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Oudhoff H, Hisler V, Baumgartner F, Rees L, Grepper D, Jaźwińska A. Skeletal muscle regeneration after extensive cryoinjury of caudal myomeres in adult zebrafish. NPJ Regen Med 2024; 9:8. [PMID: 38378693 PMCID: PMC10879182 DOI: 10.1038/s41536-024-00351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Abstract
Skeletal muscles can regenerate after minor injuries, but severe structural damage often leads to fibrosis in mammals. Whether adult zebrafish possess the capacity to reproduce profoundly destroyed musculature remains unknown. Here, a new cryoinjury model revealed that several myomeres efficiently regenerated within one month after wounding the zebrafish caudal peduncle. Wound clearance involved accumulation of the selective autophagy receptor p62, an immune response and Collagen XII deposition. New muscle formation was associated with proliferation of Pax7 expressing muscle stem cells, which gave rise to MyoD1 positive myogenic precursors, followed by myofiber differentiation. Monitoring of slow and fast muscles revealed their coordinated replacement in the superficial and profound compartments of the myomere. However, the final boundary between the muscular components was imperfectly recapitulated, allowing myofibers of different identities to intermingle. The replacement of connective with sarcomeric tissues required TOR signaling, as rapamycin treatment impaired new muscle formation, leading to persistent fibrosis. The model of zebrafish myomere restoration may provide new medical perspectives for treatment of traumatic injuries.
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Affiliation(s)
- Hendrik Oudhoff
- Department of Biology, University of Fribourg, Chemin du Musée 10, 1700, Fribourg, Switzerland
| | - Vincent Hisler
- Department of Biology, University of Fribourg, Chemin du Musée 10, 1700, Fribourg, Switzerland
| | - Florian Baumgartner
- Department of Biology, University of Fribourg, Chemin du Musée 10, 1700, Fribourg, Switzerland
| | - Lana Rees
- Department of Biology, University of Fribourg, Chemin du Musée 10, 1700, Fribourg, Switzerland
| | - Dogan Grepper
- Department of Biology, University of Fribourg, Chemin du Musée 10, 1700, Fribourg, Switzerland
| | - Anna Jaźwińska
- Department of Biology, University of Fribourg, Chemin du Musée 10, 1700, Fribourg, Switzerland.
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Marino LV, Fandinga C, Barratt J, Brady I, Denton SA, Fitzgerald K, Mills T, Palframan K, Phillips S, Rees L, Scanlan N, Ashton JJ, Beattie RM. Pedi-R-MAPP | the development, testing, validation, and refinement of a digital nutrition awareness tool. Clin Nutr 2023; 42:1701-1710. [PMID: 37531806 DOI: 10.1016/j.clnu.2023.07.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND & AIMS The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments and provide practical guidance for nutritional care. R-MAPP was adapted into Pediatric Remote Malnutrition Application (Pedi-R-MAPP) using a modified Delphi consensus, with the goal of providing a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. The aim of this study was to develop and validate a digital version of Pedi-R-MAPP using the IDEAS framework (Integrate, Design, Assess and Share). METHODS A ten-step process was completed using the IDEAS framework. This involved the four concept processes; Stage-1, Integrate (Step 1-3) identify the problem, specify the goal, and use an evidence-based approach. Stage-2, (Step 4-7) design iteratively and rapidly with user feedback. Stage 3, (Step 8-9) Assess rigorously, and Stage 4 (Step 9-10) publish and launch of the tool. RESULTS Stage 1:Evidence-based development, Pedi-R-MAPP was developed using Delphi consensus methodology. Stage 2:Iteration & design, HCPs (n = 22) from UK, Europe, South Africa, and North America were involved four workshops to further develop a paper prototype of the tool and complete small-scale testing of a beta version of the tool which resulted in eight iterations. Stage 3:Assess rigorously, Small scale retrospective testing of the tool on children with congenital heart disease (n = 80) was completed by a single researcher, with iterative changes made to improve agreement with summary advice. Large scale testing amongst (n = 745) children in different settings was completed by specialist paediatric dietitians (n = 15) advice who recorded agreement with the summary advice compared with their own clinical assessment. Paediatric dietitians were in overall agreement with the summary advice in the tool 86% (n = 640), compared to their own clinical practice. The main reasons for disagreement were i) frequency of planned review 57.1% (n = 60/105), ii) need for ongoing dietetic review due to chronic condition 20.0% (n = 21/105), iii) disagreement with recommendation for discharge 16.2% (n = 17/105) and iv) concerns with faltering growth and/or need for condition specific growth charts 6.7% (7/105). Iterative changes were made to the algorithm, leading to an improvement in agreement of the summary advice on re-evaluation to 98% (p=<0.0001). CONCLUSION A digital version of the Pedi-R-MAPP nutrition awareness tool was developed using the IDEAS framework. The summary advice provided by the tool achieved a high level of agreement when compared to paediatric dietetic assessment, by providing a structured approach to completing a remote nutrition focused assessment, along with identifying the frequency of follow-up or an in-person assessment.
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Affiliation(s)
- L V Marino
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Health Science, University of Southampton, Southampton, UK.
| | - C Fandinga
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Barratt
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - I Brady
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S A Denton
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Fitzgerald
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T Mills
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Palframan
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Phillips
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L Rees
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N Scanlan
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J J Ashton
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Medicine, University of Southampton, Southampton, UK
| | - R M Beattie
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Medicine, University of Southampton, Southampton, UK
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Rees L, König D, Jaźwińska A. Regeneration of the dermal skeleton and wound epidermis formation depend on BMP signaling in the caudal fin of platyfish. Front Cell Dev Biol 2023; 11:1134451. [PMID: 36846592 PMCID: PMC9946992 DOI: 10.3389/fcell.2023.1134451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
Fin regeneration has been extensively studied in zebrafish, a genetic model organism. Little is known about regulators of this process in distant fish taxa, such as the Poeciliidae family, represented by the platyfish. Here, we used this species to investigate the plasticity of ray branching morphogenesis following either straight amputation or excision of ray triplets. This approach revealed that ray branching can be conditionally shifted to a more distal position, suggesting non-autonomous regulation of bone patterning. To gain molecular insights into regeneration of fin-specific dermal skeleton elements, actinotrichia and lepidotrichia, we localized expression of the actinodin genes and bmp2 in the regenerative outgrowth. Blocking of the BMP type-I receptor suppressed phospho-Smad1/5 immunoreactivity, and impaired fin regeneration after blastema formation. The resulting phenotype was characterized by the absence of bone and actinotrichia restoration. In addition, the wound epidermis displayed extensive thickening. This malformation was associated with expanded Tp63 expression from the basal epithelium towards more superficial layers, suggesting abnormal tissue differentiation. Our data add to the increasing evidence for the integrative role of BMP signaling in epidermal and skeletal tissue formation during fin regeneration. This expands our understanding of common mechanisms guiding appendage restoration in diverse clades of teleosts.
