclusion
TXA reduces blood loss in surgical patients by about one-third. A total dose of 1 g appears to be sufficient for most adults. There is no evidence to support the use of high doses.
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Affiliation(s)
- K Ker
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - D Prieto-Merino
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - I Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Wu J, Duan S, Li W, Wang Y, Liu W, Zhang J, Lun L, Li X, Zhou C, Zheng Y, Liu S, Xie Y, Cai G, Chen X, Shen P, Li Y, Wang Z, Wang W, Ren H, Zhang W, Chen N, Shimamoto M, Ohsawa I, Suzuki H, Nagamachi S, Shimizu Y, Horikoshi S, Tomino Y, Cox SN, Serino G, Sallustio F, Pesce F, Schena FP, Kalbacher E, Ducher M, Fouque D, MacGregor B, Combarnous F, Fauvel JP, Sarcina C, Ferrario F, Terraneo V, Pani A, Fogazzi G, Visciano GB, De Simone I, Rastelli F, Pozzi C, Kwak IS, Seong EY, Rhee H, Lee DW, Lee SB, Yang BY, Shin MJ, Kim IY, Stangou MJ, Bantis C, Kasimatis S, Skoularopoulou M, Toulkeridis G, Pantzaki A, Papagianni A, Efstratiadis G, Yamada K, Suzuki H, Suzuki Y, Raska M, Huang ZQ, Reily C, Moldoveanu Z, Kiryluk K, Julian BA, Tomino Y, Gharavi AG, Novak J, Camilla R, Coppo R, Bellur S, Cattran D, Cook T, Feehally J, Troyanov S, Roberts I, Vergano L, Morando L, Mizerska-Wasiak M, Maldyk J, Rybi-Szuminska A, Firszt-Adamczyk A, Bienias B, Gadomska-Prokop K, Grenda R, Zajaczkowska M, Stankiewicz R, Wasilewska A, Roszkowska-Blaim M, Zhang X, Xie J, Wang W, Pan X, Guo S, Shen P, Zhang W, Chen N, Soylu A, Ozturk Y, Dogan Y, Ozmen D, Yilmaz O, Kavukcu S, Choi JY, Park GY, Jung HY, Kim KH, Kwon O, Cho JH, Kim CD, Kim YL, Park SH, Berthoux FC, Mohey H, Laurent B, Mariat C, Chen YX, Zhang W, Xu J, Chen N, Bajcsi D, Haris A, Abraham G, Legrady P, Polner K, Ronaszeki B, Balla Z, Rakonczay Z, Ivanyi B, Sonkodi S, Bredin PH, Canney M, Kennedy C, Plant LD, Clarkson MR, Naz N, Hiremath M, Banerjee A, Shah Y, Yuste C, Casian A, Jironda C, Jayne D, Smith R, Lewin M, Jones R, Merkel P, Jayne D, Izzo C, Quaglia M, Radin E, Airoldi A, Fenoglio R, Lazzarich E, Stratta P, Onusic VL, Araujo MJ, Battaini LC, Jorge LB, Dias CB, Toledo-Barros M, Toledo-Barros R, Woronik V, Cirami CL, Gallo P, Romoli E, Mecacci F, Simeone S, Minetti EE, Mello G, Rivera F, Segarra A, Praga M, Quaglia M, Radin E, Izzo C, Airoldi A, Lazzarich E, Fenoglio R, Stratta P, Dias CB, Lee J, Jorge L, Malheiro D, Barros RT, Woronik V, Zakharova EV, Stolyarevich ES, Velioglu A, Guler D, Nalcaci S, Birdal G, Arikan H, Koc M, Direskeneli H, Tuglular S, Ozener C, Guedes Marques M, Cotovio P, Ferrer F, Silva C, Botelho C, Lopes K, Maia P, Carreira A, Campos M, Alharazy S, Kong NCT, Mohammad M, Shah SA, Gafor H, Bain A. Clinical nephrology - IgA nephropathy, lupus nephritis, vasculitis. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Roberts I. LET'S TALK ABOUT SAFETY—CAN INJURY PREVENTION DO MORE HARM THAN GOOD? Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580i.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Perel P, Al-Shahi Salman R, Kawahara T, Morris Z, Prieto-Merino D, Roberts I, Sandercock P, Shakur H, Wardlaw J. CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) intracranial bleeding study: the effect of tranexamic acid in traumatic brain injury--a nested randomised, placebo-controlled trial. Health Technol Assess 2012; 16:iii-xii, 1-54. [PMID: 22417901 DOI: 10.3310/hta16130] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) has been shown to reduce blood loss in surgical patients and the risk