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Misas E, Seagle E, Jenkins EN, Rajeev M, Hurst S, Nunnally NS, Bentz ML, Lyman MM, Berkow E, Harrison LH, Schaffner W, Markus TM, Pierce R, Farley MM, Chow NA, Lockhart SR, Litvintseva AP. Genomic description of acquired fluconazole- and echinocandin-resistance in patients with serial Candida glabrata isolates. J Clin Microbiol 2024; 62:e0114023. [PMID: 38265207 PMCID: PMC10865870 DOI: 10.1128/jcm.01140-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/29/2023] [Indexed: 01/25/2024] Open
Abstract
Candida glabrata is one of the most common causes of systemic candidiasis, often resistant to antifungal medications. To describe the genomic context of emerging resistance, we conducted a retrospective analysis of 82 serially collected isolates from 33 patients from population-based candidemia surveillance in the United States. We used whole-genome sequencing to determine the genetic relationships between isolates obtained from the same patient. Phylogenetic analysis demonstrated that isolates from 29 patients were clustered by patient. The median SNPs between isolates from the same patient was 30 (range: 7-96 SNPs), while unrelated strains infected four patients. Twenty-one isolates were resistant to echinocandins, and 24 were resistant to fluconazole. All echinocandin-resistant isolates carried a mutation either in the FKS1 or FKS2 HS1 region. Of the 24 fluconazole-resistant isolates, 17 (71%) had non-synonymous polymorphisms in the PDR1 gene, which were absent in susceptible isolates. In 11 patients, a genetically related resistant isolate was collected after recovering susceptible isolates, indicating in vivo acquisition of resistance. These findings allowed us to estimate the intra-host diversity of C. glabrata and propose an upper boundary of 96 SNPs for defining genetically related isolates, which can be used to assess donor-to-host transmission, nosocomial transmission, or acquired resistance. IMPORTANCE In our study, mutations associated to azole resistance and echinocandin resistance were detected in Candida glabrata isolates using a whole-genome sequence. C. glabrata is the second most common cause of candidemia in the United States, which rapidly acquires resistance to antifungals, in vitro and in vivo.
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Affiliation(s)
- E. Misas
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - E. Seagle
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - E. N. Jenkins
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- ASRT, Inc., Atlanta, Georgia, USA
| | - M. Rajeev
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S. Hurst
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - N. S. Nunnally
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M. L. Bentz
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M. M. Lyman
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - E. Berkow
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - L. H. Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - W. Schaffner
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - T. M. Markus
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R. Pierce
- Oregon Public Health Division, Oregon Health Authority, Portland, USA
| | - M. M. Farley
- Emory University School of Medicine, Decatur, Georgia, USA
| | - N. A. Chow
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S. R. Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A. P. Litvintseva
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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LeBlanc KA, Gonzalez A, Dickens E, Olsofka J, Ortiz-Ortiz C, Verdeja JC, Pierce R. Robotic-assisted, laparoscopic, and open incisional hernia repair: early outcomes from the Prospective Hernia Study. Hernia 2021; 25:1071-1082. [PMID: 34031762 DOI: 10.1007/s10029-021-02381-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To provide a comparative analysis of short-term outcomes after open, laparoscopic, and robotic-assisted (RAS) ventral incisional hernia (VIH) repairs that include subject-reported pain medication usage and hernia-related quality of life (QOL). METHODS Subjects were ≥ 18 years old and underwent elective open, laparoscopic or RAS VIH repair without myofascial release. Perioperative clinical outcomes through 30 days were analyzed as were prescription pain medication use and subject-reported responses to the HerQLes Abdominal QOL questionnaire. Observed differences in baseline characteristics were controlled using a weighted propensity score analysis to obviate potential selection bias (inverse probability of treatment weighting, IPTW). A p value < 0.05 was considered statistically significant. RESULTS Three hundred and seventy-one subjects (RAS, n = 159; open, n = 130; laparoscopic, n = 82) were enrolled in the study across 17 medical institutions within the United States. Operative times were significantly different between the RAS and laparoscopic groups (126.2 vs 57.2, respectively; p < 0.001). Mean length of stay was comparable for RAS vs laparoscopic (1.4 ± 1.0 vs 1.4 ± 1.1, respectively; p = 0.623) and differed for the RAS vs open groups (1.4 ± 1.0 vs 2.0 ± 1.9, respectively; p < 0.001). Conversion rates differed between RAS and laparoscopic groups (0.6% vs 4.9%; p = 0.004). The number of subjects reporting the need to take prescription pain medication through the 2-4 weeks visit differed between RAS vs open (65.2% vs 79.8%; p < 0.001) and RAS vs laparoscopic (65.2% vs 78.75%; p < 0.001). For those taking prescription pain medication, the mean number of pills taken was comparable for RAS vs open (23.3 vs 20.4; p = 0.079) and RAS vs laparoscopic (23.3 vs 23.3; p = 0.786). Times to return to normal activities and to work, complication rates and HerQLes QOL scores were comparable for the RAS vs open and RAS vs laparoscopic groups. The reoperation rate within 30 days post-procedure was comparable for RAS vs laparoscopic (0.6% vs 0%; p = 0.296) and differed for RAS vs open (0.6% vs 3.1%; p = 0.038). CONCLUSIONS Short-term outcomes indicate that open, laparoscopic, and robotic-assisted approaches are effective surgical approaches to VIH repair; however, each repair technique may demonstrate advantages in terms of clinical outcomes. Observed differences in the RAS vs laparoscopic comparison are longer operative time and lower conversion rate in the RAS group. Observed differences in the RAS vs open comparison are shorter LOS and lower reoperation rate through 30 days in the RAS group. The operative time in the RAS vs open comparison is similar. The number of subjects requiring the use of prescription pain medication favored the RAS group in both comparisons; however, among subjects reporting a need for pain medication, there was no difference in the number of prescription pain medication pills taken. While the study adds to the body of evidence evaluating the open, laparoscopic, and RAS approaches, future controlled studies are needed to better understand pain and QOL outcomes related to incisional hernia repair. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02715622.
