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Wang R, Singaraju A, Marks KE, Shakib L, Dunlap G, Cunningham-Bussel A, Greisen SR, Chen L, Tirpack A, Fein M, Todd D, Macfarlane L, Goodman S, Dicarlo E, Massarotti E, Sparks J, Hamnvik OP, Min L, Jonsson AH, Brenner M, Chan KK, Bass A, Donlin L, Rao D. POS0402 CLONALLY EXPANDED CD38hi CYTOTOXIC CD8 T CELLS DEFINE THE T CELL INFILTRATE IN CHECKPOINT INHIBITOR-ASSOCIATED ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundImmune checkpoint inhibitor (ICI) therapies that promote T cell activation have improved outcomes for advanced malignancies yet can also elicit harmful autoimmune reactions. The T cell mechanisms mediating these iatrogenic autoimmune events remain unclear.ObjectivesTo investigate the immunophenotype, transcriptomic feature and clonotypes of T cells from joints of patients affected by ICI-induced inflammatory arthritis (ICI-arthritis).MethodsDetailed immunophenotyping was performed on mononuclear cells from synovial fluid (SF) using mass cytometry and flow cytometry to identify significantly altered populations in ICI-A compared to seropositive rhrumatoid arthritis (RA) and psoriatic arthritis (PsA) (p<0.05). Bulk RNA-seq was performed on altered SF CD8 T cell subsets from ICI-A, RA and PsA to investigate their transcriptomic features. Cytokine profile and pathways enriched in ICI-A CD8 T cells were examined using differentially expressed genes, intracellular staining, and in vitro culture. TCR clonotypes were examined using single cell RNA-seq of T cells from synovial fluid, tissue and blood of ICI-A.ResultsCompared to the autoimmune arthritides RA and PsA, ICI-arthritis joints contained an expanded CD38hi CD127- CD8+ T cell subset that displays cytotoxic, effector, and interferon (IFN) response signatures. Exposure of synovial T cells to Type I IFN, more so than IFN-γ, induced the CD38hi cytotoxic phenotype. Single cell transcriptomic and T cell repertoire (TCR) analyses indicated that the abundance of CD38hi CD8 T cells in ICI-arthritis resulted from proliferation of a limited number of clones. The CD38hi population appeared distinct from dysfunctional T cells and clonally most related to TCF7+ memory populations. Comparison of synovial tissue from bilateral knees of the same patient demonstrated considerable sharing of TCR clonotypes among CD38hi CD8 T cells between the two joints. Further, TCR clonotypes expanded in synovial fluid of ICI-arthritis patients were detected in circulating T cells, and circulating CD38hi CD8 T cells are also expanded in ICI-arthritis patients.ConclusionThese results define a distinct CD8 T cell subset in the synovial fluid and in the circulation of patients with ICI-A that may be directly activated by ICI therapy to mediate a tissue-specific autoimmune response.Disclosure of InterestsNone declared.
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Spence S, French A, Penderis J, Macfarlane L, Gutierrez‐Quintana R, Dickson L, Holmes K, McLauchlan G. The occurrence of cardiac abnormalities in canine steroid‐responsive meningitis arteritis. J Small Anim Pract 2019; 60:204-211. [DOI: 10.1111/jsap.12984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 12/04/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- S. Spence
- Small Animal Hospital, University of Glasgow Glasgow G61 1QH UK
| | - A. French
- Small Animal Hospital, University of Glasgow Glasgow G61 1QH UK
| | - J. Penderis
- Vet Extra Neurology Broadleys Veterinary Hospital, Stirling FK7 7LE UK
| | - L. Macfarlane
- North Downs Specialist Referrals Bletchingley RH1 4QP UK
| | | | - L. Dickson
- Small Animal Hospital, University of Glasgow Glasgow G61 1QH UK
| | | | - G. McLauchlan
- Fitzpatrick Referrals – Oncology and Soft Tissue Surrey GU2 7AJ UK
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Affiliation(s)
- J J Windsor
- National Public Health Service for Wales, Microbiology Aberystwyth, Bronglais Hospital, Caradoc Road, Aberystwyth, Ceredigion SY23 1ER, Wales.
