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Smith R, Drummond K, Lovell A, Ng YL, Gulabivala K, Bryce G. A comparison of radiographically determined periapical healing and tooth survival outcomes of root canal (re)treatment performed in two care pathways within the United Kingdom Armed Forces. Int Endod J 2024; 57:667-681. [PMID: 38512015 DOI: 10.1111/iej.14060] [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: 10/12/2023] [Revised: 02/10/2024] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
AIMS To compare radiographic periapical healing and tooth survival outcomes of root canal (re)treatment performed within two care pathways (Routine Dental Care and Referred Treatment Pathway), in the United Kingdom Armed Forces (UKAF), and determine the effects of endodontic complexity on outcomes. METHODOLOGY This retrospective cohort study included 1466 teeth in 1252 personnel who received root canal (re)treatment between 2015 and 2020. General Dental Practitioners treated 661 teeth (573 patients) (Routine cohort), whilst Dentists with a Special Interest treated 805 teeth (678 patients) (Referred cohort). The latter group were graduates of an MSc programme in Endodontics with 4-8 years of postgraduation experience. Case complexity was retrospectively determined for each tooth using the endodontic component of Restorative Index of Treatment Need (RIOTN) guidelines. Periapical healing was determined using loose radiographic criteria. The data were analysed using chi-square tests, univariate logistic regression and Cox proportional hazards models. RESULTS A significantly (p < 0.0001) larger proportion of cases of low complexity had undergone root canal treatment within the Routine versus Referred cohort. The odds of periapical healing was significantly higher within the Referred versus Routine cohort, regardless of analyses using pooled (OR = 1.17; 95% CI: 1.11, 1.22) or moderate complexity (OR = 4.71; 95% CI: 2.73, 8.11) data. Within the Routine cohort, anterior teeth had higher odds of periapical healing than posterior teeth (OR = 1.13; 95% CI: 1.04, 1.22). The 60-month cumulative tooth survival was lower (p = 0.03) in the Routine (90.5%) than the Referred (96.0%) cohort. Within the Routine cohort, the hazard of tooth loss was higher amongst posterior teeth (HR = 4.03; 95% CI: 1.92, 8.45) but lower if posterior teeth had cast restorations (HR = 0.36; 95% CI: 0.19, 0.70). For the Referred cohort, posterior teeth restored with cast restoration (vs not) had significantly lower risk of tooth loss (HR = 0.21; 95% CI: 0.08, 0.55). CONCLUSIONS For UKAF patients, root canal (re)treatment provided within the Referred pathway was significantly more likely to achieve periapical healing and better tooth survival than those provided within the Routine pathway. Posterior teeth restored with an indirect restoration had a higher proportion of tooth survival. This study supported the utility of the endodontic component of RIOTN for assessing case complexity.
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Affiliation(s)
- Robert Smith
- Defence Centre for Rehabilitative Dentistry, Defence Primary Healthcare, Aldershot, UK
| | - Karl Drummond
- Defence Centre for Rehabilitative Dentistry, Defence Primary Healthcare, Aldershot, UK
| | - Alistair Lovell
- Defence Centre for Rehabilitative Dentistry, Defence Primary Healthcare, Aldershot, UK
| | - Yuan-Ling Ng
- UCL Eastman Dental Institute, University College London, London, UK
| | | | - Graeme Bryce
- Defence Centre for Rehabilitative Dentistry, Defence Primary Healthcare, Aldershot, UK
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Myint H, Simmons M, De La Cruz J, Diaz B, Baldonado G, Edwards B, Kiriyadoss D, Drummond K, Mulkerrin EC. 1271 A NOVEL PRESSURE INJURY CARE BUNDLE FOR DEPENDENT PATIENTS WITH PRESSURE INJURIES IN BERMUDA. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.071] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Pressure injury (PI) management is a challenge in dependent patients in acute care wards (ACW) despite standard care (regular pressure relief measures, incontinence management, debridement, optimisation of hydration and nutrition).
