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Gould S, Wrzesinski C, Stebbings R, Segal L. Report from an ICT 2022 workshop on toxicology for Covid19 vaccines: Industry, regulatory and CRO perspectives. Vaccine 2023; 41:5919-5924. [PMID: 37633751 DOI: 10.1016/j.vaccine.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
The Covid pandemic took the world by surprise in late 2019 and the need for rapid development of vaccines became paramount. The challenge was how to accelerate standard vaccine development times as much as possible. With knowledge of the genetic code of SARsCOV2, vaccine manufacturers throughout the world have risen to the challenge and several new vaccines were rapidly developed for emergency use. In March 2020, global Regulatory Authorities met to consider how to start early clinical trials and accept rolling submissions. Before use in clinical trials or any mass vaccination campaigns, the safety of the candidate vaccine needs to be evaluated. Non-clinical toxicology studies are required as an important part of vaccine safety evaluation. The extent of the toxicology evaluation prior to the start of clinical trials depended on several factors, including: the type of the candidate vaccine as well as already available supportive information with the candidate vaccine or similar vaccine types. For vaccine candidates with pre-existing data, this would save valuable time whilst a full toxicology evaluation was completed in parallel. For vaccines with more limited data, toxicology data was required before clinical development could start. This workshop examined the nonclinical toxicology studies for new Covid vaccines from the perspectives of: Vaccine manufacturers with different vaccine technologies, managing global regulatory submissions/responses; CROs, managing the urgency of conducting and reporting studies and supporting new players in the vaccine world; and Regulatory Authorities, in supporting the review process, juggling the need for safety and quality with mounting pressure to approve vaccines.
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Spencer A, Nicholls I, Onianwa O, Furneaux J, Grieves J, Pottage T, Gould S, Fletcher T, Dunning J, Bennett AM, Atkinson B. Mpox virus DNA contamination can still be detected by qPCR analysis after autoclaving. J Hosp Infect 2023; 139:217-219. [PMID: 37459916 DOI: 10.1016/j.jhin.2023.07.006] [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] [Received: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A Spencer
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK.
| | - I Nicholls
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O Onianwa
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Grieves
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - T Pottage
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - A M Bennett
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - B Atkinson
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
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Atkinson B, Spencer A, Onianwa O, Furneaux J, Grieves J, Nicholls I, Gould S, Fletcher T, Dunning J, Bennett AM, Patel S, Asboe D, Whitlock G. Longitudinal mpox virus surface sampling in an outpatient setting. J Hosp Infect 2023; 135:196-198. [PMID: 36842538 DOI: 10.1016/j.jhin.2023.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Affiliation(s)
- B Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK.
| | - A Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O Onianwa
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Grieves
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - I Nicholls
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - A M Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Patel
- Chelsea & Westminster Hospital NHS Trust, London, UK
| | - D Asboe
- Chelsea & Westminster Hospital NHS Trust, London, UK
| | - G Whitlock
- Chelsea & Westminster Hospital NHS Trust, London, UK
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Atkinson B, Gould S, Spencer A, Onianwa O, Furneaux J, Grieves J, Summers S, Crocker-Buqué T, Fletcher T, Bennett A, Dunning J. Monkeypox virus contamination in an office-based workplace environment. J Hosp Infect 2022; 130:141-143. [PMID: 36055524 PMCID: PMC9428113 DOI: 10.1016/j.jhin.2022.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 10/25/2022]
Affiliation(s)
- B. Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK,Corresponding author. Address: Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - S. Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A. Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O. Onianwa
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Grieves
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S. Summers
- High Containment Microbiology, UK Health Security Agency, Porton Down, Salisbury, UK
| | - T. Crocker-Buqué
- Faculty of Public Health and Policy, London School Hygiene and Tropical Medicine, London, UK
| | - T. Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A.M. Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
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Gould S. S-11-01 Covid19 vaccine toxicology: introduction and CRO experience/perspectives. Toxicol Lett 2022. [PMCID: PMC9465512 DOI: 10.1016/j.toxlet.2022.07.100] [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: 11/26/2022]
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Beaty C, Corao-Uribe D, Saul D, Gould S. AMR After Transplant in a Child with Complex CHD and Ruptured LV Aneurysm. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gould S, Freeman J, Salinas B, Crisman R. Overcoming ex vivo cell therapy manufacturing challenges through an in vivo lentiviral platform: scalability, supply chain, and cogs. Cytotherapy 2021. [DOI: 10.1016/s1465324921005429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Elhenawy W, Hordienko S, Gould S, Oberc AM, Tsai CN, Hubbard TP, Waldor MK, Coombes BK. High-throughput fitness screening and transcriptomics identify a role for a type IV secretion system in the pathogenesis of Crohn's disease-associated Escherichia coli. Nat Commun 2021; 12:2032. [PMID: 33795670 PMCID: PMC8016931 DOI: 10.1038/s41467-021-22306-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
Adherent-invasive Escherichia coli (AIEC) are pathogenic bacteria frequently isolated from patients who have Crohn's disease (CD). Despite the phenotypic differences between AIEC and commensal E. coli, comparative genomic approaches have been unable to differentiate these two groups, making the identification of key virulence factors a challenge. Here, we conduct a high-resolution, in vivo genetic screen to map AIEC genes required for intestinal colonization of mice. In addition, we use in vivo RNA-sequencing to define the host-associated AIEC transcriptome. We identify diverse metabolic pathways required for efficient gut colonization by AIEC and show that a type IV secretion system (T4SS) is required to form biofilms on the surface of epithelial cells, thereby promoting AIEC persistence in the gut. E. coli isolated from CD patients are enriched for a T4SS, suggesting a possible connection to disease activity. Our findings establish the T4SS as a principal AIEC colonization factor and highlight the use of genome-wide screens in decoding the infection biology of CD-associated bacteria that otherwise lack a defined genetic signature.
