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Conduit C, Hutchinson AD, Leonard M, O 'Haire S, Moody M, Thomas B, Sim I, Hong W, Ahmad G, Lawrentschuk N, Lewin J, Tran B, Dhillon HM. An exploration of testicular cancer survivors' experience of ejaculatory dysfunction following retroperitoneal lymph node dissection-a sub-study of the PREPARE clinical trial. J Cancer Surviv 2023:10.1007/s11764-023-01489-9. [PMID: 37981616 DOI: 10.1007/s11764-023-01489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/20/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Ejaculatory dysfunction secondary to retrograde ejaculation or anejaculation is a complication of retroperitoneal lymph node dissection (RPLND) for survivors of testicular cancer. We explored survivors' experiences of ejaculatory dysfunction following RPLND. METHODS In a sub-study of a single-arm phase 2 clinical trial (ACTRN12622000537752/12622000542796), participants reporting ejaculatory dysfunction ≥ 6 months following RPLND were invited to complete semi-structured interviews. Purposive sampling was used. Interviews continued until thematic saturation occurred, and codebook thematic analysis of interviews was performed. RESULTS Of 58 individuals recruited to the trial, 33 (57%) reported ejaculatory dysfunction. Of these, 32 (97%) agreed to interview and 15 participated. Participants interviewed had median age 34 years (range 24-66), 12 (80%) in a long-term relationship with median time from surgery 36 months (range 11-112). Three overarching themes were identified. The first reflected the value of RPLND despite ejaculatory dysfunction. The second illuminated the impact(s) of ejaculatory dysfunction closely mapped to life stage, with flow-on impacts to fertility, sex, psychological wellbeing and communication. The third reflected information needs. Fertility was a substantial source of concern for some participants. Ejaculatory dysfunction had no effect on sex for some, whilst for others, sex was less pleasurable. Some reported benefits. Few reported ejaculatory dysfunction challenged masculinity, confidence, or self-esteem. CONCLUSIONS Future research should examine interventions to reduce distress related to fertility, challenged masculinity and body image. IMPLICATIONS FOR CANCER SURVIVORS Whilst most participants considered ejaculatory dysfunction to have little impact on their sexual function and relationships, some reported significant difficulties varying by life stage and relationship status.
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Affiliation(s)
- C Conduit
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - A D Hutchinson
- Justice & Society, Behaviour-Brain-Body Research Centre, University of South Australia, Magill, Australia
| | - M Leonard
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, Australia
| | - S O 'Haire
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - M Moody
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - B Thomas
- Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - I Sim
- Endocrinology, Monash Health and Eastern Health, Clayton, VIC, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - W Hong
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - G Ahmad
- Andrology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - N Lawrentschuk
- Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
- Urology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Lewin
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Melbourne, VIC, Australia
| | - B Tran
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia.
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
| | - H M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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Ryan T, Um J, Castleberry A, Lowes B, Moody M, Urban M. Economic Impact of Donation after Circulatory Death Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1275] [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: 04/05/2023] Open
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Urban M, Castleberry A, Um J, Stoller D, Lundgren S, Hyden M, Moody M, Oreschak K, Lowes B. Acute Rejection Following Donation after Circulatory Death Versus Brain Death Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1211] [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: 04/05/2023] Open
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Mace EM, Paust S, Conte MI, Baxley RM, Schmit MM, Patil SL, Guilz NC, Mukherjee M, Pezzi AE, Chmielowiec J, Tatineni S, Chinn IK, Akdemir ZC, Jhangiani SN, Muzny DM, Stray-Pedersen A, Bradley RE, Moody M, Connor PP, Heaps AG, Steward C, Banerjee PP, Gibbs RA, Borowiak M, Lupski JR, Jolles S, Bielinsky AK, Orange JS. Human NK cell deficiency as a result of biallelic mutations in MCM10. J Clin Invest 2020; 130:5272-5286. [PMID: 32865517 PMCID: PMC7524476 DOI: 10.1172/jci134966] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 06/24/2020] [Indexed: 12/16/2022] Open
Abstract
Human natural killer cell deficiency (NKD) arises from inborn errors of immunity that lead to impaired NK cell development, function, or both. Through the understanding of the biological perturbations in individuals with NKD, requirements for the generation of terminally mature functional innate effector cells can be elucidated. Here, we report a cause of NKD resulting from compound heterozygous mutations in minichromosomal maintenance complex member 10 (MCM10) that impaired NK cell maturation in a child with fatal susceptibility to CMV. MCM10 has not been previously associated with monogenic disease and plays a critical role in the activation and function of the eukaryotic DNA replisome. Through evaluation of patient primary fibroblasts, modeling patient mutations in fibroblast cell lines, and MCM10 knockdown in human NK cell lines, we have shown that loss of MCM10 function leads to impaired cell cycle progression and induction of DNA damage-response pathways. By modeling MCM10 deficiency in primary NK cell precursors, including patient-derived induced pluripotent stem cells, we further demonstrated that MCM10 is required for NK cell terminal maturation and acquisition of immunological system function. Together, these data define MCM10 as an NKD gene and provide biological insight into the requirement for the DNA replisome in human NK cell maturation and function.
