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Hunt R, Dagnan D, Muncer S, Copping L. An investigation into the factor structure of the Health of the Nation Outcome Scales for People with Learning Disabilities. J Intellect Disabil Res 2023; 67:1113-1123. [PMID: 37530203 DOI: 10.1111/jir.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) is one of the most used outcome measures in learning disability services in the United Kingdom. There is relatively little known of the psychometric properties of the scales. METHOD A data set of HoNOS-LD scales from 571 people with learning disabilities was randomly split into two halves. Exploratory Mokken analysis was applied to the first dataset, and confirmatory scale factor analysis was applied to the second dataset to test the fit of scale structures. RESULTS Two-factor and three-factor solutions were explored in the Mokken analysis, with the three-factor option having somewhat better characteristics. One-factor, three-factor and seven-factor solutions were explored using confirmatory factor analysis; a three-factor solution with items 8, 16, 17 and 18 used separately offers the best characteristics. CONCLUSIONS The HoNOS-LD is best conceptualised as consisting of three scales, accounting for 14 items that can be labelled as 'Cognitive and Physical Functioning', 'Behaviour and Mood Disturbances' and 'Functional Difficulties'.
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Affiliation(s)
- R Hunt
- Department of Clinical Psychology, Tees, Esk & Wear Valley NHS Foundation Trust, Darlington, UK
| | - D Dagnan
- Community Learning Disability Services, Cumbria, Northumberland Tyne & Wear NHS Foundation Trust and University of Cumbria, Workington, UK
| | - S Muncer
- Department of Psychology, Durham University, Durham, UK
| | - L Copping
- Department of Psychology, Teesside University, Middlesbrough, UK
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Hunt R, Peiris S, Weber N. Bayesian estimation of Gegenbauer processes. J STAT COMPUT SIM 2022. [DOI: 10.1080/00949655.2022.2138883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- R. Hunt
- School of Mathematics and Statistics, University of Sydney, Sydney, Australia
| | - S. Peiris
- School of Mathematics and Statistics, University of Sydney, Sydney, Australia
| | - N. Weber
- School of Mathematics and Statistics, University of Sydney, Sydney, Australia
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Hunt R, Cable J, Ellison A. Daily patterns in parasite processes: diel variation in fish louse transcriptomes. Int J Parasitol 2022; 52:509-518. [PMID: 35533730 DOI: 10.1016/j.ijpara.2022.04.001] [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: 12/15/2021] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/05/2022]
Abstract
Parasites, similar to all other organisms, time themselves to environmental cues using a molecular clock to generate and maintain rhythms. Chronotherapeutic (timed treatment) techniques based on such rhythms offer great potential for improving control of chronic, problematic parasites. Fish lice are a key disease threat in aquaculture, with current control insufficient. Assessing the rhythmicity of fish lice transcriptomes offers not only insight into the viability of chronotherapy, but the opportunity to identify new drug targets. Here, for the first known time in any crustacean parasite, diel changes in gene transcription are examined, revealing that approximately half of the Argulus foliaceus annotated transcriptome displays significant daily rhythmicity. We identified rhythmically transcribed putative clock genes including core clock/cycle and period/timeless pairs, alongside rhythms in feeding-associated genes and processes involving immune response, as well as fish louse drug targets. A substantial number of gene pathways showed peak transcription in hours immediately preceding onset of light, potentially in anticipation of peak host anti-parasite responses or in preparation for increased feeding activity. Genes related to immune haemocyte activity and chitin development were more highly transcribed 4 h post light onset, although inflammatory gene transcription was highest during dark periods. Our study provides an important resource for application of chronotherapy in fish lice; timed application could increase efficacy and/or reduce dose requirement, improving the current landscape of drug resistance and fish health while reducing the economic cost of infection.
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Affiliation(s)
- R Hunt
- School of Biosciences, Cardiff University, Cardiff CF10 3AX, United Kingdom
| | - J Cable
- School of Biosciences, Cardiff University, Cardiff CF10 3AX, United Kingdom
| | - A Ellison
- School of Natural Sciences, Bangor University, Deiniol Road, Bangor, Gwynedd, LL57 2UW, United Kingdom.
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Singh U, Castle J, Greenhalgh S, Hussain U, Descamps T, Nash S, Wilson M, Hunt R, Kirwan CC. O44: WOUND HEALING INFLAMMATORY MARKERS PREDICT PROGNOSIS AND SURVIVAL IN EARLY BREAST CANCER. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.044] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Cancer is likened to a non-healing wound. There is limited evidence on the expression of wound healing tissue inflammatory markers, CD68(pan-macrophage marker), HO-1(tumour cell marker) and FAP(cancer-associated fibroblast marker) in human breast cancer.
Method
In 201 invasive breast cancer and 58 DCIS patients, CD68+TAM expression, tumour HO-1 and fibroblast FAP expression, quantified by immunohistochemistry(dichotomised: high/present vs low/absent), was correlated with tumour factors (grade, proliferation(Ki67), ER, HER2); demographic factors, behavioural factors (smoking, alcohol) and survival status(DFS, OS)
Result
High CD68+macrophage expression was increased in invasive breast cancer, compared to DCIS, and normal tissue distant from the tumour(59%,41%and 6% respectively; p<0.001).In invasive cancer,CD68+TAM expression increased with increasing tumour grade(Grade 1:42%, Grade 2:58%, Grade 3:72%; p=0.006), high Ki67(71%vs.47%; p=0.004), ER negativity(79.4%vs.55.4%; p=0.01) and HER2(HER2 positive 81.8% vs. HER2 negative 56.3%; p=0.03). CD68+TAM expression was higher in high compared to low/intermediate grade DCIS(44% % vs. 31% p=0.52). CD68+TAM expression was increased in patients who self-reported alcohol intake(non-drinker 43% vs. drinker 62%; p=0.01). HO-1 was associated with shorter DFS(HR:3.22,p=0.027) and OS(HR:2.86,p=0.029).FAP fibroblast expression correlated with longer DFS (HR:0.296,p=0.029) and OS (HR:0.271,p=0.008).
