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Bui D, Hayward G, Chen TH, Apruzzese P, Asher S, Maslow M, Gorgone M, Hunter C, Flaherty D, Kendall M, Maslow A. Hemodynamic Monitoring In The Cardiac Surgical Patient: Comparison of Three Arterial Catheters. J Cardiothorac Vasc Anesth 2024; 38:1115-1126. [PMID: 38461034 DOI: 10.1053/j.jvca.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE Systemic systolic (SAP) and mean (MAP) arterial pressure monitoring is the cornerstone in hemodynamic management of the cardiac surgical patient, and the radial artery is the most common site of catheter placement. The present study compared 3 different arterial line procedures. It is hypothesized that a 20-G 12.7- cm catheter inserted into the radial artery will be equal to a 20-G 12.7- cm angiocath placed in the brachial artery, and superior to a 20-G 5.00 cm angiocath placed in the radial artery. DESIGN A prospective randomized control study was performed. SETTING Single academic university hospital. PARTICIPANTS Adult patients ≥18 years old undergoing nonemergent cardiac surgery using cardiopulmonary bypass (CPB). INTERVENTIONS After approval by the Rhode Island Hospital institutional review board, a randomized prospective control study to evaluate 3 different peripheral intraarterial catheter systems was performed: (1) Radial Short (RS): 20-G 5- cm catheter; (2) Radial Long (RL): 20-G 12- cm catheter; and (3) Brachial Long (BL): 20-G 12- cm catheter. MEASUREMENTS AND RESULTS Gradients between central aortic and peripheral catheters (CA-P) were compared and analyzed before CPB and 2 and 10 minutes after separation from CPB. The placement of femoral arterial lines and administration of vasoactive medications were recorded. After exclusions, 67 BL, 61 RL, and 66 RS patients were compared. Before CPB, CA-P SAP and MAP gradients were not significant among the 3 groups. Two minutes after CPB, the CA-P SAP gradient was significant for the RS group (p = 0.005) and insignificant for BL (p = 0.47) and RL (p = 0.39). Two-group analysis revealed that CA-P SAP gradients are similar between BL and RL (p = 0.84), both of which were superior to RS (p = 0.02 and p = 0.04, respectively). At 10 minutes after CPB, the CA-P SAP gradient for RS remained significant (p = 0.004) and similar to the gradient at 2 minutes. The CA-P SAP gradients increased from 2 to 10 minutes for BL (p = 0.13) and RL (p = 0.06). Two minutes after CPB, the CA-P MAP gradients were significant for the BL (p = 0.003), RL (p < 0.0001), and RS (p < 0.0001) groups. Two-group analysis revealed that the CA-P MAP gradients were lower for the BL group compared with the RL (p = 0.054) and RS (p< 0.05) groups. Ten minutes after CPB, the CA-P MAP gradients in the RL and RS groups remained significant (p < 0.0001) and both greater than the BL group (p = 0.002). A femoral arterial line was placed more frequently in the RS group (8/66 = 12.1%) than in the RL group (3/61 = 4.9%) and the BL group (2/67 = 3.0%). Vasopressin was administered significantly more frequently in the RS group. CONCLUSION Regarding CA-P SAP gradients, the RL group performed equally to the BL group, both being superior to RS. Regarding CA-P MAP gradients, BL was superior to RL and RS. Clinically, femoral line placement and vasopressin administration were fewer for the BL and RL groups when compared with the RS group. This study demonstrated the benefits of a long (12.7 cm) 20- G angiocath placed in the radial artery.
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Affiliation(s)
- Danny Bui
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Geoffrey Hayward
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Tzong Huei Chen
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | | | - Shyamal Asher
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | | | - Michelle Gorgone
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Caroline Hunter
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Devon Flaherty
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Mark Kendall
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Andrew Maslow
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI.
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Sawka D, Yadav A, Kendall M, Diorio M, Asher SR. The Impact of a New Anesthesiology Residency Program on the Number of Medical Students Matching Into Anesthesiology at a Single Institution: A Retrospective Longitudinal Study. Cureus 2023; 15:e50677. [PMID: 38229821 PMCID: PMC10791027 DOI: 10.7759/cureus.50677] [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] [Accepted: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction There are projected workforce shortages within anesthesiology exacerbated by an increase in demand for anesthesia services and an aging anesthesia workforce. Given this mismatch, it is critical for the specialty to recruit the next generation of anesthesiologists and understand the factors affecting medical students' decision to apply to anesthesiology. This study aims to evaluate the impact of establishing a new anesthesiology residency program at a single institution on the number of medical students that match into anesthesiology in the subsequent years. Methods A single-center, retrospective longitudinal study examined the number of medical students matching into anesthesiology at a single institution between 2013 and 2023, five years before and after the establishment of an accredited anesthesiology residency program. The data were compared to aggregated data on all US medical student applicants through the National Resident Matching Program. Results The pre-anesthesiology residency match rate (2013-2018) of medical students from Alpert Medical School (AMS) was 2.47% while the post-anesthesiology residency match rate (2019-2023) was 4.30%. This represents a 74% increase in the average proportion of medical students matching into anesthesiology after the start of the residency program compared to a 20% increase nationally over the same time period. The rate of change of AMS matched applicants after the implementation of the AMS anesthesia residency program increased compared to the national applicant pool (p= 0.002). Conclusion The establishment of a new accredited anesthesiology residency program increased the proportion of medical students matching into anesthesiology at the affiliated medical school in the subsequent five years. Exposure to an academic anesthesiology program improves medical student interest and ultimately matches rates in anesthesiology, a vital tool to address the projected shortages in the anesthesiology workforce.
