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Mohr AE, Pyne DB, Leite GSF, Akins D, Pugh J. A systematic scoping review of study methodology for randomized controlled trials investigating probiotics in athletic and physically active populations. J Sport Health Sci 2024; 13:61-71. [PMID: 36539062 PMCID: PMC10818115 DOI: 10.1016/j.jshs.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/25/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The purported ergogenic and health effects of probiotics have been a topic of great intrigue among researchers, practitioners, and the lay public alike. There has also been an increased research focus within the realm of sports science and exercise medicine on the athletic gut microbiota. However, compared to other ergogenic aids and dietary supplements, probiotics present unique study challenges. The objectives of this systematic scoping review were to identify and characterize study methodologies of randomized controlled trials investigating supplementation with probiotics in athletes and physically active individuals. METHODS Four databases (MEDLINE, CINAHL, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews) were searched for randomized controlled studies involving healthy athletes or physically active individuals. An intervention with probiotics and inclusion of a control and/or placebo group were essential. Only peer-reviewed articles in English were considered, and there were no date restrictions. Results were extracted and presented in tabular form to detail study protocols, characteristics, and outcomes. Bias in randomized controlled trials was determined with the RoB 2.0 tool. RESULTS A total of 45 studies were included in the review, with 35 using a parallel group design and 10 using a cross-over design. Approximately half the studies used a single probiotic and the other half a multi-strain preparation. The probiotic dose ranged from 2 × 108 to 1 × 1011 colony forming units daily, and the length of intervention was between 7 and 150 days. Fewer than half the studies directly assessed gastrointestinal symptoms, gut permeability, or the gut microbiota. The sex ratio of participants was heavily weighted toward males, and only 3 studies exclusively investigated females. Low-level adverse events were reported in only 2 studies, although the methodology of reporting varied widely. The risk of bias was generally low, although details on randomization were lacking in some studies. CONCLUSION There is a substantial body of research on the effects of probiotic supplementation in healthy athletes and physically active individuals. Considerable heterogeneity in probiotic selection and dosage as well as outcome measures has made clinical and mechanistic interpretation challenging for both health care practitioners and researchers. Attention to issues of randomization of participants, treatments and interventions, selection of outcomes, demographics, and reporting of adverse events will facilitate more trustworthy interpretation of probiotic study results and inform evidence-based guidelines.
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Affiliation(s)
- Alex E Mohr
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA.
| | - David B Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT 2617, Australia
| | - Geovana Silva Fogaça Leite
- Laboratory of Functional Fermented Food, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-030, Brazil
| | - Deborah Akins
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Jamie Pugh
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
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2
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Orlando G, Pugh J, Faulkner S, Balducci S, Sacchetti M, Pugliese G, Bazzucchi I, Haxhi J, Martinez-Valdes E, Falla D, Manolopoulos K, Nimmo MA. Muscular Adaptations to Concurrent Resistance Training and High-Intensity Interval Training in Adults with Type 2 Diabetes: A Pilot Study. Int J Environ Res Public Health 2023; 20:6746. [PMID: 37754606 PMCID: PMC10530856 DOI: 10.3390/ijerph20186746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023]
Abstract
This pilot study aimed to compare the effects of eight weeks of concurrent resistance training (RT) and high-intensity interval training (HIIT) vs. RT alone on muscle performance, mass and quality in adults with type 2 diabetes (T2DM). Twelve T2DM adults were randomly allocated to the RT + HIIT (n = 5) or RT (n = 7) group. Before and after training, maximal oxygen uptake (VO2max), muscle strength and power were evaluated by calorimetry, dynamometry and one-repetition maximum (1RM) test. Quadriceps muscle volume was determined by MRI, and muscle quality was estimated. After RT, VO2max (+12%), knee muscle power (+20%), quadriceps muscle volume (+5.9%) and quality (leg extension, +65.4%; leg step-up, +223%) and 1RM at leg extension (+66.4%), leg step-up (+267%), lat pulldown (+60.9%) and chest press (+61.2%) significantly increased. The RT + HIIT group improved on VO2max (+27%), muscle volume (+6%), muscle power (+9%) and 1RM at lat pulldown (+47%). No other differences were detected. Among groups, changes in muscle quality at leg step-up and leg extension and VO2max were significantly different. The combination of RT and HIIT effectively improves muscle function and size and increases cardiorespiratory fitness in adults with T2DM. However, HIIT combined with RT may interfere with the development of muscle quality.
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Affiliation(s)
- Giorgio Orlando
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15GD, UK
| | - Jamie Pugh
- College of Life and Environmental Sciences, University of Birmingham, Birmingham B152TT, UK; (J.P.); (M.A.N.)
- Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE113TU, UK;
| | - Steve Faulkner
- Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE113TU, UK;
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham NG14FQ, UK
| | - Stefano Balducci
- Diabetes Unit, Department of Clinical and Molecular Medicine, “La Sapienza” University, Sant’ Andrea University Hospital, 00185 Rome, Italy; (S.B.); (G.P.); (J.H.)
- Metabolic Fitness Association, 00015 Monterotondo, Italy
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (I.B.)
| | - Giuseppe Pugliese
- Diabetes Unit, Department of Clinical and Molecular Medicine, “La Sapienza” University, Sant’ Andrea University Hospital, 00185 Rome, Italy; (S.B.); (G.P.); (J.H.)
| | - Ilenia Bazzucchi
- Department of Human Movement and Sport Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (I.B.)
| | - Jonida Haxhi
- Diabetes Unit, Department of Clinical and Molecular Medicine, “La Sapienza” University, Sant’ Andrea University Hospital, 00185 Rome, Italy; (S.B.); (G.P.); (J.H.)
| | - Eduardo Martinez-Valdes
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham B152TT, UK; (E.M.-V.); (D.F.)
| | - Deborah Falla
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham B152TT, UK; (E.M.-V.); (D.F.)
| | - Konstantinos Manolopoulos
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B152TT, UK;
| | - Myra A. Nimmo
- College of Life and Environmental Sciences, University of Birmingham, Birmingham B152TT, UK; (J.P.); (M.A.N.)
- Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE113TU, UK;
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Grosicki GJ, Pugh J, Wosinska L, Quilter K, Mattimoe D, Allen J, Joyce SA, O'Sullivan O, Close GL. Ultra-Endurance triathlon competition shifts fecal metabolome independent of changes to microbiome composition. J Appl Physiol (1985) 2023; 135:549-558. [PMID: 37391884 DOI: 10.1152/japplphysiol.00024.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/22/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023] Open
Abstract
Understanding changes to gut microbiota composition and metabolic output in response to acute exercise may be necessary for understanding the mechanisms mediating the long-term health and performance benefits of exercise. Our primary objective was to characterize acute changes in the fecal microbiome and metabolome following participation in an ultra-endurance (3.9 km swim, 180.2 km bike, 42.2 km run) triathlon. An exploratory aim was to determine associations between athlete-specific factors [race performance (i.e., completion time) and lifetime years of endurance training] with pre-race gut microbiota and metabolite profiles. Stool samples from 12 triathletes (9 males/3 females; 43 ± 14 yr, 23 ± 2 kg/m2) were collected ≤48 h before and the first bowel movement following race completion. Intra- and inter-individual diversity of bacterial species and individual bacterial taxa were unaltered following race completion (P > 0.05). However, significant reductions (P < 0.05) in free and secondary bile acids [deoxycholic acid (DCA), 12-keto-lithocholic acid (12-ketoLCA)] and short-chain fatty acids (butyric and pivalic acids), and significant increases (P < 0.05) in long-chain fatty acids (oleic and palmitoleic acids) were observed. Exploratory analyses revealed several associations between pre-race bacterial taxa and fecal metabolites with race performance and lifetime history of endurance training (P < 0.05). These findings suggest that 1) acute ultra-endurance exercise shifts microbial metabolism independent of changes to community composition and 2) athlete performance level and training history relate to resting-state gut microbial ecology.NEW & NOTEWORTHY This is the first study to characterize acute changes in gut microbial ecology and metabolism following an ultra-endurance triathlon. We demonstrate changes in gut microbial community function, but not structure, as well as several associations between gut microbiome and fecal metabolome characteristics with race completion time and lifetime history of endurance training. These data add to a small but growing body of literature seeking to characterize the acute and chronic effects of exercise on the gut microbial ecosystem.
