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Stocker MD, Smith JE, Pachepsky YA, Blaustein RA. Fine-scale spatiotemporal variations in bacterial community diversity in agricultural pond water. Sci Total Environ 2024; 915:170143. [PMID: 38242477 DOI: 10.1016/j.scitotenv.2024.170143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
Microbial communities in surface waters are affected by environmental conditions and can influence changes in water quality. To explore the hypothesis that the microbiome in agricultural waters associates with spatiotemporal variations in overall water quality and, in turn, has implications for resource monitoring and management, we characterized the relationships between the microbiota and physicochemical properties in a model irrigation pond as a factor of sampling time (i.e., 9:00, 12:00, 15:00) and location within the pond (i.e., bank vs. interior sites and cross-sectional depths at 0, 1, and 2 m). The microbial communities, which were defined by 16S rRNA gene sequencing analysis, significantly varied based on all sampling factors (PERMANOVA P < 0.05 for each). While the relative abundances of dominant phyla (e.g., Proteobacteria and Bacteroidetes) were relatively stable throughout the pond, subtle yet significant increases in α-diversity were observed as the day progressed (ANOVA P < 0.001). Key water quality properties that also increased between the morning and afternoon (i.e., pH, dissolved oxygen, and temperature) positively associated with relative abundances of Cyanobacteria, though were inversely proportional to Verrucomicrobia. These properties, among additional parameters such as bioavailable nutrients (e.g., NH3, NO3, PO4), chlorophyll, phycocyanin, conductivity, and colored dissolved organic matter, exhibited significant relationships with relative abundances of various bacterial genera as well. Further investigation of the microbiota in underlying sediments revealed significant differences between the bank and interior sites of the pond (P < 0.05 for α- and β-diversity). Overall, our findings emphasize the importance of accounting for time of day and water sampling location and depth when surveying the microbiomes of irrigation ponds and other small freshwater sources.
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Affiliation(s)
- M D Stocker
- United States Department of Agriculture, Agricultural Research Services, Environmental Microbial and Food Safety Laboratory, Beltsville, MD 20705, USA.
| | - J E Smith
- United States Department of Agriculture, Agricultural Research Services, Environmental Microbial and Food Safety Laboratory, Beltsville, MD 20705, USA; Oak Ridge Institute of Science and Education, Oak Ridge, TN 37830, USA
| | - Y A Pachepsky
- United States Department of Agriculture, Agricultural Research Services, Environmental Microbial and Food Safety Laboratory, Beltsville, MD 20705, USA
| | - R A Blaustein
- University of Maryland, Department of Nutrition and Food Science, College Park, MD 20742, USA
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2
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Smith JE, Granzier H. In vivo gene editing of CAMKIID: out with the bad and in with the good. J Clin Invest 2024; 134:e176672. [PMID: 38165033 PMCID: PMC10760942 DOI: 10.1172/jci176672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
The ability to change an organism's DNA through gene editing is of great importance for the prevention and treatment of genetic and acquired diseases. Rapid progress has been made during the last decade due to the discovery and refinement of CRISPR/Cas9 as an accurate, fast, and reliable genome editing technique. In this issue of the JCI, Lebek et al. present the culmination from a line of work in the Olson laboratory focused on in vivo gene editing of CAMK2D. The paper presents a combined state-of-the-art gene therapy approach that demonstrates how gene therapy can yield cardioprotection in a mouse model and takes notable steps toward potential applicability in patients.
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3
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Guntur AR, Smith JE, Brahmandam A, DeBauche P, Cronmiller C, Lundell MJ. ZFH-2 is required for Drosophila ovarian follicle development and is expressed at the band/interband boundaries of polytene chromosomes. Dev Biol 2023; 504:1-11. [PMID: 37666353 DOI: 10.1016/j.ydbio.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
The transcription factor ZFH-2 has well-documented roles in Drosophila neurogenesis and other developmental processes. Here we provide the first evidence that ZFH-2 has a role in oogenesis. We demonstrate that ZFH-2 is expressed in the wild-type ovary and that a loss of zfh-2 function produces a mutant ovary phenotype where egg chambers are reduced in number and fused. We also show that a loss of zfh-2 function can suppress a daughterless loss-of-function ovary phenotype suggesting a possible genetic relationship between these two genes in the ovary. We also show that ZFH-2 is located at the boundary between bands and interbands on polytene chromosomes and that at a subset of these sites ZFH-2 colocalizes with the insulator/promoter cofactor CP190.
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Affiliation(s)
- Ananya R Guntur
- Department of Biology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA
| | - John E Smith
- Department of Biology, University of Virginia, P.O. Box 400328, Charlottesville, VA, 22904, USA
| | - Archana Brahmandam
- Department of Biology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA
| | - Phillip DeBauche
- Department of Biology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA
| | - Claire Cronmiller
- Department of Biology, University of Virginia, P.O. Box 400328, Charlottesville, VA, 22904, USA
| | - Martha J Lundell
- Department of Biology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
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4
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Cottey L, Smith JE, Watts S. Optimisation of mitochondrial function as a novel target for resuscitation in haemorrhagic shock: a systematic review. BMJ Mil Health 2023:e002427. [PMID: 37491136 DOI: 10.1136/military-2023-002427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/10/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Traumatic injury is one of the leading causes of death worldwide, and despite significant improvements in patient care, survival in the most severely injured patients remains unchanged. There is a crucial need for innovative approaches to improve trauma patient outcomes; this is particularly pertinent in remote or austere environments with prolonged evacuation times to definitive care. Studies suggest that maintenance of cellular homeostasis is a critical component of optimal trauma patient management, and as the cell powerhouse, it is likely that mitochondria play a pivotal role. As a result, therapies that optimise mitochondrial function could be an important future target for the treatment of critically ill trauma patients. METHODS A systematic review of the literature was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol to determine the potential role of mitochondria in traumatic injury and haemorrhagic shock (HS) and to identify current evidence for mitochondrial optimisation therapies in trauma. Articles were included if they assessed a mitochondrial targeted therapy in comparison to a control group, used a model of traumatic injury and HS and reported a method to assess mitochondrial function. RESULTS The search returned 918 articles with 37 relevant studies relating to mitochondrial optimisation identified. Included studies exploring a range of therapies with potential utility in traumatic injury and HS. Therapies were categorised into the key mitochondrial pathways impacted following traumatic injury and HS: ATP levels, cell death, oxidative stress and reactive oxygen species. CONCLUSION This systematic review provides an overview of the key cellular functions of the mitochondria following traumatic injury and HS and identifies why mitochondrial optimisation could be a viable and valuable target in optimising outcome in severely injured patients in the future.
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Affiliation(s)
- Laura Cottey
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - S Watts
- Chemical, Biological and Radiological Division, Defence Science and Technology Laboratory, Salisbury, UK
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5
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Davies RL, Thompson J, McGuire R, Smith JE, Webster S, Woolley T. Haemostatic resuscitation in practice: a descriptive analysis of blood products administered during Operation HERRICK, Afghanistan. BMJ Mil Health 2023:e002408. [PMID: 37400127 DOI: 10.1136/military-2023-002408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/10/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Life-threatening haemorrhage is the leading cause of potentially survivable injury in battlefield casualties. During Operation HERRICK (Afghanistan), mortality rates improved year on year due to a number of advances in trauma care, including haemostatic resuscitation. Blood transfusion practice has not previously been reported in detail during this period. METHODS A retrospective analysis of blood transfusion at the UK role 3 medical treatment facility (MTF) at Camp Bastion between March 2006 and September 2014 was performed. Data were extracted from two sources: the UK Joint Theatre Trauma Registry (JTTR) and the newly established Deployed Blood Transfusion Database (DBTD). RESULTS 3840 casualties were transfused 72 138 units of blood and blood products. 2709 adult casualties (71%) were fully linked with JTTR data and were transfused a total of 59 842 units. Casualties received between 1 unit and 264 units of blood product with a median of 13 units per patient. Casualties wounded by explosion required almost twice the volume of blood product transfusion as those wounded by small arms fire or in a motor vehicle collision (18 units, 9 units, and 10 units, respectively). More than half of blood products were transfused within the first 2 hours following arrival at the MTF. There was a trend towards balanced resuscitation with more equal ratios of blood and blood products being used over time. CONCLUSION This study has defined the epidemiology of blood transfusion practice during Operation HERRICK. The DBTD is the largest combined trauma database of its kind. It will ensure that lessons learnt during this period are defined and not forgotten; it should also allow further research questions to be answered in this important area of resuscitation practice.
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Affiliation(s)
- Rhys L Davies
- Anaesthetic Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - J Thompson
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | | | - J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - S Webster
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - T Woolley
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
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6
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Wood F, Roiz-de-Sa D, Pynn H, Smith JE, Bishop J, Hemingway R. Outcomes of UK military personnel treated with ice cold water immersion for exertional heat stroke. BMJ Mil Health 2022:e002133. [PMID: 36202428 DOI: 10.1136/military-2022-002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/09/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Despite mitigation efforts, exertional heat stroke (EHS) is known to occur in military personnel during training and operations. It has significant potential to cause preventable morbidity and mortality. International consensus from sports medicine organisations supports treating EHS with early rapid cooling by immersing the casualty in cold water. However, evidence remains sparse and the practice is not yet widespread in the UK. METHODS Following changes to enable on-site ice cold water immersion (ICWI) at the Royal Marines Commando Training Centre, Lympstone, UK, we prospectively gathered data on 35 patients treated with ICWI over a 3-year period. These data included the incidence of adverse events (e.g. death, cardiac arrest or critical care admission) as the primary outcome. Basic anthropometric data, cooling rates achieved and biochemical and haematological test results on days 0-5 were also gathered and analysed. RESULTS Despite being a cohort of patients in whom we might expect significant morbidity and mortality based on the severity of EHS at presentation, none experienced a serious adverse event. In this cohort with rapid initiation of effective cooling, biochemical derangement appeared less severe than that reported in previous studies. Higher body mass index (BMI) was associated with a lower cooling rate across a range of values previously reported as potentially of clinical significance. CONCLUSIONS This case series supports recent updates to UK military guidance that ICWI should be more widely adopted for the treatment of EHS. Clinicians should be aware of likely patterns of blood test abnormalities in the days following EHS. Further work should seek to establish the impact of lower rates of cooling and develop strategies to optimise cooling in patients with higher BMI.