of death in patients with traumatic bleeding, with no apparent increase in vascular occlusive events. These findings raise the possibility that it might also be effective in traumatic brain injury (TBI). OBJECTIVE The Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage Intracranial Bleeding Study (CRASH-2 IBS) was conducted to quantify the effect of an early short course of TXA on intracranial haemorrhage and new focal cerebral ischaemic lesions in patients with TBI. DESIGN CRASH-2 IBS was a prospective randomised controlled trial nested within the CRASH-2 trial. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight. We used a local pack system that selected the lowest numbered treatment pack from a box containing eight numbered packs. Apart from the pack number, the treatment packs were identical. The pack number was recorded on the entry form, which was sent to the international trial co-ordinating centre in London, UK. Once the treatment pack number was recorded, the patient was included in the trial whether or not the treatment pack was opened or the allocated treatment started. All site investigators and trial co-ordinating centre staff were masked to treatment allocation. SETTING Ten hospitals: (India) Aditya Neuroscience Centre, Sanjivani Hospital, CARE Hospital, Christian Medical College, Medical Trust Hospital, Jeevan Jyoti Hospital and (Colombia) Hospital Universitario San Vicente de Paul, Hospital Pablo Tobón Uribe, Hospital Universitario San José de Popayán and Fundación Valle del Lili. PARTICIPANTS The trial was conducted in a subset of 270 CRASH-2 trial participants. Patients eligible for inclusion in the CRASH-2 IBS fulfilled the inclusion criteria for the CRASH-2 trial, and also had TBI [Glasgow Coma Scale score of ≤ 14 and a brain computerised tomography (CT) scan compatible with TBI]. Pregnant women and patients for whom a second brain CT scan was not possible were excluded. INTERVENTIONS Participants were randomly allocated to receive either a loading dose of 1 g of TXA infused over 10 minutes followed by an intravenous infusion of 1 g over 8 hours or matching placebo. MAIN OUTCOME MEASURE The primary outcome was the increase in size of intracranial haemorrhage growth between a CT scan at hospital admission and a second scan 24-48 hours later. RESULTS One hundred and thirty-three patients were allocated to TXA and 137 to placebo, of whom information on the primary (imaging) outcome was available for 123 (92%) and 126 (92%) respectively. The analysis suggested that TXA was likely to be associated with a reduction in haemorrhage growth [adjusted difference -3.8 ml, 95% credibility interval (CrI) -11.5 ml to 3.9 ml], fewer focal ischaemic lesions [adjusted odds ratio (OR) 0.54, 95% CrI 0.20 to 1.46] and fewer deaths (adjusted OR 0.49, 95% CrI 0.22 to 1.06). CONCLUSIONS This was the first randomised controlled study to evaluate the effect of TXA in TBI patients and it found that neither moderate benefits nor moderate harmful effects can be excluded. However, although uncertainty remains, our analyses suggest that TXA administration might improve outcome in TBI patients and provide grounds for evaluating this hypothesis in future research. TRIAL REGISTRATION Current Controlled Trials ISRCTN86750102. SOURCE OF FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16, No. 13. See the HTA programme website for further project information.
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Affiliation(s)
- P Perel
- London School of Hygiene and Tropical Medicine, London, UK.
