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Thomas A, Niranjan M, Legg J. Causal Analysis of Physiological Sleep Data Using Granger Causality and Score-Based Structure Learning. Sensors (Basel) 2023; 23:9455. [PMID: 38067827 PMCID: PMC10708739 DOI: 10.3390/s23239455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
Understanding how the human body works during sleep and how this varies in the population is a task with significant implications for medicine. Polysomnographic studies, or sleep studies, are a common diagnostic method that produces a significant quantity of time-series sensor data. This study seeks to learn the causal structure from data from polysomnographic studies carried out on 600 adult volunteers in the United States. Two methods are used to learn the causal structure of these data: the well-established Granger causality and "DYNOTEARS", a modern approach that uses continuous optimisation to learn dynamic Bayesian networks (DBNs). The results from the two methods are then compared. Both methods produce graphs that have a number of similarities, including the mutual causation between electrooculogram (EOG) and electroencephelogram (EEG) signals and between sleeping position and SpO2 (blood oxygen level). However, DYNOTEARS, unlike Granger causality, frequently finds a causal link to sleeping position from the other variables. Following the creation of these causal graphs, the relationship between the discovered causal structure and the characteristics of the participants is explored. It is found that there is an association between the waist size of a participant and whether a causal link is found between the electrocardiogram (ECG) measurement and the EOG and EEG measurements. It is concluded that a person's body shape appears to impact the relationship between their heart and brain during sleep and that Granger causality and DYNOTEARS can produce differing results on real-world data.
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Affiliation(s)
- Alex Thomas
- School of Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Mahesan Niranjan
- School of Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Julian Legg
- University Hospitals Southampton NHS Trust, Southampton SO16 6YD, UK
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Legg J, Allen JL, Andrew M, Annesley C, Chatwin M, Crawford H, Elverson J, Forton J, Oulton K, Renton K, Tavare A, Tedd H, Simpson AJ. BTS Clinical Statement on the prevention and management of community-acquired pneumonia in people with learning disability. Thorax 2023; 78:s22-s52. [PMID: 36863773 DOI: 10.1136/thorax-2022-219698] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Julian Legg
- Department of Paediatric Respiratory, Southampton Children's Hospital, Southampton, UK .,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Trust & University of Southampton, Southamptom, UK
| | - Jamie-Leigh Allen
- Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Morag Andrew
- Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Michelle Chatwin
- Academic and Clinical Department of Sleep and Breathing, Royal Brompton Hospital, London, UK
| | - Hannah Crawford
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Joanna Elverson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,St Oswalds' Hospice, Newcastle upon Tyne, UK
| | | | - Kate Oulton
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kate Renton
- Paediatric Palliative Care, Southampton Children's Hospital, Southampton, UK.,Naomi House and Jacksplace, Winchester, UK
| | - Alison Tavare
- West of England Academic Health Science Network, Bristol, UK.,South West Learning Disability and Autism Team, NHS England, Bristol, UK
| | - Hilary Tedd
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A John Simpson
- Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Simpson AJ, Allen JL, Chatwin M, Crawford H, Elverson J, Ewan V, Forton J, McMullan R, Plevris J, Renton K, Tedd H, Thomas R, Legg J. BTS clinical statement on aspiration pneumonia. Thorax 2023; 78:s3-s21. [PMID: 36863772 DOI: 10.1136/thorax-2022-219699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- A John Simpson
- Medical School, Newcastle University, Newcastle upon Tyne, UK .,Newcastle upon Tyne NHS Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Michelle Chatwin
- Royal Brompton Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK.,National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
| | - Hannah Crawford
- Therapies, Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK.,Teesside University, Middlesbrough, UK.,University of Central Lancashire, Preston, UK
| | - Joanna Elverson
- Newcastle upon Tyne NHS Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,St Oswald's Hospice, Newcastle upon Tyne, UK
| | - Victoria Ewan
- Medical School, Newcastle University, Newcastle upon Tyne, UK.,South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Julian Forton
- Noah's Ark Children's Hospital for Wales, Cardiff, UK.,Cardiff University, Cardiff, UK
| | - Ronan McMullan
- Queen's University Belfast, Belfast, UK.,Belfast Health and Social Care Trust, Belfast, UK
| | - John Plevris
- University of Edinburgh, Edinburgh, UK.,Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Kate Renton
- Southampton Children's Hospital, Southampton, UK.,Naomi House & Jacksplace Hospices for Children and Young Adults, Winchester, UK
| | - Hilary Tedd
- Newcastle upon Tyne NHS Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rhys Thomas
- Medical School, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne NHS Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julian Legg
- Southampton Children's Hospital, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Trust & University of Southampton, Southampton, UK
