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Prochaska JJ, Watts MH, Zellers L, Huang D, Daza EJ, Rigdon J, Peters MJ, Henriksen L. Inequity in California's Smokefree Workplace Laws: A Legal Epidemiologic Analysis of Loophole Closures. Am J Prev Med 2020; 58:e71-e78. [PMID: 31952942 PMCID: PMC7039767 DOI: 10.1016/j.amepre.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION California's landmark 1994 Smokefree Workplace Act contained numerous exemptions, or loopholes, believed to contribute to inequities in smokefree air protections among low-income communities and communities of color (e.g., permitting smoking in warehouses, hotel common areas). Cities/counties were not prevented from adopting stronger laws. This study coded municipal laws and state law changes (in 2015-2016) for loophole closures and determined their effects in reducing inequities in smokefree workplace protections. METHODS Public health attorneys reviewed current laws for 536 of California's 539 cities and counties from January 2017 to May 2018 and coded for 19 loophole closures identified from legislative actions (inter-rater reliability, 87%). The local policy data were linked with population demographics from intercensal estimates (2012-2016) and adult smoking prevalence (2014). The analyses were cross-sectional and conducted in February-June 2019. RESULTS Between 1994 and 2018, jurisdictions closed 6.09 loopholes on average (SD=5.28). Urban jurisdictions closed more loopholes than rural jurisdictions (mean=6.40 vs 3.94, p<0.001), and loophole closure scores correlated positively with population size, median household income, and percentage white, non-Hispanic residents (p<0.001 for all). Population demographics and the loophole closure score explained 43% of the variance in jurisdictions' adult smoking prevalence. State law changes in 2015-2016 increased loophole closure scores and decreased jurisdiction variation (mean=9.74, SD=3.56); closed more loopholes in rural versus urban jurisdictions (meangain=4.44 vs 3.72, p=0.002); and in less populated, less affluent jurisdictions, with greater racial/ethnic diversity, and higher smoking prevalence (p<0.001 for all). CONCLUSIONS Although jurisdictions made important progress in closing loopholes in smokefree air law, state law changes achieved greater reductions in inequities in policy coverage.
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Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California.
| | | | | | | | - Eric Jay Daza
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California
| | - Joseph Rigdon
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California
| | | | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California
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2
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Matettore A, Ray S, Harrison DA, Brick T, Macrae D, Peters MJ, Inwald DP. Paediatric intensive care admission blood pressure and risk of death in 30,334 children. Intensive Care Med 2019; 45:1482-1483. [PMID: 31087115 DOI: 10.1007/s00134-019-05638-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Affiliation(s)
- A Matettore
- Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Trust, London, WC1N 3JH, UK.
| | - S Ray
- Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Trust, London, WC1N 3JH, UK.,Respiratory, Critical Care and Anaesthesia Section, UCL GOS Institute of Child Health, London, UK
| | - D A Harrison
- Intensive Care National Audit and Research Network, London, UK
| | - T Brick
- Cardiac Critical Care, Great Ormond Street Hospital NHS Trust, London, UK
| | - D Macrae
- Paediatric Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - M J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Trust, London, WC1N 3JH, UK.,Respiratory, Critical Care and Anaesthesia Section, UCL GOS Institute of Child Health, London, UK
| | - D P Inwald
- Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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3
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Peters MJ, Suwannapong G, Pelin A, Corradi N. Genetic and Genome Analyses Reveal Genetically Distinct Populations of the Bee Pathogen Nosema ceranae from Thailand. Microb Ecol 2019; 77:877-889. [PMID: 30288544 DOI: 10.1007/s00248-018-1268-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/25/2018] [Indexed: 06/08/2023]
Abstract
The recent global decline in Western honeybee (Apis mellifera) populations is of great concern for pollination and honey production worldwide. Declining honeybee populations are frequently infected by the microsporidian pathogen Nosema ceranae. This species was originally described in the Asiatic honeybee (Apis cerana), and its identification in global A. mellifera hives could result from a recent host transfer. Recent genome studies have found that global populations of this parasite are polyploid and that humans may have fueled their global expansion. To better understand N. ceranae biology, we investigated its genetic diversity within part of their native range (Thailand) and among different hosts (A. mellifera, A. cerana) using both PCR and genome-based methods. We find that Thai N. ceranae populations share many SNPs with other global populations and appear to be clonal. However, in stark contrast with previous studies, we found that these populations also carry many SNPs not found elsewhere, indicating that these populations have evolved in their current geographic location for some time. Our genome analyses also indicate the potential presence of diploidy within Thai populations of N. ceranae.
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Affiliation(s)
- Melissa J Peters
- Department of Biology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Adrian Pelin
- Department of Biochemistry, University of Ottawa, Ottawa, Ontario, Canada
- Center for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nicolas Corradi
- Department of Biology, University of Ottawa, Ottawa, Ontario, Canada.
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Schlapbach LJ, Gelbart B, Festa M, Kanthimathinathan HK, Peters MJ. Global paediatric critical care research: mind the gaps. Intensive Care Med 2019; 45:753-754. [PMID: 30840117 DOI: 10.1007/s00134-019-05571-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Center, Faculty of Medicine, The University of Queensland, Brisbane, Australia. .,Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia.
| | - Ben Gelbart
- University of Melbourne, Melbourne, Australia.,Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
| | - Marino Festa
- Paediatric Intensive Care Unit, Children's Hospital Westmead, Sydney, Australia.,Kids Critical Care Research Group, Kids Research, Sydney Children's Hospitals Network, Sydney, Australia
| | | | | | - M J Peters
- Respiratory, Critical Care and Anaesthesia Unit, University College London Great Ormond Street, Institute of Child Health, London, UK.,Paediatric Intensive Care Unit, Great Ormond St Hospital NHS Foundation Trust, London, UK
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Timsit JF, Citerio G, Lavilloniere M, Perner A, Ruckly S, Bakker J, Bassetti M, Benoit D, Curtis JR, Doig GS, Herridge M, Jaber S, Papazian L, Peters MJ, Singer P, Smith M, Soares M, Torres A, Vieillard-Baron A, Azoulay E. Determinants of downloads and citations for articles published in Intensive Care Medicine. Intensive Care Med 2019; 45:1058-1060. [PMID: 30788522 DOI: 10.1007/s00134-019-05569-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2019] [Indexed: 01/15/2023]
Affiliation(s)
- J F Timsit
- Inserm U 1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France.
| | - G Citerio
- Università degli Studi di Milano Bicocca, Monza, Italy
| | - M Lavilloniere
- Inserm U 1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - A Perner
- University of Copenhagen, Copenhagen, Denmark
| | - S Ruckly
- Inserm U 1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - J Bakker
- Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M Bassetti
- Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
| | - D Benoit
- Ghent University Hospital, Ghent, Belgium
| | - J R Curtis
- The University of Washington, Seattle, USA
| | - G S Doig
- University of Sydney, Sydney, Australia
| | | | - S Jaber
- Saint Eloi University Hospital, Montpellier, France
| | - L Papazian
- Aix-Marseille Université, Marseille, France
| | - M J Peters
- UCL Institute of Child Health and Great Ormond St Hospital, London, UK
| | - P Singer
- Tel Aviv University, Tel Aviv, Israel
| | - M Smith
- University College London Hospitals, London, UK
| | - M Soares
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - A Torres
- Hospital Clinic of Barcelona, CIBERES, IDIBAPS, Barcelona, Spain
| | | | - E Azoulay
- Paris Diderot Sorbonne University, Paris, France
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Heslinga SC, Konings TC, van der Horst-Bruinsma IE, Kamp O, van Halm VP, de Bruin-Bon H, Peters MJ, Nurmohamed MT. The effects of golimumab treatment on systolic and diastolic left ventricular function in ankylosing spondylitis. Biologics 2018; 12:143-149. [PMID: 30510398 PMCID: PMC6231442 DOI: 10.2147/btt.s176806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Diastolic left ventricular (LV) dysfunction appears more prevalent in ankylosing spondylitis (AS). The effects of tumor necrosis factor alpha (TNF-α) blocking therapy, a strong and effective anti-inflammatory drug, on diastolic LV function in AS are unknown. The objective of the study was to find the effects of 1-year treatment with golimumab 50 mg subcutaneously once per month on systolic and diastolic LV dysfunction in AS patients. Methods Forty consecutive AS patients were treated with TNF-α blocking therapy for 1 year. Transthoracic echocardiography was performed in all patients at baseline and after 1 year of treatment. Results Diastolic LV function improved after treatment in four out of six (67%) AS patients who completed follow-up (P=0.125), and did not develop or worsen in any of the other patients. Treatment with TNF-α blocking therapy had no effect on systolic LV function. Conclusion These findings give support to the hypothesis that diastolic LV dysfunction improves during treatment with TNF-α blocking therapy.