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Abstract
It is recommended that trilostane therapy of canine hyperadrenocorticism is monitored using an ACTH stimulation test, however this has never been validated. Three cortisol concentrations (pre-trilostane, 3-hour posttrilostane and 1-hour post-ACTH stimulation) were compared to a clinical score obtained from an owner questionnaire. There were 110 sets of 3 cortisol measurements and questionnaires obtained from 67 trilostane treated dogs. Questionnaire results were used to classify each dog as well or unwell. Well dogs were then categorised as having excellent, moderate or poor hyperadrenocorticism control, using thresholds produced by 14 independent veterinarians. Correlation co-efficients were used to compare the three cortisol concentrations to the owner score and the Kruskal Wallis and Mann-Whitney U tests were used to compare the three cortisol concentrations between categories of control. Cortisol cut-off values between significantly different categories were determined using ROC curves. Pre-trilostane and 3-hour post-trilostane cortisol were better correlated to the owner score and had cut-offs to differentiate between categories of control that had superior sensitivity and specificity results, than the post-ACTH cortisol. Iatrogenic hypoadrenocorticism was not detected in any unwell dog. This study shows that the pre-trilostane and 3-hour post-trilostane cortisol are potentially better monitoring methods than the ACTH stimulation test.
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Affiliation(s)
- L Macfarlane
- North Downs Specialist Referral, Friesian Buildings 3&4, The Brewerstreet Dairy Business Park, Brewer Street, Bletchingley, Surrey RH1 4QP, UK
| | - T Parkin
- Weipers Centre Equine Hospital, University of Glasgow, Glasgow, UK
| | - I Ramsey
- Small Animal Hospital, University of Glasgow, Glasgow, UK
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Macfarlane L, Hawkey S, Naasan H, Ibbotson S. Characteristics of actinic prurigo in Scotland: 24 cases seen between 2001 and 2015. Br J Dermatol 2016; 174:1411-4. [PMID: 26847497 DOI: 10.1111/bjd.14444] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L. Macfarlane
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital & Medical School Dundee DD1 9SY U.K
| | - S. Hawkey
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital & Medical School Dundee DD1 9SY U.K
| | - H. Naasan
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital & Medical School Dundee DD1 9SY U.K
| | - S. Ibbotson
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital & Medical School Dundee DD1 9SY U.K
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Macfarlane L, Morris J, Pratschke K, Mellor D, Scase T, Macfarlane M, Mclauchlan G. Diagnostic value of neutrophil-lymphocyte and albumin-globulin ratios in canine soft tissue sarcoma. J Small Anim Pract 2015; 57:135-41. [PMID: 26712718 DOI: 10.1111/jsap.12435] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 08/07/2015] [Accepted: 09/15/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the ability of neutrophil-to-lymphocyte ratio and albumin-to-globulin ratio to differentiate soft tissue sarcoma from benign soft tissue tumours. METHODS A retrospective study of pretreatment haematology and biochemistry in dogs diagnosed with soft tissue sarcoma or benign soft tissue tumours. The neutrophil-to-lymphocyte ratio and albumin-to-globulin ratio were compared between the two groups. In dogs diagnosed with soft tissue sarcoma, the relationship of neutrophil-to-lymphocyte ratio and albumin-to-globulin ratio to histological tumour grade (I to III) was assessed. RESULTS In the dogs with soft tissue sarcoma (n=22), the neutrophil-to-lymphocyte ratio was significantly increased and the albumin-to-globulin ratio decreased compared to those with benign soft tissue tumours (n=14). The neutrophil-to-lymphocyte ratio and albumin-to globulin ratio were not useful as predictors of tumour grade in dogs diagnosed with soft tissue sarcoma. CLINICAL SIGNIFICANCE Pretreatment neutrophil-to-lymphocyte ratio and albumin-to globulin ratio may aid with diagnosis and optimal treatment planning. Further investigation into their prognostic implications is warranted.