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Affiliation(s)
- Lana Rees
- Department of Biology, University of Fribourg, Fribourg, Switzerland
| | - Désirée König
- Department of Biology, University of Fribourg, Fribourg, Switzerland
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Rees L, König D, Jaźwińska A. Platyfish bypass the constraint of the caudal fin ventral identity in teleosts. Dev Dyn 2022; 251:1862-1879. [PMID: 35803741 PMCID: PMC9796532 DOI: 10.1002/dvdy.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The caudal fin of teleosts is characterized by dorsoventral symmetry. Despite this external morphology, the principal rays of this appendage connect to bones below the notochord, indicating the ventral (hypochordal) identity of this organ. RESULTS Here, we report that this typical architecture of the caudal fin is not fully conserved in the platyfish (Xiphophorus maculatus) and the guppy (Poecilia reticulata), representatives of the Poeciliidae family. We show that in these species, 3-4 principal rays connect to bones above the notochord, suggesting an epichordal contribution. Consistently, as examined in platyfish, dorsal identity genes zic1/4 were highly expressed in these rays, providing molecular evidence of their epichordal origin. Developmental analysis revealed that the earliest rays above the notochord emerge at the 10-ray stage of fin morphogenesis. In contrast to zebrafish and medaka, platyfish and guppies display a mirrored shape of dorsal and ventral processes of the caudal endoskeleton. Our study suggests that an ancestral bauplan expanded in poeciliids by advancing its symmetrical pattern. CONCLUSION The platyfish evolved a fin architecture with the epichordal origin of its upper principal rays and a high level of symmetry in the caudal endoskeleton. This innovative architecture highlights the adaptation of the teleost skeleton.
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Affiliation(s)
- Lana Rees
- Department of BiologyUniversity of FribourgFribourgSwitzerland
| | - Désirée König
- Department of BiologyUniversity of FribourgFribourgSwitzerland
| | - Anna Jaźwińska
- Department of BiologyUniversity of FribourgFribourgSwitzerland
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Okamoto S, Sakama T, Nakamura S, Niimura F, Sahin S, Ertan P, Evrengul H, Horasan G, Dede B, Berdeli A, Yildiz N, Cicek Deniz N, Asadov R, Yucelten D, Alpay H, Prado G, Schoeneman M, Mongia A, Paudyal B, Feygina V, Norin A, Hochman D, Tawadrous H, Bansilal V, Topaloglu R, Gulhan B, Bilginer Y, Celebi Tayfur A, Yildiz C, Ozaltin F, Duzova A, Ozen S, Aki T, Besbas N, Komaki F, Hamasaki Y, Ishikura K, Hamada R, Sakai T, Hataya H, Ogata K, Fukuzawa R, Ando T, Honda M, Malke A, Silska-Dittmar M, Soltysiak J, Blumczynski A, Ostalska-Nowicka D, Zachwieja J, Tabel Y, Oncul M, Elmas A, Kavaz A, Ozcakar ZB, Bulum B, Ekim M, Yalcinkaya F, Prikhodina L, Turpitko O, Dlin V, Gheith O, Alotaibi T, Nampoory N, Mosaad A, Halim M, Saied T, Abou Ateya H, Adel H, Mozarei I, Neir P, Hamasaki Y, Uemura O, Ishikura K, Ito S, Wada N, Hattori M, Ohashi Y, Tanaka R, Nakanishi K, Kaneko T, Honda M, Golovachova V, Odinets Y, Laszki-Szczachor K, Polak-Jonkisz D, Sobieszczanska M, Rusiecki L, Zwolinska D, Ninchoji T, Kaitoh H, Matsunoshita N, Nozu K, Nakanishi K, Yoshikawa N, Iijima K, Maglalang-Reed OM, Elises JS, Zamora MNV, Pasco P, Arejola-Tan A, Alparslan C, Dogan SM, Kose E, Elmas C, Kilinc S, Arslan N, Kebabci E, Karaca C, Yavascan O, Aksu N, Minson S, Munoz M, Vergara I, Mraz M, Vaughan R, Rees L, Olsburgh J, Calder F, Shroff R, Zaicova N, Kavaz A, Ozcakar ZB, Bulum B, Ekim M, Yalcinkaya F, Lavrenchuk O, Viktoria D, Savchenko V, Bagdasarova I, Doyon A, Bayazit A, Canpolat N, Duzova A, Kracht D, Litwin M, Ranchin B, Shroff R, Sozeri B, Wuhl E, Zeller R, Melk A, Querfeld U, Schaefer F, Sinha MD, Turner C, Booth CJ, Goldsmith DJA, Simpson JM. Paediatric nephrology - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft124] [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: 11/12/2022] Open
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Bedard M, Felteau M, Marshall S, Cullen N, Gibbons C, Dubois S, Maxwell H, Weaver B, Rees L, Gainer R, Mazmanian D. 1494 – Mindfulness-based cognitive therapy reduces depression symptoms in people who have a traumatic brain injury: results from a randomized controlled trial. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76515-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Takasawa K, Takaeda C, Higuchi M, Maeda T, Tomosugi N, Ueda N, Sasaki Y, Ikezoe M, Hagiwara M, Furuhata S, Murakami M, Shimonaka Y, Yamazaki S, Hamahata S, Hamahata S, Oue M, Kuragano T, Furuta M, Yahiro M, Kida A, Otaki Y, Hasuike Y, Nonoguchi H, Nakanishi T, Sarafidis P, Rumjon A, Ackland D, Maclaughlin H, Bansal SS, Macdougall IC, Panichi V, Rosati A, Malagnino E, Giusti R, Casani A, Betti G, Conti P, Bernabini G, Bernabini G, Gabrielli C, Caiani D, Scatena A, Migliori M, Pizzarelli F, Mitsopoulos E, Tsiatsiou M, Minasidis I, Kousoula V, Intzevidou E, Passadakis P, Vargemezis V, Tsakiris D, Yahiro M, Kida A, Otaki Y, Hasuike Y, Nonoguchi H, Nakanishi T, Kuragano T, Lines SW, Carter AM, Dunn EJ, Wright MJ, Aoyagi R, Miura T, De Paola L, Lombardi G, Coppolino G, Lombardi L, Hasuike Y, Fukumoto H, Kaibe S, Tokuyama M, Kida A, Otaki Y, Kuragano T, Nonoguchi H, Hiwasa M, Miyamoto T, Ohue H, Matsumoto A, Toyoda K, Nakanishi T, Rottembourg J, Emery C, Lafuma A, Wernli J, Zakin L, Mahi L, Borzych-Duzalka D, Bilginer Y, Pape L, Ha IS, Bak M, Chua A, Rees L, Pesle S, Cano F, Urzykowska A, Emre S, Russcasso J, Ramela V, Printza N, White C, Kuzmanovska D, Andrea V, Muller-Wiefel D, Warady B, Schaefer F, Chung JH, Park MK, Kim HL, Shin