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21
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Carter SA, Foster NA, Scarpini CG, Chattopadhyay A, Pett MR, Roberts I, Coleman N. Lipoprotein lipase is frequently overexpressed or translocated in cervical squamous cell carcinoma and promotes invasiveness through the non-catalytic C terminus. Br J Cancer 2012; 107:739-47. [PMID: 22782350 PMCID: PMC3419954 DOI: 10.1038/bjc.2012.301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 11/16/2022] Open
Abstract
Background: We studied the biological significance of genes involved in a novel t(8;12)(p21.3;p13.31) reciprocal translocation identified in cervical squamous cell carcinoma (SCC) cells. Methods: The rearranged genes were identified by breakpoint mapping, long-range PCR and sequencing. We investigated gene expression in vivo using reverse-transcription PCR and tissue microarrays, and studied the phenotypic consequences of forced gene overexpression. Results: The rearrangement involved lipoprotein lipase (LPL) and peroxisome biogenesis factor-5 (PEX5). Whereas LPL–PEX5 was expressed at low levels and contained a premature stop codon, PEX5–LPL was highly expressed and encoded a full-length chimeric protein (including the majority of the LPL coding region). Consistent with these findings, PEX5 was constitutively expressed in normal cervical squamous cells, whereas LPL expression was negligible. The LPL gene was rearranged in 1 out of 151 cervical SCCs, whereas wild-type LPL overexpression was common, being detected in 10 out of 28 tissue samples and 4 out of 10 cell lines. Forced overexpression of wild-type LPL and PEX5–LPL fusion transcripts resulted in increased invasiveness in cervical SCC cells, attributable to the C-terminal non-catalytic domain of LPL, which was retained in the fusion transcripts. Conclusion: This is the first demonstration of an expressed fusion gene in cervical SCC. Overexpressed wild-type or translocated LPL is a candidate for targeted therapy.
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Affiliation(s)
- S A Carter
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK
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22
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Muthukumar P, Venkatesh V, Curley A, Kahan BC, Choo L, Ballard S, Clarke P, Watts T, Roberts I, Stanworth S. Severe thrombocytopenia and patterns of bleeding in neonates: results from a prospective observational study and implications for use of platelet transfusions. Transfus Med 2012; 22:338-43. [PMID: 22738179 DOI: 10.1111/j.1365-3148.2012.01171.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 05/29/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe patterns of clinical bleeding in neonates with severe thrombocytopenia (ST and platelet count <60 × 10(9) L(-1)), and to investigate the factors related to bleeding. STUDY DESIGN Seven tertiary-level neonatal units enrolled neonates (n = 169) with ST. Data were collected prospectively on all clinically apparent haemorrhages. Relationships between bleeding, platelet count and baseline characteristics were explored through regression analysis. RESULTS Bleeding was recorded in most neonates with ST (138/169; 82%), including 123 neonates with minor bleeding and 15 neonates with major bleeding. The most common sites of minor bleeding were from the renal tract (haematuria 40%), endotracheal tube (21%), nasogastric tube (10%) and skin (15%). Gestational age <34 weeks, development of ST within 10 days of birth and necrotizing enterocolitis were the strongest predictors for an increased number of bleeding events. For neonates with ST, a lower platelet count was not a strong predictor of increased bleeding. CONCLUSIONS The majority of neonates with ST bleed, although most episodes are minor. These findings establish the importance of clinical factors for bleeding risk, rather than minimum platelet count. Further studies should assess the clinical significance of different types of minor bleed for neonatal outcomes, the predictive value of minor bleeding for major bleeding and the role of platelet transfusions in preventing bleeding.
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Affiliation(s)
- P Muthukumar
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK
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23
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Affiliation(s)
- I Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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24
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Abstract
Dynamic interactions between hematopoietic cells and their specialized bone marrow microenvironments, namely the vascular and osteoblastic 'niches', regulate hematopoiesis. The vascular niche is conducive for thrombopoiesis and megakaryocytes may, in turn, regulate the vascular niche, especially in supporting vascular and hematopoietic regeneration following irradiation or chemotherapy. A role for platelets in tumor growth and metastasis is well established and, more recently, the vascular niche has also been implicated as an area for preferential homing and engraftment of malignant cells. This article aims to provide an overview of the dynamic interactions between cellular and molecular components of the bone marrow vascular niche and the potential role of megakaryocytes in bone marrow malignancy.
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Affiliation(s)
- B Psaila
- Department of Haematology, Imperial College School of Medicine, London, UK.