Method
A Pressure Injury Care Bundle (PICB), introduced by the Department of Geriatrics, enhanced standard care by diligent and regular interdisciplinary team monitoring of patients with PIs following transfer to Long Term Care (LTC) wards and thus may improve outcomes. The PICB was delivered by multiple PI Nurse Champions with education of all nurse assistants and medical staff into PI aetiology/management. Progress was monitored with weekly PI measurements/photography and Nurse Champion-lead team review of all PIs. Data are presented as mean+/-1SD. After 96+/-103 days in the ACW, the PICB was applied to 30 consecutive patients aged 80+/-14 years, (19(60 %) were female). All had stage 2-4 PIs (present in 25(83%) on admission to ACW). On transfer to LTC wards, all patients had severe physical dependency with a mean Charlson Comorbidity Index of 7+/-3, 27(90%) had palliative needs and 24(80%) were bedfast. Cognitive impairment was present in 22(68%) patients with 12(37%) dying due to advanced dementia. Patients were followed for 116+/-274 days.
Results
PI improvement by >2 stages occurred in 11(36%) patients after a mean of 103 days. Ulcers closed fully after 154+/-48 days in a further 15(50 %) patients. However, new ulcers emerged or preterminal (<21 days prior to death) deterioration occurred in 5(17%) patients, related to severe contractures, preterminal poor nutrition and sarcopenia with 16(54%) patients dying.
Conclusion
These results suggest that an intensive multimodal intervention involving best practice enhanced by PI Nurse Champions and delivered by educated staff with regular PI team progress reviews results in significant improvement/healing of PIs in severely dependent patients with palliative needs. Expansion of the PICB to other wards with prospective evaluation has been planned.
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Affiliation(s)
- H Myint
- King Edward VII Memorial Hospital Department of Geriatrics, , Paget, Bermuda
| | - M Simmons
- King Edward VII Memorial Hospital Department of Geriatrics, , Paget, Bermuda
| | - J De La Cruz
- King Edward VII Memorial Hospital Department of Geriatrics, , Paget, Bermuda
| | - B Diaz
- King Edward VII Memorial Hospital Department of Geriatrics, , Paget, Bermuda
| | - G Baldonado
- King Edward VII Memorial Hospital Department of Geriatrics, , Paget, Bermuda
| | - B Edwards
- King Edward VII Memorial Hospital Department of Geriatrics, , Paget, Bermuda
| | - D Kiriyadoss
- King Edward VII Memorial Hospital Department of Geriatrics, , Paget, Bermuda
| | - K Drummond
- King Edward VII Memorial Hospital Department of Geriatrics, , Paget, Bermuda
| | - E C Mulkerrin
- King Edward VII Memorial Hospital Department of Geriatrics, , Paget, Bermuda
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Myint H, Simmons M, Cruz J, Diaz B, Baldonado G, Edwards B, Kiriyadoss D, Drummond K, Mulkerrin E. 199 A NOVEL PRESSURE INJURY CARE BUNDLE FOR DEPENDENT PATIENTS WITH PRESSURE INJURIES IN BERMUDA. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.172] [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: 11/12/2022] Open
Abstract
Abstract
Background
Pressure Injury (PI) management is challenging for dependent patients in Acute Care Wards (ACW) despite standard care (regular pressure relief measures, incontinence management, debridement, optimisation of hydration and nutrition). A Pressure Injury Care Bundle (PICB), introduced by the Department of Geriatrics, enhanced standard care by diligent and regular interdisciplinary team monitoring of patients with PIs following transfer to Long-Term Care (LTC) wards and thus may improve outcomes.
Methods
The PICB was delivered by multiple PI Nurse Champions with education of all nurse assistants and medical staff into PI aetiology/management. Progress was monitored with weekly PI measurements/photography and Nurse Champion-lead team review of all PIs. Data are presented as mean+/-1SD.
After 96+/-103 days in the ACW, the PICB was applied to 30 consecutive patients aged 80+/-14 years, (60 % female; 19/30). All had stage 2-4 PIs (present in 83% on admission to ACW). On transfer to LTC wards, all had severe physical dependency with mean Charlson Comorbidity Index of 7+/-3, 27(90%) had palliative needs and 24(80%) were bedfast. Cognitive impairment was present in 22(68%) patients with 12(37%) dying due to advanced dementia. Patients were followed for 116+/-274 days.