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Affiliation(s)
- S C Heslinga
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands, .,Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands,
| | - T C Konings
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - I E van der Horst-Bruinsma
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands, .,Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands,
| | - O Kamp
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - V P van Halm
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Hacm de Bruin-Bon
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - M J Peters
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands, .,Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands,
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Peters MJ, Marcus JM. The complete mitochondrial genome of the Bermuda buckeye butterfly Junonia coenia bergi (Insecta: Lepidoptera: Nymphalidae). Mitochondrial DNA B Resour 2016; 1:739-741. [PMID: 33490418 PMCID: PMC7800380 DOI: 10.1080/23802359.2016.1159929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Bermuda buckeye, Junonia coenia bergi, is the only butterfly endemic to Bermuda, but is largely unstudied. Whole-genome Illumina sequencing was used to obtain a complete circular mitochondrial genome sequence of 15,221 bp consisting of 22 tRNAs, 13 protein-coding genes, 2 rRNAs and a control region. Mitogenome structure and organization was found to be very similar to that of other Junonia butterfly mitogenomes. Excluding ambiguous nucleotides, the J. coenia bergi mitogenome is 99.1% identical to the J. coenia coenia mitogenome. Parsimony and maximum-likelihood phylogenetic reconstruction revealed the monophyly of subfamily Nymphalinae, genus Junonia, and species J. coenia.
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Affiliation(s)
- Melissa J Peters
- Department of Biological Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey M Marcus
- Department of Biological Sciences, University of Manitoba, Winnipeg, MB, Canada
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8
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Citerio G, Marzorati C, Timsit JF, Perner A, Bakker J, Bassetti M, Benoit D, Curtis JR, Doig GS, Herridge M, Jaber S, Papazian L, Peters MJ, Singer P, Smith M, Soares M, Torres A, Vieillard-Baron A, Azoulay E. Outcome of Manuscripts Rejected From Intensive Care Medicine: An In Silico Study. Intensive Care Med Exp 2015. [PMCID: PMC4796553 DOI: 10.1186/2197-425x-3-s1-a23] [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: 11/22/2022] Open
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9
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Zhang XY, Simpson JL, Powell H, Yang IA, Upham JW, Reynolds PN, Hodge S, James AL, Jenkins C, Peters MJ, Lin JT, Gibson PG. Full blood count parameters for the detection of asthma inflammatory phenotypes. Clin Exp Allergy 2015; 44:1137-45. [PMID: 24849076 DOI: 10.1111/cea.12345] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/04/2014] [Accepted: 04/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND In asthma, the airway inflammatory phenotype influences clinical characteristics and treatment response. Although induced sputum is the gold standard test for phenotyping asthma, a more accessible method is needed for clinical practice. OBJECTIVE To investigate whether white blood cell counts and/or their derived ratios can predict sputum eosinophils or neutrophils in uncontrolled asthma. METHODS This cross-sectional study evaluated 164 treated but uncontrolled asthmatic patients with sputum induction and blood collection. Receiver-operating characteristic (ROC) curves were used to assess the relationship between blood and sputum parameters. RESULTS There was a significant positive relationship between blood eosinophil parameters and the percentage of sputum eosinophil count. A weak but significant correlation was found between sputum neutrophil percentage and blood neutrophil percentage (r = 0.219, P = 0.005). ROC curve analysis identified that blood eosinophil percentage count was the best predictor for eosinophilic asthma, with an area under the curve (AUC) of 0.907 (P < 0.001). The optimum cut-point for blood eosinophil percentage was 2.7%, and this yielded a sensitivity of 92.2% and a specificity of 75.8%. The absolute blood eosinophil count was also highly predictive with an AUC of 0.898 (P < 0.0001) at a blood eosinophil cut-off of 0.26 × 10(9) /L. The blood eosinophil/lymphocyte ratio (ELR) and eosinophil/neutrophil ratio (ENR) were increased in eosinophilic asthma, and the neutrophil/lymphocyte ratio (NLR) was increased in neutrophilic asthma. Neutrophilic asthma could also be detected by blood neutrophil percentages and NLR, but with less accuracy. CONCLUSIONS AND CLINICAL RELEVANCE Blood eosinophil counts and derived ratios (ELR and ENR) can accurately predict eosinophilic asthma in patients with persistent uncontrolled asthma despite treatment. Blood neutrophil parameters are poor surrogates for the proportion of sputum neutrophils. Blood counts may be a useful aid in the monitoring of uncontrolled asthma.
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Affiliation(s)
- X-Y Zhang
- Department of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Graduate School, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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10
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Seccombe LM, Chung SCS, Jenkins CR, Frater CJ, Mackey DWJ, Pearson MA, Emmett L, Peters MJ. Lung perfusion and chest wall configuration is altered by glossopharyngeal breathing. Eur Respir J 2009; 36:151-6. [PMID: 19996186 DOI: 10.1183/09031936.00163209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Glossopharyngeal insufflation is used by competitive breath-hold divers to increase lung gas content above baseline total lung capacity (TLC) in order improve performance. Whilst glossopharyngeal insufflation is known to induce hypotension and tachycardia, little is known about the effects on the pulmonary circulation and structural integrity of the thorax. Six male breath-hold divers were studied. Exhaled lung volumes were measured before and after glossopharyngeal insufflation. On two study days, subjects were studied in the supine position at baseline TLC and after maximal glossopharyngeal insufflation above TLC. Tc 99(m) labelled macro-aggregated albumin was injected and a computed tomography (CT) scan of the thorax was performed during breath-hold. Single photon emission CT images determined flow and regional deposition. Registered CT images determined change in the volume of the thorax. CT and perfusion comparisons were possible in four subjects. Lung perfusion was markedly diminished in areas of expanded lung. 69% of the increase in expired lung volume was via thoracic expansion with a caudal displacement of the diaphragm. One subject who was not proficient at glossopharyngeal insufflation had no change in CT appearance or lung perfusion. We have demonstrated areas of hyperexpanded, under perfused lung created by glossopharyngeal insufflation above TLC.
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Affiliation(s)
- L M Seccombe
- Dept of Thoracic Medicine, Concord Repatriation General, Hospital, Hospital Road, Concord, Sydney, NSW 2139, Australia.
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11
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Inwald DP, Tasker RC, Peters MJ, Nadel S. Emergency management of children with severe sepsis in the United Kingdom: the results of the Paediatric Intensive Care Society sepsis audit. Arch Dis Child 2009; 94:348-53. [PMID: 19131419 DOI: 10.1136/adc.2008.153064] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To audit current UK practice of the management of severe sepsis in children against the 2002 American College of Critical Care Medicine/Pediatric Advanced Life Support (ACCM-PALS) guideline. DESIGN Prospective observational study. SETTING 17 UK paediatric intensive care units (PICUs) and two UK PICU transport services. PARTICIPANTS 200 children accepted for PICU admission within 12 h of arrival in hospital, whether or not successfully transported to a PICU, with a discharge diagnosis of sepsis or suspected sepsis. MAIN OUTCOME MEASURES Medical interventions, physiological and laboratory data to determine the presence or absence of shock, inter-hospital transfer times, predicted mortality (using the Paediatric Index of Mortality, version 2 (PIM2) scoring system) and observed mortality. RESULTS 34/200 (17%) children died following referral. Although children defined as being in shock received significantly more fluid (p<0.001) than those who were not in shock, overall fluid and inotrope management suggested by the 2002 ACCM-PALS guideline was not followed in 62% of shocked children. Binary logistic regression analysis demonstrated that the odds ratio for death, if shock was present at PICU admission, was 3.8 (95% CI 1.4 to 10.2, p = 0.008). CONCLUSIONS The presence of shock at PICU admission is associated with an increased risk of death. Despite clear consensus guidelines for the emergency management of children with severe sepsis and septic shock, most children received inadequate fluid resuscitation and inotropic support in the crucial few hours following presentation.