Conclusion
Tumour inflammation as assessed by CD68+TAM expression shows utility in identifying aggressive breast cancer sub-types. The association reported between CD68+TAM density and alcohol intake suggests a possible mechanism for alcohol as a risk factor for breast cancer. The prognostic value of HO-1 and FAP expression demonstrated here suggests a functional role of these wound healing markers in breast cancer. HO-1:Heme-oxygenase-1; FAP:Fibroblast activation protein; TAM:Tumour associated macrophage; DCIS: Ductal carcinoma in situ
Take-home message
Wound healing pathways of inflammation may be implicated in early breast cancer development
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Affiliation(s)
- U Singh
- Division of Cancer Sciences, The University of Manchester
| | - J Castle
- Division of Cancer Sciences, The University of Manchester
| | | | - U Hussain
- Manchester University NHS Foundation Trust
| | | | - S Nash
- Manchester University NHS Foundation Trust
| | - M Wilson
- Manchester University NHS Foundation Trust
| | - R Hunt
- Manchester University NHS Foundation Trust
| | - CC Kirwan
- Division of Cancer Sciences, The University of Manchester
- Manchester University NHS Foundation Trust
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Tweed CD, Wills GH, Crook AM, Amukoye E, Balanag V, Ban AYL, Bateson ALC, Betteridge MC, Brumskine W, Caoili J, Chaisson RE, Cevik M, Conradie F, Dawson R, Del Parigi A, Diacon A, Everitt DE, Fabiane SM, Hunt R, Ismail AI, Lalloo U, Lombard L, Louw C, Malahleha M, McHugh TD, Mendel CM, Mhimbira F, Moodliar RN, Nduba V, Nunn AJ, Sabi I, Sebe MA, Selepe RAP, Staples S, Swindells S, van Niekerk CH, Variava E, Spigelman M, Gillespie SH. A partially randomised trial of pretomanid, moxifloxacin and pyrazinamide for pulmonary TB. Int J Tuberc Lung Dis 2021; 25:305-314. [PMID: 33762075 PMCID: PMC8009598 DOI: 10.5588/ijtld.20.0513] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 07/01/2020] [Accepted: 01/21/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND: Treatment for TB is lengthy and toxic, and new regimens are needed.METHODS: Participants with pulmonary drug-susceptible TB (DS-TB) were randomised to receive: 200 mg pretomanid (Pa, PMD) daily, 400 mg moxifloxacin (M) and 1500 mg pyrazinamide (Z) for 6 months (6Pa200MZ) or 4 months (4Pa200MZ); 100 mg pretomanid daily for 4 months in the same combination (4Pa100MZ); or standard DS-TB treatment for 6 months. The primary outcome was treatment failure or relapse at 12 months post-randomisation. The non-inferiority margin for between-group differences was 12.0%. Recruitment was paused following three deaths and not resumed.RESULTS: Respectively 4/47 (8.5%), 11/57 (19.3%), 14/52 (26.9%) and 1/53 (1.9%) DS-TB outcomes were unfavourable in patients on 6Pa200MZ, 4Pa200MZ, 4Pa100MZ and controls. There was a 6.6% (95% CI -2.2% to 15.4%) difference per protocol and 9.9% (95%CI -4.1% to 23.9%) modified intention-to-treat difference in unfavourable responses between the control and 6Pa200MZ arms. Grade 3+ adverse events affected 68/203 (33.5%) receiving experimental regimens, and 19/68 (27.9%) on control. Ten of 203 (4.9%) participants on experimental arms and 2/68 (2.9%) controls died.CONCLUSION: PaMZ regimens did not achieve non-inferiority in this under-powered trial. An ongoing evaluation of PMD remains a priority.
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Affiliation(s)
- C D Tweed
- Medical Research Council Clinical Trials Unit, University College London (UCL), London, UK
| | - G H Wills
- Medical Research Council Clinical Trials Unit, University College London (UCL), London, UK
| | - A M Crook
- Medical Research Council Clinical Trials Unit, University College London (UCL), London, UK
| | - E Amukoye
- Centre for Respiratory Disease Research, Kenya Medical Research Institute (KEMRI), Kenyatta National Hospital, Nairobi, Kenya
| | - V Balanag
- Lung Center of the Philippines, National Centre for Pulmonary Research, Quezon City, The Philippines
| | - A Y L Ban
- Pusat Perubatan Universiti Kebangsaan, Kuala Lumpur, Malaysia
| | | | - M C Betteridge
- Global Alliance for TB Drug Development, New York, NY, USA
| | | | - J Caoili
- Tropical Disease Foundation, Makati Medical Centre, Makati City, Phillippines
| | - R E Chaisson
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M Cevik
- Medical School, University of St Andrews, St Andrews, UK
| | - F Conradie
- University of the Witwatersrand, Clinical HIV Research Unit, Johannesburg
| | - R Dawson
- University of Cape Town Lung Institute, Cape Town
| | - A Del Parigi
- Global Alliance for TB Drug Development, New York, NY, USA
| | - A Diacon
- TASK Applied Science, Bellville, South Africa & Division of Physiology, Department of Medical Biochemistry, University of Stellenbosch, Tygerberg, South Africa
| | - D E Everitt
- Global Alliance for TB Drug Development, New York, NY, USA
| | - S M Fabiane
- Medical Research Council Clinical Trials Unit, University College London (UCL), London, UK
| | - R Hunt
- Centre for Clinical Microbiology, UCL, London, UK
| | - A I Ismail
- Universiti Teknologi MARA, Selangor, Malaysia
| | - U Lalloo
- Enhancing Care Foundation, Durban International Clinical Research Site, Wentworth Hospital, Durban
| | - L Lombard
- Global Alliance for TB Drug Development, New York, NY, USA
| | - C Louw
- Madibeng Centre for Research, Brits, & Department of Family Medicine, University of Pretoria, Pretoria
| | - M Malahleha
- Setshaba Research Centre, Soshanguve, South Africa
| | - T D McHugh
- Centre for Clinical Microbiology, UCL, London, UK
| | - C M Mendel
- Global Alliance for TB Drug Development, New York, NY, USA
| | - F Mhimbira
- Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - R N Moodliar
- THINK (Tuberculosis and HIV Investigative Network), Durban, South Africa
| | | | - A J Nunn
- Medical Research Council Clinical Trials Unit, University College London (UCL), London, UK
| | - I Sabi
- Mbeya Medical Research Center, National Institute for Medical Research, Mbeya, Tanzania
| | - M A Sebe
- The Aurum Institute, Tembisa Clinical Research Centre, Tembisa
| | | | - S Staples
- THINK (Tuberculosis and HIV Investigative Network), Durban, South Africa
| | - S Swindells
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - E Variava
- Klerksdorp Tshepong Hospital, Klerksdorp, South Africa
| | - M Spigelman
- Global Alliance for TB Drug Development, New York, NY, USA
| | - S H Gillespie
- Medical School, University of St Andrews, St Andrews, UK
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Singh U, Castle J, Shaker H, Greenhalgh S, Hussain U, Descamps T, Nash S, Wilson M, Hunt R, Kirwan C. PO-75 The relationship between the coagulation and inflammatory phases of wound healing in early breast cancer. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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7
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Humphreys A, Patel A, Hunt R. Self-retaining retraction technique for axillary lymph node dissection for breast surgeons. Ann R Coll Surg Engl 2020; 102:750-751. [PMID: 32808804 DOI: 10.1308/rcsann.2020.0167] [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: 11/22/2022] Open
Affiliation(s)
- A Humphreys
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - A Patel
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - R Hunt
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
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8
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Arkin L, Buhr K, Brandling‐Bennett H, Chiu Y, Chong B, Curran M, Hunt R, Paller A, Werth V, Klein‐Gitelman M, Scheven E, Ardalan K. Practice‐based differences in paediatric DLE. Br J Dermatol 2019. [DOI: 10.1111/bjd.18396] [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: 11/30/2022]
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9
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Arkin L, Buhr K, Brandling‐Bennett H, Chiu Y, Chong B, Curran M, Hunt R, Paller A, Werth V, Klein‐Gitelman M, Scheven E, Ardalan K. 儿童 DLE 的基于实践的差异. Br J Dermatol 2019. [DOI: 10.1111/bjd.18407] [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: 11/27/2022]
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10
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Shmuylovich L, Paller A, Kiguradze T, Anderson K, Sibbald C, Tollefson M, Kunzler E, Tom W, Hedlund K, Ahmad R, Garcia-Romero M, Irfan M, Kollman K, Hunt R, Stein S, Arkin L, Wong V, Pope E, Jacobe H, Brandling-Bennet H, Cordoro K, Bercovitch L, Chiu Y. 385 Patterning of linear morphea on the face and neck: Blaschkoid or not? J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Arkin LM, Buhr K, Brandling-Bennett H, Chiu Y, Chong B, Curran M, Hunt R, Paller AS, Werth VP, Klein-Gitelman M, von Scheven E, Ardalan K. Practice-based differences in paediatric discoid lupus erythematosus. Br J Dermatol 2019; 181:805-810. [PMID: 30768778 DOI: 10.1111/bjd.17780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Children with discoid lupus erythematosus (DLE) are at risk for disfigurement and progression to systemic lupus erythematosus (SLE). Consensus is lacking regarding optimal care for children with DLE. OBJECTIVES The aim of this study was to compare practice patterns among paediatric dermatologists/rheumatologists treating paediatric DLE. METHODS An online survey was sent to 292 paediatric rheumatologists in the Childhood Arthritis and Rheumatology Research Alliance and 200 paediatric dermatologists in the Pediatric Dermatology Research Alliance. Consensus was defined as ≥ 70% agreement. RESULTS Survey response rates were 38% (76 of 200) for dermatology and 21% (60 of 292) for rheumatology. Both specialties agreed that screening labs should include complete blood counts with differential, urinalysis, complement levels, erythrocyte sedimentation rate, antinuclear antibody and other autoantibodies, hepatic function and renal function/electrolytes. Both specialties agreed that arthritis or nephritis should prompt intensified evaluation for SLE. No other patient features achieved consensus as disease-modifying risk factors. Hydroxychloroquine was agreed upon as first-line systemic therapy, but consensus was lacking for second- or third-line treatment. CONCLUSIONS We found few areas of consensus and significant practice differences between paediatric dermatologists and rheumatologists treating DLE. Knowledge gaps include risk factors for SLE, optimal screening and treatment of refractory skin disease.