Results
PI improvement by >2 stages occurred in 11(36%) patients after a mean of 103 days. Ulcers closed fully after 154+/-48 days in a further 15(50 %) patients. However, new ulcers emerged or preterminal (<21 days prior to death) deterioration occurred in 5(17%) patients, related to severe contractures, preterminal poor nutrition and sarcopenia with 16(54%) patients dying.
Conclusion
These results suggest an intensive multimodal intervention involving best practice enhanced by PI Nurse Champions and delivered by educated staff with regular PI team progress reviews results in significant improvement/healing of PIs in severely dependent patients with palliative needs. Expansion of the PICB to other wards with prospective evaluation is planned.
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Affiliation(s)
- H Myint
- King Edward VII Hospital , Paget, Bermuda
| | - M Simmons
- King Edward VII Hospital , Paget, Bermuda
| | - J Cruz
- King Edward VII Hospital , Paget, Bermuda
| | - B Diaz
- King Edward VII Hospital , Paget, Bermuda
| | | | - B Edwards
- King Edward VII Hospital , Paget, Bermuda
| | | | - K Drummond
- King Edward VII Hospital , Paget, Bermuda
| | - E Mulkerrin
- King Edward VII Hospital , Paget, Bermuda
- National University of Ireland Galway , Galway, Ireland
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Lau P, Feran B, Smith L, Lasocki A, Molania R, Smith K, Weppler A, Angel C, Kee D, Bhave P, Lee B, Yeang HA, Vergara I, Kok D, Drummond K, Neeson P, Sheppard K, Papenfuss T, Sandhu S, McArthur G. 1079MO Progression of BRAF mutant CNS metastases are associated with a transcriptional network bearing similarities with the innate PD-1 resistant signature (IPRES). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1203] [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] Open
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Morokoff A, Bennett I, Paradiso L, Luwor R, Koldej R, Li J, Ma C, Drummond K, Kaye A, Siegal T. P08.44 Preoperative serum microRNA profiles as a diagnostic tool in glioma. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fogarty G, Hong A, Dolven-Jacobsen K, Reisse C, Burmeister B, Steel V, Haydu L, Dhillon H, Shivalingham B, Drummond K, Vardy J, Nowak A, Hruby G, Scolyer R, Mandel C, Thompson J. Randomized Trial of Whole-Brain Radiation Therapy in Melanoma Brain Metastases: First Interim Analysis. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1044] [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: 10/24/2022]
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Sia Y, Field K, Rosenthal M, Drummond K. Socio-demographic factors and their impact on the number of resections for patients with recurrent glioblastoma. J Clin Neurosci 2013; 20:1362-5. [PMID: 23769599 DOI: 10.1016/j.jocn.2013.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 02/04/2013] [Accepted: 02/09/2013] [Indexed: 11/19/2022]
Abstract
Glioblastoma multiforme (GBM) is the most aggressive malignant brain tumour. Having a second or subsequent operation at recurrence may be a positive prognostic factor for survival. Recent studies suggest that socio-demographic variables may influence survival, raising the question whether surgical care differs based on these variables. We examined the relationship between selected socio-demographic variables and the number of repeat operations undergone by patients with recurrent GBM. Data from all patients diagnosed with GBM between 2001 and 2011 was obtained from a clinical database maintained across two institutions (one public, one private). The clinical and socio-demographic factors for patients who received one operation were compared to those who had two or more operations, using chi-squared analyses to determine statistical differences between groups. Socioeconomic status was measured using the Index of Relative Socioeconomic Advantage and Disadvantage scores. Of 553 patients, 449 (81%) had one operation and 104 (19%) had ≥2 operations. Patients who had ≥2 operations were significantly younger (median 55 years versus 64 years, p<0.001), less likely to have multifocal (p=0.043) or bilateral (p=0.037) disease and more likely to have initial macroscopic resection (p=0.006), than those who had only one operation. Socioeconomic status did not significantly differ between the groups (p=0.31). Similarly, there was no significant difference between the number of operations in patients from regional versus city residence and public versus private hospital. This is reassuring as it suggests similar surgical management options are available for patients regardless of socio-demographic background.