BC, Fujikawa T, Kuji T, Kakimoto M, Shibata K, Satta H, Nishihara M, Kawata S, Koguchi N, Toya Y, Umemura S, David V, Michel G, Maxime H, Paul L, Sebastien K, Francois V, Kuntsevich V, Dou Y, Thijssen S, Levin NW, Kotanko P, Kim BS, Kim BS, Park WD, Song HC, Kim HG, Kim YO, Woodburn K, Fong KL, Moriya Y, Tagawa Y, Maeda T, Kanda F, Morita N, Tomosugi N, London G, London G, Zaoui P, Covic A, Dellanna F, Goldsmith D, Gesualdo L, Mann J, Combe C, Turner M, Meunzberg M, Macdonald K, Abraham I, Gesualdo L, Combe C, Covic A, Dellanna F, Goldsmith D, London G, Mann J, Zaoui P, Turner M, Meunzberg M, Macdonald K, Abraham I, Rottembourg J, Guerin A, Diaconita M, Apruzzese R, Dou Y, Thijssen S, Kruse A, Ouellet G, Levin NW, Kotanko P, Bond C, Jensen D, Wang S, Pham E, Rubin J, Sika M, Niecestro R, Woodburn K, Fong KL, Sloneker S, Strzemienski P, Solon E, Moriya Y, Tagawa Y, Stamopoulos D, Mpakirtzi N, Grapsa E, Gogola B, Manios E, Afentakis N, Ewer J, Macdougall IC. Renal anaemia - CKD 5D. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs244] [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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Clayton RA, Bannard-Smith JP, Washington SJ, Wisely N, Columb M, Rees L. Cardiopulmonary exercise testing and length of stay in patients undergoing major surgery. Anaesthesia 2011; 66:393-4. [PMID: 21480842 DOI: 10.1111/j.1365-2044.2011.06725.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maslen CL, Rees L, Redfern PH. Role of the community pharmacist in the care of patients with chronic schizophrenia in the community. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.1996.tb00867.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
This study, using a postal questionnaire, investigated the involvement of 534 community pharmacists with patients suffering from schizophrenia. The majority of the 236 respondents regularly dispensed medication for patients with schizophrenia and almost three-quarters had been asked for advice about medication from such patients or their carers. However, the majority of respondents believed that the advice they could give to these patients was limited by their knowledge of schizophrenia (86 per cent) and of therapeutics (70 per cent). Other perceived constraints to giving advice included lack of contact with other health professionals, poor communication skills and lack of experience in dealing with the mentally ill. Respondents were significantly less confident about advising patients with schizophrenia than advising other patient groups. The results suggest that there is a need to encourage community pharmacists' participation in continuing education and to improve liaison with other community health professionals such as community psychiatric nurses.
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Affiliation(s)
- C L Maslen
- School of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, England BA2 7AY
| | - L Rees
- School of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, England BA2 7AY
| | - P H Redfern
- School of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, England BA2 7AY
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Frenette AJ, Kanji S, Rees L, Williamson DR, Perreault MM, Turgeon AF, Bernard F, Fergusson DA. Efficacy and safety of dopamine agonists in traumatic brain injury: a systematic review of randomized controlled trials. Crit Care 2011. [PMCID: PMC3066985 DOI: 10.1186/cc9731] [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: 11/24/2022] Open
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Tombaugh TN, Rees L, Baird B, Kost J. The Effects of List Difficulty and Modality of Presentation on a Computerized Version of the Paced Serial Addition Test (PSAT). J Clin Exp Neuropsychol 2010; 26:257-65. [PMID: 15202545 DOI: 10.1076/jcen.26.2.257.28080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [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: 11/03/2022]
Abstract
The Paced Serial Addition Test (PSAT) presents a series of digits at different speeds with the requirement that the two most recent numbers be added together. Although the PSAT is a relatively difficult test, its level of difficulty may be decreased by changing the number list to make the answers simpler and by presenting the digits visually rather than aurally. In view of this, the present experiment varied both task difficulty (easy vs. hard) and mode of presentation (visual vs. auditory). Task difficulty was manipulated by using two different lists composed of single digits whose answers ranged between 2 and 10 (easy) or 2 and 18 (hard). All stimuli were presented by computer which permitted measurement of response latencies, as well as correctness of responding. The results showed that mode of presentation, but not task difficulty, produced highly significant effects. Additional evidence showed that the ability to compute answers to simple addition problems must be considered as a modulator variable. However, an individual's basic arithmetic ability is not as critical as the modality in which a stimulus is presented. The lower performance associated with the auditory version (i.e., PASAT) was interpreted as an interference effect caused by both the stimulus and the response occurring in a single auditory information processing channel. This interpretation suggests that the PASAT's well documented sensitivity to traumatic brain injury (TBI) may be due, at least in part, to an increased susceptibility to interference effects rather than attributable solely to a decreased rate of information processing.
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Affiliation(s)
- T N Tombaugh
- Psychology Department, Carleton University, Ottawa, Ont., Canada.