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Affiliation(s)
- L Macfarlane
- Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH
| | - J Morris
- Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH
| | - K Pratschke
- North East Veterinary Referrals, Northumberland Business Park West, Cramlington, NE23 7RH
| | - D Mellor
- Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH
| | - T Scase
- Bridge Pathology Ltd., Horfield, Bristol, BS7 0BJ
| | - M Macfarlane
- Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH
| | - G Mclauchlan
- Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH
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Macfarlane L, Waters A, Evans A, Affleck A, Fleming C. Seven years' experience of Mohs micrographic surgery in a UK centre, and development of a UK minimum dataset and audit standards. Clin Exp Dermatol 2013; 38:262-9. [DOI: 10.1111/ced.12108] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
Affiliation(s)
- L. Macfarlane
- Department of Dermatology; Ninewells Hospital; Dundee; UK
| | - A. Waters
- Department of Dermatology; Ninewells Hospital; Dundee; UK
| | - A. Evans
- Department of Histopathology; Ninewells Hospital; Dundee; UK
| | - A. Affleck
- Department of Dermatology; Ninewells Hospital; Dundee; UK
| | - C. Fleming
- Department of Dermatology; Ninewells Hospital; Dundee; UK
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Macfarlane L, McCullough J, Lewis-Jones S. Cutaneous granulomatous reaction caused by Stenotrophomonas maltophilia following injury. Clin Exp Dermatol 2012. [PMID: 23190050 DOI: 10.1111/j.1365-2230.2012.04442.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wootton M, Walsh TR, Macfarlane L, Howe RA. Activity of mecillinam against Escherichia coli resistant to third-generation cephalosporins. J Antimicrob Chemother 2009; 65:79-81. [DOI: 10.1093/jac/dkp404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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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Clark CG, Kaffashian F, Tawari B, Windsor JJ, Twigg-Flesner A, Davies-Morel MCG, Blessmann J, Ebert F, Peschel B, Van AL, Jackson CJ, Macfarlane L, Tannich E. New insights into the phylogeny of Entamoeba species provided by analysis of four new small-subunit rRNA genes. Int J Syst Evol Microbiol 2006; 56:2235-2239. [PMID: 16957127 DOI: 10.1099/ijs.0.64208-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [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: 11/18/2022] Open
Abstract
Sequences of small-subunit rRNA genes have been obtained for four new isolates of Entamoeba. Phylogenetic analyses give new insights into the evolution of these organisms. A novel Entamoeba from pigs in Vietnam that produces uninucleate cysts proved to be unrelated to other uninucleated cyst-producing species. Revival of the name Entamoeba suis for this organism is proposed. Instead of being related to Entamoeba polecki, it shares a recent common ancestor with the non-encysting Entamoeba gingivalis in a lineage that is basal to the tetranucleate cyst-producing clade. This suggests that species producing cysts with four nuclei are descended from an ancestor that produced cysts with a single nucleus. An Entamoeba from a horse was isolated in culture. No cysts were observed in the original stool sample but the sequence is placed unequivocally within the clade of tetranucleate cyst-producing species with no other sequences being specifically related. Revival of the name Entamoeba equi for this organism is proposed. The Entamoeba ecuadoriensis sequence was found to be the most closely related to Entamoeba histolytica and Entamoeba dispar, as predicted, despite the organism having been an environmental isolate originally assigned to Entamoeba moshkovskii. Finally, a partial E. polecki gene sequence from a pig proved to be virtually identical to that of Entamoeba struthionis from an ostrich, suggesting that the latter name is a synonym.
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Affiliation(s)
- C Graham Clark
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Farrokh Kaffashian
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Blessing Tawari
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Jeffrey J Windsor
- National Public Health Service for Wales Aberystwyth, Bronglais Hospital, Aberystwyth, Ceredigion SY23 1ER, UK
| | - Anke Twigg-Flesner
- Institute of Rural Sciences, University of Wales, Aberystwyth, Ceredigion SY23 3AL, UK
| | - Mina C G Davies-Morel
- Institute of Rural Sciences, University of Wales, Aberystwyth, Ceredigion SY23 3AL, UK
| | - Joerg Blessmann
- Department of Molecular Parasitology, Bernhard Nocht Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Frank Ebert
- Department of Molecular Parasitology, Bernhard Nocht Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Babett Peschel
- Department of Molecular Parasitology, Bernhard Nocht Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - An Le Van
- Medical College, University of Hué, Hué, Vietnam
| | - Colin J Jackson
- Institute of Rural Sciences, University of Wales, Aberystwyth, Ceredigion SY23 3AL, UK
| | - Lorna Macfarlane
- National Public Health Service for Wales Aberystwyth, Bronglais Hospital, Aberystwyth, Ceredigion SY23 1ER, UK
| | - Egbert Tannich
- Department of Molecular Parasitology, Bernhard Nocht Institute for Tropical Medicine, D-20359 Hamburg, Germany
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Abstract
The internal transcribed spacer (ITS) region of the ribosomal RNA operon is frequently used for detecting sequence variation among closely related species as it is usually homogeneous within strains but evolves more rapidly than ribosomal RNA coding regions. We have studied this region in both genotypes of the human intestinal parasite Dientamoeba fragilis. In contrast to most organisms, we have identified extensive variation between copies of the sequence within the same strain. The ITS occurs in 2 major forms in each genotype but additional heterogeneity is also present within each form. The significance of this finding is unclear, but the only precedent for such variation is in the Apicomplexa, which have multiple dispersed ribosomal RNA operons in contrast to the tandem arrays found in most other eukaryotes.
