1
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Ruphrect-Smith H, Davies S, Jacob J, Edbrooke-Childs J. Ethnic differences in treatment outcome for children and young people accessing mental health support. Eur Child Adolesc Psychiatry 2024; 33:1121-1131. [PMID: 37245162 PMCID: PMC11032270 DOI: 10.1007/s00787-023-02233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
Children and Young People (CYP) from minoritized ethnic backgrounds experience structural inequalities in Children and Young People's Mental Health Settings (CYPMHS). This mixed methods study explores whether CYP's ethnicity is associated with their treatment outcomes (operationalised as 'measurable change') from CYPMHS. A multilevel multi-nominal regression analysis, controlling for age, gender, referral source, presenting difficulty, case closure reason, suggests that CYP from Asian backgrounds (OR = 0.82, CI [0.70, 0.96]) and Mixed-race (odds ratio (OR) = 0.80; 95% CI [0.69, 0.92]) are less likely to report measurable improvement in mental health difficulties compared to White British CYP. Three themes from a thematic analysis of semi-structured interviews with 15 CYP from minoritized ethnic backgrounds focused on views and experiences of ending mental health support are also presented. CYP view personalised support and the right therapist as conducive to good endings and valued a range of outcomes pertaining to empowerment. Experiences of stigma and inequalities may begin to explain the less positive outcomes experienced by Asian and Mixed-race CYP found in the regression analysis. The implications of these findings and future areas of research are suggested.
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Affiliation(s)
- H Ruphrect-Smith
- Clinical, Educational, and Health Psychology, University College London, London, UK
| | - S Davies
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK
| | - J Jacob
- Clinical, Educational, and Health Psychology, University College London, London, UK
- Child Outcomes Research Consortium, Anna Freud, London, UK
| | - J Edbrooke-Childs
- Clinical, Educational, and Health Psychology, University College London, London, UK.
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK.
- Child Outcomes Research Consortium, Anna Freud, London, UK.
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2
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Luyckx VA, Alasfar S, Bajpai D, Atwater CE, Knight J, Talbot B, Davies S, Niang A. Providing environmentally sustainable nephrology care: focus in low- and middle-income countries. Kidney Int 2024; 105:259-268. [PMID: 38008159 DOI: 10.1016/j.kint.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 11/28/2023]
Abstract
Health care on a global scale significantly contributes to carbon emissions, with high-income countries being the primary culprits. Within health care, dialysis plays a significant role as a major source of emissions. Low- and middle-income countries have a high burden of kidney disease and are facing an increasing demand for dialysis. This reality presents multiple opportunities to plan for environmentally sustainable and quality kidney care. By placing a stronger emphasis on primary and secondary prevention of kidney disease and its progression, within the framework of universal health coverage, as well as empowering patients to enhance self-care, we can significantly reduce the need for costly and environmentally detrimental kidney replacement therapy. Mandating the adoption of lean and innovative low-carbon dialysis practices while also promoting the growth of kidney transplantation would enable low- and middle-income countries to take the lead in implementing environmentally friendly nephrology practices and reducing costs, thus optimizing sustainability and the well-being of individuals living with kidney disease.
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Affiliation(s)
- V A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - S Alasfar
- Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - D Bajpai
- Department of Nephrology, Seth G.S.M.C. and K.E.M. Hospital, Mumbai, India
| | - C E Atwater
- Department of Dialysis Capacity and Technical Operations, Bridge of Life, founded by Davita Inc., Denver, Colorado, USA
| | - J Knight
- The George Institute for Global Health, Newtown, Australia; Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - B Talbot
- The George Institute for Global Health, Newtown, Australia; Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - S Davies
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Abdou Niang
- Nephrology Department, Cheikh Anta Diop University & Dalal Jamm University Hospital, Dakar, Senegal
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3
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Davies S. Case study 4. Lymphorrhoea and venous ulceration in chronic bilateral lower-limb oedema. J Wound Care 2024; 33:S20-S21. [PMID: 38150278 DOI: 10.12968/jowc.2024.33.sup1.s20] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
- Sian Davies
- District Nurse with Specialist Interest in Chronic and Complex Wounds, Hywel Dda University Health Board
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4
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Davies S. Case study 3. Venous ulceration and oedema in the left anterior lower leg. J Wound Care 2024; 33:S18-S19. [PMID: 38194318 DOI: 10.12968/jowc.2024.33.sup1a.s18] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Sian Davies
- District Nurse with Specialist Interest in Chronic and Complex Wounds, Hywel Dda University Health Board
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5
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Davies S. Case study 4. Lymphorrhoea and venous ulceration in chronic bilateral lower-limb oedema. J Wound Care 2024; 33:S20-S21. [PMID: 38194311 DOI: 10.12968/jowc.2024.33.sup1a.s20] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Sian Davies
- District Nurse with Specialist Interest in Chronic and Complex Wounds, Hywel Dda University Health Board
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6
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Davies S. Case study 3. Venous ulceration and oedema in the left anterior lower leg. J Wound Care 2024; 33:S18-S19. [PMID: 38150275 DOI: 10.12968/jowc.2024.33.sup1.s18] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
- Sian Davies
- District Nurse with Specialist Interest in Chronic and Complex Wounds, Hywel Dda University Health Board
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7
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Sands E, Davies S, Puxty RJ, Vergé V, Bouget FY, Scanlan DJ, Carré IA. Genetic and physiological responses to light quality in a deep ocean ecotype of Ostreococcus, an ecologically important photosynthetic picoeukaryote. J Exp Bot 2023; 74:6773-6789. [PMID: 37658791 PMCID: PMC10662239 DOI: 10.1093/jxb/erad347] [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] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
Phytoplankton are exposed to dramatic variations in light quality when cells are carried by upwelling or downwelling currents or encounter sediment. We investigated the potential impact of light quality changes in Ostreococcus, a key marine photosynthetic picoeukaryote, by analysing changes in its transcriptome, pigment content, and photophysiology after acclimation to monochromatic red, green, or blue light. The clade B species RCC809, isolated from the deep euphotic zone of the tropical Atlantic Ocean, responded to blue light by accelerating cell division at the expense of storage reserves and by increasing the relative level of blue-light-absorbing pigments. It responded to red and green light by increasing its potential for photoprotection. In contrast, the clade A species OTTH0595, which originated from a shallow water environment, showed no difference in photosynthetic properties and minor differences in carotenoid contents between light qualities. This was associated with the loss of candidate light-quality responsive promoter motifs identified in RCC809 genes. These results demonstrate that light quality can have a major influence on the physiology of eukaryotic phytoplankton and suggest that different light quality environments can drive selection for diverse patterns of responsiveness and environmental niche partitioning.
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Affiliation(s)
- Elizabeth Sands
- School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Sian Davies
- School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | | | - Valerie Vergé
- Université Pierre et Marie Curie, Paris 06, UMR 7621, Laboratoire d’Océanographie Microbienne, Observatoire Océanologique, Banyuls sur Mer, France
| | - François-Yves Bouget
- Université Pierre et Marie Curie, Paris 06, UMR 7621, Laboratoire d’Océanographie Microbienne, Observatoire Océanologique, Banyuls sur Mer, France
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8
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Postavaru GI, Hamilton J, Davies S, Swaby H, Michael A, Swaby R, Mukaetova-Ladinska EB. The FATHER Model of Loss and Grief After Child's Life-Limiting Illness. Pediatrics 2023:e2022059122. [PMID: 37313621 DOI: 10.1542/peds.2022-059122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 06/15/2023] Open
Abstract
CONTEXT Loss of a child to a life-limiting condition (LLC) is 1 of the most traumatic life events for parents. Research focusing on fathers' experiences is in its infancy. OBJECTIVES Using a meta-ethnographic approach, we systematically reviewed the literature around fathers' predeath and postdeath experiences of loss and grief. DATA SOURCES We searched Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Science Direct, and used the meta-ethnography reporting guidelines; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; and sampling strategy, type of study, approaches, range of years, limits, inclusion and exclusions, terms used, and electronic sources recommendations. STUDY SELECTION We used the Guide to Children's Palliative Care and the directory of LLCs to select qualitative articles published up until the end of March 2023 that described fathers' predeath and postdeath experiences of loss and grief after their child's LLC. We excluded studies that failed to differentiate outcomes between mothers and fathers. DATA EXTRACTION Extracted data included study details, participants' characteristics, response rate, source of participants, method and time of data collection, children's characteristics, and quality assessment. First-order and second-order data were also extracted. RESULTS Forty studies informed a FATHER model of loss and grief. This highlights both similarities (ambivalence, trauma responses, fatigue, anxiety, unresolved grief, guilt) and distinct features defining the predeath and postdeath experiences of loss and grief. LIMITATIONS There was a bias toward greater mother participation in research. Specific categories of fathers remain underrepresented in palliative care literature. CONCLUSIONS Many fathers experience disenfranchised grief and deterioration in mental health after a child's diagnosis and postdeath. Our model opens possibilities for personalized clinical support in the palliative care system for fathers.
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Affiliation(s)
- Gianina-Ioana Postavaru
- School of Psychology and Vision Science, University of Leicester, Lancaster Road, Leicester, United Kingdom
| | - Jenny Hamilton
- University of Lincoln School of Psychology, Lincoln, United Kingdom
| | - Sian Davies
- Lancashire and South Cumbria NHS Foundation Trust, Preston, England, United Kingdom
| | - Helen Swaby
- Nottingham Trent University, Nottingham, England, United Kingdom
| | - Anastasia Michael
- Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, England, United Kingdom; and
| | - Rabbi Swaby
- Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, England, United Kingdom; and
| | - Elizabeta B Mukaetova-Ladinska
- School of Psychology and Vision Science, University of Leicester, Lancaster Road, Leicester, United Kingdom
- The Evington Centre, Leicester, United Kingdom
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9
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Davies S, Raju D. Powerful disinfectant properties. Br Dent J 2023; 234:844. [PMID: 37349415 DOI: 10.1038/s41415-023-6035-y] [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] [Received: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Affiliation(s)
- S Davies
- Founder of CleanCert Hygiene, Tisbury, United Kingdom.
| | - D Raju
- Founder of Green Dentistry, Bognor Regis, United Kingdom.