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Affiliation(s)
- L M Arkin
- Department of Dermatology and Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A
| | - K Buhr
- Department of Biostatistics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A
| | - H Brandling-Bennett
- Department of Dermatology and Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A
| | - Y Chiu
- Department of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - B Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - M Curran
- Department of Pediatrics, University of Colorado, Denver, CO, U.S.A
| | - R Hunt
- Department of Pediatrics and Dermatology, Baylor College of Medicine, Houston, TX, U.S.A
| | - A S Paller
- Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - V P Werth
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - M Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - E von Scheven
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, U.S.A
| | - K Ardalan
- Department of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
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Blane C, Chambers A, Vallence A, Massey E, Hunt R, Court F, Vestey S, Fowler C, Allak AA. A single centre experience with breast cancer patients aged over 80 years; what factors affect treatment options and what are the long-term outcomes? Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.335] [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: 10/27/2022] Open
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13
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Stewart A, Hunt R, Mitchell R, Muhawenimana V, Wilson CAME, Jackson JA, Cable J. The cost of infection: Argulus foliaceus and its impact on the swimming performance of the three-spined stickleback ( Gasterosteus aculeatus). J R Soc Interface 2018; 15:rsif.2018.0571. [PMID: 30355808 DOI: 10.1098/rsif.2018.0571] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/04/2018] [Indexed: 11/12/2022] Open
Abstract
For fish, there can be multiple consequences of parasitic infections, including the physical impacts on swimming and the pathological costs of infection. This study used the three-spined stickleback (Gasterosteus aculeatus) and the ectoparasitic fish louse, Argulus foliaceus, to assess both physical (including form drag and mass) and pathological effects of infection. Both sustained (prolonged swimming within an open channel flume) and burst (C-start) swimming performance were measured on individual fish before (trials 1-2) and after infection (trials 3-5). Experimental infection occurred shortly before the third trial, when the physical impacts of infection could be separated from any subsequent pathology as transmission of adult parasites causes instantaneous drag effects prior to observable pathology. Despite the relatively large size of the parasite and corresponding increase in hydrodynamic drag for the host, there were no observable physical effects of infection on either sustained or burst host swimming. By contrast, parasite-induced pathology is the most probable explanation for reduced swimming performance across both tests. All sticklebacks displayed a preference for flow refugia, swimming in low-velocity regions of the flume, and this preference increased with both flow rate and infection time. This study suggests that even with large, physically demanding parasites their induced pathology is of greater concern than direct physical impact.
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Affiliation(s)
- A Stewart
- School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
| | - R Hunt
- School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
| | - R Mitchell
- School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
| | - V Muhawenimana
- School of Engineering, Cardiff University, Cardiff CF24 3AA, UK
| | - C A M E Wilson
- School of Engineering, Cardiff University, Cardiff CF24 3AA, UK
| | - J A Jackson
- School of Environment and Life Sciences, University of Salford, Salford M5 4WX, UK
| | - J Cable
- School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
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14
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Hunt R, Roberts RM, Mortimer AM. Spinal dural arteriovenous fistula: delay to radiological diagnosis and sources of radiological error. Clin Radiol 2018; 73:835.e11-835.e16. [PMID: 29898828 DOI: 10.1016/j.crad.2018.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/09/2018] [Indexed: 01/10/2023]
Abstract
AIM To highlight the magnetic resonance imaging (MRI) signs associated with spinal dural arteriovenous fistula (SDAVF) through categorisation of sources of radiological error and investigation of the delay to radiological diagnosis. MATERIAL AND METHODS This was a retrospective, observational study of cases referred to a neuroscience centre over 11 years. All patients who underwent spinal digital subtraction angiography (DSA) with a subsequent diagnosis of SDAVF were identified. Prior imaging was reviewed and compared with the formal reports issued. RESULTS Thirty-seven patients with SDAVF were initially imaged in seven institutions. Radiological abnormalities including intradural vessels (37/37, 100%), cord T2 signal change (34/37, 91.9%), and cord expansion (26/37, 70.2%) were present on prior MRI. These signs were not recognised in 22/37 (59.5%), 7/34 (20.5%), and 15/26 (57.7%) of cases, respectively. Increased T2 signal in the cord was the most commonly identified sign (27/34; 79.4%), but prompted either no diagnosis (7/34; 20.5%) or differential diagnoses including ischaemic, inflammatory, or neoplastic aetiologies or a syrinx in 11/34 (32.4%). An appropriate diagnosis was made on initial MRI in 15 patients (40.5%). The time from initial imaging to diagnosis was significantly delayed for those patients who did not have an arteriovenous vascular aetiology included in the initial differential diagnosis (281 (423.3) days versus 22 (15.7) days, p=0.03). CONCLUSION SDAVF have imaging features that are frequently missed or misinterpreted. This results in a significant delay to definitive diagnosis and therefore treatment.
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Affiliation(s)
- R Hunt
- Department of Neuroradiology, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - R M Roberts
- Department of Neuroradiology, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - A M Mortimer
- Department of Neuroradiology, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK.