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Affiliation(s)
| | - Abhishek Yadav
- Anesthesiology, Rhode Island Hospital, Brown University, Providence, USA
| | - Mark Kendall
- Anesthesiology, Rhode Island Hospital, Brown University, Providence, USA
| | - Matthew Diorio
- Anesthesiology, Rhode Island Hospital, Brown University, Providence, USA
| | - Shyamal R Asher
- Anesthesiology, Rhode Island Hospital, Brown University, Providence, USA
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Khan A, Woodhead G, Kendall M, Matiski L. Abstract No. 71 Single-Center 5-year Analysis of Survival and QoL of Catheter-Directed Therapy of High- and Intermediate-Risk PE. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.116] [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: 02/27/2023] Open
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Daiello LA, Wang DJJ, Jones RN, Boxerman J, Tremont G, O'Bryant S, Kendall M, Cioffi WG, De Oliveira GS, Ott BR, Inouye SK. Blood‐brain barrier dysfunction and perioperative neurocognitive disorders: Cognitive Recovery after Elective Surgery (CREATES) study design and methods. Alzheimers Dement 2020. [DOI: 10.1002/alz.039363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Lori A Daiello
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - Danny JJ Wang
- University of Southern California Los Angeles CA USA
| | - Richard N Jones
- Warren Alpert Medical School of Brown University Providence RI USA
| | - Jerrold Boxerman
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - Geoffrey Tremont
- Rhode Island Hospital Providence RI USA
- Rhode Island Hospital & Alpert Medical School of Brown University Neuropsychology Program Rhode Island Hospital Providence RI USA
| | - Sid O'Bryant
- University of North Texas Health Science Center Fort Worth TX USA
| | - Mark Kendall
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - William G Cioffi
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - Gildasio S. De Oliveira
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - Brian R Ott
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - Sharon K Inouye
- Marcus Institute for Aging Research Hebrew SeniorLife Boston MA USA
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Walker L, Heaton H, Monroe R, Reichard R, Kendall M, Mullan A, Goyal D. 4 Impact of the SARS-CoV-2 Pandemic on Emergency Department Presentations in an Integrated Health System. Ann Emerg Med 2020. [PMCID: PMC7598548 DOI: 10.1016/j.annemergmed.2020.09.014] [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: 11/01/2022]
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Walker L, Heaton H, Mullan A, Reichard R, Monroe R, Kendall M, Goyal D. 167 Changes in Patterns of Community Mortality during the SARS-CoV-2 Pandemic. Ann Emerg Med 2020. [PMCID: PMC7598309 DOI: 10.1016/j.annemergmed.2020.09.179] [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: 12/02/2022]
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McMorrow L, Mullineaux J, Kendall M, Gregory R. Written communications from hospital diabetes departments: standards required to mitigate unintentional harm. Diabet Med 2018; 35:1752-1753. [PMID: 30378166 DOI: 10.1111/dme.13855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - M Kendall
- Patient Representative, Leicester, UK
| | - R Gregory
- Chair, ABCD Type 1 Diabetes Clinical Collaborative-UK, Diabetes Outpatient Department, University Hospitals of Leicester NHS Trust, Leicester, UK
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Abstract
A Gerbode VSD is a communication between the left ventricle and right atrium. Etiologies include trauma, infective endocarditis, and iatrogenic causes. Echocardiographic evaluation for this defect requires a careful interrogation.
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Affiliation(s)
- Adam Kretzer
- Department of Anesthesiology, Northwestern University Medical Center, Chicago, Illinois
| | - Hassan Amhaz
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Alina Nicoara
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Mark Kendall
- Department of Anesthesiology, Rhode Island Hospital, Providence, Rhode Island
| | - Donald Glower
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mandisa-Maia Jones
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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Chakraborty R, Chandra J, Cui S, Tolley L, Cooper MA, Kendall M, Frazer IH. CD
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lineage dendritic cells determine adaptive immune responses to inflammasome activation upon sterile skin injury. Exp Dermatol 2017; 27:71-79. [DOI: 10.1111/exd.13436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Janin Chandra
- Diamantina Institute University of Queensland Brisbane QLD Australia
| | - Shuai Cui
- Diamantina Institute University of Queensland Brisbane QLD Australia
| | - Lynn Tolley
- Diamantina Institute University of Queensland Brisbane QLD Australia
| | - Matthew A. Cooper
- Institute for Molecular Bioscience University of Queensland Brisbane QLD Australia
| | - Mark Kendall
- Delivery of Drugs and Genes Group (D2G2) Australian Institute for Bioengineering and Nanotechnology University of Queensland Brisbane QLD Australia
| | - Ian H. Frazer
- Diamantina Institute University of Queensland Brisbane QLD Australia
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Murray SA, Kendall M, Mitchell G, Moine S, Amblàs-Novellas J, Boyd K. Authors' reply to Wise's letter on including palliative care doctors in treatment discussions. BMJ 2017; 357:j2432. [PMID: 28526700 DOI: 10.1136/bmj.j2432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Scott A Murray
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - M Kendall
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - G Mitchell
- Faculty of Medicine and Biomedical Science, University of Queensland, Brisbane, Australia
| | - S Moine
- Health Education and Practices Laboratory, Amiens University Hospital, Amiens, France
| | - J Amblàs-Novellas
- Geriatric and Palliative Care Department, University of Vic, Barcelona, Spain
| | - K Boyd
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Kendall M, Cowey E, Murray SA, Barber M, Borthwick S, Boyd K, McAlpine C, Stott D, Mead G. 162Experiences And Multi-Dimensional Needs of People With Major Stroke And Their Family Carers. Age Ageing 2017. [DOI: 10.1093/ageing/afx070.162] [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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Affiliation(s)
- Scott A Murray
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - M Kendall
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - G Mitchell
- Faculty of Medicine and Biomedical Science, University of Queensland, Brisbane, Australia
| | - S Moine
- Health Education and Practices Laboratory, Amiens University Hospital, Amiens, France
| | - J Amblàs-Novellas
- Geriatric and Palliative Care Department, University of Vic, Barcelona, Spain
| | - K Boyd
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Carduff E, Kendall M, Murray SA. Living and dying with metastatic bowel cancer: Serial in-depth interviews with patients. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28145036 PMCID: PMC5811826 DOI: 10.1111/ecc.12653] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 12/08/2016] [Indexed: 12/03/2022]
Abstract
Colorectal cancer is the second highest cause of cancer deaths. There are significant physical and psycho‐social effects on quality of life with advanced disease. Despite this, there are few accounts of the patient experience from advanced illness through to dying. We elicited the longitudinal experiences of living and dying with incurable metastatic colorectal cancer by conducting serial interviews with patients for 12 months or until they died. The interviews were analysed, using a narrative approach, longitudinally as case studies and then together. Thirty‐six interviews with 16 patients were conducted. Patients experience metastatic colorectal cancer in three phases; (1) Diagnosis and initial treatment; (2) Deterioration and social isolation and (3) Death and dying. Many patients initially said they hoped to survive, but, as “private” and in‐depth accounts of the experience emerged in further interviews, so did the understanding that this hope co‐existed with the knowledge that death was near. Palliative chemotherapy and the challenge of accessing private accounts of patient experience can inhibit care planning and prevent patients benefitting from an active holistic palliative care approach earlier in the disease trajectory. This study has immediate clinical relevance for health care professionals in oncology, palliative care and primary care.