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10
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Yates DRA, Davies S, Kane AD. Death is not the worst that can happen: risk scoring and outcomes in emergency laparotomy. Anaesthesia 2023. [PMID: 37017990 DOI: 10.1111/anae.16018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Affiliation(s)
- D R A Yates
- Department of Anaesthesia and Intensive Care Medicine, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
- North Yorkshire Academic Alliance of Perioperative Medicine, York, UK
| | - S Davies
- Hull York Medical School, York, UK
- North Yorkshire Academic Alliance of Perioperative Medicine, York, UK
| | - A D Kane
- South Tees University Hospital NHS Foundation Trust, Middlesborough, UK
- North Yorkshire Academic Alliance of Perioperative Medicine, York, UK
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11
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Dhanda A, Bodger K, Hood S, Henn C, Allison M, Amasiatu C, Burton R, Cramp M, Forrest E, Khetani M, MacGilchrist A, Masson S, Parker R, Sheron N, Simpson K, Vergis N, White M, Boyd A, Brind A, Joshi A, Rund A, Srivastava A, McCune A, Gartland A, Hudson B, Stableforth B, John C, Maxan E, Unitt E, Beetteridge F, Lewis H, Fellows H, Haq I, Patel J, Ryan J, Cobbold J, Pohl K, Raeburn K, Corless L, Johnston M, Subhani M, Shah N, Ali N, Rajoriya N, Bendall O, Saeed O, Berry P, Moodley P, Abdelbadiee S, Davies S, Kotha S, Ryder S, Verma S, Manship T, Kumar V, Haddadin Y. The Liverpool alcohol-related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to Hospital Episode Statistics for England. Aliment Pharmacol Ther 2023; 57:368-377. [PMID: 36397658 PMCID: PMC10099257 DOI: 10.1111/apt.17307] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/19/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emergency admissions in England for alcohol-related liver disease (ArLD) have increased steadily for decades. Statistics based on administrative data typically focus on the ArLD-specific code as the primary diagnosis and are therefore at risk of excluding ArLD admissions defined by other coding combinations. AIM To deploy the Liverpool ArLD Algorithm (LAA), which accounts for alternative coding patterns (e.g., ArLD secondary diagnosis with alcohol/liver-related primary diagnosis), to national and local datasets in the context of studying trends in ArLD admissions before and during the COVID-19 pandemic. METHODS We applied the standard approach and LAA to Hospital Episode Statistics for England (2013-21). The algorithm was also deployed at 28 hospitals to discharge coding for emergency admissions during a common 7-day period in 2019 and 2020, in which eligible patient records were reviewed manually to verify the diagnosis and extract data. RESULTS Nationally, LAA identified approximately 100% more monthly emergency admissions from 2013 to 2021 than the standard method. The annual number of ArLD-specific admissions increased by 30.4%. Of 39,667 admissions in 2020/21, only 19,949 were identified with standard approach, an estimated admission cost of £70 million in under-recorded cases. Within 28 local hospital datasets, 233 admissions were identified using the standard approach and a further 250 locally verified cases using the LAA (107% uplift). There was an 18% absolute increase in ArLD admissions in the seven-day evaluation period in 2020 versus 2019. There were no differences in disease severity or mortality, or in the proportion of admissions with decompensation of cirrhosis or alcoholic hepatitis. CONCLUSIONS The LAA can be applied successfully to local and national datasets. It consistently identifies approximately 100% more cases than the standard coding approach. The algorithm has revealed the true extent of ArLD admissions. The pandemic has compounded a long-term rise in ArLD admissions and mortality.
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Affiliation(s)
- Ashwin Dhanda
- University of Plymouth, Plymouth, UK.,South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Keith Bodger
- University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Steve Hood
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Clive Henn
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | - Michael Allison
- Cambridge Liver Unit, Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Chioma Amasiatu
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | - Robyn Burton
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | - Matthew Cramp
- University of Plymouth, Plymouth, UK.,South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Meetal Khetani
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | | | - Steven Masson
- Liver Unit, Newcastle Hospitals NHS Trust, Newcastle, UK
| | - Richard Parker
- Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Sheron
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | - Ken Simpson
- Liver Unit, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Nikhil Vergis
- Imperial College London, London, UK.,Research and Development, GlaxoSmithKline (GSK), Hertfordshire, UK
| | - Martin White
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
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12
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Hamid M, Kershaw M, Bhakthavalsalan R, Shivamurthy R, Davies S, Ahmed Z. OGBN P05 Is there still a role for routine histology in cholecystectomies for benign disease? Br J Surg 2022. [DOI: 10.1093/bjs/znac404.050] [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: 12/12/2022]
Abstract
Abstract
Background
A movement towards selective histology for benign gallbladder disease is evolving in the United Kingdom (UK). Studies propose the reliance on macroscopic features to identify incidental gallbladder cancer (IGBC). We aimed to investigate the rate of dysplastic gallbladder histology, the rate of subtotal cholecystectomy and identify any selection criteria for selective histology.
Methods
A retrospective observational study examining patients who underwent a cholecystectomy, amid the COVID-19 pandemic, between January 2020 and June 2021. This study was carried out in a large Trust in the West Midlands, UK. Multivariate logistical regression models were used to identify patient factors associated with IGBC and compare outcomes between total and subtotal cholecystectomy.
Results
There were 959 patients; 631 (65.8%) elective and 328 (34.2%) emergency cholecystectomies. Median age was 48 (35–59) years, and 724 (75.5%) patients were female. 27 (2.8%) patients had a subtotal cholecystectomy with worse post-operative complications (Clavien-Dindo grade 3+, OR 4.69, p=0.026), however no patient suffered a common bile duct injury. Eight (0.8%) patients had IGBC of which 6/8 were diagnosed as cholelithiasis on ultrasound. Five IGBCs had no macroscopic features. One patient needed further surgery and chemotherapy. Gallbladder polyps on ultrasound was the only patient factor associated with increased likelihood of IGBC (OR 14.49, p=0.014).
Conclusions
We support the current recommendation of the UK Royal College of Pathologists to routinely examine all cholecystectomies removed for benign disease, given that macroscopic features may be absent in IGBC and no clear patient factors to support a selective approach.
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Affiliation(s)
- Mohammed Hamid
- University Hospitals Birmingham NHS Trust , Birmingham , United Kingdom
| | - Marie Kershaw
- University Hospitals Birmingham NHS Trust , Birmingham , United Kingdom
| | | | | | - Sian Davies
- University Hospitals Birmingham NHS Trust , Birmingham , United Kingdom
| | - Zuhair Ahmed
- University Hospitals Birmingham NHS Trust , Birmingham , United Kingdom
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13
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Hamid M, Kershaw M, Bhakthavalsalan R, Shivamurthy R, Davies S, Ahmed Z. OGBN P16 Pre-operative group and save, is there still a need in the elective and emergency laparoscopic cholecystectomy? Br J Surg 2022. [DOI: 10.1093/bjs/znac404.061] [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: 12/12/2022]
Abstract
Abstract
Background
Laparoscopic cholecystectomy is associated with a high safety profile. This study aimed to quantify the rate of blood transfusion in the elective and emergency setting and explore patient outcome and selection for Group and Save (G&S) sampling.
Methods
A retrospective observational study investigating patients who underwent an elective or emergency laparoscopic cholecystectomy at a single Trust in the UK, between December 2019 and May 2021. Outcomes of interest were selected based on their clinical possibility of being influenced by the number of pre-operative G&S samples using multivariate logistic regression models.
Results
There were 959 patients; 631 (65.8%) elective and 328 (34.2%) emergency cholecystectomies. Median age was 48 (35–59) years, and 724 (75.5%) patients were female. Five patients (0.5%) needed blood transfusion post-operatively, with an average time of six hours. Three of these patients had haematological conditions. In adjusted models, male sex was associated with requiring a blood transfusion (OR 11.31, p=0.013); whilst having a pre-operative G&S sample had no impact on any patient outcome.
Conclusions
Blood loss requiring blood transfusion in laparoscopic surgery is very low. Male sex and haematological conditions may present as independent risk factors for blood loss in laparoscopic cholecystectomy. Pre-operative G&S sampling has no impact on patient outcome and could safely be omitted in both elective and emergency cases unless a personalised assessment suggests otherwise.
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Affiliation(s)
- Mohammed Hamid
- University Hospitals Birmingham NHS Trust , Birmingham , United Kingdom
| | - Marie Kershaw
- University Hospitals Birmingham NHS Trust , Birmingham , United Kingdom
| | | | | | - Sian Davies
- University Hospitals Birmingham NHS Trust , Birmingham , United Kingdom
| | - Zuhair Ahmed
- University Hospitals Birmingham NHS Trust , Birmingham , United Kingdom
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14
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Newman A, Picot E, Davies S, Hilton S, Carré IA, Bending GD. Circadian rhythms in the plant host influence rhythmicity of rhizosphere microbiota. BMC Biol 2022; 20:235. [PMID: 36266698 PMCID: PMC9585842 DOI: 10.1186/s12915-022-01430-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background Recent studies demonstrated that microbiota inhabiting the plant rhizosphere exhibit diel changes in abundance. To investigate the impact of plant circadian rhythms on bacterial and fungal rhythms in the rhizosphere, we analysed temporal changes in fungal and bacterial communities in the rhizosphere of Arabidopsis plants overexpressing or lacking function of the circadian clock gene LATE ELONGATED HYPOCOTYL (LHY). Results Under diel light–dark cycles, the knock-out mutant lhy-11 and the gain-of-function mutant lhy-ox both exhibited gene expression rhythms with altered timing and amplitude compared to wild-type plants. Distinct sets of bacteria and fungi were found to display rhythmic changes in abundance in the rhizosphere of both of these mutants, suggesting that abnormal patterns of rhythmicity in the plant host caused temporal reprogramming of the rhizosphere microbiome. This was associated with changes in microbial community structure, including changes in the abundance of fungal guilds known to impact on plant health. Under constant environmental conditions, microbial rhythmicity persisted in the rhizosphere of wild-type plants, indicating control by a circadian oscillator. In contrast, loss of rhythmicity in lhy-ox plants was associated with disrupted rhythms for the majority of rhizosphere microbiota. Conclusions These results show that aberrant function of the plant circadian clock is associated with altered rhythmicity of rhizosphere bacteria and fungi. In the long term, this leads to changes in composition of the rhizosphere microbiome, with potential consequences for plant health. Further research will be required to understand the functional implications of these changes and how they impact on plant health and productivity. Supplementary Information The online version contains supplementary material available at 10.1186/s12915-022-01430-z.
