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Brown F, Weidner A, Wells C, Ghumman R, McConnell S, Ngu WS, Ratcliffe E, Subramaniam S, Barbour J. UK endoscopy trainer survey: perspectives on current endoscopy training delivery, experience, barriers and opportunities. Frontline Gastroenterol 2024; 15:214-221. [PMID: 38665794 PMCID: PMC11042447 DOI: 10.1136/flgastro-2023-102557] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/20/2023] [Indexed: 04/28/2024] Open
Abstract
Objective UK endoscopy training is delivered by trainers possessing well developed endoscopy and teaching skills to help learners perform high-quality endoscopy. Train The Trainer (TTT) courses are effective, but additional trainer support is variable with little formal quality assurance. We performed a survey to map UK endoscopy training, assess trainer perspectives on training delivery and identify factors that would enhance training. Design/Method An online survey was designed by trainer representatives, in collaboration with the JAG training committee, and collected responses from trainers registered on JAG endoscopy training system e-portfolio from April to June 2022. Results There were 1024 responses from all trainer disciplines, with 813 (79%) completing TTT courses and 584 (57%) having job planned dedicated training lists (DTLs). Clinical endoscopists most frequently had job-planned DTLs (71%), and DTLs occurring at least weekly (58%). 293 (29%) respondents participated as course faculty. Trainers reported high levels of pre-procedure preparation, effective dialogue and frequent feedback. The DOPS forms were 'always/often' completed by 81% of clinical endoscopists, 73% of gastroenterologist and 58% of surgeons. 435 (42%) trainers never had peer feedback. Responses suggested training could improve by protecting training time, attending courses, participating as faculty and receiving feedback from experienced trainers. Conclusion This survey demonstrates substantial proportions of highly motivated UK trainers who value time spent teaching and learning how to teach. Skills taught on the TTT courses are often actively used in everyday training. Improved trainer course access, protected training time and formal use of existing feedback tools by peers were highlighted as measures that could support trainers' development.
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Affiliation(s)
- Fraser Brown
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Alice Weidner
- Gastroenterology, QE Gateshead, Gateshead, Tyne and Wear, UK
| | | | - Rumneet Ghumman
- Joint Advisory Group on Gastrointestinal Endoscopy, London, UK
| | - Susan McConnell
- County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | | | - Elizabeth Ratcliffe
- University of Manchester, Manchester, UK
- Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | | | - Jamie Barbour
- Gastroenterology, QE Gateshead, Gateshead, Tyne and Wear, UK
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Siau K, Beales ILP, Haycock A, Alzoubaidi D, Follows R, Haidry R, Mannath J, McConnell S, Murugananthan A, Ravindran S, Riley SA, Williams RN, Trudgill NJ, Veitch AM. JAG consensus statements for training and certification in oesophagogastroduodenoscopy. Frontline Gastroenterol 2022; 13:193-205. [PMID: 35493618 PMCID: PMC8996097 DOI: 10.1136/flgastro-2021-101907] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Training and quality assurance in oesophagogastroduodenoscopy (OGD) is important to ensure competent practice. A national evidence-based review was undertaken to update and develop standards and recommendations for OGD training and certification. METHODS Under the oversight of the Joint Advisory Group (JAG), a modified Delphi process was conducted with stakeholder representation from British Society of Gastroenterology, Association of Upper Gastrointestinal Surgeons, trainees and trainers. Recommendations on OGD training and certification were formulated following literature review and appraised using Grading of Recommendations Assessment, Development and Evaluation. These were subjected to electronic voting to achieve consensus. Accepted statements were incorporated into the updated certification pathway. RESULTS In total, 32 recommendation statements were generated for the following domains: definition of competence (4 statements), acquisition of competence (12 statements), assessment of competence (10 statements) and post-certification support (6 statements). The consensus process led to following certification criteria: (1) performing ≥250 hands-on procedures; (2) attending a JAG-accredited basic skills course; (3) attainment of relevant minimal performance standards defined by British Society of Gastroenterology/Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, (4) achieving physically unassisted D2 intubation and J-manoeuvre in ≥95% of recent procedures, (5) satisfactory performance in formative and summative direct observation of procedural skills assessments. CONCLUSION The JAG standards for diagnostic OGD have been updated following evidence-based consensus. These standards are intended to support training, improve competency assessment to uphold standards of practice and provide support to the newly-independent practitioner.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK,Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ian L P Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Adam Haycock
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Durayd Alzoubaidi
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | | | - Rehan Haidry
- Department of Gastroenterology, Division of Surgery and Interventional Science, University College London Hospital NHS Foundation Trust, London, UK