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Affiliation(s)
- Emily M. Mace
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Silke Paust
- Department of Immunology and Microbiology, Scripps Research Institute, La Jolla, California, USA
| | - Matilde I. Conte
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Ryan M. Baxley
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Megan M. Schmit
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sagar L. Patil
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicole C. Guilz
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Malini Mukherjee
- Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics
| | - Ashley E. Pezzi
- Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics
| | - Jolanta Chmielowiec
- Center for Cell and Gene Therapy, and
- Molecular and Cellular Biology Department, Baylor College of Medicine, Houston, Texas, USA
| | - Swetha Tatineni
- Department of Pediatrics
- Department of BioSciences, Rice University, Houston, Texas, USA
| | - Ivan K. Chinn
- Department of Pediatrics
- Department of Molecular and Human Genetics and
| | | | - Shalini N. Jhangiani
- Department of Molecular and Human Genetics and
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas, USA
| | - Donna M. Muzny
- Department of Molecular and Human Genetics and
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas, USA
| | - Asbjørg Stray-Pedersen
- Norwegian National Unit for Newborn Screening, Division of Pediatric and Adolescent Medicine, Oslo, Norway
| | - Rachel E. Bradley
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, Wales
| | - Mo Moody
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, Wales
| | - Philip P. Connor
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, Wales
| | - Adrian G. Heaps
- Department of Virology and Immunology, North Cumbria University Hospitals, Carlisle, United Kingdom
| | - Colin Steward
- Department of Paediatric Haematology, Oncology and Bone Marrow Transplantation, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Pinaki P. Banerjee
- Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics
| | - Richard A. Gibbs
- Department of Molecular and Human Genetics and
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas, USA
| | - Malgorzata Borowiak
- Center for Cell and Gene Therapy, and
- Molecular and Cellular Biology Department, Baylor College of Medicine, Houston, Texas, USA
- Adam Mickiewicz University, Poznan, Poland
- McNair Medical Institute, Baylor College of Medicine, Houston, Texas, USA
| | - James R. Lupski
- Department of Pediatrics
- Department of Molecular and Human Genetics and
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas, USA
- Texas Children’s Hospital, Houston, Texas, USA
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, Wales
| | - Anja K. Bielinsky
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jordan S. Orange
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
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Ponsford MJ, Steven R, Bramhall K, Burgess M, Wijetilleka S, Carne E, McGuire F, Price CR, Moody M, Zouwail S, Tahir T, Farewell D, El-Shanawany T, Jolles SRA. Clinical and laboratory characteristics of clozapine-treated patients with schizophrenia referred to a national immunodeficiency clinic reveals a B-cell signature resembling common variable immunodeficiency (CVID). J Clin Pathol 2020; 73:587-592. [PMID: 32094276 PMCID: PMC7476264 DOI: 10.1136/jclinpath-2019-206235] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 01/05/2023]
Abstract
AIMS An association between antibody deficiency and clozapine use in individuals with schizophrenia has recently been reported. We hypothesised that if clozapine-associated hypogammaglobulinaemia was clinically relevant this would manifest in referral patterns. METHODS Retrospective case note review of patients referred and assessed by Immunology Centre for Wales (ICW) between January 2005 and July 2018 with extraction of clinical and immunological features for individuals with diagnosis of schizophrenia-like illness. RESULTS 1791 adult patients were assessed at ICW during this period; 23 patients had a psychiatric diagnosis of schizophrenia or schizoaffective disorder. Principal indications for referral were findings of low calculated globulin and immunoglobulins. Clozapine was the single most commonly prescribed antipsychotic (17/23), disproportionately increased relative to reported use in the general schizophrenia population (OR 6.48, 95% CI: 1.79 to 23.5). Clozapine therapy was noted in 6/7 (86%) of patients subsequently requiring immunoglobulin replacement therapy (IgRT). Marked reduction of class-switched memory B cells (CSMB) and plasmablasts were observed in clozapine-treated individuals relative to healthy age-matched controls. Clozapine duration is associated with CSMB decline. One patient discontinued clozapine, with gradual recovery of IgG levels without use of IgRT. CONCLUSIONS Our findings are consistent with enrichment of clozapine-treatment within schizophrenic individuals referred for ICW assessment over the last 13 years. These individuals displayed clinical patterns closely resembling the primary immunodeficiency common variable immunodeficiency, however appears reversible on drug cessation. This has diagnostic, monitoring and treatment implications for psychiatry and immunology teams and directs prospective studies to address causality and the wider implications for this patient group.
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Affiliation(s)
- Mark James Ponsford
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
- Tenovus Institute, Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - Rachael Steven
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Kathyrn Bramhall
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Mathew Burgess
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Sonali Wijetilleka
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Emily Carne
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Frances McGuire
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Colin R Price
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Mo Moody
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Soha Zouwail
- Department of Medical Biochemistry, University Hospital of Wales, Cardiff, UK
- Department of Medical Biochemistry, Medical School, Alexandria University, Alexandria, Egypt
| | - Tayyeb Tahir
- Liaison Psychiatry, University Hospital of Wales, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Tariq El-Shanawany
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Stephen R A Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
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Ponsford MJ, Steven R, Bramhall K, Burgess M, Wijetilleka S, Carne E, McGuire F, Price CR, Moody M, Zouwail S, Tahir T, Farewell D, El-Shanawany T, Jolles SRA. Clinical and laboratory characteristics of clozapine-treated patients with schizophrenia referred to a national immunodeficiency clinic reveals a B-cell signature resembling common variable immunodeficiency (CVID). J Clin Pathol 2020. [PMID: 32094276 DOI: 10.1136/jclinpath‐2019‐206235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS An association between antibody deficiency and clozapine use in individuals with schizophrenia has recently been reported. We hypothesised that if clozapine-associated hypogammaglobulinaemia was clinically relevant this would manifest in referral patterns. METHODS Retrospective case note review of patients referred and assessed by Immunology Centre for Wales (ICW) between January 2005 and July 2018 with extraction of clinical and immunological features for individuals with diagnosis of schizophrenia-like illness. RESULTS 1791 adult patients were assessed at ICW during this period; 23 patients had a psychiatric diagnosis of schizophrenia or schizoaffective disorder. Principal indications for referral were findings of low calculated globulin and immunoglobulins. Clozapine was the single most commonly prescribed antipsychotic (17/23), disproportionately increased relative to reported use in the general schizophrenia population (OR 6.48, 95% CI: 1.79 to 23.5). Clozapine therapy was noted in 6/7 (86%) of patients subsequently requiring immunoglobulin replacement therapy (IgRT). Marked reduction of class-switched memory B cells (CSMB) and plasmablasts were observed in clozapine-treated individuals relative to healthy age-matched controls. Clozapine duration is associated with CSMB decline. One patient discontinued clozapine, with gradual recovery of IgG levels without use of IgRT. CONCLUSIONS Our findings are consistent with enrichment of clozapine-treatment within schizophrenic individuals referred for ICW assessment over the last 13 years. These individuals displayed clinical patterns closely resembling the primary immunodeficiency common variable immunodeficiency, however appears reversible on drug cessation. This has diagnostic, monitoring and treatment implications for psychiatry and immunology teams and directs prospective studies to address causality and the wider implications for this patient group.