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Affiliation(s)
- Amy Newman
- School of Life Sciences, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, West Midlands, UK.,Present address: National STEM Learning Centre, University of York, York, YO10 5DD, UK
| | - Emma Picot
- School of Life Sciences, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, West Midlands, UK
| | - Sian Davies
- School of Life Sciences, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, West Midlands, UK.,Present address: Micropathology Ltd, Venture Centre, Sir William Lyons Road, Coventry, CV4 7EZ, UK
| | - Sally Hilton
- School of Life Sciences, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, West Midlands, UK.,Present address: Micropathology Ltd, Venture Centre, Sir William Lyons Road, Coventry, CV4 7EZ, UK
| | - Isabelle A Carré
- School of Life Sciences, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, West Midlands, UK.
| | - Gary D Bending
- School of Life Sciences, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, West Midlands, UK
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15
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Jahnke V, Cotier S, Martin M, Davies S. SOC-I-03 Advanced qualitative and quantitative 3t3 neutral red uptake tests for more physiologically relevant in vitro phototoxicity assessment. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Olsson F, Mackay EB, Moore T, Barker P, Davies S, Hall R, Spears B, Wilkinson J, Jones ID. Annual water residence time effects on thermal structure: A potential lake restoration measure? J Environ Manage 2022; 314:115082. [PMID: 35468434 DOI: 10.1016/j.jenvman.2022.115082] [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: 12/22/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Innovative methods to combat internal loading issues in eutrophic lakes are urgently needed to speed recovery and restore systems within legislative deadlines. In stratifying lakes, internal phosphorus loading is particularly problematic during the summer stratified period when anoxia persists in the hypolimnion, promoting phosphorus release from the sediment. A novel method to inhibit stratification by reducing residence times is proposed as a way of controlling the length of the hypolimnetic anoxic period, thus reducing the loading of nutrients from the sediments into the water column. However, residence time effects on stratification length in natural lakes are not well understood. We used a systematic modelling approach to investigate the viability of changes to annual water residence time in affecting lake stratification and thermal dynamics in Elterwater, a small stratifying eutrophic lake in the northwest of England. We found that reducing annual water residence times shortened and weakened summer stratification. Based on finer-scale dynamics of lake heat fluxes and water column stability we propose seasonal or sub-seasonal management of water residence time is needed for the method to be most effective at reducing stratification as a means of controlling internal nutrient loading.
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Affiliation(s)
- Freya Olsson
- UK Centre for Ecology & Hydrology, Bailrigg, Lancaster, UK; Lancaster Environment Centre, Lancaster University, Bailrigg, Lancaster, UK.
| | | | - Tadhg Moore
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Phil Barker
- Lancaster Environment Centre, Lancaster University, Bailrigg, Lancaster, UK
| | - Sian Davies
- Environment Agency, Red Kite House, Howbery Park, Wallingford, UK
| | - Ruth Hall
- Natural England, Worcester County Hall, Spetchley Road, Worcester, UK
| | - Bryan Spears
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, UK
| | - Jayne Wilkinson
- South Cumbria Rivers Trust, The Refinery, The Clock Tower Business Centre, Low Wood, Ulverston, Cumbria, UK
| | - Ian D Jones
- Biological and Environmental Sciences, University of Stirling, Stirling, UK
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17
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Day C, Battes K, Butler B, Davies S, Farina L, Frattolillo A, George R, Giegerich T, Hanke S, Härtl T, Igitkhanov Y, Jackson T, Jayasekera N, Kathage Y, Lang P, Lawless R, Luo X, Neugebauer C, Ploeckl B, Santucci A, Schwenzer J, Teichmann T, Tijssen T, Tosti S, Varoutis S, Cortes AV. The pre-concept design of the DEMO tritium, matter injection and vacuum systems. Fusion Engineering and Design 2022. [DOI: 10.1016/j.fusengdes.2022.113139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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O’Connell Francischetto E, Jones J, Davies S, Allen K, Combes G, Damery S. 682 IMPACT OF DISCHARGE INTERVENTIONS FOR OLDER PATIENTS LEAVING HOSPITAL: A SYSTEMATIC REVIEW OF REVIEWS. Age Ageing 2022. [DOI: 10.1093/ageing/afac036.682] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
The UK has an aging population and there is an increasing need for additional care and support services for elderly patients discharged from hospital. Despite a large evidence base on different discharge services there is inconsistent findings on their effectiveness. This systematic review of reviews aimed to evaluate the impact of a variety of discharge interventions on older people leaving hospital.
Method
Ten databases were searched (including Medline and The Cochrane Library) using multiple key search terms related to ‘systematic reviews’, ‘older people’ and ‘discharge’. Only systematic reviews of interventions for people aged over 60 years that provided additional support or adapted their discharge processes were included. Outcomes of interest included mortality, readmissions, length of hospital stay, patient health status and costs. Abstract, title and full-text screening was conducted independently by two reviewers. Interventions were categorised by intervention type and a narrative synthesis was conducted on data extracted.
Results
Of the 8,748 title and abstracts reviewed, 859 full texts were assessed for eligibility, of these 91 were taken forward to quality assessment and 66 moderate or high-quality reviews were included in the final synthesis. Interventions were categorised into 10 types and had varying impact on outcomes. A statistically significant positive impact on the outcomes of interest was found for: Interventions providing ‘rehabilitation, therapy or care at home (or in the community) around the time of discharge’ reducing length of stay; ‘primary care interventions’, ‘Discharge planning/coordination or case management’ and ‘patient education’.
Conclusion
This systematic review of reviews shows that different types and configurations of discharge interventions can benefit older patients in multiple ways when compared to usual care and highlights which intervention types make no difference or have negative impacts. These findings will help to inform the development of new discharge interventions and the direction of future research.
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Affiliation(s)
- E O’Connell Francischetto
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - J Jones
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - S Davies
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - K Allen
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - G Combes
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - S Damery
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
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19
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Olsson F, Mackay EB, Barker P, Davies S, Hall R, Spears B, Exley G, Thackeray SJ, Jones ID. Can reductions in water residence time be used to disrupt seasonal stratification and control internal loading in a eutrophic monomictic lake? J Environ Manage 2022; 304:114169. [PMID: 34864421 DOI: 10.1016/j.jenvman.2021.114169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/20/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 06/13/2023]
Abstract
Anthropogenic eutrophication caused by excess loading of nutrients, especially phosphorus (P), from catchments is a major cause of lake water quality degradation. The release of P from bed sediments to the water column, termed internal loading, can exceed catchment P load in eutrophic lakes, especially those that stratify during warm summer periods. Managing internal P loading is challenging, and although a range of approaches have been implemented, long-term success is often limited, requiring lake-specific solutions. Here, we assess the manipulation of lake residence time to inhibit internal loading in Elterwater, a shallow stratifying lake in the English Lake District, UK. Since 2016, additional inflowing water has been diverted into the inner basin of Elterwater to reduce its water residence time, with the intention of limiting the length of the stratified period and reducing internal loading. Combining eight years of field data in a Before-After-Control-Impact study with process-based hydrodynamic modelling enabled the quantification of the residence time intervention effects on stratification length, water column stability, and concentrations of chlorophyll a and P. Annual water residence time was reduced during the study period by around 40% (4.9 days). Despite this change, the lake continued to stratify and developed hypolimnetic anoxia. As a result, there was little significant change in phosphorus (as total or soluble reactive phosphorus) or chlorophyll a concentrations. Summer stratification length was 2 days shorter and 7% less stable with the intervention. Our results suggest that the change to water residence time in Elterwater was insufficient to induce large enough physical changes to improve water quality. However, the minor physical changes suggest the management measure had some impact and that larger changes in water residence time may have the potential to induce reductions in internal loading. Future assessments of management requirements should combine multi-year observations and physical lake modelling to provide improved understanding of the intervention effect size required to alter the physical structure of the lake, leading to increased hypolimnetic oxygen and reduced potential for internal loading.
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Affiliation(s)
- Freya Olsson
- UK Centre for Ecology & Hydrology, Bailrigg, Lancaster, UK; Lancaster Environment Centre, Lancaster University, Bailrigg, Lancaster, UK.
| | | | - Phil Barker
- Lancaster Environment Centre, Lancaster University, Bailrigg, Lancaster, UK
| | - Sian Davies
- Environment Agency, Red Kite House, Howbery Park, Wallingford, UK
| | - Ruth Hall
- Natural England, Worcester County Hall, Spetchley Road, Worcester, UK
| | - Bryan Spears
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, UK
| | - Giles Exley
- Lancaster Environment Centre, Lancaster University, Bailrigg, Lancaster, UK
| | | | - Ian D Jones
- Biological and Environmental Sciences, University of Stirling, Stirling, UK
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20
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Davies S, Clarke E, Hardy E, Hepworth C. COVID-19, child inactivity and the introduction of an online exercise class. Physiotherapy 2022. [PMCID: PMC8848158 DOI: 10.1016/j.physio.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Davies S, Ghassemi N, Lo NY, Rathod S, Carney A, Ralph A, Kulendrarajah B, Athwal T, Cheruvu C. P-BN29 Laparoscopic cholecystectomy during the era of a Covid-19 pandemic; a cohort study. Br J Surg 2021. [PMCID: PMC9383107 DOI: 10.1093/bjs/znab430.029] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
The Covid-19 era has created a lot of uncertainty for management of common emergency and elective surgical conditions such as acute cholecystitis and other gallstone disease related emergency admissions. At our centre we continued to provide early operative intervention for patients presenting with biliary disease and acute cholecystitis throughout the Covid-19 era during both the 1st and the 2nd waves, despite a significant local surge in Covid-19 hospital admissions impacting on the available resources. Here we present the outcomes of our experience of managing such patients during the Covid-19 pandemic of 2020 of both 1st and 2nd waves.