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Affiliation(s)
- D P Inwald
- Department of Paediatrics, Faculty of Medicine, Imperial College London, London, UK.
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12
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Abstract
This randomised, double-blind, 6-month study compared budesonide/formoterol for maintenance and relief with salmeterol/fluticasone and a fixed maintenance dose of budesonide/formoterol, both with terbutaline for relief. Following a 2-week run-in, 3335 symptomatic adults and adolescents (mean FEV1 73% predicted, mean inhaled corticosteroid dose 745 microg/day) received budesonide/formoterol 160/4.5 microg one inhalation bid plus additional inhalations as needed, salmeterol/fluticasone 25/125 microg two inhalations bid plus as-needed terbutaline or budesonide/formoterol 320/9 microg one inhalation bid plus as-needed terbutaline. Budesonide/formoterol for maintenance and relief prolonged the time to first severe exacerbation requiring hospitalisation, emergency room treatment or oral steroids (primary variable) vs. fixed-dose salmeterol/fluticasone and budesonide/formoterol (p=0.0034 and p=0.023 respectively; log-rank test). Exacerbation rates were 19, 16 and 12 events/100 patients/6 months for salmeterol/fluticasone, fixed-dose budesonide/formoterol and budesonide/formoterol for maintenance and relief, respectively, [rate reduction vs. fixed-dose salmeterol/fluticasone (0.61; 95% CI 0.49-0.76, p<0.001) and vs. fixed-dose budesonide/formoterol (0.72; 95% CI 0.57-0.90, p=0.0048)]. Budesonide/formoterol maintenance and relief patients used less inhaled corticosteroid vs. salmeterol/fluticasone and fixed-dose budesonide/formoterol patients. All treatments provided similar marked improvements in lung function, asthma control days and asthma-related quality of life. Budesonide/formoterol for maintenance and relief reduces asthma exacerbations and maintains similar daily asthma control at a lower overall drug load compared with fixed-dose salmeterol/fluticasone and budesonide/formoterol.
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Affiliation(s)
- P Kuna
- Department of Pneumonology and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland. @lodz.pl
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Steen KS, Peters MJ, Zweegman S, de Groot PG, Voskuyl AE. Relapsing Splenic Vein Thrombosis Associated With Antiphospholipid Antibodies in a Patient With Wegener Granulomatosis. J Clin Rheumatol 2007; 13:92-3. [PMID: 17414539 DOI: 10.1097/01.rhu.0000260410.81377.b2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Relapsing splenic vein thrombosis, a very rare complication of Wegener granulomatosis (WG), is described in a female patient. Positive antiphospholipid antibodies found in this case are a rare occurrence in primary vasculitis, especially in WG. This probably caused or accentuated an effect of the WG on the splenic vein. Treatment of such patients with antiphospholipid syndrome and WG must include anticoagulation and immunosuppression and, as noted in this patient, the splenic vein thrombosis and other antiphospholipid syndrome and WG can resolve quickly.
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Affiliation(s)
- K S Steen
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
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14
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Stephens RCM, Fidler K, Wilson P, Barclay GR, Mythen MG, Dixon GLJ, Turner MW, Klein NJ, Peters MJ. Endotoxin immunity and the development of the systemic inflammatory response syndrome in critically ill children. Intensive Care Med 2006; 32:286-294. [PMID: 16450100 DOI: 10.1007/s00134-005-0019-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Accepted: 11/17/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND The systemic inflammatory response syndrome (SIRS) may be triggered by endotoxin. Humans have antibodies directed against the core of endotoxin (endotoxin core antibodies, EndoCAb) that appear to be protective following surgery and in sepsis. We hypothesised that children with elevated antibodies to endotoxin core would be less likely to develop SIRS in their initial period on intensive care. Because of the existing literature we defined two sub-groups according to the primary reason for ICU admission: infection and non-infection. METHODS We recruited 139 consecutive patients admitted to a paediatric intensive care unit (PICU) with more than one organ failure for longer than 12 h as part of another study. Patients were classified on admission to PICU as having an infectious or a non-infections diagnosis. The occurrence of SIRS within 48 h of admission was recorded along with detailed clinical and demographic data, EndoCAb concentration and the potential confounding variables C-reactive protein and mannose-binding lectin. RESULTS In the 71 patients admitted without infection (primarily post-operative and head injured) IgG EndoCAb was significantly lower in patients who developed SIRS than those who did not (72 vs. 131 MU/ml), independent of potential confounding variables. In patients with infection there was no significant difference in IgG EndoCAb between children developing SIRS and those who did not (111 vs. 80 MU/ml). CONCLUSION Head injured and post-operative patients admitted to PICU who develop early SIRS have significantly lower serum IgG EndoCAb levels than those who do not.
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Affiliation(s)
- R C M Stephens
- Critical Care Group, Portex Unit, Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK.
| | - K Fidler
- Infectious Diseases & Microbiology Unit, Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK
| | - P Wilson
- Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, WC1N 3JH, London, UK
| | - G R Barclay
- John Hughes Bennett Laboratory, Scottish National Blood Transfusion Service, Western General Hospital, Edinburgh, UK
| | - M G Mythen
- Critical Care Group, Portex Unit, Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK
| | - G L J Dixon
- Infectious Diseases & Microbiology Unit, Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK
| | - M W Turner
- Immunobiology Unit, Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK
| | - N J Klein
- Infectious Diseases & Microbiology Unit, Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK
| | - M J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, WC1N 3JH, London, UK
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15
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Affiliation(s)
- DP Inwald
- Portex Unit Critical Care Group, Institute of Child Health, 30 Guilford St, London WC1N 1EH, England
| | - MJ Peters
- Portex Unit Critical Care Group, Institute of Child Health, 30 Guilford St, London WC1N 1EH, England
| | - SN Faust
- Department of Paediatrics, 7th floor, QEQM Wing, Faculty of Medicine, Imperial College of Science, Technology & Medicine, St Mary's Campus, London W2 1PG
| | - M Levin
- Department of Paediatrics, 7th floor, QEQM Wing, Faculty of Medicine, Imperial College of Science, Technology & Medicine, St Mary's Campus, London W2 1PG
| | - NJM Klein
- Infectious Diseases and Microbiology Unit, Institute of Child Health, 30 Guilford St, London WC1N 1EH
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Seccombe LM, Kelly PT, Wong CK, Rogers PG, Lim S, Peters MJ. Effect of simulated commercial flight on oxygenation in patients with interstitial lung disease and chronic obstructive pulmonary disease. Thorax 2004; 59:966-70. [PMID: 15516473 PMCID: PMC1746875 DOI: 10.1136/thx.2004.022210] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Commercial aircraft cabins provide a hostile environment for patients with underlying respiratory disease. Although there are algorithms and guidelines for predicting in-flight hypoxaemia, these relate to chronic obstructive pulmonary disease (COPD) and data for interstitial lung disease (ILD) are lacking. The purpose of this study was to evaluate the effect of simulated cabin altitude on subjects with ILD at rest and during a limited walking task. METHODS Fifteen subjects with ILD and 10 subjects with COPD were recruited. All subjects had resting arterial oxygen pressure (PaO2) of >9.3 kPa. Subjects breathed a hypoxic gas mixture containing 15% oxygen with balance nitrogen for 20 minutes at rest followed by a 50 metre walking task. Pulse oximetry (SpO2) was monitored continuously with testing terminated if levels fell below 80%. Arterial blood gas tensions were taken on room air at rest and after the resting and exercise phases of breathing the gas mixture. RESULTS In both groups there was a statistically significant decrease in arterial oxygen saturation (SaO2) and PaO2 from room air to 15% oxygen at rest and from 15% oxygen at rest to the completion of the walking task. The ILD group differed significantly from the COPD group in resting 15% oxygen SaO2, PaO2, and room air pH. Means for both groups fell below recommended levels at both resting and when walking on 15% oxygen. CONCLUSION Even in the presence of acceptable arterial blood gas tensions at sea level, subjects with both ILD and COPD fall below recommended levels of oxygenation when cabin altitude is simulated. This is exacerbated by minimal exercise. Resting sea level arterial blood gas tensions are similarly poor in both COPD and ILD for predicting the response to simulated cabin altitude.
