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Borland C, Patel R. Comparing in vitro nitric oxide blood uptake to its pulmonary diffusing capacity. Nitric Oxide 2024; 143:29-43. [PMID: 38135143 DOI: 10.1016/j.niox.2023.11.006] [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: 09/19/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
Whether endothelium derived Nitric Oxide (NO) uptake by the blood is limited by a boundary layer, the red cell membrane or its interior is the subject of continued debate. Whether lung uptake of NO in the single-breath DLNO test is limited by blood or not is also debated. To understand which processes are limiting blood NO uptake we have modelled NO chemical kinetics and we have derived a shrinking core model, Thiele Modulus and FTCS (Euler) numerical solution. In a rapid reaction apparatus, NO uptake appears limited by a boundary layer, and throughout the red cell, by diffusion. In the single breath situation, and arguably with endogenous NO in vivo, NO uptake appears limited by a boundary layer and a pseudo first order chemical reaction in the outer molecular layers of the red cell. We have not found evidence to support red cell membrane limitation.
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Affiliation(s)
- Colin Borland
- Department of Medicine, University of Cambridge and Hinchingbrooke Hospital, Huntingdon, PE29 6NT, United Kingdom.
| | - Ruhi Patel
- Department of Chemical Engineering and Biotechnology, University of Cambridge, West Cambridge Site, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom
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Borland C, Moggridge G, Patel R, Patel S, Zhu Q, Vuylsteke A. Permeability and diffusivity of nitric oxide in human plasma and red cells. Nitric Oxide 2018; 78:51-59. [PMID: 29787802 DOI: 10.1016/j.niox.2018.05.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
A simple diffusion cell was made to measure the permeability and diffusivity of Nitric Oxide in human plasma and red cells. Nitric oxide was passed through the cell containing plasma or nitrited red cells enclosed by silicone membranes. Steady state permeability (αNODNO ) was calculated from the cell dimensions and from the NO bulk flow entering and leaving the cell. The diffusion coefficient (DNO) was calculated in three ways: (i) by dividing the steady state permeability by published values for solubility (αNO ) in water at 26 °C and 37 °C (ii) by a numerical method and (iii) by an analytical method. Mean steady state permeability (95% confidence intervals) were plasma (26 °C) 5.57 × 10-11 (2.35 × 10-11-1.32 × 10-10) and (37 °C) 5.48 × 10-11 (2.13 × 10-11-1.41 × 10-10) mol cm-1 s-1 atm-1 and red cells (26 °C) 6.74 × 10-12 (1.29 × 10-12-3.53 × 10-11) and (37 °C) 3.93 × 10-11 (1.39 × 10-11-1.11.10-10) mol cm-1 s-1 atm-1. Median Diffusion Coefficients (DNO) for plasma at 37 °C ranged from 3-3.36 × 10-5 cm2 s-1 and red cells 2.41-2.94 × 10-5 cm2 s-1 depending on the method used. These values may be used for modelling NO transport in vivo in the human lung and capillary. Parameters used for modelling in vivo should be measured at 37 °C.
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Affiliation(s)
- Colin Borland
- Department of Medicine, University of Cambridge and Hinchingbrooke Hospital, Huntingdon PE29 6NT, United Kingdom.
| | - Geoff Moggridge
- Department of Chemical Engineering and Biotechnology, University of Cambridge, West Cambridge Site, Philippa Fawcett Drive, Cambridge CB3 0AS, United Kingdom.
| | - Ruhi Patel
- Department of Chemical Engineering and Biotechnology, University of Cambridge, West Cambridge Site, Philippa Fawcett Drive, Cambridge CB3 0AS, United Kingdom.
| | - Suhani Patel
- Department of Respiratory Physiology, Papworth Hospital, Papworth Everard, Cambridgeshire CB23 3RE, United Kingdom.
| | - Qingyu Zhu
- Department of Chemical Engineering and Biotechnology, University of Cambridge, West Cambridge Site, Philippa Fawcett Drive, Cambridge CB3 0AS, United Kingdom.
| | - Alain Vuylsteke
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Papworth Everard, Cambridgeshire CB23 3RE, United Kingdom.