Methods
A retrospective observational study was performed on all patients presenting with acute cholecystitis and biliary disease who underwent elective and emergency surgical intervention at UHNM (University Hospital of North Midlands) during the second wave of the Covid pandemic (2nd CW) between 14/10/2020 and 14/01/2021). These were then compared with patients who presented in the first Covid wave (1st CW) of 1/03/020 – 30/06/2020,) and a control group pre-covid (CG) 1/03/2019 – 30/06/2019, Patients were identified using ICD-10 codes K80 (Cholelithiasis) and K81 (Cholecystitis) and OPCS codes.J18.1 – J18.5. Primary endpoints were length of stay, 30 day readmission rates, mortality and morbidity.
Results
A total of 146 patients were identified who underwent laparoscopic cholecystectomy during the study time period (2ndCW). In comparison to 104 patients during the first covid wave cohort (1st CW) and the control group (CG) of 217 patients in the preceding non covid year. Length of stay (LOS) was significantly lower in the 2ndCW cohort in comparison to both the previous 1st CW cohort and the CG cohort (p < 0.0001), with readmissions also being statistically lower (5% vs 15% and 12% respectively p = 0.027). There was no statistical difference in outcomes for post-operative complications as per Clavien-Dindo classification.
Conclusions
Overall our study demonstrates that the recommended good practice of early surgical intervention in both emergency and elective gallstone disease can continue during the pandemic periods without any significant impact on patient care & outcomes. Also during this period length of stay was significantly shorted and lower 30 day readmission rates which are likely to be multifactorial but where lessons could be potentially learnt.
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22
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Kalogeras K, Zuhair M, Kabir T, Jabbour R, Dalby M, Ghada M, Shai S, Katsianos E, Iqbal M, Naganuma T, Davies S, Shannon J, Duncan A, Vavuranakis M, Panoulas V. Real-world comparison of the last generation balloon-expandable and self-expanding valves in patients undergoing TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2191] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The balloon expandable (BE) Edwards Sapien-S3/Ultra, and the self-expanding (SE) Medtronic Evolut-Pro represent the main volume of transcatheter aortic valve implantation (TAVI) procedures conducted worldwide.
Purpose
The present study represents the largest real-world comparison of periprocedural and short-term outcome between the aforementioned last generation devices.
Methods
Consecutive patients who had undergone TAVI with either the BE (S3/Ultra) or SE (Evolut-Pro/R-34mm if 34mm valve was required) device, in five centers were retrospectively studied. Periprocedural and short-term outcomes were recorded and compared.
Results
In total, 1341 patients (58.5% male) were treated with contemporary BE and SE valves (574 and 767pts with BE and SE respectively) and followed up for a median of 18.7 (IQR 30) months. Baseline demographics were similar between the two groups apart from severe left ventricle (LV) systolic impairment and extensive aorta calcification, being more prevalent amongst BE and SE groups respectively. Patients treated with the Evolut-Pro/R34mm device had significantly lower peak (16±9mmHg for SE vs 23.9±6mmHg for the BE valves, p=0.001) and mean (8.6±6mmHg SE vs 11.2±5.2mmHg BE, p=0.001) gradients at discharge.
Conversely, the BE group demonstrated significantly lower rates of at least moderate residual aortic regurgitation (AR) post-operatively (0.7% vs 5.2% for BE and SE valves respectively, p<0.001). Interestingly, the rate of new permanent pacemaker (PPM) required after the implantation in initially pacemaker-free patients, was higher for the S3/Ultra cohort compared to the self-expanding valve group (14.4% vs 12.3% respectively, p=0.001). No statistical difference was recorded between valve groups regarding cerebrovascular events (3.4% vs. 2.7% for SE and BE respectively, p=0.466), major vascular complications (4.2% vs. 3.0% for SE and BE respectively, p=0.251) and death to hospital discharge (1.6% vs. 2.9% for SE and BE respectively, p=0.117).
One-year Kaplan-Meier estimated survival was similar between the two groups (88.7% for BE vs. 91.4% for SE valves, plog-rank=0.093). When adjusting for age, extensive calcification of the aorta and baseline LV function all caused mortality hazard ratios were similar between patients treated with BE vs SE valves (HR 1.39; 95% CI 0.97 to 1.98, p=0.07).
Conclusions
Real life comparison of the last generation balloon expandable and self-expanding devices demonstrates superiority of the former in terms of residual PVL, at the expense of higher transvalvular gradients and higher need of new PPM implantation. The latter however may represent differences in center practices with regards to thresholds for permanent pacing. Long-term follow-up and future larger trials are required to establish any potential long-term difference in clinical outcomes and prognosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Kalogeras
- Athens Chest Hospital Sotiria, 3rd Department of Cardiology, University of Athens, Athens, Greece
| | - M Zuhair
- Imperial College London, London, United Kingdom
| | - T Kabir
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - R Jabbour
- Imperial College London, London, United Kingdom
| | - M Dalby
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - M Ghada
- Imperial College London, London, United Kingdom
| | - S Shai
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | - E Katsianos
- Athens Chest Hospital Sotiria, 3rd Department of Cardiology, University of Athens, Athens, Greece
| | - M Iqbal
- Imperial College London, London, United Kingdom
| | | | - S Davies
- Imperial College London, London, United Kingdom
| | - J Shannon
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | - A Duncan
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | - M Vavuranakis
- Athens Chest Hospital Sotiria, 3rd Department of Cardiology, University of Athens, Athens, Greece
| | - V Panoulas
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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23
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Mansor MS, Rozali FZ, Davies S, Nor SM, Ramli R. High-throughput sequencing reveals dietary segregation in Malaysian babblers. Curr Zool 2021; 68:381-389. [PMID: 36090137 PMCID: PMC9450176 DOI: 10.1093/cz/zoab074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/28/2021] [Indexed: 11/24/2022] Open
Abstract
The coexistence of numerous species within a community results from how those species use available resources. Babblers are one of the major groups of Malaysian insectivorous birds, which frequently forage in dense vegetation cover and have a high level of sympatry. Therefore, examining the diet, prey selection, and niche segregation of babblers can be challenging. In this study, we used high-throughput sequencing to investigate potential dietary overlap or segregation among 10 babbler species of the 4 genera of the family Pellorneidae and Timaliidae: Pellorneum, Malacopteron, Stachyris, and Cyanoderma in central peninsular Malaysia. We tested the hypothesis that trophically similar species may differ in resource use to avoid competitive exclusion. We identified 81 distinct arthropod taxa from fecal samples, belonging to 71 families representing 13 orders, which were predominantly from 16 dipteran, 13 lepidopteran, and 10 coleopteran families. Of all the prey taxa consumed, 45% were found to be distinct across the 10 babbler species, and ˂35% were shared simultaneously by ≥3 babbler species, indicating minimal dietary overlap. The black-throated babbler Stachyris nigricollis and moustached babbler Malacopteron magnirostre had the most generalist tendencies because they consumed a greater variety of prey taxa. Small dietary overlap values (Ojk) and a relatively wide range of food resources suggest that dietary segregation occurred among the studied babblers. The great diversity of prey consumed revealed the presence of dietary flexibility among the sympatric insectivorous birds, thus reducing any active dietary competition and facilitating the coexistence through niche partitioning.
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Affiliation(s)
- Mohammad Saiful Mansor
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
| | | | - Sian Davies
- Micropathology Ltd, University of Warwick Science Park, Coventry, CV4 7EZ, UK
| | - Shukor Md Nor
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
| | - Rosli Ramli
- Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
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24
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Mcleod RJW, Wilks L, Davies S, Elhassan HA. 448 The Impact of Noise in the Operating Theatre: A Review of the Evidence. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.143] [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
Background
Noise has been recognised to have a negative impact on performance and wellbeing in many settings. Average noise levels have been found to range between 51-79 dB in operating theatres. Despite this, there is little research investigating the effect of noise on surgical team functioning.
Method
A literature review to look at the impact of noise in the operating theatre was performed on MEDLINE which included the search terms ‘noise’ OR ‘distraction’ AND ‘technical skill’ OR ‘Surgical skill’ OR ‘Operating Room’. 10 of 307 articles identified were deemed relevant.
Results
8 of 10 studies found noise to be detrimental to communication and surgical performance, particularly regarding total errors and time to task completion. No studies found noise to be beneficial. Two studies found case irrelevant verbal communication to be a frequent form of noise pollution in operating theatres; this is both perceived by surgeons to be distracting and delays patient care. Noise was most harmful to trainees.
Conclusions
Noise and irrelevant verbal communications were both found to be harmful to surgical performance, surgeon experience and team functioning. The worsened effect on the trainee exposes an urgent need to address noise pollution in the training environment.
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Affiliation(s)
| | - L Wilks
- Morriston Hospital, Swansea, United Kingdom
| | - S Davies
- Morriston Hospital, Swansea, United Kingdom
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25
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Maishman T, Sheikh H, Boger P, Kelly J, Cozens K, Bateman A, Davies S, Fay M, Sharland D, Jackson A. A Phase II Study of Biodegradable Stents Plus Palliative Radiotherapy in Oesophageal Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e225-e231. [PMID: 33402268 DOI: 10.1016/j.clon.2020.12.010] [Citation(s) in RCA: 4] [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: 07/17/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 01/21/2023]
Abstract
AIMS Self-expanding metal stents provide rapid improvement of dysphagia in oesophageal cancer but are associated with complications. The aim of the present study was to test the effectiveness of an alternative treatment of combining biodegradable stents with radiotherapy. MATERIALS AND METHODS A Simon two-stage single-arm prospective phase II trial design was used to determine the efficacy of biodegradable stents plus radiotherapy in patients with dysphagia caused by oesophagus cancer who were unsuitable for radical treatment. Fourteen patients were recruited and data from 12 were included in the final analyses. RESULTS Five of 12 patients met the primary end point: one stent-related patient death; four further interventions for dysphagia within 16 weeks of stenting (41.7%, 95% confidence interval 15.2-72.3%). The median time to a 10-point deterioration of quality of life was 2.7 weeks. Nine patients died within 52 weeks of registration. The median time to death from any cause was 15.0 weeks (95% confidence interval 9.6-not reached). CONCLUSION The high re-intervention observed, which met the pre-defined early stopping criteria, meant that the suggested alternative treatment was not sufficiently effective to be considered for a larger scale trial design. Further work is needed to define the place of biodegradable stents in the management of malignant oesophageal strictures.