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Affiliation(s)
- K A LeBlanc
- Our Lady of the Lake Regional Medical Center, 7777 Hennessy Blvd., Suite 612, Baton Rouge, LA, 70808, USA.
| | - A Gonzalez
- Baptist Health South Florida, Miami, FL, USA
| | - E Dickens
- Hillcrest Medical Center, Tulsa, OK, USA
| | - J Olsofka
- Louisville Surgical Associates, Louisville, KY, USA
| | | | - J-C Verdeja
- Baptist Health South Florida, Miami, FL, USA
| | - R Pierce
- Vanderbilt University Medical Center, Nashville, TN, USA
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Labuda SM, Garner K, Cima M, Moulton-Meissner H, Laufer Halpin A, Charles-Toney N, Yu P, Bolton E, Pierce R, Crist MB, Gomes D, Gable P, McAllister G, Lawsin A, Houston H, Patil N, Wheeler JG, Bradsher R, Vyas K, Haselow D. Bloodstream Infections With a Novel Nontuberculous Mycobacterium Involving 52 Outpatient Oncology Clinic Patients-Arkansas, 2018. Clin Infect Dis 2020; 71:e178-e185. [PMID: 31872853 PMCID: PMC7938859 DOI: 10.1093/cid/ciz1120] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In July 2018, the Arkansas Department of Health (ADH) was notified by hospital A of 3 patients with bloodstream infections (BSIs) with a rapidly growing nontuberculous Mycobacterium (NTM) species; on 5 September 2018, 6 additional BSIs were reported. All were among oncology patients at clinic A. We investigated to identify sources and to prevent further infections. METHODS ADH performed an onsite investigation at clinic A on 7 September 2018 and reviewed patient charts, obtained environmental samples, and cultured isolates. The isolates were sequenced (whole genome, 16S, rpoB) by the Centers for Disease Control and Prevention to determine species identity and relatedness. RESULTS By 31 December 2018, 52 of 151 (34%) oncology patients with chemotherapy ports accessed at clinic A during 22 March-12 September 2018 had NTM BSIs. Infected patients received significantly more saline flushes than uninfected patients (P < .001) during the risk period. NTM grew from 6 unused saline flushes compounded by clinic A. The identified species was novel and designated Mycobacterium FVL 201832. Isolates from patients and saline flushes were highly related by whole-genome sequencing, indicating a common source. Clinic A changed to prefilled saline flushes on 12 September as recommended. CONCLUSIONS Mycobacterium FVL 201832 caused BSIs in oncology clinic patients. Laboratory data allowed investigators to rapidly link infections to contaminated saline flushes; cooperation between multiple institutions resulted in timely outbreak resolution. New state policies being considered because of this outbreak include adding extrapulmonary NTM to ADH's reportable disease list and providing more oversight to outpatient oncology clinics.
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Affiliation(s)
- Sarah M Labuda
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Michael Cima
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- US Public Health Service, Rockville, Maryland, USA
| | - Nadege Charles-Toney
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Peter Yu
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Erin Bolton
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Reid Pierce
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Matthew B Crist
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Danica Gomes
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adrian Lawsin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hollis Houston
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - J Gary Wheeler
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Robert Bradsher
- University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Keyur Vyas
- University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Dirk Haselow
- Arkansas Department of Health, Little Rock, Arkansas, USA
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Algazi A, Guarino M, Panella T, Celebi J, Csiki I, Drumheller A, Campbell J, Pierce R, Smith W. 924P SNS-301 added to pembrolizumab in patients (Pts) with ASPH+ advanced squamous cell carcinoma of the head & neck (SCCHN). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1039] [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: 10/23/2022] Open
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Morrison L, Gillmore R, Pierce R. Detection and management of hyperglycaemia in oncology patients receiving systemic anti-cancer therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pierce R, Lessler J, Popoola VO, Milstone AM. Meticillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme. J Hosp Infect 2016; 95:91-97. [PMID: 27887754 DOI: 10.1016/j.jhin.2016.10.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 07/01/2016] [Accepted: 10/23/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Meticillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare-associated infection in the neonatal intensive care unit (NICU). Decolonization may eliminate bacterial reservoirs that drive MRSA transmission. AIM To measure the association between colonization pressure from decolonized and non-decolonized neonates and MRSA acquisition to inform use of this strategy for control of endemic MRSA. METHODS An eight-year retrospective cohort study was conducted in a level-4 NICU that used active surveillance cultures and decolonization for MRSA control. Weekly colonization pressure exposures were defined as the number of patient-days of concurrent admission with treated (decolonized) and untreated (non-decolonized) MRSA carriers in the preceding seven days. Poisson regression was used to estimate risk of incident MRSA colonization associated with colonization pressure exposures. The population-attributable fraction was calculated to assess the proportion of overall unit MRSA incidence attributable to treated or untreated patients in this setting. FINDINGS Every person-day increase in exposure to an untreated MRSA carrier was associated with a 6% increase in MRSA acquisition risk [relative risk (RR): 1.06; 95% confidence interval (CI): 1.01-1.11]. Risk of acquisition was not influenced by exposure to treated, isolated MRSA carriers (RR: 1.01; 95% CI: 0.98-1.04). In the context of this MRSA control programme, 22% (95% CI: 4.0-37) of MRSA acquisition could be attributed to exposures to untreated MRSA carriers. CONCLUSION Untreated MRSA carriers were an important reservoir for transmission. Decolonized patients on contact isolation posed no detectable transmission threat, supporting the hypothesis that decolonization may reduce patient-to-patient transmission. Non-patient reservoirs may contribute to unit MRSA acquisition and require further investigation.
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Affiliation(s)
- R Pierce
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - V O Popoola
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - A M Milstone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MA, USA; Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MA, USA.
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Neshat-Vahid S, Pierce R, Hersey D, Raffini LJ, Faustino EVS. Association of thrombophilia and catheter-associated thrombosis in children: a systematic review and meta-analysis. J Thromb Haemost 2016; 14:1749-58. [PMID: 27306795 PMCID: PMC5035642 DOI: 10.1111/jth.13388] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 01/25/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED Essentials It is unclear if thrombophilia increases the risk of catheter-associated thrombosis in children. We conducted a meta-analysis on thrombophilia and pediatric catheter-associated thrombosis. Presence of ≥1 trait confers additional risk of venous thrombosis in children with catheters. Limitations of included studies preclude us from recommending routine thrombophilia testing. SUMMARY Background The association between thrombophilia and deep vein thrombosis (DVT) associated with central venous catheter (CVC) use, the most important pediatric risk factor for thrombosis, is unclear in children. Pediatric studies with small sample sizes have reported conflicting results. We sought to evaluate whether, among children with CVCs, thrombophilia increases the risk of CVC-associated DVT (CADVT). Materials and methods We systematically searched MEDLINE, EMBASE, the Web of Science, the Cochrane Central Register for Controlled Trials, PubMed and reference lists for controlled studies published from the inception of the database until September 2015. Included were studies of children aged <21 years with CVCs who were systematically tested for thrombophilic traits that are commonly screened for in clinical practice. Pooled prevalence rates and pooled odds ratios (pORs) of CADVT with thrombophilia were estimated by use of a random effects model. Results We analyzed 16 cohort studies with 1279 children, 277 of whom had CADVT, and with 12 traits tested. There was significant heterogeneity in the included studies. The presence of one or more traits was associated with CADVT (pOR 3.20; 95% confidence interval [CI] 1.56-6.54). Although the prevalence of most traits was < 0.10, children with protein C deficiency, elevated factor VIII levels and the FV Leiden mutation had an increased prevalence of CADVT. The association with thrombophilia seemed to be stronger for symptomatic CADVT (pOR 6.71; 95% CI 1.93-23.37) than for asymptomatic CADVT (pOR 2.14; 95% CI 1.10-4.18). Conclusions On the basis of the low prevalence of specific traits, the relatively weak association with CADVT, and the limitations of the included studies, we cannot recommend routine testing of thrombophilias in children with CADVT.