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Borland C, Guénard H. The history of the pulmonary diffusing capacity for nitric oxide DL,NO. Respir Physiol Neurobiol 2016; 241:3-6. [PMID: 27916736 DOI: 10.1016/j.resp.2016.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
The DL,NO (TL,NO) had its unexpected origins in the Paris "events" of 1968 and the unsuccessful efforts of the UK tobacco industry in the 1970's to create a "safer cigarette". Adoption of the technique has been slow due to the instability of NO in air, lack of standardisation of the technique and lack of agreement as to whether DL,NO is equal to or merely reflects membrane diffusing capacity (DM). With the availability of inexpensive analysers, standardisation of the technique and publication of reference equations we believe that its worldwide use will increase.
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Affiliation(s)
- Colin Borland
- Department of Medicine University of Cambridge, UK and Hinchingbrooke Hospital, Huntingdon, UK.
| | - Hervé Guénard
- Physiologie et EFR, Université Bordeaux 2 et CHU Bordeaux, France.
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Newark C, Borland C, Bashford S. 9 * A SIMPLE SCORE TO IDENTIFY FRAIL OLDER PATIENTS. Age Ageing 2015. [DOI: 10.1093/ageing/afv029.09] [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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Affiliation(s)
- Colin Borland
- Hinchingbrooke Health Care NHS Trust, Huntingdon, UK
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Zavorsky GS, Borland C. Confusion in reporting pulmonary diffusing capacity for nitric oxide and the alveolar-capillary membrane conductance for nitric oxide. Eur J Prev Cardiol 2014; 22:312-3. [PMID: 24676716 DOI: 10.1177/2047487314528872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Gerald S Zavorsky
- Department of Health and Sport Sciences, University of Louisville, USA Department of Physiology and Biophysics, University of Louisville, USA
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Borland C. The T(LNO)/T(LCO) ratio in pulmonary function test interpretation. Eur Respir J 2014; 43:310. [PMID: 24381325 DOI: 10.1183/09031936.00023913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Borland C, Bottrill F, Jones A, Sparkes C, Vuylsteke A. The significant blood resistance to lung nitric oxide transfer lies within the red cell. J Appl Physiol (1985) 2014; 116:32-41. [DOI: 10.1152/japplphysiol.00786.2013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The lung nitric oxide (NO) diffusing capacity (DlNO) mainly reflects alveolar-capillary membrane conductance (Dm). However, blood resistance has been shown in vitro and in vivo. To explore whether this resistance lies in the plasma, the red blood cell (RBC) membrane, or in the RBC interior, we measured the NO diffusing capacity (Dno) in a membrane oxygenator circuit containing ∼1 liter of horse or human blood exposed to 14 parts per million NO under physiological conditions on 7 separate days. We compared results across a 1,000-fold change in extracellular diffusivity using dextrans, plasma, and physiological salt solution. We halved RBC surface area by comparing horse and human RBCs. We altered the diffusive resistance of the RBC interior by adding sodium nitrite converting oxyhemoglobin to methemoglobin. Neither increased viscosity nor reduced RBC size reduced Dno. Adding sodium nitrite increased methemoglobin and was associated with a steady fall in Dno ( P < 0.001). Similar results were obtained at NO concentrations found in vivo. The RBC interior appears to be the site of the blood resistance.
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Affiliation(s)
- Colin Borland
- Department of Anaesthetic Research, Papworth Hospital, Cambridgeshire, United Kingdom
| | - Fiona Bottrill
- Department of Anaesthetic Research, Papworth Hospital, Cambridgeshire, United Kingdom
| | - Aled Jones
- Department of Anaesthetic Research, Papworth Hospital, Cambridgeshire, United Kingdom
| | - Chris Sparkes
- Department of Anaesthetic Research, Papworth Hospital, Cambridgeshire, United Kingdom
| | - Alain Vuylsteke
- Department of Anaesthetic Research, Papworth Hospital, Cambridgeshire, United Kingdom
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Goh C, Wong SC, Borland C. Persistent orocutaneous and anal fistulae induced by nicorandil: a case report. J Med Case Rep 2009; 3:119. [PMID: 19946537 PMCID: PMC2783060 DOI: 10.1186/1752-1947-3-119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 11/12/2009] [Indexed: 11/24/2022] Open
Abstract
Introduction Although nicorandil is prescribed widely, awareness of its potential to cause serious complications to the gastrointestinal tract mucosa is limited. Whilst nicorandil-induced oral and anal ulceration is well documented in the literature, nicorandil-induced fistulation is not. This is the first report in the literature of a single patient demonstrating simultaneous orocutaneous and anal fistulae during nicorandil therapy. Two separate cases of orocutaneous and anal fistulae associated nicorandil usage have previously been documented in specialist journals. Case presentation A 71-year-old Caucasian man presented with a 3-year history of concurrent orocutaneous and anal fistulae. He had been exposed to 30 mg twice-daily nicorandil therapy for 4 years. Both fistulae responded poorly to intensive and prolonged conventional treatment but healed promptly on reduction and eventual withdrawal of nicorandil therapy. Conclusion Management of resistant cases of orocutaneous and anal fistulae in patients on high-dose nicorandil therapy may be impossible without reduction or even withdrawal of nicorandil.