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Thirlwell S, Rees L, Beaupierre A, Gillespie M. Creating A Valid And Reliable BMT Inpatient Acuity Tool That Reflects Current BMT Nursing Practice And Workload. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.136] [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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Waters AM, Pappworth I, Marchbank K, Bockenhauer D, Tullus K, Pickering MC, Strain L, Sebire N, Shroff R, Marks SD, Goodship THJ, Rees L. Successful renal transplantation in factor H autoantibody associated HUS with CFHR1 and 3 deficiency and CFH variant G2850T. Am J Transplant 2010; 10:168-72. [PMID: 19951285 DOI: 10.1111/j.1600-6143.2009.02870.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Factor H (CFH) autoantibodies are associated with atypical hemolytic uremic syndrome (aHUS). Peritransplantation plasma exchange therapy and intensification of immunosuppression, with adjuvant use of anti-CD20 monoclonal antibodies has recently been advocated for cases of CFH-autoantibody associated aHUS. In this report, we describe successful deceased donor renal transplantation in a case of CFH-autoantibody associated aHUS with combined CFHR1 and 3 deficiency in addition to the CFH sequence variant, (cG2850T, pGln950His). CFH-autoantibodies were detected 2 weeks prior to transplantation. Disease recurrence was not observed using basiliximab, an IL2-receptor antagonist and high-dose corticosteroids with mycophenolate mofetil. Adjuvant therapies such as Rituximab nor intensification of plasma therapy were employed. Consequently, careful consideration needs to be given to the use of additional immunosuppression in certain cases of CFH-autoantibody associated aHUS. Serial measurement of CFH-autoantibodies is required in the immediate pre- and posttransplantation period to further clarify their role as a factor in the recurrence of aHUS posttransplantation. Furthermore, delineation of the functional significance of CFH-autoantibodies is warranted in individual cases.
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Affiliation(s)
- A M Waters
- Department of Nephro-Urology, Great Ormond Street Hospital for Children NHS Trust, and Faculty of Medicine, Imperial College, London, UK.
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Krischock L, Gullett A, Bockenhauer D, Rees L, Trompeter RS, Marks SD. Calcineurin-inhibitor free immunosuppression with mycophenolate mofetil and corticosteroids in paediatric renal transplantation improves renal allograft function without increasing acute rejection. Pediatr Transplant 2009; 13:475-81. [PMID: 18992054 DOI: 10.1111/j.1399-3046.2008.01031.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to determine whether CNIs can be safely withdrawn in paediatric patients with declining renal allograft function receiving MMF and corticosteroids for long-term immunosuppression following renal transplantation. We performed a retrospective review of paediatric renal transplant recipients who received MMF with corticosteroids at least three months after transplantation with or without CNI in a single centre. Thirty-eight children (71% male), mean age 7.2 +/- 3.7 yr received MMF and corticosteroids, with 29 (76%) receiving a CNI. Mean follow-up was 59.2 +/- 42 months post-MMF commencement and 109 +/- 98.8 months post-transplantation. Patient and renal allograft survival were 100% and 94%, respectively. There was a significant improvement in eGFR after MMF introduction both in children on a CNI and those where the CNI was withdrawn, with stabilisation of eGFR after two yr. There was no significant difference in the number of acute rejection episodes prior to or following introduction of MMF between the groups. MMF in combination with corticosteroids is a safe and effective immunosuppressive regimen in paediatric renal transplantation. Complete withdrawal of CNIs after conversion to MMF should be considered in all patients, to preserve renal function as evidenced by improved eGFR.
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Affiliation(s)
- L Krischock
- Department of Paediatric Nephrology, Great Ormond Street Hospital, London, UK
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Birchall M, Inman C, Laycock G, Sait L, Vandeimen P, Rees L, Cogan T, Phillips A, Burt R, Mitchard L, Ayling S, Stokes C, Humphrey T, Stevens M, Bailey M. The development of upper airway mucosal immune architecture depends on peri-natal bacterial colonisation. Clin Otolaryngol 2008. [DOI: 10.1111/j.1749-4486.2008.01747_3.x] [Citation(s) in RCA: 4] [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: 11/29/2022]
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Birchall M, Rees L, Phillips A, Johnston N, Postma G, Koufman J, Bailey M. MHC molecule expression in laryngeal epithelium of patients with laryngopharyngeal reflux compared to normal subjects. Clin Otolaryngol 2006. [DOI: 10.1111/j.1365-2273.2006.01341_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rees L. A novel instrument for in-situX-ray inspection of protein crystals in multi-well plates. Acta Crystallogr A 2006. [DOI: 10.1107/s0108767306099752] [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: 11/11/2022] Open
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Winyard PJD, Bharucha T, De Bruyn R, Dillon MJ, van't Hoff W, Trompeter RS, Liesner R, Wade A, Rees L. Perinatal renal venous thrombosis: presenting renal length predicts outcome. Arch Dis Child Fetal Neonatal Ed 2006; 91:F273-8. [PMID: 16464938 PMCID: PMC2672730 DOI: 10.1136/adc.2005.083717] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [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] [Indexed: 11/03/2022]
Abstract
BACKGROUND Renal venous thrombosis (RVT) is the most common form of venous thrombosis in neonates, causing both acute and long term kidney dysfunction. Historical predisposing factors include dehydration, maternal diabetes, and umbilical catheters, but recent reports highlight associations with prothrombotic abnormalities. STUDY Twenty three patients with neonatal RVT were analysed over 15 years. Predisposing factors, presentation, and procoagulant status were compared with renal outcome using multilevel modelling. RESULTS Median presentation was on day 1: 19/23 (83%) had pre/perinatal problems, including fetal distress (14), intrauterine growth retardation (five), and pre-identified renal abnormalities (two); 8/18 (44%) had procoagulant abnormalities, particularly factor V Leiden mutations (4/18). Long term abnormalities were detected in 28/34 (82%) affected kidneys; mean glomerular filtration rate was 93.6 versus 70.2 ml/min/1.73 m2 in unilateral versus bilateral cases (difference 23.4; 95% confidence interval 6.4 to 40.4; p = 0.01). No correlation was observed between procoagulant tendencies and outcome, but presenting renal length had a significant negative correlation: mean fall in estimated single kidney glomerular filtration rate was 3 ml/min/1.73 m2 (95% confidence interval 3.7 to -2.2; p = 0.001) per 1 mm increase, and kidneys larger than 6 cm at presentation never had a normal outcome. CONCLUSIONS This subgroup of neonatal RVT would be better termed perinatal RVT to reflect antenatal and birth related antecedents. Prothrombotic defects should be considered in all patients with perinatal RVT. Kidney length at presentation correlated negatively with renal outcome. The latter, novel observation raises the question of whether larger organs should be treated more aggressively in future.