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Affiliation(s)
- Felix Wood
- Emergency Department, Derriford Hospital, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | | | - H Pynn
- Emergency Department, Bristol Royal Infirmary, Bristol, UK
- Royal Army Medical Corps, Aldershot, UK
| | - J E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - J Bishop
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - R Hemingway
- Medical Centre, Commando Training Centre Royal Marines, Lympstone, UK
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7
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Methawasin M, Farman GP, Granzier-Nakajima S, Strom J, Kiss B, Smith JE, Granzier H. Shortening the thick filament by partial deletion of titin's C-zone alters cardiac function by reducing the operating sarcomere length range. J Mol Cell Cardiol 2022; 165:103-114. [PMID: 35031281 PMCID: PMC8940690 DOI: 10.1016/j.yjmcc.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
Titin's C-zone is an inextensible segment in titin, comprised of 11 super-repeats and located in the cMyBP-C-containing region of the thick filament. Previously we showed that deletion of titin's super-repeats C1 and C2 (TtnΔC1-2 model) results in shorter thick filaments and contractile dysfunction of the left ventricular (LV) chamber but that unexpectedly LV diastolic stiffness is normal. Here we studied the contraction-relaxation kinetics from the time-varying elastance of the LV and intact cardiomyocyte, cellular work loops of intact cardiomyocytes, Ca2+ transients, cross-bridge kinetics, and myofilament Ca2+ sensitivity. Intact cardiomyocytes of TtnΔC1-2 mice exhibit systolic dysfunction and impaired relaxation. The time-varying elastance at both LV and single-cell levels showed that activation kinetics are normal in TtnΔC1-2 mice, but that relaxation is slower. The slowed relaxation is, in part, attributable to an increased myofilament Ca2+ sensitivity and slower early Ca2+ reuptake. Cross-bridge dynamics showed that cross-bridge kinetics are normal but that the number of force-generating cross-bridges is reduced. In vivo sarcomere length (SL) measurements revealed that in TtnΔC1-2 mice the operating SL range of the LV is shifted towards shorter lengths. This normalizes the apparent cell and LV diastolic stiffness but further reduces systolic force as systole occurs further down on the ascending limb of the force-SL relation. We propose that the reduced working SLs reflect titin's role in regulating diastolic stiffness by altering the number of sarcomeres in series. Overall, our study reveals that thick filament length regulation by titin's C-zone is critical for normal cardiac function.
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Affiliation(s)
- Mei Methawasin
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, United States of America.
| | - Gerrie P Farman
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, United States of America
| | - Shawtaroh Granzier-Nakajima
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, United States of America
| | - Joshua Strom
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, United States of America
| | - Balazs Kiss
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, United States of America
| | - John E Smith
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, United States of America
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, United States of America.
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8
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Methawasin M, Farman GP, Granzier-Nakajima S, Strom JG, Smith JE, Granzier HL. Abstract P315: Shortening The Thick Filament By Partial Deletion Of Titin’S C-zone Alters Cardiac Function By Reducing The Operating Sarcomere Length Range Of The Heart. Circ Res 2021. [DOI: 10.1161/res.129.suppl_1.p315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Titin’s C-zone is the inextensible part of titin that binds along the thick filament at its cMyBP-C -containing region. Previously it was shown that deletion of titin’s super-repeats C1 and C2 (
Ttn
ΔC1-2
mouse model) results in shorter thick filaments and contractile dysfunction, but LV chamber stiffness is normal. Here we studied the contraction-relaxation kinetics from the time-varying elastance of the left ventricle (LV) and from cellular work loops of intact loaded cardiac myocytes. Ca
2+
transients were also measured as well as crossbridge cycling kinetics and Ca
2+
sensitivity of force. It was found that intact cardiomyocytes of
Ttn
ΔC1-2
mice exhibit systolic dysfunction and impaired relaxation. The time-varying elastance of the LV chamber showed that the kinetics of LV activation are normal but that relaxation is slower in
Ttn
ΔC1-2
mice. The slowed relaxation was, in part, attributable to an increased myofilament Ca
2+
sensitivity and slower early Ca
2+
reuptake. Dynamic stiffness at the myofilament level showed that cross-bridge kinetics are normal, but that the number of force-generating cross-bridges is reduced. In vivo sarcomere length (SL) measurements in the mid-wall region of the LV revealed that the operating SL range is shifted in
Ttn
ΔC1-2
mice towards shorter lengths. This normalizes the apparent cell and LV chamber stiffness but reduces the number of force generating cross-bridges due to suboptimal thin and thick filament overlap. Thus the contractile dysfunction in
Ttn
ΔC1-2
mice is not only due to shorter thick filaments but also to a reduced operating sarcomere length range. Overall these results reveal that for normal cardiac function, thick filament length regulation by titin’s C-zone is critical.
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9
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Nordmann G, Ralph J, Smith JE. Evolution of the deployed medical director role in an era of contingency operations: reflections from a United Nations operation. BMJ Mil Health 2021; 167:335-339. [PMID: 34083373 DOI: 10.1136/bmjmilitary-2020-001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/04/2022]
Abstract
This paper examines the development and evolution of the deployed medical director (DMD) role and argues for the re-establishment of a formal selection process and training pathway. Recent deployments into new areas of operations, deployment of smaller medical treatment facilities (MTFs), the reduced numbers of deployments for clinicians, working with various multinational partners and both military and civilian organisations all pose specific problems for DMDs. The initial and then continued deployment of a secondary care role 2 MTF as part of the United Nations Mission in South Sudan illustrated some of these challenges. Although a novel operation, the broad categories of these new challenges were similar to the historical challenges facing the first DMDs in Afghanistan. Corporate memory loss may be unavoidable to some degree due to rapid turnover in appointments, particularly in single service and joint headquarters. However, individual memory and experience remains extant within the military medical deployable workforce. After the cessation of UK military deployed hospital care involvement in Afghanistan, the UK DMD formal training pathway ended. This paper argues for the re-establishment of a more formal DMD selection process and training pathway to ensure that organisational learning is optimised.
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Affiliation(s)
- Giles Nordmann
- Academic Department of Anaesthesia, Royal Centre for Defence Medicine, Birmingham, UK .,Head of Capability Combat Service Support (Medical), Capability Directorate, UK Army Headquarters, Andover, UK
| | - J Ralph
- Royal Centre for Defence Medicine Clinical Unit, Queen Elizabeth Hospital, Birmingham, West Midlands, UK
| | - J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK.,Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, Devon, UK
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10
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Gohlke J, Tonino P, Lindqvist J, Smith JE, Granzier H. The number of Z-repeats and super-repeats in nebulin greatly varies across vertebrates and scales with animal size. J Gen Physiol 2020; 153:211611. [PMID: 33337482 PMCID: PMC7754682 DOI: 10.1085/jgp.202012783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022] Open
Abstract
Nebulin is a skeletal muscle protein that associates with the sarcomeric thin filaments and has functions in regulating the length of the thin filament and the structure of the Z-disk. Here we investigated the nebulin gene in 53 species of birds, fish, amphibians, reptiles, and mammals. In all species, nebulin has a similar domain composition that mostly consists of ∼30-residue modules (or simple repeats), each containing an actin-binding site. All species have a large region where simple repeats are organized into seven-module super-repeats, each containing a tropomyosin binding site. The number of super-repeats shows high interspecies variation, ranging from 21 (zebrafish, hummingbird) to 31 (camel, chimpanzee), and, importantly, scales with body size. The higher number of super-repeats in large animals was shown to increase thin filament length, which is expected to increase the sarcomere length for optimal force production, increase the energy efficiency of isometric force production, and lower the shortening velocity of muscle. It has been known since the work of A.V. Hill in 1950 that as species increase in size, the shortening velocity of their muscle is reduced, and the present work shows that nebulin contributes to the mechanistic basis. Finally, we analyzed the differentially spliced simple repeats in nebulin's C terminus, whose inclusion correlates with the width of the Z-disk. The number of Z-repeats greatly varies (from 5 to 18) and correlates with the number of super-repeats. We propose that the resulting increase in the width of the Z-disk in large animals increases the number of contacts between nebulin and structural Z-disk proteins when the Z-disk is stressed for long durations.
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Affiliation(s)
- Jochen Gohlke
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Paola Tonino
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Johan Lindqvist
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - John E Smith
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
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11
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Kiss B, Gohlke J, Tonino P, Hourani Z, Kolb J, Strom J, Alekhina O, Smith JE, Ottenheijm C, Gregorio C, Granzier H. Nebulin and Lmod2 are critical for specifying thin-filament length in skeletal muscle. Sci Adv 2020; 6:6/46/eabc1992. [PMID: 33177085 PMCID: PMC7673738 DOI: 10.1126/sciadv.abc1992] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 09/23/2020] [Indexed: 06/07/2023]
Abstract
Regulating the thin-filament length in muscle is crucial for controlling the number of myosin motors that generate power. The giant protein nebulin forms a long slender filament that associates along the length of the thin filament in skeletal muscle with functions that remain largely obscure. Here nebulin's role in thin-filament length regulation was investigated by targeting entire super-repeats in the Neb gene; nebulin was either shortened or lengthened by 115 nm. Its effect on thin-filament length was studied using high-resolution structural and functional techniques. Results revealed that thin-filament length is strictly regulated by the length of nebulin in fast muscles. Nebulin's control is less tight in slow muscle types where a distal nebulin-free thin-filament segment exists, the length of which was found to be regulated by leiomodin-2 (Lmod2). We propose that strict length control by nebulin promotes high-speed shortening and that dual-regulation by nebulin/Lmod2 enhances contraction efficiency.
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Affiliation(s)
- Balázs Kiss
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Jochen Gohlke
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Paola Tonino
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Zaynab Hourani
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Justin Kolb
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Joshua Strom
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Olga Alekhina
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - John E Smith
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Coen Ottenheijm
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Carol Gregorio
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA.