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Affiliation(s)
- S Neshat-Vahid
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - R Pierce
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - D Hersey
- Medical Library, Yale School of Medicine, New Haven, CT, USA
| | - L J Raffini
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - E V S Faustino
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
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Watts J, Maloney R, Keedwell R, Holzapfel A, Neill E, Pierce R, Sim J, Browne T, Miller N, Moore S. Pāteke (Anas chlorotis) population trends in response to predator control on Great Barrier Island and Northland, New Zealand. New Zealand Journal of Zoology 2016. [DOI: 10.1080/03014223.2016.1154078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J Watts
- Department of Zoology, University of Otago, Dunedin, New Zealand
| | - R Maloney
- Department of Conservation, Science and Policy Group, Christchurch, New Zealand
| | - R Keedwell
- 24 Buick Crescent, Palmerston North 4412, New Zealand
| | - A Holzapfel
- Department of Conservation, Science and Policy Group, Hamilton, New Zealand
| | - E Neill
- Department of Conservation, Whangarei, New Zealand
| | - R Pierce
- Department of Conservation, Whangarei, New Zealand
| | - J Sim
- Department of Conservation, Great Barrier Island, New Zealand
| | - T Browne
- Department of Conservation, Whangarei, New Zealand
| | - N Miller
- Department of Conservation, Whangarei, New Zealand
| | - S Moore
- Department of Conservation, Whangarei, New Zealand
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Pierce R, Andersen GJ. 3D spatial attention effects are independent of projected 2D size and location for older and younger observers. J Vis 2013. [DOI: 10.1167/13.9.1121] [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: 11/24/2022] Open
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Pierce R, Bian Z, Braunstein M, Andersen G. The role of binocular disparity and projected size in the detection of curved trajectories. J Vis 2012. [DOI: 10.1167/12.9.1194] [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: 11/24/2022] Open
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Pierce R, Bian Z, Andersen G. Age related differences in the spatial extent of attention in 3D space. J Vis 2011. [DOI: 10.1167/11.11.470] [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: 11/24/2022] Open
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Pierce R, Bian Z, Andersen G. The effects of binocular disparity on the detection of curved trajectories are independent of motion direction. J Vis 2010. [DOI: 10.1167/10.7.376] [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: 11/24/2022] Open
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Pierce R, Bian Z, Andersen G. The effect of binocular disparity on the detection of curved trajectories. J Vis 2010. [DOI: 10.1167/9.8.265] [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: 11/24/2022] Open
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Abstract
We report on an interferometer designed to provide 1-10 nm/square root(Hz) displacement measurement resolution, in the range 0.01 Hz to 1 Hz, while in low Earth orbit. The interferometer comprises two units, each with its own laser and in separate satellites, which would be in the same orbit separated by approximately 50 km. We discuss the requirements on the interferometer subsystem and describe the optical transponder distance measurement, including a phase locking method to generate a heterodyne beat signal between the two lasers. Design, fabrication, and testing of a "flightlike" engineering model interferometer is outlined, and results from environmental and performance tests are reported.
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Affiliation(s)
- R Pierce
- Ball Aerospace & Technologies Corporation, 1600 Commerce Street, Boulder, Colorado 80306-1062, USA
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Peyton PJ, Fortuin M, Robinson GJB, Stuart-Andrews C, Pierce R, Thompson BR. The rate of alveolar-capillary uptake of sevoflurane and nitrous oxide following anaesthetic induction. Anaesthesia 2008; 63:358-63. [DOI: 10.1111/j.1365-2044.2007.05355.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pierce R, White D, Malhotra A, Edwards JK, Kleverlaan D, Palmer L, Trinder J. Upper airway collapsibility, dilator muscle activation and resistance in sleep apnoea. Eur Respir J 2007; 30:345-53. [PMID: 17459896 PMCID: PMC3817291 DOI: 10.1183/09031936.00063406] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The calibre of the upper airway is thought to be dependant upon its passive anatomy/collapsibility and the activation of pharyngeal dilator muscles. During awake periods, the more collapsible upper airway in obstructive sleep apnoea (OSA) increases the dilator muscle activity through a negative-pressure reflex. A direct correlation between the critical closing pressure (P(crit)), as a measure of anatomy/collapsability and electromyogram (EMG) activity of genioglossus EMG (GG-EMG) and tensor palatini EMG (TP-EMG), was hypothesised. The relationship between these indices and pharyngeal resistance (R(phar)) was also examined. The study involved eight males with a mean age of 48 (interquartile range 46-52) yrs with OSA, and an apnoea/hypopnoea index of 75 (65-101).hr(-1) on two nights breathing normally and on nasal continuous positive airway pressure (nCPAP). The P(crit )was measured during nonrapid eye movement sleep on nCPAP using brief, incremental reductions in mask pressure. GG-EMG and TP-EMG were measured breath-by-breath, awake, during sleep onset and on nCPAP. R(phar) was measured using airway pressures and flow. Wakeful GG-EMG, early sleep TP-EMG and the sleep decrement in TP-EMG were directly related to P(crit). Muscle activation was negatively correlated with R(phar) for TP-EMG awake and GG-EMG early in sleep. In conclusion these results confirm that dilator muscle activation is directly related to airway narrowing and reduces resistance across patients with obstructive sleep apnoea.
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Affiliation(s)
- R Pierce
- Institute for Breathing and Sleep, Bowen Centre, Austin Hospital, Heidelberg, Victoria 3084, Australia.
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Peyton PJ, Stuart-Andrews C, Deo K, Strahan F, Robinson GJB, Thompson BR, Pierce R. Persisting concentrating and second gas effects on oxygenation during N2O anaesthesia. Anaesthesia 2006; 61:322-9. [PMID: 16548949 DOI: 10.1111/j.1365-2044.2006.04579.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Theoretical modelling predicts that the concentrating effect of nitrous oxide (N2O) uptake on alveolar oxygenation is a persisting phenomenon at typical levels of ventilation - perfusion (V/Q) inhomogeneity under anaesthesia. We sought clinical confirmation of this in 20 anaesthetised patients. Arterial oxygen pressure (P(aO2)) was measured after a minimum of 30 min of relaxant general anaesthesia with an inspired oxygen (F(I O2)) of 30%. Patients were randomly allocated to two groups. The intervention group had N2O introduced following baseline blood gas measurements, and the control group continued breathing an identical F(I O2) in nitrogen (N2). The primary outcome variable was change in P(aO2). Mean (SD) in P(aO2) was increased by 1.80 (1.80) kPa after receiving a mean of 47.5 min of N2O compared with baseline conditions breathing O2/N2 (p = 0.01). This change was significantly greater (p = 0.03) than that in the control group: + 0.09 (1.37) kPa, p = 0.83 and confirms the presence of significant persisting concentrating and second gas effects.
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Affiliation(s)
- P J Peyton
- Joint Director of Research, Department of Anaesthesia, Austin Hospital, Heidelberg, 3084, Melbourne, Australia.