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Affiliation(s)
- Jeffrey J Windsor
- National Public Health Service for Wales Aberystwyth, Bronglais Hospital, Aberystwyth, Ceredigion, SY23 1ER, Wales, United Kingdom
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Ijaz S, Arnold E, Banks M, Bendall RP, Cramp ME, Cunningham R, Dalton HR, Harrison TJ, Hill SF, Macfarlane L, Meigh RE, Shafi S, Sheppard MJ, Smithson J, Wilson MP, Teo CG. Non-travel-associated hepatitis E in England and Wales: demographic, clinical, and molecular epidemiological characteristics. J Infect Dis 2005; 192:1166-72. [PMID: 16136458 DOI: 10.1086/444396] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 05/02/2005] [Indexed: 01/01/2023] Open
Abstract
Between 1996 and 2003, 186 cases of hepatitis E were serologically diagnosed. Of these, 17 (9%) were not associated with recent travel abroad. Patients were >55 years old (range, 56-82 years old) and tended to be male (76%). Two patients presented with fulminant hepatitis. A total of 129 (69%) cases were associated with recent travel to countries where hepatitis E virus (HEV) is hyperendemic. Compared with patients with travel-associated disease, patients with non-travel-associated disease were more likely to be older, living in coastal or estuarine areas, not of South Asian ethnicity, and infected by genotype 3 strains of HEV. The genotype 3 subgenomic nucleotide sequences were unique and closely related to those from British pigs. Patients infected by HEV indigenous to England and Wales tended to belong to a distinct demographic group, there were multiple sources of infection, and pigs might have been a viral reservoir.
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Affiliation(s)
- Samreen Ijaz
- Virus Reference Division, Centre for Infections, Health Protection Agency, University College London, London, United Kingdom
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Windsor JJ, Macfarlane L. Irritable bowel syndrome: the need to exclude Dientamoeba fragilis. Am J Trop Med Hyg 2005; 72:501; author reply 501-2. [PMID: 15891119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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Affiliation(s)
- J J Windsor
- National Public Health Service for Wales Aberystwyth, Bronglais Hospital, Aberystwyth, Ceredigion.
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Abstract
Symptoms associated with Dientamoeba fragilis include diarrhoea, abdominal pain, nausea, vomiting, epigastric pain and weight loss. A possible link between D. fragilis and irritable bowel syndrome (IBS)-like symptoms has been reported, and therefore the presence of this parasite should be excluded before making a diagnosis of IBS. Over a six-month period, 976 faecal samples were submitted to NPHS Microbiology Aberystwyth for routine microbiological analysis. All samples were also cultured for parasites using Robinson's xenic medium. Trichrome staining was undertaken whenever practicable, but many stools had insufficient material. D. fragilis was isolated from 25 (2.6%) patients, whereas Cryptosporidium spp. was detected in 16 (1.6%) patients. D. fragilis was only detected in nine (1.3%) out of 685 specimens stained with trichrome, although four of the 25 culture-positive stools had insufficient sample for staining. Parasite culture proved to be less laborious than trichrome staining and dramatically increased D. fragilis detection rate.
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Affiliation(s)
- J J Windsor
- NPHS Microbiology Aberystwyth, Bronglais Hospital, Caradoc Road, Aberystwyth, Ceredigion, SY23 1ER, UK.
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Miller WR, Dixon JM, Macfarlane L, Cameron D, Anderson TJ. Pathological features of breast cancer response following neoadjuvant treatment with either letrozole or tamoxifen. Eur J Cancer 2003; 39:462-8. [PMID: 12751376 DOI: 10.1016/s0959-8049(02)00600-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [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: 10/27/2022]
Abstract
Morphological characteristics, grading features, proliferation marker MIB1, apoptosis (by Tdt-mediated duTP-biotin nick-end labelling (TUNEL)), Bcl-2 expression, oestrogen receptor (ER) and progesterone receptor (PgR) status were compared in ER-positive breast cancers before and after 3 months of neoadjuvant therapy with either letrozole or tamoxifen. Daily treatment was with letrozole 2.5 mg (12 patients) or 10 mg (12 patients), or with tamoxifen 20 mg(24 patients). Letrozole treatment was associated with a pathological response in 17 of 24 (71%) patients. The predominant change in grading features was a decrease in mitosis, and the expression of MIB1 was reduced in all of the 22 evaluable cases. Whilst only marginal changes were observed in ER expression following letrozole therapy, PgR reactivity was reduced in 20 of 21 evaluable cases which were initially PgR-positive, becoming undetectable in 16 patients. Tamoxifen treatment was associated with pathological response in 15 of 24 (63%) tumours. In contrast to letrozole, the dominant change in grading feature was an increase in tubule formation, ER score was markedly reduced in most cases, and the most common effect on PgR was an increased expression. Following treatment with either tamoxifen or letrozole, variable effects were observed on the apoptotic index and expression of Bcl-2. These results indicate that both letrozole and tamoxifen have marked influences on the pathological features of breast cancer during neoadjuvant therapy. However, the effects of the two agents varied such that the phenotypes of letrozole- and tamoxifen-treated tumours differ markedly. Effects on clinical, pathological and biological endpoints were frequently disconcordant--future studies will therefore require the evaluation of multiple parameters in order to fully assess tumour response.