| | - Jayan Mannath
- Department of Gastroenterology, Coventry and Warwickshire NHS trust, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Susan McConnell
- Endoscopy Department, University Hospital of North Durham, Durham, UK
| | - Aravinth Murugananthan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Surgery and Cancer, Imperial College London, London, UK
| | - Stuart A Riley
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - R N Williams
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nigel John Trudgill
- Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Andrew M Veitch
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK,President-Elect, British Society of Gastroenterology, London, UK
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Ratcliffe E, Subramaniam S, Ngu WS, McConnell S, Beales ILP, McCrudden R, Smith GV, Wells C. Endoscopy training in the UK pre-COVID-19 environment: a multidisciplinary survey of endoscopy training and the experience of reciprocal feedback. Frontline Gastroenterol 2021; 13:39-44. [PMID: 34963796 PMCID: PMC7902317 DOI: 10.1136/flgastro-2020-101734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Training in gastrointestinal endoscopy in the UK occurs predominantly in a real world one-to-one trainer to trainee interaction. Previous surveys have shown surgical and gastroenterology trainees have had mixed experiences of supervision and training, and no surveys have explored specifically the role of trainee to trainer feedback. This study aimed to explore the experience of training and of providing trainer feedback for all disciplines of endoscopy trainees. DESIGN/METHOD An online survey designed in collaboration with Joint Advisory Committee training committee and trainee representatives was distributed from January 2020 but was interrupted by the COVID-19 pandemic and hence terminated early. RESULTS There were 129 responses, including trainees from all disciplines and regions, of which 86/129 (66.7%) rated the culture in their endoscopy units favourably-either good or excellent. 65/129 (50.4%) trainees reported having one or more training lists allocated per week, with 41/129 (31.8%) reporting only ad hoc lists. 100/129 (77.5%) respondents were given feedback and 97/129 (75.2%) were provided with learning points from the list. 65/129 (50.4%) respondents reported their trainer completed a direct observation of procedure or direct observation of polypectomies. 73/129 (56.6%) respondents reported that they felt able to give feedback to their trainer, with 88/129 (68.2%) feeling they could do this accurately. Barriers to trainer feedback cited included time constraints, lack of anonymity and concerns about affecting the trainer-trainee relationship. CONCLUSION Overall, the training environment has improved since previous surveys. There are still issues around interdisciplinary differences with some surgical trainees finding the training environment less welcoming, and trainee perceptions of hierarchical barriers and trainer responsiveness to feedback limiting the accuracy of their feedback.
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Affiliation(s)
- Elizabeth Ratcliffe
- Endoscopy department, Wrightington Wigan and Leigh NHS Foundation Trust, Leigh, UK
| | | | - Wee Sing Ngu
- JAG endoscopy representative, The Dukes' Club, London, UK
| | - Susan McConnell
- Endoscopy department, County Durham and Darlington NHS Foundation Trust, Darlington, Darlington, UK
| | - Ian L P Beales
- Gastroenterology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Raymond McCrudden
- Gastroenterology, Royal Bournemouth Hospital, Bournemouth, Bournemouth, UK
| | | | - Christopher Wells
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, Hartlepool, UK
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Eresen A, McConnell S, Birch SM, Griffin JF, Kornegay JN, Ji JX. Tissue classification in a canine model of Duchenne Muscular Dystrophy using quantitative MRI parameters. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:4066-4069. [PMID: 29060790 DOI: 10.1109/embc.2017.8037749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Duchenne Muscular Dystrophy (DMD) is a genetic disorder caused by dystrophin protein deficiency. Muscle biopsy is the gold standard to determine the disease severity and progression. MRI has shown potential for monitoring disease progression or assessing the treatment effectiveness. In this study, multiple quantitative MRI parameters were used to classify the tissue components in a canine model of DMD disease using histoimmunochemistry analysis as a "ground truth". Results show that multiple MRI parameters may be used to reliably classify the muscular tissue and generate a high-resolution tissue type maps, which can be used as potential non-invasive imaging biomarkers for the DMD.
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Eresen A, McConnell S, Birch SM, Griffin JF, Kornegay JN, Ji JX. Localized MRI and histological image correlation in a canine model of duchenne muscular dystrophy. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:4083-4086. [PMID: 28269180 DOI: 10.1109/embc.2016.7591624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Duchenne Muscular Dystrophy (DMD) is a fatal X-linked disorder. Therapeutic assessments currently require muscle biopsy to ascertain information about the status of disease progression. MRI shows potential to be used in place of muscle biopsy for therapeutic assessments. In this work, localized histological data and various MRI parameters were correlated in a canine model of DMD. The results indicate several MRI parameters may be useful as biomarkers of disease progression.