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Affiliation(s)
- T Maishman
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - H Sheikh
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Boger
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Kelly
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Cozens
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - A Bateman
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Davies
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Fay
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Sharland
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Jackson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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26
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Hamed MO, Barlow AD, Dolezalova N, Khosla S, Sagar A, Gribble FM, Davies S, Murphy MP, Hosgood SA, Nicholson ML, Saeb-Parsy K. Ex vivo normothermic perfusion of isolated segmental porcine bowel: a novel functional model of the small intestine. BJS Open 2021; 5:6220254. [PMID: 33839750 PMCID: PMC8038264 DOI: 10.1093/bjsopen/zrab009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/26/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is an unmet need for suitable ex vivo large animal models in experimental gastroenterology and intestinal transplantation. This study details a reliable and effective technique for ex vivo normothermic perfusion (EVNP) of segmental porcine small intestine. METHODS Segments of small intestine, 1.5-3.0 m in length, were retrieved from terminally anaesthetized pigs. After a period of cold ischaemia, EVNP was performed for 2 h at 37°C with a mean pressure of 80 mmHg using oxygenated autologous blood diluted with Ringer's solution. The duration of EVNP was extended to 4 h for a second set of experiments in which two segments of proximal to mid-ileum (1.5-3.0 m) were retrieved from each animal and reperfused with whole blood (control) or leucocyte-depleted blood to examine the impact of leucocyte depletion on reperfusion injury. RESULTS After a mean cold ischaemia time of 5 h and 20 min, EVNP was performed in an initial group of four pigs. In the second set of experiments, five pigs were used in each group. In all experiments bowel segments were well perfused and exhibited peristalsis during EVNP. Venous glucose levels significantly increased following luminal glucose stimulation (mean(s.e.m.) basal level 1.8(0.6) mmol/l versus peak 15.5(5.8) mmol/l; P < 0.001) and glucagon-like peptide 1 (GLP-1) levels increased in all experiments, demonstrating intact absorptive and secretory intestinal functions. There were no significant differences between control and leucocyte-depleted animals regarding blood flow, venous glucose, GLP-1 levels or histopathology at the end of 4 h of EVNP. CONCLUSIONS This novel model is suitable for the investigation of gastrointestinal physiology, pathology and ischaemia reperfusion injury, along with evaluation of potential therapeutic interventions.
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Affiliation(s)
- M O Hamed
- Correspondence to: Department of Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK (e-mail:)
| | - A D Barlow
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - N Dolezalova
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - S Khosla
- Wellcome Trust – MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - A Sagar
- Wellcome Trust – MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - F M Gribble
- Department of Histopathology, University of Cambridge, Cambridge, UK
| | - S Davies
- Department of Histopathology, University of Cambridge, Cambridge, UK
| | - M P Murphy
- MRC Mitochondrial Biology Unit, Cambridge, UK
| | - S A Hosgood
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - M L Nicholson
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - K Saeb-Parsy
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
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Schneider J, Davies S, Howarth A, GARCIA SANCHEZ J, Rao N, Grandy S, Bhatt P, Parackal A, Wong D, Briggs A. POS-321 TRANSLATING THE FINDINGS OF THE ROXADUSTAT NDD GLOBAL PHASE 3 PROGRAM INTO COST OFFSETS FROM A CANADIAN HEALTHCARE PERSPECTIVE. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.337] [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] Open
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Flexman AM, Shillcutt SK, Davies S, Lorello GR. Current status and solutions for gender equity in anaesthesia research. Anaesthesia 2021; 76 Suppl 4:32-38. [PMID: 33682100 DOI: 10.1111/anae.15361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
Despite increasing numbers of women entering anaesthesia, they remain persistently under-represented within academic anaesthesia and research. Gender discordance is seen across multiple aspects of research, including authorship, editorship, peer review, grant receipt, speaking and leading. Women are also under-represented at higher faculty ranks and in department chair positions. These inequities are further magnified for women with intersectional identities, such as those who identify as Black, indigenous and women of colour. Several barriers to participation in research have been identified to date, including a disproportionate amount of family responsibilities, a disproportionate burden of clinical service, gender bias, sexual harassment and the gender pay gap. Several strategies to improve gender equity have been proposed. Increasing access to formal mentorship of women in academic medicine is frequently cited and has been used by healthcare institutions and medical societies. Senior faculty and leaders must also be conscious of including women in sponsorship and networking opportunities. Institutions should provide support for parents of all genders, including supportive parental leave policies and flexible work models. Women should also be materially supported to attend formal educational conferences targeted for women, aimed at improving networking, peer support and professional development. Finally, leaders must display a clear intolerance for sexual harassment and discrimination to drive culture change. Peers and leaders alike, of all genders, can act as upstanders and speak up on behalf of targets of discrimination, both in the moment or after the fact. Gender inequities have persisted for far too long and can no longer be ignored. Diversifying the anaesthesia research community is essential to the future of the field.
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Affiliation(s)
- A M Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - S K Shillcutt
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Davies
- Trinity College, Cambridge University, Cambridge, UK
| | - G R Lorello
- Department of Anesthesiology and Pain Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
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Atkin L, King B, Duffus-Grovell D, Meagher H, Chaplin S, Davies S. Highly exuding non-healing leg ulcers: a surmountable challenge. ACTA ACUST UNITED AC 2021; 30:S3-S20. [PMID: 33881928 DOI: 10.12968/bjon.2021.30.sup5.s1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Leanne Atkin
- Lecturer Practitioner, University of Huddersfield and Vascular Nurse Consultant, Pinderfields Hospital, Wakefield, UK
| | - Brenda King
- Independent Nurse Consultant, Tissue Viability, Wound Care Connections
| | - Delma Duffus-Grovell
- Tissue Viability Nurse Specialist, Community Team, Guy's and St Thomas's Hospital NHS Foundation Trust, London
| | - Helen Meagher
- Registered Advanced Nurse Practitioner Tissue Viability, University Hospital Limerick, Republic of Ireland
| | - Shauna Chaplin
- Vascular Clinical Nurse Specialist, University Hospital Limerick, Republic of Ireland
| | - Sian Davies
- District Nurse with Specialist Interest in Chronic and Complex Wounds, 3Ts Locality, Carmarthenshire
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Davies S, Sergot L, Qamhia N, Pawade J, Chakraverty J. Case report: Primary bone lymphoma presenting as a painful supraclavicular lump. Radiol Case Rep 2021; 16:871-873. [PMID: 33552343 PMCID: PMC7850962 DOI: 10.1016/j.radcr.2021.01.038] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022] Open
Abstract
Primary bone lymphoma is a rare type of non-Hodgkin's lymphoma. It commonly arises from long bones such as the femur in the appendicular skeleton. The authors present a case of primary bone lymphoma of the clavicle, an uncommon location for this pathology, presenting as a painful supraclavicular lump in a 76-year-old woman. Magnetic resonance imaging and ultrasound examinations showed the typical feature of preservation of the bony cortex, and PET-CT revealed no alternative primary site of malignancy. This case highlights the importance of considering typical imaging characteristics of a lesion, even if it presents in an unusual site, as well as the value of completion imaging in clinical practice to secure a diagnosis.
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Affiliation(s)
- Sian Davies
- Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
| | - Leon Sergot
- Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
| | - Naim Qamhia
- Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
| | - Joya Pawade
- Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
| | - Julian Chakraverty
- Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
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Mulder PA, van Balkom IDC, Landlust AM, Priolo M, Menke LA, Acero IH, Alkuraya FS, Arias P, Bernardini L, Bijlsma EK, Cole T, Coubes C, Dapia I, Davies S, Di Donato N, Elcioglu NH, Fahrner JA, Foster A, González NG, Huber I, Iascone M, Kaiser AS, Kamath A, Kooblall K, Lapunzina P, Liebelt J, Lynch SA, Maas SM, Mammì C, Mathijssen IB, McKee S, Mirzaa GM, Montgomery T, Neubauer D, Neumann TE, Pintomalli L, Pisanti MA, Plomp AS, Price S, Salter C, Santos-Simarro F, Sarda P, Schanze D, Segovia M, Shaw-Smith C, Smithson S, Suri M, Tatton-Brown K, Tenorio J, Thakker RV, Valdez RM, Van Haeringen A, Van Hagen JM, Zenker M, Zollino M, Dunn WW, Piening S, Hennekam RC. Development, behaviour and sensory processing in Marshall-Smith syndrome and Malan syndrome: phenotype comparison in two related syndromes. J Intellect Disabil Res 2020; 64:956-969. [PMID: 33034087 PMCID: PMC8957705 DOI: 10.1111/jir.12787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ultrarare Marshall-Smith and Malan syndromes, caused by changes of the gene nuclear factor I X (NFIX), are characterised by intellectual disability (ID) and behavioural problems, although questions remain. Here, development and behaviour are studied and compared in a cross-sectional study, and results are presented with genetic findings. METHODS Behavioural phenotypes are compared of eight individuals with Marshall-Smith syndrome (three male individuals) and seven with Malan syndrome (four male individuals). Long-term follow-up assessment of cognition and adaptive behaviour was possible in three individuals with Marshall-Smith syndrome. RESULTS Marshall-Smith syndrome individuals have more severe ID, less adaptive behaviour, more impaired speech and less reciprocal interaction compared with individuals with Malan syndrome. Sensory processing difficulties occur in both syndromes. Follow-up measurement of cognition and adaptive behaviour in Marshall-Smith syndrome shows different individual learning curves over time. CONCLUSIONS Results show significant between and within syndrome variability. Different NFIX variants underlie distinct clinical phenotypes leading to separate entities. Cognitive, adaptive and sensory impairments are common in both syndromes and increase the risk of challenging behaviour. This study highlights the value of considering behaviour within developmental and environmental context. To improve quality of life, adaptations to environment and treatment are suggested to create a better person-environment fit.