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Carter V, Pierce R, Dufour S, Arme C, Hoole D. The tapeworm Ligula intestinalis (Cestoda: Pseudophyllidea) inhibits LH expression and puberty in its teleost host, Rutilus rutilus. Reproduction 2005; 130:939-45. [PMID: 16322554 DOI: 10.1530/rep.1.00742] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The tapewormLigula intestinalisoccurs in the body cavity of its cyprinid second intermediate host, in this study the roachRutilus rutilus, and inhibits host gonadal development. The mechanism by which infected fish are prevented from reproducing is unknown. Comparison of parameters, such as body length and weight, and condition factor and age, between infected and uninfected individuals, indicated only minor effects of parasitism on growth and condition. In contrast, seasonal gonadal development, as observed in uninfected fish, did not occur in infected fish, and gonads remained small and blocked at the primary oocyte stage in female roach. As immature ovaries and testes are still present, the parasite is presumed to act upon the brain–pituitary–gonadal axis of the fish to inhibit further development of reproductive organs. We investigated theLigula/fish interaction at the level of the pituitary gland by determination of gonadotrophin (LH) content using a heterologous RIA for carp (Cyprinus carpio) LHβ subunit. The results indicated that the pituitary glands of infected roach contained approximately 50% less LH than non-infected fish. After the cloning and sequencing of roach LHβ subunit, we measured roach LHβ mRNA levels by real-time RT-PCR. A corresponding 50% reduction in LHβ mRNA pituitary levels was determined. These results reflect a significant and measurable effect of parasitism on the pituitary gland, and lend support to the hypothesis that excretory/secretory products released from the parasite interact with the brain–pituitary–gonadal axis of the fish host and thus inhibit gonadal development.
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Affiliation(s)
- V Carter
- Centre for Applied Entomology and Parasitology, School of Life Sciences, Huxley Building, Keele University, Staffordshire ST5 5BG, UK
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Guillou F, Mitta G, Dissous C, Pierce R, Coustau C. Use of individual polymorphism to validate potential functional markers: case of a candidate lectin (BgSel) differentially expressed in susceptible and resistant strains of Biomphalaria glabrata. Comp Biochem Physiol B Biochem Mol Biol 2004; 138:175-81. [PMID: 15193273 DOI: 10.1016/j.cbpc.2004.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Revised: 03/16/2004] [Accepted: 03/17/2004] [Indexed: 10/26/2022]
Abstract
BgSel has been identified in Biomphalaria glabrata as a candidate adhesion molecule exhibiting both an Ig-like domain and a carbohydrate recognition domain showing similarities with the l domain of C-type lectins. As susceptibility or resistance of B. glabrata to the trematode Echinostoma caproni correlates with a differential hemocytic adhesive behavior, we investigated the expression of BgSel in snails selected for their susceptibility or resistance. Semi-quantitative RT-PCR analysis of BgSel expression revealed that (i) BgSel expression level was high in susceptible snails and almost undetectable in resistant snails, and that (ii) exposure to the parasite did not affect the expression level of BgSel in either strain. In order to validate this apparent association between low levels of BgSel expression and resistance, we used Real-Time PCR to characterize the relative expression of BgSel in individual snails segregating for susceptibility/resistance. Results established that differential expression of BgSel represents a functional strain marker, but is not a marker of resistance/susceptibility. It is suggested that this correlative approach may be a rapid and efficient alternative to complete functional analyses, and may facilitate the validation of candidate transcripts potentially identified through the numerous differential analyses of animal transcriptomes.
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Affiliation(s)
- F Guillou
- Parasitologie fonctionnelle et évolutive, UMR CNRS 5555, 52 Avenue Paul Alduy, Université de Perpignan, 66860 Perpignan Cedex, France
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Forrest DL, Thompson K, Dorcas VG, Couban SH, Pierce R. Low molecular weight heparin for the prevention of hepatic veno-occlusive disease (VOD) after hematopoietic stem cell transplantation: a prospective phase II study. Bone Marrow Transplant 2003; 31:1143-9. [PMID: 12796794 PMCID: PMC7091773 DOI: 10.1038/sj.bmt.1704087] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [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] [Indexed: 12/20/2022]
Abstract
We evaluated 40 patients undergoing high-dose chemo/radiotherapy (HDCT) and hematopoietic stem cell transplantation (HSCT) (allogeneic (22), autologous (18)) to determine the safety and feasibility of administering low molecular weight heparin (LMWH) as hepatic veno-occlusive disease (VOD) prophylaxis. Patients received a once daily subcutaneous injection of dalteparin 2500 anti-Xa i.u. commencing the day prior to starting HDCT, and continuing until day +30 post HSCT or hospital discharge, whichever came first. Dosage adjustments were made for patients developing renal failure. All bleeding episodes were recorded and graded and VOD was diagnosed and graded according to Seattle criteria. At 100 days of follow-up, the overall survival and probability of regimen-related mortality were 85 and 15%, respectively. Nine patients developed VOD. The probability of developing VOD post allogeneic and autologous HSCT was 28% (95% CI, 6-45) and 17% (95% CI, 0-32), respectively. VOD was graded as moderate (n=8) and severe (n=1). VOD resolved in all cases except for one patient who died secondary to severe VOD and multiorgan failure. Clinically significant bleeding episodes occurred in three patients; 24 patients developed minor bleeding not requiring specific therapy. All bleeding episodes resolved. These results suggest that LMWH for VOD prophylaxis is safe with a low incidence of serious bleeding events. Whether it is superior to unfractionated heparin, however, is unknown and should be addressed within the context of a randomized controlled trial.
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Affiliation(s)
- D L Forrest
- The Bone Marrow Transplantation Program of Atlantic Canada, Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
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Pierce R, Taylor P. Rationale for including orofacial myofunctional therapy in university training programs. Int J Orofacial Myology 2001; 27:24-32. [PMID: 11892368] [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: 02/24/2023]
Abstract
This article provides information on the need felt by speech-language pathologists for training in orofacial myofunctional phenomena. Results of a survey indicate 97.7% of respondents felt training is necessary, while only 7.9% felt their training was adequate. ASHA position statements regarding orofacial myology are reviewed. ASHA and IAOM suggested competencies are also included.
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Abstract
PURPOSE The purpose of this study was to evaluate the impact of Medicare coverage limitations and claim denials on noninvasive vascular diagnostic testing. METHODS All Medicare claims for noninvasive vascular diagnostic studies from January 1, 1999, to December 31, 1999, were identified from the hospital billing database according to Current Procedural Terminology codes for carotid artery duplex ultrasound scan, venous duplex ultrasound scan, and lower-extremity arterial Doppler scan. Reasons for Medicare denial of payment for these tests were reviewed and a cost analysis was performed. RESULTS During the 1-year period, there were 1096 noninvasive vascular diagnostic studies performed on Medicare patients. Of these 1096 tests, 176 (16.1%) were denied by Medicare (19.6% of 408 carotid duplex ultrasound scans, 16.8% of 345 venous duplex ultrasound scans, and 11.1% of 343 lower-extremity arterial Doppler scans). Of the noninvasive vascular tests denied by Medicare, an abnormal result was present in 72.5% of carotid duplex ultrasound scans, 32.8% of venous duplex ultrasound scans, and 78.9% of lower-extremity arterial Doppler scans. Overall, 88.1% of all initially denied claims (N = 176) were ultimately reimbursed by Medicare after resubmission, including 77.1% of the 118 claims denied based on compliance rules for "medical necessity." CONCLUSION Because of coverage limitations, Medicare denials of noninvasive vascular diagnostic tests can lead to potential uncompensated physician and hospital technical fees if denied claims are unrecognized. Vascular laboratories performing these tests need to review compliance with Medicare guidelines. Improvements may need to be made at both the provider and Medicare carrier levels in obtaining reimbursement for appropriately ordered noninvasive vascular diagnostic studies.