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15
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Hunt R, Hoffman CM, Emani S, Trenor CC, Emani SM, Faraoni D, Kimchi-Sarfaty C, Ibla JC. Elevated preoperative von Willebrand factor is associated with perioperative thrombosis in infants and neonates with congenital heart disease. J Thromb Haemost 2017; 15:2306-2316. [PMID: 28981194 DOI: 10.1111/jth.13860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 04/19/2017] [Indexed: 01/19/2023]
Abstract
Essentials Perioperative thrombosis is a major cause of morbidity and mortality in congenital heart disease. Neonates and infants undergoing repair of congenital heart lesions were prospectively followed. Elevated von Willebrand factor (VWF) to ADAMTS-13 activity ratios typified the postoperative period. Thrombosis was associated with preoperative VWF activity and cryoprecipitate transfusion SUMMARY: Background The surgical repair of congenital heart malformations is frequently complicated by perioperative thrombosis of unclear etiology. An imbalance between von Willebrand factor (VWF) and ADAMTS-13 is an emerging variable in thrombosis. Objectives To describe perioperative changes to VWF, ADAMTS-13 and NETosis, and evaluate clinical and biochemical associations with postoperative thrombosis. Methods Neonates and infants undergoing palliation or definitive surgical repair of congenital heart malformations were recruited (n = 133). Preoperative and postoperative plasma levels of VWF, ADAMTS-13 and markers of NETosis were determined. Patients were followed for up to 30 days for the occurrence of thrombosis. Univariate and multivariate logistic regression analyses were conducted to identify variables associated with thrombosis. Results We identified significant postoperative increases in VWF activity, VWF level, DNA-histone complexes and cell-free DNA with an overall decrease in ADAMTS-13 activity. Patients experiencing postoperative thrombotic events (9%) were characterized by surgery performed at a lower intraoperative temperature, higher preoperative lactic acid levels, and higher preoperative VWF activity and level. A multivariate logistic regression model identified preoperative VWF activity (odds ratio (OR) 8.39 per IU mL-1 , 95% confidence interval [CI] 1.73-40.55) and transfusion of cryoprecipitate (OR 1.10 per mL kg-1 , 95% CI 1.03-1.17) as being associated with thrombosis. Conclusions Pediatric patients undergoing surgical repair of congenital heart malformations are exposed to high levels of VWF with diminished or minimal change to ADAMTS-13 in the immediate postoperative period. Elevated preoperative VWF activity is associated with postoperative thrombosis in pediatric congenital heart disease.
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Affiliation(s)
- R Hunt
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapeutics, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - C M Hoffman
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapeutics, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - S Emani
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - C C Trenor
- Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - S M Emani
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - D Faraoni
- Division of Cardiac Anesthesia, Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - C Kimchi-Sarfaty
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapeutics, Center for Biologics Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - J C Ibla
- Department of Anesthesiology Perioperative and Pain Medicine, Division of Cardiac Anesthesia, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Yeh C, Su H, Martinez C, Hunt R, Freeman A, Shah N, Davis C. P287 The big masquerade: atopy as the presenting symptom of DOCK8 deficiency. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.203] [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: 10/18/2022]
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17
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Ying A, Sharafat S, Youssef M, An J, Hunt R, Rainsberry P, Abdou M. Engineering Scaling Requirements for Solid Breeder Blanket Testing. Fusion Science and Technology 2017. [DOI: 10.13182/fst05-a823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Ying
- Fusion Engineering Science, Mechanical and Aerospace Engineering Department University of California, Los Angeles Los Angeles, California, USA
| | - S. Sharafat
- Fusion Engineering Science, Mechanical and Aerospace Engineering Department University of California, Los Angeles Los Angeles, California, USA
| | - M. Youssef
- Fusion Engineering Science, Mechanical and Aerospace Engineering Department University of California, Los Angeles Los Angeles, California, USA
| | - J. An
- Fusion Engineering Science, Mechanical and Aerospace Engineering Department University of California, Los Angeles Los Angeles, California, USA
| | - R. Hunt
- Fusion Engineering Science, Mechanical and Aerospace Engineering Department University of California, Los Angeles Los Angeles, California, USA
| | - P. Rainsberry
- Fusion Engineering Science, Mechanical and Aerospace Engineering Department University of California, Los Angeles Los Angeles, California, USA
| | - M. Abdou
- Fusion Engineering Science, Mechanical and Aerospace Engineering Department University of California, Los Angeles Los Angeles, California, USA
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18
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Popa T, Hunt R, Pasternack N, Hallett M, Meunier S. P225 Dissecting the sense of agency by targeted low-frequency rTMS. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Barigye R, Davis S, Hunt R, Hunt N, Walsh S, Elliott N, Dyrting K, Weir R, Melville LF. Post-viraemic detection of bovine ephemeral fever virus by use of autogenous lymphoid tissue-derived bovine primary cell cultures. Aust Vet J 2017; 95:49-52. [PMID: 28124418 DOI: 10.1111/avj.12551] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The potential tissue replication sites and specific cell types that support in vivo virus survival beyond the acute phase of bovine ephemeral fever virus (BEFV) infection have not been fully defined in cattle. To clarify the knowledge gap, tissue specimens were tested after collection from an adult steer necropsied 1 week after acute BEF. CASE REPORT Significant necropsy findings included fibrinoproliferative synovitis in the stifle joints and fibrin clot-laden fluid in serous body cavities. Moderate numbers of infiltrating neutrophils were demonstrated in sections of the prefemoral lymph nodes and haemal node, and lymphoid hyperplasia in the spleen, haemal node and prefemoral lymph nodes. Viral RNA was detected by qRT-PCR in fresh spleen, haemal node, prefemoral lymph node, synovial fluid and in several spleen-derived cell cultures. BEFV was isolated from autogenously derived splenic primary cell cultures 6 days after cessation of viraemia, and characteristic bullet-shaped virions were confirmed by electron microscopy of an ultrathin haemal node section. In sections of the spleen, haemal node and other tissues, immunohistochemistry demonstrated BEFV antigens that were intracellularly associated with probable histiocytic cells. CONCLUSION BEFV has preferential tropism for bovine lymphoid tissues and the spleen and haemal node may be potential sites for post-viraemic virus replication.
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Affiliation(s)
- R Barigye
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, Darwin, Northern Territory, Australia.,Department of Veterinary Medicine, College of Food & Agriculture, United Arab Emirates University, Al Ain, UAE
| | - S Davis
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, Darwin, Northern Territory, Australia
| | - R Hunt
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, Darwin, Northern Territory, Australia
| | - N Hunt
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, Darwin, Northern Territory, Australia
| | - S Walsh
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, Darwin, Northern Territory, Australia
| | - N Elliott
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, Darwin, Northern Territory, Australia
| | - K Dyrting
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, Darwin, Northern Territory, Australia
| | - R Weir
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, Darwin, Northern Territory, Australia
| | - L F Melville
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, Darwin, Northern Territory, Australia
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20
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Malfertheiner P, Megraud F, O'Morain CA, Gisbert JP, Kuipers EJ, Axon AT, Bazzoli F, Gasbarrini A, Atherton J, Graham DY, Hunt R, Moayyedi P, Rokkas T, Rugge M, Selgrad M, Suerbaum S, Sugano K, El-Omar EM. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017; 66:6-30. [PMID: 27707777 DOI: 10.1136/gutjnl-2016-312288] [Citation(s) in RCA: 1745] [Impact Index Per Article: 249.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/09/2016] [Indexed: 02/06/2023]
Abstract
Important progress has been made in the management of Helicobacter pylori infection and in this fifth edition of the Maastricht Consensus Report, key aspects related to the clinical role of H. pylori were re-evaluated in 2015. In the Maastricht V/Florence Consensus Conference, 43 experts from 24 countries examined new data related to H. pylori in five subdivided workshops: (1) Indications/Associations, (2) Diagnosis, (3) Treatment, (4) Prevention/Public Health, (5) H. pylori and the Gastric Microbiota. The results of the individual workshops were presented to a final consensus voting that included all participants. Recommendations are provided on the basis of the best available evidence and relevance to the management of H. pylori infection in the various clinical scenarios.