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Affiliation(s)
- L M Seccombe
- Department of Thoracic Medicine, Concord Repatriation General Hospital, Sydney, Australia.
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Chin RFM, Verhulst L, Neville BGR, Peters MJ, Scott RC. Inappropriate emergency management of status epilepticus in children contributes to need for intensive care. J Neurol Neurosurg Psychiatry 2004; 75:1584-8. [PMID: 15489391 PMCID: PMC1738784 DOI: 10.1136/jnnp.2003.032797] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To characterise the clinical features, emergency pre-paediatric intensive care (PIC) treatment, and course of status epilepticus (SE) in children admitted to PIC. This may provide insight into reasons for admission to PIC and provide a framework for the development of strategies that decrease the requirement for intensive care. DESIGN Cross sectional, retrospective study. SETTING A tertiary paediatric institution's intensive care unit. PARTICIPANTS The admission database and all discharge summaries of each admission to a tertiary paediatric institution's PIC over a three year period were searched for children aged between 29 days and 15 years with a diagnosis of SE or related diagnoses. The case notes of potential cases of SE were systematically reviewed, and clinical and demographic data extracted using a standard data collection form. RESULTS Most children with SE admitted to PIC are aged less than 5 years, male to female ratio 1:1, and most (77%) will have had no previous episodes of SE. Prolonged febrile convulsions, SE related to central nervous system infection, and SE associated with epilepsy occur in similar proportions. Contrary to the Advanced Paediatric Life Support guidelines many children admitted to PIC for SE receive over two doses, or inadequate doses, of benzodiazepine. There is a risk of respiratory depression following administration of over two doses of benzodiazepine (chi2 = 3.4, p = 0.066). Children with SE admitted to PIC who had prehospital emergency treatment are more likely to receive over two doses of benzodiazepines (chi2 = 11.5, p = 0.001), and to subsequently develop respiratory insufficiency (chi2 = 6.2, p = 0.01). Mortality is low. Further study is required to determine the morbidity associated with SE in childhood requiring intensive care. CONCLUSIONS As the risk of respiratory depression is greater with more than two doses of benzodiazepines, clinicians should not disregard prehospital treatment of SE. As pre-PIC treatment of SE is inadequate in many cases, appropriate audit and modifications of standard guidelines are required.
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Affiliation(s)
- R F M Chin
- Neurosciences Unit, Institute of Child Health, University College London, WC1N 1EH, UK.
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Abstract
BACKGROUND Endothelial dysfunction contributes to ischemia-reperfusion injury (IRI) and is reduced by ischemic preconditioning (IPC). IPC may involve activation of ATP-sensitive potassium channels (K(ATP)). We determined whether modulation of K(ATP) channels occurs in endothelial IPC in humans. METHODS AND RESULTS IRI of the forearm was induced by inflating a blood pressure cuff to 200 mm Hg for 20 minutes in healthy volunteers. K(ATP) activation was modulated by intra-arterial glibenclamide (blocker) and diazoxide (opener). Endothelial function (response to intra-arterial acetylcholine) was assessed with forearm plethysmography before and after (1) 15-minute reperfusion, (2) IRI preceded by IPC (3 five-minute periods of ischemia), (3) IRI preceded by IPC with glibenclamide, (4) IPC followed by glibenclamide before IRI, (5) IRI preceded by diazoxide, and (6) IRI preceded by coinfusion of glibenclamide with diazoxide. IRI caused endothelial dysfunction (P=0.002), which IPC prevented (P=0.40). Glibenclamide abolished IPC when given contemporaneously with (P=0.003) or during IRI (P=0.0005). Diazoxide prevented endothelial dysfunction after IRI (P=0.68) but not when coinfused with glibenclamide. CONCLUSIONS Glibenclamide abolishes and diazoxide mimics endothelial IPC in humans. The time course of the effect of glibenclamide suggests involvement of K(ATP) channels as effectors of endothelial IPC in vivo. These data may have implications for understanding the therapeutic role of agents that modulate K(ATP) channel function.
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Affiliation(s)
- M W Broadhead
- Centre for Clinical Pharmacology, University College London, London, United Kingdom.
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Abstract
The use of radionuclide ventilation lung scan to characterise the physiological effects of tracheobronchomalacia is a novel application of this non-invasive technique. In the reported case the right upper lobe was found to be not ventilated below a pressure of 20 cm H2O despite evidence from a dynamic tracheobronchogram of the right upper lobe bronchus opening at the lower pressure of 15 cm H2O.
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Affiliation(s)
- A Gour
- Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
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Peters MJ, Heyderman RS, Faust S, Dixon GLJ, Inwald DP, Klein NJ. Severe meningococcal disease is characterized by early neutrophil but not platelet activation and increased formation and consumption of platelet-neutrophil complexes. J Leukoc Biol 2003; 73:722-30. [PMID: 12773504 DOI: 10.1189/jlb.1002509] [Citation(s) in RCA: 16] [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] [Indexed: 11/24/2022] Open
Abstract
Approximately 25% of polymorphonuclear leukocytes (PMNL) circulate in heterotypic complexes with one or more activated platelets. These platelet-neutrophil complexes (PNC) require platelet CD62P expression for their formation and represent activated subpopulations of both cell types. In this study, we have investigated the presence, time course, and mechanisms of PNC formation in 32 cases of severe pediatric meningococcal disease (MD) requiring intensive care. There were marked early increases in PMNL CD11b/CD18 expression and activation, and reduced CD62L expression compared with intensive care unit control cases. Minimal platelet expression of the active form of alphaIIbbeta3 (GpIIb/IIIa) was seen. PNC were reduced on presentation and fell to very low levels after 24 h. Immunostaining of skin biopsies demonstrated that PNC appear outside the circulation in MD. In vitro studies of anticoagulated whole blood inoculated with Neisseria meningitidis supported these clinical findings with marked increases in PMNL CD11b/CD18 expression and activation but no detectable changes in platelet-activated alphaIIbbeta3 or CD62P expression. In vitro PMNL activation with N. meningitidis (or other agonists) potentiated the formation of PNC in response to platelet activation with adenine diphosphate. Therefore, in severe MD, PMNL activation is likely to promote PNC formation, and we suggest that the reduced levels of PNC seen in established MD reflect rapid loss of PNC from the circulation rather than reduced formation.
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Affiliation(s)
- M J Peters
- Infection and Microbiology Unit and. Portex Unit Critical Care Group, Institute of Child Health, London, United Kingdom.
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Stinstra J, Golbach E, van Leeuwen P, Lange S, Menendez T, Moshage W, Schleussner E, Kaehler C, Horigome H, Shigemitsu S, Peters MJ. Multicentre study of fetal cardiac time intervals using magnetocardiography. BJOG 2002; 109:1235-43. [PMID: 12452461 DOI: 10.1046/j.1471-0528.2002.01057.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE A database with reference values of the durations of the various waveforms in a magnetocardiogram of fetuses in uncomplicated pregnancies is assessed. This database will be of help to discriminate between pathologic and healthy fetuses. A fetal magnetocardiogram is a recording of the magnetic field in a location near the maternal abdomen and reflects the electric activity within the fetal heart. It is a non-invasive method, which can be used with nearly 100% reliability from the 20th week of gestation onward. DESIGN Durations of the waveforms were assembled from averaged magnetocardiograms and statistically processed. SETTING Fetal magnetocardiograms were measured with different magnetocardiographs. All measurements were carried out in magnetically shielded rooms. SAMPLE Fetal magnetocardiograms were obtained for 582 healthy patients. METHOD The durations of the waveforms were extracted from fetal magnetocardiograms measured at the cooperating centres. The variables collected included the duration of the P-wave, the PR interval, the PQ interval, the QRS complex, the QT interval and the T-wave and QTc value. The results were compared with values extracted from electrocardiograms of fetuses measured via electrodes attached to the maternal abdomen, from electrocardiograms measured during labour using a scalp electrode, and from electrocardiograms recorded in newborns, that were found in the literature. MAIN OUTCOME MEASURES Values of the durations are given as a function of gestational age including the regression line as well as the bounds marking the 90%, 95% and 98% prediction interval. RESULTS The durations of the P-wave, the PR interval, the QRS complex, the QT interval and QTc value increase linearly with gestational age. The durations of the PQ interval and the T-wave are independent of fetal age. CONCLUSION The values found agree with those found in the literature. The scatter of the data is wide due to the variation in normal physiology, the measuring system and signal processing and the subjectivity of the researcher. However, the system can define normal ranges and may be used in diagnosis.