- Allan and Alfie Endowed Chair for Heart Disease in Women Research, Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ 85721, USA
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12
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Smith JE, Stocker MD, Wolny JL, Hill RL, Pachepsky YA. Intraseasonal variation of phycocyanin concentrations and environmental covariates in two agricultural irrigation ponds in Maryland, USA. Environ Monit Assess 2020; 192:706. [PMID: 33064217 DOI: 10.1007/s10661-020-08664-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
Recently, cyanobacteria blooms have become a concern for agricultural irrigation water quality. Numerous studies have shown that cyanotoxins from these harmful algal blooms (HABs) can be transported to and assimilated into crops when present in irrigation waters. Phycocyanin is a pigment known only to occur in cyanobacteria and is often used to indicate cyanobacteria presence in waters. The objective of this work was to identify the most influential environmental covariates affecting the phycocyanin concentrations in agricultural irrigation ponds that experience cyanobacteria blooms of the potentially toxigenic species Microcystis and Aphanizomenon using machine learning methodology. The study was performed at two agricultural irrigation ponds over a 5-month period in the summer of 2018. Phycocyanin concentrations, along with sensor-based and fluorometer-based water quality parameters including turbidity (NTU), pH, dissolved oxygen (DO), fluorescent dissolved organic matter (fDOM), conductivity, chlorophyll, color dissolved organic matter (CDOM), and extracted chlorophyll were measured. Regression tree analyses were used to determine the most influential water quality parameters on phycocyanin concentrations. Nearshore sampling locations had higher phycocyanin concentrations than interior sampling locations and "zones" of consistently higher concentrations of phycocyanin were found in both ponds. The regression tree analyses indicated extracted chlorophyll, CDOM, and NTU were the three most influential parameters on phycocyanin concentrations. This study indicates that sensor-based and fluorometer-based water quality parameters could be useful to identify spatial patterns of phycocyanin concentrations and therefore, cyanobacteria blooms, in agricultural irrigation ponds and potentially other water bodies.
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Affiliation(s)
- J E Smith
- Environmental Microbial and Food Safety Laboratory, Beltsville Agricultural Research Center, ARS-USDA, Beltsville, MD, USA.
- Department of Environmental Science and Technology, University of Maryland, College Park, MD, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - M D Stocker
- Environmental Microbial and Food Safety Laboratory, Beltsville Agricultural Research Center, ARS-USDA, Beltsville, MD, USA
- Department of Environmental Science and Technology, University of Maryland, College Park, MD, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - J L Wolny
- Resource Assessment Service, Maryland Department of Natural Resources, Annapolis, MD, USA
| | - R L Hill
- Department of Environmental Science and Technology, University of Maryland, College Park, MD, USA
| | - Y A Pachepsky
- Environmental Microbial and Food Safety Laboratory, Beltsville Agricultural Research Center, ARS-USDA, Beltsville, MD, USA
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13
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Webster S, Barnard EBG, Smith JE, Marsden MER, Wright C. Killed in action (KIA): an analysis of military personnel who died of their injuries before reaching a definitive medical treatment facility in Afghanistan (2004-2014). BMJ Mil Health 2020; 167:84-88. [PMID: 32487673 DOI: 10.1136/bmjmilitary-2020-001490] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/14/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The majority of combat deaths occur before arrival at a medical treatment facility but no previous studies have comprehensively examined this phase of care. METHODS The UK Joint Theatre Trauma Registry was used to identify all UK military personnel who died in Afghanistan (2004-2014). These data were linked to non-medical tactical and operational records to provide an accurate timeline of events. Cause of death was determined from records taken at postmortem review. The primary objective was to report time between injury and death in those killed in action (KIA); secondary objectives included: reporting mortality at key North Atlantic Treaty Organisation timelines (0, 10, 60, 120 min), comparison of temporal lethality for different anatomical injuries and analysing trends in the case fatality rate (CFR). RESULTS 2413 UK personnel were injured in Afghanistan from 2004 to 2014; 448 died, with a CFR of 18.6%. 390 (87.1%) of these died prehospital (n=348 KIA, n=42 killed non-enemy action). Complete data were available for n=303 (87.1%) KIA: median Injury Severity Score 75.0 (IQR 55.5-75.0). The predominant mechanisms were improvised explosive device (n=166, 54.8%) and gunshot wound (n=96, 31.7%).In the KIA cohort, the median time to death was 0.0 (IQR 0.0-21.8) min; 173 (57.1%) died immediately (0 min). At 10, 60 and 120 min post injury, 205 (67.7%), 277 (91.4%) and 300 (99.0%) casualties were dead, respectively. Whole body primary injury had the fastest mortality. Overall prehospital CFR improved throughout the period while in-hospital CFR remained constant. CONCLUSION Over two-thirds of KIA deaths occurred within 10 min of injury. Improvement in the CFR in Afghanistan was predominantly in the prehospital phase.
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Affiliation(s)
- Stacey Webster
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK .,The 2nd Battalion Parachute Regiment, Colchester, UK
| | - E B G Barnard
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK.,Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK
| | - M E R Marsden
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK.,Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - C Wright
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK
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14
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Abstract
BACKGROUND Low myocardial cGMP-PKG (cyclic guanosine monophosphate-protein kinase G) activity has been associated with increased cardiomyocyte diastolic stiffness in heart failure with preserved ejection fraction. Cyclic guanosine monophosphate is mainly hydrolyzed by PDE (phosphodiesterases) 5a and 9a. Importantly, PDE9a expression has been reported to be upregulated in human heart failure with preserved ejection fraction myocardium and chronic administration of a PDE9a inhibitor reverses preestablished cardiac hypertrophy and systolic dysfunction in mice subjected to transverse aortic constriction (TAC). We hypothesized that inhibiting PDE9a activity ameliorates diastolic dysfunction. METHODS To examine the effect of chronic PDE9a inhibition, 2 diastolic dysfunction mouse models were studied: (1) TAC-deoxycorticosterone acetate and (2) Leprdb/db. PDE9a inhibitor (5 and 8 mg/kg per day) was administered to the mice via subcutaneously implanted osmotic minipumps for 28 days. The effect of acute PDE9a inhibition was investigated in intact cardiomyocytes isolated from TAC-deoxycorticosterone acetate mice. Atrial natriuretic peptide together with PDE9a inhibitor were administered to the isolated intact cardiomyocytes through the cell perfusate. RESULTS For acute inhibition, no cellular stiffness reduction was found, whereas chronic PDE9a inhibition resulted in reduced left ventricular chamber stiffness in TAC-deoxycorticosterone acetate, but not in Leprdb/db mice. Passive cardiomyocyte stiffness was reduced by chronic PDE9a inhibition, with no differences in myocardial fibrosis or cardiac morphometry. PDE9a inhibition increased the ventricular-arterial coupling ratio, reflecting impaired systolic function. CONCLUSIONS Chronic PDE9a inhibition lowers left ventricular chamber stiffness in TAC-deoxycorticosterone acetate mice. However, the usefulness of PDE9a inhibition to treat high-diastolic stiffness may be limited as the required PDE9a inhibitor dose also impairs systolic function, observed as a decline in ventricular-arterial coordination, in this model.
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Affiliation(s)
- Mei Methawasin
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - Joshua Strom
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - Tomasz Borkowski
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - Zaynab Hourani
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - Ray Runyan
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - John E Smith
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - Henk Granzier
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
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15
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Horne S, Gurney I, Smith JE. UK Defence Medical Services’ support to the development of a multiagency major incident plan in South Sudan. BMJ Mil Health 2020; 167:330-334. [DOI: 10.1136/jramc-2019-001264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/03/2022]
Abstract
UK Defence Medical Services personnel deployed in support of the United Nations Mission in South Sudan as part of Operation TRENTON in 2017–2018. One key contribution was the development of a multiagency major incident plan in collaboration with key stakeholders within the region, including our UN partners, other troop-contributing countries and non-governmental organisations. This paper describes the process and contribution made, with some transferable lessons for future similar operations, such as adaptation of our courses. Major incident management is one of several technical areas ripe for a proactive Defence Healthcare Engagement strategy, seeking to offer capacity building in areas where Defence is rich in expertise that is highly sought after by other sectors.
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16
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Jeyanathan J, Smith JE, Sellon E. Civil-military cooperation on operational deployment: the Bentiu State Hospital medical training programme. BMJ Mil Health 2020; 167:353-355. [PMID: 32123004 PMCID: PMC8485134 DOI: 10.1136/jramc-2019-001302] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022]
Abstract
The United Nations Mission in South Sudan has a mandate to protect civilians and support the delivery of humanitarian assistance. Recognising this during Operation TRENTON, UK staff of the UN level 2 hospital were able to support the people of Bentiu through initiatives to develop local health services with on-the-ground civil–military cooperation. The Bentiu State Hospital Medical Training Programme was developed to train and mentor staff associated with healthcare in Bentiu, to help improve service delivery, support local health services with on-the-ground non-governmental organisation/military coordination and to create a platform to facilitate the sharing of information to support local health services with the overall humanitarian response. It was recognised how important it was to deliver a programme that carefully understood the unique challenging limitations, circumstances and environment. Hence careful tailoring of the programme was essential to ensure that the training was valuable, implementable and durable, long beyond the operational deployment of TRENTON. Despite the logistical and practical complexities, the programme was very positively received, and the training team believed that the development and progress made would build a small part of the future infrastructure of healthcare delivery in the region. Future contingency operations are likely to take place in the resource- limited austere environment. As reflected in this deployed initiative, local health training activity providing key knowledge to build resilience for the current and immediate future is a precious and important defence engagement utility.
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Affiliation(s)
- Jeyasankar Jeyanathan
- Academic Department of Military Anaesthesia and Critical Care, Institute of Research and Development, Birmingham Research Park, Birmingham, UK .,Department of Intensive Care Medicine and Department of Anaesthetics, St George's University Hospital London, London, UK
| | - J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK.,Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - E Sellon
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
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17
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Jeyanathan J, O'Brien D, Smith JE. Intensive care medicine on military operations in the resource-limited environment: a case series. BMJ Mil Health 2020; 167:320-322. [PMID: 32123005 DOI: 10.1136/jramc-2019-001344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/16/2019] [Indexed: 11/04/2022]
Abstract
This paper describes a series of critically ill patients who were cared for at a UK military field hospital during Op TRENTON 4, in support of the United Nations Mission in South Sudan. These cases highlight the potential challenges in managing the critically ill patient during contingency operations that take place in an austere resource-limited environment.