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Affiliation(s)
- W R Miller
- Department of Oncology, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK.
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Windsor JJ, Macfarlane L, Hughes-Thapa G, Jones SKA, Whiteside TM. Incidence of Blastocystis hominis in faecal samples submitted for routine microbiological analysis. Br J Biomed Sci 2002; 59:154-7. [PMID: 12371057 DOI: 10.1080/09674845.2002.11783653] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [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: 10/20/2022]
Abstract
Over a one-year period, 1390 faecal samples were submitted to Aberystwyth Public Health Laboratory for routine microbiological examination. All were stained using a commercial trichrome method. Blastocystis hominis was detected in 96 (6.9%), making it the most common parasite found in the study. Of the B. hominis-positive specimens, 73% were missed on direct microscopy. Molecular typing of B. hominis has revealed extensive genetic diversity in morphologically identical strains and thus detection by microscopy alone may not be sufficient to confirm the role of this organism in human disease.
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Affiliation(s)
- J J Windsor
- Aberystwyth Public Health Laboratory, Bronglais Hospital, Caradoc Road, Aberystwyth, Ceredigion, SY23 1ER, Wales.
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Macfarlane L. Growing awareness of gender in urban policies. Women Environ 2002:32-4. [PMID: 12347278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Windsor JJ, Macfarlane L, Whiteside TM. Blastocystis hominis. Br J Biomed Sci 2002; 58:253. [PMID: 11788005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Windsor JJ, Macfarlane L, Whiteside TM, Chalmers RM, Thomas AL, Joynson DH. Blastocystis hominis: a common yet neglected human parasite. Br J Biomed Sci 2001; 58:129-30. [PMID: 11440205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Snell GI, Griffiths A, Macfarlane L, Gabbay E, Shiraishi T, Esmore DS, Williams TJ. Maximizing thoracic organ transplant opportunities: the importance of efficient coordination. J Heart Lung Transplant 2000; 19:401-7. [PMID: 10775822 DOI: 10.1016/s1053-2498(00)00071-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 11/22/2022] Open
Abstract
BACKGROUND In Australia, despite large distances and one of the world's lowest multiorgan donor rates (11.4/million population/year), the thoracic organ transplant (TOTx) rate of 9.6/million population/year is one of the world's highest. METHODS As an example of the Australian approach, a system of transplant coordination and organ allocation has evolved at the Alfred Hospital. Donor organs are assigned locally, or between the 4 major TOTx units on rotation. The recipient team then selects appropriate recipients, matching by blood group, size, cytomegalovirus (CMV) status, prospective cross matching and clinical status. An experienced recipient coordinator takes responsibility for organization of the retrieval and transplant process, including all operating room staff, all medical personnel, and transport for the donor team and the potential TOTx recipients. RESULTS Between February 1989 and February 1999, 307 hearts, 48 heart/ lung, 124 single and 116 bilateral lung transplants were performed from 452 donor offers (52% beyond 500 miles). This represents 1.74 organs transplanted/thoracic donor and compares favourably to American United Network for Organ Sharing (1.43) and European (1.3) figures. CONCLUSIONS The Australia TOTx model has enabled high transplant rates by efficiently using the available donor organs. This has been achieved through an enlarged, experience TOTx team, the optimizing of donor acceptance criteria and improving coordination logistics to allow multiple thoracic procedures simultaneously.