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Affiliation(s)
- P A Mulder
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - I D C van Balkom
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - A M Landlust
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - M Priolo
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - L A Menke
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - I H Acero
- Genetics Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - F S Alkuraya
- Saudi Human Genome Project, King Abdulaziz City for Science and Technology, and Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - P Arias
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - L Bernardini
- Cytogenetics Unit, Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - E K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Coubes
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - I Dapia
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - S Davies
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - N Di Donato
- Institute for Clinical Genetics, TU Dresden, Dresden, Germany
| | - N H Elcioglu
- Department of Pediatric Genetics, Marmara University Medical School, Istanbul and Eastern Mediterranean University, Mersin, Turkey
| | - J A Fahrner
- McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Foster
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N G González
- Unit Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I Huber
- Sørland Hospital, Kristiansand, Norway
| | - M Iascone
- Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A-S Kaiser
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - A Kamath
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - K Kooblall
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Lapunzina
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - J Liebelt
- South Australian Clinical Genetics Services, Women's and Children's Hospital, North Adelaide, Australia
| | - S A Lynch
- UCD Academic Centre on Rare Diseases, School of Medicine and Medical Sciences, University College Dublin, and Clinical Genetics, Temple Street Children's University Hospital, Dublin, Ireland
| | - S M Maas
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - C Mammì
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - I B Mathijssen
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S McKee
- Northern Ireland Regional Genetics Service, Belfast Health and Social Care Trust, Belfast, UK
| | - G M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, and Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - T Montgomery
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Neubauer
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - T E Neumann
- Mitteldeutscher Praxisverbund Humangenetik, Halle, Germany
| | - L Pintomalli
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - M A Pisanti
- Medical Genetic and Laboratory Unit, "Antonio Cardarelli" Hospital, Naples, Italy
| | - A S Plomp
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S Price
- Department of Clinical Genetics, Northampton General Hospital NHS Trust, Northampton, UK
| | - C Salter
- Wessex Clinical Genetics Service, Princess Ann Hospital, Southampton, UK
| | - F Santos-Simarro
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - P Sarda
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - D Schanze
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Segovia
- CENAGEM, Centro Nacional de Genética, Buenos Aires, Argentina
| | - C Shaw-Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Smithson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - M Suri
- Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Tatton-Brown
- Division of Genetics and Epidemiology, Institute of Cancer Research, London and South West Thames Regional Genetics Service, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - J Tenorio
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - R V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - R M Valdez
- Genetics Unit, Hospital Militar Central "Cirujano Mayor Dr. Cosme Argerich", Buenos Aires, Argentina
| | - A Van Haeringen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - J M Van Hagen
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, Netherlands
| | - M Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Zollino
- Department of Laboratory Medicine, Institute of Medical Genetics, Catholic University, Rome, Italy
| | - W W Dunn
- Department of Occupational Therapy Education, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - S Piening
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - R C Hennekam
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Vandenbriele C, Balthazar T, Wilson J, Ledot S, Smith R, Caetano A, Adriaenssens T, Goetschalckx K, Janssens S, Dubois C, Jacobs S, Meyns B, Davies S, Price S. Left heart Impella-device to bridge acute mitral regurgitation to MitraClip-procedure: a novel implementation of percutaneous mechanical circulatory support. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Acute mitral regurgitation (MR) is an emergency, often requiring urgent surgery. Severe acute MR presenting with hemodynamic collapse is usually caused by papillary muscle rupture or dysfunction after acute myocardial infarction (AMI) or chordal rupture, resulting in flail mitral leaflet(s). Preoperative stabilization is complex due to concomitant hemodynamic collapse and hypoxic respiratory failure. Finding the right balance between both preload and inotropic support is challenging. When patients are too sick for immediate surgical intervention, mechanical circulatory support can be considered because of its ability to both unload and reduce of cardiac work while increasing coronary perfusion and cardiac output. Nevertheless, even after initial stabilization, surgical risk remains high in critically ill acute severe MR patients and transcatheter treatments such as MitraClip are increasingly being explored.
Methods
Between August 2017 and September 2019, patients presenting with acute severe mitral regurgitation and considered too ill for immediate surgical intervention (EURO-II score >11.2% plus pulmonary oedema necessitating mechanical ventilation and/or hemodynamic instability), were selected for an Impella-assisted LV unloading technique as bridge to MitraClip-procedure. Five patients were selected for the combined left Impella/MitraClip-procedure in two tertiary cardiac ICUs.
Results
The mean age was 72 years. The cause of MR was ischemic in 20% and all patients presented in cardiogenic shock state, necessitating mechanical ventilation. The overall cardiac operative risk assessment (Euro-II) score predicted a 35% chance of in-hospital mortality. Cardiac output was severely impaired (mean LVOT VTI 8.2 cm). All patients were on inotropic support and supported by an Impella-CP pVAD (mean flow 2.5 Liter per minute; mean 6.3 days of support). In all cases, we managed to reduce the LVEDP below 15 mmHg using the combination of medical therapy (afterload reduction, inotropes), mechanical ventilation and pVAD-therapy. The MR was significantly reduced by a MitraClip-procedure in each Impella supported patient. The overall survival at discharge was 80%. One patient with late referral and multiple organ failure at presentation deceased due to refractory cardiogenic shock. Overall, severe MR was reduced to grade 1+ and all four patients survived 6 months after discharge with only one readmission for decompensated heart failure.
Conclusions
A combined strategy of Impella and MitraClip appears to be a novel, feasible alternative for patients presenting with acute, severe MR unable to proceed to a corrective surgical procedure at presentation due to severe left ventricular forward flow failure. In these cases, the early initiation of pVAD-support may reduce the risk of development of irreversible end- organ damage and dysfunction. Exploration in a larger, randomised population is warranted to investigate this strategy further.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - T Balthazar
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - J Wilson
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - R Smith
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A.F Caetano
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | | | | | - S Janssens
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - C Dubois
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - S Jacobs
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - B Meyns
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - S Davies
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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Sergot L, Davies S, Davison P, Chakraverty J. 21 year old male with atraumatic right hip pain. Skeletal Radiol 2020; 49:1861-1863. [PMID: 32447470 DOI: 10.1007/s00256-020-03460-6] [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: 02/02/2023]
Affiliation(s)
- Leon Sergot
- Department of Radiology, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK.
| | - Sian Davies
- Department of Radiology, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
| | - Paul Davison
- Department of Radiology, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
| | - Julian Chakraverty
- Department of Radiology, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
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Sergot L, Davies S, Davison P, Chakraverty J. A 21-year-old male with atraumatic right hip pain: diagnosis and discussion. Skeletal Radiol 2020; 49:1885-1886. [PMID: 32495014 DOI: 10.1007/s00256-020-03461-5] [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: 02/02/2023]
Affiliation(s)
- Leon Sergot
- Department of Radiology, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK.
| | - Sian Davies
- Department of Radiology, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
| | - Paul Davison
- Department of Radiology, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
| | - Julian Chakraverty
- Department of Radiology, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, BS1 3NU, UK
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Davies S, Ghallab M, Hajibandeh S, Hajibandeh S, Addison S. Three-dimensional versus two-dimensional imaging during laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials. Langenbecks Arch Surg 2020; 405:563-572. [PMID: 32572555 DOI: 10.1007/s00423-020-01909-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/12/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To evaluate the comparative outcomes of three-dimensional (3D) versus two-dimensional (2D) imaging during laparoscopic cholecystectomy. METHODS We conducted a systematic search of electronic information sources and bibliographic reference lists and applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Procedure time, Calot's triangle dissection time, gallbladder removal time, gallbladder perforation, intraoperative bleeding, postoperative complications, conversion to open and intraoperative errors were the evaluated outcome parameters. RESULTS We identified 6 randomised controlled trials (RCT) reporting a total of 577 patients who underwent laparoscopic cholecystectomy using 3D (n = 282) or 2D (n = 295) imaging. The 3D imaging was associated with significantly shorter procedure time (MD - 4.23, 95% CI - 8.14 to - 0.32, p = 0.03), Calot's triangle dissection time (MD - 4.19, 95% CI - 6.52 to - 1.86, p = 0.0004) and significantly lower risk of gallbladder perforation (RR 0.50, 95% CI 0.28-0.88, p = 0.02) compared to the 2D approach. No significant difference was found in gallbladder removal time (MD - 0.79, 95% CI - 2.24 to 0.66, p = 0.28), intraoperative bleeding (RR 1.14, 95% CI 0.68-1.90, p = 0.61), postoperative complications (RD - 0.01, 95% CI - 0.06 to 0.05, p = 0.85), conversion to open (RD 0.00, 95% CI - 0.02 to 0.03, p = 0.70) or intraoperative errors (RR 0.96, 95% CI 0.79-1.17, p = 0.70) between the two groups. CONCLUSIONS Although our findings suggest that the use of 3D imaging during laparoscopic cholecystectomy may be associated with significantly shorter procedure time, Calot's triangle dissection time and gallbladder injury compared to the 2D imaging, the differences seem to be clinically insignificant. Moreover, both approaches carry s similar risk of postoperative morbidities. The impact of the surgeon's level of experience and difficulty of the procedure on the outcomes of each imaging modality remains unknown.
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Affiliation(s)
- Sian Davies
- Department of General Surgery, The Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Mohammed Ghallab
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shahab Hajibandeh
- Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK
| | - Shahin Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
| | - Sarah Addison
- Department of General and Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Arshaghi TE, Clifford J, Davies S, Barry F. Mesenchymal stem cell exosome characterisation and high-throughput quantification by fluorescence polarisation spectroscopy. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Skapinakis P, Lewis G, Davies S, Brugha T, Prince M, Singleton N. Panic disorder and subthreshold panic in the UK general population: Epidemiology, comorbidity and functional limitation. Eur Psychiatry 2020; 26:354-62. [DOI: 10.1016/j.eurpsy.2010.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/14/2010] [Accepted: 06/23/2010] [Indexed: 10/19/2022] Open
Abstract
AbstractObjectiveThe epidemiology of panic disorder has not been investigated in the past in the UK using a nationally representative sample of the population. The aim of the present paper was to examine the epidemiology, comorbidity and functional impairment of subthreshold panic and panic disorder with or without agoraphobia.MethodWe used data from the 2000 Office for National Statistics Psychiatric Morbidity survey (N = 8580). Panic disorder and agoraphobia were assessed with the Revised Clinical Interview Schedule (CIS-R).ResultThe prevalence of panic disorder with or without agoraphobia was 1.70% (95% confidence interval: 1.41–2.03%). Subthreshold panic was more common. Economic inactivity was consistently associated with all syndromes. The comorbidity pattern of the panic syndromes and the associated functional impairment show that panic-related conditions are important public health problems, even in subthreshold status.ConclusionsThe findings show that efforts to reduce the disability associated with psychiatric disorders should include detection and management of panic disorder.