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Affiliation(s)
- Jeyasankar Jeyanathan
- Academic Department of Military Anaesthesia and Critical Care, Institute of Research and Development, Birmingham Research Park, Birmingham, UK .,Department of Intensive Care Medicine and Department of Anaesthetics, St George's University Hospital London, London, UK
| | - D O'Brien
- Department of Intensive Care Medicine, Buckinghamshire Healthcare NHS Trust, Aylesbury, Buckinghamshire, UK
| | - J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK.,Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
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18
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Abstract
Abstract
A gas-liquid chromatographic (GLC) method is described for determining residues of levamisole, (1-)-(2,3,5,6-tetrahydro-6-phenylimidazo[2,1-b] thiazole), in milk. Levamisole is extracted from an alkaline milk sample with water-saturated ethyl acetate. After co-extractives are removed by various partitionings, the levamisole concentration is measured by GLC by using an alkali (RbSO4) flame ionization detector, vs. an external standard. This method is satisfactory for determining levamisole residues as low as 0.01 ppm in bovine milk. Apparent residues in control milk samples averaged <0.001 ppm. Recoveries of 0.01–2.0 ppm added levamisole ranged from 86.5 to 113%. Animals treated with various Tramisol® formulations showed apparent levamisole residues below the validated sensitivity of the method (0.01 ppm) at sampling periods exceeding 48 hr.
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Affiliation(s)
- John E Smith
- American Cyanamid Co., Agricultural Division, PO Box 400, Princeton, NJ 08540
| | - N Robert Pasarela
- American Cyanamid Co., Agricultural Division, PO Box 400, Princeton, NJ 08540
| | - John C Wyckoff
- American Cyanamid Co., Agricultural Division, PO Box 400, Princeton, NJ 08540
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19
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Abstract
Abstract
Polarographic residue methods have been developed for determining robenidine (Robenz), 1,3-bis[(p-chlorobenzylidene)amino]. guanidine monohydrochloride, in chicken tissues, eggs, litter, soil, and plants. The compound is extracted from chicken fat, skin, muscle, liver, and eggs with ethyl acetate; from blood with acetone; from plant tissue, litter, and kidney with acidic acetone; and from soil with basic methanol. After extraction by high-speed blending or overnight shaking, the extract is cleaned up by evaporation, solvent partition, and/or elution from CG-50 ion exchange resin. Robenidine is quantitated by differential cathode ray polarography, using acidic aqueous methanol or acetic acid (1+1) supporting electrolyte. Recoveries ranged from 64 to 125% with an average overall recovery of 90%. The validated sensitivity is 0.1 ppm for chicken tissues, soil, and plants, 0.01 ppm for eggs, and 1 ppm for litter.
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Affiliation(s)
- John E Smith
- American Cyanamid Co., Agricultural Division, PO Box 400, Princeton, NJ 08540
| | - N Robert Pasarela
- American Cyanamid Co., Agricultural Division, PO Box 400, Princeton, NJ 08540
| | - John C Wyckoff
- American Cyanamid Co., Agricultural Division, PO Box 400, Princeton, NJ 08540
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20
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Li F, Kolb J, Crudele J, Tonino P, Hourani Z, Smith JE, Chamberlain JS, Granzier H. Expressing a Z-disk nebulin fragment in nebulin-deficient mouse muscle: effects on muscle structure and function. Skelet Muscle 2020; 10:2. [PMID: 31992366 PMCID: PMC6986074 DOI: 10.1186/s13395-019-0219-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/11/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nebulin is a critical thin filament-binding protein that spans from the Z-disk of the skeletal muscle sarcomere to near the pointed end of the thin filament. Its massive size and actin-binding property allows it to provide the thin filaments with structural and regulatory support. When this protein is lost, nemaline myopathy occurs. Nemaline myopathy causes severe muscle weakness as well as structural defects on a sarcomeric level. There is no known cure for this disease. METHODS We studied whether sarcomeric structure and function can be improved by introducing nebulin's Z-disk region into a nebulin-deficient mouse model (Neb cKO) through adeno-associated viral (AAV) vector therapy. Following this treatment, the structural and functional characteristics of both vehicle-treated and AAV-treated Neb cKO and control muscles were studied. RESULTS Intramuscular injection of this AAV construct resulted in a successful expression of the Z-disk fragment within the target muscles. This expression was significantly higher in Neb cKO mice than control mice. Analysis of protein expression revealed that the nebulin fragment was localized exclusively to the Z-disks and that Neb cKO expressed the nebulin fragment at levels comparable to the level of full-length nebulin in control mice. Additionally, the Z-disk fragment displaced full-length nebulin in control mice, resulting in nemaline rod body formation and a worsening of muscle function. Neb cKO mice experienced a slight functional benefit from the AAV treatment, with a small increase in force and fatigue resistance. Disease progression was also slowed as indicated by improved muscle structure and myosin isoform expression. CONCLUSIONS This study reveals that nebulin fragments are well-received by nebulin-deficient mouse muscles and that limited functional benefits are achievable.
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Affiliation(s)
- Frank Li
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | - Justin Kolb
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | - Julie Crudele
- Department of Neurology, University of Washington, Seattle, WA, 98109-8055, USA
| | - Paola Tonino
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | - Zaynab Hourani
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | - John E Smith
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | | | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, 85721, USA.
- Medical Research Building, RM 325, 1656 E Mabel St, Tucson, AZ, 85721, USA.
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21
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Ramakrishna N, Lacey J, Candlish AA, Smith JE, Goodbrand IA. Monoclonal Antibody-Based Enzyme Linked Immunosorbent Assay of Aflatoxin B1, T-2 Toxin, and Ochratoxin A in Barley. J AOAC Int 2020. [DOI: 10.1093/jaoac/73.1.71] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aflatoxin B1 (B1), T-2 toxin (T2), and ochratoxin A (OA) were assayed in a single extract from barley grain by using competitive enzyme linked immunosorbent assays (ELISAs) with monoclonal antibodies. B1 and T2 monoclonal antibodies were conjugated to horseradish peroxidase for direct competitive ELISA while an indirect competitive ELISA was used for OA determination. The competitive ELISA detected 0.1 ng/mL of B1f 10 ng/mL of T2, or 1 ng/mL of OA. Acetonitrile- 0.5% KCI-6% H2S04 (89 + 10 + 1 ) extracts of barley grain either were diluted 1:10 for direct assay or were subjected to a simple liquid-liquid cleanup procedure to concentrate the extract 10:1 before assay. For cleanup, water was added to the acetonltrile extract to partition water-soluble interfering substances, and then the mycotoxins were re-extracted with chloroform. The chloroform extract was evaporated to dryness and redissolved in Tris HCI buffer for ELISA. The mean recoveries from barley spiked with 4-60 ng/g of B1( 50-5000 ng/g of T2, and 5-500 ng/g of OA were, respectively, 93.8, 80.6, and 95.8%. The mean within-assay, Inter-assay, and subsample coefficients of variation by ELISA of barley grain colonized with toxigenic fungi were <12% for Bi and OA but as high as 17% forT2.
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Affiliation(s)
- Nannapaneni Ramakrishna
- A.F.R.C. Institute of Arable Crops Research, Rothamsted Experimental Station, Plant Pathology Department, Harpenden, Herts. AL5 2JQ, United Kingdom
| | - John Lacey
- A.F.R.C. Institute of Arable Crops Research, Rothamsted Experimental Station, Plant Pathology Department, Harpenden, Herts. AL5 2JQ, United Kingdom
| | | | - John E Smith
- University of Strathclyde, Department of Bioscience and Biotechnology, Glasgow Gl IXW, United Kingdom
| | - Ian A Goodbrand
- University of Strathclyde, Department of Bioscience and Biotechnology, Glasgow Gl IXW, United Kingdom
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22
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Oates EC, Jones KJ, Donkervoort S, Charlton A, Brammah S, Smith JE, Ware JS, Yau KS, Swanson LC, Whiffin N, Peduto AJ, Bournazos A, Waddell LB, Farrar MA, Sampaio HA, Teoh HL, Lamont PJ, Mowat D, Fitzsimons RB, Corbett AJ, Ryan MM, O'Grady GL, Sandaradura SA, Ghaoui R, Joshi H, Marshall JL, Nolan MA, Kaur S, Punetha J, Töpf A, Harris E, Bakshi M, Genetti CA, Marttila M, Werlauff U, Streichenberger N, Pestronk A, Mazanti I, Pinner JR, Vuillerot C, Grosmann C, Camacho A, Mohassel P, Leach ME, Foley AR, Bharucha-Goebel D, Collins J, Connolly AM, Gilbreath HR, Iannaccone ST, Castro D, Cummings BB, Webster RI, Lazaro L, Vissing J, Coppens S, Deconinck N, Luk HM, Thomas NH, Foulds NC, Illingworth MA, Ellard S, McLean CA, Phadke R, Ravenscroft G, Witting N, Hackman P, Richard I, Cooper ST, Kamsteeg EJ, Hoffman EP, Bushby K, Straub V, Udd B, Ferreiro A, North KN, Clarke NF, Lek M, Beggs AH, Bönnemann CG, MacArthur DG, Granzier H, Davis MR, Laing NG. Congenital Titinopathy: Comprehensive characterization and pathogenic insights. Ann Neurol 2019; 83:1105-1124. [PMID: 29691892 PMCID: PMC6105519 DOI: 10.1002/ana.25241] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Comprehensive clinical characterization of congenital titinopathy to facilitate diagnosis and management of this important emerging disorder. METHODS Using massively parallel sequencing we identified 30 patients from 27 families with 2 pathogenic nonsense, frameshift and/or splice site TTN mutations in trans. We then undertook a detailed analysis of the clinical, histopathological and imaging features of these patients. RESULTS All patients had prenatal or early onset hypotonia and/or congenital contractures. None had ophthalmoplegia. Scoliosis and respiratory insufficiency typically developed early and progressed rapidly, whereas limb weakness was often slowly progressive, and usually did not prevent independent walking. Cardiac involvement was present in 46% of patients. Relatives of 2 patients had dilated cardiomyopathy. Creatine kinase levels were normal to moderately elevated. Increased fiber size variation, internalized nuclei and cores were common histopathological abnormalities. Cap-like regions, whorled or ring fibers, and mitochondrial accumulations were also observed. Muscle magnetic resonance imaging showed gluteal, hamstring and calf muscle involvement. Western blot analysis showed a near-normal sized titin protein in all samples. The presence of 2 mutations predicted to impact both N2BA and N2B cardiac isoforms appeared to be associated with greatest risk of cardiac involvement. One-third of patients had 1 mutation predicted to impact exons present in fetal skeletal muscle, but not included within the mature skeletal muscle isoform transcript. This strongly suggests developmental isoforms are involved in the pathogenesis of this congenital/early onset disorder. INTERPRETATION This detailed clinical reference dataset will greatly facilitate diagnostic confirmation and management of patients, and has provided important insights into disease pathogenesis. Ann Neurol 2018;83:1105-1124.