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Affiliation(s)
- Mark James Ponsford
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK .,Tenovus Institute, Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - Rachael Steven
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Kathyrn Bramhall
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Mathew Burgess
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Sonali Wijetilleka
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Emily Carne
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Frances McGuire
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Colin R Price
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Mo Moody
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Soha Zouwail
- Department of Medical Biochemistry, University Hospital of Wales, Cardiff, UK.,Department of Medical Biochemistry, Medical School, Alexandria University, Alexandria, Egypt
| | - Tayyeb Tahir
- Liaison Psychiatry, University Hospital of Wales, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Tariq El-Shanawany
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Stephen R A Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
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Ponsford M, Castle D, Tahir T, Robinson R, Wade W, Steven R, Bramhall K, Moody M, Carne E, Ford C, Farewell D, Williams P, El-Shanawany T, Jolles S. Clozapine is associated with secondary antibody deficiency. Br J Psychiatry 2018; 214:1-7. [PMID: 30259827 PMCID: PMC6429246 DOI: 10.1192/bjp.2018.152] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/20/2018] [Accepted: 07/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Schizophrenia affects 1% of the population. Clozapine is the only medication licensed for treatment-resistant schizophrenia and is intensively monitored to prevent harm from neutropenia. Clozapine is also associated with increased risk of pneumonia although the mechanism is poorly understood.AimsTo investigate the potential association between clozapine and antibody deficiency. METHODS Patients taking clozapine and patients who were clozapine-naive and receiving alternative antipsychotics were recruited and completed a lifestyle, medication and infection-burden questionnaire. Serum total immunoglobulins (immunoglobulin (Ig)G, IgA, IgM) and specific IgG antibodies to haemophilus influenzae type B, tetanus and IgG, IgA and IgM to pneumococcus were measured. RESULTS Immunoglobulins were all significantly reduced in the clozapine-treated group (n = 123) compared with the clozapine-naive group (n = 111). Odds ratios (ORs) for a reduction in clozapine:control immunoglobulin values below the fifth percentile were IgG, OR = 6.00 (95% CI 1.31-27.44); IgA, OR = 16.75 (95% CI 2.18-128.60); and IgM, OR = 3.26 (95% CI 1.75-6.08). These findings remained significant despite exclusion of other potential causes of hypogammaglobulinaemia. In addition, duration on clozapine was associated with decline in IgG. A higher proportion of the clozapine-treated group reported taking more than five courses of antibiotics in the preceding year (5.3% (n = 5) versus 1% (n = 1). CONCLUSIONS Clozapine use was associated with significantly reduced immunoglobulin levels and an increased proportion of patients using more than five antibiotic courses in a year. Antibody testing is not included in existing clozapine monitoring programmes but may represent a mechanistic explanation and modifiable risk factor for the increased rates of pneumonia and sepsis-related mortality previously reported in this vulnerable cohort.Declaration of interestS.J. has received support from CSL Behring, Shire, LFB, Biotest, Binding Site, Sanofi, GSK, UCB Pharma, Grifols, BPL SOBI, Weatherden, Zarodex and Octapharma for projects, advisory boards, meetings, studies, speaker and clinical trials.
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Affiliation(s)
- Mark Ponsford
- Immunology Specialist Registrar, Immunodeficiency Centre for Wales, University Hospital of Wales and Welsh Clinical Academic Trainee, Cardiff University, UK
| | - Daniel Castle
- Neurology Specialist Registrar, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Tayyeb Tahir
- Professor of Psychiatry, Department of Liaison Psychiatry, University Hospital of Wales, UK
| | - Rebecca Robinson
- Research Officer, Health and Care Research Wales, University Hospital of Wales, UK
| | - Wendy Wade
- Research Manager, Health and Care Research Wales, University Hospital of Wales, UK
| | - Rachael Steven
- Immunology Clinical Scientist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Kathryn Bramhall
- Immunology Biomedical Scientist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Mo Moody
- Immunology Biomedical Scientist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Emily Carne
- Immunology Clinical Nurse Specialist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Catherine Ford
- Mental Health Nurse, Community Mental Health Team, University Hospital of Wales, UK
| | - Daniel Farewell
- Reader, Division of Population Medicine, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, UK
| | - Paul Williams
- Consultant Immunologist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Tariq El-Shanawany
- Consultant Immunologist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Stephen Jolles
- Professor of Clinical Immunology, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
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Wijaya S, Harrison E, Moody M, Wilson C, Hughes-Davies L, Caldas C, Earl H, Baird R. Pneumocystis jiroveci pneumonia (PCP) in patients receiving weekly chemotherapy for metastatic breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.058] [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: 11/14/2022] Open
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Cheng H, Chen W, He H, Bradley E, Moody M. ENHANCING STUDENTS’ LEARNING THROUGH FLIPPED WORKSHOPS IN A REQUIRED 4TH YEAR GERIATRIC CLERKSHIP. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3670] [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: 11/14/2022] Open
Affiliation(s)
| | - W. Chen
- UVA, CHARLOTTESVILLE, Virginia
| | - H. He
- UVA, CHARLOTTESVILLE, Virginia
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Franks PJ, Moody M, Moffatt CJ, Patton J, Bradley L, Chaloner D, Stevens J. Quality of life in a trial of short stretch versus four-layer bandaging in the management of chronic venous ulceration. Phlebology 2016. [DOI: 10.1258/026835504323080371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To evaluate health-related quality of life (HRQoL) in a prospective randomized trial of patients suffering from venous ulceration comparing a generic four-layer elastic bandage (4LB) with a new cohesive short stretch bandage system (CSSB). Methods: Randomized prospective open parallel groups trial in community leg ulcer clinics within twelve trusts in England and Northern Ireland. Patients newly presenting for treatment suffering from chronic venous ulceration, with ankle brachial pressure index (ABPI) >0.8 were entered into the trial. Patients were asked to complete the Nottingham Health Profile (NHP) at entry, at end of trial period (withdrawal or healing), and at 24 weeks. Principal analysis was the comparison of final NHP scores using linear regression with baseline scores entered as a covariate. Results: In all, 154 of the 156 patients who entered the trial completed the initial questionnaire, with 139/154 (90.2%) patients completing at least one follow-up questionnaire. Improvements were noted for all scores after 24 weeks. The improvements were significantly greater in the 114 patients whose ulcers had healed compared with the 40 whose ulcers remained open in the domains of bodily pain (mean difference [d]=13.2, 95% CI 3.6-22.9, P =0.008), emotional reactions (d=10.5, 95% CI 2.8-18.1, P =0.007) and social isolation (d=8.5, 95% CI 1.2-15.9, P =0.024). There were similar mean scores between the 72 patients treated with the 4LB and the 82 patients treated with CSSB for all domains of the NHP, the largest adjusted difference favoured CSSB for energy (d=3.6, 95% CI-4.3-11.4, P =0.37). Conclusions: Patients suffering from leg ulceration show improvements in perceived health following effective ulcer management. The two bandage systems achieved similar improvements in perceived health over 24 weeks.