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25
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Edwards P, Durand MA, Hollister M, Green J, Lutchmun S, Kessel A, Roberts I. Scald risk in social housing can be reduced through thermostatic control system without increasing Legionella risk: a cluster randomised trial. Arch Dis Child 2011; 96:1097-102. [PMID: 21937486 DOI: 10.1136/archdischild-2011-300606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To quantify the effects of a thermostatic control system in social (public) housing on the prevalence of dangerous (>60°C) water temperatures and on fuel consumption. DESIGN Pair-matched double-blind cluster randomised controlled trial. SETTING Social housing in a deprived inner-London borough. PARTICIPANTS 150 households recruited as clusters from 22 social housing estates. Four small estates were combined into two clusters (resulting in a total of 10 pairs of clusters). INTERVENTION Social housing estate boiler houses were randomised to a thermostatic control sterilisation programme (heating water to 65°C during 00:00-06:00 h and to 50°C from 06:00 to 00:00 h daily) or to standard control (constant temperature 65°C). MAIN OUTCOME MEASURES Water temperature over 60°C ('dangerous') after running taps for 1 min and daily fuel consumption (cubic feet of gas). RESULTS 10 clusters (80 households) were allocated to the sterilisation programme and 10 clusters (70 households) to control, of which 73 and 67 households, respectively, were analysed. Prevalence of dangerous (>60°C) hot water temperatures at 1 min was significantly reduced with the sterilisation programme (mean of cluster prevalence 1% in sterilisation programme group vs 34% in control group; absolute difference 33%, 95% CI 12% to 54%; p=0.006). Prevalence of high (>55°C) hot water temperatures at 1 min was significantly reduced (31% sterilisation vs 59% control; absolute difference 28%, 95% CI 9% to 47%; p=0.009). Gas consumption per day reduced more in the control group than in the sterilisation programme group, although not statistically significantly (p=0.125). CONCLUSIONS The thermostatic control with daily sterilisation was effective in capping hot water temperatures and therefore reduced scald risk. Although expected to save energy, fuel consumption was increased relative to the control group. Trial registration ClinicalTrials.gov ID: NCT00874692.
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Affiliation(s)
- P Edwards
- NPHIR, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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26
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Roberts I. Tranexamic Acid: a recipe for saving lives in traumatic bleeding. Int J Occup Environ Med 2011; 2:189-190. [PMID: 23022837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
Renal cell carcinomas (RCCs) account for 3% of all solid neoplasms, with an increased incidence after renal transplantation. In transplant recipients, RCCs predominantly occur in the patient's native kidneys. Herein is reported a case of a localized RCC of recipient origin that developed in the donor allograft and was detected 8 years after renal transplantation. Treatment with high-intensity focussed ultrasound followed by partial nephrectomy was successful, averting the need for dialysis therapy.
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Affiliation(s)
- A Chakera
- Oxford Kidney Unit, Churchill Hospital, Headington, Oxford, England.
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Roberts I, Stott R. Doctors and climate change. Int J Occup Environ Med 2011; 2:8-10. [PMID: 23022813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Goss C, Roberts I, DiGuiseppi C. The utility for identification of best available evidence of a register of controlled studies that evaluate interventions to prevent alcohol-impaired driving. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Foster N, Carter S, Ng G, Pett M, Roberts I, Coleman N. Molecular cytogenetic analysis of cervical squamous cell carcinoma cells demonstrates discordant levels of numerical and structural chromosomal instability and identifies 'selected' chromosome rearrangements. Cytogenet Genome Res 2010; 127:9-20. [PMID: 20224276 DOI: 10.1159/000290954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2009] [Indexed: 11/19/2022] Open
Abstract
The processes underlying the karyotype complexity and heterogeneity characteristic of cervical squamous cell carcinoma (SCC) cells are not well understood, nor is it known which chromosome abnormalities provide a selective advantage. We used molecular cytogenetics to quantify for the first time the prevalence of all chromosomal abnormalities detectable in 8 cervical SCC cell lines. Of 225 rearrangements identified, 118 occurred frequently (> or =70% metaphases) in one or more lines, indicating selection. Most of these selected rearrangements (107; 48% of the total) were included in published lists of abnormalities detected in independent cell stocks (although their significance was not previously recognised), indicating that they arose early in the establishment of the lines and were therefore most likely to have been present in the original tumours. The 8 cell lines showed 4.7- and 11.0-fold variation in levels of numerical and structural chromosomal instability (N-CIN and S-CIN) respectively, as determined by quantifying non-clonal abnormalities. We observed discordance between N-CIN and S-CIN (p = 0.148), with modal chromosome number showing a strong association with N-CIN (p = 0.007) but not with S-CIN (p = 0.602). These data imply that different mechanisms underlie N-CIN and S-CIN in cervical SCC. Despite ongoing S-CIN, newly arisen in vitro rearrangements were infrequently selected, supporting the view that selection is an important determinant of somatic evolution in malignancy. There was a positive association between numbers of non-clonal and clonal rearrangements (p = 0.002 for non-clonal vs. selected rearrangements), suggesting that factors affecting S-CIN determine the total numbers of rearrangements present in established cervical SCC cells.