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Mall MA, Brugha R, Gartner S, Legg J, Moeller A, Mondejar-Lopez P, Prais D, Pressler T, Ratjen F, Reix P, Robinson PD, Selvadurai H, Stehling F, Ahluwalia N, Arteaga-Solis E, Bruinsma BG, Jennings M, Moskowitz SM, Noel S, Tian S, Weinstock TG, Wu P, Wainwright CE, Davies JC. Efficacy and Safety of Elexacaftor/Tezacaftor/Ivacaftor in Children 6 Through 11 Years of Age with Cystic Fibrosis Heterozygous for F508del and a Minimal Function Mutation: A Phase 3b, Randomized, Placebo-controlled Study. Am J Respir Crit Care Med 2022; 206:1361-1369. [PMID: 35816621 PMCID: PMC9746869 DOI: 10.1164/rccm.202202-0392oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: The triple-combination regimen elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) was shown to be safe and efficacious in children aged 6 through 11 years with cystic fibrosis and at least one F508del-CFTR allele in a phase 3, open-label, single-arm study. Objectives: To further evaluate the efficacy and safety of ELX/TEZ/IVA in children 6 through 11 years of age with cystic fibrosis heterozygous for F508del and a minimal function CFTR mutation (F/MF genotypes) in a randomized, double-blind, placebo-controlled phase 3b trial. Methods: Children were randomized to receive either ELX/TEZ/IVA (n = 60) or placebo (n = 61) during a 24-week treatment period. The dose of ELX/TEZ/IVA administered was based on weight at screening, with children <30 kg receiving ELX 100 mg once daily, TEZ 50 mg once daily, and IVA 75 mg every 12 hours, and children ⩾30 kg receiving ELX 200 mg once daily, TEZ 100 mg once daily, and IVA 150 mg every 12 hours (adult dose). Measurements and Main Results: The primary endpoint was absolute change in lung clearance index2.5 from baseline through Week 24. Children given ELX/TEZ/IVA had a mean decrease in lung clearance index2.5 of 2.29 units (95% confidence interval [CI], 1.97-2.60) compared with 0.02 units (95% CI, -0.29 to 0.34) in children given placebo (between-group treatment difference, -2.26 units; 95% CI, -2.71 to -1.81; P < 0.0001). ELX/TEZ/IVA treatment also led to improvements in the secondary endpoint of sweat chloride concentration (between-group treatment difference, -51.2 mmol/L; 95% CI, -55.3 to -47.1) and in the other endpoints of percent predicted FEV1 (between-group treatment difference, 11.0 percentage points; 95% CI, 6.9-15.1) and Cystic Fibrosis Questionnaire-Revised Respiratory domain score (between-group treatment difference, 5.5 points; 95% CI, 1.0-10.0) compared with placebo from baseline through Week 24. The most common adverse events in children receiving ELX/TEZ/IVA were headache and cough (30.0% and 23.3%, respectively); most adverse events were mild or moderate in severity. Conclusions: In this first randomized, controlled study of a cystic fibrosis transmembrane conductance regulator modulator conducted in children 6 through 11 years of age with F/MF genotypes, ELX/TEZ/IVA treatment led to significant improvements in lung function, as well as robust improvements in respiratory symptoms and cystic fibrosis transmembrane conductance regulator function. ELX/TEZ/IVA was generally safe and well tolerated in this pediatric population with no new safety findings.
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Affiliation(s)
- Marcus A. Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin and,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany;,German Center for Lung Research, Associated Partner, Berlin, Germany
| | - Rossa Brugha
- Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Julian Legg
- Southampton Children's Hospital, Hampshire, United Kingdom
| | | | | | - Dario Prais
- Schneider Children’s Medical Center of Israel, Petah Tikva, Israel;,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Felix Ratjen
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Philippe Reix
- Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Paul D. Robinson
- The Children’s Hospital at Westmead, Sydney Children’s Hospital Network, Sydney, Australia
| | - Hiran Selvadurai
- The Children’s Hospital at Westmead, Sydney Children’s Hospital Network, Sydney, Australia
| | - Florian Stehling
- Universitätsklinikum Essen, Klinik für Kinderheilkunde III, Essen, Germany
| | - Neil Ahluwalia
- Vertex Pharmaceuticals Incorporated, Boston, Massachussetts
| | | | | | - Mark Jennings
- Vertex Pharmaceuticals Incorporated, Boston, Massachussetts
| | | | - Sabrina Noel
- Vertex Pharmaceuticals Incorporated, Boston, Massachussetts
| | - Simon Tian
- Vertex Pharmaceuticals Incorporated, Boston, Massachussetts
| | | | - Pan Wu
- Vertex Pharmaceuticals Incorporated, Boston, Massachussetts
| | | | - Jane C. Davies
- National Heart and Lung Institute, Imperial College London, London, United Kingdom;,Royal Brompton and Harefield Hospitals, part of Guy’s and St Thomas’ NHS Trust, London, United Kingdom; and,European Cystic Fibrosis Society Lung Clearance Index Core Facility, London, United Kingdom
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Griese M, Tullis E, Chilvers M, Fabrizzi B, Jain R, Legg J, Mall M, McKone E, Polineni D, Poplawska K, Robinson P, Taylor-Cousar J, Ahluwalia N, Doolittle C, Jennings M, Moskowitz S, Prieto-Centurion V, Tan Y, Tian S, Vinarsky V, Weinstock T, Xuan F, Ramsey B, Daines C. 170 Long-term safety and efficacy of elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis and at least one F508del allele: 144-week interim results from an open-label extension study. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00861-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Collaço N, Legg J, Day M, Culliford D, Campion A, West C, Darlington AS. COVID-19: Impact, experiences, and support needs of children and young adults with cystic fibrosis and parents. Pediatr Pulmonol 2021; 56:2845-2853. [PMID: 34138526 PMCID: PMC8441823 DOI: 10.1002/ppul.25537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/25/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Little is known about the impact of COVID-19 and the United Kingdom's (UK) national shielding advice on people with cystic fibrosis (CF) and their families. This study explored the experiences and support needs of children and young adults (CYAs) with CF, and parents who have a child with CF, during the COVID-19 pandemic. METHODS CYAs with CF and parents of CYAs with CF completed a UK wide online survey with open and closed questions exploring experiences, information and support needs and decision-making processes. Qualitative thematic content analysis and descriptive quantitative analyses were