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Jolles S, Jones R, Ponsford MJ, Moody M, Selwood C, El-Shanawany T. Analysis of Specific Antibody Levels to Tetanus, Hib and Pneumococcus in Patients with Antibody Deficiency Receiving Immunoglobulin Replacement. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1246] [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: 10/24/2022]
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Heaps A, Carter S, Selwood C, Moody M, Unsworth J, Deacock S, Sumar N, Bansal A, Hayman G, El-Shanawany T, Williams P, Kaminski E, Jolles S. The utility of the ISAC allergen array in the investigation of idiopathic anaphylaxis. Clin Exp Immunol 2014; 177:483-90. [PMID: 24654858 DOI: 10.1111/cei.12334] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 12/13/2022] Open
Abstract
A diagnosis of idiopathic anaphylaxis following a detailed clinical assessment remains very challenging for patients and clinicians. Risk reduction strategies such as allergen avoidance are not possible. This study investigated whether the (ISAC) allergen array with 103 allergens would add diagnostic value in patients with idiopathic anaphylaxis. We extended the specific immunoglobulin (Ig)E testing in 110 patients with a diagnosis of idiopathic anaphylaxis from five UK specialist centres using ISAC arrays. These were divided into three groups: score I identified no new allergen sensitization beyond those known by previous assessment, score II identified new sensitizations which were not thought likely to explain the anaphylaxis and score III identified new sensitizations felt to have a high likelihood of being responsible for the anaphylaxis. A proportion (50%) of score III patients underwent clinical reassessment to substantiate the link to anaphylaxis in this group. The results show that 20% of the arrays were classified as score III with a high likelihood of identifying the cause of the anaphylaxis. A wide range of major allergens were identified, the most frequent being omega-5-gliadin and shrimp, together accounting for 45% of the previously unrecognized sensitizations. The ISAC array contributed to the diagnosis in 20% of patients with idiopathic anaphylaxis. It may offer additional information where a careful allergy history and follow-on testing have not revealed the cause of the anaphylaxis.
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Affiliation(s)
- A Heaps
- Department of Immunology, University Hospital of Wales, Cardiff, UK
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Jolles S, Borrell R, Zouwail S, Heaps A, Sharp H, Moody M, Selwood C, Williams P, Phillips C, Hood K, Holding S, El Shanawany T. Calculated globulin (CG) as a screening test for antibody deficiency. Clin Exp Immunol 2014; 177:671-8. [PMID: 24784320 PMCID: PMC4137851 DOI: 10.1111/cei.12369] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2014] [Indexed: 01/15/2023] Open
Abstract
Calculated globulin (total protein - albumin) is usually tested as part of a liver function test profile in both primary and secondary care and determines the serum globulin concentration, of which immunoglobulins are a major component. The main use hitherto of calculated globulin is to detect paraproteins when the level is high. This study investigated the potential to use low levels of calculated globulin to detect antibody deficiency. Serum samples with calculated globulin cut-off < 18 g/l based on results of a pilot study were collected from nine hospitals in Wales over a 12-month period. Anonymized request information was obtained and the samples tested for immunoglobulin levels, serum electrophoresis and, if appropriate, immunofixation. A method comparison for albumin measurement using bromocresol green and bromocresol purple was undertaken. Eighty-nine per cent (737 of 826) samples had an immunoglobulin (Ig)G level of < 6 g/l using the bromocresol green methodology with a cut-off of < 18 g/l, and 56% (459) had an IgG of < 4 g/l. Patients with both secondary and primary antibody deficiency were discovered and serum electrophoresis and immunofixation showed that 1·2% (10) had previously undetected small paraproteins associated with immune-paresis. Using bromocresol purple, 74% of samples had an IgG of < 6 g/l using a cut-off of < 23 g/l. Screening using calculated globulin with defined cut-off values detects both primary and secondary antibody deficiency and new paraproteins associated with immune-paresis. It is cheap, widely available and under-utilized. Antibody-deficient patients have been discovered using information from calculated globulin values, shortening diagnostic delay and time to treatment with immunoglobulin replacement therapy.
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Affiliation(s)
- S Jolles
- Department of Immunology, University Hospital of Wales, Cardiff, UK
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14
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Yang G, Holl T, Nojima T, Verkoczy L, Moody M, Haynes B, Kitamura D, Kelsoe G. The role of immunological tolerance in humoral responses to the 2F5 epitope of HIV-1 (P6183). The Journal of Immunology 2013. [DOI: 10.4049/jimmunol.190.supp.118.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Abstract
Many human antibodies (Ab), e.g., 2F5, that neutralize multiple clades of HIV-1 are self-reactive. We previously identified kynureninase (KYNU) as the primary self-antigen recognized by 2F5, suggesting that generation of Ab to the 2F5 epitope of HIV-1 may be proscribed by immune tolerance, a notion supported by impaired B-cell development in mice expressing the 2F5 VH and VL regions (2F5 KI). Here, we use Nojima-Kitamura single B-cell cultures to determine the pre- and post-tolerance Ab repertoire to HIV-1. All cultured B cells differentiate into IgG-secreting cells, including autoreactive cells normally subject to tolerization in vivo. The pre-tolerance compartment (small pre-B) from 2F5 KI mice represents cells that express the 2F5 V(D)J rearrangements, and maintain reactivity to HIV-1 gp41, KYNU, and cardiolipin. Mature, post-tolerance B cells from 2F5 KI mice, however, are purged of gp41- and KYNU-reactivity, but retain cardiolipin-binding, and sequence analysis reveals extensive light-chain editing. This loss of HIV-reactivity is followed in unmodified C57BL/6 mice, where B cells expressing 2F5-like BCR are lost during maturation in the bone marrow, as determined by binding to 2F5 epitope. Our results demonstrate that tolerance of the 2F5 epitope is driven by specific reactivity to KYNU, but not general cross-reactivity to cardiolipin and offer a mechanism for determining how immunological tolerance impairs humoral responses to HIV-1.