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Affiliation(s)
- Gregory J Grosicki
- Biodynamics and Human Performance Center, Georgia Southern University - Armstrong Campus, Savannah, Georgia, United States
| | - Jamie Pugh
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Laura Wosinska
- Teagasc Food Research Centre, Moorepark, Fermoy, Ireland
| | - Karina Quilter
- School of Biochemistry and Cell Biology, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Darragh Mattimoe
- School of Biochemistry and Cell Biology, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Jacob Allen
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States
| | - Susan A Joyce
- School of Biochemistry and Cell Biology, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Orla O'Sullivan
- Teagasc Food Research Centre, Moorepark, Fermoy, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- VistaMilk SFI Research Centre, Fermoy, Ireland
| | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Wilson PB, Fearn R, Pugh J. Occurrence and Impacts of Gastrointestinal Symptoms in Team-Sport Athletes: A Preliminary Survey. Clin J Sport Med 2023; 33:239-245. [PMID: 36476634 DOI: 10.1097/jsm.0000000000001113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Although gastrointestinal (GI) symptoms are prevalent in endurance athletes, scant research has examined GI symptoms in team-sport athletes, their impacts, and explanatory factors. This study aimed to assess the prevalence and severity of GI symptoms in team-sport athletes and identify potential risk factors. DESIGN An observational anonymous survey. SETTING Online. PARTICIPANTS Hundred forty-three athletes (79 men and 64 women) from team-based sports, with soccer, rugby, and American football athletes comprising approximately 75% of the sample. ASSESSMENTS OF RISK FACTORS Age, gender, body mass index, competition experience, trait anxiety, and resting GI symptoms. MAIN OUTCOMES Gastrointestinal symptoms during training and competition. RESULTS Overall, past-month GI symptoms during training and competition were mild and relatively infrequent. However, 13.9% and 37.5% of men and women, respectively, reported that GI symptoms had ever impacted their performance. In comparison to men, women reported that nausea, bloating, and abdominal cramping were more likely to have affected performance ( P < 0.05). Women also had higher trait anxiety and higher scores for resting GI symptoms, during-training GI symptoms, and during-competition GI symptoms ( P < 0.001). Resting GI symptoms were the strongest predictor of training and competition GI symptoms (ρ = 0.46-0.67), although trait anxiety was also consistently correlated with competition GI symptoms (ρ = 0.29-0.38). CONCLUSIONS This study suggests that female team-sport athletes experience a higher burden of GI symptoms than males, and that resting symptoms and anxiety predict competition symptoms. Interventions targeting anxiety could theoretically reduce GI symptoms in some team-sport athletes, but this should be confirmed through experimental designs.
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Affiliation(s)
- Patrick B Wilson
- Human Movement Sciences Department, Human Performance Laboratory, Old Dominion University, Norfolk, Virginia
| | - Robert Fearn
- Department of Gastroenterology, University of California Irvine, Irvine, California; and
| | - Jamie Pugh
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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5
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Taylor HL, Garabello G, Pugh J, Morton J, Langan-Evans C, Louis J, Borgersen R, Areta JL. Patterns of energy availability of free-living athletes display day-to-day variability that is not reflected in laboratory-based protocols: Insights from elite male road cyclists. J Sports Sci 2022; 40:1849-1856. [PMID: 36062921 DOI: 10.1080/02640414.2022.2115676] [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: 10/14/2022]
Abstract
The physiological effects of low energy availability (EA) have been studied using a homogenous daily EA pattern in laboratory settings. However, whether this daily EA pattern represents those of free-living athletes and is therefore ecologically valid is unknown. To investigate this, we assessed daily exercise energy expenditure, energy intake and EA in 10 free-living elite male road cyclists (20 min Mean Maximal Power: 5.27 ± 0.25 W · kg-1) during 7 consecutive days of late pre-season training. Energy intake was measured using the remote-food photography method and exercise energy expenditure estimated from cycling crank-based power-metres. Seven-day mean ± SD energy intake and exercise energy expenditure was 57.9 ± 10.4 and 38.4 ± 8.6 kcal · kg FFM-1 · day-1, respectively. EA was 19.5 ± 9.1 kcal · kg FFM-1 · day-1. Within-participants correlation between daily energy intake and exercise energy expenditure was .62 (95% CI: .43 - .75; P < .001), and .60 (95% CI: .41 - .74; P < .001) between carbohydrate intake and exercise energy expenditure. However, energy intake only partially compensated for exercise energy expenditure, increasing 210 kcal · day-1 per 1000 kcal · day-1 increase in expenditure. EA patterns displayed marked day-to-day fluctuation (range: -22 to 76 kcal · kg FFM-1 · day-1). The validity of research using homogenous low EA patterns therefore requires further investigation.
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Affiliation(s)
- Harry L Taylor
- Research Institute for Sport & Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | - Giacomo Garabello
- Research Institute for Sport & Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | - Jamie Pugh
- Research Institute for Sport & Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | - James Morton
- Research Institute for Sport & Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | - Carl Langan-Evans
- Research Institute for Sport & Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | - Julien Louis
- Research Institute for Sport & Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | | | - Jose L Areta
- Research Institute for Sport & Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
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Mohr AE, Pugh J, O'Sullivan O, Black K, Townsend JR, Pyne DB, Wardenaar FC, West NP, Whisner CM, McFarland LV. Best Practices for Probiotic Research in Athletic and Physically Active Populations: Guidance for Future Randomized Controlled Trials. Front Nutr 2022; 9:809983. [PMID: 35350412 PMCID: PMC8957944 DOI: 10.3389/fnut.2022.809983] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/26/2022] [Indexed: 12/12/2022] Open
Abstract
Probiotic supplementation, traditionally used for the prevention or treatment of a variety of disease indications, is now recognized in a variety of population groups including athletes and those physically active for improving general health and performance. However, experimental and clinical trials with probiotics commonly suffer from design flaws and different outcome measures, making comparison and synthesis of conclusions difficult. Here we review current randomized controlled trials (RCTs) using probiotics for performance improvement, prevention of common illnesses, or general health, in a specific target population (athletes and those physically active). Future RCTs should address the key elements of (1) properly defining and characterizing a probiotic intervention, (2) study design factors, (3) study population characteristics, and (4) outcome measures, that will allow valid conclusions to be drawn. Careful evaluation and implementation of these elements should yield improved trials, which will better facilitate the generation of evidence-based probiotic supplementation recommendations for athletes and physically active individuals.
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Affiliation(s)
- Alex E. Mohr
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
- *Correspondence: Alex E. Mohr
| | - Jamie Pugh
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Orla O'Sullivan
- Teagasc Food Research Centre, Moorepark, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Katherine Black
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Jeremy R. Townsend
- Exercise and Nutrition Science Graduate Program, Lipscomb University, Nashville, TN, United States
| | - David B. Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Floris C. Wardenaar
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Nicholas P. West
- School of Medical Science and Menzies Health Institute of QLD, Griffith Health, Griffith University, Southport, QLD, Australia
| | - Corrie M. Whisner
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Lynne V. McFarland
- Department of Medicinal Chemistry, University of Washington, Seattle, WA, United States
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Tree A, Hall E, Ostler P, van der Voet H, Loblaw A, Chu W, Ford D, Tolan S, Jain S, Martin A, Staffurth J, Camilleri P, Kancherla K, Frew J, Brand D, Chan A, Dayes I, Brown S, Pugh J, Burnett S, Dufton A, Griffin C, Mahmud M, Naismith O, van As N, of the O. OC-0289 Comparison of side effects at 2 years in the randomised PACE-B trial (SBRT vs standard radiotherapy). Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06839-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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King L, Cullen SJ, O'Connor S, McGoldrick A, Pugh J, Warrington G, Woods G, Nevill AM, Losty C. Common mental disorders among Irish jockeys: prevalence and risk factors. PHYSICIAN SPORTSMED 2021; 49:207-213. [PMID: 32777964 DOI: 10.1080/00913847.2020.1808435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Jockeys compete in a sport, horseracing, renowned for its physical and psychological demands. Previous research has identified that common mental disorders (CMDs) may be prevalent among this unique population of athletes. The aim of the present study was to further explore the prevalence of CMDs among jockeys and to test for associations with potential risk factors. METHODS An anonymous survey was distributed to professional jockey online. Self-report screening tools for four CMDs (psychological distress, depression, generalized anxiety, and adverse alcohol use) were included alongside predictor variables from questionnaires assessing for burnout, career satisfaction, social support, and the contemplation of retirement. Binary logistic regression was used to explore associations between CMDs (present versus not present) and risk factors. Eighty-four professional jockeys completed the questionnaire (response rate = 52%). RESULTS In total, 79% of jockeys met the threshold for at least one CMD. Prevalence (%) of CMD varied as follows: adverse alcohol (61%), depression (35%), generalized anxiety (27%), and psychological distress (19%). Burnout, career (dis)satisfaction, lower levels of social support, and the contemplation of retirement increased the odds of meeting the criteria for CMDs. CONCLUSION The findings indicate that jockeys report CMD symptoms at comparable rates to athletes in other sports. The study was the first to highlight potential risk factors as predictors of CMDs among jockeys, including burnout, career satisfaction, and the current contemplation of retirement. Screening tools for the risk factors demonstrated may, therefore, provide useful in the early identification of CMDs among jockeys. The development of jockey-specific assessment tools, education programmes, and interventions may help better understand and support the mental health of jockeys.