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Affiliation(s)
- P J D Winyard
- Renal Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Rees L. Safety in Bottle feeding and Safe Preparation. S Afr Fam Pract (2004) 2005. [DOI: 10.1080/20786204.2005.10873306] [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] Open
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22
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Rees L. Healthy digestion in infants. S Afr Fam Pract (2004) 2005. [DOI: 10.1080/20786204.2005.10873257] [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] Open
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23
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Rees L. Immunity and the infant GI-tract. S Afr Fam Pract (2004) 2005. [DOI: 10.1080/20786204.2005.10873235] [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] Open
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24
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Rees L. Prevention of Allergies. S Afr Fam Pract (2004) 2005. [DOI: 10.1080/20786204.2005.10873198] [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] Open
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Rees L, Birchall M, Bailey M, Thomas S. A systematic review of case-control studies of human papillomavirus infection in laryngeal squamous cell carcinoma. ACTA ACUST UNITED AC 2005; 29:301-6. [PMID: 15270812 DOI: 10.1111/j.1365-2273.2004.00841.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 11/27/2022]
Abstract
A role for human papillomavirus (HPV) has been suggested in laryngeal squamous cell carcinoma (LSCC). In order to quantitate the available evidence, we reviewed studies examining the risk of laryngeal cancer-associated HPV. PubMed was searched for case-control studies conducted worldwide and published in any language since 1966. Relevant papers were hand-searched and cross-referenced. Six studies met the inclusion criteria. The studies are heterogeneous in the methods used to harvest tissue samples and techniques for detecting the virus within the tissue. HPV-16 positivity among cases ranged from 2.7% to 46.9% and 0-5.7% among controls. Two studies showed a significantly increased risk of LSCC if HPV-16 was present (OR 18.5, 95% CI 2.2-154.8, OR 2.6, 95% CI 1.1-6.0). An increased risk was also observed for glottic versus supraglottic cancer in one study (OR 9.69, 95% CI 1.47-64.04). The direction of effect is towards an increase in risk of LSCC in people with evidence of HPV-16 infection. There is marked heterogeneity in the methods used to detect the virus and frequency with which it is detected. An adequately powered study using a reliable detection technique is required to confirm and quantify this risk and to examine effect modification.
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Affiliation(s)
- L Rees
- Laryngeal Research Group, Department of Otolaryngology, Division of Surgery, University of Bristol, Bristol, UK
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Royan J, Tombaugh TN, Rees L, Francis M. The Adjusting-Paced Serial Addition Test (Adjusting-PSAT): thresholds for speed of information processing as a function of stimulus modality and problem complexity. Arch Clin Neuropsychol 2004; 19:131-43. [PMID: 14670386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
A modified computer version of the PASAT (Adjusting-PSAT; ) is described that measures speed of information processing and working memory by means of a temporal threshold rather than number of correct responses. This is accomplished by making the duration of the interval between numbers depend on the correctness of responding-a correct response decreases the interval between digits and an incorrect response increases the interval. Modality of presentation (visual and auditory) was factorially combined with problem difficulty (answers between 2-10 or 2-18). Performance of 60 healthy student volunteers on the Adjusting-PSAT was compared to that obtained on several traditional neuropsychological measures (Digit Span, Trail Making Test, and Symbol Digit Modality Test) and on a test of basic addition skills. The visual version of the test produced a lower threshold than did the auditory version, but problem difficulty did not produce a significant effect. Of the neuropsychological tests, Trails-B (TMT-B) was most highly correlated with thresholds. However, regression analyses revealed that math ability accounted for more variance than did TMT-B. The clinical implications of these finding are discussed.
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Affiliation(s)
- J Royan
- University of Victoria, BC, Victoria, Canada
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Royan J, Tombaugh T, Rees L, Francis M. The Adjusting-Paced Serial Addition Test (Adjusting-PSAT): thresholds for speed of information processing as a function of stimulus modality and problem complexity. Arch Clin Neuropsychol 2004. [DOI: 10.1093/arclin/19.1.131] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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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Abstract
Since December 1995, pediatric renal transplant recipients in our unit have received a DMSA scan as soon as possible post-transplant in order to provide a baseline for comparison in the event of subsequent complications. We retrospectively reviewed the case notes and DMSA scans of the 45 patients who underwent a scan within 9 wk of their transplant to see if pre or peri-transplant factors or post-transplant complications were associated with defects on scanning. Forty percentage of scans had defects. The presence of defects was not associated with potential predisposing factors such as patient or donor age, cadaveric or live donation, cold ischemia time, multiple donor vessels, the use of non-heart beating donors, the mean time to scan, the serum creatinine, or the presence of structural renal tract anomalies predisposing to UTI. However, 87% of patients had complications before the scan, including UTI, rejection, acute tubular necrosis, transplant biopsy and drug toxicity. Children with no clinical complications had a significantly reduced risk of a defect (p = 0.035), while biopsy was associated with the presence of defects (p = 0.0034). Twenty patients had one or more follow up DMSA scans: one patient developed a new focal defect. In conclusion, renal transplant defects are frequently found on DMSA scanning even early after transplantation and are non-specifically associated with many different complications.
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Affiliation(s)
- C Hutchinson
- Department of Nephrology, Great Ormond Street Hospital, London, UK.
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Shroff R, Trompeter R, Cubitt D, Thaker U, Rees L. Epstein-Barr virus monitoring in paediatric renal transplant recipients. Pediatr Nephrol 2002; 17:770-5. [PMID: 12215833 DOI: 10.1007/s00467-002-0931-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2002] [Revised: 05/22/2002] [Accepted: 05/23/2002] [Indexed: 01/31/2023]
Abstract
Prospective Epstein-Barr virus (EBV) surveillance post transplant was undertaken by qualitative polymerase chain reaction testing for EBV DNA in plasma so as to detect EBV viremia as early as possible and thereby attempt to pre-empt post-transplant lymphoproliferative disease by reduction of immunosuppression. Forty-three children (46 transplants) were followed for a median (range) of 15.5 (3-25) months. Thirty-one children (67%) were EBV seropositive pre transplant. Twenty children (44%) developed EBV viremia; of these 9 (60%) were seronegative and 11 (36%) seropositive recipients. Primary infection developed later (median difference 14.2 weeks, P=0.009), was more likely to be symptomatic (odds ratio 2.91, 95% confidence interval 0.95-4.88) and associated with a rise in serum creatinine (odds ratio 6.13, 95% confidence interval 4.13-8.13) than reactivation disease. There was a higher incidence of EBV disease in children receiving quadruple therapy and tacrolimus (odds ratio 13.2, 95% confidence interval 11.5-14.9) compared with those given cyclosporin-based immunosuppression. Immunosuppression was reduced when EBV infection was detected. All children became asymptomatic and renal function returned to normal by a median (range) of 17 (6-52) days, although mild relapses occurred in 3 children. Regular EBV surveillance allowed prompt reduction of immunosuppression and was associated with a good outcome in this group of children.