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Affiliation(s)
| | - T. Holl
- 1Immunology, Duke Univ., Durham, NC
| | | | | | - M. Moody
- 2Duke Human Vaccine Inst., Durham, NC
| | - Barton Haynes
- 1Immunology, Duke Univ., Durham, NC
- 2Duke Human Vaccine Inst., Durham, NC
| | - Daisuke Kitamura
- 3Research Institute for Biological Sciences, Tokyo University of Science, Noda, Japan
| | - Garnett Kelsoe
- 1Immunology, Duke Univ., Durham, NC
- 2Duke Human Vaccine Inst., Durham, NC
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15
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Pollara J, Bonsignori M, Moody M, Alam M, Liao H, Hwang K, Pickeral J, Kappes J, Ochsenbauer C, Soderberg K, Gurley TC, Kozink DM, Marshall DJ, Whitesides JF, Montefiori D, Robinson JE, Kaewkungwal J, Nitayaphan S, Pitisuttithum P, Rerks-Ngarm S, Kim J, Michael N, Tomaras G, Haynes BF, Ferrari G. Vaccine-induced ADCC-mediating antibodies target unique and overlapping envelope epitopes. Retrovirology 2012. [PMCID: PMC3441773 DOI: 10.1186/1742-4690-9-s2-o39] [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: 11/25/2022] Open
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16
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Moody M, Drinker MS, Gurley TC, Amos JD, Eudailey JA, Armand LC, Parks R, Gray ES, Morris L, Finzi A, Yang X, Sodroski J, Liao H, Tomaras GD, Montefiori DC, Haynes BF. Isolation of a clonal lineage of IgA broadly neutralizing antibodies from a chronically infected Tanzanian subject. Retrovirology 2012. [PMCID: PMC3441298 DOI: 10.1186/1742-4690-9-s2-o35] [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: 11/19/2022] Open
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17
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Moody M, Trama AM, Bonsignori M, Tsao C, Drinker MS, Gurley TC, Amos JD, Eudailey JA, Armand LC, Parks R, Lloyd KE, Wang S, Seo K, Lee J, Jackson KJ, Hoh R, Pham T, Roskin KM, Boyd SD, Fire AZ, Gray ES, Morris L, Liao H, Tomaras GD, Kepler TB, Kelsoe G, Haynes BF. Antibody lineages with evidence of somatic hypermutation persisting for >4 years in a South African subject with broad neutralizing activity. Retrovirology 2012. [PMCID: PMC3442051 DOI: 10.1186/1742-4690-9-s2-p85] [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: 11/30/2022] Open
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18
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Mukesh M, Barnett G, Qian W, Wilkinson J, Parashar D, Twyman N, Wishart G, Moody M, Wilson C, Coles C. OC-0369 QUALITY OF LIFE IN EARLY BREAST CANCER: RESULTS FROM CAMBRIDGE BREAST INTENSITY-MODULATED RADIOTHERAPY TRIAL. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70708-9] [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: 10/28/2022]
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Su KY, McWilliams L, Liang X, Floyd S, Amos J, Moody M, Kuraoka M, Kelsoe G. CD27 expression patterns on human developing B cells in fetal and adult tissues (111.27). The Journal of Immunology 2012. [DOI: 10.4049/jimmunol.188.supp.111.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
CD27 is an accepted marker for memory B cells in humans. However, CD27 expression was recently demonstrated on substantial populations of human B cells in cord blood and fetal liver (FL), tissues that contain few if any memory B lymphocytes. In addition, CD27 expression was recently proposed to identify natural B cells, the human counterpart of murine B-1 B cells. These observations led us to explore the characteristics of human, CD27+ B cells, and particularly developing B cells. Comparing B cells from FL, cord blood, and adult bone marrow (BM), we found CD27 expression as early as the pro-B cell stage. Moreover, the frequency of CD27+ pro-B cells was higher in FL than in BM. Expression of TdT, RAG1 and VpreB in CD27+ pro-B cells was similar to conventional, CD27- pro-B cells, confirming their identity as B-lineage progenitors. Developmentally immature CD27- and CD27+ B cells showed no significant differences in VH gene usage, VH mutation frequencies, or CDRH3 length, excluding the possibility of contamination by memory B cells. Interestingly, when placed in an in vitro culture system optimized to support the maturation of human fetal pro-B cells and murine B-1 B cells, CD27+ pro-B cells differentiated into IgM+ immature and transitional B cells significantly more efficiently than did autochthonous CD27- pro-B cells. In conclusion, we have demonstrated functional CD27+ pro-B cells in FL and BM that may identify a predominantly fetal, B-cell lineage in humans.
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Affiliation(s)
- Kuei-Ying Su
- 1Immunology, Duke University Medical Center, Durham, NC
| | | | - Xiaoe Liang
- 1Immunology, Duke University Medical Center, Durham, NC
| | - Serina Floyd
- 3Obstetrics & Gynecology, Duke University Medical Center, Durham, NC
| | - Joshua Amos
- 2Pediatrics, Duke University Medical Center, Durham, NC
- 4Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC
| | - M. Moody
- 2Pediatrics, Duke University Medical Center, Durham, NC
- 4Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC
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20
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McWilliams L, Su K, Liang X, Floyd S, Amos J, Moody M, Kelsoe G, Kuraoka M. CD27+ Developing B Cells are Common in Human Fetal Liver. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.906] [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: 10/14/2022]
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21
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Abstract
A diffusion model for the joint action of genotype-dependent migration and genotype-independent population regulation is derived and investigated. The diploid, monoecious population occupies a finite chain of equally spaced colonies; generations are discrete and nonoverlapping; mating is random in each colony. A boundary-value problem is deduced for the gene frequencies at a multiallelic locus in the absence of mutation, selection, and random drift. This problem is studied for two alleles and constant and uniform population density and drift and diffusion coefficients. All equilibria are shown to be monotone, and explicit conditions for a protected polymorphism are established. Two examples of asymptotically stable clines are presented. It is demonstrated that genotype dependence of the mean displacements is necessary to produce or maintain spatial differentiation of gene frequencies.
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Affiliation(s)
- T Nagylaki
- Department of Biophysics and Theoretical Biology, The University of Chicago, 920 East 58th Street, Chicago, Illinois 60637
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22
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Liao L, Chen X, Dixon A, Munshaw S, Moody M, Zhang R, Nagel A, Foulger A, Derosa K, Parks R, Mcparland M, Whitesides J, Marshall D, Amos J, Yang Y, Gao F, Shea T, Margolis D, Shaw G, Markowitz M, Denny T, Kelsoe G, Tomaras G, Kepler T, Haynes B. P04-45. Characterization of the plasma cell repertoire in acute HIV-1 infection (AHI). Retrovirology 2009. [PMCID: PMC2767977 DOI: 10.1186/1742-4690-6-s3-p73] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Pollard LC, Murray J, Moody M, Stewart EJ, Choy EHS. A randomised, double-blind, placebo-controlled trial of a recombinant version of human alpha-fetoprotein (MM-093) in patients with active rheumatoid arthritis. Ann Rheum Dis 2006; 66:687-9. [PMID: 17114190 PMCID: PMC1954634 DOI: 10.1136/ard.2006.059436] [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: 12/21/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) tends to remit during pregnancy, with more patients achieving remission in the third trimester, coinciding with an increase in levels of alpha-fetoprotein (AFP). In vitro and animal studies have shown that AFP has immunomodulatory properties. MM-093 is a non-glycosylated, recombinant version of human AFP. OBJECTIVE To assess the safety, tolerability and clinical effects of MM-093 during a 12-week, randomised, double-blind, placebo-controlled study. METHODS 12 patients with RA, who had active disease and were on stable doses of methotrexate, received weekly subcutaneous injections of placebo or 21 mg of MM-093. Assessments were carried out at baseline and weekly thereafter. RESULTS Baseline characteristics were similar in both groups. There was one dropout in the placebo group, due to flare of disease. Treatment with MM-093 was well tolerated. No serious adverse event was observed. By day 85, MM-093 produced a significant mean improvement from baseline in Disease Activity Score 28 (DAS28; 0.913 vs 0.008, p = 0.033) and patient's global assessment (28.9% vs -36.3%, p = 0.02) compared with placebo. CONCLUSION This is the first randomised, controlled trial of MM-093, a recombinant version of human AFP, in patients with RA. MM-093 was well tolerated. Evidence of efficacy was observed, suggesting that MM-093 may have therapeutic potential in RA.