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Affiliation(s)
- E Carduff
- Marie Curie Hospice, Glasgow, UK.,Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Edinburgh, UK
| | - M Kendall
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Edinburgh, UK
| | - S A Murray
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Edinburgh, UK
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Liu B, Limback J, Kendall M, Valente M, Armaly J, Grekoski V, Pinizzotto A, Pepe J, Burt J, Ward T. Safety of computed tomographic–guided bone marrow biopsy in thrombocytopenic patients: a retrospective review of 1020 bone marrow biopsies. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.764] [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: 10/20/2022] Open
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Liu B, Kendall M, O’Dell M, Flores M, Limback J, Pepe J, Burt J, Contreras F, Lewis A, Ward T. Cortical tangential vs. a non-tangential approach in computed tomography (CT)-guided native medical renal biopsy: a comparison of efficacy and safety. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.947] [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: 10/20/2022] Open
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McCormick ZL, Nelson A, Bhave M, Zhukalin M, Kendall M, McCarthy RJ, Khan D, Nagpal G, Walega DR. A Prospective Randomized Comparative Trial of Targeted Steroid Injection Via Epidural Catheter Versus Standard C7-T1 Interlaminar Approach for the Treatment of Unilateral Cervical Radicular Pain. Reg Anesth Pain Med 2017; 42:82-89. [DOI: 10.1097/aap.0000000000000521] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mason B, Boyd K, Murray SA, Steyn J, Cormie P, Kendall M, Munday D, Weller D, Fife S, Murchie P, Campbell C. O-115 Developing a computerised search to help UK general practices identify more patients for advance care planning: A feasibility study. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.114] [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: 11/04/2022]
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Kendall M. Vaccinating against influenza in children without needles: A new initiative. J PEDIAT INF DIS-GER 2015. [DOI: 10.3233/jpi-120349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mark Kendall
- Delivery of Drugs and Genes Group (D2G2), Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia
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Carduff E, Highet G, Finucane A, Kendall M, Jarvis A, Harrison N, Greenacre J, Murray SA. PILOTING A NEW APPROACH TO IDENTIFYING, ASSESSING AND SUPPORTING CARERS OF PEOPLE WITH PALLIATIVE CARE NEEDS IN PRIMARY CARE. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kendall M, Carduff E, Lloyd A, Kimbell B, Pinnock H, Murray SA. DANCING TO A DIFFERENT TUNE: LIVING AND DYING WITH CANCER, ORGAN FAILURE AND PHYSICAL FRAILTY. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wong S, White J, Kendall M, Nelson M. THE DILEMMA IN END OF LIFE LIVES ON: MORAL DISTRESS OVER END OF LIFE IN CRITICAL CARE. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.682] [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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Mainzer A, Bauer J, Cutri RM, Grav T, Masiero J, Beck R, Clarkson P, Conrow T, Dailey J, Eisenhardt P, Fabinsky B, Fajardo-Acosta S, Fowler J, Gelino C, Grillmair C, Heinrichsen I, Kendall M, Kirkpatrick JD, Liu F, Masci F, McCallon H, Nugent CR, Papin M, Rice E, Royer D, Ryan T, Sevilla P, Sonnett S, Stevenson R, Thompson DB, Wheelock S, Wiemer D, Wittman M, Wright E, Yan L. INITIAL PERFORMANCE OF THENEOWISEREACTIVATION MISSION. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/792/1/30] [Citation(s) in RCA: 303] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cawley D, Billings J, Oliver D, Kendall M, Pinnock H. Potential triggers for the holistic assessment of people with severe chronic obstructive pulmonary disease: analysis of multiperspective, serial qualitative interviews. BMJ Support Palliat Care 2014; 4:152-160. [PMID: 24681560 DOI: 10.1136/bmjspcare-2013-000629] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study explores the narrative accounts of chronic obstructive pulmonary disease (COPD) to identify events that potentially could act as triggers for provision of supportive and palliative care. Trigger events must have meaning for the patient/carer, be visible to professionals, and have value in provoking useful actions. METHODS A purposive sample of people with severe COPD, and their informal and professional carers, was recruited from primary/secondary care in Scotland. Indepth participant-led interviews allowed people to tell their illness story. Events occurring throughout the individual's account of the COPD journey were identified, and analysed thematically with regard to the meaning, visibility and use as potential triggers. RESULTS Events identified from 92 transcripts (21 patients, 13 family carers, 18 professionals) punctuated the disease trajectory and crossed multiprofessional boundaries of care. These reflected advancing disease (increasing carer burden, becoming housebound, appointment frequency, increasing burden of disease, shifting priorities of care) or were an intervention addressing the consequences of advancing disease (requesting disabled parking, home adaptations, hospital admissions). Despite being meaningful in terms of increasing disability, many were invisible to professionals. Others were isolated events symptomatic of wider, ongoing disability which could potentially have use as triggers. CONCLUSIONS Meaningful events can be identified within the story of COPD which reflect wider needs, are clearly visible to alert professionals, and be of use in terms of potentially guiding supportive interventions. To achieve this level of usefulness, services will need to promote health and social care integration with clear processes to facilitate holistic assessment when a trigger is detected.