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Affiliation(s)
- R Shroff
- Department of Nephrology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
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Fairbanks LD, Cameron JS, Venkat-Raman G, Rigden SPA, Rees L, Van'T Hoff W, Mansell M, Pattison J, Goldsmith DJA, Simmonds HA. Early treatment with allopurinol in familial juvenile hyerpuricaemic nephropathy (FJHN) ameliorates the long-term progression of renal disease. QJM 2002; 95:597-607. [PMID: 12205338 DOI: 10.1093/qjmed/95.9.597] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The efficacy of allopurinol in autosomal dominant familial juvenile hyperuricaemic nephropathy (FJHN) has been disputed. AIM To address this question, in the absence of controlled trials. DESIGN Retrospective long-term follow-up study. METHODS All kindreds were biochemically screened. Measurements included uric acid clearance, creatinine clearance, serum creatinine, and glomerular filtration rate (GFR). We used five siblings who had died or progressed to transplantation, ten other deceased relatives, and two index cases (one untreated, one non-compliant) as controls to assess the effects of allopurinol. RESULTS Of eight families with FJHN, six had a strong history of renal disease and early parental death (mean age 41 years, n=10). Of 27 patients started immediately on allopurinol and treated uninterruptedly, 21 responded well, including three children born subsequently. Eight siblings (mean age 19 years) with a normal plasma creatinine at start (<120 micromol/l, mean GFR 80 ml/min/1.73 m(2)) retained stable renal function (mean 14.5 years, mean age 34 years, GFR 85 ml/min/1.73 m(2)). Of the 13 other responders, treated for up to 34 years, 10 with a creatinine <200 micromol/l at diagnosis (mean age 28 years, mean creatinine 137 micromol/l at start) now have a mean creatinine of 210 micromol/l. In contrast, five patients (mean age 26 years) with a creatinine >200 micromol/l (GFR <35 ml/min/1.73 m(2)) when allopurinol commenced, plus one untreated index case, all progressed rapidly (mean 6 years) to end-stage renal failure. In two others (one non-compliant, one initially untreated), GFR fell by >50% in 7 years. Introduction of allopurinol in the latter has stabilized GFR. DISCUSSION Allopurinol reduced the morbidity and mortality from renal failure seen in untreated siblings and previous generations of these families. Early diagnosis of FJHN is important, so that treatment can begin before irreversible renal damage has developed.
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Affiliation(s)
- L D Fairbanks
- Purine Research Unit GKT, Guy's Hospital, London, UK
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Pinkerton CR, Hann I, Weston CL, Mapp T, Wotherspoon A, Hobson R, Kelly DA, Vergani D, Hadzic D, Rees L, Burke M, Alero Thomas J. Immunodeficiency-related lymphoproliferative disorders: prospective data from the United Kingdom Children's Cancer Study Group Registry. Br J Haematol 2002; 118:456-61. [PMID: 12139732 DOI: 10.1046/j.1365-2141.2002.03681.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical data and biological samples were prospectively collected in 42 children with lymphoproliferative disease (LPD) secondary to organ/bone marrow transplant-related immunosuppression (30: 11 liver, 10 heart/lung, 8 kidney and 1 bone marrow), other drug-induced immunosuppression (2), congenital immunodeficiency (8) or human immunodeficiency virus (HIV)-related immune dysfunction (2). Ages ranged from 10 months to 17 years and there were 15 girls. Pathology was centrally reviewed and showed polymorphic features in 5 cases, monomorphic in 23, mixed pattern in 5 patients and 9 other types. Using the Revised European-American Classification of Lymphoid Neoplasms, 5 were B lymphoblastoid, 24 were high-grade B and 14 were other subtypes. Using the Pittsburgh classification, 9 were lymphadenopathic, 10 were systemic, 25 were lymphomatous and, with the Murphy grouping for non-Hodgkin's lymphoma (NHL), 10 were localized and 32 non-localized. Twenty-four out of 38 evaluable cases were Epstein-Barr virus positive. Thirty-five patients were evaluable for clonality; 24 were monoclonal and 11 were polyclonal. Reduced immunosuppression in solid organ transplant patients resulted in resolution of disease in 14/24, which was sustained in 11. Nineteen patients received chemotherapy, 14/18 evaluable responded, which was sustained in 8 cases. Seven out of 29 solid organ transplant and 10/13 other immune-deficient patients died. In the largest group of patients, solid organ transplants, no significant clinical or biological characteristics that predicted outcome were identified. In the transplant group close monitoring of response during reduction in immunosuppression is essential and the early use of B NHL chemotherapy may be effective.
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Affiliation(s)
- C R Pinkerton
- Department of Paediatric Oncology, Royal Marsden NHS Trust, Downs Road, Sutton, Surrey SM2 5PT, UK.
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Bennett-Richards K, Kattenhorn M, Donald A, Oakley G, Varghese Z, Rees L, Deanfield JE. Does oral folic acid lower total homocysteine levels and improve endothelial function in children with chronic renal failure? Circulation 2002; 105:1810-5. [PMID: 11956124 DOI: 10.1161/01.cir.0000014417.95833.1d] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [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: 11/16/2022]
Abstract
BACKGROUND Accelerated vascular disease is common in chronic renal failure (CRF) and accounts for significant mortality and morbidity. Elevated homocysteine levels may contribute by an effect on endothelial function. METHODS AND RESULTS We performed a double-blind placebo-controlled randomized crossover trial of folic acid at 5 mg/m2 in 25 normotensive children 12+/-3 (7 to 17) years of age with CRF (glomerular filtration rate 26.8+/-13.2 mL/min per 1.73 m2) of noninflammatory etiology. Each subject underwent two 8-week periods of folic acid and placebo separated by an 8-week washout period. The effect of folic acid on homocysteine levels, LDL oxidation, and both endothelial-dependent and -independent vascular function were measured. After oral folic acid, serum folate levels rose from 11.7+/-4.25 to 635+/-519 microg/L (P=0.001), red cell folate levels rose from 364+/-195 to 2891+/-2623 microg/L (P<0.001), and total homocysteine levels fell from 10.28+/-4.16 to 8.62+/-2.32 micromol/L (P=0.03). In addition, there was a significant improvement in flow-mediated dilatation (FMD) (endothelial-dependent dilatation) from 7.21+/-2.8% to 8.47+/-3.01% (P=0.036) with no change in response to glyceryl trinitrate (endothelial-independent dilatation). There was no significant change in FMD or glyceryl trinitrate during the placebo phase. There was, however, no significant difference in final FMD after placebo or folic acid. Lag times for LDL oxidation were prolonged during the treatment phase (58.4+/-18.7 to 68.1+/-25.9 minutes, P=0.01). CONCLUSION Folic acid supplementation in children with CRF may improve endothelial function with an increased resistance of LDL to oxidation.