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Affiliation(s)
- Y Sia
- Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, VIC 3050, Australia.
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Nagasawa DT, Bergsneider M, Kelly D, Shafa B, Duong D, Ausman J, Liau L, McBride D, Yang I, Mann BS, Yabroff R, Harlan L, Zeruto C, Abrams J, Gondi V, Eickhoff J, Tome WA, Kozak KR, Mehta MP, Field KM, Drummond K, Yilmaz M, Gibbs P, Rosenthal MA, Allaei R, Johnson KJ, Hooten AJ, Kaste E, Ross JA, Largaespada DA, Johnson DR, O'Neill BP, Rice T, Zheng S, Xiao Y, Decker PA, McCoy LS, Smirnov I, Patoka JS, Hansen HM, Wiemels JL, Tihan T, Prados MD, Chang SM, Berger MS, Pico A, Rynearson A, Voss J, Caron A, Kosel ML, Fridley BL, Lachance DH, O'Neill BP, Giannini C, Wiencke JK, Jenkins RB, Wrensch MR, Xiao Y, Decker PA, Rice T, Hansen HM, Wiemels JL, Tihan T, Prados MD, Chang SM, Berger MS, Kosel ML, Fridley BL, Lachance DH, O'Neill BP, Buckner JC, Burch PA, Thompson RC, Nabors LB, Olson JJ, Brem S, Madden MH, Browning JE, Wiencke JK, Egan KM, Jenkins RB, Wrensch MR, Pereira EA, Livermore J, Alexe DM, Ma R, Ansorge O, Cadoux-Hudson TA, Johnson DR, O'Neill BP, Wang M, Dignam J, Won M, Curran W, Mehta M, Gilbert M, Terry AR, Barker FG, Leffert LR, Bateman B, Souter I, Plotkin SR, Ishaq O, Montgomery J, Terezakis S, Wharam M, Lim M, Holdhoff M, Kleinberg L, Redmond K, Kruchko C, Paker AM, Chi TL, Kamiya-Matsuoka C, Loghin ME, Lautenschlaeger T, Dedousi-Huebner V, Chakravarti A. EPIDEMIOLOGY. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor149] [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: 11/14/2022] Open
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9
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Field K, Rosenthal M, Yilmaz M, Gibbs P, Drummond K. 8716 POSTER Novel Features That Impact the Outcome of Patients With Glioblastoma Multiforme – Multivariate Analysis From a Comprehensive Dataset. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72267-5] [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: 10/17/2022]
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10
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Bradley J, Painter T, Drummond K, Edwards J. South Australian Experience of Minimally Invasive Mitral Valve Repair—A Review of the First 100 Consecutive Patients with Mitral Regurgitation. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.560] [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: 11/25/2022]
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11
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Field KM, Rosenthal M, Kosmider S, Gibbs P, Drummond K. Using a prospective comprehensive database to define features that impact the outcome of patients with glioblastoma multiforme. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2092] [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: 11/20/2022] Open
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12
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Rosenthal M, Field KM, Gibbs P, Wohlers T, Drummond K. Preoperative blood parameters as biomarkers for high-grade gliomas. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2077] [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: 11/20/2022] Open
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13
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Dally M, Rosenthal M, Drummond K, Murphy M, Cher L, Ashley D, Thursfield V, Giles G. Radiotherapy management of patients diagnosed with glioma in Victoria (1998-2000): A retrospective cohort study. J Med Imaging Radiat Oncol 2009; 53:318-24. [DOI: 10.1111/j.1754-9485.2009.02072.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rosenthal M, Drummond K, Dally M, Murphy M, Cher L, Ashley D, Thursfield V, Giles G. Glioma patterns of care in Victoria from 1998–2000. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.11521] [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: 11/20/2022] Open
Abstract
11521 Background: The management of Gliomas is complex and requires a multidisciplinary approach. The care of such patients (pts) may be variable. The State of Victoria has a population of approximately 4 million people and over 300 new glioma cases diagnosed annually. Methods: This was a retrospective cohort study conducted by surveying doctors involved in managing incident adult glioma cases identified from the population based Victorian Cancer Registry during 1998–2000. The survey was conducted in 2004–5 obtaining at least four years follow-up data on all pts. Results: 828 pts were considered eligible for this study. 264 pts (32%) were aged over 70 years and 92 (11%) were aged over 80 years. 