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Affiliation(s)
- L C Pollard
- Sir Alfred Baring Garrod Clinical Trials Unit, Academic Department of Rheumatology, King's College London, London SE5 9RJ, UK
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25
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Yavrouian E, Lopez B, Moody M, Cunningham M, Starnes V. Mitral Valve Repair with Ring Annuloplasty: Ischemic versus Nonischemic Mitral Regurgitation. J Investig Med 2006. [DOI: 10.1177/108155890605401s111] [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: 01/09/2023]
Affiliation(s)
- E.J. Yavrouian
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - B. Lopez
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - M. Moody
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - M.J. Cunningham
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - V.A. Starnes
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
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26
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Yavrouian EJ, Lopez B, Moody M, Cunningham MJ, Starnes VA. 228 MITRAL VALVE REPAIR WITH RING ANNULOPLASTY: ISCHEMIC VERSUS NONISCHEMIC MITRAL REGURGITATION. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.227] [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: 11/18/2022]
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27
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Semmes OJ, Cazares LH, Ward MD, Qi L, Moody M, Maloney E, Morris J, Trosset MW, Hisada M, Gygi S, Jacobson S. Discrete serum protein signatures discriminate between human retrovirus-associated hematologic and neurologic disease. Leukemia 2005; 19:1229-38. [PMID: 15889159 DOI: 10.1038/sj.leu.2403781] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [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: 11/10/2022]
Abstract
The human T-cell leukemia virus type I (HTLV-I) is the causative agent for adult T-cell leukemia (ATL) and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Approximately 5% of infected individuals will develop either disease and currently there are no diagnostic tools for early detection or accurate assessment of disease state. We have employed high-throughput expression profiling of serum proteins using mass spectrometry to identify protein expression patterns that can discern between disease states of HTLV-I-infected individuals. Our study group consisted of 42 ATL, 50 HAM/TSP, and 38 normal controls. Spectral peaks corresponding to peptide ions were generated from MS-TOF data. We applied Classification and Regression Tree analysis to build a decision algorithm, which achieved 77% correct classification rate across the three groups. A second cohort of 10 ATL, 10 HAM and 10 control samples was used to validate this result. Linear discriminate analysis was performed to verify and visualize class separation. Affinity and sizing chromatography coupled with tandem mass spectrometry was used to identify three peaks specifically overexpressed in ATL: an 11.7 kDa fragment of alpha trypsin inhibitor, and two contiguous fragments (19.9 and 11.9 kDa) of haproglobin-2. To the best of our knowledge, this is the first application of protein profiling to distinguish between two disease states resulting from a single infectious agent.
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Affiliation(s)
- O J Semmes
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA, USA.
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28
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Abstract
As part of a major project to develop a primary care trust-based framework of lymphoedema management, the educational needs of community nurses regarding the care of patients with lymphoedema were assessed using focus groups and questionnaires. Community nurses assessed their current knowledge and skill in the care and management of patients with lymphoedema as adequate or poor. They were concerned about their lack of knowledge and skill and were uncertain regarding their role relative to other professions involved in the care of this patient group. At the same time they understood the importance of their role in providing ongoing care, recognizing problems, offering sound advice and referring on to a specialist practitioner when necessary. Any education provision that prepares community nurses for their role within a framework of lymphoedema management should emphasize the important place they occupy in providing long-term care for this patient group.
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Affiliation(s)
- P A Morgan
- Centre for Research and Implementation of Clinical Practice (CRICP), Faculty of Health and Human Sciences, Thames Valley University, London
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29
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Affiliation(s)
- S El-Hadi
- University Hospital of Wales, Heath Park, Cardiff CF4 4XW, Wales, UK.
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30
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Abstract
A crucial role in the regulation of epithelial chloride secretion is played by the phosphoinositide PtdIns(3,4,5)P3 . Membrane-permeant derivatives of this and other naturally occurring phosphoinositides have been synthesized. These derivatives, which can be bioactivated, were used in investigations on nasal epithelia of patients suffering from cystic fibrosis.
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Affiliation(s)
- C Dinkel
- Institut für Organische Chemie, Universität Bremen, UFT Leobener Strasse, 28359 Bremen, Germany
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31
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Ysseldyke J, Thurlow M, Bielinski J, House A, Moody M, Haigh J. The relationship between instructional and assessment accommodations in an inclusive state accountability system. J Learn Disabil 2001; 34:212-220. [PMID: 15499876 DOI: 10.1177/002221940103400302] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We investigated the kinds of instructional and assessment accommodations students with disabilities receive, and the extent to which instructional accommodations match assessment accommodations. Most students who had IEPs in specific content areas received instructional accommodations in those areas, and there were no differences by disability type. We provide data on the specific types of accommodations used. Overall, students' assessment accommodations matched their instructional accommodations, though many students received testing accommodations that had not been received in instruction. Implications are discussed for IEP teams who make decisions about instructional and assessment accommodations.
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Affiliation(s)
- J Ysseldyke
- College of Education and Human Development, University of Minnesota, Minneapolis 55455, USA
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Blagden S, Corrie P, McAdam K, Pam I, Moody M. Study to compare tolerability of standard versus modified mayo regimen 5-fluorouracil. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81618-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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33
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Harrison GM, Bennett AJ, Moody M, Read GF, Williams PE. Use of formalin-fixed, propidium iodide-stained human leukocytes as a standard for enumerating CD4+ T lymphocytes in a single-platform assay. Clin Diagn Lab Immunol 2001; 8:397-401. [PMID: 11238228 PMCID: PMC96069 DOI: 10.1128/cdli.8.2.397-401.2001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A new, inexpensive method is described that enables lymphocytes to be enumerated very precisely. Normal leukocytes were simultaneously stained and fixed with a propidium iodide-paraformaldehyde solution. The preparation obtained (CellBeads) was used as an internal standard for cell enumeration by flow cytometry and was stable at 4 degrees C for at least 60 days. Unlike synthetic beads, the CellBeads behaved similarly to normal cells during red blood cell lysis and cell washing procedures. When known numbers of CellBeads were added to whole-blood samples and the numbers of CellBeads and lymphocytes were determined, highly reproducible and accurate enumerations were obtained-far more so than when synthetic beads were used. This inexpensive method is suitable for routine use.