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Affiliation(s)
- L King
- Department of Sport and Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | - S J Cullen
- Department of Sport and Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | - S O'Connor
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - A McGoldrick
- Irish Horseracing Regulatory Board, Kildare, Ireland
| | - J Pugh
- Irish Horseracing Regulatory Board, Kildare, Ireland
| | - G Warrington
- Health Research Institute, University of Limerick, Limerick, Ireland.,Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - G Woods
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland
| | - A M Nevill
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK
| | - C Losty
- Department of Sport and Exercise Science, Waterford Institute of Technology, Waterford, Ireland
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9
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Wilson PB, Russell H, Pugh J. Anxiety may be a risk factor for experiencing gastrointestinal symptoms during endurance races: An observational study. Eur J Sport Sci 2020; 21:421-427. [PMID: 32251613 DOI: 10.1080/17461391.2020.1746836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/13/2022]
Abstract
Scarce research has examined the links between stress, anxiety, and gastrointestinal (GI) symptoms during competition, despite that they are positively correlated in the general population. A total of 186 endurance athletes completed the Perceived Stress Scale (PSS)-14, Anxiety Sensitivity Index (ASI)-3, and State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) before races. Afterwards, they reported the severity of in-race GI symptoms. Associations between high levels of stress and anxiety (defined as the top tertile) and GI distress (≥3 on a 0-10 scale) were examined using logistic regression. Athletes with high PSS-14 scores did not have greater odds of GI symptoms, except nausea (odds ratio [OR] = 2.21, 95% confidence interval [CI] 1.02-4.78). High scores on the STICSA-trait were associated with nausea (OR = 3.43, 95% CI 1.57-7.50) and regurgitation/reflux (OR = 3.31, 95% CI 1.26-8.73). Among a sub-sample of 125 participants that completed STICSA-state questionnaires, higher anxiety was associated with nausea (OR = 5.57, 95% CI 1.96-15.83), regurgitation/reflux (OR = 3.75, 95% CI 1.17-12.00), fullness (OR = 2.98, 95% CI 1.05-8.49), and cramping (OR = 3.99, 95% CI 1.36-11.68). The ORs remained relatively stable after adjusting for age, gender, experience, body mass index, type of race, and race duration. ASI-3 scores were not associated with symptoms. Individuals with higher levels of anxiety, especially on the morning of a race, may be prone GI distress, particularly nausea, regurgitation/reflux, and cramping.
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Affiliation(s)
| | - Hayley Russell
- Health and Exercise Science, Gustavus Adolphus College, St. Peter, USA
| | - Jamie Pugh
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Jimenez-Pascual A, Hale J, Kordowski A, Pugh J, Rao S, Silver D, Alban T, Watson D, Chen R, McIntyre T, Colombo G, Taraboletti G, Holmberg K, Forsberg-Nilsson K, Lathia J, Siebzehnrubl F. The metalloproteinase ADAMDEC1 maintains a novel growth factor signalling loop in glioblastoma cancer stem cells. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz167.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Glioblastomas (GBM) are lethal brain tumours where poor outcome is attributed to cellular heterogeneity, therapeutic resistance, and a highly infiltrative nature. These characteristics are preferentially linked to GBM cancer stem cells (GSCs), but how GSCs maintain their stemness is incompletely understood and the subject of intense investigation. Here, we identify a novel growth factor signalling loop that induces and maintains GSCs. This loop consists of an atypical metalloproteinase, a disintegrin and metalloproteinase domain-like protein decysin 1 (ADAMDEC1), secreted by GSCs. ADAMDEC1 solubilizes fibroblast growth factor-2 (FGF2) in the tumour microenvironment. We find that GSCs exclusively express FGF receptor 1 (FGFR1), which upon binding of FGF2 induces upregulation of Zinc finger E-box-binding homeobox 1 (ZEB1). ZEB1 is a regulator of stemness and tumour initiation, and therefore ADAMDEC1-FGF2-FGFR1 signalling promotes malignancy in GBM. We further show that ZEB1 regulates ADAMDEC1 expression, creating a positive feedback loop. Genetic or pharmacological targeting of components of this axis attenuates self-renewal and tumour growth. These findings reveal a new signalling axis for GSC maintenance and highlight ADAMDEC1 and FGFR1 as potential therapeutic targets in GBM.
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Affiliation(s)
| | - James Hale
- Lerner Research Institute, Cleveland Clinic, Cleveland, United States of America
| | - Anja Kordowski
- Cardiff University School of Biosciences, Cardiff, United Kingdom
| | - Jamie Pugh
- Cardiff University School of Biosciences, Cardiff, United Kingdom
| | - Shilpa Rao
- Lerner Research Institute, Cleveland Clinic, Cleveland, United States of America
| | - Daniel Silver
- Lerner Research Institute, Cleveland Clinic, Cleveland, United States of America
| | - Tyler Alban
- Lerner Research Institute, Cleveland Clinic, Cleveland, United States of America
| | - Defne Watson
- Lerner Research Institute, Cleveland Clinic, Cleveland, United States of America
| | - Rui Chen
- Lerner Research Institute, Cleveland Clinic, Cleveland, United States of America
| | - Thomas McIntyre
- Lerner Research Institute, Cleveland Clinic, Cleveland, United States of America
- Department of Molecular Medicine, Case Western Reserve University, Cleveland, United States of America
| | - Giorgio Colombo
- University of Pavia and Institute of Molecular Recognition Chemistry (ICRM-CNR), Milano, Italy
| | | | - Karl Holmberg
- Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Justin Lathia
- Lerner Research Institute, Cleveland Clinic, Cleveland, United States of America
- Department of Molecular Medicine, Case Western Reserve University, Cleveland, United States of America
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Jimenez-Pascual A, Hale JS, Kordowski A, Pugh J, Silver DJ, Bayik D, Roversi G, Alban TJ, Rao S, Chen R, McIntyre TM, Colombo G, Taraboletti G, Holmberg KO, Forsberg-Nilsson K, Lathia JD, Siebzehnrubl FA. ADAMDEC1 Maintains a Growth Factor Signaling Loop in Cancer Stem Cells. Cancer Discov 2019; 9:1574-1589. [PMID: 31434712 DOI: 10.1158/2159-8290.cd-18-1308] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023]
Abstract
Glioblastomas (GBM) are lethal brain tumors where poor outcome is attributed to cellular heterogeneity, therapeutic resistance, and a highly infiltrative nature. These characteristics are preferentially linked to GBM cancer stem cells (GSC), but how GSCs maintain their stemness is incompletely understood and the subject of intense investigation. Here, we identify a novel signaling loop that induces and maintains GSCs consisting of an atypical metalloproteinase, ADAMDEC1, secreted by GSCs. ADAMDEC1 rapidly solubilizes FGF2 to stimulate FGFR1 expressed on GSCs. FGFR1 signaling induces upregulation of ZEB1 via ERK1/2 that regulates ADAMDEC1 expression through miR-203, creating a positive feedback loop. Genetic or pharmacologic targeting of components of this axis attenuates self-renewal and tumor growth. These findings reveal a new signaling axis for GSC maintenance and highlight ADAMDEC1 and FGFR1 as potential therapeutic targets in GBM. SIGNIFICANCE: Cancer stem cells (CSC) drive tumor growth in many cancers including GBM. We identified a novel sheddase, ADAMDEC1, which initiates an FGF autocrine loop to promote stemness in CSCs. This loop can be targeted to reduce GBM growth.This article is highlighted in the In This Issue feature, p. 1469.
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Affiliation(s)
- Ana Jimenez-Pascual
- Cardiff University School of Biosciences, European Cancer Stem Cell Research Institute, Cardiff, United Kingdom
| | - James S Hale
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. .,Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Anja Kordowski
- Cardiff University School of Biosciences, European Cancer Stem Cell Research Institute, Cardiff, United Kingdom
| | - Jamie Pugh
- Cardiff University School of Biosciences, European Cancer Stem Cell Research Institute, Cardiff, United Kingdom
| | - Daniel J Silver
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Defne Bayik
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Gustavo Roversi
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tyler J Alban
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Molecular Medicine, Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Shilpa Rao
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Rui Chen
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thomas M McIntyre
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Molecular Medicine, Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Giorgio Colombo
- Department of Chemistry, University of Pavia and Institute of Molecular Recognition Chemistry (ICRM-CNR), Milano, Italy
| | | | - Karl O Holmberg
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Karin Forsberg-Nilsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Justin D Lathia
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. .,Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Molecular Medicine, Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Florian A Siebzehnrubl
- Cardiff University School of Biosciences, European Cancer Stem Cell Research Institute, Cardiff, United Kingdom.
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12
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Hammond KM, Sale C, Fraser W, Tang J, Shepherd SO, Strauss JA, Close GL, Cocks M, Louis J, Pugh J, Stewart C, Sharples AP, Morton JP. Post-exercise carbohydrate and energy availability induce independent effects on skeletal muscle cell signalling and bone turnover: implications for training adaptation. J Physiol 2019; 597:4779-4796. [PMID: 31364768 DOI: 10.1113/jp278209] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 04/26/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022] Open
Abstract
KEY POINTS Reduced carbohydrate (CHO) availability before and after exercise may augment endurance training-induced adaptations of human skeletal muscle, as mediated via modulation of cell signalling pathways. However, it is not known whether such responses are mediated by CHO restriction, energy restriction or a combination of both. In recovery from a twice per day training protocol where muscle glycogen concentration is maintained within 200-350 mmol kg-1 dry weight (dw), we demonstrate that acute post-exercise CHO and energy restriction (i.e. < 24 h) does not potentiate potent cell signalling pathways that regulate hallmark adaptations associated with endurance training. In contrast, consuming CHO before, during and after an acute training session attenuated markers of bone resorption, effects that are independent of energy availability. Whilst the enhanced muscle adaptations associated with CHO restriction may be regulated by absolute muscle glycogen concentration, the acute within-day fluctuations in CHO availability inherent to twice per day training may have chronic implications for bone turnover. ABSTRACT We examined the effects of post-exercise carbohydrate (CHO) and energy availability (EA) on potent skeletal muscle cell signalling pathways (regulating mitochondrial biogenesis and lipid metabolism) and indicators of bone metabolism. In a repeated measures design, nine males completed a morning (AM) and afternoon (PM) high-intensity interval (HIT) (8 × 5 min at 85% V ̇ O 2 peak ) running protocol (interspersed by 3.5 h) under dietary conditions of (1) high CHO availability (HCHO: CHO ∼12 g kg-1 , EA∼ 60 kcal kg-1 fat free mass (FFM)), (2) reduced CHO but high fat availability (LCHF: CHO ∼3 (-1 , EA∼ 60 kcal kg-1 FFM) or (3), reduced CHO and reduced energy availability (LCAL: CHO ∼3 g kg-1 , EA∼ 20 kcal kg-1 FFM). Muscle glycogen was reduced to ∼200 mmol kg-1 dw in all trials immediately post PM HIT (P < 0.01) and remained lower at 17 h (171, 194 and 316 mmol kg-1 dw) post PM HIT in LCHF and LCAL (P < 0.001) compared to HCHO. Exercise induced comparable p38MAPK phosphorylation (P < 0.05) immediately post PM HIT and similar mRNA expression (all P < 0.05) of PGC-1α, p53 and CPT1 mRNA in HCHO, LCHF and LCAL. Post-exercise circulating βCTX was lower in HCHO (P < 0.05) compared to LCHF and LCAL whereas exercise-induced increases in IL-6 were larger in LCAL (P < 0.05) compared to LCHF and HCHO. In conditions where glycogen concentration is maintained within 200-350 mmol kg-1 dw, we conclude post-exercise CHO and energy restriction (i.e. < 24 h) does not potentiate cell signalling pathways that regulate hallmark adaptations associated with endurance training. In contrast, consuming CHO before, during and after HIT running attenuates bone resorption, effects that are independent of energy availability and circulating IL-6.