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Brown EA, Davies SJ, Heimbürger O, Meeus F, Mellotte G, Rosman J, Rutherford P, Van Bree M, Borras M, Brown E, Caillette–Beaudoin A, Clutterbuck E, Davies S, D'Auzac C, Ekstrand A, Frandsen N, Freida P, Heimbürger O, Kuypers+ D, Gasthuisberg+ A, Mactier R, MacNamara E, Malmsten G, Mastrangelo F, Meeus F, Melotte G, Perez–Contreras J, Riegel W, Rodrigues A, Rodriguez–Carmona A, Rosman J, Rutherford P, Scanziani R, Vega Diaz N, Vychytil A, Weinreich T. Adequacy Targets Can be Met in Anuric Patients by Automated Peritoneal Dialysis: Baseline Data from Eapos. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s19] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
♦ Objective Conventional continuous ambulatory peritoneal dialysis (CAPD) in patients without residual renal function and with high solute transport is associated with worse clinical outcomes. Automated peritoneal dialysis (APD) has the potential to improve both solute clearance and ultrafiltration in these circumstances, but its efficacy as a treatment modality is unknown. The European Automated Peritoneal Dialysis Outcomes Study (EAPOS) is a 2-year, prospective, European multi-center study designed to determine APD feasibility and clinical outcomes in anuric patients. The present article describes the baseline data for patients recruited into the study. ♦ Design All PD patients treated in the participating centers were screened for inclusion criteria [urinary output < 100 mL/24 h, or residual renal function (RRF) < 1 mL/min, or both]. After enrollment, changes were made to the dialysis prescription to achieve a weekly creatinine clearance above 60 L per 1.73 m2 and an ultrafiltration rate above 750 mL in 24 hours. ♦ Setting The study is being conducted in 26 dialysis centers in 13 European countries. ♦ Baseline Data Collection The information collected includes patient demographics, dialysis prescription, achieved weekly creatinine clearance, and 24-hour ultra-filtration (UF). ♦ Results The study enrolled 177 anuric patients. Median dialysis duration before enrollment was 22.5 months (range: 0 – 285 months). Mean solute transport measured as the dialysate-to-plasma ratio of creatinine (D/PCr) was 0.74 ± 0.12. Patients received APD for a median of 9.0 hours overnight (range: 7 – 12 hours) using a median of 11.0 L of fluid (range: 6 – 28.75 L). Median daytime volume was 4.0 L (range: 0.0 – 9.0 L). Tidal dialysis was used in 26 patients, and icodextrin in 86 patients. At baseline, before treatment optimization, the weekly mean total creatinine clearance was 65.2 ± 14.4 L/1.73 m2, with 105 patients (60%) achieving the target of more than 60 L/1.73 m2. At baseline, 81% of patients with high transport, 69% with high-average transport, and 40% with low-average transport met the target. At baseline, 70% of patients with a body surface area (BSA) below 1.7 m2, 60% with a BSA of 1.7 – 2.0 m2, and 56% with a BSA above 2.0 m2 achieved 60 L/1.73 m2 weekly. Median UF was 1090 mL/24 h, and 75% of patients achieved the UF target of more than 750 mL/24 h. ♦ Conclusion This baseline analysis of anuric patients recruited into the EAPOS study demonstrates that a high proportion of anuric patients on APD can achieve dialysis and ultrafiltration targets using a variety of regimes. This 2-year follow-up study aims to optimize APD prescription to reach predefined clearance and ultrafiltration targets, and to observe the resulting clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - M. Borras
- Hospital Amau de Vilanova, Lerida, Spain
| | - E. Brown
- Charing Cross Hospital, London, U.K
| | | | | | - S. Davies
- North Staffordshire Hospital, Stoke-on-Trent, U.K
| | - C. D'Auzac
- Hôpital Européen Georges Pompidou, Paris, France
| | - A. Ekstrand
- Helsinki University Hospital, Helsinki, Finland
| | | | - P. Freida
- Centre Hospitalier Louis Pasteur, Cherbourg, France
| | | | | | | | - R. Mactier
- Stobhill Hospital NHS Trust, Glasgow, Scotland, U.K
| | - E. MacNamara
- Centre Hospitalier Germon et Gauthier, Bethune, France
| | - G. Malmsten
- Orebro Medical Center Hospital, Orebro, Sweden
| | | | - F. Meeus
- Centre Hospitalier Louise Michel Evry, Evry, France
| | | | | | - W. Riegel
- Klinikum Darmstadt, Darmstadt, Germany
| | | | | | - J. Rosman
- Westeinde Hospital, The Hague, Netherlands
| | | | | | - N. Vega Diaz
- Hospital Nuestra Senora del Pino, Las Palmas, Spain
| | - A. Vychytil
- Universitat Klinik für Innere Medezin III, Vienna, Austria
| | - T. Weinreich
- Dialyse Institüt Villingen– Schwenningen, Schwenningen, Germany
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Peacock M, Paterson J, Reed L, Davies S, Carter S, Coe A, Clarkson J. Innovation in Fischer–Tropsch: Developing Fundamental Understanding to Support Commercial Opportunities. Top Catal 2020. [DOI: 10.1007/s11244-020-01239-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractIn this contribution we provide details of the BP-Johnson Matthey proprietary Fischer–Tropsch technology and the advanced CANS reactor and catalyst system. The advanced CANS catalyst carrier reactor provides superior heat transfer, reduced pressure drop and higher productivity that lead to major economic savings. Fundamental understanding of catalyst behaviour is also key to obtaining a catalyst that is stable over the lifetime of its use. Synthesis, calcination and reduction steps introduce changes in the catalyst properties prior to syngas introduction. In particular, the presence of water can affect the final catalyst performance. The activity of a good catalyst can be significantly reduced by a sub-optimal activation or start-up. Similarly, stable operation and minimising deactivation are vital for long and stable catalyst life, with years of operation without requiring regeneration. In this report we also share a fundamental study on the catalyst activation across different catalyst supports. This combines advanced in situ techniques with reactor testing to explore the role of the support on catalyst performance. The results illustrate the critical need for a logical and systematic catalyst development programme to explore these effects to optimise the whole FT process. The combination of a joint approach in development plays a key role in a long term success in a process. The fundamental catalyst understanding, optimisation and improvements in combination with the novel CANS reactor design maximise their potential and offer the potential for a world leading technology.
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Davies S, Marino L, Underwood T, West M. Handgrip strength and nutritional status as a predictor of postoperative complications following oesophagectomy and gastrectomy. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.039] [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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Roberts J, Kontou K, Davies S, Gray T. P1.07-02 Implementation of a Health and Wellbeing Programme in Conjunction with Pulmonary Rehabiliatation. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1011] [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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Davidson M, Mansukhani S, Starling N, Chau I, Watkins D, Cunningham D, Rao S, Lazaro-Alcausi R, Griffiths B, Barber L, Morganstein D, Forster M, Davies S, Begum R, Gillbanks A, Kalaitzaki E, Wotherspoon A, Von Loga K, Chaudry A, Gerlinger M. Perioperative FLOT + anti-PD-L1 avelumab (FLOT-A) chemo-immunotherapy in resectable oesophagogastric adenocarcinoma (OGA): Safety and biomarker data from the ICONIC trial safety run-in. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.002] [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: 11/14/2022] Open
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Vandenbriele C, Wilson J, Baker A, Azzu A, Gambaro A, Morosin M, Arachchillage D, Rosenberg A, Davies S, Trimlett R, Ledot S, Price S. P1718Veno-arterial ECMO versus Left Impella bleeding complications in cardiogenic shock patients on dual antiplatelet therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0473] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Selective groups of patients, presenting with INTERMACS-1 cardiogenic shock due to acute ischaemic heart failure, may benefit from mechanical circulatory support (MCS). Patients with biventricular failure, severe septic shock or oxygenation problems should be selected for VA-ECMO, although the left Impella-CP heart pump can be considered as a less invasive alternative in supporting predominantly left ventricular failure. Bleeding issues are a major concern in patients on MCS, especially in this group where triple anticoagulation therapy (unfractionated heparin (UFH) for prevention of pump thrombosis and dual antiplatelet therapy (DAPT) after coronary stenting) is necessitated. We aim to investigate the bleeding and transfusion rate in DAPT-patients on VA-ECMO versus Impella.
Methods
We report single center data for 51 VA-ECMO and 8 Impella patients between 2011 and 2019. Indication for MCS was acute ischaemic cardiogenic shock. Patient demographics, transfusions and reported/radiographically diagnosed bleeding (BARC-classification) complications were analyzed. All patients received UFH and low dose aspirin plus clopidogrel or ticagrelor. Impella flow was at least 2.5 L/min. Transfusion targets were Hb >7 g/dl, fibrinogen >100 mg/dl (or >150 mg/dl when active bleeding) and platelet count >50/fL.
Results
Impella patients were significantly older (VA-ECMO 52.8 vs. Impella 62.4; p=0.02) as compared to the VA-ECMO group. Anti-Xa-levels and length of the MCS-run (mean 7.9 VA-ECMO vs. 6.4 days Impella) were comparable in both groups. Occurrences of minor bleeds was comparable between both groups (mainly oozing from the insertion site in the ImpellaTM group 63% vs. VA-ECMO 72%; p>0.05) but major bleedings with BARC score of 3 or more were significantly lower in the Impella group (13% vs. VA-ECMO 65%; p=0.005). Platelet and red blood cell transfusions were significantly lower in the Impella group (0.1 units of platelets per day vs. 1.1 units of platelets per day on VA-ECMO; p=0.002 and 0.8 units of RBCs per day vs. 2.6 units of RBCs per day on VA-ECMO; p=0.02).