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Affiliation(s)
- Wael Elhenawy
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, Hamilton, ON, Canada
| | - Sarah Hordienko
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Steven Gould
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Alexander M Oberc
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Caressa N Tsai
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Troy P Hubbard
- Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
| | - Matthew K Waldor
- Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
- Howard Hughes Medical Institute, Boston, MA, USA
| | - Brian K Coombes
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.
- Michael G. DeGroote Institute for Infectious Disease Research, Hamilton, ON, Canada.
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.
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Gould S, Knowling E, Smola R, Titer K, Martin K. Efficacy of a cadaver-based procedural skills lab for internal medicine residents. Cogent Medicine 2020. [DOI: 10.1080/2331205x.2020.1780065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ateba-Ngoa U, Edoa JR, Adegbite BR, Rossatanga EG, Madiou D, Mfoumbi A, Mevyann C, Achimi Agbo P, Mahoumbou J, Gould S, Lell B, Adegnika AA, Köhler C, Kremsner PG, Massinga-Loembe M, Alabi A, Grobusch MP. Implementation of multidrug-resistant tuberculosis (MDR-TB) treatment in Gabon: lessons learnt from the field. Infection 2019; 47:811-816. [PMID: 31073710 DOI: 10.1007/s15010-019-01314-5] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/30/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Since May 2016, WHO recommended a 9-12 month short-treatment regimen for multidrug-resistant tuberculosis (MDR-TB) treatment known as the 'Bangladesh Regimen'. However, limited data exist on the appropriateness thereof, and its implementation in low- and middle-income countries (LMIC). We report here on the pilot phase of the evaluation of the Bangladesh regimen in Gabon, prior to its endorsement by the WHO. METHODS This ongoing observational study started in September 2015. Intensive training of hospital health workers as well as community information and education were conducted. GeneXpert-confirmed MDR-TB patients received the second-line anti-tuberculosis drugs (4KmMfxPtoHCfzEZ/5MfxCfzEZ). Sputum smears and cultures were done monthly. Adverse events were monitored daily. RESULTS Eleven patients have been treated for MDR-TB piloting the short regimen. All were HIV-negative and presented in poor health with extensive pulmonary lesions. The overall sputum culture conversion rate was 64% after 4 months of treatment. Three patients developed marked hearing loss; one a transient cutaneous rash. Of 11 patients in our continuous care, 7 (63.6%) significantly improved clinically and bacteriologically. One (9.1%) patient experienced a treatment failure, two (18.2%) died, and one (9.1%) was lost to follow up. CONCLUSIONS Our pioneering data on systematic MDR-TB treatment in Gabon, with currently almost total absence of resistance against the second-line drugs, demonstrate that a 9-month regimen has the capacity to facilitate early culture negativity and sustained clinical improvement. Close adverse events monitoring and continuous care are vital to success.
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Affiliation(s)
- U Ateba-Ngoa
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - J R Edoa
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - B R Adegbite
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - E G Rossatanga
- Centre Hospitalier Régional Georges Rawiri de Lambaréné, Lambarene, Gabon
| | - D Madiou
- Centre Hospitalier Régional Georges Rawiri de Lambaréné, Lambarene, Gabon
| | - A Mfoumbi
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - C Mevyann
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - P Achimi Agbo
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - J Mahoumbou
- Programme National de Lutte contre la Tuberculose, Ministry of Health, Libreville, Gabon
| | - S Gould
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - B Lell
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - A A Adegnika
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - C Köhler
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - P G Kremsner
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - M Massinga-Loembe
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - A Alabi
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - M P Grobusch
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon.
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany.
- Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
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Curry B, Gould S. Scoping Review: Medicinal Benefits of Cannabis Related to Stimulating Appetite in Populations at Risk for Nutritional Deficiency. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.015] [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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Holt D, Bouder F, Elemuwa C, Gaedicke G, Khamesipour A, Kisler B, Kochhar S, Kutalek R, Maurer W, Obermeier P, Seeber L, Trusko B, Gould S, Rath B. The importance of the patient voice in vaccination and vaccine safety-are we listening? Clin Microbiol Infect 2016; 22 Suppl 5:S146-S153. [PMID: 27939015 DOI: 10.1016/j.cmi.2016.09.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 04/25/2016] [Revised: 09/14/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
Much has been written about the patient-physician relationship over the years. This relationship is essential in maintaining trust in the complex arena of modern diagnostic techniques, treatment and prevention, including vaccines and vaccine safety. However, a great deal of this material was written from the viewpoint of clinicians and academics. The patient voice may be positive or negative, fragmented or complex. Information sources are weighed and treated differently, according to the value system and risk perceptions of the individual. In post-trust societies, when people have less confidence in health authorities, communication needs to be more than a paternalistic top-down process. Notions of empowerment and individual patient choice are becoming crucial in medical care. The 'voice of the patient', which includes healthy individuals receiving vaccines, needs to be heard, considered and addressed. With respect to childhood immunizations, this will be the voice of the parent or caregiver. The key to addressing any concerns could be to listen more and to develop a communication style that is trust-based and science-informed. Regulatory agencies are encouraging clinical and patient-reported outcomes research under the umbrella of personalized medicine, and this is an important step forward. This paper attempts to reflect the paradigm shift towards increasing attention to the patient voice in vaccination and vaccine safety.