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Affiliation(s)
- J Stinstra
- Low-Temperature Division, University of Twente, Enschede, The Netherlands
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Abstract
OBJECTIVES To test the usefulness and reliability of fetal magnetocardiography as a diagnostic or screening tool, both for fetuses with arrhythmias as well as for fetuses with a congenital heart defect. METHODS We describe 21 women with either a fetal arrhythmia or a congenital heart defect discovered during prenatal evaluation by sonography. Four fetuses showed a complete atrioventricular block, two an atrial flutter, nine ventricular extrasystole, and one a complete irregular heart rate. Five fetuses were suspected to have a congenital heart defect. In all cases magnetocardiograms were recorded. RESULTS Nine fetuses with extrasystole showed a range of premature atrial contractions, premature junctional beats or premature ventricular contractions. Two fetuses with atrial flutter showed typical flutter waves and four fetuses with complete atrioventricular block showed an uncoupling of P-wave and QRS complex. One fetus showed a pattern suggestive of a bundle branch block. In three of four fetuses with confirmed congenital heart defects the magnetocardiogram showed abnormalities. CONCLUSION Fetal magnetocardiography allows an insight into the electrophysiological aspects of the fetal heart, is accurate in the classification of fetal arrhythmias, and shows potential as a tool in defining a population at risk for congenital heart defects.
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Affiliation(s)
- H W P Quartero
- Department of Obstetrics and Gynecology, Medisch Spectrum Twente, Enschede, the Netherlands.
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Abstract
Both fetal electrocardiography and fetal magnetocardiography are influenced by the volume conduction within the abdomen of the pregnant woman. In this paper, various models are used to simulate this influence. Such models are helpful to determine where to attach electrodes at the maternal abdomen in case fetal ECGs are measured and where to position the magnetocardiograph in case fetal MCGs are measured. Another goal is to assess the influence of individual differences, such as the amount of amniotic fluid. Seven models based on MR-images have been created, four for the third trimester of gestation, with the fetus in left occiput position, and three for the second trimester. The models consist of four compartments; the fetus, the vernix caseosa, the amniotic fluid, and the remainder of the maternal abdomen. It turns out that individual differences have a large impact on the fetal MCG and that the best measurement positions are expected over the centre of the abdomen near the fetal heart. The fetal ECG is dependent on the vernix caseosa and when this layer is present, the fetal ECG is best measured by two electrodes, one over the fetal mouth and the other over the bottom of the fetus.
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Affiliation(s)
- J G Stinstra
- Faculty of Applied Physics, Twente University, NL-7500 AE Enschede, The Netherlands
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Abstract
The electrical conductivity of human tissue at low frequencies is discussed when a uniform electric field is applied to some tissue containing many cells. Human tissue is described as a suspension of particles in a conducting solution. Relations are derived for the apparent conductivity of a cell surrounded by a membrane. These relations can be used to estimate the accuracy of a model that considers the cell as a non-conducting particle. Usually, a tissue is composed of several types of particles. A relationship that expresses the effective conductivity of a suspension of one type of ellipsoidal particles could be found in the literature. The orientation of the particles could be uniform or they could be randomly distributed. For non-conducting particles, this expression is known as Archie's law. The expression is extended such that also the effective conductivity of a suspension of various types of particles can be calculated. The result is evaluated for the cortex of the brain using experimental data given in the literature.
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Affiliation(s)
- M J Peters
- Department of Applied Physics, Biomagnetic Centre, University of Twente, Enschede, Netherlands.
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Inwald DP, Kirkham FJ, Peters MJ, Lane R, Wade A, Evans JP, Klein NJ. Platelet and leucocyte activation in childhood sickle cell disease: association with nocturnal hypoxaemia. Br J Haematol 2000; 111:474-81. [PMID: 11122087 DOI: 10.1046/j.1365-2141.2000.02353.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We hypothesized that vaso-occlusive events in childhood sickle cell disease (SCD) may relate to inflammatory cell activation as well as interactions between sickle erythrocytes and vascular endothelium. Peripheral blood was examined from 24 children with SCD, of whom 12 had neurological sequelae and seven had frequent painful crises, and 10 control subjects. Platelet (CD62P and CD40L expression) and granulocyte (CD11b expression) activation and levels of platelet-erythrocyte and platelet-granulocyte complexes were determined by flow cytometry. Platelets (P = 0.019), neutrophils (P = 0.02) and monocytes (P = 0.001) were more activated and there were increased platelet-erythrocyte complexes (P = 0.026) in SCD patients compared with controls. Platelet-granulocyte complexes were not raised. There were no differences between the different groups of SCD. As hypoxia activates monocytes, platelets and endothelial cells and causes sickling of SCD erythrocytes, we also investigated 20 SCD patients with overnight pulse oximetry. Minimum overnight saturation correlated with the level of platelet-erythrocyte complexes (Spearman's rho -0.668, P < 0.02), neutrophil CD11b (Spearman's rho -0.466, P = 0.038) and monocyte CD11b (Spearman's rho -0.652, P = 0. 002). These findings provide important clues about the mechanism by which SCD patients may become predisposed to vaso-occlusive events.
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Affiliation(s)
- D P Inwald
- Portex Unit of Anaesthesia, Intensive Care and Respiratory Medicine, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Kotowicz K, Dixon GL, Klein NJ, Peters MJ, Callard RE. Biological function of CD40 on human endothelial cells: costimulation with CD40 ligand and interleukin-4 selectively induces expression of vascular cell adhesion molecule-1 and P-selectin resulting in preferential adhesion of lymphocytes. Immunology 2000; 100:441-8. [PMID: 10929070 PMCID: PMC2327040 DOI: 10.1046/j.1365-2567.2000.00061.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [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: 01/30/2023] Open
Abstract
The expression of adhesion molecules on vascular endothelial cells determines the pattern of migration and extravasation of leucocytes in inflammation and immunity. Here we show that costimulation with CD40 ligand (CD40L) and interleukin (IL)-4 (or IL-13) gives rise to a unique pattern of adhesion molecule expression by human umbilical vein endothelial cells (HUVEC). CD40 ligation alone enhanced expression of vascular cell adhesion molecule-1 (VCAM-1), intracellular adhesion molecule-1 (ICAM-1) and E-selectin whereas IL-4 and IL-13 increased expression of VCAM-1 and P-selectin but not ICAM-1 or E-selectin. When IL-4 and CD40L were combined there was an additional increase of both VCAM-1 and P-selectin, but ICAM-1 and E-selectin were both inhibited. The combined effects of IL-4 and CD40L signalling were not the result of altered response kinetics, enhanced sensitivity of the endothelium, or increased expression of CD40 or the IL-4 receptor. The rise in VCAM-1 expression induced by combined IL-4 and CD40L stimulation was slower and more sustained than with tumour necrosis factor-alpha (TNF-alpha) and occurred only on a subset (75-80%) of the endothelial cell population compared to 100% with TNF-alpha. Costimulation with IL-4 and CD40L increased adhesion of T cells and B cells above levels obtained with either signal alone, but decreased adhesion of neutrophils. Furthermore, CD40 and IL-4 synergistically increased IL-6 but decreased IL-8 production by HUVEC. These results show that interactions between IL-4 and CD40 on endothelial cells give rise to specific patterns of adhesion molecule expression and cytokine production that may have important implications for lymphocyte and neutrophil migration and function at sites of inflammation.