undertaken. RESULTS CYAs aged 10-30 years (n = 99) and parents of CYAs aged 0-34 years (n = 145) responded. Parents (72.7%) and CYAs (50.0%) worried about the virus, and both were vigilant for virus symptoms (82.7% and 79.7%). Over three-quarters of CYAs were worried about their own health if they caught the virus. CYAs worried about feeling more isolated during the virus (64.9%). Qualitative findings reported the following themes: (1) Disruption-caused by isolation, (2) impact on psychological wellbeing, (3) safety of shielding, and (4) healthcare and treatment provision-changes to care, access and support. CONCLUSIONS The impact of COVID-19 and UK shielding advice to have no contact with anyone outside the household caused disruption to the lives and routines of individuals in relation to work, education, social lives, relationships, CF management routines and support. Parents and CYAs highlighted the need for clear, up-to-date and tailored advice on individualized risks and shielding.
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Affiliation(s)
- Nicole Collaço
- School of Health Sciences, University of Southampton, Southampton, England
| | - Julian Legg
- Cystic Fibrosis Department, Southampton Children's Hospital, Southampton, England.,NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Maria Day
- Cystic Fibrosis Department, Southampton Children's Hospital, Southampton, England
| | - David Culliford
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, England
| | - Anna Campion
- Cystic Fibrosis Department, Southampton Children's Hospital, Southampton, England
| | - Carolyn West
- Cystic Fibrosis Department, Southampton Children's Hospital, Southampton, England
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Bush A, Bhatt JM, Carroll W, Child F, Connett G, Doull I, Gilchrist F, Grigg J, Langton-Hewer S, Legg J, Lenney W, Paton J, Shields M, Sinha I. The ERS approach to e-cigarettes is entirely rational. Eur Respir J 2020; 55:2000413. [PMID: 32381632 DOI: 10.1183/13993003.00413-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Andrew Bush
- Imperial College, National Heart and Lung Institute, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jayesh Mahendra Bhatt
- Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK
| | - Will Carroll
- Paediatrics, Derby Hospitals NHS Trust, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Frances Child
- Dept of Respiratory Paediatrics, Central Manchester and Manchester Children, Manchester, UK
| | - Gary Connett
- University Hospital Southampton NHS Foundation Trust, University Hospital Southampton, Southampton, UK
| | - Iolo Doull
- Children's Hospital for Wales, Cardiff, UK
| | - Francis Gilchrist
- Paediatric Respiratory Services, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke-on-Trent, UK
- Institute of Applied Clinical Science, Keele University, Keele, UK
| | - Jonathan Grigg
- Centre for Paediatrics, Queen Mary University London, London, UK
| | | | - Julian Legg
- Southampton University Hospitals NHS Trust, Southampton, UK
| | - Warren Lenney
- Academic Department of Child Health, University Hospital of North Staffordshire and Keele University, Stoke-on-Trent, UK
| | - James Paton
- Royal Hospital for Sick Children, Glasgow, UK
| | - Michael Shields
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Ian Sinha
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Bush A, Bhatt JM, Connett GJ, Doull I, Gilchrist FJ, Grigg J, Langton Hewer SC, Legg J, Lenney W, Sinha IP. A public health emergency among young people. The Lancet Respiratory Medicine 2020; 8:231-233. [DOI: 10.1016/s2213-2600(19)30468-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022]
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Phillips S, Neto A, Legg J. ePS4.06 Vitamin E in paediatric patients with cystic fibrosis - is supplementation routinely required? J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yonge C, Payne S, Bright V, Legg J, McGinnity T, Connett G. P361 A qualitative assessment of the relative benefits of Insight on-line and I-adhere software in assessing nebuliser usage. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30653-8] [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: 11/17/2022]
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Howlin RP, Cathie K, Hall-Stoodley L, Cornelius V, Duignan C, Allan RN, Fernandez BO, Barraud N, Bruce KD, Jefferies J, Kelso M, Kjelleberg S, Rice SA, Rogers GB, Pink S, Smith C, Sukhtankar PS, Salib R, Legg J, Carroll M, Daniels T, Feelisch M, Stoodley P, Clarke SC, Connett G, Faust SN, Webb JS. Low-Dose Nitric Oxide as Targeted Anti-biofilm Adjunctive Therapy to Treat Chronic Pseudomonas aeruginosa Infection in Cystic Fibrosis. Mol Ther 2017; 25:2104-2116. [PMID: 28750737 PMCID: PMC5589160 DOI: 10.1016/j.ymthe.2017.06.021] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 12/31/2022] Open
Abstract
Despite aggressive antibiotic therapy, bronchopulmonary colonization by Pseudomonas aeruginosa causes persistent morbidity and mortality in cystic fibrosis (CF). Chronic P. aeruginosa infection in the CF lung is associated with structured, antibiotic-tolerant bacterial aggregates known as biofilms. We have demonstrated the effects of non-bactericidal, low-dose nitric oxide (NO), a signaling molecule that induces biofilm dispersal, as a novel adjunctive therapy for P. aeruginosa biofilm infection in CF in an ex vivo model and a proof-of-concept double-blind clinical trial. Submicromolar NO concentrations alone caused disruption of biofilms within ex vivo CF sputum and a statistically significant decrease in ex vivo biofilm tolerance to tobramycin and tobramycin combined with ceftazidime. In the 12-patient randomized clinical trial, 10 ppm NO inhalation caused significant reduction in P. aeruginosa biofilm aggregates compared with placebo across 7 days of treatment. Our results suggest a benefit of using low-dose NO as adjunctive therapy to enhance the efficacy of antibiotics used to treat acute P. aeruginosa exacerbations in CF. Strategies to induce the disruption of biofilms have the potential to overcome biofilm-associated antibiotic tolerance in CF and other biofilm-related diseases.