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Affiliation(s)
- D Holt
- Confederation of Meningitis Organizations, Kerhars, Le Haut Corlay, France; The Vienna Vaccine Safety Initiative, Berlin, Germany
| | - F Bouder
- The Vienna Vaccine Safety Initiative, Berlin, Germany; Department of Technology and Society Studies, Maastricht University, Maastricht, The Netherlands.
| | - C Elemuwa
- The Vienna Vaccine Safety Initiative, Berlin, Germany; National Primary Healthcare Development Agency (NPHCDA), Abuja, Nigeria
| | - G Gaedicke
- The Vienna Vaccine Safety Initiative, Berlin, Germany; Department of Paediatrics and Adolescent Medicine, University of Innsbruck, Austria
| | - A Khamesipour
- The Vienna Vaccine Safety Initiative, Berlin, Germany; Centre for Research & Training in Skin Diseases & Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - B Kisler
- The Vienna Vaccine Safety Initiative, Berlin, Germany; Clinical Data Interchange Standards Consortium, Austin, TX, USA
| | - S Kochhar
- The Vienna Vaccine Safety Initiative, Berlin, Germany; Global Healthcare Consulting, New Delhi, India
| | - R Kutalek
- The Vienna Vaccine Safety Initiative, Berlin, Germany; Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Austria
| | - W Maurer
- The Vienna Vaccine Safety Initiative, Berlin, Germany; Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Austria
| | - P Obermeier
- The Vienna Vaccine Safety Initiative, Berlin, Germany; Department of Paediatrics, Charité University Medical Centre, Berlin, Germany
| | - L Seeber
- The Vienna Vaccine Safety Initiative, Berlin, Germany; Department of Paediatrics, Charité University Medical Centre, Berlin, Germany
| | - B Trusko
- The Vienna Vaccine Safety Initiative, Berlin, Germany; International Association of Innovation Professionals, Sugar Land, TX, USA
| | - S Gould
- SJG Consultancy, Lyon, France
| | - B Rath
- The Vienna Vaccine Safety Initiative, Berlin, Germany; Department of Paediatrics, Charité University Medical Centre, Berlin, Germany.
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Gould S. Creative Classroom Response Systems (CRS, Clickers) Methods in Foods, Nutrition, and Dietetics Higher Education. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Levesque CL, Jalukar S, Gould S, Patience JF. 171 Impact of hydrolyzed yeast product in nursery pig diets on growth performance and immune response. J Anim Sci 2016. [DOI: 10.2527/msasas2016-171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bokhari S, Walsh U, Qurashi K, Liasis L, Watfah J, Sen M, Gould S. Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis. Ann R Coll Surg Engl 2015; 98:107-15. [PMID: 26673047 DOI: 10.1308/rcsann.2016.0049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. METHODS The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. RESULTS The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to 'surgeon preference/skill', was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs. CONCLUSIONS A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital.
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Affiliation(s)
- S Bokhari
- London North West Healthcare NHS Trust , UK
| | - U Walsh
- London North West Healthcare NHS Trust , UK
| | - K Qurashi
- London North West Healthcare NHS Trust , UK
| | - L Liasis
- London North West Healthcare NHS Trust , UK
| | - J Watfah
- London North West Healthcare NHS Trust , UK
| | - M Sen
- London North West Healthcare NHS Trust , UK
| | - S Gould
- London North West Healthcare NHS Trust , UK
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Bokhari S, Kulendran M, Liasis L, Qurashi K, Sen M, Gould S. Implementation of a novel emergency surgical unit significantly improves the management of gallstone pancreatitis. Ann R Coll Surg Engl 2015; 97:308-14. [PMID: 26263941 PMCID: PMC4473871 DOI: 10.1308/003588415x14181254789402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Accepted: 01/11/2015] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Emergency surgery is changing rapidly with a greater workload, early subspecialisation and centralisation of emergency care. We describe the impact of a novel emergency surgical unit (ESU) on the definitive management of patients with gallstone pancreatitis (GSP). METHODS A comparative audit was undertaken for all admissions with GSP before and after the introduction of the ESU over a six-month period. The impact on compliance with British Society of Gastroenterology (BSG) guidelines was assessed. RESULTS Thirty-five patients were treated for GSP between December 2013 and May 2014, after the introduction of the ESU. This was twice the nationally reported average for a UK trust over a six-month period. All patients received definitive management for their GSP and 100% of all suitable patients received treatment during the index admission or within two weeks of discharge. This was a significantly greater proportion than that prior to the introduction of the ESU (57%, p=0.0001) as well as the recently reported national average (34%). The mean length of total inpatient stay was reduced significantly after the ESU was introduced from 13.7 ± 4.7 days to 7.8 ± 2.1 days (p=0.03). The mean length of postoperative stay also fell significantly from 6.7 ± 2.6 days to 1.8 ± 0.8 days (p=0.001). CONCLUSIONS A dedicated ESU following national recommendations for emergency surgery care by way of using dedicated emergency surgeons and a streamlined protocol for common presentations has been shown by audit of current practice to significantly improve the management of patients presenting to a busy district general hospital with GSP.