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Affiliation(s)
- Kelly M Hammond
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - Craig Sale
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, UK
| | - William Fraser
- Norwich Medical School, University of East Anglia, Norfolk and Norwich University Hospital, Norfolk, NR4 7UY, UK
| | - Jonathan Tang
- Norwich Medical School, University of East Anglia, Norfolk and Norwich University Hospital, Norfolk, NR4 7UY, UK
| | - Sam O Shepherd
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - Juliette A Strauss
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - Matt Cocks
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - Julien Louis
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - Jamie Pugh
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - Claire Stewart
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - Adam P Sharples
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
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Pugh J, Wagenmakers A, Morton J, Doran D, Fielding B, Fleming S, Close G. Probiotic supplementation improves total and exogenous CHO oxidation in trained male cyclists: A randomized, double‐blind, placebo‐controlled cross‐over trial. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.839.4] [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: 11/11/2022]
Affiliation(s)
- Jamie Pugh
- Liverpool John Moores UniversityLiverpoolUnited Kingdom
| | | | - James Morton
- Liverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Dominic Doran
- Liverpool John Moores UniversityLiverpoolUnited Kingdom
| | | | | | - Graeme Close
- Liverpool John Moores UniversityLiverpoolUnited Kingdom
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14
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Stretton C, Pugh J, McDonagh B, McArdle A, Close G, Jackson M. Oxidation of Peroxiredoxins in Response to Hydrogen Peroxide and Contractile Activity in Skeletal Muscle. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.701.11] [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: 11/11/2022]
Affiliation(s)
- Clare Stretton
- The MRC‐ Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA)University of LiverpoolLiverpoolUnited Kingdom
| | - Jamie Pugh
- Research and Sport and Exercise ScienceLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | | | - Anne McArdle
- The MRC‐ Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA)University of LiverpoolLiverpoolUnited Kingdom
| | - Graeme Close
- Research and Sport and Exercise ScienceLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Malcolm Jackson
- The MRC‐ Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA)University of LiverpoolLiverpoolUnited Kingdom
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15
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Hemmings K, Girithananda A, Robertson R, Pugh J, Scalabrin M, Mora S, McArdle A. Exosomal Signaling by Skeletal Muscle: Role in Neuromuscular Ageing. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.536.20] [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: 11/11/2022]
Affiliation(s)
| | | | | | - Jamie Pugh
- University of LiverpoolLiverpoolUnited Kingdom
| | | | - Silvia Mora
- University of LiverpoolLiverpoolUnited Kingdom
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16
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Levoska M, Pugh J, Nelson G, Hanona P, Tamura D, Heller E, Khan S, Scheibye-Knudsen M, DiGiovanna J, Kraemer K. 753 Use of hierarchical clustering and principal component analysis for deep phenotyping of patients with mutations in XPD (ERCC2): trichothiodystrophy (TTD), xeroderma pigmentosum (XP) and XP/TTD. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.763] [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: 10/17/2022]
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Abstract
Background A growing number of hemodialysis patients are dependent upon central venous catheters (CVCs) for long-term vascular access. Although many complications of CVCs have been documented, the phenomenon of the stuck catheter is described relatively infrequently. Case report We describe a case where attempts to remove the line by exploration of the jugular insertion site in theater were unsuccessful and the line was internalized. Discussion The case is then discussed with all available cases in the literature to suggest principles of managing and preventing the stuck catheter phenomenon.
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Affiliation(s)
- M. Field
- Department of Vascular and General Surgery, University Hospital North Staffordshire, Stoke-on-Trent - UK
| | - J. Pugh
- The Medical School, Keele University, Stoke-on-Trent - UK
| | - J. Asquith
- Department of Radiology, University Hospital North Staffordshire, Stoke-on-Trent - UK
| | - S. Davies
- Department of Nephrology, University Hospital North Staffordshire, Stoke-on-Trent - UK
| | - A.D. Pherwani
- Department of Vascular and General Surgery, University Hospital North Staffordshire, Stoke-on-Trent - UK
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18
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Athanasiou M, Smith RM, Pugh J, Gong Y, Cryan MJ, Wang T. Monolithically multi-color lasing from an InGaN microdisk on a Si substrate. Sci Rep 2017; 7:10086. [PMID: 28855663 PMCID: PMC5577231 DOI: 10.1038/s41598-017-10712-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] [Received: 02/03/2017] [Accepted: 08/14/2017] [Indexed: 11/09/2022] Open
Abstract
An optically pumped multi-color laser has been achieved using an InGaN/GaN based micro-disk with an undercut structure on a silicon substrate. The micro-disk laser has been fabricated by means of a combination of a cost-effective microsphere lithography technique and subsequent dry/wet etching processes. The microdisk laser is approximately 1 μm in diameter. The structure was designed in such a way that the vertical components of the whispering gallery (WG) modes formed can be effectively suppressed. Consequently, three clean lasing peaks at 442 nm, 493 nm and 522 nm have been achieved at room temperature by simply using a continuous-wave diode laser as an optical pumping source. Time-resolved micro photoluminescence (PL) measurements have been performed in order to further confirm the lasing by investigating the excitonic recombination dynamics of these lasing peaks. A three dimensional finite-difference-time-domain (FDTD) simulation has been used for the structure design.
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Affiliation(s)
- M Athanasiou
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - R M Smith
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - J Pugh
- Department of Electrical and Electronic Engineering, University of Bristol, Bristol, United Kingdom
| | - Y Gong
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - M J Cryan
- Department of Electrical and Electronic Engineering, University of Bristol, Bristol, United Kingdom
| | - T Wang
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, United Kingdom.
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19
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Douglas T, Pugh J, Singh I, Savulescu J, Fazel S. Risk assessment tools in criminal justice and forensic psychiatry: The need for better data. Eur Psychiatry 2017; 42:134-137. [PMID: 28371726 PMCID: PMC5408162 DOI: 10.1016/j.eurpsy.2016.12.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 12/04/2016] [Accepted: 12/11/2016] [Indexed: 11/20/2022] Open
Abstract
Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk assessment tools.
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Affiliation(s)
- T Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom
| | - J Pugh
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom
| | - I Singh
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom
| | - J Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom
| | - S Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
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20
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Levoska M, Pugh J, Bembry R, Hanona P, Khan S, Heller E, Nelson G, Scheibye-Knudson M, Tamura D, DiGiovanna J, Kraemer K. 267 Deep phenotyping of patients with xeroderma pigmentosum and trichothiodystrophy. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.283] [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: 10/19/2022]
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Affiliation(s)
- P S Walker
- Howmedica, Inc and Harvard University Medical School
| | - M Ben-Dov
- Howmedica, Inc, Rutherford, New Jersey
| | - M J Askew
- Northwestern University, Chicago, Illinois (Rehabitation Engineering Program)
| | - J Pugh
- Hospital for Joint Diseases Orthopaedic Institute, New York (Division of Bioengineering)
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22
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Pugh J, Khan S, Tamura D, Merideth M, Heller E, DiGiovanna J, Kraemer K. 368 Influence of paternal alleles on clinical outcome in trichothiodsytrophy. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Gabriel BM, Pugh J, Pruneta-Deloche V, Moulin P, Ratkevicius A, Gray SR. The effect of high intensity interval exercise on postprandial triacylglycerol and leukocyte activation--monitored for 48 h post exercise. PLoS One 2013; 8:e82669. [PMID: 24349333 PMCID: PMC3857256 DOI: 10.1371/journal.pone.0082669] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/26/2013] [Indexed: 01/20/2023] Open
Abstract
Postprandial phenomenon are thought to contribute to atherogenesis alongside activation of the immune system. A single bout of high intensity interval exercise attenuates postprandial triacylglycerol (TG), although the longevity and mechanisms underlying this observation are unknown. The aims of this study were to determine whether this attenuation in postprandial TG remained 2 days after high intensity interval exercise, to monitor markers of leukocyte activation and investigate the underlying mechanisms. Eight young men each completed two three day trials. On day 1: subjects rested (Control) or performed 5 x 30 s maximal sprints (high intensity interval exercise). On day 2 and 3 subjects consumed high fat meals for breakfast and 3 h later for lunch. Blood samples were taken at various times and analysed for TG, glucose and TG-rich lipoprotein (TRL)-bound LPL-dependent TRL-TG hydrolysis (LTTH). Flow cytometry was used to evaluate granulocyte, monocyte and lymphocyte CD11b and CD36 expression. On day 2 after high intensity interval exercise TG area under the curve was lower (P<0.05) (7.46±1.53 mmol/l/7h) compared to the control trial (9.47±3.04 mmol/l/7h) with no differences during day 3 of the trial. LTTH activity was higher (P<0.05) after high intensity interval exercise, at 2 hours of day 2, compared to control. Granulocyte, monocyte and lymphocyte CD11b expression increased with time over day 2 and 3 of the study (P<0.0001). Lymphocyte and monocyte CD36 expression decreased with time over day 2 and 3 (P<0.05). There were no differences between trials in CD11b and CD36 expression on any leukocytes. A single session of high intensity interval exercise attenuated postprandial TG on day 2 of the study, with this effect abolished by day 3.The reduction in postprandial TG was associated with an increase in LTTH. High intensity interval exercise had no effect on postprandial responses of CD11b or CD36.