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Affiliation(s)
- Robert P Howlin
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Centre for Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK; Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Katrina Cathie
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Luanne Hall-Stoodley
- Microbial Infection and Immunity, The Ohio State University College of Medicine, Columbus, OH 43210-2210, USA; Southampton NIHR Wellcome Trust Clinical Research Facility, Southampton SO16 6YD, UK
| | - Victoria Cornelius
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; Imperial College London School of Public Health, London SW7 2AZ, UK
| | - Caroline Duignan
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Centre for Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Raymond N Allan
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK; Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK; Southampton NIHR Wellcome Trust Clinical Research Facility, Southampton SO16 6YD, UK
| | - Bernadette O Fernandez
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Nicolas Barraud
- Centre for Marine Bio-Innovation and School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Ken D Bruce
- Kings College London Institute of Pharmaceutical Science, London WC2R 2LS, UK
| | - Johanna Jefferies
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK; Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK; Public Health England, Southampton SO17 1BJ, UK
| | - Michael Kelso
- Illawarra Health and Medical Research Institute and School of Chemistry, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Staffan Kjelleberg
- Centre for Marine Bio-Innovation and School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia; Singapore Centre on Environmental Life Sciences Engineering and Nanyang Technological University, School of Biological Sciences, Singapore 637551, Singapore
| | - Scott A Rice
- Centre for Marine Bio-Innovation and School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia; Singapore Centre on Environmental Life Sciences Engineering and Nanyang Technological University, School of Biological Sciences, Singapore 637551, Singapore
| | - Geraint B Rogers
- Kings College London Institute of Pharmaceutical Science, London WC2R 2LS, UK; Infection and Immunity Theme, South Australia Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia; Flinders University School of Medicine, Bedford Park, Adelaide, SA 5042, Australia
| | - Sandra Pink
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK
| | - Caroline Smith
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK
| | - Priya S Sukhtankar
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK; Southampton NIHR Wellcome Trust Clinical Research Facility, Southampton SO16 6YD, UK
| | - Rami Salib
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK; Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Julian Legg
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK
| | - Mary Carroll
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK
| | - Thomas Daniels
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK
| | - Martin Feelisch
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK; Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Paul Stoodley
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Microbial Infection and Immunity, The Ohio State University College of Medicine, Columbus, OH 43210-2210, USA; National Centre for Advanced Tribology at Southampton, Faculty of Engineering, University of Southampton, Southampton SO17 1BJ, UK
| | - Stuart C Clarke
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK; Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK; Public Health England, Southampton SO17 1BJ, UK
| | - Gary Connett
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK
| | - Saul N Faust
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK; Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK; Southampton NIHR Wellcome Trust Clinical Research Facility, Southampton SO16 6YD, UK.