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Affiliation(s)
- S Bokhari
- London North West Healthcare NHS Trust, UK
| | | | - L Liasis
- London North West Healthcare NHS Trust, UK
| | - K Qurashi
- London North West Healthcare NHS Trust, UK
| | - M Sen
- London North West Healthcare NHS Trust, UK
| | - S Gould
- London North West Healthcare NHS Trust, UK
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Affiliation(s)
- P Morar
- North West London Hospitals NHS Trust, Department of Surgery, Northwick Park and St Marks Hospital, Middlesex HA1 3UJ, UK
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Price D, Ryan F, Mascarenhas L, West D, Gould S, Hutton C, Ryan D. P277 State of the Union - An Assessment of Current Adult Asthmatics, Their Demographics, Treatment and Outcomes in 210 Practises Across the UK. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ryan D, Ryan F, Mascarenhas L, Saralaya D, Britton M, Ziegenweidt JV, Burden A, Hutton C, Gould S, David P. P276 The Impact of the Optimum Patient Care Service on Outcomes for Adult Asthmatic Patients: Abstract P276 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fitzgerald LA, Kevitiyagala D, Gould S, Zengeya S. Neonatal sepsis: A, B, C-don't ever forget herpes. Case Reports 2011; 2011:bcr.07.2011.4423. [DOI: 10.1136/bcr.07.2011.4423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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O'Connor A, Brace S, Gould S, Dewell R, Engelken T. A Randomized Clinical Trial Evaluating a Farm-of-Origin Autogenous Moraxella bovis Vaccine to Control Infectious Bovine Keratoconjunctivis (Pinkeye) in Beef Cattle. J Vet Intern Med 2011; 25:1447-53. [DOI: 10.1111/j.1939-1676.2011.00803.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/24/2011] [Accepted: 08/09/2011] [Indexed: 11/28/2022] Open
Affiliation(s)
- A.M. O'Connor
- Department of Veterinary Diagnostics and Production Animal Medicine; Iowa State University College of Veterinary Medicine; Ames; IA
| | - S. Brace
- Department of Veterinary Diagnostics and Production Animal Medicine; Iowa State University College of Veterinary Medicine; Ames; IA
| | - S. Gould
- Department of Veterinary Diagnostics and Production Animal Medicine; Iowa State University College of Veterinary Medicine; Ames; IA
| | - R. Dewell
- Department of Veterinary Diagnostics and Production Animal Medicine; Iowa State University College of Veterinary Medicine; Ames; IA
| | - T. Engelken
- Department of Veterinary Diagnostics and Production Animal Medicine; Iowa State University College of Veterinary Medicine; Ames; IA
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Glait SA, Schwarzkopf R, Gould S, Bosco J, Slover J. Is repetitive intraoperative splash basin use a source of bacterial contamination in total joint replacement? Orthopedics 2011; 34:e546-9. [PMID: 21902155 DOI: 10.3928/01477447-20110714-06] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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: 02/03/2023]
Abstract
Splash basins are used in arthroplasty cases to wash instruments. Several studies in the literature have shown these basins being a potential source of bacterial infection. This study assesses the risk of contamination of intraoperative splash basins used to wash and store instruments. A total of 46 random clean primary arthroplasty cases (32 hips, 13 knees, and 1 unicondylar knee) were studied by taking cultures of sterile splash basins as soon as they are opened (controls) and again at wound closure after instruments and debris have come into contact with the sterile water. All cultures were taken with sterile culture swabs and sent to the laboratory for aerobic, anaerobic, and fungal culture. Outcome measured was any positive culture. A total of 92 cultures from 46 cases were tested. Only 1 (2.17%) control culture, which grew Streptococcus viridans, was positive for bacterial growth. One of 46 samples (2.17%) taken at wound closure was positive for coagulase-negative Staphylococcus. Mean time between basin opening and wound closure was 180±45 minutes. For the 1 infected sample taken at the conclusion of the case, it was 240 minutes. Previous studies show contamination rates as high as 74% for splash basins used intraoperatively. Our study contradicts the belief that splash basins are a high source of infection, with only 2.17% of basins showing contamination. Splash basins can be a potential source of contamination, but the risk is not as high as previously cited in the orthopedic literature.
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Affiliation(s)
- Sergio A Glait
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, USA
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Shen H, Gould S, Kinyon J, Opriessnig T, O’Connor A. Development and evaluation of a multiplex real-time PCR assay for the detection and differentiation of Moraxella bovis, Moraxella bovoculi and Moraxella ovis in pure culture isolates and lacrimal swabs collected from conventionally raised cattle. J Appl Microbiol 2011; 111:1037-43. [DOI: 10.1111/j.1365-2672.2011.05123.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ravel G, Mantel N, Lang J, Gould S. Toxicity, biodistribution and shedding of Sanofi Pasteur live, attenuated, tetravalent, dengue vaccine in cynomolgus monkeys. Toxicol Lett 2011. [DOI: 10.1016/j.toxlet.2011.05.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fairbrother W, Wong H, Budha N, Blackwood B, Gould S, Erickson R, LoRusso P, Eckhardt S, Wagner A, Chan I. 82 Pharmacokinetic–pharmacodynamic modeling of the effect of GDC-0152, a selective antagonist of the inhibitor of apoptosis (IAP) proteins, on monocyte chemotactic protein-1 (MCP-1) indicates species differences in MCP-1 response. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71787-0] [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: 11/17/2022] Open
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Rahman N, Chouhan J, Gould S, Joseph V, Grant H, Hitchcock R, Johnson P, Lakhoo K. Rectal biopsy for Hirschsprung's disease--are we performing too many? Eur J Pediatr Surg 2010; 20:95-7. [PMID: 20397119 DOI: 10.1055/s-0029-1241820] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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: 10/19/2022]
Abstract
BACKGROUND Rectal biopsy is considered the gold standard for the diagnosis of Hirschsprung's disease. The aim of this study was to evaluate the outcome of rectal biopsies performed in our institution, and to determine whether we are performing an adequate number of biopsies in patients presenting with features suggestive of this disease. METHODS A retrospective analysis was conducted of patients who underwent rectal biopsy to exclude Hirschsprung's disease over a seven year period between 2000 and 2006. The histological diagnosis of Hirschsprung's disease was made using haematoxylin and eosin as well as acetylcholinesterase on frozen section. Patients were grouped into three age categories: neonates (group A), infants (group B) and those over 1 year of age (group C). The results of the biopsies were compared between groups. RESULTS A total of 668 patients underwent rectal biopsy. 18 samples were insufficient. Based on the histological studies of 650 suitable samples, 73 (11%) were positive and 577 (89%) were negative for Hirschsprung's disease. Of the 73 positive biopsies, 34 (47%) were from group A, 20 (27%) from group B and 19 (26%) from group C. The percentage of positive biopsies was much higher in group A with 29% (34 out of 118) compared to group B with 15% (20 out of 135) and group C with 5% (19 out of 395). Three complications of minor rectal bleeding occurred. CONCLUSIONS With 3 complications and 18 insufficient samples out of 668, rectal biopsy is a safe procedure and remains the gold standard for the diagnosis of Hirschsprung's disease, despite the large number of negative biopsies. Contrary to some reports in the literature which question the need for rectal biopsy in those presenting after the neonatal period, 53% of our positive diagnoses were made in children presenting after this period, with 19 positive biopsies out of 395 (5%) performed in children above the age of 1 year.