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Affiliation(s)
- N Foster
- Hutchison/MRC Centre, Cambridge, UK
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Clarke SA, Skinner R, Guest J, Darbyshire P, Cooper J, Shah F, Roberts I, Eiser C. Health-related quality of life and financial impact of caring for a child with Thalassaemia Major in the UK. Child Care Health Dev 2010; 36:118-22. [PMID: 19961496 DOI: 10.1111/j.1365-2214.2009.01043.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Thalassaemia Major (TM) is a serious condition characterized by life-long dependence on blood transfusions and chelation therapy. Our aim was to determine health-related quality of life (HRQOL) in children with TM living in the UK, and the impact of caring for a child receiving National Health Service treatment on family finances. METHODS This was a cross-sectional assessment of HRQOL in children (n= 22) with TM aged 8-18 years. Children were recruited from three UK Paediatric Haematology and Bone Marrow Transplant centres. Mothers completed measures of their child's HRQOL [PedsQL 4.0 (Measurement Model for the Pediatric Quality of Life Inventory, James W. Varni PhD, PedMetrics, Quantifying the Qualitative SM, Copyright 1998-2009)] and behaviour (Strengths and Difficulties questionnaire), and the impact of caring for the child on family finances. RESULTS Child behaviour was within the normal range but child HRQOL was significantly lower than population norms. Family financial concerns associated with TM were associated with poorer child HRQOL (P= 0.020). CONCLUSIONS Thalassaemia Major poses a considerable challenge to child HRQOL, well documented in areas of the world where TM is prevalent. Despite the availability of National Health Service care and financial benefits our study suggests a similar burden in the UK.
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Affiliation(s)
- S A Clarke
- Department of Psychology, University of Sheffield, Sheffield S102TP, UK.
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Ng GYT, Roberts I, New HV. Exchange transfusion and intravenous immunoglobulin use in the UK. Arch Dis Child Fetal Neonatal Ed 2010; 95:F76-7. [PMID: 20019204 DOI: 10.1136/adc.2009.162123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Roberts I. A tale of two health ministers. West J Med 2009. [DOI: 10.1136/bmj.b5591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kemp S, Roberts I, Gamble C, Wilkinson S, Davidson JE, Baildam EM, Cleary AG, McCann LJ, Beresford MW. A randomized comparative trial of generalized vs targeted physiotherapy in the management of childhood hypermobility. Rheumatology (Oxford) 2009; 49:315-25. [DOI: 10.1093/rheumatology/kep362] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Roberts I. Opportunity knocks: health wins from action on global warming. Assoc Med J 2009. [DOI: 10.1136/bmj.b4947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Roberts I. It's the fossil fuels, stupid. West J Med 2009. [DOI: 10.1136/bmj.b1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Roberts I. Stopping the traffic. West J Med 2009. [DOI: 10.1136/bmj.b493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Pedestrian injuries are a leading cause of death and disability. Transport policy decisions have a major impact on the risk of pedestrian injury, but the effects cannot usually be quantified in controlled studies. However, mathematical modeling can help to establish the injury consequences of transport policy decisions. METHODS A stochastic mathematical model was developed to estimate the effect of alternative transport scenarios on pedestrian injury risk. The model is based on a mechanistic description of pedestrian injury causation and comprises four sub-models: vehicle dynamics, pedestrian dynamics, collision incidence, and injury severity. RESULTS The model was used to estimate the yearly pedestrian injury rate for a baseline scenario, corresponding to current traffic conditions in London, UK, and three alternative scenarios, comprising reductions in vehicle speed, traffic volume, and vehicle mass. The model simulated a baseline injury rate of 88 per 100,000. Compared with baseline, a 15% reduction in mean speed resulted in a 21% reduction in injury rate and a 75% reduction in fatality rate. A 15% reduction in traffic volume resulted in a 14% reduction in injury rate and a 25% reduction in fatality rate. Reducing vehicle mass by 15% did not reduce the number of injuries, but a 25% reduction resulted in less severe injuries. CONCLUSIONS The model simulated well the rates and severity of pedestrian injury corresponding to the baseline scenario and made predictions for different transport policy scenarios. However, it is offered primarily as a generic decision support tool for the assessment of alternative policies by transport authorities.