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Affiliation(s)
- Emily C Oates
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,School of Biotechnology and Biomolecular Sciences, Faculty of Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kristi J Jones
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandra Donkervoort
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Amanda Charlton
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Histopathology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Susan Brammah
- Electron Microscope Unit, Department of Anatomical Pathology, Concord Repatriation General Hospital, Concord, Sydney, New South Wales, Australia
| | - John E Smith
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - James S Ware
- National Heart and Lung Institute and MRC London Institute of Medical Science, Imperial College London, London, United Kingdom.,Royal Brompton and Harefield Hospitals NHS Trust, London, United Kingdom
| | - Kyle S Yau
- Institute for Medical Research and Centre for Medical Research, University of Western Australia, Nedlands, Western Australia, Australia
| | - Lindsay C Swanson
- Manton Center for Orphan Disease Research, Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Nicola Whiffin
- National Heart and Lung Institute and MRC London Institute of Medical Science, Imperial College London, London, United Kingdom.,Royal Brompton and Harefield Hospitals NHS Trust, London, United Kingdom
| | - Anthony J Peduto
- Department of Radiology, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney Western Clinical School, Sydney, New South Wales, Australia
| | - Adam Bournazos
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leigh B Waddell
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle A Farrar
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Hugo A Sampaio
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Hooi Ling Teoh
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Phillipa J Lamont
- Neurogenetic Unit, Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - David Mowat
- School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Medical Genetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Robin B Fitzsimons
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alastair J Corbett
- Department of Neurology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Monique M Ryan
- Department of Neurology, Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Gina L O'Grady
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Paediatric Neuroservices, Starship Child Health, Auckland, New Zealand
| | - Sarah A Sandaradura
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Roula Ghaoui
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Himanshu Joshi
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jamie L Marshall
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA.,Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Melinda A Nolan
- Paediatric Neuroservices, Starship Child Health, Auckland, New Zealand
| | - Simranpreet Kaur
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jaya Punetha
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC.,Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ana Töpf
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elizabeth Harris
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Madhura Bakshi
- Department of Clinical Genetics, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Casie A Genetti
- Manton Center for Orphan Disease Research, Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Minttu Marttila
- Manton Center for Orphan Disease Research, Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Ulla Werlauff
- Danish National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | - Nathalie Streichenberger
- Neuropathology Department, Hospices Civils Lyon, Claude Bernard University, Lyon1, France.,NeuroMyogene Institute, CNRS UMR 5310, INSERM U1217, Lyon, France
| | - Alan Pestronk
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO.,Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO
| | - Ingrid Mazanti
- Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Jason R Pinner
- Department of Medical Genomics, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
| | - Carole Vuillerot
- Woman-Mother-Child Hospital, Hospices Civils Lyon, Bron, France.,Claude Bernard University Lyon1, France
| | - Carla Grosmann
- University of California, San Diego/Rady Children's Hospital, San Diego, CA
| | - Ana Camacho
- Child Neurology Unit, Department of Neurology, October 12 University Hospital, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Payam Mohassel
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Meganne E Leach
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - A Reghan Foley
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Diana Bharucha-Goebel
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.,Division of Neurology, Children's National Health System, Washington, DC
| | | | - Anne M Connolly
- Neuromuscular Division, Departments of Neurology and Pediatrics, Washington University School of Medicine, Saint Louis, MO
| | - Heather R Gilbreath
- Department of Advanced Practice, Children's Medical Center of Dallas, Dallas, TX
| | - Susan T Iannaccone
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Diana Castro
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Beryl B Cummings
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA.,Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA
| | - Richard I Webster
- T. Y. Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Leïla Lazaro
- Pediatric Service, Basque Coast Hospital Center, Bayonne, France
| | - John Vissing
- Neuromuscular Clinic and Research Unit, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Coppens
- Department of Pediatric Neurology, Neuromuscular Reference Center, Erasmus Hospital, Free University of Brussels, Brussels, Belgium.,Department of Pediatric Neurology, Neuromuscular Reference Center, Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium
| | - Nicolas Deconinck
- Department of Pediatric Neurology, Neuromuscular Reference Center, Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium
| | - Ho-Ming Luk
- Clinical Genetic Service, Department of Health, Hong Kong, China
| | - Neil H Thomas
- Department of Paediatric Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Nicola C Foulds
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Marjorie A Illingworth
- Department of Paediatric Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Sian Ellard
- University of Exeter Medical School, Exeter, United Kingdom.,Department of Molecular Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Catriona A McLean
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Rahul Phadke
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, United Kingdom
| | - Gianina Ravenscroft
- Harry Perkins Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Nanna Witting
- Copenhagen Neuromuscular Unit and Department of Neurology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Peter Hackman
- Folkhälsan Institute of Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | | | - Sandra T Cooper
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Eric P Hoffman
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC.,Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kate Bushby
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bjarne Udd
- Folkhälsan Institute of Genetics, Medicum, University of Helsinki, Helsinki, Finland.,Neuromuscular Research Center, Tampere University and University Hospital, Neurology, Tampere, Finland.,Department of Medical Genetics, University of Helsinki, Helsinki, Finland.,Vaasa Central Hospital, Department of Neurology, Vaasa, Finland
| | - Ana Ferreiro
- Pathophysiology of Striated Muscles Laboratory, Unit of Functional and Adaptative Biology, BFA, Paris Diderot University/CNRS, Sorbonne Paris Cité, Paris, France.,Public Hospital Network of Paris, Paris-East Reference Center Neuromuscular Diseases, Pitié-Salpêtrière Hospital Group, Paris, France
| | - Kathryn N North
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Nigel F Clarke
- Institute for Neuroscience and Muscle Research, Kid's Research Institute, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Monkol Lek
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA
| | - Alan H Beggs
- Manton Center for Orphan Disease Research, Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Daniel G MacArthur
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Mark R Davis
- Department of Diagnostic Genomics, PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia
| | - Nigel G Laing
- Harry Perkins Institute, University of Western Australia, Nedlands, Western Australia, Australia
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23
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Tonino P, Kiss B, Gohlke J, Smith JE, Granzier H. Fine mapping titin's C-zone: Matching cardiac myosin-binding protein C stripes with titin's super-repeats. J Mol Cell Cardiol 2019; 133:47-56. [PMID: 31158359 DOI: 10.1016/j.yjmcc.2019.05.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/22/2019] [Accepted: 05/30/2019] [Indexed: 01/04/2023]
Abstract
Titin is largely comprised of serially-linked immunoglobulin (Ig) and fibronectin type-III (Fn3) domains. Many of these domains are arranged in an 11 domain super-repeat pattern that is repeated 11 times, forming the so-named titin C-zone in the A-band region of the sarcomere. Each super-repeat is thought to provide binding sites for thick filament proteins, such as cMyBP-C (cardiac myosin-binding protein C). However, it remains to be established which of titin's 11 C-zone super-repeats anchor cMyBP-C as titin contains 11 super-repeats and cMyBP-C is found in 9 stripes only. To study the layout of titin's C-zone in relation to MyBP-C, immunolabeling studies were performed on mouse skinned myocardium with antibodies to titin and cMyBP-C, using both immuno-electron microscopy and super-resolution optical microscopy. Results indicate that cMyBP-C locates near the interface between titin's C-zone super-repeats. Studies on a mouse model in which two of titin's C-zone repeats have been genetically deleted support that the first Ig domain of a super-repeat is important for anchoring cMyBP-C but also Fn3 domains located at the end of the preceding repeat. Furthermore, not all super-repeat interfaces are equal as the interface between super-repeat 1 and 2 (close to titin's D-zone) does not contain cMyBP-C. Finally, titin's C-zone does not extend all the way to the bare zone but instead terminates at the level of the second myosin crown. This study enhances insights in the molecular layout of the C-zone of titin, its relation to cMyBP-C, and its possible roles in cardiomyopathies.
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Affiliation(s)
- Paola Tonino
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA; Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ 85721, USA
| | - Balazs Kiss
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA; Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ 85721, USA
| | - Jochen Gohlke
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA; Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ 85721, USA
| | - John E Smith
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA; Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ 85721, USA
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA; Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ 85721, USA.
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24
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Abstract
The introduction of next-generation sequencing technology has revealed that mutations in the gene that encodes titin (TTN) are linked to multiple skeletal and cardiac myopathies. The most prominent of these myopathies is dilated cardiomyopathy (DCM). Over 60 genes are linked to the etiology of DCM, but by far, the leading cause of DCM is mutations in TTN with truncating variants in TTN (TTNtvs) associated with familial DCM in ∼ 20% of the cases. Titin is a large (3-4 MDa) and abundant protein that forms the third myofilament type of striated muscle where it spans half the sarcomere, from the Z-disk to the M-line. The underlying mechanisms by which titin mutations induce disease are poorly understood and targeted therapies are not available. Here, we review what is known about TTN mutations in muscle disease, with a major focus on DCM. We highlight that exon skipping might provide a possible therapeutic avenue to address diseases that arise from TTNtvs.
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Affiliation(s)
- Dalma Kellermayer
- Department of Cellular and Molecular Medicine, University of Arizona, MRB 325. 1656 E Mabel Street, Tucson, AZ, 85724-5217, USA.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ, 85721, USA
| | - John E Smith
- Department of Cellular and Molecular Medicine, University of Arizona, MRB 325. 1656 E Mabel Street, Tucson, AZ, 85724-5217, USA.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ, 85721, USA
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, MRB 325. 1656 E Mabel Street, Tucson, AZ, 85724-5217, USA. .,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ, 85721, USA.