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Affiliation(s)
- P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - F Megraud
- Laboratoire de Bactériologie, Inserm U853, Université de Bordeaux, Bordeaux, France
| | - C A O'Morain
- Faculty of Health Sciences, Trinity College, Dublin, Ireland
| | - J P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - E J Kuipers
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - F Bazzoli
- Internal Medicine and Gastroenterology, University of Bologna Italy, Bologna, Italy
| | - A Gasbarrini
- Gastroenterology, and Liver Unit, Internal Medicine, Roma, Italy
| | | | - D Y Graham
- Department of Medicine (111D), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - R Hunt
- Department of Medicine, McMaster University, Hamilton, Canada.,Hillcroft, Beaconsfield, Buckinghamshire, UK
| | - P Moayyedi
- Department of Gastroenterology, McMaster University, Hamilton, Canada
| | - T Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, Athens, Greece
| | - M Rugge
- Department of Diagnostic Sciences, University of Padova, Padova, Italy
| | | | - S Suerbaum
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie, Hannover, Germany
| | - K Sugano
- Department of Medicine, Jichi Medical School, Tochigi, Japan
| | - E M El-Omar
- St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
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21
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Barigye R, Davis S, Hunt R, Hunt N, Walsh S, Elliott N, Burnup C, Aumann S, Day C, Dyrting K, Weir R, Melville LF. Viral neurotropism, peripheral neuropathy and other morphological abnormalities in bovine ephemeral fever virus-infected downer cattle. Aust Vet J 2016; 94:362-70. [PMID: 27671080 DOI: 10.1111/avj.12482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/10/2015] [Revised: 08/10/2015] [Accepted: 09/07/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study assessed the neurotropism of bovine ephemeral fever (BEF) virus (BEFV) and described histomorphological abnormalities of the brain, spinal cord and peripheral nerves that may causally contribute to paresis or paralysis in BEF. METHODS Four paralysed and six asymptomatic but virus-infected cattle were monitored, and blood and serum samples screened by qRT-PCR, virus isolation and neutralisation tests. Fresh brain, spinal cord, peripheral nerve and other tissues were qRT-PCR-tested for viral RNA, while formalin-fixed specimens were processed routinely and immunohistochemically evaluated for histomorphological abnormalities and viral antigen distribution, respectively. RESULTS The neurotropism of BEFV was immunohistochemically confirmed in the brain and peripheral nerves and peripheral neuropathy was demonstrated in three paralysed but not the six aneurological but virus-infected animals. Wallerian degeneration (WD) was present in the ventral funicular white matter of the lumbar spinal cord of a paralysed steer and in cervical and thoracic spinal cord segments of three paralysed animals. Although no spinal cord lesions were seen in the steer euthanased within 7 days of illness, peripheral neuropathy was present and more severe in nerves of the brachial plexuses than in the gluteal or fibular nerves. The only steer with WD in the lumbar spinal cord also showed intrahistiocytic cell viral antigen that was spatially distributed within areas of moderate brain stem encephalitis. CONCLUSION The data confirmed neurotropism of BEFV in cattle and documented histomorphological abnormalities in peripheral nerves and brain which, together with spinal cord lesions, may contribute to chronic paralysis in BEFV-infected downer cattle.
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Affiliation(s)
- R Barigye
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia. ,
| | - S Davis
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
| | - R Hunt
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
| | - N Hunt
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
| | - S Walsh
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
| | - N Elliott
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
| | - C Burnup
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
| | - S Aumann
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
| | - C Day
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
| | - K Dyrting
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
| | - R Weir
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
| | - L F Melville
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, Northern Territory 0801, Australia
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Maxwell AJ, Bundred NJ, Harvey J, Hunt R, Morris J, Lim YY. A randomised pilot study comparing 13 G vacuum-assisted biopsy and conventional 14 G core needle biopsy of axillary lymph nodes in women with breast cancer. Clin Radiol 2016; 71:551-7. [PMID: 27040801 DOI: 10.1016/j.crad.2016.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/04/2016] [Accepted: 02/26/2016] [Indexed: 12/11/2022]
Abstract
AIM To compare the acceptability, safety, and feasibility of vacuum-assisted biopsy (VAB) and core needle biopsy (CNB) of axillary lymph nodes in women with breast cancer. MATERIALS AND METHODS This parallel, non-blinded, randomised study was approved by the National Research Ethics Service. Following written informed consent, women with abnormal appearing axillary lymph nodes and radiologically malignant breast masses were randomised 1:1 to lymph node sampling under local anaesthetic with either 14 G CNB or 13 G VAB in a single UK centre. Primary outcomes were study uptake rate and patient willingness to undergo a repeat procedure if necessary. Procedure duration, immediate and post-procedure pain scores, diagnostic yield, complications, and surgical histopathology were recorded. RESULTS Ninety-five women were approached; 81 (85.3%) consented and were randomised. Forty underwent CNB; 40 underwent VAB; one was excluded. Median age was 57 years. The median procedure time was 2 minutes for both techniques. The median number of samples obtained was three for CNB and four for VAB. Median pain scores for the procedure and first 3 days were 1/10 and 1/10 for CNB and 1/10 and 2/10 for VAB (p=0.11 and 0.04). More women were prepared to undergo repeat CNB compared to VAB, but the difference was not significant (38/39 versus 33/39; p=0.11). Two patients developed a haematoma after VAB. One CNB and six VABs failed to yield adequate tissue (p=0.11), but the sensitivity was similar at 79% and 78%. CONCLUSION Study uptake was high. Acceptability of the two procedures was similar, but VAB was associated with more post-procedure pain. The sensitivity appears to be similar.
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Affiliation(s)
- A J Maxwell
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK; Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
| | - N J Bundred
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK; Institute of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Wilmslow Road, Manchester M20 4QL, UK
| | - J Harvey
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - R Hunt
- Department of Histopathology, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - J Morris
- Medical Statistics Department, Education and Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK; Centre for Biostatistics, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Y Y Lim
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK; Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PT, UK
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Barigye R, Melville LF, Davis S, Walsh S, Hunt N, Hunt R. Kinetics of selected plasma cytokines during innate-adaptive immune response transition in adult cattle infected with the bovine ephemeral fever virus. Vet Microbiol 2016; 186:111-6. [PMID: 27016765 DOI: 10.1016/j.vetmic.2016.02.024] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/12/2016] [Accepted: 02/23/2016] [Indexed: 11/26/2022]
Abstract
While virus neutralizing antibodies are known to be variably protective against bovine ephemeral fever (BEF) virus (BEFV) infections, the cytokine events that mediate the nascent adaptive immune response have not been defined in cattle. This study determined the plasma kinetics of IL-2, IFN-γ, IL-6, and IL-10 during the period of innate-immune response transition and evaluated the relationship between the virus neutralizing antibody response and viraemia in BEFV-infected cattle. Plasma from four virus-infected and uninfected negative control animals was tested by cytokine-specific immunoenzymatic assays, viraemia monitored by qRT-PCR, and virus neutralizing antibody titres determined using a standard protocol. Unlike the negative controls, plasma IL-6 and IL-10 were increased in all the virus-infected animals starting several days prior to initiation of viraemia. In one animal, plasma IL-2 and IFN-γ were consistently higher than in the other three virus-infected animals and the negative control mean. The animal with the strongest IL-2 and IFN-γ responses had the shortest viraemia while the heifer with the lowest IL-2/IFN-γ indices demonstrated the longest viraemia. Evidently, increase in plasma IL-6 and IL-10 precedes seroconversion during BEFV infections in cattle suggesting the two cytokines may influence immunological events that pave way to B-cell activation and seroconversion. While there is remarkable variability in IL-2 and IFN-γ expression amongst BEFV-infected animals, increased plasma levels of the two cytokines appear to be associated with a shorter viraemia. Ongoing studies will help define the precise role of T cells in anti-BEFV adaptive immune responses.