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Affiliation(s)
- Z Chalabi
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Abstract
OBJECTIVE To examine the variation in serious injuries in children by the level of deprivation in an area and by types of settlement. METHODS Hospital admission rates for serious injury to children aged 0-15 years in census lower super output areas in England during the 5-year period 1 April 1999 to 31 March 2004 were analysed. RESULTS Rates of serious injury in children were higher in the most deprived areas than in the least deprived for pedestrians (rate ratio (RR) 4.1; 95% CI 2.8 to 6.0) and cyclists (RR 3.0; 95% CI 1.9 to 4.7). Rates of serious pedestrian injury were lower in towns and fringe areas (RR 0.67; 95% CI 0.53 to 0.86) and in village (RR 0.64; 95% CI 0.50 to 0.83) areas than in urban areas. The rate of serious injury to cyclists was lower in London than other urban areas (RR 0.78; 95% CI 0.62 to 0.98). The rate of serious injury to car occupants was higher in village than urban areas (RR 1.51; 95% CI 1.05 to 2.17). Rates of serious injury caused by falls were higher in London (RR 1.60; 95% CI 1.47 to 1.75) and lower in villages (RR 0.76; 95% CI 0.66 to 0.88) than in urban areas. Steeper socio-economic gradients in serious injury rates were identified in rural areas for cyclists and for children suffering falls. CONCLUSIONS Socio-economic inequalities in serious injury exist across the whole of England, particularly for child pedestrians. Rates of serious injury vary by settlement type, and inequalities vary by cause of injury between rural and urban settings.
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Affiliation(s)
- P Edwards
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.
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Solez K, Colvin RB, Racusen LC, Haas M, Sis B, Mengel M, Halloran PF, Baldwin W, Banfi G, Collins AB, Cosio F, David DSR, Drachenberg C, Einecke G, Fogo AB, Gibson IW, Glotz D, Iskandar SS, Kraus E, Lerut E, Mannon RB, Mihatsch M, Nankivell BJ, Nickeleit V, Papadimitriou JC, Randhawa P, Regele H, Renaudin K, Roberts I, Seron D, Smith RN, Valente M. Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant 2008; 8:753-60. [PMID: 18294345 DOI: 10.1111/j.1600-6143.2008.02159.x] [Citation(s) in RCA: 1473] [Impact Index Per Article: 92.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The 9th Banff Conference on Allograft Pathology was held in La Coruna, Spain on June 23-29, 2007. A total of 235 pathologists, clinicians and scientists met to address unsolved issues in transplantation and adapt the Banff schema for renal allograft rejection in response to emerging data and technologies. The outcome of the consensus discussions on renal pathology is provided in this article. Major updates from the 2007 Banff Conference were: inclusion of peritubular capillaritis grading, C4d scoring, interpretation of C4d deposition without morphological evidence of active rejection, application of the Banff criteria to zero-time and protocol biopsies and introduction of a new scoring for total interstitial inflammation (ti-score). In addition, emerging research data led to the establishment of collaborative working groups addressing issues like isolated 'v' lesion and incorporation of omics-technologies, paving the way for future combination of graft biopsy and molecular parameters within the Banff process.
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Affiliation(s)
- K Solez
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada.