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25
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Brynnel A, Hernandez Y, Kiss B, Lindqvist J, Adler M, Kolb J, Van der Pijl R, Gohlke J, Strom J, Smith JE, Granzier HL. Downsizing the Giant Titin Reveals its Dominant Roles in Skeletal Muscle Passive Stiffness and Longitudinal Hypertrophy. Biophys J 2019. [DOI: 10.1016/j.bpj.2018.11.2178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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26
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Kiss B, Tonino P, Kolb J, Smith JE, Granzier HL. Experimentally Varying the Number of Super-Repeats in the Neb Gene of the Mouse - Assessing the Role of Nebulin in Thin Filament Length Regulation. Biophys J 2019. [DOI: 10.1016/j.bpj.2018.11.2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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27
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Cottey L, Jefferys S, Woolley T, Smith JE. Use of supplemental oxygen in emergency patients: a systematic review and recommendations for military clinical practice. J ROY ARMY MED CORPS 2018; 165:416-420. [PMID: 30554164 DOI: 10.1136/jramc-2018-001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Supplemental oxygen is a key element of emergency treatment algorithms. However, in the operational environment, oxygen supply poses a challenge. The lack of high-quality evidence alongside emerging technologies provides the opportunity to challenge current guidelines. The aim of this review was to appraise the evidence for the administration of oxygen in emergency patients and give recommendations for its use in clinical practice. METHODS A critical review of the literature was undertaken to determine the evidence for emergency supplemental oxygen use. RESULTS Based on interpretation of the limited available evidence, five key recommendations are made: pulse oximetry should be continuous and initiated as early as possible; oxygen should be available to all trauma and medical patients in the forward operating environment; if peripheral oxygen saturations (SpO2) are greater than or equal to 92%, supplemental oxygen is not routinely required; if SpO2 is less than 92%, supplemental oxygen should be titrated to achieve an SpO2 of greater than 92%; and if flow rates of greater than 5 L/min are required, then urgent evacuation and critical care support should be requested. CONCLUSION Oxygen is not universally required for all patients. Current guidelines aim to prevent hypoxia but with potentially conservative limits. Oxygen should be administered to maintain SpO2 at 92% or above. New areas for research, highlighted in this review, may provide a future approach for oxygen use from point of injury to definitive care.
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Affiliation(s)
- Laura Cottey
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK .,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - S Jefferys
- Emergency Department, Chelsea and Westminster NHS Foundation Trust, London, UK.,Army Medical Service, Support Unit, Camberley, UK
| | - T Woolley
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK.,Anaesthetic Department, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - J E Smith
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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28
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Vassallo J, Smith JE. Authors response: Marsden MER, Mossadegh S, Marsh W, et al. J R Army Med Corps Epub ahead of print. doi:10.1136/jramc-2018-001057. BMJ Mil Health 2018; 166:205. [PMID: 30455391 DOI: 10.1136/jramc-2018-001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/04/2022]
Affiliation(s)
- James Vassallo
- Institute of Naval Medicine, Hampshire, UK .,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
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29
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Rockett M, Creanor S, Squire R, Barton A, Benger J, Cocking L, Ewings P, Eyre V, Smith JE. The impact of emergency department patient-controlled analgesia (PCA) on the incidence of chronic pain following trauma and non-traumatic abdominal pain. Anaesthesia 2018; 74:69-73. [PMID: 30367688 PMCID: PMC6587467 DOI: 10.1111/anae.14476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 12/19/2022]
Abstract
The effect of patient-controlled analgesia during the emergency phase of care on the prevalence of persistent pain is unkown. We studied individuals with traumatic injuries or abdominal pain 6 months after hospital admission via the emergency department using an opportunistic observational study design. This was conducted using postal questionnaires that were sent to participants recruited to the multi-centre pain solutions in the emergency setting study. Patients with prior chronic pain states or opioid use were not studied. Questionnaires included the EQ5D, the Brief Pain Inventory and the Hospital Anxiety and Depression scale. Overall, 141 out of 286 (49% 95%CI 44-56%) patients were included in this follow-up study. Participants presenting with trauma were more likely to develop persistent pain than those presenting with abdominal pain, 45 out of 64 (70%) vs. 24 out of 77 (31%); 95%CI 24-54%, p < 0.001. There were no statistically significant associations between persistent pain and analgesic modality during hospital admission, age or sex. Across both abdominal pain and traumatic injury groups, participants with persistent pain had lower EQ5D mobility scores, worse overall health and higher anxiety and depression scores (p < 0.05). In the abdominal pain group, 13 out of 50 (26%) patients using patient-controlled analgesia developed persistent pain vs. 11 out of 27 (41%) of those with usual treatment; 95%CI for difference (control - patient-controlled analgesia) -8 to 39%, p = 0.183. Acute pain scores at the time of hospital admission were higher in participants who developed persistent pain; 95%CI 0.7-23.6, p = 0.039. For traumatic pain, 25 out of 35 (71%) patients given patient-controlled analgesia developed persistent pain vs. 20 out of 29 (69%) patients with usual treatment; 95%CI -30 to 24%, p = 0.830. Persistent pain is common 6 months after hospital admission, particularly following trauma. The study findings suggest that it may be possible to reduce persistent pain (at least in patients with abdominal pain) by delivering better acute pain management. Further research is needed to confirm this hypothesis.
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Affiliation(s)
- M Rockett
- Anaesthesia and Pain Medicine, Plymouth University Hospitals NHS Trust, Plymouth, UK
| | - S Creanor
- Clinical Trials and Medical Statistics, University of Plymouth, UK
| | - R Squire
- Plymouth University Hospitals NHS Trust, Plymouth, UK
| | - A Barton
- NIHR Research Design Service South West, London, UK
| | - J Benger
- Emergency Care, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - P Ewings
- NIHR Research Design Service South West, London, UK
| | - V Eyre
- Re:Cognition Health Ltd, Plymouth, UK
| | - J E Smith
- Emergency Medicine, Plymouth University Hospitals NHS Trust, Plymouth, UK
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30
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Winstanley M, Smith JE, Wright C. Catastrophic haemorrhage in military major trauma patients: a retrospective database analysis of haemostatic agents used on the battlefield. J ROY ARMY MED CORPS 2018; 165:405-409. [DOI: 10.1136/jramc-2018-001031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 11/04/2022]
Abstract
ObjectivesCatastrophic haemorrhage is a leading cause of morbidity and mortality in trauma, in both military and civilian settings. There are numerous studies looking at the effectiveness of different haemostatic agents in the laboratory but few in a clinical setting. This study analyses the use of haemostatic dressings used in patients injured on the battlefield and their association with survival.MethodA retrospective database review was undertaken using the UK Joint Theatre Trauma Registry from 2003 to 2014, during combat operations in Iraq and Afghanistan. Data included patient demographics, the use of haemostatic dressings, New Injury Severity Score (NISS) and patient outcome.ResultsOf 3792 cases, a haemostatic dressing was applied in 317 (either Celox, Hemcon or Quickclot). When comparing patients who had a haemostatic dressing applied versus no haemostatic agent, there was a 7% improvement in survival. Celox was the only individual haemostatic dressing that was associated with a statistically significant improvement in survival, which was most apparent in the more severely injured (NISS 36–75).ConclusionWe have shown an association between use of haemostatic agents and improved survival, mostly in those with more severe injuries, which is particularly evident in those administered Celox. This supports the continued use of haemostatic agents as part of initial haemorrhage control for patients injured in conflict and suggests that civilian organisations that may need to deal with patients with similar injury patterns should consider their use and implementation.
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31
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Houlberg K, O'Brien D, Smith JE. Experience of the medical audit form on Op TRENTON 4. BMJ Mil Health 2018; 167:369. [PMID: 29804096 DOI: 10.1136/jramc-2018-000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 11/04/2022]
Affiliation(s)
| | - D O'Brien
- Institute of Naval Medicine, Hampshire, UK
| | - J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK.,Emergency Department, Derriford Hospital, Plymouth, UK
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32
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Khan M, Jeyanathan J, Smith JE. Novel use for the abdominal tourniquet in the management of postpartum haemorrhage. J ROY ARMY MED CORPS 2018; 164:463. [PMID: 29626141 DOI: 10.1136/jramc-2018-000953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Mansoor Khan
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - J Jeyanathan
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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33
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Vassallo J, Horne S, Smith JE. Triage and the Modified Physiological Triage Tool-24 (MPTT-24). BMJ Mil Health 2018; 166:33-36. [PMID: 29301857 DOI: 10.1136/jramc-2017-000878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/03/2022]
Abstract
Major incidents occur on a regular basis. So far in 2017, England has witnessed five terrorism-related major incidents, resulting in approximately 40 fatalities and 400 injured. Triage is a key principle in the effective management of a major incident and involves prioritising patients on the basis of their clinical acuity. This paper describes the limitations associated with existing methods of primary major incident triage and the process of developing a new and improved triage tool-the Modified Physiological Triage Tool-24 (MPTT-24). Whilst the MPTT-24 is likely to be the optimum physiological method for primary major incident triage, it needs to be accompanied by an appropriate secondary triage process. The existing UK military and civilian secondary triage tool, the Triage Sort, is described, which offers little advantage over primary methods for identifying patients who require life-saving intervention. Further research is required to identify the optimum method of secondary triage.