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Affiliation(s)
- K Bennett-Richards
- Department of Nephrology, Great Ormond Street Hospital for Children NHS Trust and Institute of Child Health, London, UK.
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Kapila P, Jones J, Rees L. Effect of chronic renal failure and prednisolone on the growth hormone-insulin-like growth factor axis. Pediatr Nephrol 2001; 16:1099-104. [PMID: 11793109 DOI: 10.1007/s004670100037] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2000] [Accepted: 07/12/2001] [Indexed: 11/29/2022]
Abstract
Abnormalities of the growth hormone (GH)/ insulin-like growth factor (IGF) axis have been reported in children with chronic renal failure (CRF) and post-transplant, and are thought to contribute to poor growth. This study examined the effect of CRF and steroid therapy (given post-transplant and to children with normal renal function) on the GH-IGF axis in children with normal and abnormal growth. Thirty-one children with CRF, ten on dialysis, 26 with renal transplants and ten taking steroid therapy but with normal renal function, were studied. IGF-I, measured by radioimmunoassay, was normal but IGF bioactivity was low in groups with a decreased glomerular filtration rate (P<0.05). Transplanted children growing at a subnormal growth rate had lower IGF bioactivity than those growing at a normal rate (P=0.03), but there was no such difference in bioactivity in children with CRF. There was no correlation between IGF bioactivity and prednisolone treatment. There was no correlation between IGF binding proteins 1, 2 or 3 and growth.
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Affiliation(s)
- P Kapila
- Department of Nephrourology, Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK.
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Abstract
BACKGROUND This article details an audit of the supply of medications by specialist nurses at a genitourinary medicine clinic. CONCLUSION The use of patient group directions resulted in a reduced number of prescriptions being required from doctors, thus saving time for them, the nurses and patients.
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Affiliation(s)
- K Miles
- Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, London.
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Rees L, Tombaugh T, Francis M. The adjusting-PASAT: a new procedure for determining thresholds for speed of information processing. Arch Clin Neuropsychol 2000. [DOI: 10.1093/arclin/15.8.690a] [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: 11/12/2022] Open
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Rees L. The adjusting-PASAT: a new procedure for determining thresholds for speed of information processing. Arch Clin Neuropsychol 2000. [DOI: 10.1016/s0887-6177(00)80073-6] [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: 11/24/2022] Open
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Abstract
Lymphocyte subsets and T cell activation markers were measured in ten children with renal transplants for up to 1 year before and during their 1st year of recombinant human growth hormone (rhGH) treatment. The number of lymphocytes, helper or cytotoxic T cells or natural killer cells, and the T cell expression of CD25, CD26 and HLA-DR antigens were not altered by rhGH. B cell numbers declined both before and during treatment. There was no difference in lymphocyte subset numbers between children with and without rejection episodes.
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Affiliation(s)
- H Maxwell
- Department of Paediatric Nephrology, Institute of Child Health, London, UK.
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Abstract
We report on three children with severe, recurrent focal segmental glomeruloscerosis (FSGS) in their first allografts, treated with methylprednisolone, plasma exchange and cyclophosphamide. This protocol is based on a previous publication showing its successful use in three children. Our patients were 2 girls and 1 boy, aged 14.5, 14.6 and 13.2 years, respectively, at transplant. Concomitant immunosuppression included cyclosporin A and prednisolone. Recurrence occurred in all three patients within 24 h, and specific treatment was commenced within 48 h. All patients developed anuria and were dialysed. The boy stopped dialysis after 4 weeks, and has stable chronic renal failure (CRF) and no proteinuria 3 years later. One girl required dialysis for 4 months, and 3 years later has CRF with non-nephrotic range proteinuria. The other girl remained dialysis-dependent and died from septic complications. We conclude that even anuric patients treated with this protocol may have an improvement in renal function and reduction of proteinuria, which can last for over 3 years. However, treatment may need to be prolonged and carries the substantial risks of heavy immunosuppression.
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Affiliation(s)
- M A Saleem
- Department of Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
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Abstract
The clinical course and 3-year follow-up of a female patient aged 11 years who presented with nephrotic syndrome and renal failure is described. The renal biopsy revealed type II membranoproliferative glomerulonephritis or dense deposit disease. She was treated with penicillin prophylaxis, frusemide and captopril, and was not given immunosuppression, anticoagulation or antiplatelet therapy. Despite poor prognostic clinical and pathological features, she had spontaneous resolution of her renal failure and proteinuria, although her proteinuria recurred 17 months post presentation. Her unusual progress, with improvement in her disease activity and normalisation of her glomerular filtration rate, is described.
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Affiliation(s)
- S D Marks
- Department of Paediatric Nephrourology, Great Ormond Street Hospital for Children NHS Trust, London, UK
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Koziell A, Charmandari E, Hindmarsh PC, Rees L, Scambler P, Brook CG. Frasier syndrome, part of the Denys Drash continuum or simply a WT1 gene associated disorder of intersex and nephropathy? Clin Endocrinol (Oxf) 2000; 52:519-24. [PMID: 10762296 DOI: 10.1046/j.1365-2265.2000.00980.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Dysfunction of the Wilms' Tumour gene (WT1), a transcription factor critical for normal development and function of the urogenital tract, can result in both tumourigenesis [corrected] and urogenital abnormalities. The association of WT1 gene mutations with most cases of Denys-Drash syndrome is well described. More recently WT1 mutations have also been described in a related condition, Frasier syndrome. We report a case where genetic analysis showed a WT1 mutation typically associated with Frasier syndrome: a 1228 + 5 guanine to adenine substitution at the 3' alternative splice donor site in intron 9. The case provides a focus for the discussion of recent evidence that Denys Drash and Frasier syndrome form two ends of a spectrum of disorders. In addition, it illustrates the increasing significance of genetic investigation within clinical practice for diagnostic, prognostic and therapeutic purposes and the importance of karyotype analysis in phenotypically normal girls with renal disease.