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Affiliation(s)
| | - Jamie Pugh
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | | | - Philippe Moulin
- Endocrinology Department, Hopital Louis Pradel, University Lyon, Lyon, France
| | - Aivaras Ratkevicius
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Stuart Robert Gray
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
- * E-mail:
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24
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Shamji M, Moon ES, Glennie R, Soroceanu A, Lin C, Bailey C, Simmonds A, Fehlings M, Dodwell E, Dold A, El-Hawary R, Hashem M, Dold A, Dold A, Jones S, Bailey C, Karadimas S, Whitehurst D, Norton J, Norton J, Manson N, Kesani A, Bednar D, Lundine K, Hartig D, Fichadi A, Fehlings M, Kim S, Harris S, Lin C, Gill J, Abraham E, Shamji M, Choi S, Goldstein C, Wang Z, McCabe M, Noonan V, Nadeau M, Ferrara S, Kelly A, Melnyk A, Arora D, Quateen A, Dea N, Ranganathan A, Zhang Y, Casha S, Rajamanickam K, Santos A, Santos A, Wilson J, Wilson J, Street J, Wilson J, Lewis R, Noonan V, Street J, El-Hawary R, Egge N, Lin C, Schouten R, Lin C, Kim A, Kwon B, Huang E, Hwang P, Allen K, Jing L, Mata B, Gabr M, Richardson W, Setton L, Karadimas S, Fehlings M, Fleming J, Bailey C, Gurr K, Bailey S, Siddiqi F, Lawendy A, Sanders D, Staudt M, Canacari E, Brown E, Robinson A, McGuire K, Chrysostoum C, Rampersaud YR, Dvorak M, Thomas K, Boyd M, Gurr K, Bailey S, Nadeau M, Fisher C, Batke J, Street J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Vaccaro A, Chapman J, Arnold P, Shaffrey C, Kopjar B, Snyder B, Wright J, Lewis S, Zeller R, El-Hawary R, Moroz P, Bacon S, Jarzem P, Hedden D, Howard J, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Parent E, Hill D, Hedden D, Moreau M, Mahood J, Lewis S, Bodrogi A, Abbas H, Goldstein S, Bronstein Y, Bacon S, Chua S, Magana S, Van Houwelingen A, Halpern E, Jhaveri S, Lewis S, Lim A, Leelapattana P, Fleming J, Siddiqqi F, Bailey S, Gurr K, Moon ES, Satkunendrarajah K, Fehlings M, Noonan V, Dvorak M, Bryan S, Aronyk K, Fox R, Nataraj A, Pugh J, Elliott R, McKeon M, Abraham E, Fleming J, Gurr K, Bailey S, Siddiqi F, Bailey C, Davis G, Rogers M, Staples M, Quan G, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Shamji M, Hurlbert R, Jacobs W, Duplessis S, Casha S, Jha N, Hewson S, Massicotte E, Kopjar B, Mortaz S, Coyte P, Rampersaud Y, Rampersaud Y, Goldstein S, Andrew B, Modi H, Magana S, Lewis S, Roffey D, Miles I, Wai E, Manson N, Eastwood D, Elliot R, McKeon M, Bains I, Yong E, Sutherland G, Hurlbert R, Rampersaud Y, Chan V, Persaud O, Koshkin A, Brull R, Hassan N, Petis S, Kowalczuk M, Petrisor B, Drew B, Bhandari M, DiPaola C, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, McLachlin S, Bailey S, Gurr K, Bailey C, Dunning C, Fehlings M, Vaccaro A, Wing P, Itshayek E, Biering-Sorensen F, Dvorak M, McLachlin S, Bailey S, Gurr K, Dunning C, Bailey C, Bradi A, Pokrupa R, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Kelly A, Wen T, Kingwell S, Chak J, Singh V, Cripton P, Fisher C, Dvorak M, Oxland T, Wali Z, Yen D, Alfllouse A, Alzahrani A, Jiang H, Mahood J, Kortbeek F, Fox R, Nataraj A, Street J, Boyd M, Paquette S, Kwon B, Batke J, Dvorak M, Fisher C, Reddy R, Rampersaud R, Hurlbert J, Yong W, Casha S, Zygun D, McGowan D, Bains I, Yong V, Hurlbert R, Mendis B, Chakraborty S, Nguyen T, Tsai E, Chen A, Atkins D, Noonan V, Drew B, Tsui D, Townson A, Dvorak M, Chen A, Atkins D, Noonan V, Drew B, Dvorak M, Craven C, Ford M, Ahn H, Drew B, Fehlings M, Kiss A, Vaccaro A, Harrop J, Grossman R, Frankowski R, Guest J, Dvorak M, Aarabi B, Fehlings M, Noonan V, Cheung A, Sun B, Dvorak M, Vaccaro A, Harrop J, Massicotte E, Dvorak M, Fisher C, Rampersaud R, Lewis S, Fehlings M, Marais L, Noonan V, Queyranne M, Fehlings M, Dvorak M, Atkins D, Hurlbert R, Fox R, Fourney D, Johnson M, Fehlings M, Ahn H, Ford M, Yee A, Finkelstein J, Tsai E, Bailey C, Drew B, Paquet J, Parent S, Christie S, Dvorak M, Noonan V, Cheung A, Sun B, Dvorak M, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Lange J, DiPaola C, Lapinsky A, Connolly P, Eck J, Rabin D, Zeller R, Lewis S, Lee R, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, DiPaola C, Street J, Bodrogi A, Goldstein S, Sofia M, Lewis S, Shin J, Tung K, Ahn H, Lee R, Batke J, Ghag R, Noonan V, Dvorak M, Goyal T, Littlewood J, Bains I, Cho R, Thomas K, Swamy G. Canadian Spine Society abstracts1.1.01 Supraspinal modulation of gait abnormalities associated with noncompressive radiculopathy may be mediated by altered neurotransmitter sensitivity1.1.02 Neuroprotective effects of the sodium-glutamate blocker riluzole in the setting of experimental chronic spondylotic myelopathy1.1.03 The effect of timing to decompression in cauda equina syndrome using a rat model1.2.04 Intraoperative waste in spine surgery: incidence, cost and effectiveness of an educational program1.2.05 Looking beyond the clinical box: the health services impact of surgical adverse events1.2.06 Brace versus no brace for the treatment of thoracolumbar burst fractures without neurologic injury: a multicentre prospective randomized controlled trial1.2.07 Adverse event rates in surgically treated spine injuries without neurologic deficit1.2.08 Functional and quality of life outcomes in geriatric patients with type II odontoid fracture: 1-year results from the AOSpine North America Multi-Center Prospective GOF Study1.3.09 National US practices in pediatric spinal fusion: in-hospital complications, length of stay, mortality, costs and BMP utilization1.3.10 Current trends in the surgical treatment of adolescent idiopathic scoliosis in Canada1.3.11 Sagittal spinopelvic parameters help predict the risk of proximal junctional kyphosis for children treated with posterior distraction-based implants1.4.12 Correlations between changes in surface topography and changes in radiograph measurements from before to 6 months after surgery in adolescents with idiopathic scoliosis1.4.13 High upper instrumented vertebra (UIV) sagittal angle is associated with UIV fracture in adult deformity corrections1.4.14 Correction of adult idiopathic scoliosis using intraoperative skeletal traction1.5.01 Cauda equina: using management protocols to reduce delays in diagnosis1.5.02 Predicting the need for tracheostomy in patients with acute traumatic spinal cord injury1.5.03 A novel animal model of cervical spondylotic myelopathy: an opportunity to identify new therapeutic targets1.5.04 A review of preference-based measures of health-related quality of life in spinal cord injury research1.5.05 Predicting postoperative neuropathic pain following surgery involving nerve root manipulation based on intraoperative electromyographic activity1.5.06 Detecting positional injuries in prone spinal surgery1.5.07 Percutaneous thoracolumbar stabilization for trauma: surgical morbidity, clinical outcomes and revision surgery1.5.08 Systemic inflammatory response syndrome in spinal cord injury patients: Does its presence at admission affect patient outcomes?2.1.15 One hundred years of spine surgery — a review of the evolution of our craft and practice in the spine surgical century [presentation]2.1.16 Prevalence of preoperative MRI findings of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion2.1.17 Adverse event rates of surgically treated cervical spondylopathic myelopathy2.1.18 Morphometricand dynamic changes in the cervical spine following anterior cervical discectomy and fusion and cervical disc arthroplasty2.1.19 Is surgery for cervical spondylotic myelopathy cost-effective? A cost–utility analysis based on data from the AO Spine North American Prospective Multicentre CSM Study2.2.20 Cost–utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis (DLS)2.2.21 Minimally invasive surgery lumbar fusion for low-grade isthmic and degenerative spondylolisthesis: 2- to 5-year follow-up2.2.22 Results and complications of posterior-only reduction and fusion for high-grade spondylolisthesis2.3.23 Fusion versus no fusion in patients with central lumbar spinal stenosis and foraminal stenosis undergoing decompression surgery: comparison of outcomes at baseline and follow-up2.3.24 Two-year results of interspinous spacers (DIAM) as an alternative to arthrodesis for lumbar degenerative disorders2.3.25 Treatment of herniated lumbar disc by sequestrectomy or conventional discectomy2.4.26 No sustained benefit of continuous epidural analgesia for minimally invasive lumbar fusion: a randomized double-blinded placebo controlled study2.4.27 Evidence and current practice in the radiologic assessment of lumbar spine fusion2.4.28 Wiltse versus midline approach for decompression and fusion of the lumbar spine2.5.09 The effect of soft tissue restraints following type II odontoid fractures in the elderly — a biomechanical study2.5.10 Development of an international spinal cord injury (SCI) spinal column injury basic data set2.5.11 Evaluation of instrumentation techniques for a unilateral facet perch and fracture using a validated soft tissue injury model2.5.12 