| | - Jeremy S Webb
- NIHR Southampton Respiratory Biomedical Research Centre, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton SO16, 6YD, UK; Centre for Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK; Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK
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Keenan V, Payne S, Yonge C, Saynor Z, Legg J, Connett G. 254 Feasibility of implementing cardiopulmonary exercise testing in a regional paediatric cystic fibrosis centre in the UK. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30597-0] [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: 11/16/2022]
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Affiliation(s)
- Jonathan Hall
- Principal Clinical Advice Pharmacist, Southampton Medicines Advice Service, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Julian Legg
- Head of Paediatric Respiratory Department, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Pike K, Selby A, Price S, Warner J, Connett G, Legg J, Lucas JSA, Peters S, Buckley H, Magier K, Foote K, Drew K, Morris R, Lancaster N, Roberts G. Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial. Clin Respir J 2016; 7:204-13. [PMID: 22747899 DOI: 10.1111/j.1752-699x.2012.00306.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Inhaled corticosteroid therapy (ICS) for asthma is currently modified according to symptoms and lung function. Fractional exhaled nitric oxide (FENO) has been demonstrated to be a non-invasive marker of eosinophilic inflammation. Studies of FENO-driven asthma management show variable success. Objectives: This study aimed to evaluate whether monitoring FENO can improve outpatient management of children with moderate to severe asthma using a pragmatic design. METHODS Children aged 6–17 years with moderate to severe asthma were recruited. Their asthma was stabilised before randomisation to FENO-driven therapy or to a standard management group where therapy was driven by conventional markers of asthma control. ICS or long-acting bronchodilator therapies were altered according to FENO levels in combination with reported symptoms in the FENO group. Participants were assessed 2 monthly for 12 months. ICS dose and exacerbation frequency change were compared between groups in an intention to treat analysis. RESULTS Ninety children were randomised. No difference was found between the two groups in either change in corticosteroid dose or exacerbation frequency. Results were similar in a planned secondary analysis of atopic asthmatics. CONCLUSION FENO-guided ICS titration does not appear to reduce corticosteroid usage or exacerbation frequency in paediatric outpatients with moderate to severe asthma. This may reflect limitations in FENO-driven management algorithms, as there are now concerns that FENO levels relate to atopy as much as they relate to asthma control.
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Affiliation(s)
- Katharine Pike
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Gahleitner F, Legg J, Holland E, Pearson S, Roberts G. The validity and acceptability of a text-based monitoring system for pediatric asthma studies. Pediatr Pulmonol 2016; 51:5-12. [PMID: 25847724 DOI: 10.1002/ppul.23200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 02/14/2015] [Accepted: 02/20/2015] [Indexed: 11/07/2022]
Abstract
A meaningful analysis in research requires robust, valid data. Paper diaries allow the collection of data from individuals over time but are notorious for poor compliance and validity. SMS-technology is a novel method for data collection in medical research. Time-tagged SMS are transferred directly to an electronic file. We used SMS to collect symptoms and peak flow rate (PEFR) meter readings from 32 children with asthma. Parents responded first to five SMS daily for 7 days during an asymptomatic period and then for 14 days during a cold. Compliance with use of PEFR meter and SMS system were assessed. Digital PEFR meters enabled data download at the end of the study to confirm validity of transmitted data. Parents of 24 participants provided feedback about this data collection tool. Mean (±SD) "SMS-diary and PEFR-meter compliance" were 96% (±8) and 84% (±21) during baseline and 91% (±12) and 82% (±20) during cold respectively. Correctly reported PEFR values were found in 65.5% of all cases, in 8.3% PEFR values sent were "self-invented" and 2.4% of values were missing. All of the 22 parents completing the baseline questionnaire were happy to use SMS for this study. Of the 20 parents completing the follow up questionnaire, 95% (19/20) found the system user-friendly, 55% (11/20) would be more likely to participate in studies if they were using SMS data collection and 25% (5/20) were "sometimes unhappy" about receiving messages. This real-time capture of data is well accepted and could avoid some of the pitfalls of backfilled paper diaries.
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Affiliation(s)
- Florian Gahleitner
- NIHR Respiratory Biomedical Research Unit, University Hospitals of Southampton, NHS Foundation Trust, Southampton, UK
| | - Julian Legg
- NIHR Respiratory Biomedical Research Unit, University Hospitals of Southampton, NHS Foundation Trust, Southampton, UK
| | - Emma Holland
- NIHR Respiratory Biomedical Research Unit, University Hospitals of Southampton, NHS Foundation Trust, Southampton, UK
| | - Sarah Pearson
- NIHR Respiratory Biomedical Research Unit, University Hospitals of Southampton, NHS Foundation Trust, Southampton, UK
| | - Graham Roberts
- NIHR Respiratory Biomedical Research Unit, University Hospitals of Southampton, NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK
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Legg J, Davies E, Raich AL, Dettori JR, Sherry N. Surgical correction of scoliosis in children with spastic quadriplegia: benefits, adverse effects, and patient selection. Evid Based Spine Care J 2014; 5:38-51. [PMID: 24715871 PMCID: PMC3969433 DOI: 10.1055/s-0034-1370898] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/17/2013] [Indexed: 11/25/2022]
Abstract
STUDY RATIONALE Cerebral palsy (CP) is a group of nonprogressive syndromes of posture and motor impairment associated with lesions of the immature brain. Spastic quadriplegia is the most severe form with a high incidence of scoliosis, back pain, respiratory compromise, pelvic obliquity, and poor sitting balance. Surgical stabilization of the spine is an effective technique for correcting deformity and restoring sitting posture. The decision to operate in this group of patients is challenging. OBJECTIVES The aim of this study is to determine the benefits of surgical correction of scoliosis in children with spastic quadriplegia, the adverse effects of this treatment, and what preoperative factors affect patient outcome after surgical correction. MATERIALS AND METHODS A systematic review was undertaken to identify studies describing benefits and adverse effects of surgery in spastic quadriplegia. Factors affecting patient outcome following surgical correction of scoliosis were assessed. Studies involving adults and nonspastic quadriplegia were excluded. RESULTS A total of 10 case series and 1 prospective and 3 retrospective cohort studies met inclusion criteria. There was significant variation in the overall risk of complications (range, 10.9-70.9%), mortality (range, 2.8-19%), respiratory/pulmonary complications (range, 26.9-57.1%), and infection (range, 2.5-56.8%). Factors associated with a worse outcome were a significant degree of thoracic kyphosis, days in the intensive care unit, and poor nutritional status. CONCLUSION Caregivers report a high degree of satisfaction with scoliosis surgery for children with spastic quadriplegia. There is limited evidence of preoperative factors that can predict patient outcome after scoliosis. There is a need for well-designed prospective studies of scoliosis surgery in spastic quadriplegia.