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Affiliation(s)
- Cyndi Goh
- Department of Medicine, Hinchingbrooke Hospital, Hinchingbrooke Heath Care NHS Trust, Huntingdon, Cambridgeshire PE29 6NT, UK
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Abstract
A simple model lung has been designed using a membrane oxygenator circuit comprising two membrane oxygenators primed with one to two litres of equine blood, giving reproducible results over several hours. Normoxia and normocapnia were achieved consistently over the duration of the test with a blood flow of 2.5 l/min, oxygenator ventilation gas flow of 5 l/min air with 0.3 l/min O2 and deoxygenator ventilation gas flow of 5 l/min 5% CO2 in N2 with 0.2 l/min CO2. The measured PaO2 was 81.3 (SD 3.35 mmHg), PvO2 38.3 (SD 1.38 mmHg), PvCO2 60.6 (SD 1.13 mmHg) and PaCO2 36.1 (SD 0.69mmHg). MO2 and MCO2 were 116 ml/min and 169 ml/min, respectively. An increasing linear relationship was observed for FiO2 and the corresponding PaO2 and, similarly, with FiCO2 and PvCO2, providing reference ranges for this model.
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Affiliation(s)
- H Dunningham
- Cambridge Perfusion Services, Papworth Hospital, Papworth Everard, Cambridge, CAMBS, UK
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Borland C. Good candidates surface in MTAS. West J Med 2007. [DOI: 10.1136/bmj.39156.727222.fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
To model lung nitric oxide (NO) and carbon monoxide (CO) uptake, a membrane oxygenator circuit was primed with horse blood flowing at 2.5 l/min. Its gas channel was ventilated with 5 parts/million NO, 0.02% CO, and 22% O2at 5 l/min. NO diffusing capacity (Dno) and CO diffusing capacity (Dco) were calculated from inlet and outlet gas concentrations and flow rates: Dno = 13.45 ml·min−1·Torr−1(SD 5.84) and Dco = 1.22 ml·min−1·Torr−1(SD 0.3). Dno and Dco increased ( P = 0.002) with blood volume/surface area. 1/Dno ( P < 0.001) and 1/Dco ( P < 0.001) increased with 1/Hb. Dno ( P = 0.01) and Dco ( P = 0.004) fell with increasing gas flow. Dno but not Dco increased with hemolysis ( P = 0.001), indicating Dno dependence on red cell diffusive resistance. The posthemolysis value for membrane diffusing capacity = 41 ml·min−1·Torr−1is the true membrane diffusing capacity of the system. No change in Dno or Dco occurred with changing blood flow rate. 1/Dco increased ( P = 0.009) with increasing Po2. Dno and Dco appear to be diffusion limited, and Dco reaction limited. In this apparatus, the red cell and plasma offer a significant barrier to NO but not CO diffusion. Applying the Roughton-Forster model yields similar specific transfer conductance of blood per milliliter for NO and CO to previous estimates. This approach allows alteration of membrane area/blood volume, blood flow, gas flow, oxygen tension, red cell integrity, and hematocrit (over a larger range than encountered clinically), while keeping other variables constant. Although structurally very different, it offers a functional model of lung NO and CO transfer.
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Affiliation(s)
- Colin Borland
- Department of Medicine, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire PE18 8NT, United Kingdom.
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Enoch DA, Karas JA, Emery MM, Borland C. Two cases of parotid gland infection with bacteraemia due to meticillin-resistant Staphylococcus aureus. J Med Microbiol 2006; 55:463-465. [PMID: 16533996 DOI: 10.1099/jmm.0.46444-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Parotid gland infection as a source of meticillin-resistant Staphylococcus aureus bacteraemia has been rarely reported. It is predominantly a disease of the elderly and is associated with significant mortality. Two cases are described here that presented over a 6 month history at a district general hospital. Many cases may be preventable with adequate hydration and good oral hygiene, combined with effective infection control.