Bleeding/transfusion VA-ECMO vs Impella
Conclusions
Bleeding is a frequent complication of MCS. However, in our cohort, triple anticoagulation in acute cardiogenic shock due to ischaemic left ventricle failure resulted in a lower major bleeding rate when support was given by the left Impella device as compared with VA-ECMO therapy group. As a result, platelet and red blood cell transfusions were lower in the Impella group. These findings are likely to be partly explained by the increased number and size of cannulas in VA-ECMO, as well as the increased risk of haemolysis and consumptive coagulopathy due to the complexity and extensive foreign body surface of the ECMO-circuit. We conclude that Impella support should be considered as a safer option than VA-ECMO with regards to bleeding in patients with ischaemic left ventricular failure who require DAPT and MCS as a bridge to recovery or other definitive therapy.
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - J Wilson
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Baker
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Azzu
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - M Morosin
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - D Arachchillage
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Rosenberg
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Davies
- Royal Brompton and Harefield NHS Foundation Trust, Cardiology, London, United Kingdom
| | - R Trimlett
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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Autran-Martínez M, Cortes-Acevedo P, Cerón-Gutiérrez L, Davies S, Mendoza-Elvira ES, Martínez-Rodríguez HA, Liboni C, Pérez-Valencia V, Döffinger R, Barcenas-Morales G. High incidence of anti-cytokine autoantibodies in dogs with immune diseases suggests important immuno-regulatory functions. Vet Immunol Immunopathol 2019; 214:109902. [PMID: 31378221 DOI: 10.1016/j.vetimm.2019.109902] [Citation(s) in RCA: 1] [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: 02/12/2019] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 11/30/2022]
Abstract
Autoantibodies against cytokines have been associated with immunodeficiency, susceptibility to infectious diseases, autoimmunity and inflammation in humans, but have not yet been investigated in the Veterinary field so far. The aim of the current study was to determine the presence of anti-cytokine autoantibodies in canines suffering from various conditions including recurrent infections, autoimmune diseases and cancer in comparison to healthy controls. This is the first report of the presence of autoantibodies against cytokines in dogs. A total of 101 serum samples (51 patients and 50 clinically healthy dogs) from the state of Mexico and surroundings were analysed using a multiplex bead-based flow cytometry assay. Results show significant levels of various anti-cytokine autoantibodies in diseased dogs but not in healthy controls. In addition we show distinct associations of various disease types to the specificity of anti-cytokine autoantibodies and to response complexities. Apart from the direct functional/causal implication of anti-cytokine auto-antibodies on disease processes, this findings point to the possibility to use anti-cytokine response patterns as diagnostic tools.
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Affiliation(s)
- M Autran-Martínez
- Laboratorio 2 Inmunología, Facultad de Estudios Superiores (FES) Cuautitlán, Universidad Nacional Autonoma de México (UNAM), Mexico
| | - P Cortes-Acevedo
- Laboratorio 2 Inmunología, Facultad de Estudios Superiores (FES) Cuautitlán, Universidad Nacional Autonoma de México (UNAM), Mexico
| | - L Cerón-Gutiérrez
- Department of Clinical Biochemistry and Immunology, Addenbrookes Hospital and National Institute of Health Research (NIHR), Cambridge Biomedical Research Centre, Cambridge, UK
| | - S Davies
- Department of Clinical Biochemistry and Immunology, Addenbrookes Hospital and National Institute of Health Research (NIHR), Cambridge Biomedical Research Centre, Cambridge, UK
| | - E S Mendoza-Elvira
- Laboratorio de Microbiología. FES Cuautitlan, UNAM, Estado de México, Mexico
| | | | - C Liboni
- Universitá degli studi di Padova, Dipartimento di Scienze Biomediche- Via Ugo Bassi, 58/B-35131 Padova Italy Fondazione Istituto di Ricerca Pediatrica Cittá della Speranza-Corso Stati Uniti, 4-37127, Padova, Italy
| | | | - R Döffinger
- Department of Clinical Biochemistry and Immunology, Addenbrookes Hospital and National Institute of Health Research (NIHR), Cambridge Biomedical Research Centre, Cambridge, UK.
| | - G Barcenas-Morales
- Laboratorio 2 Inmunología, Facultad de Estudios Superiores (FES) Cuautitlán, Universidad Nacional Autonoma de México (UNAM), Mexico
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Cullis B, Brusselmans A, Davies S, Finkelstein O F, Hendricks K, McCulloch M, Smoyer E W, Feehally J. SAT-157 THE SAVING YOUNG LIVES PROGRAM: PROOF OF PRINCIPLE AND OVERCOMING BARRIERS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.189] [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: 11/29/2022] Open
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Howell S, Hoeks S, West R, Wheatcroft S, Hoeft A, Leva B, Plichon B, Damster S, Momeni M, Watremez C, Kahn D, Dincq AS, Danila A, Wittmann M, Struck R, Rüddel T, Kessler F, Rasche S, Matsota P, Hasani A, Gudaityte J, Karbonskiene A, Ferreira R, Carvalho S, Tomescu D, Martac C, Grintescu I, Mirea L, Serrano L, Serrano L, Sierra P, Sabaté S, Hernando D, Matute P, Trashorras M, Suñé M, Sarmiento L, Hervias A, González O, Hermina A, González O, Hermina A, Navarro Perez R, Orts M, Fernandez-Garcia R, Sanchez Pérez D, Sepulveda Gil I, Monedero P, Hidalgo F, Mbongo C, Pont A, Reyes H, Bartolo C, Galera S, Valentijn T, Stolker R, Tugrul M, Emre Demirel E, Hough M, Griffiths K, Birch S, Beardow Z, Elliot S, Thompson J, Bowrey S, Northey M, Melson H, Telford R, Nadolski M, Potter A, Fuller D, Rose A, Varma S, Simeson K, Pettit J, Smith N, Martinson V, Sleight L, Naylor C, Watt P, Raymode P, Dunk N, Twohey L, Hollos L, Davies S, Gibson A, Coleman Z, Tamm T, Joscak J, Zsisku L, Zuleika M, Carvalho P, Collyer T, Ryan J, Colling K, Dharmarajah S, Krishnan A, Paddle J, Fouracres A, Arnell K, Muhammad K. Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery. Br J Anaesth 2019; 122:170-179. [DOI: 10.1016/j.bja.2018.09.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/16/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023] Open
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Duerden L, Markos V, Davies S. Service evaluation: should magnetic resonance (MR) liver be supervised by the reporting radiologist? Clin Radiol 2018. [DOI: 10.1016/j.crad.2018.07.113] [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: 11/28/2022]
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Davies S, George A, Macallister A, Barton H, Youssef A, Boyle L, Sequeiros I. “It's all in the history”: A service evaluation of the quality of radiological requests in acute imaging. Radiography (Lond) 2018; 24:252-256. [DOI: 10.1016/j.radi.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/11/2018] [Accepted: 03/18/2018] [Indexed: 10/17/2022]
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Kaseda R, Tsuchida Y, Gamboa JL, Zhong J, Zhang L, Yang H, Dikalova A, Bian A, Davies S, Fogo AF, Linton MF, Brown NJ, Ikizler TA, Kon V. Angiotensin receptor blocker vs ACE inhibitor effects on HDL functionality in patients on maintenance hemodialysis. Nutr Metab Cardiovasc Dis 2018; 28:582-591. [PMID: 29691148 PMCID: PMC5959764 DOI: 10.1016/j.numecd.2018.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Angiotensin receptor blockers (ARB) and angiotensin converting enzyme inhibitors (ACEI) reduce cardiovascular events in the general population. Maintenance hemodialysis (MHD) patients are at high cardiovascular risk but few studies have directly addressed the comparative efficacy of these drugs. MHD disrupts the normally atheroprotective actions of high density lipoprotein (HDL), therefore, we compared ACEI or ARB treatment on HDL functions in MHD. METHODS AND RESULTS HDL was isolated at the starting point (pre) and 3-6 months later (post) in 30 MHD randomly assigned to placebo, ramipril or valsartan. Outcomes included cholesterol efflux, inflammatory cytokine response, effects on Toll-like receptors (TLR), superoxide production, methylarginine and serum amyloid A (SAA) levels. HDL from ARB- or ACEI-treated subjects was more effective in maintaining efflux than HDL of placebo. HDL from ARB- or ACEI-treated subjects but not placebo lessened cellular superoxide production. In contrast, neither ARB nor ACEI improved HDL anti-inflammatory effect. Indeed, HDL of ACEI-treated subjects potentiated the cytokine responses in association with activation of TLR but did not alter the HDL content of methylarginines or SAA. CONCLUSION Both ACEI and ARB stabilized HDL cholesterol acceptor function and sustained cellular anti-oxidative effects but not anti-inflammatory effects, and ACEI-treatment instead amplified the HDL inflammatory response. The findings reveal possible utility of antagonizing angiotensin actions in MDH and suggest a possible mechanism for superiority of ARB vs ACEI in the setting of advanced kidney disease.
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Affiliation(s)
- R Kaseda
- Pediatric Nephrology, VUMC, Nashville, TN, USA
| | - Y Tsuchida
- Pediatric Nephrology, VUMC, Nashville, TN, USA
| | | | - J Zhong
- Pediatric Nephrology, VUMC, Nashville, TN, USA; Pathology, Microbiology and Immunology, Nashville, TN, USA
| | - L Zhang
- Pharmacology, Nashville, TN, USA
| | - H Yang
- Pediatric Nephrology, VUMC, Nashville, TN, USA; Pathology, Microbiology and Immunology, Nashville, TN, USA
| | | | - A Bian
- Biostatistics, Vanderbilt Medical Center, Nashville, TN, USA
| | - S Davies
- Pharmacology, Nashville, TN, USA
| | - A F Fogo
- Pediatric Nephrology, VUMC, Nashville, TN, USA; Medicine, Nashville, TN, USA; Pathology, Microbiology and Immunology, Nashville, TN, USA
| | | | | | | | - V Kon
- Pediatric Nephrology, VUMC, Nashville, TN, USA.
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