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Affiliation(s)
- G M Harrison
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
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34
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Abstract
OBJECTIVE The purpose of this study was done to compare the anti-spectrin autoantibody levels in the parotid saliva of Sjögren's syndrome patients and in the parotid saliva of healthy control subjects. METHODS The salivary anti-spectrin autoantibody levels of 20 Sjögren's patients and of 20 healthy controls were compared by means of the slot blot immunoassay and the alkaline phosphatase method. RESULTS Various anti-spectrin autoantibody levels were detected in the saliva of both patients and controls. The color intensity of the blots was scored on a scale of 1 to 3. The scores were deemed to indicate the anti-spectrin autoantibody levels in saliva (1 = low, 2 = moderate, and 3 = high). The Mann-Whitney U test did not reveal a significant difference in the anti-spectrin autoantibody levels of patients and the anti-spectrin autoantibody levels of controls (P > or = .31). These results do not support a pathologic role for anti-spectrin autoantibody in Sjögren's syndrome. CONCLUSIONS The overall result of this study substantiates that anti-spectrin autoantibodies occur naturally in saliva. Their role in immune surveillance or pathology is not clear at present.
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Affiliation(s)
- M Moody
- Baylor College of Dentistry, Texas A & M University, Dallas 75246, USA
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35
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Masago R, Aiba-Masago S, Talal N, Zuluaga FJ, Al-Hashimi I, Moody M, Lau CA, Peck AB, Brayer J, Humphreys-Beher MG, Dang H. Elevated proapoptotic Bax and caspase 3 activation in the NOD.scid model of Sjögren's syndrome. Arthritis Rheum 2001; 44:693-702. [PMID: 11263785 DOI: 10.1002/1529-0131(200103)44:3<693::aid-anr119>3.0.co;2-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Salivary gland epithelial cells in patients with Sjögren's syndrome (SS) and in NOD and NODscid mice express Fas and Fas ligand, and these cells die from apoptosis. To elucidate the intracellular molecular mechanisms responsible for this salivary gland epithelial cell apoptosis, expression of the Bcl-2 family of proteins (Bcl-2, Bcl-xL, Bax) and caspase (caspases 3 and 8) was studied in young (ages 8-10 weeks) and old (ages 17-28 weeks) NOD and NOD.scid mice. METHODS Sections of frozen salivary gland tissue were obtained from NOD and NOD.scid mice and from the lip biopsy material of SS patients. Immunohistochemistry or Western blot analysis was performed to assess the apoptotic-associated proteins. RESULTS Levels of Bax and caspase 3 were elevated in the epithelial cells of glands from old NOD mice, but not in those from young NOD mice. In contrast, epithelial cells from both young and old NOD.scid mice exhibited strong expression of Bax and caspase 3. Western blot analysis showed that the activated form of caspase 3 was increased 2-5-fold in the glands from old NOD, old NOD.scid, and young NOD.scid mice compared with those from young NOD mice. Caspase 3 was also significantly elevated (P < 0.01) in SS patients whose focus scores were grade 3 or 4. In the SS patients' biopsy tissue and in the mouse glands, cells with fragmented DNA were positive for caspase 3. CONCLUSION These results demonstrate that salivary gland epithelial cells in NOD and NOD.scid mice overexpress the proapoptotic molecules Bax and caspase 3. Bax could be the gene responsible for initiation of caspase activation, epithelial cell destruction, and lymphocyte glandular localization in SS.
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Affiliation(s)
- R Masago
- The University of Texas Health Science Center, San Antonio, USA
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36
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Moody M. Why nurses end up in court. Nurs Times 2001; 97:24-6. [PMID: 11954214] [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: 02/24/2023]
Affiliation(s)
- M Moody
- Centre for Research and Implementation of Clinical Practice, Thames Valley University
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Witcher R, Harbin K, Moody M. Adequate physician documentation can help prevent payment errors. Doctors, hospital coders can partner to reduce mistakes. J Ark Med Soc 2000; 96:432-4. [PMID: 10846343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Abstract
A postal survey of pharmacists in a random sample of community pharmacies in Great Britain was carried out to ascertain the factors which influenced their decisions when recommending a product for Over The Counter (OTC) sale. Six categories of condition which regularly present in community pharmacies were selected and the pharmacists were asked to state which first line product they would recommend for each condition, in an uncomplicated situation with no other relevant problems. Of the 1138 questionnaires sent, 635 were suitable for analysis giving a response rate of 56.7%. The recommendations were found to be appropriate in 99.7% of cases. Factors which had the greatest influence on product selection were active ingredients, evidence of product efficacy, ease of use by patient and patient characteristics such as age and concurrent medication. Economic factors such as profit, pressures of excess stock and product promotion by sales representatives were shown to have a significantly greater influence on proprietor pharmacists than the other categories of pharmacist. The results of this study suggest that in the majority of cases pharmacists' decisions on OTC drug therapy are based on clinical and patient factors and whilst commercial factors may be involved they do not compromise the quality of the recommendations.
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Affiliation(s)
- E Kennedy
- School of Pharmacy, Robert Gordon University, Aberdeen
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Moody M. Relieve the pressure. Elder Care 1999; 11:12-4. [PMID: 10614268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Abstract
Fifty-two patients (26 in each group) were recruited into this randomized, comparative, controlled trial of Rosidal K short-stretch compression bandage and SurePress long-stretch compression bandage in the treatment of venous leg ulcers. Patients were monitored for a maximum of 12 weeks. Each patient was seen weekly by a research nurse, who recorded the study variables. The mean percentage reduction in the wound bed surface area during the study period was 52% in the SurePress group and 73% in the Rosidal K group. Eight patients in each group saw their ulcers heal within the study period. The average limb volume reduction, based on the first 4 weeks of data collection, was 2.3 cm for those in the Rosidal K group and 3.9 cm in the SurePress group. Ulcer size increased in six patients allocated to SurePress bandages and in four patients allocated to Rosidal K bandages.
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Abstract
STM Healthcare is a division of the Recticel Group which has been actively involved in the production and use of polyurethane foams for the past 40 years, and is now one of Europe's leading manufacturers of polyurethane foam for insulation, packaging, filtration, aerospace, the automotive and furniture industries, domestic and specialist bedding and seating products. STM Healthcare is able to draw upon the wealth of experience and expertise of the manufacturing facilities, enabling products to be developed using the latest environmentally friendly specification foams best suited to the requirements of pressure-reduction technology. All STM Healthcare mattresses, cushions and Linknurse mattresses are manufactured with Safeguard combustion modified high resilience foams. (Linknurse is a licensed product name; products are manufactured by Recticel and distributed by STM).