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Affiliation(s)
- M A Passman
- Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2735, USA.
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Kane KY, Pierce R. Clinical inquiries. What are the most effective treatments for bacterial vaginosis in nonpregnant women? J Fam Pract 2001; 50:399-400. [PMID: 11350701] [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: 05/23/2023]
Affiliation(s)
- K Y Kane
- University of Missouri-Columbia, USA
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Trinder J, Padula M, Berlowitz D, Kleiman J, Breen S, Rochford P, Worsnop C, Thompson B, Pierce R. Cardiac and respiratory activity at arousal from sleep under controlled ventilation conditions. J Appl Physiol (1985) 2001; 90:1455-63. [PMID: 11247947 DOI: 10.1152/jappl.2001.90.4.1455] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Arousal from sleep is associated with elevated cardiac and respiratory activity. It is unclear whether this occurs because of homeostatic mechanisms or a reflex activation response associated with arousal. Cardiorespiratory activity was measured during spontaneous arousals from sleep in subjects breathing passively on a ventilator. Under such conditions, homeostatic mechanisms are eliminated. Ventilation, end-tidal PCO2, mask pressure, diaphragmatic electromyograph, heart rate, and blood pressure were measured in four normal subjects under two conditions: assisted ventilation and a normal ventilation control condition. In the control condition, there was a normal, sleep-related fall in ventilation and rise in end-tidal PCO2. Subsequently, at an arousal, there was an increase in respiratory and cardiac activity. In the ventilator condition, a vigorous cardiorespiratory response to a spontaneous arousal from sleep remained. These results indicate that sleep-related respiratory stimuli are not necessary for the occurrence of elevated cardiorespiratory activity at an arousal from sleep and are consistent with the hypothesis that such activity is at least in part due to a reflex activation response.
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Affiliation(s)
- J Trinder
- Department of Psychology, University of Melbourne, Parkville, Victoria 3052, Australia.
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Abstract
Twenty-six ambulatory children underwent preoperative and 1-year postoperative assessments after selective dorsal rhizotomy. These included spasticity, passive range of motion, tone, three-dimensional motion analysis, and electromyography. Independent and dependent ambulators were evaluated separately. A decrease in spasticity was found in all lower extremity muscle groups. An increase in passive range of motion was found only at the hip for both independent and dependent ambulators. Gait changes included increases in velocity and stride length in the independent ambulators. An improvement in hip extension during stance was found in the dependent ambulators only; however, an increase in knee extension and dorsiflexion in stance were seen in both groups. Selective dorsal rhizotomy improves both passive and dynamic range of motion in children with spastic diplegia.
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Affiliation(s)
- S S Thomas
- Shriners Hospital for Crippled Children, Portland Unit, OR 97201, USA
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Gillies C, Pierce R, Clout M, King CM. Home ranges of introduced mustelids and feral Cats at Trounson Kauri Park, New Zealand. Mamm Rev 2000. [DOI: 10.1046/j.1365-2907.2000.0075a.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: 11/20/2022]
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Worsnop C, Kay A, Kim Y, Trinder J, Pierce R. Effect of age on sleep onset-related changes in respiratory pump and upper airway muscle function. J Appl Physiol (1985) 2000; 88:1831-9. [PMID: 10797148 DOI: 10.1152/jappl.2000.88.5.1831] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In normal young men, there is an abrupt fall in ventilation (VE), a rise in upper airway resistance (UAR), and falls in the activities of the diaphragm (Di), intercostals (IC), genioglossus (GG), and tensor palatini (TP) at sleep onset. On waking, there is an abrupt increase in VE and fall in UAR and an increase in the activities of Di, IC, GG, and TP. The aim of this study was to determine whether these changes are age dependent. Nine men aged 20 to 25 yr were compared with nine men aged 42 to 67 yr. Airflow, UAR, Di, and IC surface electromyograms (EMGs) and the intramuscular EMGs of GG and TP were recorded. It was found that the falls in IC, GG, and TP at the transition from alpha to theta electroencephalogram (EEG) activity were significantly greater in the older than in the younger men (P < 0.05) and that the fall in Di was also greater, although this was only marginally significant (P = 0.15). The rise in GG at theta-to-alpha transitions was also greater in the older than in the younger men, and there was a trend for TP to be higher.
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Affiliation(s)
- C Worsnop
- Department of Respiratory Medicine, Austin and Repatriation Medical Centre, Heidelberg, Victoria 3084, Australia.
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Trottein F, Mollicone R, Fontaine J, de Mendonça R, Piller F, Pierce R, Oriol R, Capron M. Molecular cloning of a putative alpha3-fucosyltransferase from Schistosoma mansoni. Mol Biochem Parasitol 2000; 107:279-87. [PMID: 10779604 DOI: 10.1016/s0166-6851(00)00213-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/17/2022]
Abstract
Alpha 3-fucosylation of protein or lipid substrates is an important component of the host/parasite interactions during schistosomiasis. In this process, alpha3-fucosyltransferases (alpha3-FucTs) are considered as key enzymes ensuring both parasite survival and adaptation in their (in)vertebrate hosts. In this paper, we report the molecular cloning of a putative alpha3-FucT from Schistosoma mansoni that we termed SmFucTA. The full-length SmFucTA encodes a typical transmembrane type II protein with a short cytoplasmic domain, a transmembrane segment and a long C-terminal catalytic domain. In this region, the GDP-fucose binding site is well conserved whereas the putative acceptor site displays sequence divergence compared to the corresponding region from vertebrate and invertebrate alpha3-FucTs. Southern blot analysis suggested that SmFucTA is present as several copies or has highly related counterparts in the S. mansoni genome. Northern blot revealed a single SmFucTA transcript at 2 kb in adult worms. Affinity purified antibodies directed against recombinant SmFucTA identified a 50 kDa native protein that localizes to the subtegumental and parenchymal regions of adult worms.