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Affiliation(s)
- D Cawley
- Centre for Professional Practice, University of Kent, Chatham Maritime, Kent, UK
| | - J Billings
- Reader in Applied Health Research, Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - D Oliver
- Honorary Reader / Consultant in Palliative Medicine, Centre for Professional Practice, University of Kent, Chatham Maritime, Kent, UK
| | - M Kendall
- Senior research Fellow, Primary Palliative Care Research Group, Centre for Population Health Studies, The University of Edinburgh, Edinburgh, Scotland, UK
| | - H Pinnock
- Reader, Allergy and Respiratory Research Group, Centre for Population Health Studies, The University of Edinburgh, Chatham Maritime, Kent, UK
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Mason BL, Boyd K, Murray SA, Steyn J, Cormie P, Kendall M, Munday D, Weller D, Fife S, Murchie P, Campbell C. ELECTRONIC COMPUTER SEARCHES IN PRIMARY CARE CAN LEAD TO GREATER IDENTIFICATION OF NON-MALIGNANT PATIENTS FOR PALLIATIVE CARE. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.12] [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: 11/03/2022]
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Kendall M, Buckingham S, Ferguson S, Sheikh A, Murray SA, Boyd K, Pinnock H, MacNee W, Worth A, White P. HELPING PEOPLE WITH VERY SEVERE COPD: FEASIBILITY STUDY OF A NOVEL COMMUNITY-BASED HOLISTIC INTERVENTION. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nurmatov UB, Buckingham S, Kendall M, Sheikh A, Pinnock H. P207 Can Holistic Interventions Improve the Care of People with Severe Chronic Obstructive Pulmonary Disease (COPD)? A Systematic Review. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jenkins D, Corrie S, Flaim C, Kendall M. High density and high aspect ratio solid micro-nanoprojection arrays for targeted skin vaccine delivery and specific antibody extraction. RSC Adv 2012. [DOI: 10.1039/c2ra20153d] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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McKechnie J, Gorle K, Kendall M. NP019 Setting a best practices standard for pericardial drainage: Part two. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.08.090] [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: 10/16/2022] Open
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Rainey P, Morris C, Kendall M, Murray SA, Cameron D. Celebrating user involvement in research. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000020.4] [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: 11/03/2022]
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Highet G, Murray SA, Campbell C, Kendall M, Rainey P, Neal R, Rose P, Anandan C, Amoakwa E, Weller D. Resolving tensions: optimising the role of primary care in lung cancer follow-up care. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000020.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mason BL, Barclay S, Dale J, Daveson B, Donaldson A, Epiphaniou E, Harding R, Higginson IJ, Kendall M, Munday D, Nanton V, Shipman C, Murray SA. Co-ordination of generalist end of life care in the UK: a multi-site ethnographic study. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000020.10] [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: 11/04/2022]
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Crawford SA, Costford SR, Aguer C, Thomas SC, deKemp RA, DaSilva JN, Lafontaine D, Kendall M, Dent R, Beanlands RSB, McPherson R, Harper ME. Naturally occurring R225W mutation of the gene encoding AMP-activated protein kinase (AMPK)gamma(3) results in increased oxidative capacity and glucose uptake in human primary myotubes. Diabetologia 2010; 53:1986-97. [PMID: 20473479 DOI: 10.1007/s00125-010-1788-7] [Citation(s) in RCA: 19] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 04/12/2010] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS AMP-activated protein kinase (AMPK) has a broad role in the regulation of glucose and lipid metabolism making it a promising target in the treatment of type 2 diabetes mellitus. We therefore sought to characterise for the first time the effects of chronic AMPK activation on skeletal muscle carbohydrate metabolism in carriers of the rare gain-of-function mutation of the gene encoding AMPKgamma(3) subunit, PRKAG3 R225W. METHODS Aspects of fuel metabolism were studied in vitro in myocytes isolated from vastus lateralis of PRKAG3 R225W carriers and matched control participants. In vivo, muscular strength and fatigue were evaluated by isokinetic dynamometer and surface electromyography, respectively. Glucose uptake in exercising quadriceps was determined using [(18)F]fluorodeoxyglucose and positron emission tomography. RESULTS Myotubes from PRKAG3 R225W carriers had threefold higher mitochondrial content (p < 0.01) and oxidative capacity, higher leak-dependent respiration (1.6-fold, p < 0.05), higher basal glucose uptake (twofold, p < 0.01) and higher glycogen synthesis rates (twofold, p < 0.05) than control myotubes. They also had higher levels of intracellular glycogen (p < 0.01) and a trend for lower intramuscular triacylglycerol stores. R225W carriers showed remarkable resistance to muscular fatigue and a trend for increased glucose uptake in exercising muscle in vivo. CONCLUSIONS/INTERPRETATION Through the enhancement of skeletal muscle glucose uptake and increased mitochondrial content, the R225W mutation may significantly enhance exercise performance. These findings are also consistent with the hypothesis that the gamma(3) subunit of AMPK is a promising tissue-specific target for the treatment of type 2 diabetes mellitus, a condition in which glucose uptake and mitochondrial function are impaired.