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Affiliation(s)
- D A Enoch
- Clinical Microbiology and Public Health Laboratory, Health Protection Agency East of England, Addenbrooke's Hospital, Hill's Road, Cambridge, Cambridgeshire CB2 2QQ, UK
| | - J A Karas
- Clinical Microbiology and Public Health Laboratory, Health Protection Agency East of England, Papworth Hospital, Papworth Everard, Cambridgeshire CB3 8RE, UK
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Abstract
Using a rapidly responding nitric oxide (NO) analyzer, we measured the steady-state NO diffusing capacity (DL(NO)) from end-tidal NO. The diffusing capacity of the alveolar capillary membrane and pulmonary capillary blood volume were calculated from the steady-state diffusing capacity for CO (measured simultaneously) and the specific transfer conductance of blood per milliliter for NO and for CO. Nine men were studied bicycling at an average O(2) consumption of 1.3 +/- 0.2 l/min (mean +/- SD). DL(NO) was 202.7 +/- 71.2 ml. min(-1). Torr(-1) and steady-state diffusing capacity for CO, calculated from end-tidal (assumed alveolar) CO(2), mixed expired CO(2), and mixed expired CO, was 46.9 +/- 12.8 ml. min(-1). Torr(-1). NO dead space = (VT x FE(NO) - VT x FA(NO))/(FI(NO) - FA(NO)) = 209 +/- 88 ml, where VT is tidal volume and FE(NO), FI(NO), and FA(NO) are mixed exhaled, inhaled, and alveolar NO concentrations, respectively. We used the Bohr equation to estimate CO(2) dead space from mixed exhaled and end-tidal (assumed alveolar) CO(2) = 430 +/- 136 ml. Predicted anatomic dead space = 199 +/- 22 ml. Membrane diffusing capacity was 333 and 166 ml. min(-1). Torr(-1) for NO and CO, respectively, and pulmonary capillary blood volume was 140 ml. Inhalation of repeated breaths of NO over 80 s did not alter DL(NO) at the concentrations used.
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Affiliation(s)
- C Borland
- Department of Medicine, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire PE18 8NT, United Kingdom.
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Abstract
Collaborative working in care for older people is often seen as a desirable goal. However, there can be problems with this approach. This paper reports on a single blind randomized controlled trial which was carried out to compare outcomes of rehabilitation in two settings: a day hospital and social services day centres augmented by visiting therapists. The subjects were 105 older patients. Principal outcome measures were the Barthel Index, Philadelphia Geriatric Centre Morale Scale and the Caregiver Strain Index. Two aspects of the trial are examined here. Firstly, we investigated whether trial patients were more disabled than regular day centre attendees. Levels of health and well being amongst trial patients were compared with those of a random sample of 20 regular attendees from both of the participating day centres and an additional voluntary sector day centre. Secondly, key staff from the different settings were interviewed to assess how well the day centre model had worked in practice. Trial patients were significantly more disabled than regular day centre attendees according to the Barthel Index (P < 0.001), but this difference was no longer significant after three months of treatment. The day centre model had several problems, principally discharge policy, acceptability, facilities and attitudes of staff and regular attendees. Positive aspects of the day centre model, as well as successful rehabilitation, included shared skills, knowledge and resources. This paper suggests that collaborative working in day centres requires multipurpose facilities. If health staff maintain a permanent presence, benefits can include improved joint working, easier access to health care and the use of rehabilitative therapy as a preventative strategy. Day care settings can be analyzed as representing different types of communities. Allowing older users a greater degree of choice in facilities may increase the acceptability of care.
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Affiliation(s)
- S Burch
- Social Policy, Anglia Polytechnic University, East Road, Cambridge CB1 1PT, UK.
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Abstract
OBJECTIVE To compare day hospital to day centre rehabilitation using scales to measure mobility, activities of daily living and quality of life. DESIGN Single blind randomized controlled trial with home assessments at baseline (twice), six weeks and three months. SETTING Mainly rural health district. Day hospital and social services day centres in market towns. INTERVENTIONS Day hospital treatment or day centre rehabilitation by a physiotherapist and two health support workers. MAIN OUTCOME MEASURES World Health Organization mobility scale scored with and without aid, Nottingham Extended Activities of Daily Living Scale and Nottingham Health Profile. SUBJECTS One hundred and five physically disabled older patients living at home referred for day hospital rehabilitation or maintenance before discharge from hospital (66) or referred as outpatients (39). RESULTS At three months there were no statistically significant differences between rehabilitation at day hospital and day centre for any of the outcome measurements. However, there were significant improvements between baseline and three months for the following subscales [mean change per six-week period (95% confidence interval) ]: WHO mobility subscale (with aid) -0.67 (-0.99,-0.35); Nottingham Health Profile mobility subscale -10 (-15.5,-4.5) Nottingham extended ADL mobility subscale +3.08 (1.78,4.37); Nottingham extended ADL leisure subscale +1.66 (0.96,2.36). CONCLUSION There were no differences between day hospital and day centre in the outcomes measured. Day rehabilitation appeared to improve functional ability and mobility and scales reflecting these domains deserve further evaluation as outcome measures in this patient group. However, no improvement in quality of life was observed.