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Kabbara N, Locatelli F, Rocha V, Ghavamzadeh A, Bernaudin F, Li CK, Vermylen C, Stein J, Beruchel A, Cordonnier C, Roberts I, Socié G, Gluckman E, Walters M. 6: A Multicentric Comparative Analysis of Outcomes of HLA Identical Related Cord Blood and Bone Marrow Transplantation in Patients With Beta-Thalassemia or Sickle Cell Disease. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Campbell M, Snowdon C, Francis D, Elbourne D, McDonald A, Knight R, Entwistle V, Garcia J, Roberts I, Grant A, Grant A. Recruitment to randomised trials: strategies for trial enrolment and participation study. The STEPS study. Health Technol Assess 2007; 11:iii, ix-105. [PMID: 17999843 DOI: 10.3310/hta11480] [Citation(s) in RCA: 312] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - A Grant
- Health Services Research Unit, University of Aberdeen, UK
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Abstract
BACKGROUND Colloid solutions are widely used in fluid resuscitation of critically ill patients. There are several choices of colloid and there is ongoing debate about the relative effectiveness of colloids compared to crystalloid fluids. OBJECTIVES To assess the effects of colloids compared to crystalloids for fluid resuscitation in critically ill patients. SEARCH STRATEGY We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE, the National Research Register, Web of Science and MetaRegister. Bibliographies of trials and review articles retrieved were searched. The searches were last updated in December 2006. SELECTION CRITERIA Randomised controlled trials (RCTs) of colloids compared to crystalloids, in patients requiring volume replacement. Cross-over trials and trials in pregnant women and neonates were excluded. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and rated quality of allocation concealment. Trials with a 'double-intervention', such as those comparing colloid in hypertonic crystalloid to isotonic crystalloid, were analysed separately. The analysis was stratified according to colloid type and quality of allocation concealment. MAIN RESULTS We identified 63 eligible trials, 55 of these presented mortality data. COLLOIDS COMPARED TO CRYSTALLOIDS: Albumin or plasma protein fraction - 23 trials reported data on mortality, including a total of 7,754 patients. The pooled relative risk (RR) from these trials was 1.01 (95% confidence interval [95% CI] 0.92 to 1.10). When the trial with poor quality allocation concealment was excluded, pooled RR was 1.00 (95% CI 0.91 to 1.09). Hydroxyethyl starch - 16 trials compared hydroxyethyl starch with crystalloids, n = 637 patients. The pooled RR was 1.05 (95% CI 0.63 to 1.75). Modified gelatin - 11 trials compared modified gelatin with crystalloid, n = 506 patients. The pooled RR was 0.91 (95% CI 0.49 to 1.72). Dextran - nine trials compared dextran with a crystalloid, n = 834 patients. The pooled RR was 1.24 (95% CI 0.94 to 1.65). COLLOIDS IN HYPERTONIC CRYSTALLOID COMPARED TO ISOTONIC CRYSTALLOID: Eight trials compared dextran in hypertonic crystalloid with isotonic crystalloid, including 1,283 randomised participants. Pooled RR was 0.88 (95% CI 0.74 to 1.05). AUTHORS' CONCLUSIONS There is no evidence from RCTs that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids, in patients with trauma, burns or following surgery. As colloids are not associated with an improvement in survival, and as they are more expensive than crystalloids, it is hard to see how their continued use in these patients can be justified outside the context of RCTs.
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Affiliation(s)
- P Perel
- London School of Hygiene & Tropical Medicine, Nutrition & Public Health Intervention Research Unit, Keppel Street, London, UK, WC1E 7HT.
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Minassian A, Leung J, Roberts I, Winearls C, Byren I. An unusual case of post-infectious glomerulonephritis. J Infect 2007. [DOI: 10.1016/j.jinf.2007.04.027] [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: 10/23/2022]
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Vyas P, Norton A, Tunstall-Pedoe O, Roberts I. 132 INVITED Acute megakaryoblastic leukaemia in Down syndrome and non-Down syndrome patients – molecular signature of a disease – subtypes with distinct treatment outcomes. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
OBJECTIVE The World Bank believes that the car manufacturers can make a valuable contribution to road safety in poor countries and has established the Global Road Safety Partnership (GRSP) for this purpose. However, some commentators are sceptical. The authors examined road safety policy documents to assess the extent of any bias. DESIGN Word frequency analyses of road safety policy documents from the World Health Organization (WHO) and the GRSP. MAIN OUTCOME MEASURES The relative occurrence of key road safety terms was quantified by calculating a word prevalence ratio with 95% confidence intervals. Terms for which there was a fourfold difference in prevalence between the documents were tabulated. RESULTS Compared to WHO's World report on road traffic injury prevention, the GRSP road safety documents were substantially less likely to use the words speed, speed limits, child restraint, pedestrian, public transport, walking, and cycling, but substantially more likely to use the words school, campaign, driver training, and billboard. CONCLUSIONS There are important differences in emphasis in road safety policy documents prepared by WHO and the GRSP. Vigilance is needed to ensure that the road safety interventions that the car industry supports are based on sound evidence of effectiveness.