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Affiliation(s)
- F Trottein
- INSERM U167, Institut Pasteur de Lille, 59019, Lille, France
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Saarialho-Kere U, Kerkelä E, Jeskanen L, Hasan T, Pierce R, Starcher B, Raudasoja R, Ranki A, Oikarinen A, Vaalamo M. Accumulation of matrilysin (MMP-7) and macrophage metalloelastase (MMP-12) in actinic damage. J Invest Dermatol 1999; 113:664-72. [PMID: 10504457 DOI: 10.1046/j.1523-1747.1999.00731.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Photodamage is characterized by degradation of collagen and accumulation of abnormal elastin in the superficial dermis and several matrix metalloproteinases have previously been implicated in this process. Using immunohistochemistry and in situ hybridization, we have studied the localization of two elastolytic matrix metalloproteinases, matrilysin (matrix metalloproteinase-7) and human macrophage metalloelastase (matrix metalloproteinase-12) in solar damage. Human macrophage metalloelastase protein was detected in the superficial dermis in areas of elastotic material. Matrix metalloproteinase-7 was seen in the mid-dermis in regions with less damaged elastic fibers and morphologically better preserved collagen as well as in a band-like pattern below basal keratinocytes in eight of 18 solar elastosis. In samples taken from healthy volunteers 3 d after repeated ultraviolet A or ultraviolet B photoprovocation, occasional immunopositive cells for human macrophage metalloelastase (stromal) or matrix metalloproteinase-7 (sweat gland epithelium) were detected. In samples taken 1 d after ultraviolet B exposure, however, basal keratinocytes were matrix metalloproteinase-7 immunopositive, explaining the linear immunostaining below basal keratinocytes noted particularly in ultraviolet B treated 3 d specimens. Upregulation of metalloelastase was also demonstrated in the skin of hairless mice after repeated ultraviolet exposure. In normal skin, no staining for human macrophage metalloelastase or matrix metalloproteinase-7 was observed in association with elastin. The amount of immunoreactivity for the substrates of matrix metalloproteinase-7, versican, and tenascin, was clearly increased in solar elastosis and photoprovocated skin; versican but not tenascin was detected in the same areas as matrix metalloproteinase-7. Our results suggest that both matrix metalloproteinase-7 and -12 may contribute to remodeling of elastotic areas in sun-damaged skin.
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Affiliation(s)
- U Saarialho-Kere
- Department of Dermatology, Helsinki University Central Hospital, Finland.
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Epstein JS, Gaines A, Kapit R, Pierce R, Potter R, Varricchio F. Important drug information: immune globulin intravenous (human). Int J Trauma Nurs 1999; 5:139-40. [PMID: 10661146 DOI: 10.1016/s1075-4210(99)90011-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J S Epstein
- Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, MD 20852-1448, USA
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Patel RJ, Gray DR, Pierce R, Jafari M. Impact of therapeutic interchange from pravastatin to lovastatin in a Veterans Affairs Medical Center. Am J Manag Care 1999; 5:465-74. [PMID: 10387386] [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: 02/13/2023]
Abstract
OBJECTIVE To evaluate the impact of a therapeutic interchange from pravastatin to lovastatin on treatment outcomes, quality of life, patient satisfaction, and costs. STUDY DESIGN A prospective cohort study of 170 patients switched from pravastatin to lovastatin from September 1997 through November 1997. PATIENTS AND METHODS The therapeutic interchange program promoting lovastatin as the preferred agent went into effect June 2, 1997 after Merck & Co. was awarded the Veterans Health Administration national contract for 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Patients were switched to lovastatin by either their primary care physician during routine clinic visits or the pharmacist by mail. The following outcomes were measured before and after conversion to lovastatin: lipid values, liver function tests, National Cholesterol Education Program (NCEP) low-density cholesterol (LDL-C) goals achieved, quality of life (QOL) (measured by the Medical Outcomes Study 36-item short-form health survey [SF-36]), medication tolerance (measured with a global symptom survey), patient satisfaction, and cost-minimization analysis. RESULTS Lipid values and liver function test results were similar for pravastatin and lovastatin treatment. Forty percent of patients achieved NCEP LDL-C goals before and after formulary conversion. There were no significant differences between pravastatin and lovastatin in QOL, medication tolerance, and patient satisfaction. The projected cost savings from this therapeutic interchange was approximately $211,000 annually. CONCLUSION Therapeutic interchange from pravastatin to lovastatin resulted in substantial cost savings. QOL, patient satisfaction, and achievement of NCEP LDL-C goals were maintained.
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Affiliation(s)
- R J Patel
- VA Medical Center, Pharmacy Service, Long Beach, CA 90822, USA
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Starcher B, Pierce R, Hinek A. UVB irradiation stimulates deposition of new elastic fibers by modified epithelial cells surrounding the hair follicles and sebaceous glands in mice. J Invest Dermatol 1999; 112:450-5. [PMID: 10201528 DOI: 10.1046/j.1523-1747.1999.00553.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UVB irradiation stimulates the synthesis of elastin in the skin of humans and experimental animals. In this study we localized the site and the cells that are responsible for the synthesis of murine dermal elastic fibers. SKH-1 hairless mice were irradiated with UVB and the skin removed for light microscopy, electron microscopy, in situ hybridization, immunohistochemistry, and biochemical studies. In response to chronic low doses of UVB there was an initial moderate increase in tropoelastin mRNA in the papillary dermis. By contrast, there was a continuous marked elevation of collagen alpha1(I) message localizing to sites of inflammatory cell influx throughout the upper and lower dermis. After 25 wk of UV irradiation there was a 2-fold increase in skin elastin, yet total collagen remained unchanged. Serial desmosine analysis from en face sections indicated the increase in elastin content was due to dermal elastic fibers, an increase in the size and number of the dermal cysts, and an increase in subpanniculus elastic fibers. Elastin stains of en face sections suggested that the elastic fibers in the upper dermis were exclusively derived from cells lining the epithelial root sheath and sebaceous glands. In response to UV irradiation, the elastic fibers increased in number and size, wrapping around these structures and aligning in both directions as long fibers parallel to the body axis. Electron micrographs indicated that modified epithelial cells in close proximity to the flattened epithelial cells that encircled the root sheath and sebaceous glands were the source of the elastic fibers.
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Affiliation(s)
- B Starcher
- Department of Biochemistry, The University of Texas Health Center, Tyler 75710, USA
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Abstract
Ventilation decreases at sleep onset. This change is initiated abruptly at alpha-theta electroencephalographic transitions. The aim of this study was to determine the contributions of reduced activity in respiratory pump muscles and upper airway dilator muscles to this change. Surface electromyograms over the diaphragm (Di) and intercostal muscles and fine-wire intramuscular electrodes in genioglossus (GG) and tensor palatini (TP) muscles were recorded in nine healthy young men. It was shown that phasic Di and both phasic and tonic TP activities were lower during theta than during alpha activity. Breath-by-breath analysis of the changes at alpha-theta transitions during the sleep-onset period showed a number of changes. At alpha-theta transitions, phasic activity of Di, intercostal, and GG muscles fell and rose again, and phasic and tonic activities of TP fell and remained at low levels during theta. With a state transition from theta to alpha, the phasic and tonic activities of the Di, GG, and TP increased dramatically. It is now clear that the fall in ventilation that occurs with sleep is related to a fall in activities of both upper airway dilator muscles and respiratory pump muscles.