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Affiliation(s)
- K Kotowicz
- Immunobiology Unit, Institute of Child Health, London, UK
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Abstract
OBJECTIVES The accuracy of electrical impedance tomography was investigated. METHODS The conductivities of the different compartments of the volume conductor were estimated by utilizing the boundary element method. The approach was tested for realistic head models with either 3 or 4 compartments. The impact of a geometrical error in the head model was investigated and the estimated conductivities were assigned to the compartments of the volume conductor used for the source imaging. The localization errors were quantified. RESULTS The method used allowed the estimation of the conductivity of the compartments. The poor conductivity of the skull decreased the precision with which the conductivity of deeper structures could be estimated. A geometrical error in the head model was compensated by the estimated conductivities. However, the estimated conductivities did not cancel the geometrical error in the head model as localization errors of the order of 10-20 mm were obtained. CONCLUSIONS In principle, the conductivity estimation of the distinct regions in the head is possible. The application of conductivity estimation to increase the accuracy of source localization remains questionable.
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Affiliation(s)
- M J van Burik
- Low Temperature Division, Faculty of Applied Physics, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
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Abstract
OBJECTIVE To examine the effects of time, sex and age at diagnosis on lung cancer incidence rates and the distribution of the histological types of lung cancer in New South Wales. DESIGN AND SETTING Retrospective analysis of data from the NSW Cancer Registry and Australian Bureau of Statistics population data for NSW for 1985-1995. MAIN OUTCOME MEASURES Trends in lung cancer incidence rates between 1985 and 1995 for men and women aged over 30 years; changes in incidence rates within age groups; and incidence rates of histological subtypes relative to sex and age. RESULTS The incidence of lung cancer in men aged 40-80 years fell, while that in women aged over 65 rose. Rates were stable in younger women and older men. Incidence rates in men aged 40-60 years fell by 40%-60%. Were it not for the reduction in incidence rates in men between 1985 and 1995, the number of male lung cancer cases in 1995 would have been greater by 389 (95% CI, 362-415). In women, increasing incidence rates were responsible for an extra 242 cases (95% CI, 232-253) in 1995. Adenocarcinoma comprised a greater percentage of lung cancer cases in younger people, while squamous-cell carcinoma increases steadily with age in both men and women. Women with lung cancer are less likely to have squamous-cell carcinoma (25% for women v. 40% for men) and therefore more likely than men to have adenocarcinoma (35% of new female cases v. 26% for men) or small-cell lung cancer (24% v. 19%). CONCLUSIONS Increased smoking cessation has seen a halving of lung cancer rates in middle-aged men. Whether this represents delayed or prevented cases is uncertain. The distribution of histological subtypes of lung cancer in women is different from that in men, and it is not clear whether this difference is hormone-dependent or related to historical patterns of smoking.
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Affiliation(s)
- L C Morgan
- Department of Thoracic Medicine, Concord Repatriation General Hospital, Concord, NSW
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Abstract
Mucociliary clearance is impaired in many diseases of the respiratory system. We have developed a method for measuring tracheal mucus velocity by the dynamic study of a single point source of radioactivity deposited in the trachea by cricothyroid injection. Preliminary results suggest that patients with airways disease have very low tracheal mucus velocities (<2 mm x min(-1)). The aim of this experiment was to explore the ability of current scintillation detection systems to track a single point as it moves in a dynamic study in small increments and at low velocity (movements of the order of 1 mm). Background noise was estimated to contribute an error in positioning of 0.16 mm (1 standard deviation). Overall errors in velocity were estimated at 0.2 mm x min(-1). This suggests that standard instrumentation in use in most nuclear medicine departments has the capacity to measure accurately velocities as low as 1 mm x min(-1).
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Affiliation(s)
- L C Morgan
- Department of Respiratory Medicine, Concord Repatriation General Hospital, NSW, Australia.
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Abstract
CD40 ligand (CD40L), a membrane protein expressed on activated T cells, plays a pivotal role in B cell proliferation and differentiation. Mutations in the CD40L gene are associated with a rare immunodeficiency state, X-linked hyper IgM syndrome (XLHIGM). Recently, platelets have been described as capable of expressing CD40L within minutes of stimulation. We have developed a rapid technique to determine expression of CD40L on activated platelets by flow cytometry in whole blood. We have demonstrated that this technique is useful in neonatal screening, in rapid diagnosis and in determining reconstitution by donor bone marrow post-transplantation.
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Affiliation(s)
- D P Inwald
- Portex Department of Anaesthesia, Intensive Therapy and Respiratory Medicine and Immunobiology Unit, Institute of Child Health, London, UK.
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Abstract
Somatosensory evoked magnetic fields and electrical potentials were measured in eight patients with unilateral neuropathic pain. After median nerve stimulation on the painful side, the amplitudes of the evoked responses were enhanced 2 to 3 times at a latency of about 100 ms compared to the responses of the contralateral, unaffected side. After posterior tibial nerve stimulation an enhancement was found at latencies around 110 ms and 150 ms. The scalp distribution of the magnetic field at the latencies of "abnormal" responses was dipolar and the responses could be ascribed to a current dipole. Three (of the eight) patients underwent spinal cord stimulation (SCS) for their pain. The enhancement of the evoked responses to stimulation of the painful side decreased after spinal cord stimulation. After a long period of spinal cord stimulation only (e.g., a year) during which the patient reported to be pain free, these "abnormal" responses were no longer observed.
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Affiliation(s)
- P J Theuvenet
- Department of Anesthesiology, Medical Centre of Alkmaar, The Netherlands
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Peters MJ, Dixon G, Kotowicz KT, Hatch DJ, Heyderman RS, Klein NJ. Circulating platelet-neutrophil complexes represent a subpopulation of activated neutrophils primed for adhesion, phagocytosis and intracellular killing. Br J Haematol 1999; 106:391-9. [PMID: 10460597 DOI: 10.1046/j.1365-2141.1999.01553.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Platelets play a prominent role in linking the processes of inflammation, haemostasis and thrombosis. Recent studies have shown that platelets form heterotypic aggregates with leucocytes via platelet CD62P and leucocyte beta2 integrins. These interactions have been observed in vitro in blood taken from healthy volunteers and in clinical conditions in which thrombosis and inflammation are prominent. This study investigated the properties of platelet-neutrophil complexes (PNCs) in anticoagulated whole blood. At rest, neutrophils in PNCs exhibit a significantly more activated adhesion molecule profile than free neutrophils with increased CD11b expression and activation (increased binding of the CD11b/CD18 'activation reporter' monoclonal antibody 24) and decreased CD62L expression. In addition, neutrophils in PNCs phagocytosed significantly more Neisseria meningitidis and produced more toxic oxygen metabolites than free neutrophils. Stimulation with the platelet agonist adenosine diphosphate (ADP) led to further increases in CD11b expression and activation, loss of CD62L as well as increased phagocytosis and toxic oxygen metabolite production throughout the whole neutrophil population. When these experiments were repeated with the CD62P blocking antibody G1 the effects were inhibited to a variable extent, dependent upon the parameter under investigation. These results indicate that both soluble and contact-dependent factors contribute to platelet-mediated neutrophil activation. Platelet neutrophil complexes represent a large subpopulation of neutrophils with a more activated adhesion molecule profile, and a greater capacity for phagocytosis and toxic oxygen metabolite production. This study provides further support for a role for PNCs in both health and disease.