105 (13%) did not have a histologic diagnosis and 473 (57%) had glioblastoma multiforme (GBM). Complete macroscopic resection was performed in 209 pts (25%). Of all pts with a glioma, 612 (74%) and 326 (54%) were referred at initial diagnosis for consideration of radiotherapy and chemotherapy respectively. In 473 pts with GBM, 406 (86%) and 147 (31%) pts were initially referred for consideration of radiotherapy and chemotherapy respectively. Only 39 pts(5%) were enrolled on a clinical trial. The median survival for pts with a GBM was 7.4 months with a 3% five-year survival. Conclusions: This is one of the largest ever-reported glioma management surveys. Much of the patient demographics and approach to treatment were expected and represent a reasonable “standard of care”. Importantly, this study emphasises the elderly nature of this patient population and identifies areas of concern including: absence of histologic diagnosis, lack of multi-disciplinary care and low clinical trial enrolment. No significant financial relationships to disclose.
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Affiliation(s)
- M. Rosenthal
- Royal Melbourne Hospital, Victoria, Australia; Alfred Hospital, Victoria, Australia; St Vincent’s Hospital, Victoria, Australia; Austin Health, Victoria, Australia; Cancer Council of Victoria, Victoria, Australia
| | - K. Drummond
- Royal Melbourne Hospital, Victoria, Australia; Alfred Hospital, Victoria, Australia; St Vincent’s Hospital, Victoria, Australia; Austin Health, Victoria, Australia; Cancer Council of Victoria, Victoria, Australia
| | - M. Dally
- Royal Melbourne Hospital, Victoria, Australia; Alfred Hospital, Victoria, Australia; St Vincent’s Hospital, Victoria, Australia; Austin Health, Victoria, Australia; Cancer Council of Victoria, Victoria, Australia
| | - M. Murphy
- Royal Melbourne Hospital, Victoria, Australia; Alfred Hospital, Victoria, Australia; St Vincent’s Hospital, Victoria, Australia; Austin Health, Victoria, Australia; Cancer Council of Victoria, Victoria, Australia
| | - L. Cher
- Royal Melbourne Hospital, Victoria, Australia; Alfred Hospital, Victoria, Australia; St Vincent’s Hospital, Victoria, Australia; Austin Health, Victoria, Australia; Cancer Council of Victoria, Victoria, Australia
| | - D. Ashley
- Royal Melbourne Hospital, Victoria, Australia; Alfred Hospital, Victoria, Australia; St Vincent’s Hospital, Victoria, Australia; Austin Health, Victoria, Australia; Cancer Council of Victoria, Victoria, Australia
| | - V. Thursfield
- Royal Melbourne Hospital, Victoria, Australia; Alfred Hospital, Victoria, Australia; St Vincent’s Hospital, Victoria, Australia; Austin Health, Victoria, Australia; Cancer Council of Victoria, Victoria, Australia
| | - G. Giles
- Royal Melbourne Hospital, Victoria, Australia; Alfred Hospital, Victoria, Australia; St Vincent’s Hospital, Victoria, Australia; Austin Health, Victoria, Australia; Cancer Council of Victoria, Victoria, Australia
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Turnbull J, Drummond K, Huang Z, Kinnunen T, Ford-Perriss M, Murphy M, Guimond S. Heparan sulphate sulphotransferase expression in mice and Caenorhabditis elegans. Biochem Soc Trans 2003; 31:343-8. [PMID: 12653634 DOI: 10.1042/bst0310343] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heparan sulphate (HS) acts as a multifunctional cell regulator, with specific sulphated saccharide sequences designed for selective interactions with many proteins. Functionally, these interactions result in regulation of the protein activities, and there is growing evidence that cells can dynamically alter the structure of HS sequences that they display. HS biosynthesis involves the action of a complex set of enzymes with polymerase, epimerase and sulphotransferase (ST) activities. In higher organisms, multiple isoforms of STs decorate the nascent HS chains with specific patterns of sulphation that confer selective biological functions. The study of HSSTs in model organisms provides a valuable opportunity to examine the expression of these enzymes in relation to the structure and activities of the HS produced. Here we describe that, in mice, there are stage-specific combinations of HSST isoenzymes that underlie the synthesis of different HS species at different times in the developing brain. This differential expression of HSSTs results in the synthesis of structurally variant HS species that form functional signalling complexes with specific fibroblast growth factors and their receptors. Regulated synthesis of specific HS species could be a mechanism for the regulation of proliferation and differentiation in the developing brain. We also describe evidence that a Caenorhabditis elegans orthologue of the mammalian 2OST enzyme, called HST-2, is essential for the normal development of this nematode. Together, these studies emphasize the importance of HSSTs in the biosynthesis of functionally variant HS proteoglycans, and demonstrate the importance of these complex regulatory molecules in developmental processes.