Decreasing neurologic consequences in patients with spinal infection: the testing of a novel diagnostic guideline2.5.13 Prospective analysis of adverse events in surgical treatment of degenerative spondylolisthesis2.5.14 Load transfer characteristics between posterior fusion devices and the lumbar spine under anterior shear loading: an in vitro investigation2.5.15 Preoperative predictive clinical and radiographic factors influencing functional outcome after lumbar discectomy2.5.16 A Thoracolumbar Injury Classification and Severity Score (TLICS) of 4: What should we really do?3.1.29 Adverse events in emergent oncologic spine surgery: a prospective analysis3.1.30 En-bloc resection of primary spinal and paraspinal tumours with critical vascular involvement3.1.31 The treatment impact of minocycline on quantitative MRI in acute spinal cord injury3.1.32 Benefit of minocycline in spinal cord injury — results of a double-blind randomized placebo-controlled study3.2.33 Improvement of magnetic resonance imaging correlation with unilateral motor or sensory deficits using diffusion tensor imaging3.2.34 Comparing care delivery for acute traumatic spinal cord injury in 2 Canadian centres: How do the processes of care differ?3.2.35 Improving access to early surgery: a comparison of 2 centres3.3.36 The effects of early surgical decompression on motor recovery after traumatic spinal cord injury: results of a Canadian multicentre study3.3.37 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors3.3.38 Effect of motor score on adverse events and quality of life in patients with traumatic spinal cord injury3.4.39 The impact of facet dislocation on neurologic recovery after cervical spinal cord injury: an analysis of data on 325 patients from the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS)3.4.40 Toward a more precise understanding of the epidemiology of traumatic spinal cord injury in Canada3.4.41 Access to care (ACT) for traumatic SCI: a survey of acute Canadian spine centres3.4.42 Use of the Spine Adverse Events Severity (SAVES) instrument for traumatic spinal cord injury3.5.17 Does the type of distraction-based growing system for early onset scoliosis affect postoperative sagittal alignment?3.5.18 Comparison of radiation exposure during thoracolumbar fusion using fluoroscopic guidance versus anatomic placement of pedicle screws3.5.19 Skeletal traction for intraoperative reduction in adolescent idiopathic scoliosis3.5.20 Utility of intraoperative cone-beam computed tomography (O-ARM) and stereotactic navigation in acute spinal trauma surgery3.5.21 Use of a central compression rod to reduce thoracic level spinal osteotomies3.5.22 ICD-10 coding accuracy for spinal cord injured patients3.5.23 Feasibility of patient recruitment in acute SCI trials3.5.24 Treatment of adult degenerative scoliosis with DLIF approaches. Can J Surg 2012. [DOI: 10.1503/cjs.012212] [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: 11/01/2022] Open
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Pugh J, Horn P, Arthur T. Classification of Postconcussive Headaches in Children (P03.220). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.220] [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: 11/15/2022] Open
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Field M, Pugh J, Asquith J, Davies S, Pherwani AD. A stuck hemodialysis central venous catheter. J Vasc Access 2008; 9:301-303. [PMID: 19085904] [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: 05/27/2023] Open
Abstract
BACKGROUND A growing number of hemodialysis patients are dependent upon central venous catheters (CVCs) for long-term vascular access. Although many complications of CVCs have been documented, the phenomenon of the stuck catheter is described relatively infrequently. CASE REPORT We describe a case where attempts to remove the line by exploration of the jugular insertion site in theater were unsuccessful and the line was internalized. DISCUSSION The case is then discussed with all available cases in the literature to suggest principles of managing and preventing the stuck catheter phenomenon.
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Affiliation(s)
- M Field
- Department of Vascular and General Surgery, University Hospital North Staffordshire, The Medical School, Keele University, Stoke-on-Trent, UK.
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Reiber GE, Smith DG, Carter J, Fotieo G, Deery HG, Sangeorzan JA, Lavery L, Pugh J, Peter-Riesch B, Assal JP, del Aguila M, Diehr P, Patrick DL, Boyko EJ. A comparison of diabetic foot ulcer patients managed in VHA and non-VHA settings. J Rehabil Res Dev 2001; 38:309-17. [PMID: 11440262] [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: 02/20/2023]
Abstract
OBJECTIVE To compare patients with diabetes and new onset foot ulcers treated in Veterans Health Administration (VHA) and non-VHA settings. METHODS The treatment of patients with new onset diabetic foot ulcers was prospectively monitored in three VHA and three non-VHA hospitals and outpatient settings until ulcer healing, amputation, or death. RESULTS Of the 302 individuals enrolled in this study, 47% were veterans receiving VHA care. There were no significant differences between veterans and nonveterans in baseline wound classification, diabetes severity, or comorbid conditions. Veterans received significantly fewer sharp debridements, total contact casts, and custom inserts than their nonveteran counterparts, and they had significantly more x-rays, local saline irrigations, IV antibiotics, and prescriptions for bed rest. The percentage of amputations was higher in veterans but did not achieve statistical significance. CONCLUSIONS Many commonly held stereotypes of veteran men were not found. Veterans and nonveterans with foot ulcers were similar in terms of health and foot history, diabetes severity, and comorbid conditions. There was considerable variation in treatment of diabetic foot ulcers between VHA and non-VHA care. Yet this variation did not result in statistically significant differences in ulcer outcomes.
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Affiliation(s)
- G E Reiber
- VA Puget Sound Health Care System, Seattle, WA 98108, USA.
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Pugh J, Clarke L, Gray J, Haveman J, Lawler P, Bonner S. Presence of relatives during testing for brain stem death: questionnaire study. BMJ 2000; 321:1505-6. [PMID: 11118177 PMCID: PMC27553 DOI: 10.1136/bmj.321.7275.1505] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2000] [Indexed: 11/03/2022]
Affiliation(s)
- J Pugh
- Intensive Care Unit, South Cleveland Hospital, Middlesbrough TS4 3BW, UK
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Rocco MV, Frankenfield DL, Frederick PR, Pugh J, McClellan WM, Owen WF. Intermediate outcomes by race and ethnicity in peritoneal dialysis patients: results from the 1997 ESRD Core Indicators Project. National ESRD Core Indicators Workgroup. Perit Dial Int 2000; 20:328-35. [PMID: 10898051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Hispanics are the fastest growing minority group in the United States, and approximately 10% of all end-stage renal disease (ESRD) patients are Hispanic. Few data are available, however, regarding dialysis adequacy and anemia management in Hispanic patients receiving peritoneal dialysis in the U.S. METHODS Data from the Health Care Financing Administration (HCFA) ESRD Core Indicators Project were used to assess racial and ethnic differences in selected intermediate outcomes for peritoneal dialysis patients. RESULTS Of the 1219 patients for whom data were available from the 1997 sample, 9% were Hispanic, 24% were non-Hispanic blacks, and 59% were non-Hispanic whites. Hispanics were more likely to have diabetes mellitus as a cause of ESRD compared to blacks or whites, and both Hispanics and blacks were younger than white patients (both p < 0.001). Although whites had higher weekly Kt/V and creatinine clearance values compared to blacks or Hispanics (p < 0.05), blacks had been dialyzing longer (p < 0.01) and were more likely to be anuric compared to the other two groups (p < 0.001). Blacks had significantly lower mean hematocrit values (p < 0.001) and a greater proportion of patients who had a hematocrit level less than 28% (p < 0.05) compared to Hispanics or whites, despite receiving significantly larger weekly mean epoetin alfa doses (p < 0.05) and having significantly higher mean serum ferritin concentrations (p < 0.01). Multivariate logistic regression analysis revealed significant differences by race/ethnicity for experiencing a weekly Kt/V urea < 2.0 and hypertension, but not for other intermediate outcomes examined (weekly creatinine clearance < 60 L/week/1.73 m2, Hct < 30%, and serum albumin < 3.5/3.2 g/dL). CONCLUSION Hispanics had adequacy values similar to blacks and anemia parameters similar to whites. Additional studies are needed to determine the etiologies of the differences in intermediate outcomes by racial and ethnic groupings in peritoneal dialysis patients.