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Affiliation(s)
- S A Crawford
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Kendall M. Owen Lyndon Wade. West J Med 2009. [DOI: 10.1136/bmj.b848] [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: 11/03/2022]
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Murray S, Barclay S, Bennett MI, Kendall M, Amir Z, Lloyd-Williams M. Palliative care research in the community: it is time to progress this emerging field. Palliat Med 2008; 22:609-11. [PMID: 18612026 DOI: 10.1177/0269216308093578] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S Murray
- Primary Palliative Care Research Group Division of Community Health Sciences:General Practice University of Edinburgh Edinburgh
| | - S Barclay
- General Practice Research Unit Institute of Public Health Cambridge
| | - MI Bennett
- International Observatory on End of Life Care Institute for Health Research Lancaster University Lancaster
| | - M Kendall
- Primary Palliative Care Research Group Division of Community Health Sciences:General Practice University of Edinburgh Edinburgh
| | - Z Amir
- School of Nursing, Midwifery and Social Work The University of Manchester Manchester
| | - M Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group School of Population Community and Behavioural Sciences Liverpool
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Johnson M, Boyd K, Kendall M, Wee B. A catalyst for research in supportive and palliative care for patients with advanced heart failure. A meeting convened by the Science Committee of the APM and Hull-York Medical School. Palliat Med 2008; 22:291-2. [PMID: 18477724 DOI: 10.1177/0269216307087143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M Johnson
- Hull-York Medical School, and St. Catherine's Hospice Throxenby Lane, Scarborough, N Yorks, UK.
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Meehan KR, Wu J, Bengtson E, Hill J, Ely P, Szczepiorkowski Z, Kendall M, Ernstoff MS. Early recovery of aggressive cytotoxic cells and improved immune resurgence with post-transplant immunotherapy for multiple myeloma. Bone Marrow Transplant 2007; 39:695-703. [PMID: 17417660 DOI: 10.1038/sj.bmt.1705665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A phase I/II trial evaluated early administration and dose escalation of interleukin (IL)-2 with granulocyte macrophage colony stimulating factor (GM-CSF) post-transplant. Following melphalan (200 mg/m(2)) and an autologous transplant, IL-2 was initiated (day 0) and continued for 4 weeks. GM-CSF (250 mcg/m(2)/day) began on day 5. Fifteen of 19 patients completed therapy. No treatment-related deaths occurred. IL-2 (1 x 10(6) IU/m(2)/day) was not tolerated in two of six patients due to > or =grade 3 fatigue/diarrhea (n=1) or supraventricular tachycardia (n=1). The maximum tolerated dose of IL-2 was 6 x 10(5) IU/m(2)/day; this dose was well tolerated by 11 of 13 patients. Neutrophil and platelet engraftment occurred on day 13 (median; range 10-17 days) and day 13 (median; range 0-74 days), respectively. When compared to control patients, there was a marked increase in the number of CD3+ T cells (P=0.005), CD4+ T cells (P=0.01), CD8+ T cells (P=0.001) and CD4+CD25+Treg cells (P=0.015) post-transplant. Cytotoxicity directed against myeloma cells was markedly increased when compared to control patients (P=0.017). This unique trial design using early administration of IL-2 with GM-CSF during the period of lymphodepletion, demonstrated a marked increase in the number and function of early cytotoxic effector T cells, without suppression of engraftment.
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Affiliation(s)
- K R Meehan
- Bone Marrow Transplant Program, Dartmouth Hitchcock Medical Center, Dartmouth Medical School and the Norris Cotton Cancer Center, Lebanon, NH 03756, USA.
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Tirlapur UK, Mulholland WJ, Bellhouse BJ, Kendall M, Cornhill JF, Cui Z. Femtosecond two-photon high-resolution 3D imaging, spatial-volume rendering and microspectral characterization of immunolocalized MHC-II and mLangerin/CD207 antigens in the mouse epidermis. Microsc Res Tech 2006; 69:767-75. [PMID: 16941665 DOI: 10.1002/jemt.20331] [Citation(s) in RCA: 13] [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: 11/06/2022]
Abstract
Langerhans cells (LCs) play a sentinel role by initiating both adaptive and innate immune responses to antigens pertinent to the skin. With the discovery of various LCs markers including antibodies to major histocompatibility complex class II (MHC-II) molecules and CD1a, intracellular presence of racket-shaped "Birbeck granules," and very recently Langerin/CD207, LCs can be readily distinguished from other subsets of dendritic cells. Femtosecond two-photon laser scanning microscopy (TPLSM) in recent years has emerged as an alternative to the single photon-excitation based confocal laser scanning microscope (CLSM), particularly for minimally-invasive deep-tissue 3D and 4D vital as well as nonvital biomedical imaging. We have recently combined high resolution two-photon immunofluorescence (using anti MHC-II and Langerin/CD207 antibodies) imaging with microspectroscopy and advanced image-processing/volume-rendering modalities. In this work, we demonstrate the use of this novel state-of-the-art combinational approach to characterize the steady state 3D organization and spectral features of the mouse epidermis, particularly to identify the spatial distribution of LCs. Our findings provide unequivocal direct evidence that, in the mouse epidermis, the MHC-II and mLangerin/CD207 antigens do indeed manifest a high degree of colocalization around the nucleus of the LCs, while in the distal dendritic processes, mLangerin/CD207 antigens are rather sparsely distributed as punctuate structures. This unique possibility to simultaneously visualize high resolution 3D-resolved spatial distributions of two different immuno-reactive antigens, namely MHC-II and mLangerin/CD207, along with the nuclei of LCs and the adjacent epidermal cells can find interesting applications. These could involve aspects associated with pragmatic analysis of the kinetics of LCs migration as a function of immuno-dermatological responses during (1) human Immunodeficiency virus disease progression, (2) vaccination and targeted gene therapy, (3) skin transplantation/plastic surgery, (4) ultraviolet and other radiation exposure, (5) tissue-engineering of 3D skin constructs, as well as in (6) cosmetic industry, to unravel the influence of cosmeceuticals.