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Affiliation(s)
- G I Snell
- Lung and Heart Transplant Services, Alfred Hospital, Commercial Rd, Prahran, Melbourne, Australia
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Macfarlane L, Walker J, Borrow R, Oppenheim BA, Fox AJ. Improved recognition of MRSA case clusters by the application of molecular subtyping using pulsed-field gel electrophoresis. J Hosp Infect 1999; 41:29-37. [PMID: 9949962 DOI: 10.1016/s0195-6701(99)90034-8] [Citation(s) in RCA: 28] [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: 10/26/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly common in hospital and community populations, making the recognition of true nosocomial outbreaks more difficult. We have used pulsed-field gel electrophoresis (PFGE) with Sma I digestion to analyse retrospectively two perceived outbreaks of epidemic methicillin-resistant Staphylococcus aureus 15 (EMRSA 15) colonization. The first cluster of cases in patients and staff on a general ward (ward D) revealed three different antibiograms based on differences in ciprofloxacin and rifampicin sensitivities. All isolates typed using PFGE, which was more discriminatory than phage-typing. One PFGE banding profile labelled type 5 was predominant, but 12 isolates proved to be subtypes of type 5 and two were PFGE type 11. Four staff members carried a strain not found in patients, three carried strains found in patients and transient carriage was highlighted as a problem when screening staff. PFGE enhanced the epidemiological data and proved that the cases on this ward did not comprise one large outbreak but numerous sporadic cases and smaller clusters. In contrast, isolates from a second cluster of cases which occurred on ward F were indistinguishable using antibiograms, phage-typing and PFGE, confirming this was more likely to be a true outbreak of colonization. We conclude that PFGE usefully augments epidemiological information and allows more logical infection control decisions to be made, with better utilization of scarce resources.
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Affiliation(s)
- L Macfarlane
- Manchester Public Health Laboratory, Withington Hospital, West Didsbury
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Macfarlane L, Lees P. Hospital activity. Barred facts. Health Serv J 1997; 107:26-9. [PMID: 10166679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Barcode technology is applicable to a number of crucial management issues in the NHS, including internal efficiency, contract pricing and the effectiveness of care. Its enormous potential lies in the ability to record in detail over a number of dimensions such as time, staff group, patient type, and cost. But the effort involved is considerable. Projects have to be actively managed, users have to be willing participants and data has to be analysed. Where short cuts have been sought, projects have failed to deliver their full potential. The data is merely a means to an end, but a very powerful one. It brings together people who may normally work independently, and the process of collecting barcode data is a perfect mechanism for bringing together the patient, the professional and the purse strings.
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Abstract
1. Experiments carried out on guinea-pig isolated ileum with carbachol as agonist and diphenyl-acetoxyethyl-dimethyl-ethyl-ammonium (DADMEA) bromide as antagonist gave results which fit the theoretical relation between fractional inhibition (Q) of the effects of an agonist ([A]) and the concentration of a competitive antagonist ([B]): this also involves the Hill coefficient (logistic slope factor, P) for the agonist concentration-response curve and the degree of agonist stimulation, [A]/[A]50, where [A]50 produces a half-maximum response. 2. Values of IC50 and an exponent, P', can be obtained by fitting Q to [B] using a logistic approximation to the relation. Both P' and IC50 should be greater with higher agonist stimulation but the increase in P' may be masked by errors in extreme values of Q. Estimates of IC50, however, invariably increased with higher agonist stimulation but with a steep concentration-response curve (P > 1) and low agonist stimulation ([A]/[A]50 < 1, IC50 can be less than KD. 3. KD was calculated from the results in three ways; (i) by a least-squares fit of Q to [B] using the values of P and [A]/[A]50 calculated from the control concentration-response curve; (ii) from the value of IC50 for each line and the values of P and [A]/[A]50 and (iii) by using the agonist concentration-response curve to calculate the dose-ratio and estimate of KD for each in the presence of the antagonist. The methods gave similar results (nM: 11 experiments), 12.4 +/- 1.1 (i), 11.7 +/- 0.9 (ii), 14.8 +/- 1.6 (iii) but there are advantages in using methods (i) or (ii) rather than (iii). 4. The method by which KD is calculated is less important than the experimental design: the plan used in this work, with alternative small and large responses from the tissue, is very suitable for estimating KD with low concentrations of antagonists and small dose-ratios. Although it is not a sensitive test for competitive behaviour because only a small range of concentrations of antagonist is tested, the estimate of affinity should be free from complications involved in the use of higher concentrations of antagonist (and agonist) and the nature of the antagonism can always be checked by doing further experiments in the presence of a known competitive antagonist.
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Affiliation(s)
- R B Barlow
- University Department of Pharmacology, Edinburgh
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