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Affiliation(s)
- S Burch
- Hinchingbrooke Hospital, Huntingdon, UK
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Abstract
OBJECTIVE To compare the outcome of day hospital to day centre rehabilitation. DESIGN Single blind randomized controlled trial with home assessments at baseline (twice), six weeks and three months. SETTING Mainly rural health district. Day hospital and social services day centres in market towns. SUBJECTS One hundred and five physically disabled older patients living at home referred for day hospital rehabilitation or maintenance before discharge from hospital (66) or referred as outpatients (39). INTERVENTIONS Day hospital treatment or day centre rehabilitation by a physiotherapist and two health support workers. MAIN OUTCOME MEASURES Barthel Index, Philadelphia Geriatric Morale Scale and Caregiver Strain Index. RESULTS More day centre (23/55) than day hospital patients (6/50) (p <0.001) withdrew from allocated treatment by choice or because of operational difficulties. Both groups improved significantly in functional ability and reduction of care-giver strain by three months but there was no significant difference between groups. The mean improvement in Barthel Index (standard error) for day hospital = +1.5 (0.41) (n = 34) and day centres = +1.5 (0.48) (n = 38). The mean difference (95% confidence interval) between day hospital and day centre was 0 (-1.28, +1.28). Likewise the mean Philadelphia Geriatric Morale Scale improvement for day hospital +1.8 (0.66) (n = 35) and day centres was +0.9 (0.63) (n = 38). The mean difference was -0.88 (-2.7, +0.95). The mean reduction in Caregiver Strain for day hospital was -1.45 (0.5) (n = 23) and day centre was -1.59 (0.47) (n = 27). The difference was -0.14 (1.52, +1.24). (These analyses are all on an intention-to-treat basis.) CONCLUSION Whilst the improvement in functional ability and care-giver strain was similar in both groups, day centre rehabilitation was less popular and had practical difficulties. If these difficulties can be overcome the model should be tested elsewhere.
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Affiliation(s)
- S Burch
- Hinchingbrooke Hospital, Huntingdon, Cambs, UK
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Borland C, Burch S, Mackay M, Longbottom J, Prevost A. The Huntingdon Day Hospital Trial: Secondary Outcome Measures. Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_1.p18-c] [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: 11/12/2022] Open
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Borland C, Wilkinson C, Hogarth K. Anticoagulants for venous thrombosis. Postgrad Med J 1997; 73:687. [PMID: 9498000 PMCID: PMC2431479 DOI: 10.1136/pgmj.73.864.687-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Holemans JA, Reidy JF, Borland C, Hawkins P, Pechlaner C, Buratti T, Wiedermann C, Fitzmaurice D, Murray ET, Hobbs FDR. Diagnosing pulmonary embolism. West J Med 1997. [DOI: 10.1136/bmj.314.7093.1550] [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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Borland C. Diagnosing pulmonary embolism. Three non-invasive techniques failed to get a mention. BMJ 1997; 314:1550. [PMID: 9183208 PMCID: PMC2126748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
Acetonitrile (methyl cyanide) is a common industrial organic solvent but is a rare cause of poisoning. We report the first recorded UK case. Acetonitrile is slowly converted to cyanide, resulting in delayed toxicity. We describe a case of deliberate self-poisoning by a 39-year-old woman resulting in cyanide poisoning 11 hours later which was successfully treated by repeated boluses of sodium nitrite and thiosulphate. The half-life of conversion of acetonitrile was 40 hours and harmful blood cyanide levels persisted for over 24 hours after ingestion. Departments treating or advising in cases of poisoning need to be aware of the delayed toxicity of acetonitrile. Monitoring in an intensive care unit of cases of acetonitrile poisoning should continue for 24-48 hours.