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Affiliation(s)
- I Roberts
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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Muralidhar B, Goldstein LD, Ng G, Winder DM, Palmer RD, Gooding EL, Barbosa-Morais NL, Mukherjee G, Thorne NP, Roberts I, Pett MR, Coleman N. Global microRNA profiles in cervical squamous cell carcinoma depend on Drosha expression levels. J Pathol 2007; 212:368-77. [PMID: 17471471 DOI: 10.1002/path.2179] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Gain of chromosome 5p is seen in over 50% of advanced cervical squamous cell carcinomas (SCCs), although the genes responsible for the selective advantage provided by this abnormality are poorly understood. In the W12 cervical carcinogenesis model, we observed that 5p gain was rapidly selected over approximately 15 population doublings and was associated with the acquisition of a growth advantage and invasiveness. The most significantly upregulated transcript following 5p gain was the microRNA (miRNA) processor Drosha. In clinically progressed cervical SCC, Drosha copy-number gain was seen in 21/36 clinical samples and 8/10 cell lines and there was a significant association between Drosha transcript levels and copy-number gain. Other genes in the miRNA processing pathway, DGCR8, XPO5 and Dicer, showed infrequent copy-number gain and over-expression. Drosha copy-number and expression were not elevated in pre-malignant cervical squamous intraepithelial lesions. Importantly, global miRNA profiling showed that Drosha over-expression in cervical SCC appears to be of functional significance. Unsupervised principal component analysis of a mixed panel of cervical SCC cell lines and clinical specimens showed clear separation according to Drosha over-expression. miRNAs most significantly associated with Drosha over-expression are implicated in carcinogenesis in other tissues, suggesting that they regulate fundamental processes in neoplastic progression. Our evidence suggests that copy-number driven over-expression of Drosha and consequent changes in miRNAs are likely to be important contributors to the selective advantage provided by 5p gain in cervical neoplastic progression.
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Affiliation(s)
- B Muralidhar
- Medical Research Council Cancer Cell Unit, Cambridge, CB2 0XZ, UK
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Ng G, Winder D, Muralidhar B, Gooding E, Roberts I, Pett M, Mukherjee G, Huang J, Coleman N. Gain and overexpression of the oncostatin M receptor occur frequently in cervical squamous cell carcinoma and are associated with adverse clinical outcome. J Pathol 2007; 212:325-34. [PMID: 17516585 DOI: 10.1002/path.2184] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
For many oncogenes, increased expression resulting from copy number gain confers a selective advantage to cells that consequently make up the tumour bulk. To identify oncogenes of potential biological significance in cervical squamous cell carcinoma (SCC), 36 primary samples and ten cell lines were screened by array comparative genomic hybridization (CGH). The most commonly occurring regions of copy number gain that also showed amplification were 5p15.2-14.3 (59%), 5p13.3 (65%), and 5p13.2-13.1 (63%). Gene copy numbers were significantly associated with expression levels for three candidate oncogenes at these loci: OSMR (oncostatin M receptor) (p=0.03), PDZK3 (PDZ domain containing protein 3) (p=0.04), and TRIO (triple functional domain) (p=0.03). Further examination by fluorescence in situ hybridization on a tissue microarray of 110 primary cervical SCC samples revealed copy number gain frequencies of 60.9%, 57.3%, and 54.5% for OSMR, PDZK3, and TRIO, respectively, with OSMR adversely influencing overall patient survival independently of tumour stage (p=0.046). By array CGH, copy number gain of OSMR was not seen in any of 40 microdissected precursor cervical squamous intraepithelial lesions (SILs). Moreover, global mRNA expression analysis, using Affymetrix U133A 2.0 Arrays, showed no overexpression of OSMR in SILs, suggesting that OSMR gain and overexpression are relatively late steps in cervical carcinogenesis. In the cervical SCC cell lines CaSki and SW756, exogenous OSM activated downstream-signalling elements of OSMR including STAT3, p44/42 MAPK, and S6 ribosomal protein, and induced transcription of the angiogenic factor VEGF, effects that were reduced by OSMR depletion using RNA interference. We conclude that copy number gain of OSMR is frequently found in cervical SCC and is associated with adverse clinical outcome. As well as being a potential prognostic marker, OSMR is a candidate cell surface therapeutic target.
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Affiliation(s)
- G Ng
- Medical Research Council Cancer Cell Unit, Hutchison/MRC Research Centre, Hills Road, Cambridge CB2 0XZ, UK
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