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Affiliation(s)
- Uday K Tirlapur
- Department of Engineering Science, Oxford Institute of Biomedical Engineering, University of Oxford, Oxford OX1 3PJ, United Kingdom.
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Abstract
A challenge in epidermal DNA vaccination is the efficient and targeted delivery of polynucleotides to immunologically sensitive Langerhans cells. This paper investigates this particular challenge for physical delivery approaches. The skin immunology and material properties are examined in the context of the physical cell targeting requirements of the viable epidermis. Selected current physical cell targeting technologies engineered to meet these needs are examined: needle and syringe; diffusion patches; liquid jet injectors; microneedle arrays/patches; and biolistic particle injection. The operating methods and relative performance of these approaches are discussed, with a comment on potential future developments and technologies.
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Affiliation(s)
- Mark Kendall
- The PowderJect Centre for Gene and Drug Delivery Research, Department of Engineering Science, University of Oxford, 43 Banbury Road, Oxford OX2 6PE, United Kingdom.
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42
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Kendall M, Mitchell TJ, Costigan G, Armitage M, Lenzo JC, Thomas JA, von Garnier C, Zosky GR, Turner DJ, Stumbles PA, Sly PD, Holt PG, Thomas WR. Downregulation of IgE antibody and allergic responses in the lung by epidermal biolistic microparticle delivery. J Allergy Clin Immunol 2006; 117:275-82. [PMID: 16461127 DOI: 10.1016/j.jaci.2005.09.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 05/30/2005] [Revised: 09/08/2005] [Accepted: 09/08/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Biolistic injections provide a needle-free delivery of antigen-laden microparticles to the epithelium. The precision of the injection preferentially targets the Langerhans cell network, which, although ideal for vaccination, might not be suitable for the downregulation of immune responses in immunotherapy. OBJECTIVE We sought to determine the ability of biolistic injection of antigen into the epithelium of sensitized mice to inhibit IgE antibody and lung inflammatory responses produced by further exposure to antigen. METHODS Mice were sensitized by means of a needle injection of ovalbumin (OVA) in alum and given a series of biolistic injections of OVA or vehicle control, followed by a boost of OVA in alum. Serum IgE and IgG antibodies were measured before and after the boost. The mice were then challenged intranasally, and the infiltration of inflammatory cells was measured by means of bronchoalveolar lavage. Airway reactivity of the challenged mice was measured by examining responses to methacholine with forced oscillatory techniques. RESULTS Biolistic injection of OVA into the dorsal skin of sensitized mice markedly inhibited IgE and IgG1 antibody responses induced by boosting. IgG2a antibody responses were reduced rather than stimulated. The eosinophilic inflammation in the bronchoalveolar lavage fluid induced by intranasal challenge was also markedly inhibited. Lung hyperreactivity showed an initial increase and then a decrease of responsiveness to methacholine, with elastance returning to the level of unsensitized mice. Biolistic injection into the buccal epithelium was also inhibitory. CONCLUSIONS Biolistic injection of allergen inhibited the boosting of IgE antibody and eosinophilic lung inflammatory responses without inducing T(H)1 immunity.
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Affiliation(s)
- Mark Kendall
- The PowderJect Centre for Gene and Drug Delivery Research, University of Oxford, UK
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43
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Read ML, Singh S, Ahmed Z, Stevenson M, Briggs SS, Oupicky D, Barrett LB, Spice R, Kendall M, Berry M, Preece JA, Logan A, Seymour LW. A versatile reducible polycation-based system for efficient delivery of a broad range of nucleic acids. Nucleic Acids Res 2005; 33:e86. [PMID: 15914665 PMCID: PMC1140087 DOI: 10.1093/nar/gni085] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Synthetic vectors based on reducible polycations consisting of histidine and polylysine residues (HIS RPCs) were evaluated for their ability to deliver nucleic acids. Initial experiments showed that RPC-based vectors with at least 70% histidine content mediated efficient levels of gene transfer without requirement for the endosomolytic agent chloroquine. Significant gene transfer was observed in a range of cell types achieving up to a 5-fold increase in the percentage of transfected cells compared to 25 kDa PEI, a gold standard synthetic vector. In contrast to 25 kDa PEI, HIS RPCs also mediated efficient transfer of other nucleic acids, including mRNA encoding green fluorescent protein in PC-3 cells and siRNA directed against the neurotrophin receptor p75NTR in post-mitotic cultures of rat dorsal root ganglion cell neurons. Experiments to elevate intracellular glutathione and linear profiling of cell images captured by multiphoton fluorescent microscopy highlighted that parameters such as the molecular weight and rate of cleavage of HIS RPCs were important factors in determining transfection activity. Altogether, these results demonstrate that HIS RPCs represent a novel and versatile type of vector that can be used for efficient cytoplasmic delivery of a broad range of nucleic acids. This should enable different or a combination of therapeutic strategies to be evaluated using a single type of polycation-based vector.
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Affiliation(s)
- Martin L Read
- Molecular Neuroscience Group, Department of Medicine, University of Birmingham Birmingham, B15 2TT, UK.