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Affiliation(s)
- C Worsnop
- Department of Respiratory Medicine, Austin and Repatriation Medical Centre, Heidelberg, Victoria 3084, Australia
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Affiliation(s)
- C Worsnop
- Department of Respiratory Medicine, Austin and Repatriation Medical Centre, Heidelberg, Victoria
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Abstract
We report on a new patient with d-transposition of the great arteries who was found to have deletion of 22q11.2. He had minor facial anomalies, normal T- and B-cell subsets, and transient hypocalcemia. Similar to rare previous reports, our patient's extracardiac manifestations were relatively mild.
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Affiliation(s)
- M Marble
- Human Genetics Program, Hayward Genetics Center, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA
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Affiliation(s)
- H Escriva
- INSERM U167, Institut Pasteur de Lille, France
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Neuzil DF, Garrard CL, Berkman RA, Pierce R, Naslund TC. Duplex-directed vena caval filter placement: report of initial experience. Surgery 1998; 123:470-4. [PMID: 9551075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fluoroscopy, cost, and patient transport contribute to difficulties occasionally associated with the placement of vena caval filters. Follow-up data in the literature document the use of duplex ultrasonography in visualizing the filter and determining caval patency. Filter placement at the bedside or in the vascular laboratory with duplex ultrasonography may simplify this common procedure. We have attempted to define the feasibility of this method. METHODS Patients referred to the vascular surgery service for vena caval interruption were evaluated for ability to visualize the renal veins and inferior vena cava. Location of renal veins, maximum diameter of the vena cava, and presence or absence of thrombus were documented. If visualization was adequate, placement was performed at the bedside for patients in intensive care or in the vascular laboratory for nonmonitored patients. The initial 10 patients and subsequent patients in whom there was a question of adequate deployment underwent completion abdominal roentgenography. Patient follow-up was difficult. Duplex ultrasonography was used to assess migration, thrombus adherent to the filter, and vena caval patency. Patients in whom filter placement was prophylactic were given anticoagulants at the discretion of the primary physician. Inadequate visualization or vena caval size greater than 28 mm prompted fluoroscopic placement of the vena caval filter, because only Greenfield titanium filters were used in the study. RESULTS Twenty-nine patients were referred for vena caval interruption. Inadequate visualization occurred in four obese patients, and filters were placed by fluoroscopy. There were no vena caval measurements greater than 24 mm. Twenty-five filters were placed without technical difficulty. One filter tilted into the right renal vein, requiring a suprarenal filter placed by fluoroscopy. Patient retrieval for follow-up has been difficult, but by ultrasonography there has been one vena caval thrombosis and no major filter migration. There have been no reported pulmonary emboli other than the one patient with initial tilt of the filter. CONCLUSIONS Placement of vena caval filters is feasible with duplex ultrasonography. Visualization is the only limiting condition to placement and occurs rarely. Reducing the need for fluoroscopy, lowering costs, and not needing to transport the critically ill patient support the use of this system. Intravascular ultrasonography in selected patients may eliminate the need for fluoroscopic placement of vena caval filters.
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Affiliation(s)
- D F Neuzil
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tenn. 37232-2735, USA
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Nunn CR, Neuzil D, Naslund T, Bass JG, Jenkins JM, Pierce R, Morris JA. Cost-effective method for bedside insertion of vena caval filters in trauma patients. J Trauma 1997; 43:752-8. [PMID: 9390485 DOI: 10.1097/00005373-199711000-00004] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The need for patient transport for inferior vena cava (IVC) filter placement impacts patient safety, comfort, charges, and nursing care. Bedside, ultrasound-guided IVC filter placement may offer an acceptable, cost-effective alternative. METHODS Prospective cohort study of 55 consecutive trauma patients requiring IVC filter placement. During a 13-month period (August of 1995-September of 1996), patients meeting criteria for IVC filter were evaluated. Complications were recorded, and the potential financial savings were determined. RESULTS Of 3,172 trauma admissions, 55 patients met IVC filter criteria and 49 patients had IVC filters placed under ultrasound guidance. In six patients (10.9%), ultrasound guided filter placement failed. There were four complications in four patients (8.2%). Over 13 months, charges were reduced by $69,800 when compared with radiology suite placement and $118,300 when compared with operative placement. CONCLUSIONS Ultrasound guided, bedside placement of IVC filters is a safe, cost-effective method of pulmonary embolism prophylaxis in select trauma patients.
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Affiliation(s)
- C R Nunn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA
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Buckon CE, Thomas S, Pierce R, Piatt JH, Aiona MD. Developmental skills of children with spastic diplegia: functional and qualitative changes after selective dorsal rhizotomy. Arch Phys Med Rehabil 1997; 78:946-51. [PMID: 9305266 DOI: 10.1016/s0003-9993(97)90055-1] [Citation(s) in RCA: 18] [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: 02/05/2023]
Abstract
OBJECTIVE This study examined changes in muscle tone, passive range of motion, stability, and mobility in developmental skills at 6 months and 1 year after selective dorsal rhizotomy (SDR). DESIGN Prospective outcome study of a consecutive sample. SETTING Private children's hospital. PATIENTS Twenty-six children with spastic diplegia: 13 independent and 13 dependent ambulators (assistive devices). RESULTS A decrease in spasticity was seen at 6 months after SDR, with no further decrease at 1 year. Increases in passive range of motion of the hip and ankle were seen at 6 months after SDR. The ability to assume and maintain developmental positions with improved alignment and stability was seen more frequently at 6 months after SDR, whereas an improvement in the ability to perform transitional movements was seen more frequently at 1 year after SDR. CONCLUSION SDR decreases spasticity and increases lower extremity range of motion in children with spastic diplegia and appears to be associated with the ability to assume a greater variety of developmental positions with improved alignment, thus greater stability. Improvements in the ability to perform difficult transitional movements at 1 year after SDR are most likely the result of the combined effect of maturation, SDR, and intensive therapeutic intervention.
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Affiliation(s)
- C E Buckon
- Shriners Hospital for Children, Oregon Health Sciences University, Portland, USA
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Maiorino M, Pierce R, Flohé L. Product of the Schistosoma mansoni glutathione peroxidase gene is a selenium containing phospholipid hydroperoxide glutathione peroxidase (PHGPx) sharing molecular weight and substrate specificity with its mammalian counterpart. Biomed Environ Sci 1997; 10:209-213. [PMID: 9315312] [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
In the blood fluke Schistosoma mansoni a functionally active, monomeric, phospholipid hydroperoxide glutathione peroxidase (PHGPx) has been purified and characterized. This enzyme contains a catalytically active selenocysteine. The protein has been shown to be the product of a cloned gene, previously referred to as a glutathione peroxidase gene. S. mansoni PHGPx has been found 5 times more abundant in female than in male worm extract. As in vertebrate PHGPx, homology alignment indicates that the residues involved in the glutathione binding by the tetrametric cellular glutathione peroxidase are mutated in the S. mansoni enzyme. Thus, this aspect appears a landmark of the PHGPx-type of glutathione peroxidases, which might be of functional relevance.