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Bell CR, Persad R, Moody M. Orthotopic bladder substitution by detubularized sigmoid using a new method of neovesicourethral anastomosis. Br J Urol 1998; 82:313-4. [PMID: 9722783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Thornton CG, MacLellan KM, Brink TL, Lockwood DE, Romagnoli M, Turner J, Merz WG, Schwalbe RS, Moody M, Lue Y, Passen S. Novel method for processing respiratory specimens for detection of mycobacteria by using C18-carboxypropylbetaine: blinded study. J Clin Microbiol 1998; 36:1996-2003. [PMID: 9650951 PMCID: PMC104967 DOI: 10.1128/jcm.36.7.1996-2003.1998] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/1997] [Accepted: 01/07/1998] [Indexed: 02/08/2023] Open
Abstract
A novel method for processing respiratory specimens to improve culture and acid-fast staining of mycobacteria is introduced. This new method utilized N,N-dimethyl-N-(n-octadecyl)-N-(3-carboxypropyl)ammonium inner salt (Chemical Abstract Service no. 78195-27-4), also known as C18-carboxypropylbetaine (CB-18). In a blinded, five-center study, CB-18-based processing was compared to the standard method combining NALC and NaOH (NALC/NaOH). A total of 573 respiratory specimens were tested. Individual specimens were split approximately equally; the host institutions processed half of each specimen by the NALC/NaOH method, while the other half was processed with CB-18 at Quest Diagnostics--Baltimore. A total of 106 specimens were culture positive for acid-fast bacilli (AFB). Replacement of the primary decontamination agent with CB-18 caused changes in all diagnostic parameters. Aggregate culture sensitivity improved by approximately 43% (P < 0.01), and smear sensitivity improved by approximately 58% (P < 0.01). The sensitivity of smear relative to that of M. tuberculosis isolates exceeded 93% (P < 0.01) when specimens were processed with CB-18. The average times to a positive result were reduced by 7.3 days in liquid culture (P < 0.01) and 5.3 days on solid media (P < 0.05); however, the CB-18 method had a 20.8% contamination rate in liquid culture versus a rate of approximately 7.5% with NALC/NaOH processing. There were also unusual reductions in liquid culture sensitivity and smear specificity among CB-18-processed specimens. The characteristics of the latter parameters suggested that refinement of the CB-18 processing method should allow further improvements in culture sensitivity. This study showed that the CB-18 method has the potential to improve both smear and culture detection for these important human pathogens.
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Affiliation(s)
- C G Thornton
- Department of Molecular Biology and Genetics, Quest Diagnostics--Baltimore, Maryland 21227, USA.
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Abstract
The eradication of pungent wound odour is one of the most challenging problems for health professionals involved in wound management. The presence of malodour can cause immeasurable distress for the patient and his/her family, making many sufferers' lives one of self-imposed exile. Clinical research using topical metronidazole over the past 20 years clearly indicates that metronidazole is effective against the anaerobic bacteria that cause these foul and distressing odours. Seton Healthcare produces a commercial preparation called Metrotop--a topical metronidazole gel which is available on prescription.
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Affiliation(s)
- M Moody
- Salisbury Healthcare NHS Trust
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Moody M. The Improtec range of pressure-relieving mattresses and overlays. Br J Nurs 1998; 7:167-70. [PMID: 9536676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Increasing knowledge of the pathophysiology of pressure sores influences our thoughts on the best methods of meeting the Department of Health (1993) target of a 5-10% reduction in the incidence of pressure sores. Elderly people are one of the most at-risk groups as they tend to suffer disproportionately from neurological and cardiovascular disease. Patients suffering with shock, dehydration and prolonged hypothermia due to some traumatic event feature high on the at-risk category, especially if the patient lies for any period of time on an unprotected accident and emergency (A&E) or theatre trolley. Spenco Healthcare International has developed Improtec, a specially designed range of high-quality, cost-effective products for use in (A&E) units, treatment rooms, operating theatres, hospital wards and the community.
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Affiliation(s)
- M Moody
- Salisbury Healthcare NHS Trust
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Moody M. Intermittent sequential compression therapy in lower limb disorders. Prof Nurse 1997; 12:423-425. [PMID: 9128699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The development of more compact equipment and multi-chambered compression garments has extended the use of intermittent compression therapy in the treatment of venous insufficiency and venous ulcers, lymphoedema and lipodermatosclerosis. Further research into the therapeutic effects of this therapy is required.
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Affiliation(s)
- M Moody
- Salisbury Healthcare NHS Trust
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Moody M. Problem wounds: a nursing challenge (continuing education credit). Nurs Stand 1995; 9:3-8; quiz 10-2. [PMID: 7718447 DOI: 10.7748/ns.9.25.3.s56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Day A, Dombranski S, Farkas C, Foster C, Godin J, Moody M, Morrison M, Tamer C. Managing sacral pressure ulcers with hydrocolloid dressings: results of a controlled, clinical study. Ostomy Wound Manage 1995; 41:52-4, 56, 58 passim. [PMID: 7598778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
One-hundred and three patients with Stage II and III sacral pressure ulcers were enrolled in a prospective, controlled, multi-center clinical study to evaluate and compare dressing performance, safety and efficacy. Fifty-two patients were randomized to treatment with a triangle-shaped hydrocolloid border dressing and 51 patients were randomized to a different, oval shape, hydrocolloid dressing. The majority of patients (70 percent) utilized a pressure reducing mattress or bed. Most ulcers were Stage II, had existed for < 1 month and exhibited no change utilizing previous treatments. Patients and wounds were similarly distributed among treatment groups. Patients in the oval dressing group were more likely to exhibit a product related adverse reaction resulting in discontinuation of treatment as compared to patients treated with the triangle border dressing (p = 0.057, Fisher's Exact Test). Wear time was longest for wounds dressed with the triangle dressing applied point down. Incontinence reduced the interval between dressing changes in both groups. Healing was more likely to occur in wounds dressed with the triangle border dressing. These ulcers showed a greater reduction in ulcer width as compared to wounds dressed with the oval dressing (p < 0.03, Fisher's Exact Test).
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Blondel O, Bell GI, Moody M, Miller RJ, Gibbons SJ. Creation of an inositol 1,4,5-trisphosphate-sensitive Ca2+ store in secretory granules of insulin-producing cells. J Biol Chem 1994; 269:27167-70. [PMID: 7961623] [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: 01/28/2023] Open
Abstract
A rapid rise in the cytosolic free Ca2+ concentration due to influx of extracellular Ca2+ or mobilization from intracellular stores is the primary trigger for exocytosis from secretory cells. Our understanding as to the precise role of Ca2+ mobilization has been complicated by the presence of several types of Ca2+ stores in most cells. We now demonstrate that overexpression of the type 3 inositol 1,4,5-trisphosphate (IP3) receptor in insulin-secreting beta TC-3 cells results in the creation of a unique IP3-sensitive Ca2+ pool, restricted to the insulin secretory granules of these cells.
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Affiliation(s)
- O Blondel
- Howard Hughes Medical Institute, University of Chicago, Illinois 60637
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Blondel O, Bell GI, Moody M, Miller RJ, Gibbons SJ. Creation of an inositol 1,4,5-trisphosphate-sensitive Ca2+ store in secretory granules of insulin-producing cells. J Biol Chem 1994. [DOI: 10.1016/s0021-9258(18)46962-1] [Citation(s) in RCA: 17] [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: 10/22/2022] Open
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