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Affiliation(s)
- J Turnbull
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, U.K.
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Shriver Z, Raman R, Venkataraman G, Drummond K, Turnbull J, Toida T, Linhardt R, Biemann K, Sasisekharan R. Sequencing of 3-O sulfate containing heparin decasaccharides with a partial antithrombin III binding site. Proc Natl Acad Sci U S A 2000; 97:10359-64. [PMID: 10984531 PMCID: PMC27029 DOI: 10.1073/pnas.97.19.10359] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [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: 12/11/2022] Open
Abstract
Heparin- and heparan sulfate-like glycosaminoglycans (HLGAGs) represent an important class of molecules that interact with and modulate the activity of growth factors, enzymes, and morphogens. Of the many biological functions for this class of molecules, one of its most important functions is its interaction with antithrombin III (AT-III). AT-III binding to a specific heparin pentasaccharide sequence, containing an unusual 3-O sulfate on a N-sulfated, 6-O sulfated glucosamine, increases 1,000-fold AT-III's ability to inhibit specific proteases in the coagulation cascade. In this manner, HLGAGs play an important biological and pharmacological role in the modulation of blood clotting. Recently, a sequencing methodology was developed to further structure-function relationships of this important class of molecules. This methodology combines a property-encoded nomenclature scheme to handle the large information content (properties) of HLGAGs, with matrix-assisted laser desorption ionization MS and enzymatic and chemical degradation as experimental constraints to rapidly sequence picomole quantities of HLGAG oligosaccharides. Using the above property-encoded nomenclature-matrix-assisted laser desorption ionization approach, we found that the sequence of the decasaccharide used in this study is DeltaU(2S)H(NS,6S)I(2S)H(NS, 6S)I(2S)H(NS,6S)IH(NAc,6S)GH(NS,3S,6S) (+/-DDD4-7). We confirmed our results by using integral glycan sequencing and one-dimensional proton NMR. Furthermore, we show that this approach is flexible and is able to derive sequence information on an oligosaccharide mixture. Thus, this methodology will make possible both the analysis of other unusual sequences in HLGAGs with important biological activity as well as provide the basis for the structural analysis of these pharamacologically important group of heparin/heparan sulfates.