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Affiliation(s)
- M Maiorino
- Dipartimento di Chimica Biologica, Università di Padova, Italy
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Escriva H, Safi R, Hänni C, Langlois MC, Saumitou-Laprade P, Stehelin D, Capron A, Pierce R, Laudet V. Ligand binding was acquired during evolution of nuclear receptors. Proc Natl Acad Sci U S A 1997; 94:6803-8. [PMID: 9192646 PMCID: PMC21239 DOI: 10.1073/pnas.94.13.6803] [Citation(s) in RCA: 298] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The nuclear receptor (NR) superfamily comprises, in addition to ligand-activated transcription factors, members for which no ligand has been identified to date. We demonstrate that orphan receptors are randomly distributed in the evolutionary tree and that there is no relationship between the position of a given liganded receptor in the tree and the chemical nature of its ligand. NRs are specific to metazoans, as revealed by a screen of NR-related sequences in early- and non-metazoan organisms. The analysis of the NR gene duplication pattern during the evolution of metazoans shows that the present NR diversity arose from two waves of gene duplications. Strikingly, our results suggest that the ancestral NR was an orphan receptor that acquired ligand-binding ability during subsequent evolution.
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Affiliation(s)
- H Escriva
- Institut National de la Santé et de la Recherche Médicale U167 Relations Hôte-Parasite et Stratégies Vaccinales, Institut Pasteur de Lille, 1 rue Calmette, 59019, Lille Cedex, France
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47
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Remoué F, Poulain-Godefroy O, Mielcarek N, Pierce R, Capron A, Locht C, Riveau G. Local transient induction of inflammatory cytokines after intranasal administration of recombinant Bordetella pertussis. Microb Pathog 1997; 22:305-13. [PMID: 9160300 DOI: 10.1006/mpat.1996.0130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Inflammatory cytokines have been described to play a critical role in the orientation and amplification of the IgA immune response. In this study, we show that the intranasal administration of a Bordetella pertussis strain expressing the protective antigen glutathione-S-transferase of Schistosoma mansoni (Sm28GST) induced an inflammatory response in the lungs of mice, characterized by the production of inflammatory cytokines, such as Tumor Necrosis Factor alpha, Interleukin-6 and Transforming-Growth Factor beta. The production and the secretion of these cytokines in lung tissues were early and transient. Their presence was observed only during the first week after administration despite the persistence of the bacteria for 1 month. Two weeks after inoculation, Interleukin-10 secretion was detected in the lungs, which could explain the decrease in the production of inflammatory cytokines. These inflammation-regulating cytokines, induced in the lungs by the presence of the bacterial vector, could be part of the process generating the local immune response, in particular the anti-Sm28GST IgA response.
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Affiliation(s)
- F Remoué
- Laboratoire INSERM U167, Institut Pasteur, Lille, France
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48
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Meadows L, Wang W, den Haan JM, Blokland E, Reinhardus C, Drijfhout JW, Shabanowitz J, Pierce R, Agulnik AI, Bishop CE, Hunt DF, Goulmy E, Engelhard VH. The HLA-A*0201-restricted H-Y antigen contains a posttranslationally modified cysteine that significantly affects T cell recognition. Immunity 1997; 6:273-81. [PMID: 9075928 DOI: 10.1016/s1074-7613(00)80330-1] [Citation(s) in RCA: 225] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A peptide recognized by two cytotoxic T cell clones specific for the human minor histocompatibility antigen H-Y and restricted by HLA-A*0201 was identified. This peptide originates from SMCY, as do two other H-Y epitopes, supporting the importance of this protein as a major source of H-Y determinants in mice and humans. In naturally processed peptides, T cells only recognize posttranslationally altered forms of this peptide that have undergone modification of a cysteine residue in the seventh position. One of these modifications involves attachment of a second cysteine residue via a disulfide bond. This modification has profound effects on T cell recognition and also occurs in other class I MHC-associated peptides, supporting its general importance as an immunological determinant.
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Affiliation(s)
- L Meadows
- Department of Chemistry, University of Virginia, Charlottesville 22901, USA
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Pierce R, Henry M, Kelly D, Sherblom P, Kozlowsky W, Wichterman G, Miller TW. Temephos distribution and persistence in a southwest Florida salt marsh community. J Am Mosq Control Assoc 1996; 12:637-646. [PMID: 9046469] [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 distribution and persistence of the mosquito larvicide temephos was monitored throughout an intertidal salt marsh community in southwest Florida following routine aerial applications of Abate 4-E (43% temephos) from 1988 through 1993. Temephos was found to be more highly concentrated in the surface water microlayer than in mid-depth water, exhibiting a mean of 330 micrograms/liter at the surface and 12 micrograms/liter at mid-depth from 1 fl. oz./acre applications and 120 micrograms/liter in the surface and 4.5 micrograms/liter in mid-depth water for 0.5 fl. oz./acre applications. Concentrations at both surface and mid-depth diminished rapidly within the first 24 hours. Mangrove leaves provided the most persistent reservoir for temephos, remaining more than 7 days. Temephos residues also were observed in select salt marsh organisms, including the sheepshead minnow (Cyprinodon variegatus), adult fiddler crabs (Uca rapax) and the ribbed mussel (Geukensia sp.).
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Affiliation(s)
- R Pierce
- Mote Marine Laboratory, Sarasota, FL 34240, USA
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Maiorino M, Roche C, Kiess M, Koenig K, Gawlik D, Matthes M, Naldini E, Pierce R, Flohé L. A selenium-containing phospholipid-hydroperoxide glutathione peroxidase in Schistosoma mansoni. Eur J Biochem 1996; 238:838-44. [PMID: 8706688 DOI: 10.1111/j.1432-1033.1996.0838w.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The 100000Xg supernatant parasite platyhelminth Schistosoma mansoni exhibits a glutathione peroxidase activity with the substrate phosphatidylcholine hydroperoxide. Purification yielded a protein of 20 kDa molecular mass both on gel filtration column chromatography and SDS/PAGE, thus suggesting that S. mansoni expresses a protein similar to the mammalian selenoenzynic phospholipid-hydroperoxide glutathione peroxidase. Kinetic analysis and substrate specificity corroborated this assumption, the second-order rate constants for the oxidation of the ground-state enzyme (k+1) being higher with phosphatidylcholine hydroperoxide than with other peroxide substrates, such as cumene liydroperoxide or H2O2, and quantitatively similar to those of mammalian phospholipid-hydroperoxide glutathione peroxidase. Partial sequencing of the protein and selenium measurement by neutron activation analysis established that the purified peroxidase corresponded to the product of the S. mansoni gene previously reported and supposed to encode a selenium-containing glutathione peroxidase [Roche, C., Williams, D. L., Khalife, J., LePresle, T., Capron, A. & Pierce, R. J. (1994) Cloning and characterization of gene encoding Schistosoma mansoni glutathione peroxidase, Gene 138, 149 - 152]. S. mansoni thus contains a scienoperoxidase sharing molecular mass, catalytic efficiency and substrate specificity with phospholipid-hydroperoxide glutathione peroxidase, dismantling the concept that those enzymes are unique to vertebrate organisms.
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Affiliation(s)
- M Maiorino
- Dipartimento di Chimica Biologica, Università di Padova, Italy
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