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Affiliation(s)
- M Mueller
- Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, UK
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Borland C, Burch S, McKay M, Longbottom J, Prevost T. A Randomised Controlled Trial of Day Hospital and Day Centre Rehabilitation. Age Ageing 1997. [DOI: 10.1093/ageing/26.suppl_3.p22-c] [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: 11/14/2022] Open
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Borland C. A PATIENT WHO CHANGED MY PRACTICE. West J Med 1996. [DOI: 10.1136/bmj.313.7052.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Unexplained or primary pulmonary hypertension results in an obliteration and obstruction of resistance pulmonary arteries. In these patients gas exchange is impaired and the measurement of gas transfer for carbon monoxide is usually reduced. This has been thought to represent a reduction in pulmonary alveolar capillary blood volume (Vc). A single breath test, measuring simultaneously the uptake of both nitric oxide (NO) and carbon monoxide (CO), provides a simple and practical measurement of membrane diffusion (Dm) and Vc. METHODS A standard single breath test for the measurement of gas transfer for carbon monoxide (TLCO) was adapted to include NO (40 ppm) in the inhaled gas mixture and a breath-hold time at total lung capacity of 7.5 seconds was used. Twelve patients with primary pulmonary hypertension and 10 similar normal volunteers were studied while seated at rest. RESULTS The patients had reduced values for TLCO and TLNO. The mean (SD) value of Dm in the patients was 36.7 (32.1) mmol/min.kPa compared with 52.8 (23.9) mmol/min.kPa in the normal subjects. Vc in the patients was 0.03 (0.03) 1 and 0.06 (0.01) 1 in the normal subjects. CONCLUSIONS The simultaneous measurement of NO and CO uptake is possible in healthy volunteers and patients with primary hypertension. In these patients capillary blood volume is reduced compared with normal subjects.
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Affiliation(s)
- C Borland
- Department of Respiratory Physiology, Papworth Hospital, Cambridge, UK
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Cremona G, Higenbottam TW, Mayoral V, Alexander G, Demoncheaux E, Borland C, Roe P, Jones GJ. Elevated exhaled nitric oxide in patients with hepatopulmonary syndrome. Eur Respir J 1995; 8:1883-5. [PMID: 8620957 DOI: 10.1183/09031936.95.08111883] [Citation(s) in RCA: 150] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The hypoxaemia of hepatopulmonary syndrome, seen in severe chronic liver dysfunction, occurs as a result of precapillary pulmonary arterial dilatation and arteriovenous communications. These abnormalities contribute to the mismatch between ventilation and perfusion, and the right to left blood flow shunting. Nitric oxide (NO) is a powerful vasodilator concerned with the regulation of pulmonary vascular tone in man. Using a chemiluminescence analyser, we have measured endogenously produced NO in the exhaled air of three patients with the hepatopulmonary syndrome, six normoxaemic cirrhotic patients and six healthy volunteers. The subjects breathed NO-free air throughout the measurements. The molar rate of production of exhaled NO was raised almost threefold in the patients with hepatopulmonary syndrome compared with normal volunteers and with normoxaemic cirrhotic patients. Hypoxia per se, achieved in the normal volunteers by breathing a hypoxic gas mixture, reduced rather than increased the exhaled NO. One hepatopulmonary syndrome patient received an orthotopic liver transplant and achieved normoxaemia after 3 months. The exhaled NO also returned to normal. Increased pulmonary production of NO could contribute to the development of the hepatopulmonary syndrome.
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Affiliation(s)
- G Cremona
- Dept of Respiratory Physiology, Addenbrookes Hospital, Cambridge, UK
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Burch S, Borland C. Are Day Hospital Patients More Disabled Than Day Centre Attenders? Age Ageing 1995. [DOI: 10.1093/ageing/24.suppl_1.p23-b] [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: 11/15/2022] Open
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Abstract
A case of acute perinephric abscess due to chronic parenchymal disease and calculi is presented. During percutaneous drainage a reno-splenic vein communication developed acutely. The aetiology and treatment complications of perinephric abscesses are reviewed.
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Affiliation(s)
- I E Stewart
- Department of Radiology, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, UK
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Cremona G, Higenbottam T, Borland C, Mist B. Mixed expired nitric oxide in primary pulmonary hypertension in relation to lung diffusion capacity. QJM 1994; 87:547-51. [PMID: 7953503] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The mixed expired nitric oxide (NO) production of the lungs of patients with primary pulmonary hypertension (PPH) and normal subjects was measured to determine the relationship between NO production and the diffusion capacity of the lung (KCO). Expired air was collected from eight patients with PPH and 20 healthy volunteers for analysis by a chemiluminescent analyser. Mean pulmonary artery pressure in the PPH patients was 59.5 +/- 6.45 mmHg and their mean cardiac output was 2.95 +/- 0.35 l/min. All patients and subjects underwent measurements of FEV1, VC and KCO. The rate of production of NO in mixed exhaled air was lower in the PPH group compared to the controls (2.85 +/- 0.7 vs. 4.69 +/- 0.35 nM/min; p < 0.05). There was a good correlation of expired NO with the KCO (r = 0.7; n = 30; p < 0.001). When corrected, KCO differences in exhaled NO were not significant (p = 0.09). We conclude that the low exhaled NO observed in PPH patients is a reflection of the reduced blood capillary volume in these patients rather than a decreased basal production of NO.