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Affiliation(s)
- Julian Legg
- Department of Paediatric Respiratory Medicine, University Hospital Southampton, Southampton Children's Hospital, Southampton, United Kingdom
- National Institute of Health Research Biomedical Research Unit in Respiratory Disease, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Evan Davies
- Department of Paediatric Spine Surgery, University Hospital Southampton, Southampton Children's Hospital, Southampton, United Kingdom
| | - Annie L. Raich
- Spectrum Research, Inc., Tacoma, Washington, United States
| | | | - Ned Sherry
- Spectrum Research, Inc., Tacoma, Washington, United States
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Gahleitner F, Legg J, Holland E, Pearson S, Roberts G. P76 ‐ Can we successfully collect research data from children with asthma using a SMS system? Clin Transl Allergy 2014. [PMCID: PMC4082094 DOI: 10.1186/2045-7022-4-s1-p131] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Florian Gahleitner
- NIHR Respiratory Biomedical Research UnitUniversity Hospitals of Southampton Foundation TrustSouthamptonUnited Kingdom
| | - Julian Legg
- NIHR Respiratory Biomedical Research UnitUniversity Hospitals of Southampton Foundation TrustSouthamptonUnited Kingdom
| | - Emma Holland
- NIHR Respiratory Biomedical Research UnitUniversity Hospitals of Southampton Foundation TrustSouthamptonUnited Kingdom
| | - Sarah Pearson
- NIHR Respiratory Biomedical Research UnitUniversity Hospitals of Southampton Foundation TrustSouthamptonUnited Kingdom
| | - Graham Roberts
- NIHR Respiratory Biomedical Research UnitUniversity Hospitals of Southampton Foundation TrustSouthamptonUnited Kingdom
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Borooah S, Grant B, Blaikie A, Styles C, Sutherland S, Forrest G, Curry P, Legg J, Walker A, Sanders R. Using electronic referral with digital imaging between primary and secondary ophthalmic services: a long term prospective analysis of regional service redesign. Eye (Lond) 2012; 27:392-7. [PMID: 23258310 DOI: 10.1038/eye.2012.278] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Demands on publicly funded ophthalmic services worldwide continue to increase with new treatments, waiting time targets, working time limits, and restricted budgets. These highlight the necessity to develop innovative ways of utilising existing capacity more effectively. METHOD A new regional, fully electronic ophthalmic-referral service with digital imaging was trialled using existing information-technology (IT) infrastructure. Following successful pilot study, the service was rolled out regionally. Service delivery data was prospectively collated for all the attendances in the year prior to (2006) and the year following (2008) introduction. RESULTS Comparing 2006 against 2008, median waiting times reduced (14 vs 4 weeks), and fewer new patients were observed (8714 vs 7462 P<0.0001), with 1359 referrals receiving electronic diagnosis (e-diagnosis). New patient did not arrive (635 vs 503 P<0.0001) and emergencies also reduced (2671 v 1984 P<0.0001). DISCUSSION Novel use of existing IT infrastructure improves communication between primary and secondary care. This promotes more effective use of limited outpatient capacity by retaining patients with non-progressive, asymptomatic pathology in the community, whilst fast-tracking patients with sight-threatening disease. Resultant significant, sustained improvements in regional service delivery point to a simple model that could easily be adopted by other providers of universal healthcare globally.
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Affiliation(s)
- S Borooah
- Princess Alexandra Eye Pavilion, Edinburgh, UK.
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Maslin K, Curbishley T, Kay H, Legg J. 251 Should %ideal body weight (%IBW) or body mass index percentile (BMIp) be used to assess growth in children with cystic fibrosis? J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60420-2] [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: 11/26/2022]
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Curbishley T, Maslin K, Kay H, Legg J. 267 Increasing rates of obesity in CF children in the South West of England over the last decade. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60436-6] [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: 10/28/2022]
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Legg J, Walker A, Connett G, Bruce K. WS20.6 Comparison of microbial composition in the lower airway of young children with and without cystic fibrosis using 16S rRNA gene pyrosequencing. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Despite being recognised for over two millennia and having an increasing incidence in many countries, the management of childhood empyema remains controversial. This review examines the recent literature on its causes and investigation then focuses on its treatment. Following a trial of appropriate intravenous antibiotics, the evidence would currently support the use of chest drain insertion with urokinase instillation as first line treatment with video-assisted thoracoscopic surgery to be used for failure of medical management. A treatment algorithm is proposed to guide clinical practice.