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Affiliation(s)
- M J Peters
- Department of Immunobiology, Intensive Care and Respiratory Medicine, Institute of Child Health, London, UK
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Mazur JE, Devlin JW, Peters MJ, Jankowski MA, Iannuzzi MC, Zarowitz BJ. Single versus multiple doses of acetazolamide for metabolic alkalosis in critically ill medical patients: a randomized, double-blind trial. Crit Care Med 1999; 27:1257-61. [PMID: 10446816 DOI: 10.1097/00003246-199907000-00004] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare two dosing regimens of acetazolamide for the reversal of metabolic alkalosis in mechanically ventilated patients with asthma or chronic obstructive pulmonary disease. DESIGN A randomized, double-blind, placebo-controlled trial. SETTING A 35-bed medical intensive care unit in a tertiary care teaching hospital. PATIENTS Forty mechanically ventilated patients with a metabolic alkalosis (arterial pH > or = 7.48 and serum bicarbonate concentration > or = 26 mEq/L) resistant to fluid or potassium therapy (serum potassium concentration, > or = 4 mEq/L) not receiving acetazolamide or sodium bicarbonate in the previous 72 hrs. INTERVENTIONS Stratified by previous diuretic use and randomized to receive intravenous administration of acetazolamide, one dose of 500 mg or 250 mg every 6 hrs for a total of four doses. MEASUREMENTS AND MAIN RESULTS Serum bicarbonate and potassium concentrations were drawn every 6 hrs for 72 hrs, arterial blood gases were drawn every 12 hrs for 72 hrs, and both urine chloride and pH were drawn at hours 0, 6, 12, 18, 24, 48, and 72. By using generalized estimating equation techniques, no difference was found between the two dosing regimens at any point over the study period for serum bicarbonate, serum potassium, or urine chloride end points. Results did not differ between diuretic- and nondiuretic-treated patients. Serum bicarbonate concentrations remained significantly decreased in both treatment groups 72 hrs after administration of the first acetazolamide dose (31.8 +/- 4.9-25.3 +/- 3.8 mEq/L, p < .0001 [250 mg x 4]; 31.9 +/- 25.4-25.4 +/- 3.6 mEq/L, p < .0001 [500 mg x 1]). CONCLUSIONS We conclude that a single 500-mg dose of acetazolamide reverses nonchloride responsive metabolic alkaloses in medical intensive care unit patients as effectively as multiple doses of 250 mg. Studies to examine the prolonged duration of action of acetazolamide observed in this study as well as the effect of acetazolamide on clinical end points, such as duration of mechanical ventilation, are warranted.
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Affiliation(s)
- J E Mazur
- Department of Pharmacy Services, Henry Ford Health System, Detroit, MI, USA
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Knösche TR, Berends EM, Jagers HR, Peters MJ. Determining the number of independent sources of the EEG: a simulation study on information criteria. Brain Topogr 1999; 11:111-24. [PMID: 9880169 DOI: 10.1023/a:1022202521439] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 11/12/2022]
Abstract
The separation of signal and noise is an important problem in the analysis of EEG and MEG data. Furthermore, many source localisation strategies need the number of independent signal components as input parameter (e.g., dipole fit, multiple signal classification). Information criteria offer a relatively objective way to separate the space spanned by the principal components of the data covariance matrix into a signal and a noise part. Eighteen such criteria were extensively tested by simulations. They differ with respect to the statistical model of the data, the assumptions on the noise, and the correction term. In the simulations, different dipole sources were used to generate EEG, which was then distorted by Gaussian correlated or uncorrelated noise. The noise level, the accuracy of the noise covariance matrix used by the criteria, the numbers of channels and time samples, and the stochastic or deterministic nature of the source waveforms were varied. The performance of the criteria was very variable. For each criterion, limits for the noise level and the relative inaccuracy of the noise covariance matrix could be established. Taking more channels or time steps did increase the criteria's ability to tolerate noise, but at the same time, made them more vulnerable to inaccuracies in the (estimated) noise covariance matrices. Out of the eighteen criteria investigated, we recommend two criteria that are best suited for the cases of (1) high noise and accurate covariances and (2) low noise and less accurate covariances.
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Affiliation(s)
- T R Knösche
- Max-Planck-Institute of Cognitive Neuroscience, Leipzig, Germany
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Abstract
The influence of the volume conductor on the EEG, MEG, fetal ECG and fetal MCG is studied by means of simulations. The assumption that the Maxwell equations can be used in a quasi-static approximation is reconsidered and the fact that the conductivity of human tissue is frequency dependent is taken into account. It is found that displacement currents have a substantial effect on the fetal ECG and to a lesser degree on the fetal MCG. Moreover, the frequency dependence of the conductivity of the tissues within the head may have a considerable effect on the EEG.
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Affiliation(s)
- J G Stinstra
- Graduate School Integrated BioMedical Engineering for Restoration of Human Function (iBME), Faculty of Applied Physics, University of Twente, Enschede, The Netherlands.
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Devlin JW, Ben-Menachem T, Ulep SK, Peters MJ, Fogel RP, Zarowitz BJ. Stress ulcer prophylaxis in medical ICU patients: annual utilization in relation to the incidence of endoscopically proven stress ulceration. Ann Pharmacother 1998; 32:869-74. [PMID: 9762371 DOI: 10.1345/aph.18080] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To measure changes in the proportion of medical intensive care unit (MICU) patients prescribed pharmacologic stress ulcer prophylaxis therapy over a 4-year period in relation to the incidence of stress-related ulceration detected by endoscopy at our institution. DESIGN Retrospective 4-year review of pharmacy and endoscopy databases. SETTING A 35-bed MICU. PATIENTS Patients (n = 2941) admitted to the MICU for longer than 24 hours, between January 1, 1993, and December 31, 1996, without acute gastrointestinal hemorrhage on admission. METHODS Records were reviewed to identify patients prescribed pharmacologic stress ulcer prophylaxis (> 24 h of sucralfate or a histamine2-receptor antagonist [H2RA]), and patients with evidence of stress ulceration during endoscopy. RESULTS The number of patients per year receiving stress ulcer prophylaxis significantly (p < 0.001) decreased between 1993 and 1996: 1993, 492/693 (71%); 1994, 478/798 (60%); 1995, 295/670 (44%); 1996, 164/780 (21%). There was no difference between years in the median duration of stress ulcer prophylaxis therapy or the proportion of patients receiving sucralfate versus H2RA therapy. There was no difference (p = 0.91) between years in the annual incidence of definite or possible stress-related ulceration: 1993, 6/693 (0.87%); 1994, 5/798 (0.63%); 1995, 6/670 (0.90%); 1996, 5/780 (0.64%). CONCLUSIONS The incidence of endoscopically proven stress-related ulceration has remained unchanged over the past 4 years in our MICU despite significantly fewer patients receiving pharmacologic stress ulcer prophylaxis therapy.
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Affiliation(s)
- J W Devlin
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA.
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Abstract
Volume conductor models that are commonly used to describe the EEG and MEG neglect holes in the skull, lesions, the ventricles, and anisotropic conductivity of the skull. To determine the influence of these features, simulations were carried out using the finite element method. The simulations showed that a hole in the skull will have a large effect on the EEG, and as one of the consequences localisation errors up to 15 mm may occur. The effect on the MEG is negligible. The presence of a lesion may cause the shape and magnitude of the EEG and MEG to change. Hence, a lesion has to be taken into account, if the active neurones are close to it. Moreover, a localisation procedure may fail if the lesion is not included in the volume conductor model. Inclusion of the ventricles in the volume conductor model is necessary only if sources are in their vicinity or if their sizes are unusually large. Anisotropic conductivity of the skull has a smearing effect on the EEG but does not influence the MEG.
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Affiliation(s)
- S P van den Broek
- Biomagnetic Centre, Faculty of Applied Physics, Low Temperature Division, University of Twente, Enschede, The Netherlands
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Abstract
We describe a patient with combined meningococcal septicemia and meningitis, cerebral edema and acute respiratory distress syndrome, in whom we balanced the conflicting carbon dioxide strategies for optimal pulmonary and neurological management using jugular oxygen saturation (SjvO2) monitoring to identify the upper limit of "tolerable" hypercapnia. Our observations suggest that significant acidosis was not well tolerated; however, cautious induction of pH down to 7.32 and an arterial carbon dioxide tension (PaCO2) < 5.9 kPa was tolerated acutely without significant cerebral hyperemia. Moreover, with the development of metabolic compensation and normal pH, higher levels of PaCO2 could be permitted. In similar cerebro-pulmonary circumstances we suggest that these findings warrant consideration. Alternatively, invasive monitoring of SjvO2 could be undertaken so that patient-specific criteria for permissive hypercapnia can be determined.