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44
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Kendall M, Mitchell T, Wrighton-Smith P. Intradermal ballistic delivery of micro-particles into excised human skin for pharmaceutical applications. J Biomech 2005; 37:1733-41. [PMID: 15388316 DOI: 10.1016/j.jbiomech.2004.01.032] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2004] [Indexed: 10/26/2022]
Abstract
A unique form of needle-free drug and vaccine delivery is under investigation. The principle of the concept is to accelerate pharmaceuticals in particle form to a momentum sufficient to penetrate the outer layer of the human skin for a pharmacological effect. The relationship between the key particle impact parameters and particle penetration depth in excised human skin has been experimentally determined. Research devices have been used to deliver particles of a range of radii (0.89-53 microm), and density (1.08-18.2 g/cm3) at controlled and incremental impact velocities between 160 and 640 m/s. Analysis of the particle impact data reveals particle penetration depth as a function of particle density, radius and impact velocity. The experimental relationship provides a criterion for the optimal selection of particle parameters and velocity to target specific layers within the skin. Furthermore, some sources of variability in penetration depth have also been established. The experimental data have also been compared with a mechanistic Unified Penetration Model with good agreement.
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Affiliation(s)
- Mark Kendall
- The Powderject Centre for Gene and Drug Delivery Research, Department of Engineering Science, University of Oxford, Oxford, UK.
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45
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Payne JP, Kemp SJ, Dewar A, Goldstraw P, Kendall M, Chen LC, Tetley TD. Effects of airborne World Trade Center dust on cytokine release by primary human lung cells in vitro. J Occup Environ Med 2004; 46:420-7. [PMID: 15167388 DOI: 10.1097/01.jom.0000126021.25149.64] [Citation(s) in RCA: 36] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are continuing concerns regarding the respiratory health effects of airborne particulate matter (PM) after the destruction of the World Trade Centre (WTC). We examined cytokine (interleukin [IL]-8, IL-6, tumor necrosis factor-alpha) release by primary human lung alveolar macrophages (AM) and type II epithelial cells after exposure to WTC PM2.5 (indoor and outdoor), PM10-2.5 (indoor), and PM53-10 (outdoor), fractionated from settled dusts within 2 months of the incident. There was an increase in AM cytokine/chemokine release at 5 and/or 50 microg/well WTC PM, which fell at 500 microg/well. Type II cells did not release tumor necrosis factor-alpha, and the increase in IL-8 and IL-6, although significant, was lower than that of AM. Respirable PM generated by the WTC collapse stimulates inflammatory mediator release by lung cells, which may contribute to the increased incidence of respiratory illness since September 11th 2001.
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Affiliation(s)
- J P Payne
- Lung Cell Biology, National Heart & Lung Institute, Imperial College, London, UK
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46
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Sukhani R, Nader A, Candido KD, Doty R, Benzon HT, Yaghmour E, Kendall M, McCarthy R. Nerve Stimulator-Assisted Evoked Motor Response Predicts the Latency and Success of a Single-Injection Sciatic Block. Anesth Analg 2004; 99:584-8, table of contents. [PMID: 15271744 DOI: 10.1213/01.ane.0000122823.50592.c9] [Citation(s) in RCA: 25] [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: 11/05/2022]
Abstract
Variable onset latency of single-injection sciatic nerve block (SNB) may result from drug deposition insufficiently close to all components of the nerve. We hypothesized that this variability is caused by the needle tip position relative to neural components, which is objectified by the type of evoked motor response (EMR) elicited before local anesthetic injection. One-hundred ASA I-II patients undergoing reconstructive ankle surgery received infragluteal-parabiceps SNB using 0.4 mL/kg (maximum 35 mL) of levobupivacaine 0.625%. The end-point for injection was the first elicited EMR: inversion (I), plantar flexion (PF), dorsiflexion (DF), or eversion (E) at 0.2-0.4 mA. The frequencies of the EMRs were: I 40%, PF 43%, E 14%, and DF 3%. SNB was considered complete if both tibial and common peroneal nerves were blocked and failed if either analgesia to pinprick was not observed at 30 min or anesthesia at 60 min. Patients with an EMR of I demonstrated shorter mean times (+/-95% confidence interval [CI]) to complete the block with 8.5 (95% CI, 6.2-10.8) min compared to 27.0 (95% CI, 20.6-33.4) min after PF (P < 0.001) and 30.4 (95% CI, 24.9-35.8) min after E (P < 0.001). No rescue blocks were required in group I compared with 24% (P = 0.001) and 71% (P < 0.001) of patients in groups PF and E, respectively. We conclude that EMR type during nerve stimulator-assisted single-injection SNB predicts latency and success of complete SNB because the observed EMR is related to the positioning of the needle tip relative to the tibial and common peroneal nerves.
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Affiliation(s)
- Radha Sukhani
- Department of Anesthesiology, Northwestern University/Feinberg School of Medicine, 251 E. Huron Street, F5-704, Chicago, IL 60611, USA.
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Kendall M, Rishworth S, Carter F, Mitchell T. Effects of relative humidity and ambient temperature on the ballistic delivery of micro-particles to excised porcine skin. J Invest Dermatol 2004; 122:739-46. [PMID: 15086561 DOI: 10.1111/j.0022-202x.2004.22320.x] [Citation(s) in RCA: 55] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The effectiveness of ballistic particle delivery to the skin is often dependent upon breaching the stratum corneum (SC) and targeting cells within defined layers of the viable epidermis. This paper experimentally determines the influence of relative humidity (RH) and temperature on the ballistic delivery of particles to the skin. Gold particles of radius 0.9+/-0.6 microm were accelerated by a hand-held supersonic device to impact freshly excised porcine skin at 410-665 m per s. Increasing the RH from 15% to 95% (temperature at 25 degrees C) led to a particle penetration increase by a factor of 1.8. Temperature increases from 20 degrees C to 40 degrees C (RH at 15%) enhanced particle penetration 2-fold. In both cases, these increases were sufficient to move the target layer from the SC to the viable epidermis. Relative trends in particle penetration compared well with predictions from a theoretical model well. Calculated absolute penetration depths are 6-fold greater than the measurements. The inversely calculated dynamic yield stress of the SC is up to a factor of 10 higher than reported quasi-static measurements, due to changes in tissue failure modes over a strain-rate range spanning 10 orders of magnitude. If targeted particle delivery is required, it is recommended that the environmental RH and temperature be monitored.