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Affiliation(s)
- Woolf Walker
- Regional Paediatric Respiratory Unit, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton, UK
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Stressmann FA, Connett GJ, Goss K, Kollamparambil TG, Patel N, Payne MS, Puddy V, Legg J, Bruce KD, Rogers GB. The use of culture-independent tools to characterize bacteria in endo-tracheal aspirates from pre-term infants at risk of bronchopulmonary dysplasia. J Perinat Med 2010; 38:333-7. [PMID: 20121490 DOI: 10.1515/jpm.2010.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although premature infants are increasingly surviving the neonatal period, up to one-third develop bronchopulmonary dysplasia (BPD). Despite evidence that bacterial colonization of the neonatal respiratory tract by certain bacteria may be a risk factor in BPD development, little is known about the role these bacteria play. The aim of this study was to investigate the use of culture-independent molecular profiling methodologies to identify potential etiological agents in neonatal airway secretions. This study used terminal restriction fragment length polymorphism (T-RFLP) and clone sequence analyses to characterize bacterial species in endo-tracheal (ET) aspirates from eight intubated pre-term infants. A wide range of different bacteria was identified in the samples. Forty-seven T-RF band lengths were resolved in the sample set, with a range of 0-15 separate species in each patient. Clone sequence analyses confirmed the identity of individual species detected by T-RFLP. We speculate that the identification of known opportunistic pathogens including S. aureus, Enterobacter sp., Moraxella catarrhalis, Pseudomonas aeruginosa and Streptococcus sp., within the airways of pre-term infants, might be causally related to the subsequent development of BPD. Further, we suggest that culture-independent techniques, such as T-RFLP, hold important potential for the characterization of neonatal conditions, such as BPD.
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Affiliation(s)
- Franziska A Stressmann
- Molecular Microbiology Research Laboratory, Pharmaceutical Science Division, 150 Stamford Street, Franklin-Wilkins Building, King's College London, London, SE1 9NH, UK
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Lane C, Knight D, Burgess S, Franklin P, Horak F, Legg J, Moeller A, Stick S. Epithelial inducible nitric oxide synthase activity is the major determinant of nitric oxide concentration in exhaled breath. Thorax 2004; 59:757-60. [PMID: 15333851 PMCID: PMC1747143 DOI: 10.1136/thx.2003.014894] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The fractional concentration of nitric oxide (NO) in exhaled breath (FeNO) is increased in asthma. There is a general assumption that NO synthase (NOS) 2 in epithelium is the main source of NO in exhaled breath. However, there is no direct evidence to support the assumption and data from animal models suggest that non-inducible NOS systems have important roles in determining airway reactivity, regulating inflammation, and might contribute significantly to NO measured in exhaled breath. METHODS Bronchial epithelial cells were obtained from healthy, atopic, and asthmatic children by non-bronchoscopic brushing. Exhaled NO (FeNO) was measured directly using a fast response chemiluminescence NO analyser. RNA was extracted from the epithelial cells and real time polymerase chain reaction was used to determine the expression of NOS isoenzymes. NOS2 was examined in macrophages and epithelial cells by immunohistochemistry. RESULTS NOS1 mRNA was not detectable. NOS3 mRNA was detected in 36 of 43 samples at lower levels than NOS2 mRNA which was detectable in all samples. The median FeNO was 15.5 ppb (95% CI 10 to 18.1). There was a significant correlation between FeNO and NOS2 expression (R = 0.672, p<0.001). All epithelial cells exhibited NOS2 staining, whereas staining in the macrophages was variable and not related to phenotype. CONCLUSIONS Only NOS2 expression was associated with FeNO in respiratory epithelial cells obtained from children (R = 0.672; p<0.001). This suggests that FeNO variability is largely determined by epithelial NOS2 expression with little contribution from other isoforms.
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Affiliation(s)
- C Lane
- School of Paediatrics and Child Health, University of Western Ausatralia, Perth, Western Australia
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Morrison H, Sherman LS, Legg J, Banine F, Isacke C, Haipek CA, Gutmann DH, Ponta H, Herrlich P. The NF2 tumor suppressor gene product, merlin, mediates contact inhibition of growth through interactions with CD44. Genes Dev 2001; 15:968-80. [PMID: 11316791 PMCID: PMC312675 DOI: 10.1101/gad.189601] [Citation(s) in RCA: 383] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The neurofibromatosis-2 (NF2) gene encodes merlin, an ezrin-radixin-moesin-(ERM)-related protein that functions as a tumor suppressor. We found that merlin mediates contact inhibition of growth through signals from the extracellular matrix. At high cell density, merlin becomes hypo-phosphorylated and inhibits cell growth in response to hyaluronate (HA), a mucopolysaccharide that surrounds cells. Merlin's growth-inhibitory activity depends on specific interaction with the cytoplasmic tail of CD44, a transmembrane HA receptor. At low cell density, merlin is phosphorylated, growth permissive, and exists in a complex with ezrin, moesin, and CD44. These data indicate that merlin and CD44 form a molecular switch that specifies cell growth arrest or proliferation.