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Newgard CD, Sanchez BJ, Bulger EM, Brasel KJ, Byers A, Buick JE, Sheehan KL, Guyette FX, King RV, Mena‐Munoz J, Minei JP, Schmicker RH, Kerby JD, Wang HE, Gray R, Christenson J, Christenson J, Andrusiek D, Heest R, Goulding J, Balfour N, Rainier‐Pope N, Beeson J, Gamber M, Simonson R, Gandhi R, Witham W, Simonson R, Ramsay M, Fabian TC, Croce MA, Magnotti LJ, Maish GO, Schroeppel TJ, Zarzaur BL, Weinberg JA, Holley J, Ludwig G, Burnett A, Barnes D, Aufderheide TP, Pirrallo RG, Colella R, Forster R, Pukansky L, Sternig K, Chin E, Krueger K, Szewczuga D, Funk R, Jacobsen G, Spitzer J, Cohn J, Jankowski M, Whitaker R, Rohlfing M, Rosandish T, Remington A, Knitter J, Ugaste R, Saidler T, Reminga T, Shepherd D, Holzhauer P, Rubin J, Skold C, Alvarez O, Harkins H, Barthell E, Haselow W, Yee A, Whitcomb J, Castro EE, Motarjeme S, Coogan P, Rader K, Glaspy J, Gerschke G, Croft H, Brin M, Wilson C, Johnson A, Kumprey W, Ateyyah KA, Gourlay D, Kaslow O, Stiell I, Vaillancourt C, Dreyer J, Munkley D, Prpic J, Maloney J, Affleck A, Bradford P, Trickett J, Sykes N, Graham E, Hedges C, MacPhee R, Nolan L, McLeod S, Luke R, Michaud S, Broughton M, Klass C, Morassutti P, Callaway C, Tisherman S, Daya M, Wittwer L, Jui J, Muhr MD, Griffith J, Free C, Warden CR, Gorman K, Beeler T, Conway W, Newton C, Geiger C, Colvin J, Hollingsworth M, Shertz M, Malone S, Keim E, Sahni R, DeHart S, Freedman S, Moreno R, Chin J, Snyder S, Boyce D, Charleston M, Stevens M, Schult E, Sullivan S, Getsfrid J, Barnes R, Schreiber M, Karmy‐Jones R, Dean Gubler K, Davis DP, Vilke GM, Garcia EM, Coimbra R, Sise MJ, Copass M, Rea T, Eisenberg M, Morrison LJ, Nathens A, Verbeek R, Cheskes S, Rizoli SB, Slutsky A, Mokedanz D, Austin D, Moran P, Wright G, Martin M, Sanderson M, MacDonald R, McConnell S, Jones V, Beckett W, Baker A, Hutchinson J, Choong K, Welsford M, Sne N, Rizoli S. A Geospatial Analysis of Severe Firearm Injuries Compared to Other Injury Mechanisms: Event Characteristics, Location, Timing, and Outcomes. Acad Emerg Med 2016; 23:554-65. [PMID: 26836571 DOI: 10.1111/acem.12930] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/04/2015] [Accepted: 12/06/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Relatively little is known about the context and location of firearm injury events. Using a prospective cohort of trauma patients, we describe and compare severe firearm injury events to other violent and nonviolent injury mechanisms regarding incident location, proximity to home, time of day, spatial clustering, and outcomes. METHODS This was a secondary analysis of a prospective cohort of injured children and adults with hypotension or Glasgow Coma Scale score ≤ 8, injured by one of four primary injury mechanisms (firearm, stabbing, assault, and motor vehicle collision [MVC]) who were transported by emergency medical services to a Level I or II trauma center in 10 regions of the United States and Canada from January 1, 2010, through June 30, 2011. We used descriptive statistics and geospatial analyses to compare the injury groups, distance from home, outcomes, and spatial clustering. RESULTS There were 2,079 persons available for analysis, including 506 (24.3%) firearm injuries, 297 (14.3%) stabbings, 339 (16.3%) assaults, and 950 (45.7%) MVCs. Firearm injuries resulted in the highest proportion of serious injuries (66.3%), early critical resources (75.3%), and in-hospital mortality (53.5%). Injury events occurring within 1 mile of a patient's home included 53.9% of stabbings, 49.2% of firearm events, 41.3% of assaults, and 20.0% of MVCs; the non-MVC events frequently occurred at home. While there was geospatial clustering, 94.4% of firearm events occurred outside of geographic clusters. CONCLUSIONS Severe firearm events tend to occur within a patient's own neighborhood, often at home, and generally outside of geospatial clusters. Public health efforts should focus on the home in all types of neighborhoods to reduce firearm violence.