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Affiliation(s)
- R Barigye
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia.
| | - L F Melville
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
| | - S Davis
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
| | - S Walsh
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
| | - N Hunt
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
| | - R Hunt
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
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Shand J, Heggie A, Pellicano A, Hunt R, Massie J, Kilpatrick N, Bordbar P, Adhikari A. Outcomes of mandibular distraction for the management of neonates and infants with micrognathia and upper airway obstruction. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.971] [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: 11/26/2022]
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Barigye R, Melville LF, Davis S, Walsh S, Hunt N, Hunt R, Elliot N. Kinetics of pro-inflammatory cytokines, interleukin-10, and virus neutralising antibodies during acute ephemeral fever virus infections in Brahman cattle. Vet Immunol Immunopathol 2015; 168:159-63. [PMID: 26386675 DOI: 10.1016/j.vetimm.2015.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/22/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
While fever and inflammation are hallmark features of bovine ephemeral fever (BEF), the cytokine networks that underlie the acute phase of the disease have not been empirically defined in cattle. This study characterised the plasma kinetics of proinflammatory cytokines (IL-1β, IL-6, TNF-α) and IL-10 during acute BEF and elucidated on the relationship between the onset of the virus neutralizing antibody response and resolution of viraemia in natural BEF virus (BEFV) infections in cattle. Plasma from three BEFV-infected and three uninfected cattle was tested for the study cytokines by a cELISA, viraemia monitored by qRT-PCR, and virus neutralizing antibody titres determined using a standard protocol. Unlike the negative controls, plasma concentrations of IL-1β, TNF-α, IL-6, and IL-10 were consistently increased in the three virus-infected animals. Two of the infected heifers were recumbent and pyrexic on the first day of monitoring and increased cytokine production was already in progress by the time viraemia was detected in all the three infected animals. In all the virus-infected heifers, IL-1β was the most strongly expressed cytokine, IL-6 and IL-10 manifested intermediate plasma concentrations while TNF-α was the least expressed and demonstrated bi-phasic peaks three and five days after the onset of pyrexia. In two of the BEFV-infected heifers, viraemia resolved on the day of seroconversion while in the other infected animal, viral RNA was detectable up to three days after seroconversion. The present data document variable increase in plasma IL-1β, IL-6, TNF-α, and IL-10 during natural BEFV infections and the fact that upregulation of all but TNF-α precedes seroconversion. In addition to virus neutralising antibodies, it is likely that cytokine-mediated cellular mechanisms may be required for resolution of viraemia in BEF. Considering the anti-inflammatory properties of IL-10, its upregulation may potentially antagonise the fever response in BEFV-infected cattle.
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Affiliation(s)
- R Barigye
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia.
| | - L F Melville
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
| | - S Davis
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
| | - S Walsh
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
| | - N Hunt
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
| | - R Hunt
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
| | - N Elliot
- Berrimah Veterinary Laboratories, Department of Primary Industry & Fisheries, GPO Box 3000, Darwin, NT 0801, Australia
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Moayyedi P, Hunt R, Armstrong D, Lei Y, Bukoski M, White R. The impact of intensifying acid suppression on sleep disturbance related to gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 2013; 37:730-7. [PMID: 23432146 DOI: 10.1111/apt.12254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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] [Received: 10/01/2012] [Revised: 10/16/2012] [Accepted: 01/30/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sleep disturbance is common in patients with GERD but there has been little evaluation of this problem in primary care in patients already taking therapy. AIM To evaluate the impact of administering a questionnaire (PASS test) to identify patients with sleep problems and evaluate the efficacy of esomeprazole to improve sleep disturbance in patients with GERD. METHODS This was a primary care based cluster-randomised, open-label study where practices were assigned to intervention or control groups. PASS test failures continued current therapy (control) or were switched to 4 weeks' once-daily esomeprazole 20 or 40 mg (intervention). Patients were evaluated at the end of 4 weeks and the outcomes that were assessed were the sleep questions from the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire and the presence or absence of sleep disturbance from the PASS test questionnaire. RESULTS A total of 1388 patients with evaluable data at 4 weeks were included in the analysis and 825 reported GERD-related sleep disturbance at baseline. At 4 weeks, 161 of 291 of control patients (55%) reported continued sleep disturbance compared to 120 of 534 (22.5%) of intervention patients [number needed to treat of 3: 95% confidence intervals (CI): 2.5-4]. There was a mean improvement in QOLRAD scores related to sleep in the intervention patients compared to control patients (mean improvement = 4.91; 95% CI: 3.73-6.09). CONCLUSION A PASS strategy identifies GERD patients with sleep disturbance in primary care that will benefit from a change in acid-suppressive therapy. ClinicalTrials.gov identifier: NCT00392002; study code: D9612L00096.
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Affiliation(s)
- P Moayyedi
- Division of Gastroenterology, McMaster University, Hamilton, ON, Canada.
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Hunt R, Holl M, Bailey A, Macnaughton P. Primary percutaneous coronary angioplasty and therapeutic hypothermia in out-of-hospital cardiac arrest. Crit Care 2013. [PMCID: PMC3642787 DOI: 10.1186/cc12247] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hunt R, Maynard N, Ferguson D. PO28 Review of indeterminate (B3) breast core biopsy in young women in one centre in southwest England. Breast 2012. [DOI: 10.1016/s0960-9776(12)70040-1] [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: 11/25/2022] Open
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Hunt R, Mulhall J, Dunn J. PO29 The role of nipple smears in young women and their value in cancer diagnoses in one centre in southwest England. Breast 2012. [DOI: 10.1016/s0960-9776(12)70041-3] [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: 11/26/2022] Open
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Hunt R. The development of statutory law in South Australia to support advance care planning. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000250.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hunt R, Jones L, Owen L, Seal M. Sustaining respecting patient choices® (RPC) advance care planning. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000250.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Carter J, Price R, Gill J, Hunt R, Thorne A, El-Abbar M. NICE Breast Reconstruction guidelines. Are we good enough? Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Ying A, Waku T, Youchison D, Hunt R, Zhang H, Ulrickson M. A subcooled boiling heat transfer predictive model for ITER EHF FW designs. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2011.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yap P, Hunt R, Das D. Education and Imaging: Hepatobiliary and pancreatic: venesection for hemochromatosis. J Gastroenterol Hepatol 2011; 26:934. [PMID: 21488950 DOI: 10.1111/j.1440-1746.2011.06739.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- P Yap
- Department of Gastroenterology, Stepping Hill Hospital, Stockport NHS Foundation Trust, United Kingdom
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Kapil V, Sattin RW, Sasser S, McGuire LC, Hunt R. Field triage: optimising injury outcomes through use of a revised on-scene decision-making protocol. Inj Prev 2010; 16:284-5. [DOI: 10.1136/ip.2010.028506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- R Hunt
- Physiological Laboratory of Columbia University at the College of Physicians and Surgeons, New York
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Abstract
The experiments described in Part IV of this paper show that in whatever manner the problem of the relation of the vagus to the accelerators is approached, whether the accelerators are stimulated during a stimulation of the vagus, or the vagus during a stimulation of the accelerators, or both are stimulated simultaneously, either for a short or for a longer period, the result is the same, viz., the effect upon the rate of the heart is determined entirely by the relative strength of the stimuli applied to the two nerves. If the stimuli are of approximately the same strength, as judged by the effect of stimulating the nerves separately, the rate of the heart is but slightly affected; if the stimulus applied to the vagus is the stronger, the heart is slowed; if it is weaker, the heart is accelerated. In all cases the result of stimulating the two nerves simultaneously is approximately the algebraic sum of the results of stimulating them separately; sometimes the inhibitory effect slightly predominates, but not more frequently than does the accelerator effect. Moreover, the two nerves may be stimulated simultaneously for a considerable period of time without either completely overcoming the effect of the other. Thus as far as their effect upon the rate of the ventricular beat is concerned, the vagus and accelerator nerves seem to be purely antagonistic; the statement that a minimal stimulation of the one can completely overcome a maximal stimulation of the other is undoubtedly incorrect, and the hypotheses as to the mode of action of these nerves upon the heart, based upon this statement, lose their chief support.