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Affiliation(s)
- N Rahman
- Oxford Children's Hospital, Department of Paediatric Surgery, Oxford, United Kingdom
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Bani-Hani MG, Al-Nowfal A, Gould S. High jejunal perforation complicating tuberculous abdominal cocoon: a rare presentation in immune-competent male patient. J Gastrointest Surg 2009; 13:1373-5. [PMID: 19238494 DOI: 10.1007/s11605-009-0825-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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: 01/28/2009] [Accepted: 01/28/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tuberculosis (TB) peritonitis is a rare presentation of TB that is typically insidious, presenting with systemic symptoms and nonspecific abdominal pain. In the majority of the cases, this leads to bowel obstruction and rarely causes abdominal cocoon. The disease process predominantly affects the small bowel with a tendency to involve the terminal ileum, leading to perforation on rare occasions. METHODS We are presenting a case report of multiple small-bowel perforations in immune-competent male patient complicating a TB cocoon and discuss clinical course and therapeutic options. DISCUSSION TB cocoon is a rare form of TB peritonitis presenting usually in the form of bowel obstruction. However, TB can cause multiple bowel perforations, particularly in children and immune-compromised patients. Such presentation carries a high rate of mortality. With the global increase in TB infections and the emergence of aggressive, multidrug-resistant strains, more severe manifestations are expected to increase. We presented a case of such severe acute manifestation on a background of insidious TB cocoon in a fit immune-competent male. Although primary repair of TB perforation is considered hazardous, it could not be avoided on this occasion. Nevertheless, proximal defunctioning jejunostomy and the early use of anti-TB drugs seemed to facilitate healing in such scenario. CONCLUSIONS TB should be considered in all cases of atypical bowel perforations. Proximal jejunostomy and early use of anti-TB drugs can facilitate primary repair in aggressive TB infection with multiple bowel perforations.
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Affiliation(s)
- M G Bani-Hani
- North West London Hospitals NHS Trust, Northwick Park Hospital, Harrow, Middlesex, UK.
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Wills SJ, Arrese M, Torrance A, Lloyd S, Pratschke K, Whitbread T, Gould S. Pneumonyssoides species infestation in two Pekingese dogs in the UK. J Small Anim Pract 2008; 49:107-9. [PMID: 18251989 DOI: 10.1111/j.1748-5827.2007.00500.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Two male, neutered, Pekingese dogs aged four years and 12 years were presented for acute-onset nasal pruritus and sneezing following a visit to a beach in northern Scotland. Routine nasal investigations revealed the presence of the canine nasal mite Pneumonyssoides both by direct visualisation and histopathologically. Resolution of clinical signs was observed following selamectin treatment. To the authors' knowledge, this report describes the first cases of Pneumonyssoides infestation in non-travelled UK dogs.
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Affiliation(s)
- S J Wills
- Great Western Referrals, Unit 10, Berkshire House, County Park Business Park, Shrivenham Road, Swindon SN1 2NR, UK
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Abstract
We report a 14-year-old girl who presented with epigastric pain, vomiting, and an upper abdominal mass. A diagnosis of trichobezoar was made on ultrasound and she went on to have a laparotomy, where a large trichobezoar was extracted with a tail that extended into the small intestine.
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Affiliation(s)
- Catherine Western
- Department of General Surgery, North Devon District Hospital, Raleigh Park, Barnstaple, Devon, EX31 4JB, UK.
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Farrugia MK, Raza SA, Gould S, Lakhoo K. Congenital lung lesions: classification and concordance of radiological appearance and surgical pathology. Pediatr Surg Int 2008; 24:987-91. [PMID: 18665370 DOI: 10.1007/s00383-008-2201-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
Congenital lung lesions are diagnosed antenatally in the majority of cases. Postnatal management includes chest radiography and CT-scanning, followed by either surgical resection or CT surveillance. Pre-operatively, lesions are often "labelled" as CCAM (and the Stocker classification incorrectly applied), sequestration, or lobar emphysema, and their frequent "hybrid" nature sometimes missed. The aim of our study was to correlate antenatal and postnatal radiological diagnoses and classification of congenital lung lesions with surgical and pathological outcome. Twenty-six consecutive cases of antenatally-diagnosed cystic lung lesions managed at our centre between January 2003 and April 2007 were reviewed. Diagnoses were: cystic adenomatoid malformations (CCAM) in 13 cases (50.0%), three bronchopulmonary sequestrations (11.5%), "hybrid" lesions in eight cases (30.8%), one isolated lobar emphysema (3.8%) and a normal lung segment with anomalous systemic supply (3.8%). Overall concordance rate between prenatal ultrasound and resection pathology was 61.5%, whereas CT findings correlated with pathology in 65.4% of cases. Incorrect radiological classification resulted in one morbidity, when an attempted thoracoscopic resection of a presumed CCAM had to be converted to an open procedure due to bleeding from an unsuspected anomalous vessel. The common embryological origin of these lesions, and the need for standardisation of reporting is discussed. We propose that lesions should be classified anatomically according to their nature, arterial supply and venous drainage in order to reduce discrepancies between radiological, intra-operative and pathological reporting.