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Affiliation(s)
- G Cremona
- Department of Respiratory Physiology, Papworth Hospital, Papworth Everard, Cambridge, UK
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Abstract
BACKGROUND Nitric oxide is released from pulmonary endothelial cells and contributes to the low pulmonary vascular resistance. The resistance pulmonary arteries are in close anatomical proximity to membranous airways, so it is likely that some pulmonary endothelial nitric oxide will enter the airspace to allow its measurement in the exhaled breath. METHODS Exhaled air was collected from a single full exhalation and during tidal breathing. This was analysed for concentrations of nitric oxide, nitrogen dioxide, and carbon dioxide to give alveolar (FA) and mixed expired (FE) concentrations. Eight normal subjects were studied and laboratory air was similarly analysed using, respectively, chemiluminescent and infrared analysers. RESULTS There was no relation between FA concentrations and the laboratory air concentrations. From the single breath, the ratio of (Fano/Faco2) x (Feco2/Feno) had a mean value of 0.92 (95% confidence interval 0.7 to 1.14). As this does not differ from unity, nitric oxide is likely to be derived from the same regions of the lungs as carbon dioxide. During tidal breathing the Feno ranged from 8.3 to 20.3 parts per billion. CONCLUSIONS It is possible to measure endogenous pulmonary nitric oxide production in the exhaled air in man.
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Affiliation(s)
- C Borland
- Department of Respiratory Physiology, Papworth Hospital, Cambridge
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Reuser T, Flanagan DW, Borland C, Bannerjee DK. Acute Angle Closure Glaucoma Occurring after Nebulized Bronchodilator Treatment with Ipratropium Bromide and Salbutamol. Med Chir Trans 1992; 85:499-500. [PMID: 1404209 PMCID: PMC1293605 DOI: 10.1177/014107689208500828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- T Reuser
- Department of Ophthalmology, Hinchingbrooke Hospital, Huntingdon
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Borland C, Cox Y. NO and CO transfer. Eur Respir J 1991. [DOI: 10.1183/09031936.93.04060766a] [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: 12/12/2022]
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Borland C, Cox Y. NO and CO transfer. Eur Respir J 1991; 4:766. [PMID: 1889506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Borland C. NO and CO transfer. Eur Respir J 1990; 3:977-8. [PMID: 2292308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
To determine what governs nitric oxide (NO) yields of cigarettes and to obtain a range of yields for contemporary cigarettes 17 UK, 14 US, 8 French and 1 Turkish brand were analysed using a chemiluminescent analyser and standard smoking machine. The country of origin appeared to be the major factor affecting NO yield. US and French brands exceeded UK values by 3-5 fold. Apart from a reduced NO yield in UK ventilated filtered brands, the design of a cigarette and its tar, nicotine and carbon monoxide (CO) yield had little effect on NO yield. It is argued that these international differences in NO yields reflect differences in the nitrate content of tobaccos traditionally used in manufacture in those countries over many years. Despite their probable increased lifetime exposure to NO (and by implication nitrosamine exposure) there appears to be little evidence that US and French smokers are at greater risk of lung disease than their UK counterparts.
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Abstract
To estimate the frequency of diuretic-related electrolyte disorders in the elderly, 561 consecutive admissions to three acute geriatric units were studied. For the 287 admissions to one unit, discharge/death diagnoses were also examined in relation to admission diuretic therapy. Sodium concentrations were significantly lower, and urea and creatinine significantly higher, in patients on diuretics, though the size of the differences was small. Comparing different preparations sodium concentrations were significantly lower on Moduretic than on Dyazide or Navidrex K and on frusemide when combined with a potassium-retaining diuretic rather than a potassium supplement. Potassium concentrations were significantly lower on Bendrofluazide alone compared to Navidrex K or Moduretic. Diuretics were positively associated with cardiac failure, ischaemic heart disease, airflow obstruction and obstructive large bowel disorders but negatively with Parkinson's disease. No significant association was found with falls, immobility or confusion. Major electrolyte disorders on diuretics appear to be unusual but important differences exist between preparations. Similarly major illness resulting from diuretic therapy is rare but minor morbidity may be more common.