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Affiliation(s)
- R Hunt
- Physiological Laboratory of the Johns Hopkins University
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Affiliation(s)
- R Hunt
- Physiological Laboratory of Columbia University at the College of Physicians and Surgeons, New York
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Gunn J, Hunt R, Goldsworthy M, Beca J, Shekerdemian L. Neurodevelopmental Outcome in Infants Undergoing Early Surgery for Congenital Heart Disease. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.613] [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: 11/25/2022]
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Hunt R, Laidlaw I. Re: A complication of intra-gastric balloon therapy. Surgeon 2009; 7:319. [PMID: 19848067 DOI: 10.1016/s1479-666x(09)80011-5] [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: 05/28/2023]
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Rostom A, Moayyedi P, Hunt R. Canadian consensus guidelines on long-term nonsteroidal anti-inflammatory drug therapy and the need for gastroprotection: benefits versus risks. Aliment Pharmacol Ther 2009; 29:481-96. [PMID: 19053986 DOI: 10.1111/j.1365-2036.2008.03905.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [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: 12/12/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, but are not without risks. AIM To provide evidence-based management recommendations to help clinicians determine optimal long-term NSAID therapy and the need for gastroprotective strategies based on an assessment of both gastrointestinal (GI) and cardiovascular (CV) risks. METHODS A multidisciplinary group of 21 voting participants revised and voted on the statements and the strength of evidence (assessed according to GRADE) at a consensus meeting. RESULTS An algorithmic approach was developed to help manage patients who require long-term NSAID therapy. The use of low-dose acetylsalicylic acid in patients with high CV risk was assumed. For patients at low GI and CV risk, a traditional NSAID alone may be acceptable. For patients with low GI risk and high CV risk, full-dose naproxen may have a lower potential for CV risk than other NSAIDs. In patients with high GI and low CV risk, a COX-2 inhibitor plus a proton pump inhibitor (PPI) may offer the best GI safety profile. When both GI and CV risks are high and NSAID therapy is absolutely necessary, risk should be prioritized. If the primary concern is GI risk, a COX-2 inhibitor plus a PPI is recommended; if CV risk, naproxen 500 mg b.d. plus a PPI would be preferred. NSAIDs should be used at the lowest effective dose for the shortest possible duration. CONCLUSION More large, long-term trials that examine clinical outcomes of complicated and symptomatic upper and lower GI ulcers are needed.
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Affiliation(s)
- A Rostom
- Division of Gastroenterology, University of Calgary Medical Clinic, AB, Canada.
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Brent L, Hunt R, Hutchinson IV, Medawar PB, Palmer L, Welsh L. Host recognition of fetal antigens: do they induce specific antibodies? Ciba Found Symp 2008; 96:125-45. [PMID: 6343001 DOI: 10.1002/9780470720776.ch8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to ascertain whether the protection afforded to adult mice against the induction and growth of 3-methylcholanthrene-induced tumours by prior exposure to syngeneic fetal cells has an immunological basis. Adult CBA mice were inoculated with fetal cells according to a variety of protocols and the sera were tested for their ability to bind to fetal and adult tissue cells, using a staphylococcal protein A binding assay. All 10 sera tested showed some degree of binding though this varied from strong to weak, and there was some cross-reactivity with adult thymic cells but relatively little with adult spleen cells. Absorption studies were carried out with one of these sera and with two others raised against testicular and thymic cells, respectively. The absorption patterns obtained so far suggest that fetal cells possess at least three, and possibly up to five, distinct antigens. Although none of the anti-fetal sera were produced with a sensitizing protocol identical with that used in in vivo protection, some of them were so close as to suggest that protection is associated with, and perhaps causally related to, these IgG antibodies. The in vitro evidence presented here, together with the in vivo data of P. B. Medawar & R. Hunt, shows that antigens are shared between fetal cells and adult thymic and testicular cells. It therefore lends support to the notion that the production of a vaccine against anaplastic neoplasms, using immunogens derived from adult tissues, is within the realms of possibility.
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Turton JA, Hicks RM, Gwynne J, Hunt R, Hawkey CM. Retinoid toxicity. Ciba Found Symp 2008; 113:220-51. [PMID: 3875458 DOI: 10.1002/9780470720943.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The long-term effects of N-ethylretinamide (NER) on the haematology of the rat, and the dose-related effects of retinoids on lymphoid organs of the mouse and rat were investigated. Retinoid-induced long-bone changes were used to develop a method for quantifying skeletal effects. This technique was used to investigate the activity of five retinamides in inducing long-bone changes in the rat. The ability of non-steroidal anti-inflammatory compounds (NSAICs) to prevent retinoid-induced skeletal effects was examined, and preliminary investigations made into the mechanisms of retinoid-induced long-bone remodelling. NER-fed rats had reduced red blood cell counts and fibrinogen values. Retinoids caused dose-related proliferation of the spleen and lymph nodes in the mouse and to a lesser extent in the rat. They induced dose-related reductions in femoral diaphysis and medullary cavity diameters in both rats and mice. Aspirin prevented NER-induced changes of rat long bones, but subsequent studies indicated this effect may be closely dependent on the dose level of both the retinoid and NSAIC administered. Retinoids induce rapid long-bone remodelling in the rat which tends to revert on feeding a control diet, but remodelling processes are different in the young growing rat and the mature animal.
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Abstract
Even if the inoculation of fetal tissue cells were a dependable and uniformly successful method of protecting experimental animals against chemically or virally induced tumours, it would for obvious reasons still not be feasible to use fetal tissues for such a purpose in human beings. Among possible substitutes syngeneic spermatozoa were tested on the grounds that they are the only adult cells that express T-alleles, but neither they nor teratocarcinoma cells protected mice against tumours raised by 3-methylcholanthrene. Testicular and thymic cells and tissue fragments have given effective protection in a number of experiments and it is noteworthy that fetal tissues, testicular cells and thymus cells are cross-reactive in respect of anti-embryo antibodies. Testicular cells probably act like fetal cells and, like fetal cells, are very prone to give rise to 'enhancement'. Thymic cells do not 'enhance' and may act quite differently. The variability of results--a source of grave concern--is attributed to the insensitivity of the test system which is ill-adapted to show up low degrees of protection.