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Affiliation(s)
- M K Farrugia
- Department of Paediatric Surgery, Children's Hospital Oxford, University of Oxford and John Radcliffe Hospital, Oxford, OX3 9DU, UK
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Prabhudesai SG, Gould S, Rekhraj S, Tekkis PP, Glazer G, Ziprin P. Artificial neural networks: useful aid in diagnosing acute appendicitis. World J Surg 2008; 32:305-9; discussion 310-1. [PMID: 18043966 DOI: 10.1007/s00268-007-9298-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND [corrected] The purpose of the study was to assess the role of artificial neural networks (ANNs) in the diagnosis of appendicitis in patients presenting with acute right iliac fossa (RIF) pain and comparing its performance with the assessment made by experienced clinicians and the Alvarado score. METHODS After training and testing an ANN, data from 60 patients presenting with suspected appendicitis over a 6-month period to a teaching hospital was collected prospectively. Accuracy of diagnosing appendicitis by the clinician, the Alvarado score, and the ANN was compared. RESULTS The sensitivity, specificity, and positive and negative predictive values of the ANN were 100%, 97.2%, 96.0%, and 100% respectively. The ability of the ANN to exclude accurately the diagnosis of appendicitis in patients without true appendicitis was statistically significant compared to the clinical performance (p=0.031) and Alvarado score of >or=6 (p=0.004) and nearly significant compared to the Alvarado score of >or=7 (p=0.063). CONCLUSIONS ANNs can be an effective tool for accurately diagnosing appendicitis and may reduce unnecessary appendectomies.
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Affiliation(s)
- S G Prabhudesai
- Department of Biosurgery and Surgical Technology, Faculty of Medicine, Imperial College London, St. Mary's Hospital Campus, Room 1029, 10th floor QEQM Building, Praed Street, London, W2 1NY, UK.
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Ostman-Smith I, Wettrell G, Keeton B, Holmgren D, Ergander U, Gould S, Bowker C, Verdicchio M. Age- and gender-specific mortality rates in childhood hypertrophic cardiomyopathy. Eur Heart J 2008; 29:1160-7. [PMID: 18385119 DOI: 10.1093/eurheartj/ehn122] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ingegerd Ostman-Smith
- Division of Paediatrics, Department of Clinical Sciences, Sahlgren Academy, Queen Silvia Childreńs Hospital SE-416 85, Gothenburg, Sweden.
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Brott DA, Jones HB, Gould S, Valentin JP, Evans G, Richardson RJ, Louden C. Current status and future directions for diagnostic markers of drug-induced vascular injury. Cancer Biomark 2007; 1:15-28. [PMID: 17192029 DOI: 10.3233/cbm-2005-1104] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recently, there has been an increased incidence of vascular toxicity in pre-clinical toxicology studies. This is of concern because of the uncertain relevance and extrapolation of this finding to humans. In dogs, profound heart rate (HR) and mean arterial pressure (MAP) changes were considered surrogate markers for drug-induced vascular injury until the early 1990s when endothelin receptor antagonists (ETRA) did not significantly alter HR or MAP but induced identical lesions in the coronary arteries of dogs. Thus significant alterations in HR and MAP were found not to be a prerequisite for this lesion. Clinically, the potential for vascular injury coupled with the lack of an unequivocal non-invasive diagnostic marker is an issue of concern to pharmaceutical companies and the regulatory authorities. Therefore, qualification and validation of biomarkers as diagnostic tools for drug-induced vascular injury would add great value to risk management and expedite the drug development process. This review focuses on the status, progress and future trends in vascular biology aimed at identification and development of diagnostic markers that are specific, sensitive and possess potential utility in both a pre-clinical and clinical setting.
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Affiliation(s)
- D A Brott
- Global Safety Assessment, AstraZeneca Pharmaceuticals, Wilmington, DE 19850-5437, USA.
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Dar W, Gould S, Sullivan K, Demartino J, Knechtle S. 111. J Surg Res 2007. [DOI: 10.1016/j.jss.2006.12.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dobson J, Villiers E, Roulois A, Gould S, Mellor P, Hoather T, Watson P. Histiocytic sarcoma of the spleen in flat-coated retrievers with regenerative anaemia and hypoproteinaemia. Vet Rec 2006; 158:825-9. [PMID: 16782856 DOI: 10.1136/vr.158.24.825] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Three flat-coated retrievers with a regenerative anaemia were examined. They were hypoproteinaemic suggesting that the anaemia might be due to blood loss, but it was not possible to identify a site of haemorrhage. All three had splenomegaly with splenic abnormalities apparent on ultrasonography. Ultimately all three animals were shown to have a histiocytic sarcoma involving the spleen and other tissues. A fourth flat-coated retriever with anaemia, hypoproteinaemia and an abdominal mass was also diagnosed with a histiocytic sarcoma of the spleen following splenectomy. It is postulated that the dogs' anaemia was due to erythrophagocytosis, either directly by neoplastic cells or by reactive macrophages.