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Affiliation(s)
- M V Rocco
- Department of Internal Medicine, Section of Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1053, USA.
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Abstract
The benefits of research being undertaken by more than one researcher cannot be underestimated. Having one researcher with intimate knowledge of the organisation and another who could provide a dispassionate view, paid dividends in this study into shared governance from an ethnographic perspective.
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Affiliation(s)
- J Pugh
- Kettering General Hospital NHS Trust
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Abstract
BACKGROUND Nontraumatic lower limb amputation is a serious complication of both diabetic neuropathy and peripheral vascular disease. Many people with end-stage renal disease (ESRD) suffer from advanced progression of these diseases. This study presents descriptive information on the rate of lower limb amputation among people with ESRD who are covered by the Medicare program. METHODS Using hospital bill data for the years 1991 through 1994 from the Health Care Financing Administration's ESRD program management and medical information system (PMMIS), amputations were based on ICD9 coding. These hospitalizations were then linked back to the PMMIS enrollment database for calculation of rates. RESULTS The rate of lower limb amputation increased during the four-year period from 4.8 per 100 person years in 1991 to 6.2 in 1994. Among persons whose renal failure was attributed to diabetic nephropathy, the rates in 1991 and 1994 were 11.8 and 13.8, respectively. The rate among diabetic persons with ESRD was 10 times as great as among the diabetic population at large. Two thirds died within two years following the first amputation. CONCLUSIONS The ESRD population is at an extremely high risk of lower limb amputation. Coordinated programs to screen for high-risk feet and to provide regular foot care for those at high risk combined with guidelines for treatment and referral of ulceration are needed.
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Affiliation(s)
- P W Eggers
- Division of Health, Information and Outcomes, HealthCare Financing Administration, Baltimore, Maryland 21244-1850, USA.
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Frankenfield DL, Rocco MV, Frederick PR, Pugh J, McClellan WM, Owen WF. Racial/ethnic analysis of selected intermediate outcomes for hemodialysis patients: results from the 1997 ESRD Core Indicators Project. Am J Kidney Dis 1999; 34:721-30. [PMID: 10516355 DOI: 10.1016/s0272-6386(99)70399-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [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: 01/29/2023]
Abstract
Principal goals of the End-Stage Renal Disease (ESRD) Core Indicators Project are to improve the care provided to ESRD patients and to identify categorical variability in intermediate outcomes of dialysis care. The purpose of the current analysis is to extend our observations about the variability of intermediate outcomes of ESRD care among different racial and gender groups to a previously unreported group, Hispanic Americans. This group is a significant and growing minority segment of the ESRD population. A random sample of Medicare-eligible adult, in-center, hemodialysis patients was selected and stratified from an end-of-year ESRD patient census for 1996. Of the 6,858 patients in the final sample, 45% were non-Hispanic whites, 36% were non-Hispanic blacks, and 11% were Hispanic. Whites were older than blacks or Hispanics (P < 0.001). Hispanics were more likely to have diabetes mellitus as a primary diagnosis than either blacks or whites (P < 0.001). Even though they received longer hemodialysis times and were treated with high-flux hemodialyzers, blacks had significantly lower hemodialysis doses than white or Hispanic patients (P < 0.001). The intradialytic weight losses were greater for blacks (P < 0.05). The delivered hemodialysis dose was lower for blacks than for whites or Hispanics whether measured as a urea reduction ratio (URR) or as the Kt/V calculated by the second generation formula of Daugirdas (median 1. 32, 1.36, and 1.37, respectively, P < 0.001). Hispanics and whites had modestly higher hematocrits than blacks (33.2, 33.2, and 33.0%, respectively, P < 0.01). There was no significant difference among groups in the weekly prescribed epoetin alfa dose ( approximately 172 units/kg/week). A significantly greater proportion of Hispanic patients had transferrin saturations >/=20% compared with the other two groups (P < 0.001). Logistic regression modeling revealed that whites were significantly more likely to have serum albumin <3. 5(BCG)/3.2(BCP) gm/dL (OR 1.4, p < 0.01); blacks were significantly more likely to have a delivered Kt/V < 1.2 (OR 1.4, P < 0.001) and hematocrit <30%, (OR 1.2; P < 0.05) and both blacks and Hispanics were significantly more likely to have a delivered URR < 65% (OR 1.5, P < 0.001 and 1.2, P < 0.05, respectively).
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Affiliation(s)
- D L Frankenfield
- Section of Nephrology, Health Care Financing Administration, Baltimore, MD 21244, USA.
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Abstract
Huntington's Disease transgenic mice were used for an exploration into the stability of a trinucleotide repeat. The brain shows heterogeneous somatic instability that increases quantitatively with age. To test somatic CAG-repeat alterations during long-term culture, DNA was extracted from transgenic tissue, primary fibroblasts, and SV40-immortalized fibroblasts at intervals of approximately 100 cell doublings. In fibroblasts derived from an adult mouse, there was an initial short truncation of the repeat, followed by an emerging population of cells showing continuous slow expansion. After 15 months in continuous culture (approximately 600 cell doublings following transformation) the major CAG peak has increased from 155 to approximately 170 triplets. This in vitro system can now be used to assay factors that affect instability.
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Affiliation(s)
- K Manley
- David Axelrod Institute, Wadsworth Center, New York State Department of Health, New Scotland Avenue, P.O. Box 22002, Albany, NY 12201-2002, USA
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Abstract
Twelve-hour shift rostering offers an alternative to the traditional 8- and 10-hour shifts usually worked in Australian nursing practice. This paper outlines the implementation process involved in introducing 12-hour shifts in a Melbourne hospital intensive care unit. The process was instigated by the nursing staff. After extensive consultation with the union and hospital management, a roster pattern of two 12-hour days, followed by 12-hour night shifts then days off, was introduced. Independent researchers were engaged to evaluate the impact of the 12-hour shifts on staff well-being and work performance. Effects on staff retention, sick leave and inservice education were examined. The researchers found that well-being and work performance were minimally affected by the 12-hour shift roster, while staff retention and sick leave were unaffected. Further, the pattern of 12-hour shifts, which was democratically implemented, was preferred by the nursing staff and did not diminish their well-being and work performance.
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Brooks F, Mitchell M, Pugh J. Shared governance as a way to involve staff in decision-making. Nurs Times 1998; 94:56-7. [PMID: 9923384] [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: 02/10/2023]
Abstract
Increasing the involvement of clinicians in decision-making is a key part of recent NHS policy. One model designed to increase involvement is shared governance. This article describes the approach to shared governance developed at Kettering General Hospital. Ongoing evaluation of the scheme suggests benefits in terms of personal and professional development for those involved.
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Affiliation(s)
- F Brooks
- Institute For Health Services Research, University of Luton
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Hunt LM, Pugh J, Valenzuela M. How patients adapt diabetes self-care recommendations in everyday life. J Fam Pract 1998; 46:207-215. [PMID: 9519018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Our study explored behavioral factors affecting what patients with type 2 diabetes do for self-care and why they do it. The findings were used to develop clinical recommendations to improve intervention strategies. METHODS Interviewers, using open-ended questions, explored patients' own perceptions and assessments of self-care behaviors. The fifty-one subjects were self-identified Mexican Americans who had type 2 diabetes for at least 6 months, and had no major impairment as a result of this diabetes. Texts of patient interviews were analyzed by building and refining matrixes to display and compare central themes regarding treatment strategies and their contexts. RESULTS All patients were trying to control their diabetes, but none of them followed recommendations completely. Instead, they adapted self-care behaviors to the exigencies of everyday life. Key factors influencing patients' treatment choices were: (1) the belief in the power of modern medicine; (2) the desire to act and feel "normal"; (3) the desire to avoid physical symptoms; and (4) limited economic resources. CONCLUSIONS As patients apply treatment recommendations in the context of their everyday lives, they continually must make many small decisions affecting self-care behavior. The specific contexts of patients' lives, including their economic, educational, and cultural circumstances, determine how the generalized principles of type 2 diabetes management are implemented. Clinical strategies must be responsive to these circumstances in order to enable patients to make appropriate decisions when adapting their self-care behaviors to their own situations.
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Affiliation(s)
- L M Hunt
- School of Nursing, University of Texas Health Science Center at San Antonio 78284-7947, USA.