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Abstract
BACKGROUND Newborn animal studies and pilot studies in humans suggest that mild hypothermia following peripartum hypoxia-ischaemia in newborn infants may reduce neurological sequelae without adverse effects. OBJECTIVES To determine the effect of therapeutic hypothermia in encephalopathic asphyxiated newborn infants on mortality, long-term neurodevelopmental disability and clinically important side effects. SEARCH STRATEGY The standard search strategy of the Neonatal Review Group as outlined in The Cochrane Library (Issue 2, 2007) was used. Randomised controlled trials evaluating therapeutic hypothermia in term newborns with hypoxic ischaemic encephalopathy were identified by searching the Oxford Database of Perinatal Trials, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007), MEDLINE (1966 to June 2007), previous reviews including cross-references, abstracts, conferences, symposia proceedings, expert informants and journal hand searching. SELECTION CRITERIA Randomised controlled trials comparing the use of therapeutic hypothermia with standard care in encephalopathic newborn infants with evidence of peripartum asphyxia and without recognisable major congenital anomalies were included. The primary outcome measure was death or long-term major neurodevelopmental disability. Other outcomes included adverse effects of cooling and 'early' indicators of neurodevelopmental outcome. DATA COLLECTION AND ANALYSIS Three review authors independently selected, assessed the quality of and extracted data from the included studies. Authors were contacted for further information. Meta-analyses were performed using relative risk and risk difference for dichotomous data, and weighted mean difference for continuous data with 95% confidence intervals. MAIN RESULTS Eight randomised controlled trials were included in this review, comprising 638 term infants with moderate/ severe encephalopathy and evidence of intrapartum asphyxia. Therapeutic hypothermia resulted in a statistically significant and clinically important reduction in the combined outcome of mortality or major neurodevelopmental disability to 18 months of age [typical RR 0.76 (95% CI 0.65, 0.89), typical RD -0.15 (95% CI -0.24, -0.07), NNT 7 (95% CI 4, 14)]. Cooling also resulted in statistically significant reductions in mortality [typical RR 0.74 (95% CI 0.58, 0.94), typical RD -0.09 (95% CI -0.16, -0.02), NNT 11 (95% CI 6, 50)] and in neurodevelopmental disability in survivors [typical RR 0.68 (95% CI 0.51, 0.92), typical RD -0.13 (95% CI -0.23, -0.03), NNT 8 (95% CI 4, 33)]. Some adverse effects of hypothermia included an increase in the need for inotrope support of borderline significance and a significant increase in thrombocytopaenia. AUTHORS' CONCLUSIONS There is evidence from the eight randomised controlled trials included in this systematic review (n = 638) that therapeutic hypothermia is beneficial to term newborns with hypoxic ischaemic encephalopathy. Cooling reduces mortality without increasing major disability in survivors. The benefits of cooling on survival and neurodevelopment outweigh the short-term adverse effects. However, this review comprises an analysis based on less than half of all infants currently known to be randomised into eligible trials of cooling. Incorporation of data from ongoing and completed randomised trials (n = 829) will be important to clarify the effectiveness of cooling and to provide more information on the safety of therapeutic hypothermia, but could also alter these conclusions. Further trials to determine the appropriate method of providing therapeutic hypothermia, including comparison of whole body with selective head cooling with mild systemic hypothermia, are required.
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Affiliation(s)
- S Jacobs
- Royal Women's Hospital, Neonatal Services, 132 Grattan Street, Carlton, Melbourne, Victoria, Australia, 3953.
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Ying A, Narula M, Hunt R, Abdou M, Ando Y, Komada I. Integrated thermo-fluid analysis towards helium flow path design for an ITER solid breeder blanket module. Fusion Engineering and Design 2007. [DOI: 10.1016/j.fusengdes.2007.05.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, Graham D, Hunt R, Rokkas T, Vakil N, Kuipers EJ. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007; 56:772-81. [PMID: 17170018 PMCID: PMC1954853 DOI: 10.1136/gut.2006.101634] [Citation(s) in RCA: 1286] [Impact Index Per Article: 75.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2006] [Indexed: 02/06/2023]
Abstract
BACKGROUND Guidelines on the management of Helicobacter pylori, which cover indications for management and treatment strategies, were produced in 2000. AIMS To update the guidelines at the European Helicobacter Study Group (EHSG) Third Maastricht Consensus Conference, with emphasis on the potential of H pylori eradication for the prevention of gastric cancer. RESULTS Eradication of H pylori infection is recommended in (a) patients with gastroduodenal diseases such as peptic ulcer disease and low grade gastric, mucosa associated lymphoid tissue (MALT) lymphoma; (b) patients with atrophic gastritis; (c) first degree relatives of patients with gastric cancer; (d) patients with unexplained iron deficiency anaemia; and (e) patients with chronic idiopathic thrombocytopenic purpura. Recurrent abdominal pain in children is not an indication for a "test and treat" strategy if other causes are excluded. Eradication of H pylori infection (a) does not cause gastro-oesophageal reflux disease (GORD) or exacerbate GORD, and (b) may prevent peptic ulcer in patients who are naïve users of non-steroidal anti-inflammatory drugs (NSAIDs). H pylori eradication is less effective than proton pump inhibitor (PPI) treatment in preventing ulcer recurrence in long term NSAID users. In primary care a test and treat strategy using a non-invasive test is recommended in adult patients with persistent dyspepsia under the age of 45. The urea breath test, stool antigen tests, and serological kits with a high accuracy are non-invasive tests which should be used for the diagnosis of H pylori infection. Triple therapy using a PPI with clarithromycin and amoxicillin or metronidazole given twice daily remains the recommended first choice treatment. Bismuth-containing quadruple therapy, if available, is also a first choice treatment option. Rescue treatment should be based on antimicrobial susceptibility. CONCLUSION The global burden of gastric cancer is considerable but varies geographically. Eradication of H pylori infection has the potential to reduce the risk of gastric cancer development.
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Affiliation(s)
- P Malfertheiner
- Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Zentrum für Innere Medizin, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Leipziger Strasse 44, D-39120 Magdeburg, Germany.
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Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, Graham D, Hunt R, Rokkas T, Vakil N, Kuipers EJ. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007. [PMID: 17170018 DOI: 10.1036/gut.2006.101634] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines on the management of Helicobacter pylori, which cover indications for management and treatment strategies, were produced in 2000. AIMS To update the guidelines at the European Helicobacter Study Group (EHSG) Third Maastricht Consensus Conference, with emphasis on the potential of H pylori eradication for the prevention of gastric cancer. RESULTS Eradication of H pylori infection is recommended in (a) patients with gastroduodenal diseases such as peptic ulcer disease and low grade gastric, mucosa associated lymphoid tissue (MALT) lymphoma; (b) patients with atrophic gastritis; (c) first degree relatives of patients with gastric cancer; (d) patients with unexplained iron deficiency anaemia; and (e) patients with chronic idiopathic thrombocytopenic purpura. Recurrent abdominal pain in children is not an indication for a "test and treat" strategy if other causes are excluded. Eradication of H pylori infection (a) does not cause gastro-oesophageal reflux disease (GORD) or exacerbate GORD, and (b) may prevent peptic ulcer in patients who are naïve users of non-steroidal anti-inflammatory drugs (NSAIDs). H pylori eradication is less effective than proton pump inhibitor (PPI) treatment in preventing ulcer recurrence in long term NSAID users. In primary care a test and treat strategy using a non-invasive test is recommended in adult patients with persistent dyspepsia under the age of 45. The urea breath test, stool antigen tests, and serological kits with a high accuracy are non-invasive tests which should be used for the diagnosis of H pylori infection. Triple therapy using a PPI with clarithromycin and amoxicillin or metronidazole given twice daily remains the recommended first choice treatment. Bismuth-containing quadruple therapy, if available, is also a first choice treatment option. Rescue treatment should be based on antimicrobial susceptibility. CONCLUSION The global burden of gastric cancer is considerable but varies geographically. Eradication of H pylori infection has the potential to reduce the risk of gastric cancer development.
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Affiliation(s)
- P Malfertheiner
- Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Zentrum für Innere Medizin, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Leipziger Strasse 44, D-39120 Magdeburg, Germany.
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