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Affiliation(s)
- H Morrison
- Forschungszentrum Karlsruhe, Institute of Toxicology and Genetics, and University of Karlsruhe, Institute of Genetics, 76021 Karlsruhe, Germany
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Gupta S, Chimbira W, Watkins S, Crawford H, Marden B, Legg J, Marsh MJ. Acute lung injury in paediatric intensive care: course and outcome. Crit Care 2001. [PMCID: PMC3333421 DOI: 10.1186/cc1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Until the recent introduction of long acting beta 2-agonists and the leukotriene antagonists, the drug treatment of asthma had remained largely unchanged for a quarter century. Recent studies have demonstrated the efficacy of the long acting beta 2-agonists in the management of asthma in children and highlighted their value as an adjunct to inhaled corticosteroids. The leukotriene antagonists are an important new class of drug therapy which target a specific area of asthma pathogenesis. Whilst they have been shown to be effective for asthma, their exact role in the clinical situation remains to be established. Recent guidelines have emphasised the important role of inflammation in persistent asthma and recommended the early institution of anti-inflammatory treatment. Many patients remain uncontrolled despite high doses of anti-inflammatory agents including oral corticosteroids. Recent experience with other immunomodulatory agents such as cyclosporin, methotrexate and intravenous immunoglobulin has highlighed their potential as steroid sparing agents. With improved understanding of asthma pathogenesis the potential for specific targeted therapies has become evident. Monoclonal antibodies to IgE and certain cytokines are being investigated as possible treatments for asthma. Similarly, preliminary studies of selective phosphodiesterase inhibitors in asthmatic individuals have been encouraging. Other potential therapies include platelet-activating factor receptor antagonists, tryptase inhibitors and prostaglandin E analogs. The continued development of such targeted treatments should ensure a greater diversity of therapeutic options for the management of asthma in the new millennium.
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Affiliation(s)
- J Legg
- Institute of Child Health, Southampton University, U.K
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Sheikh H, Legg J, Lewis C, Peck D, Isacke C. Discrete domains within the hyaluronan receptor CD44 regulate membrane localization and cell migration. Cell Adhes Commun 1998; 6:149-56. [PMID: 9823466 DOI: 10.3109/15419069809004471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CD44 is the principle transmembrane receptor for the extracellular matrix glycosaminoglycan, hyaluronan. This receptor: ligand interaction is required for many normal cellular processes including lymphocyte homing into inflammatory sites, assembly of a pericellular matrix during chondrogenesis, wound healing and tissue morphogenesis during development. In order to mediate these diverse events, CD44 expressing cells must be able to regulate, and respond to, interactions with hyaluronan. The mechanisms responsible have been subject to scrutiny over the past few years as it has become clear that their disruption can underlie the progression of both metastatic tumours and chronic inflammatory diseases. Here we describe recent data identifying discrete regions within the transmembrane and cytoplasmic domains of CD44 which regulate this important adhesion receptor.
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Affiliation(s)
- H Sheikh
- Department of Biology, Imperial College of Science, Technology and Medicine, London, UK
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Legg J. Prophylaxis after HIV exposure. Am Fam Physician 1997; 56:1574, 1577-8. [PMID: 9351425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fan-Havard P, Kucukarslan S, Legg J, Russell F, Laurila TL, Berger MJ, Green SK, Pathak D. Continuity of pharmaceutical services for patients with AIDS in the transition from hospital to home. Am J Health Syst Pharm 1997; 54:1407-12. [PMID: 9194986 DOI: 10.1093/ajhp/54.12.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- P Fan-Havard
- College of Pharmacy, Ohio State University (OSU) Columbus 43210-1291, USA.
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Olsen K, Legg J, Stiff M. Vulnerability of the self: barrier and penetration scores of depressed patients. J Pers Assess 1982; 46:481-5. [PMID: 7143192 DOI: 10.1207/s15327752jpa4605_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Brief Psychiatric Rating Scale measures and percentage of Barrier and Penetration responses on the Holtzman Inkblot Technique were used as indicators of vulnerability of the self during a depressive episode. Sixty-three depressed inpatients grouped according to diagnostic categories and depressive subtypes were evaluated prior to and after three weeks of treatment, and compared with twenty-one normal controls. Patients differed from normals initially and improved on rating measures of severity of illness and depression. Barrier scores did not reflect difference or improvement and, contrary to the predicted vulnerability theory, normals had higher penetration scores than the patients. Results were discussed in terms of vulnerability being a potential sign of emotional responsiveness rather than pathology.
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Legg J. A PRELIMINARY NOTE ON THE USE OF TWO RECENTLY INTRODUCED INSECTICIDES, CHLORDANE AND TOXAPHENE, IN THE CONTROL OF THE CATTLE TICK (BOOPHILUS MICROPLUS). Aust Vet J 1949. [DOI: 10.1111/j.1751-0813.1949.tb13989.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Legg J. Fly movements and measures of control. Aust Vet J 1945; 21:60-64. [PMID: 21005471] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Roberts FHS, Legg J. NICOTINE SULPHATE: ITS USE IN THE TREATMENT OF CATTLE LICE (HÆEMATOPINUS EURYSTERNUS NITZSCH). Aust Vet J 1938. [DOI: 10.1111/j.1751-0813.1938.tb04181.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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