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Affiliation(s)
- J Dobson
- Department of Clinical Veterinary Medicine, The Queen's Veterinary School Hospital, University of Cambridge, Madingley Road, Cambridge CB3 0ES
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Schwingle BW, Smith JA, Blanchette RA, Gould S, Blanchette BL, Pokorny J, Cohen SD. First Report of Dieback and Leaf Lesions on Rhododendron sp. Caused by Phytophthora hedraiandra in the United States. Plant Dis 2006; 90:109. [PMID: 30786487 DOI: 10.1094/pd-90-0109a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Surveys for Phytophthora ramorum in Minnesota nurseries revealed the presence of P. hedraiandra de Cock & Man in't Veld and several other Phytophthora species but not P. ramorum. Symptomatic leaf and stem tissues from diseased Rhododendron and Quercus species were cultured on PARP, a selective growth medium for Phytophthora (3). The Phytophthora isolates obtained were later identified by sequencing the internal transcribed spacer (ITS) region of the rDNA and comparing the sequences with those in GenBank using BLAST searches (1). The ITS sequences of six cultures (GenBank Accession Nos. DQ139804-DQ139809), isolated during 2003 from various Rhododendron cultivars exhibiting leaf lesions and shoot dieback, showed 100% identity with the ITS sequence of P. hedraiandra (GenBank Accession No. AY707987) (2). This is a recently described pathogenic species from the Netherlands responsible for causing leaf spots on Viburnum spp. Since the ITS sequence of P. hedraiandra differs little from that of P. cactorum (2), we verified one isolate to be P. hedraiandra by sequencing the mitochondrial cytochrome c oxidase subunit I gene (cox1) (GenBank Accession No. DQ139810). Comparison of this sequence with the P. hedraiandra voucher specimen in GenBank (Accession No. AY769115) showed 99% identity, which was the closest match. Reproductive structures were measured on V8 juice agar. The average oogonium diameter for three isolates was 29 μm with a range of 26 to 32 μm, while the average antheridium length was 13 μm (11 to 15 μm). Sporangium length and width averages on crushed hemp seeds were 32 μm (28 to 36 μm) and 26 μm (21 to 30 μm), respectively, with the average length to width ratio of 1.25 (1.23 to 1.29). Pathogenicity tests on Rhododendron cv. Mikkeli were carried out using three of our P. hedraiandra isolates. Spore suspensions of 2 × 104 zoospores per ml were used to mist-spray shoots of five, 3-year-old plants for each isolate. Five controls were mist sprayed with water. After inoculation, plants were placed in plastic bags in a dark growth chamber (22°C) for 7 days and then moved to a greenhouse. Leaf blotches and shoot dieback were apparent 5 days after inoculation, and P. hedraiandra was reisolated from those symptomatic tissues and identified by an exact match of the ITS sequence. Necrotic areas lengthened from the shoot tips to the main stems of the plants while expanding into petioles and leaves. No symptoms were observed on control plants. To our knowledge, this is the first report of P. hedraiandra in the United States as well as the first report of Koch's postulates performed with P. hedraiandra on Rhododendron cv. Mikkeli. The significance of this disease to other woody plants in nurseries or the landscape is unknown, and further study is needed to determine the host range and extent of the disease that may occur from this introduction. References: (1) S. F. Altschul et al. J. Mol. Biol. 215:403, 1990. (2) A. W. A.M de Cock and C. A. Lévesque. Stud Mycol 50:481, 2004. (3) D. C. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society, St. Paul, MN, 1996.
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Affiliation(s)
- B W Schwingle
- Department of Plant Pathology, University of Minnesota, St. Paul 55108
| | - J A Smith
- Department of Plant Pathology, University of Minnesota, St. Paul 55108
| | - R A Blanchette
- Department of Plant Pathology, University of Minnesota, St. Paul 55108
| | - S Gould
- Department of Plant Pathology, University of Minnesota, St. Paul 55108
| | - B L Blanchette
- Department of Plant Pathology, University of Minnesota, St. Paul 55108
| | - J Pokorny
- USDA Forest Service, Northeastern Area State and Private Forestry, St. Paul, MN 55108
| | - S D Cohen
- USDA, APHIS, PPD, Riverdale, MD 20737
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Brott D, Gould S, Jones H, Schofield J, Prior H, Valentin JP, Bjurstrom S, Kenne K, Schuppe-Koistinen I, Katein A, Foster-Brown L, Betton G, Richardson R, Evans G, Louden C. Biomarkers of drug-induced vascular injury. Toxicol Appl Pharmacol 2005; 207:441-5. [PMID: 15982681 DOI: 10.1016/j.taap.2005.04.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2004] [Revised: 02/23/2005] [Accepted: 04/01/2005] [Indexed: 11/20/2022]
Abstract
In pre-clinical safety studies, drug-induced vascular injury is an issue of concern because there are no obvious diagnostic markers for pre-clinical or clinical monitoring and there is an intellectual gap in our understanding of the pathogenesis of this lesion. While vasodilatation and increased shear stress appear to play a role, the exact mechanism(s) of injury to the primary targets, smooth muscle and endothelial cells are unknown. However, evaluation of novel markers for potential clinical monitoring with a mechanistic underpinning would add value in risk assessment and management. This mini review focuses on the progress to identify diagnostic markers of drug-induced vascular injury. Von Willebrand factor (vWF), released upon perturbation of endothelial cells, is transiently increased in plasma prior to morphological evidence of damage in dogs or rats treated with vascular toxicants. Therefore, vWF might be a predictive biomarker of vascular injury. However, vWF is not an appropriate biomarker of lesion progression or severity since levels return to baseline values when there is morphological evidence of injury. A potential mechanistically linked biomarker of vascular injury is caveolin-1. Expression of this protein, localized primarily to smooth muscle and endothelial cells, decreases with the onset of vascular damage. Since vascular injury involves multiple mediators and cell types, evaluation of a panel rather than a single biomarker may be more useful in monitoring early and severe progressive vascular injury.
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Affiliation(s)
- D Brott
- Safety Assessment, AstraZeneca Pharmaceuticals, CRDL-138, 1800 Concord Pike, PO Box 15437, Wilmington, DE 19850-5437, USA
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Moorthy K, Munz Y, Orchard TR, Gould S, Rockall T, Darzi A. An innovative method for the assessment of skills in lower gastrointestinal endoscopy. Surg Endosc 2004; 18:1613-9. [PMID: 15931472 DOI: 10.1007/s00464-004-9002-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Accepted: 05/27/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although virtual reality (VR) simulators can be used ability to objectively assess skills in endoscopy, the evaluation is solely quantitative. We have developed a novel method for the objective assessment of technical skills in lower gastrointestinal (GI) endoscopy that incorporates qualitative as well as quantitative measures. METHODS We developed a virtual endoscopy suite by deconstructing the VR simulator to enable a more realistic and ergonomic placement of the monitor. Trainee endoscopists with varying levels of experience performed the case 4 task of the simulator. Ten essential components of endoscopic performance were rated on a five-point Likert scale (global score) by three independent observers. These observers viewed two videos (one showing scope handling and the other showing the monitor image), which were synchronized and played simultaneously. RESULTS The study population comprised six experts (group 1, > 200 procedures), seven subjects with intermediate experience (group 2, 20-80 procedures), and seven novices (group 3, 1-10 procedures). The global score was found to discriminate the level of skills across all three groups (p < 0.001). There were significant differences between groups 1 and 2 (p = 0.003) and groups 2 and 3 (p = 0.004). There was a significant correlation between the global score and the percentage of red-out (without vision) as recorded by the simulator (correlation coefficients = -0.61, p = 0.004). CONCLUSION This novel method for the assessment of technical skills in lower GI endoscopy has construct validity and high interrater reliability.