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Abstract
The purpose of this study was to test whether cough response to inhaled ultrasonically nebulized fluid is dependent on the ionic content of the fluid. Coughing was recorded in human volunteers during inhalation of aqueous solutions in a series of double blind randomized experiments. The occurrence of cough was found to be dependent on the concentration of chloride ions in the inhaled fluid, cough frequency progressively increasing as chloride ion concentration was reduced. It is proposed that the ion composition of the surface lining fluid of the airway may moderate the cough response by means of a chemo-receptor, although tonicity may also be important.
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Abstract
The authors analyzed the blood of a group of 336 smokers and 336 non-smokers to determine if tobacco smoke, potentially the major source of nitrogen oxide pollution for 40% of the adult population, significantly reduces oxygen carrying capacity as a result of methemoglobin formation. Each blood sample was analyzed for carboxyhemoglobin, methemoglobin, and hemoglobin using an automated spectrophotometer. The mean value of methemoglobin in the smokers did not exceed that in the non-smokers; in fact, the level in the non-smokers was significantly greater. As expected, carboxyhemoglobin levels in smokers substantially exceeded those in non-smokers. The authors conclude that methemoglobin arising from cigarette smoke exposure does not interfere with the oxygen carrying capacity of the blood in smokers.
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Borland C, Higenbottam T. Do the oxides of nitrogen in cigarette smoke cause emphysema in smokers? Tokai J Exp Clin Med 1985; 10:371-3. [PMID: 3836518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Borland C, Chamberlain A, Barber B, Higenbottam T. Pulmonary epithelial permeability after inhaling saline, distilled water "fog" and cold air. Chest 1985; 87:373-6. [PMID: 3882351 DOI: 10.1378/chest.87.3.373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
It is recognized that hyperventilation of cold air and the inhalation of fine mists of distilled water provoke significant bronchoconstriction in the asthmatic individual, yet little is known as to how these provocations affect the structural integrity of the alveolar epithelial membrane. In 11 normal subjects, the following effects have been studied: cold air hyperventilation for three minutes, inhalation of 80 L of ultrasonically nebulized distilled water "fog," and 80 L of isotonic saline "fog" on the half time clearance (T1/2) from the alveoli of technetium 99m diethylene triamine penta acetate (DTPA), inhaled as an aerosol. The DTPA T1/2 provided a measurement of pulmonary epithelial permeability.
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Millson D, Borland C, Murphy P, Davison W. Hyponatraemia and Moduretic (amiloride plus hydrochlorothiazide). Br Med J (Clin Res Ed) 1984; 289:1308-9. [PMID: 6437528 PMCID: PMC1443504 DOI: 10.1136/bmj.289.6454.1308-d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Borland C, Chamberlain A, Higenbottam T, Shipley M, Rose G. Carbon monoxide yield of cigarettes and its relation to cardiorespiratory disease. West J Med 1984. [DOI: 10.1136/bmj.288.6416.566-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Borland C, Chamberlain A, Higenbottam T, Shipley M, Rose G. Carbon monoxide yield of cigarettes and its relation to cardiorespiratory disease. Br Med J (Clin Res Ed) 1983; 287:1583-6. [PMID: 6416512 PMCID: PMC1549826 DOI: 10.1136/bmj.287.6405.1583] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Estimates of the carbon monoxide yield of their cigarettes have been obtained for 4910 smokers (68% of all smokers) in the Whitehall study of men aged 40 to 64. In the 10 years after examination 635 men died. When men smoking cigarettes with high carbon monoxide yield were compared with those smoking cigarettes with a low yield, and after adjusting for age, employment grade, amount smoked, and tar yield, the risk of death was 32% lower for coronary heart disease, 49% higher for lung cancer, and 10% lower for total mortality; these differences were not statistically significant. Among men who said that they inhaled the risk of fatal coronary heart disease was 51% lower in the high carbon monoxide group (p less than 0.01), while the risk of lung cancer was 75% higher. These results provide no evidence that a smoker can reduce his risk of death by smoking a brand with a low carbon monoxide yield; he might even increase it. The complex interactions between characteristics of the smoker, smoking behaviour, constituents of tobacco smoke, and health are again demonstrated.
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