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Affiliation(s)
- R C Tasker
- Department of Paediatric Intensive Care, Great Ormond Street Hospital for Children, London, UK
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Peters MJ, Tasker RC, Kiff KM, Yates R, Hatch DJ. Acute hypoxemic respiratory failure in children: case mix and the utility of respiratory severity indices. Intensive Care Med 1998; 24:699-705. [PMID: 9722040 PMCID: PMC7094931 DOI: 10.1007/s001340050647] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Acute hypoxemic respiratory failure (AHRF) is a common reason for emergency pediatric intensive care. An objective assessment of disease severity from acute physiological parameters would be of value in clinical practice and in the design of clinical trials. We hypothesised that there was a difference in the best early respiratory indices in those who died compared with those who survived. DESIGN A prospective observational study of 118 consecutive AHRF admissions with data analysis incorporating all blood gases. SETTING A pediatric intensive care unit in a national children's hospital. INTERVENTIONS None. RESULTS Mortality was 26/118, 22% (95 % confidence interval 18-26%). There were no significant differences in the best alveolar-arterial oxygen tension gradient (A-aDO2, torr), oxygenation index (OI), ventilation index (VI), or PaO2/FIO2 during the first 2 days of intensive care between the survivors and non-survivors. Only the mean airway pressure (MAP, cm H2O) used for supportive care was significantly different on days 0 and 1 (p < 0.05) with higher pressure being used in non-survivors. Multiple logistic regression analysis did not identify any gas exchange or ventilator parameter independently associated with mortality. Rather, all deaths were associated with coincident pathology or multi-organ system failure, or perceived treatment futility due to pre-existing diagnoses instead of unsupportable respiratory failure. When using previously published predictors of outcome (VI > 40 and OI > 40; A-aDO2 > 450 for 24 h; A-aDO2 > 470 or MAP > 23; or A-aDO2 > 420) the risk of mortality was overestimated significantly in the current population. CONCLUSION The original hypothesis was refuted. It appears that the outcome of AHRF in present day pediatric critical care is principally related to the severity of associated pathology and now no longer solely to the severity of respiratory failure. Further studies in larger series are needed to confirm these findings.
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Affiliation(s)
- M J Peters
- Department of Paediatric Intensive Care, Great Ormond Street Hospital for Children, London, UK
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Abstract
Evidence is increasing that platelets can initiate and propagate inflammatory processes by interacting with leucocytes and the vascular endothelium. Platelets have been shown to bind to neutrophils, existing as platelet/neutrophil complexes (PNC) within the circulation. We describe a simple flow cytometric method for assessing and investigating platelet interactions with neutrophils in small volumes of whole blood. Twenty-five percent (sd 6%) of circulating neutrophils from healthy adults were associated with platelets. Formation of these platelet-neutrophil complexes was CD62P (P-selectin) and divalent cation dependent. Platelet activation (with ADP or thrombin) caused a rapid and sustained rise in %PNC which differed from the pattern of free platelet activation as assessed by CD62P expression. F-met-leu-phe induced neutrophil activation but did not increase the percentage PNC. Platelet activation also caused increased neutrophil CD11b/CD18 expression which was most marked on neutrophils complexed with platelets. This straightforward technique is simple, reproducible, and allows assessment of platelet-neutrophil interactions and activation of neutrophils. It may also provide a method for estimating platelet activation in whole blood.
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Affiliation(s)
- M J Peters
- Department of Immunobiology, Institute of Child Health, London, UK.
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Affiliation(s)
- G R Storey
- Department of Nuclear Medicine, Concord Hospital, Sydney, Australia
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Grimsditch M, Mattson JE, Sowers CH, Bader SD, Peters MJ. Confined Phonons in Metallic Superlattices: Raman Study of Co/Ru. Phys Rev Lett 1996; 77:2025-2028. [PMID: 10061838 DOI: 10.1103/physrevlett.77.2025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Abstract
The finite-element method in combination with the Biot-Savart law is described to compute the magnetic field distribution generated by a dipolar source within a homogeneous volume conductor of an arbitrary shape. In order to calculate the three independent components of the magnetic field outside the volume conductor by means of the Biot-Savart law, the distribution of the current throughout the medium is required. A finite-element mesh is constructed using four-node tetrahedral elements. The potential in each node is computed numerically by the finite-element method using the proper continuity conditions across the boundaries. The gradient of the potential denotes the current density within an element. The components of the magnetic induction are calculated by numerical integration, applying the current density within the tetrahedrons. Simulations are carried out to assess the numerical accuracy for a homogeneous spherical volume conductor. Errors of 3% can be obtained with a locally refined spherical mesh containing about 1000 nodes, for dipoles at any depth and any orientation. A homogeneous realistically shaped model with the shape of the inside of the skull is obtained from magnetic resonance images.
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Ossenblok P, Wilts G, Numminen J, Peters MJ, Lopes da Silva FH. Locating the cortical sources of somatosensory evoked responses by integration of EEG and MEG. Electroencephalogr Clin Neurophysiol Suppl 1996; 46:183-91. [PMID: 9059792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P Ossenblok
- Department of Neurology, Medical Spectrum Twente, Enschede, Netherlands
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Abstract
Regular treatment with beta 2-agonists has been reported to be associated with an increase in risk of asthma death or near death, and with a deterioration in asthma symptom control. Low-dose beta 2-agonists provide effective bronchodilatation and bronchoprotection, even though maximal bronchodilatation is not achieved, and they may offer a better safety profile. In a double-blind, randomized,, cross-over study, we evaluated the efficacy of low-dose salbutamol metered-dose inhaler (50 micrograms.puff-1), used over a period of 2 weeks, compared with a standard dose (100 micrograms.puff-1) in control of asthma symptoms in 20 moderately severe asthmatic subjects using inhaled glucocorticosteroid therapy. Asthma control was assessed by symptom scores, peak flow rates, spirometry, inhaler usage and, where possible, by bronchial responsiveness to methacholine. Despite a 46% reduction in mean weekly salbutamol dosage, mean forced expiratory volume in one second (FEV1), morning and evening peak expiratory flow (PEF), PEF variability, dose of methacholine provoking a 20% decrease in FEV1 (PC20) (n=9), and symptom scores showed no difference between low-dose and standard inhaler treatment periods. Low-dose inhaler administration resulted in a small but significant increase in number of inhaler actuations. Low-dose salbutamol metered-dose inhaler may, thus, be useful for control of symptoms in moderately severe asthma. This strategy could be used to achieve a reduction in total beta 2-agonist usage, which may minimize any potential for adverse effects.
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Affiliation(s)
- D H Yates
- Dept of Thoracic Medicine, National Heart & Lung Institute, London, UK
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49
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Abstract
Inverse solution techniques based on electroencephalograph (EEG) measurements have become a powerful means of gaining knowledge about the functioning of the brain. A model of the head and a potential computation method are necessary to describe the EEG problem mathematically. The generation of realistically shaped three-compartment models of the head is discussed. The isolated problem approach for the boundary element method is applied to develop a fast and accurate numerical solution of the EEG forward problem. Accuracy studies with this approach show that dipole positions can be reconstructed within a distance of 3 mm from the original positions. Inverse simulations indicate that the incorporation of the individual head shape may significantly influence the reconstructed dipole position but not its magnitude and orientation, in comparison with the commonly used three-sphere model. However, the presence of noise in the simulated potential data affects the solutions based on realistically shaped models more than those of the simple three-sphere model. The increased sensitivity of the former models to noise in the data remains a serious drawback for their practical application to EEG source localisations.
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Affiliation(s)
- F Zanow
- Faculty of Applied Physics, University of Twente, Enschede, The Netherlands
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50
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Adcock IM, Peters MJ, Brown CR, Stevens DA, Barnes PJ. High concentrations of beta-adrenergic agonists inhibit DNA binding of glucocorticoids in human lung in vitro. Biochem Soc Trans 1995; 23:217S. [PMID: 7672237 DOI: 10.1042/bst023217s] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- I M Adcock
- Department of Thoracic Medicine, National Heart & Lung Institute, London, U.K
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