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Affiliation(s)
- James Vassallo
- Division of Emergency Medicine, University of Cape Town, South Africa .,Institute of Naval Medicine, Hampshire, UK
| | - S Horne
- Emergency Department, Derriford Hospital, Plymouth, UK
| | - J E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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34
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Vassallo J, Smith JE, Wallis LA. Major incident triage and the implementation of a new triage tool, the MPTT-24. J ROY ARMY MED CORPS 2017; 164:103-106. [PMID: 29055894 PMCID: PMC5969370 DOI: 10.1136/jramc-2017-000819] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 11/12/2022]
Abstract
Introduction The Modified Physiological Triage Tool (MPTT) is a recently developed primary triage tool and in comparison with existing tools demonstrates the greatest sensitivity at predicting need for life-saving intervention (LSI) within both military and civilian populations. To improve its applicability, we proposed to increase the upper respiratory rate (RR) threshold to 24 breaths per minute (bpm) to produce the MPTT-24. Our aim was to conduct a feasibility analysis of the proposed MPTT-24, comparing its performance with the existing UK Military Sieve. Method A retrospective review of the Joint Theatre Trauma Registry (JTTR) and Trauma Audit Research Network (TARN) databases was performed for all adult (>18 years) patients presenting between 2006–2013 (JTTR) and 2014 (TARN). Patients were defined as priority one (P1) if they received one or more LSIs. Using first recorded hospital RR in isolation, sensitivity and specificity of the ≥24 bpm threshold was compared with the existing threshold (≥22 bpm) at predicting P1 status. Patients were then categorised as P1 or not-P1 by the MPTT, MPTT-24 and the UK Military Sieve. Results The MPTT and MPTT-24 outperformed existing UK methods of triage with a statistically significant (p<0.001) increase in sensitivity of between 25.5% and 29.5%. In both populations, the MPTT-24 demonstrated an absolute reduction in sensitivity with an increase in specificity when compared with the MPTT. A statistically significant difference was observed between the MPTT and MPTT-24 in the way they categorised TARN and JTTR cases as P1 (p<0.001). Conclusions When compared with the existing MPTT, the MPTT-24 allows for a more rapid triage assessment. Both continue to outperform existing methods of primary major incident triage and within the military setting, the slight increase in undertriage is offset by a reduction in overtriage. We recommend that the MPTT-24 be considered as a replacement to the existing UK Military Sieve.
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Affiliation(s)
- James Vassallo
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Naval Medicine, Gosport, UK
| | - J E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, UK
| | - L A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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35
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Tonino P, Kiss B, Strom J, Methawasin M, Smith JE, Kolb J, Labeit S, Granzier H. The giant protein titin regulates the length of the striated muscle thick filament. Nat Commun 2017; 8:1041. [PMID: 29051486 PMCID: PMC5648799 DOI: 10.1038/s41467-017-01144-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/22/2017] [Indexed: 01/13/2023] Open
Abstract
The contractile machinery of heart and skeletal muscles has as an essential component the thick filament, comprised of the molecular motor myosin. The thick filament is of a precisely controlled length, defining thereby the force level that muscles generate and how this force varies with muscle length. It has been speculated that the mechanism by which thick filament length is controlled involves the giant protein titin, but no conclusive support for this hypothesis exists. Here we show that in a mouse model in which we deleted two of titin’s C-zone super-repeats, thick filament length is reduced in cardiac and skeletal muscles. In addition, functional studies reveal reduced force generation and a dilated cardiomyopathy (DCM) phenotype. Thus, regulation of thick filament length depends on titin and is critical for maintaining muscle health. Thick filaments in skeletal muscle and heart are composed of myosin. The authors show that the length of thick filaments is defined by titin, and that alterations in titin length affect force generation and lead to dilated cardiomyopathy in mice.
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Affiliation(s)
- Paola Tonino
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, 85721, USA.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona, 85721, USA
| | - Balazs Kiss
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, 85721, USA.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona, 85721, USA
| | - Josh Strom
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, 85721, USA.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona, 85721, USA
| | - Mei Methawasin
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, 85721, USA.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona, 85721, USA
| | - John E Smith
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, 85721, USA.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona, 85721, USA
| | - Justin Kolb
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, 85721, USA.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona, 85721, USA
| | - Siegfried Labeit
- Department of Integrative Pathophysiology, Medical Faculty Mannheim, Mannheim, 68167, Germany.,DZHK, Mannheim-Heidelberg, 68167, Germany
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, 85721, USA. .,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona, 85721, USA.
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Barnard EBG, Hunt PAF, Lewis PEH, Smith JE. The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry. J ROY ARMY MED CORPS 2017; 164:150-154. [DOI: 10.1136/jramc-2017-000818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/20/2017] [Accepted: 08/22/2017] [Indexed: 11/04/2022]
Abstract
BackgroundThe UK military was continuously engaged in armed conflict in Iraq and Afghanistan between 2003 and 2014, resulting in 629 UK fatalities. Traumatic cardiac arrest (TCA) is a precursor to traumatic death, but data on military outcomes are limited. In order to better inform military treatment protocols, the aim of this study was to define the epidemiology of TCA in the military population with a particular focus on survival rates and injury patterns.MethodsA retrospective database analysis of the UK Joint Theatre Trauma Registry was undertaken. Patients who were transported to a UK deployed hospital between 2003 and 2014 and suffered TCA were included. Those patients injured by asphyxiation, electrocution, burns without other significant trauma and drowning were excluded. Data included mechanism of injury, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) for each body region and survival to deployed (Role 3) field hospital discharge.Results424 TCA patients were identified during the study period; median age was 23 years, with a median ISS of 45. The most common mechanism of injury was explosive (55.7%), followed by gunshot wound (38.9%), road traffic collision (3.5%), crush (1.7%) and fall (0.2%). 45 patients (10.6% (95% CI 8.0% to 13.9%)) survived to deployed (Role 3) hospital discharge. The most prevalent body region with a severe to maximum AIS injury was the head, followed by the lower limbs, thorax and abdomen. Haemorrhage secondary to abdominal and lower limb injury was associated with survival; traumatic brain injury was associated with death.ConclusionsThis study has shown that short-term survival from TCA in a military population is 10.6%. With appropriate and aggressive early management, although unlikely, survival is still potentially possible in military patients who suffer traumatic cardiac arrest.
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Vassallo J, Horne S, Smith JE, Wallis LA. The prospective validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to major incident triage. J ROY ARMY MED CORPS 2017; 163:383-387. [DOI: 10.1136/jramc-2017-000771] [Citation(s) in RCA: 6] [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] [Received: 02/23/2017] [Revised: 05/06/2017] [Accepted: 05/21/2017] [Indexed: 11/04/2022]
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Pritchard C, Smith JE, Creanor S, Squire R, Barton A, Benger J, Cocking L, Ewings P, Rockett M. The cost-effectiveness of patient-controlled analgesia vs. standard care in patients presenting to the Emergency Department in pain, who are subsequently admitted to hospital. Anaesthesia 2017; 72:953-960. [PMID: 28547753 DOI: 10.1111/anae.13932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Abstract
The clinical effectiveness of patient-controlled analgesia has been demonstrated in a variety of settings. However, patient-controlled analgesia is rarely utilised in the Emergency Department. The aim of this study was to compare the cost-effectiveness of patient-controlled analgesia vs. standard care in participants admitted to hospital from the Emergency Department with pain due to traumatic injury or non-traumatic abdominal pain. Pain scores were measured hourly for 12 h using a visual analogue scale. Cost-effectiveness was measured as the additional cost per hour in moderate to severe pain avoided by using patient-controlled analgesia rather than standard care (the incremental cost-effectiveness ratio). Sampling variation was estimated using bootstrap methods and the effects of parameter uncertainty explored in a sensitivity analysis. The cost per hour in moderate or severe pain averted was estimated as £24.77 (€29.05, US$30.80) (bootstrap estimated 95%CI £8.72 to £89.17) for participants suffering pain from traumatic injuries and £15.17 (€17.79, US$18.86) (bootstrap estimate 95%CI £9.03 to £46.00) for participants with non-traumatic abdominal pain. Overall costs were higher with patient-controlled analgesia than standard care in both groups: pain from traumatic injuries incurred an additional £18.58 (€21.79 US$23.10) (95%CI £15.81 to £21.35) per 12 h; and non-traumatic abdominal pain an additional £20.18 (€23.67 US$25.09) (95%CI £19.45 to £20.84) per 12 h.
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Affiliation(s)
- C Pritchard
- NIHR Research Design Service, South West, UK
| | - J E Smith
- Department of Anaesthesia, Critical Care and Pain Medicine, Derriford Hospital, Plymouth, UK
| | - S Creanor
- Department of Medical Statistics, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - R Squire
- Emergency Department, Critical Care and Pain Medicine, Derriford Hospital, Plymouth, UK
| | - A Barton
- NIHR Research Design Service, South West, UK
| | - J Benger
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - L Cocking
- Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - P Ewings
- NIHR Research Design Service, South West, UK
| | - M Rockett
- Department of Anaesthesia, Critical Care and Pain Medicine, Derriford Hospital, Plymouth, UK
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Barnard EB, Smith JE, Manning JE, Rall JM, Cox JM, Bebarta VS, Ross JD. A DESCRIPTIVE PARADIGM OF ESCALATING ENDOVASCULAR INTERVENTION FOR THE MANAGEMENT OF TRAUMATIC CARDIAC ARREST IN A SWINE MODEL OF NON-COMPRESSIBLE TORSO HAEMORRHAGE. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.5] [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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40
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Barnard EB, Smith JE, Manning JE, Rall JM, Cox JM, Bebarta VS, Ross JD. SELECTIVE AORTIC ARCH PERFUSION FOR THE REVERSAL OF HAEMORRHAGE-INDUCED TRAUMATIC CARDIAC ARREST IN A SWINE MODEL OF NON-COMPRESSIBLE TORSO HAEMORRHAGE. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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41
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Smith JE, Squire R, Pritchard C, Ewings P, Barton A, Rockett M, Creanor S, Hayward C, Eyre V, Cocking L, Benger J. THE COST-EFFECTIVENESS OF PATIENT CONTROLLED ANALGESIA VERSUS ROUTINE CARE IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT IN PAIN, WHO ARE SUBSEQUENTLY ADMITTED TO HOSPITAL. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.19] [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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Abstract
Aim Major trauma (MT) has traditionally been viewed as a disease of young men caused by high-energy transfer mechanisms of injury, which has been reflected in the configuration of MT services. With ageing populations in Western societies, it is anticipated that the elderly will comprise an increasing proportion of the MT workload. The aim of this study was to describe changes in the demographics of MT in a developed Western health system over the last 20 years. Methods The Trauma Audit Research Network (TARN) database was interrogated to identify all cases of MT (injury severity score >15) between 1990 and the end of 2013. Age at presentation, gender, mechanism of injury and use of CT were recorded. For convenience, cases were categorised by age groups of 25 years and by common mechanisms of injury. Longitudinal changes each year were recorded. Results Profound changes in the demographics of recorded MT were observed. In 1990, the mean age of MT patients within the TARN database was 36.1, the largest age group suffering MT was 0–24 years (39.3%), the most common causative mechanism was road traffic collision (59.1%), 72.7% were male and 33.6% underwent CT. By 2013, mean age had increased to 53.8 years, the single largest age group was 25–50 years (27.1%), closely followed by those >75 years (26.9%), the most common mechanism was low falls (39.1%), 68.3% were male and 86.8% underwent CT. Conclusions This study suggests that the MT population identified in the UK is becoming more elderly, and the predominant mechanism that precipitates MT is a fall from <2 m. Significant improvements in outcomes from MT may be expected if services targeting the specific needs of the elderly are developed within MT centres.