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Affiliation(s)
- A Koziell
- London Centre for Paediatric Endocrinology, University College London, London, UK
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Abstract
BACKGROUND We aimed to assess the outcome and growth of infants with severe chronic renal failure (CRF). One hundred and one children presented between January 1, 1986, and December 12, 1998, with a glomerular filtration rate (GFR) of <20 mL/min/1.73 m2. The median (range) age at presentation was 0.3 (0 to 1.5) years, and follow-up was 7.6 (1.5 to 13) years. One- and five-year survival rates were 87 and 78%, respectively. The growth of the 81 children who survived over two years was evaluated. Eighty-one percent were enterally fed from age 0.7 (0 to 4.5) years for 1.9 (0.1 to 6.8) years. Forty-six percent had a gastrostomy, and 22% a Nissen fundoplication. Twenty-five were managed conservatively. Twenty were transplanted without dialysis at age 4 (1.7 to 8.5) years, and 36 were dialyzed at age 1.1 (0 to 9.8) before transplantation at age 2. 4 (1.3 to 10) years. RESULTS The mean (SD) height standard deviation score increased from -2.16 (1.34) at 6 months (N = 63) to -1.97 (1.37) at 1 year (N = 75), -1.79 (1.29) at 2 years (N = 75), -1.33 (1.29) at 3 years (N = 68, P = 0.0006), -1.27 (1.04) at 5 years (N = 47, P = 0.0001), and -0.85 (0.82) at 10 years (N = 18, P = 0.001). The body mass index was in the normal range in the majority of patients. CONCLUSION Mortality in infants with CRF occurs mainly in the first year of life. With early enteral feeding, the mean height standard deviation score is within the normal range from one year of age.
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Affiliation(s)
- J A Kari
- Renal Unit, Gt. Ormond St. Hospital for Children NHS Trust, London, England, United Kingdom
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Abstract
The growth of short children with chronic renal failure (CRF) and renal transplants was assessed over 10 years following entry into a 1-year trial of recombinant human growth hormone (rhGH) therapy. Patients were divided into three groups: 6 prepubertal patients with CRF (group 1), mean (range) age at start of trial 7.7 (5.0-10.4) years; 6 prepubertal patients with renal transplants (group 2), age 11.9 (9.5-14.6) years; and 6 pubertal patients with renal transplants (group 3), age 15.6 (14.1-18.3) years. In group 1, the mean (range) height standard deviation score (Ht SDS) increased from -2.9 (-3.7 to -2.2) to -1.9 (-2.9 to -0.5) over 4.0 (0.3-9.1) years of rhGH (P=0.04), and was -1.6 (-2.9 to -0.4) after 10 years of follow-up (NS). In group 2 Ht SDS increased from -3.3 (-4.5 to -1.9) to -2.9 (-5.4 to -0.5) over 2.7 (1.0-6.0) years and was -3.0 (-6.3 to -0.1) at final height (NS). In group 3 Ht SDS increased from -3.4 (-4.3 to -2.6) to -3.0 (-3.4 to -2.2) over 1.4 (0.2-2.3) years (NS) and was -2.5 (-3.0 to -1.9) at final height (P=0.03 from stopping rhGH to final height). Final height was attained in 13 patients, in whom Ht SDS increased from -3.2 (-4.3 to -1.9) to -2.6 (-3.9 to -0.5) on rhGH (P=0.004) and to -2.2 (-4.4 to -0.1) after stopping treatment (P=0.04). Four patients died, 2 have chronic hepatitis C, and 1 has had surgery for parathyroid adenomata. In conclusion, the majority of patients had an improvement in Ht SDS while on rhGH, which was maintained after stopping treatment.
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Affiliation(s)
- L Rees
- Nephrourology Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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47
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Abstract
Between March 1987 and December 1997, 59 renal transplants [49 cadaveric, 10 live related (LRD)], were performed in 54 children aged 5 years and younger. Six children required a second transplant. The median (range) age of the recipients was 2.9 (1.4-5.0) years; mean weight was 12.6 kg (7.4-23) and donor age 11 (2-50) years. Immunosuppression was cyclosporin or FK506, prednisolone, and azathioprine. Antithymocyte globulin was given as induction therapy for second transplants. Patient survival was 98.3%; 1 patient died from upper gastrointestinal haemorrhage. Graft survival was 67.7% at 1 year, 57.4% at 5 years, and 45.2% at 10 years. No LRD graft was lost during 7 years of follow-up. Thrombosis was the main cause of graft loss (10 cases) followed by vascular rejection (2 cases). There was no significant difference in graft survival between recipients aged less than 2, 2-3, and 3-5 years. The height standard deviation score (+/-SD) improved from -2.1+/-1.3 at transplantation to -1.0+/-1.3 at 1 year, -1.1+/-1.5 at 5 years, and to -0.14+/-1.1 at 10 years.
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Affiliation(s)
- J A Kari
- Renal Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK
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48
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Plaisted K, Swettenham J, Rees L. Children with autism show local precedence in a divided attention task and global precedence in a selective attention task. J Child Psychol Psychiatry 1999; 40:733-42. [PMID: 10433407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Children with a diagnosis of autism and typically developing children were given two variations of the Navon task (Navon, 1977), which required responding to a target that could appear at the global level, the local level, or both levels. In one variation, the divided attention task, no information was given to children regarding the level at which a target would appear on any one trial. In the other, the selective attention task, children were instructed to attend to either the local or the global level. Typically developing children made most errors when the target appeared at the local level whereas children with autism made more errors when the target appeared at the global level in the divided attention task. Both groups of children were quicker to respond to the global target than the local target in the selective attention task. The presence of normal global processing in the children with autism in one task but not in the other is discussed in terms of a deficit in mechanisms that inhibit local information in the absence of overt priming or voluntary selective attention to local information.
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Affiliation(s)
- K Plaisted
- Department of Experimental Psychology, University of Cambridge, UK.
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Tombaugh TN, Kozak J, Rees L. Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Arch Clin Neuropsychol 1999; 14:167-77. [PMID: 14590600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Normative data stratified by three levels of age (16-59, 60-79, and 80-95 years) and three levels of education (0-8, 9-12, and 13-21 years) are presented for phonemic verbal fluency (FAS) and categorical verbal fluency (Animal Naming). The normative sample, aged 16 to 95 years, consisted of 1,300 cognitively intact individuals who resided in the community. Years of education ranged from 0 to 21. The total number of words in 1 minute for each of the letters F, A, and S was correlated r =.52 with the number of animal names generated in 1 minute. Regression analyses showed that FAS was more sensitive to the effects of education (18.6% of the variance) than age (11.0% of the variance). The opposite relationship occurred for Animal Naming, where age accounted for 23.4% of the variance and education accounted only for 13.6%. Gender accounted for less than 1% of variance for FAS and Animal Naming. The clinical utility of these norms is discussed.
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Affiliation(s)
- T N Tombaugh
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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50
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Tombaugh TN, Kozak J, Rees L. Normative Data Stratified by Age and Education for Two Measures of Verbal Fluency: FAS and Animal Naming. Arch Clin Neuropsychol 1999. [DOI: 10.1093/arclin/14.2.167] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [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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