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Affiliation(s)
- K Moorthy
- Department of Surgical Oncology and Technology, Imperial College, St. Mary's Hospital, London, W2 INY, England, United Kingdom.
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Sato Y, Gould S. Correction. Biosynthesis of the Kinamycin Antibiotics by Strepomyces murayamaensis. Determination of the Origin of Carbon, Hydrogen, and Oxygen Atoms by 13C NMR Spectroscopy. J Am Chem Soc 2004. [DOI: 10.1021/ja00250a602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vaughan N, Gould S, Darzi A, Birnie K, Gedroyc W. Magnetic resonance guided general surgery. Surg Technol Int 2002; 8:83-8. [PMID: 12451514] [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] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Image guided surgery can be defined as the intraoperative use of a radiologicai technique to give the surgeon information not available from direct inspection or palpation of the surgical field. This information may then be used to change the course of an operative procedure. Magnetic resonance (MR) imaging has the potential to be the most useful radiologicai technique in the developing field of image guided surgery.
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Affiliation(s)
- N Vaughan
- St. Mary's Hospital, London, England, UK
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Abstract
OBJECTIVE To investigate whether antenatal diagnosis of coarctation of the aorta results in reduced mortality and improved preoperative haemodynamic stability compared with postnatal diagnosis. DESIGN Retrospective review of all cases of coarctation of the aorta presenting to a tertiary fetal and neonatal cardiology service from January 1994 to December 1998. METHODS Prenatal, postnatal, and necropsy records were reviewed to determine survival in the two groups. Markers of preoperative illness severity were recorded, including presence of femoral pulse, collapse, left ventricular function, ductal patency on echocardiography, coagulation status, duration of intensive care unit and total hospital stay, heart rate, respiratory rate, plasma creatinine, plasma potassium, and right upper limb blood pressure. A univarate and multivariate analysis was conducted on all variables and a cumulative score was created and subjected to logistic regression analysis. RESULTS Both collapse and death were more common in the postnatally diagnosed group (p < 0.05). Femoral pulses were more likely to be palpable and there was echocardiographic evidence of duct patency in the antenatally diagnosed infants (p < 0.001 and p < 0.05, respectively). An increased respiratory rate was associated with postnatal presentation (p < 0.05). Infants with haemodynamic instability preoperatively were more likely to have been diagnosed postnatally (p < 0.01). CONCLUSIONS Antenatal diagnosis of coarctation of the aorta is associated with improved survival and preoperative clinical condition.
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Affiliation(s)
- O Franklin
- Fetal Cardiology Unit, John Radcliffe Hospital, Oxford, UK
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Agarwal T, Refson J, Gould S. The 'Tellytubby Tummy', a novel technique for laparostomy management. Ann R Coll Surg Engl 2001; 83:440. [PMID: 11777146 PMCID: PMC2503676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- T Agarwal
- Academic Surgical Unit, St Mary's Hospital, London, UK
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Anderson J, Ramsay A, Gould S, Pritchard-Jones K. PAX3-FKHR induces morphological change and enhances cellular proliferation and invasion in rhabdomyosarcoma. Am J Pathol 2001; 159:1089-96. [PMID: 11549601 PMCID: PMC1850440 DOI: 10.1016/s0002-9440(10)61784-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Alveolar rhabdomyosarcoma (ARMS) is consistently associated with the characteristic translocations t(2;13)(q35;q14) and t(1;13)(p36;q14), which encode for the PAX3-FKHR and PAX7-FKHR fusion oncoproteins respectively. We have investigated the relationship between PAX3-FKHR expression and ARMS histogenesis in primary tumors and cell culture systems. In a blinded histological review of discrepant primary tumors in which there was PAX3-FKHR expression but embryonal histology, we found small areas of alveolar histology in 6 of 11 cases. This suggests that histology alone may under-represent the association between PAX3-FKHR and ARMS, and we investigated this link by examining the effect of ectopic PAX3-FKHR expression on RMS cells. Two cell lines, RD and HX170C, were stably transfected with a PAX3-FKHR expression construct. In cloned transfectants derived from both lines, PAX3-FKHR expression resulted in increased proliferative rate in vitro and promoted cell growth in the absence of added growth factors. Tumors that formed as xenografts in immunodeficient mice were faster growing, more locally invasive, and had a denser, more pleomorphic architecture than untransfected or empty vector transfected tumors. The characteristic clefts and alveolar spaces of ARMS, however, were not seen. In contrast, tumors grown as xenografts from individual clones derived from ARMS cell lines showed all of the classical morphological features of ARMS suggesting divergence in vivo from precursor cells propagated in culture.
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Affiliation(s)
- J Anderson
- Unit of Molecular Haematology, Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom.
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Abstract
In one health region between 1991 and 1996, 105 (11%) of all stillbirths were delivered by caesarean section. Forty-eight (46%) were unexpected at the time of birth, two of whom were macerated. Most of the macerated stillbirths were one of a multiple pregnancy, while 22 of the fresh stillbirths were delivered by caesarean section prior to the onset of labour. Twenty-one caesarean sections were performed because of failed attempts to induce labour, or at the request of the mother. The unexpectedly high rate of stillbirths delivered by caesarean section could be reduced by improved methods and understanding of antenatal and intrapartum fetal monitoring and techniques for inducing labour.
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