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Affiliation(s)
- A Kehoe
- Emergency Department, Derriford Hospital, Plymouth, UK Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - J E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, UK
| | - A Edwards
- Trauma Audit Research Network (TARN), University of Manchester, Hope Hospital, Salford, UK
| | - D Yates
- Trauma Audit Research Network (TARN), University of Manchester, Hope Hospital, Salford, UK
| | - F Lecky
- Trauma Audit Research Network (TARN), University of Manchester, Hope Hospital, Salford, UK EMRiS Group, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Kyle T, le Clerc S, Thomas A, Greaves I, Whittaker V, Smith JE. The success of battlefield surgical airway insertion in severely injured military patients: a UK perspective. J ROY ARMY MED CORPS 2016; 162:460-464. [DOI: 10.1136/jramc-2016-000637] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/14/2016] [Accepted: 04/17/2016] [Indexed: 11/03/2022]
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Smith JE, Withnall RDJ, Rickard RF, Lamb D, Sitch A, Hodgetts TJ. A pilot study to evaluate the utility of live training (LIVEX) in the operational preparedness of UK military trauma teams. Postgrad Med J 2016; 92:697-700. [DOI: 10.1136/postgradmedj-2015-133585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 12/22/2015] [Accepted: 04/17/2016] [Indexed: 11/04/2022]
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Methawasin M, Strom JG, Fernandez V, Saripalli C, Smith JE, Granzier HL. Upregulating Compliant Titin in the Heart Attenuates Left Ventricular Stiffness in a Mouse Model with Diastolic Dysfunction. Biophys J 2016. [DOI: 10.1016/j.bpj.2015.11.1605] [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: 10/22/2022] Open
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Kehoe A, Smith JE, Bouamra O, Edwards A, Yates D, Lecky F. Older patients with traumatic brain injury present with a higher GCS score than younger patients for a given severity of injury. Emerg Med J 2016; 33:381-5. [DOI: 10.1136/emermed-2015-205180] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/29/2015] [Indexed: 11/03/2022]
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Begay RL, Graw S, Sinagra G, Merlo M, Slavov D, Gowan K, Jones KL, Barbati G, Spezzacatene A, Brun F, Di Lenarda A, Smith JE, Granzier HL, Mestroni L, Taylor M. Role of Titin Missense Variants in Dilated Cardiomyopathy. J Am Heart Assoc 2015; 4:e002645. [PMID: 26567375 PMCID: PMC4845231 DOI: 10.1161/jaha.115.002645] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 09/17/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND The titin gene (TTN) encodes the largest human protein, which plays a central role in sarcomere organization and passive myocyte stiffness. TTN truncating mutations cause dilated cardiomyopathy (DCM); however, the role of TTN missense variants in DCM has been difficult to elucidate because of the presence of background TTN variation. METHODS AND RESULTS A cohort of 147 DCM index subjects underwent DNA sequencing for 313 TTN exons covering the N2B and N2BA cardiac isoforms of TTN. Of the 348 missense variants, we identified 44 "severe" rare variants by using a bioinformatic filtering process in 37 probands. Of these, 5 probands were double heterozygotes (additional variant in another DCM gene) and 7 were compound heterozygotes (2 TTN "severe" variants). Segregation analysis allowed the classification of the "severe" variants into 5 "likely" (cosegregating), 5 "unlikely" (noncosegregating), and 34 "possibly" (where family structure precluded segregation analysis) disease-causing variants. Patients with DCM carrying "likely" or "possibly" pathogenic TTN "severe" variants did not show a different outcome compared with "unlikely" and noncarriers of a "severe" TTN variant. However, the "likely" and "possibly" disease-causing variants were overrepresented in the C-zone of the A-band region of the sarcomere. CONCLUSIONS TTN missense variants are common and present a challenge for bioinformatic classification, especially when informative families are not available. Although DCM patients carrying bioinformatically "severe" TTN variants do not appear to have a worse clinical course than noncarriers, the nonrandom distribution of "likely" and "possibly" disease-causing variants suggests a potential biological role for some TTN missense variants.
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Affiliation(s)
- Rene L. Begay
- University of Colorado Denver CU‐Cardiovascular InstituteAuroraCO
| | - Sharon Graw
- University of Colorado Denver CU‐Cardiovascular InstituteAuroraCO
| | - Gianfranco Sinagra
- Cardiovascular Department “Ospedali Riuniti” and Cardiovascular CenterASS1‐Trieste and University of TriesteTriesteItaly
| | - Marco Merlo
- Cardiovascular Department “Ospedali Riuniti” and Cardiovascular CenterASS1‐Trieste and University of TriesteTriesteItaly
| | - Dobromir Slavov
- University of Colorado Denver CU‐Cardiovascular InstituteAuroraCO
| | - Katherine Gowan
- Department of Biochemistry and Molecular GeneticsUniversity of ColoradoAuroraCO
| | - Kenneth L. Jones
- Department of Biochemistry and Molecular GeneticsUniversity of ColoradoAuroraCO
| | - Giulia Barbati
- Cardiovascular Department “Ospedali Riuniti” and Cardiovascular CenterASS1‐Trieste and University of TriesteTriesteItaly
| | - Anita Spezzacatene
- Cardiovascular Department “Ospedali Riuniti” and Cardiovascular CenterASS1‐Trieste and University of TriesteTriesteItaly
| | - Francesca Brun
- Cardiovascular Department “Ospedali Riuniti” and Cardiovascular CenterASS1‐Trieste and University of TriesteTriesteItaly
| | - Andrea Di Lenarda
- Cardiovascular Department “Ospedali Riuniti” and Cardiovascular CenterASS1‐Trieste and University of TriesteTriesteItaly
| | - John E. Smith
- Molecular Cardiovascular Research ProgramUniversity of ArizonaTucsonAZ
| | - Henk L. Granzier
- Molecular Cardiovascular Research ProgramUniversity of ArizonaTucsonAZ
| | - Luisa Mestroni
- University of Colorado Denver CU‐Cardiovascular InstituteAuroraCO
| | - Matthew Taylor
- University of Colorado Denver CU‐Cardiovascular InstituteAuroraCO
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Smith JE, Le Clerc S, Hunt PAF. Challenging the dogma of traumatic cardiac arrest management: a military perspective. Emerg Med J 2015; 32:955-60. [PMID: 26493124 DOI: 10.1136/emermed-2015-204684] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/28/2015] [Indexed: 11/04/2022]
Abstract
Attempts to resuscitate patients in traumatic cardiac arrest (TCA) have, in the past, been viewed as futile. However, reported outcomes from TCA in the past five years, particularly from military series, are improving. The pathophysiology of TCA is different to medical causes of cardiac arrest, and therefore, treatment priorities may also need to be different. This article reviews recent literature describing the pathophysiology of TCA and describes how the military has challenged the assumption that outcome is universally poor in these patients.
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Affiliation(s)
- J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK Emergency Department, Derriford Hospital, Plymouth, UK
| | - S Le Clerc
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK Emergency Department, James Cook University Hospital, Middlesbrough, UK
| | - P A F Hunt
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK Emergency Department, James Cook University Hospital, Middlesbrough, UK
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Lay E, Nutland S, Smith JE, Hiles I, Smith RAG, Seilly DJ, Buchberger A, Schwaeble W, Lachmann PJ. Complotype affects the extent of down-regulation by Factor I of the C3b feedback cycle in vitro. Clin Exp Immunol 2015; 181:314-22. [PMID: 25124117 DOI: 10.1111/cei.12437] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 01/12/2023] Open
Abstract
Sera from a large panel of normal subjects were typed for three common polymorphisms, one in C3 (R102G) and two in Factor H (V62I and Y402H), that influence predisposition to age-related macular degeneration and to some forms of kidney disease. Three groups of sera were tested; those that were homozygous for the three risk alleles; those that were heterozygous for all three; and those homozygous for the low-risk alleles. These groups vary in their response to the addition of exogenous Factor I when the alternative complement pathway is activated by zymosan. Both the reduction in the maximum amount of iC3b formed and the rate at which the iC3b is converted to C3dg are affected. For both reactions the at-risk complotype requires higher doses of Factor I to produce similar down-regulation. Because iC3b reacting with the complement receptor CR3 is a major mechanism by which complement activation gives rise to inflammation, the breakdown of iC3b to C3dg can be seen to have major significance for reducing complement-induced inflammation. These findings demonstrate for the first time that sera from subjects with different complement alleles behave as predicted in an in-vitro assay of the down-regulation of the alternative complement pathway by increasing the concentration of Factor I. These results support the hypothesis that exogenous Factor I may be a valuable therapeutic aid for down-regulating hyperactivity of the C3b feedback cycle, thereby providing a treatment for age-related macular degeneration and other inflammatory diseases of later life.
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Affiliation(s)
- E Lay
- Department of Veterinary Medicine, University of Cambridge, UK
| | - S Nutland
- Cambridge Bioresource, Cambridge University and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J E Smith
- Immuno-inflammation Therapy Area, GlaxoSmithKline R&D, Stevenage, Hertfordshire, UK
| | - I Hiles
- Biopharm-Discovery, GlaxoSmithKline R&D, Stevenage, Hertfordshire, UK
| | - R A G Smith
- Protein Therapeutics Laboratory, MRC Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - D J Seilly
- Department of Veterinary Medicine, University of Cambridge, UK
| | - A Buchberger
- Department of Infection, University of Leicester, Leicester, UK
| | - W Schwaeble
- Department of Infection, University of Leicester, Leicester, UK
| | - P J Lachmann
- Department of Veterinary Medicine, University of Cambridge, UK
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