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Pugh J, Campolo M. Mornington Peninsula Hospital Intensive care unit, Victoria, Australia. Aust Crit Care 1995; 8:8-9. [PMID: 8704395 DOI: 10.1016/s1036-7314(95)70291-0] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Richards D, Szykowny L, Weller EB, Weller RA, Pugh J. Ethics for the Society of Biological Psychiatry. Biol Psychiatry 1995; 38:562-5. [PMID: 8562670 DOI: 10.1016/0006-3223(95)00456-q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Pugh J. Minorities and ESRD. Part II. Tracking causes of ESRD in the Hispanic population. Nephrol News Issues 1995; 9:13, 16. [PMID: 7494589] [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: 01/25/2023]
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Pugh J. Minorities and ESRD. Part I. Tracking the causes of ESRD in the Hispanic population. Nephrol News Issues 1995; 9:34. [PMID: 7501034] [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: 01/25/2023]
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Fourel I, Cullen JM, Saputelli J, Aldrich CE, Schaffer P, Averett DR, Pugh J, Mason WS. Evidence that hepatocyte turnover is required for rapid clearance of duck hepatitis B virus during antiviral therapy of chronically infected ducks. J Virol 1994; 68:8321-30. [PMID: 7966625 PMCID: PMC237301 DOI: 10.1128/jvi.68.12.8321-8330.1994] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Duck hepatitis B virus (DHBV) DNA synthesis in congenitally infected ducks is inhibited by 2'-deoxycarbocyclic guanosine (2'-CDG). Three months of therapy reduces the number of infected hepatocytes at least 10-fold (W.S. Mason, J. Cullen, J. Saputelli, T.-T. Wu, C. Liu, W.T. London, E. Lustbader, P. Schaffer, A.P. O'Connell, I. Fourel, C.E. Aldrich, and A.R. Jilbert, Hepatology 19:393-411, 1994). The present study was performed to determine the kinetics of disappearance of infected hepatocytes and to evaluate the role of hepatocyte turnover in this process. Essentially all hepatocytes were infected before drug therapy. Oral treatment with 2'-CDG resulted in a prompt reduction in the number of infected hepatocytes. After 2 weeks, only 30 to 50% appeared to still be infected, and less than 10% were detectably infected after 5 weeks of therapy. To assess the possible role of hepatocyte turnover in these changes, 5-bromo-2'-deoxyuridine (BUdR) was administered 8 h before liver biopsy to label host DNA in hepatocytes passing through S phase, and stained nuclei were detected in tissue sections by using an antibody reactive to BUdR. The extent of nuclear labeling after 5 weeks was the same as that before therapy (ca. 1%). However, biopsies taken after 2 weeks of therapy showed a ca. 10-fold elevation in the number of nuclei labeled with BUdR. This result suggested that a rapid clearance of infected hepatocytes by 2'-CDG was caused not just by the inhibition of viral replication but also by an acceleration of the rate of hepatocyte turnover. To test this possibility further, antiviral therapy was carried out with another strong inhibitor of DHBV DNA synthesis, 5-fluoro-2',3'-dideoxy-3'-thiacytidine (524W), which did not accelerate hepatocyte turnover in ducks. 524W administration led to a strong inhibition of virus production but to a slower rate of decline in the number of infected hepatocytes, so that ca. 50% (and perhaps more) were still infected after 3 months of therapy. In addition, histopathologic evaluation of 2'-CDG-treated ducks revealed liver injury, especially at the start of therapy. No liver damage was observed during 524W therapy. These results imply that clearance of infected hepatocytes from the liver is correlated with hepatocyte turnover. Thus, in the absence of immune clearance or other sources for the accelerated elimination of infected hepatocytes, inhibitors of virus replication would have to be administered for a long period to substantially reduce the burden of infected hepatocytes in the liver.
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Affiliation(s)
- I Fourel
- Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111
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Abstract
Three commercial disinfectants (two quaternary formulations and one phenolic) were tested against human hepatitis B virus (HHBV). The treated virus was assayed for infectivity by the chimpanzee assay and for morphological alteration by the Morphological Alteration and Disintegration Test. The same agents were tested against duck hepatitis B virus in a duck hepatocyte infectivity assay. It is apparent that human and duck hepatitis viruses were relatively susceptible to disinfection, becoming noninfectious after < or = 10 min of contact with the disinfectant. The Morphological Alteration and Disintegration Test accurately predicted activity in the two infectivity tests. The anti-human hepatitis B virus effect of the low-level quaternary ammonium germicides is a novel finding and suggest that members of the family Hepadnaviridae are relatively susceptible to chemical agents.
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Affiliation(s)
- D L Prince
- Gibraltar Biological Laboratories, Inc., Fairfield, New Jersey 07004
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Pinnelas D, De La Torre R, Pugh J, Strand C, Horowitz SF. Total serum cholesterol levels in Asians living in New York City: results of a self-referred cholesterol screening. N Y State J Med 1992; 92:245-9. [PMID: 1641208] [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: 12/28/2022]
Abstract
Asians historically have low total cholesterol levels and low incidence of coronary heart disease. In performing a coronary heart disease and total cholesterol screening in New York City's Chinatown, we obtained data supportive of previous studies, which focused on Japanese populations and described the influence of environment on total cholesterol. In the present study, Chinese living in Chinatown have higher levels of total cholesterol than would be expected from studies of Chinese living in Shanghai. For every age group examined, Asian-born Chinese living in Chinatown had higher total cholesterol levels than both urban and rural Chinese in Shanghai. In subjects less than or equal to 30 years of age, urban males in Shanghai had cholesterol levels of 160 +/- 34 mg/dL, compared with 206 +/- 38 mg/dL for Asian-born males in Chinatown. For females in the same age category, cholesterol levels were 162 +/- 35 mg/dL vs 224 +/- 45 mg/dL, respectively. Applying National Cholesterol Education Panel (NCEP) guidelines, the distribution of desirable, borderline-high, and high blood cholesterol levels for the Chinese in Chinatown (41%, 35%, and 23%, respectively) were similar to a group of Caucasians screened (42%, 32%, and 26%) and the group recently used to determine the prevalence of high blood cholesterol in American adults (43%, 30%, and 27%). Studies are needed to stratify the risk of coronary heart disease in other groups that traditionally have a low incidence of coronary heart disease, but which now have adopted Western lifestyles.
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Affiliation(s)
- D Pinnelas
- Department of Medicine, Beth Israel Medical Center, NY 10003
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Pugh J. Primary nursing. A role, not a title. Nurs Times 1990; 86:65. [PMID: 2235561] [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: 12/30/2022]
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Horwich AL, Furtak K, Pugh J, Summers J. Synthesis of hepadnavirus particles that contain replication-defective duck hepatitis B virus genomes in cultured HuH7 cells. J Virol 1990; 64:642-50. [PMID: 2153230 PMCID: PMC249155 DOI: 10.1128/jvi.64.2.642-650.1990] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
To evaluate the possibility of producing transducible replication-defective hepadnaviruses, cloned mutant duck hepatitis B virus genomes were tested both for virus antigen production and viral DNA synthesis following transfection into the human hepatoma cell line HuH7. Deletion of a cis-acting 12-nucleotide sequence implicated in viral DNA synthesis, direct repeat 1 (DR1), resulted in the loss of ability to synthesize both mature viral DNA and infectious virus. The delta DR1 mutant, however, produced envelope and core antigens and was shown to provide trans-acting functions required for the assembly of infection-competent particles. Thus, mutants with mutations in viral genes could be rescued as DNA-containing viral particles after cotransfection with delta DR1. The efficiency of rescue was influenced by the site of mutation. A mutant DNA encoding truncated core and envelope proteins not only was poorly rescued but also was able to suppress the production from a wild-type DNA of infectious virus.
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Affiliation(s)
- A L Horwich
- Department of Human Genetics, Yale University School of Medicine, New Haven, Connecticut 06510
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Pruzansky ME, Pugh J, Siffert RS. Deterioration of trapeziometacarpal arthritis due to trigger thumb: a biomechanical evaluation. Mt Sinai J Med 1990; 57:30-3. [PMID: 2320019] [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: 12/31/2022]
Abstract
Patients with trigger thumb and trapeziometacarpal joint arthritis accompanied by swan-neck deformity of their first rays find that their arthritic pain becomes worse whenever their thumbs "catch." Six hands with adduction contracture and arthritis of the trapeziometacarpal joint are studied biomechanically and demonstrate significantly excessive shear forces (p less than 0.01) around their trapeziometacarpal joint relative to six normal hands. Increased pain with deformity suggests aggressive treatment of trigger thumb in cases such as these.
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Affiliation(s)
- M E Pruzansky
- Department of Orthopaedics, Mount Sinai School of Medicine, New York, NY
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Pugh J. Nurses' perceptions of lifting techniques. Nurs Times 1989; 85:55. [PMID: 2616285] [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: 01/01/2023]
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Abstract
Four cadaver pelves were dissected of soft tissue and each of the eight hemipelves instrumented with ten rosette strain gauges. Static loading was conducted to simulate single leg stance, and applied through the intact hip joint. The medial portion of the pelvis was under tension directed vertically and the lateral ilium was in compression. This strain pattern is consistent with bending applied to the ilium from the action of the abductor and joint reaction forces.
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Affiliation(s)
- M Ries
- Department of Orthopaedic Surgery, State University of New York, Stony BrooK 11794-8181
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Abstract
The amino acid composition of the major duck hepatitis B virus (DHBV) core particle proteins was determined. The results of this analysis indicated that cores are composed of a single major protein that initiates translation from the second available AUG in the DHBV core gene. Proteins isolated from core particles purified from the cytoplasm of DHBV-infected duck hepatocytes exhibited heterogeneity in sodium dodecyl sulfate-polyacrylamide gel electrophoresis, independent of the stage of viral DNA maturation. Incubation of native cores with alkaline phosphatase removed this heterogeneity, indicating that phosphorylation of external amino acids was responsible. Core protein isolated from mature DHBV purified from serum of infected animals did not display heterogeneity, suggesting a possible role for dephosphorylation in virus maturation.
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Affiliation(s)
- J Pugh
- Fox Chase Cancer Center, Institute for Cancer Research, Philadelphia, Pennsylvania 19111
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