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Affiliation(s)
- Z Shriver
- Division of Bioengineering and Environmental Health, Harvard-Massachusetts Institute of Technology, Biomedical Engineering, Cambridge, MA 02139, USA
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Drummond K. Counterpoint--chemotherapy is useful in the treatment of gliomas. J Clin Neurosci 2000; 7:466-7. [PMID: 10942678 DOI: 10.1054/jocn.2000.0688] [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: 11/18/2022]
Affiliation(s)
- K Drummond
- The Department of Surgery, The Royal Melbourne Hospital Parkville, Victoria, Australia
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Brito PL, Fioretto P, Drummond K, Kim Y, Steffes MW, Basgen JM, Sisson-Ross S, Mauer M. Proximal tubular basement membrane width in insulin-dependent diabetes mellitus. Kidney Int 1998; 53:754-61. [PMID: 9507223 DOI: 10.1046/j.1523-1755.1998.00809.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.9] [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: 02/06/2023]
Abstract
Although glomerular structure has been studied, careful evaluation of tubular basement membrane (TBM) structure in diabetes in humans has not been done. We measured proximal TBM width, glomerular basement membrane (GBM) width, mesangial fractional volume [Vv(Mes/glom)], mesangial matrix fractional volume [Vv(MM/glom)], and cortical interstitial fractional volume [Vv(Int/cortex)] in 35 insulin-dependent diabetic (IDDM) patients and 20 controls. The patients' mean age was 28 +/- 10 years (X +/- SD) and IDDM duration was 17 +/- 8 years. Twenty-five patients were normoalbuminuric, four microalbuminuric, and six had overt proteinuria. Tubular basement membrane and GBM widths were measured by the orthogonal intercept method and mesangial and interstitial parameters by point counting. The TBM width was 915 +/- 320 nm in IDDM patients and 558 +/- 116 nm in controls (P = 0.0005); the TBM width was also increased in normoalbuminuric patients (849 +/- 297 nm, P = 0.0005). The TBM width was strongly directly related to GBM width (r = 0.67, P < 0.001), Vv(Mes/glom) (r = 0.52, P < 0.01), and Vv(MM/glom) (r = 0.61, P < 0.001), but only weakly to Vv(Int/cortex) (r = 0.29, NS). The TBM width (r = 0.65, P < 0.001) and GBM width (r = 0.65, P < 0.001) were strongly related to hemoglobin A1C (HbA1C), while the Vv(Mes/glom) (r = 0.35, P < 0.05) and Vv(Int/cortex) (r = 0.30, NS) were only weakly related to HbA1C. Thus, increased proximal TBM width is an integral component of early nephropathology in IDDM patients. This study suggests that the metabolic disturbances of diabetes are strong determinants of the constellation of structural abnormalities occurring in human diabetic nephropathy.
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Affiliation(s)
- P L Brito
- Department of Pediatrics, University of Minnesota, Minneapolis, USA
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Affiliation(s)
- R W Bilous
- Department of Medicine, University of Newcastle upon Tyne, UK
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Drummond K. In-service training: how do employees learn best? Hosp Food Nutr Focus 1989; 6:1, 3-4. [PMID: 10296328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Drummond K, Levy-Marchal C, Laborde K, Kindermans C, Wright C, Dechaux M, Czernichow P. Enalapril does not alter renal function in normotensive, normoalbuminuric, hyperfiltering type 1 (insulin-dependent) diabetic children. Diabetologia 1989; 32:255-60. [PMID: 2547680 DOI: 10.1007/bf00285294] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Using a prospective randomised double-blind crossover design, the effect of the angiotensin converting enzyme inhibitor enalapril compared to a placebo was studied in 18 normotensive, normoalbuminuric Type 1 (insulin-dependent) diabetic children. Each patient had a high normal or clearly elevated glomerular filtration rate (145 ml.min-1.1.73 m2 or higher) in the 6 months prior to the study. Enalapril, 0.5 mg.kg-1.day-1, was given for 4 weeks followed by placebo for 4 weeks, or vice versa. At the end of each period, glomerular filtration rate, renal plasma flow, blood pressure, plasma renin activity, and converting enzyme activity were determined. Enalapril caused significant reduction (p = less than 0.001) in blood pressure and converting enzyme activity and a rise in plasma renin activity. A slight but not significant rise in glomerular filtration rate and renal plasma flow without change in filtration fraction was observed. These data suggest that the renin angiotensin system is not involved in the glomerular hyperfiltration of Type 1 diabetes, and can be interpreted as showing no evidence for the presence of intraglomerular hypertension in these patients.
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Affiliation(s)
- K Drummond
- Department of Pediatrics, Hôpital Necker-Enfants Malades, Paris, France
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Drummond K. Call on all nurses to speak out about what is happening with regard to Griffiths. Nurs Stand (1984) 1985:5. [PMID: 3852068] [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: 01/07/2023]
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