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Affiliation(s)
- Mark Kendall
- The PowderJect Centre for Gene and Drug Delivery Research, Department of Engineering Science, University of Oxford, Oxford, UK.
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Sparringa RA, Kendall M, Westby A, Owens JD. Effects of temperature, pH, water activity and CO2 concentration on growth of Rhizopus oligosporus NRRL 2710. J Appl Microbiol 2002; 92:329-37. [PMID: 11849362 DOI: 10.1046/j.1365-2672.2002.01534.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [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: 11/20/2022]
Abstract
AIMS To investigate the effects of temperature, pH, water activity (aw) and CO2 concentration on the growth of Rhizopus oligosporus NRRL 2710. METHODS AND RESULTS Hyphal extension rates from mycelial and spore inocula were measured on media with different aw (approximately 1.0, 0.98 and 0.96) and pH (3.5, 5.5 and 7.5) incubated at 30, 37 or 42 degrees C in atmospheres containing 0.03, 12.5 or 25% (v/v) CO2. The effects of environmental conditions on hyphal extension rate were modelled using surface response methodology. The rate of hyphal extension was very sensitive to pH, exhibiting a pronounced optimum at pH 5.5-5.8. The hyphal extension rate was less sensitive to temperature, aw or CO2, exhibiting maximum rates at 42 degrees C, a(w) approximately 1.0 and 0.03% (v/v) CO2. CONCLUSIONS The fastest hyphal extension rate (1.7 mm h(-1)) was predicted to occur at 42 degrees C, pH 5.85, a(w) approximately 1.0 and 0.03% CO2. SIGNIFICANCE AND IMPACT OF THE STUDY The present work is the first to model the simultaneous effects of temperature, pH, aw and CO2 concentration on mould growth. The information relates to tempe fermentation and to possible control of the microflora in Tanzanian cassava heap fermentations.
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Affiliation(s)
- R A Sparringa
- School of Food Biosciences, The University of Reading, Reading, UK
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Kim A, Anderson KF, Berliner J, Bryzik C, Hassan J, Jensen J, Kendall M, Mertz HJ, Morrow T, Rao A, Wozniak JA. A Comparison of the Hybrid III and BioRID II Dummies in Low-Severity, Rear-Impact Sled Tests. Stapp Car Crash J 2001; 45:257-84. [PMID: 17458749 DOI: 10.4271/2001-22-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A BioRID II dummy and a Hybrid III dummy, each representative of a midsize adult male, were tested side-by-side in simulated rear-impact sled tests. In all tests the dummies were restrained by 3-point belt systems. The results of 4 test sets conducted at a nominal change in velocity (deltaV) of 16 km/hr are presented and discussed. In three of the test sets, bucket seats were used. The head restraints were placed in the up-position in two of the three test sets and in the down-position in the third set of tests. In the fourth test set, rigid seats without any head restraints were used. While analyzing the BioRID II data, the presence of an axial neck load acting on the head, which bypassed the upper neck load transducer, was discovered in all the reported tests. The implication of this observation is that the axial force and all the moments measured by the BioRID II upper neck load transducer could be erroneous. A second concern with the BioRID II data was the high frequency noise observed, especially on the T1 acceleration response which is used in the NIC calculation. The 18 Hz filter used to process the T1 acceleration data for the NIC calculation attenuated the peak NIC values by 15% as compared to the SAE 180 filtered values. The unmeasured neck loads and high-frequency noise issues need to be resolved before additional BioRID II testing is done. A third concern with the BioRID II is the initial position of its head in the automotive seating posture. It is higher and more forward than that of the 50(th) percentile adult male.
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Affiliation(s)
- A Kim
- BioRID II Evaluation Task Group of the Occupant Safety Research Partnership/USCAR
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Ring C, Harrison LK, Winzer A, Carroll D, Drayson M, Kendall M. Secretory immunoglobulin A and cardiovascular reactions to mental arithmetic, cold pressor, and exercise: effects of alpha-adrenergic blockade. Psychophysiology 2000; 37:634-43. [PMID: 11037040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The mechanism underlying acute changes in secretory immunoglobulin A (sIgA) remains to be determined. In this experiment, sIgA and cardiovascular activity were monitored at rest and while participants performed a mental arithmetic task, cold pressor, and submaximal cycle exercise following placebo or 1 mg of the alpha-adrenergic blocker, doxazosin. Under placebo, the tasks produced patterns of cardiovascular activity indicative of combined alpha- and beta-adrenergic, alpha-adrenergic, and beta-adrenergic activation, respectively. Doxazosin was associated with reduced blood pressure during cold pressor, but not during arithmetic or exercise. Mental arithmetic elicited increases in sIgA concentration and exercise produced increases in both sIgA concentration and secretion rate; these changes were unaffected by alpha blockade. In contrast, the cold pressor was associated with decreases in both sIgA concentration and secretion rate, which were blocked by doxazosin. These data suggest that acute decreases, but not increases, in sIgA are mediated by alpha-adrenergic mechanisms.
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Affiliation(s)
- C Ring
- School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, UK.
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