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Affiliation(s)
- Craig D. Newgard
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Health & Science University Portland OR
| | | | | | - Karen J. Brasel
- Department of Surgery Medical College of Wisconsin Milwaukee WI
- Department of Surgery Oregon Health & Science University Portland OR
| | - Adam Byers
- St. Michael's Hospital Toronto Ontario Canada
| | | | | | - Frank X. Guyette
- Department of Emergency Medicine University of Pittsburgh Medical Center Pittsburgh PA
| | | | - Jorge Mena‐Munoz
- Department of Emergency Medicine University of Pittsburgh Medical Center Pittsburgh PA
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McConville M, Hanna REB, Brennan GP, Edgar HWJ, McConnell S, McCoy M, Castillo R, Hernández-Campos A, Fairweather I. Impact of compound alpha treatment in vivo on egg production by the liver fluke, Fasciola hepatica. Vet Parasitol 2011; 187:183-95. [PMID: 22285009 DOI: 10.1016/j.vetpar.2011.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 12/12/2011] [Accepted: 12/20/2011] [Indexed: 11/30/2022]
Abstract
Sheep infected with the triclabendazole-susceptible Cullompton isolate of Fasciola hepatica were treated with compound alpha at a dosage of 15 mg/kg at 12 weeks post-infection. Adult flukes were recovered from the bile ducts at 24h, 48 h and 72 h post-treatment (pt). They were processed for whole mount analysis, histology and transmission electron microscopy of the female reproductive system: specifically, the uterus, Mehlis' gland, ovary and vitellaria. As judged by the appearance of the uterus, normal egg production ceased within 24h of treatment; this phenomenon preceded significant changes to the other reproductive organs. Over the 3-day pt period, there was a progressive decline in the number of oogonia in the ovary, together with an increase in the number of eosinophilic and apoptotic oocytes and vacuolation and shrinkage of the ovarian tubules. There was a shift in the cell population within the vitelline follicles at 48 h pt, with relatively greater numbers of mature vitelline cells and fewer immature cells. The follicles were vacuolated and the shell globule clusters in the mature cells were disorganised. Greater disruption was seen at 72 h pt, with a reduction in the size of the follicles and rupture of cells, releasing their content into the lumen of the follicles. These histological observations were confirmed and extended at the TEM level. Thus, examination of electron micrographs showed that disruption of the shell globule clusters was evident at 48 h pt, which coincided with the start of the breakdown of the mature cells and of the nurse cell network. These degenerative changes were more conspicuous at 72 h pt. In the Mehlis' gland, shrinkage and vacuolation of the cells and their cytoplasmic extensions became progressively greater from 48 h to 72 h pt, and secretory activity declined. The changes in the reproductive organs and inhibition of egg production are put in context of the overall time-course of drug action.
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Affiliation(s)
- M McConville
- Parasite Therapeutics Research Group, School of Biological Sciences, Medical Biology Centre, The Queen's University of Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom
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Hanna R, Gordon A, Moffett D, Edgar H, Oliver L, McConnell S, Shaw L, Brennan G, Fairweather I. Fasciola hepatica: Comparative effects of host resistance and parasite intra-specific interactions on size and reproductive histology in flukes from rats infected with isolates differing in triclabendazole sensitivity. Vet Parasitol 2011; 178:251-63. [DOI: 10.1016/j.vetpar.2011.01.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 01/05/2011] [Accepted: 01/20/2011] [Indexed: 11/30/2022]
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McConnell S, Scholl J. Addressing Criteria in the Development of a New 4-H Foods Project. JYD 2010. [DOI: 10.5195/jyd.2010.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
As youth and society changes, 4-H projects must change and adapt. Make it with Mixes, a 4-H curriculum, provides a new way of looking at food preparation. It may be one of the first state foods projects created without an emphasis on “from scratch” cooking or baking. Aimed at beginning 4-H members, ages 9 to 13, the project teaches cooking skills with the aid of commercial mixes. However, the main focus of the project is on making comparisons between food labels, costs per serving, and recognizing quality food products. Science and mathematics activities are also incorporated into the curriculum. This article discusses the organization, criteria and strategies used to create this new foods project.
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Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Does land-based exercise reduce pain and disability associated with hip osteoarthritis? A meta-analysis of randomized controlled trials. Osteoarthritis Cartilage 2010; 18:613-20. [PMID: 20188228 DOI: 10.1016/j.joca.2010.01.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 01/05/2010] [Accepted: 01/29/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if clinical guidelines recommending therapeutic exercise for people with hip osteoarthritis (OA) are supported by rigorous scientific evidence. METHODS A meta-analysis of randomized controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based exercise program (as opposed to exercises conducted in the water) with a non-exercise group in terms of hip pain and/or self-reported physical function. RESULTS Thirty-two RCTs were identified, but only five met the inclusion criteria. Only one of the five included RCTs restricted recruitment to people with hip OA, the other four RCTs also recruiting participants with knee OA. The five included studies provided data on 204 and 187 hip OA participants for pain and physical function, respectively. Combining the results of the five included RCTs using a fixed-effects model demonstrated a small treatment effect for pain (standardized mean difference (SMD) -0.38; 95% confidence interval (CI) -0.67 to -0.09). No significant benefit in terms of improved self-reported physical function was detected (SMD -0.02; 95% CI -0.31 to 0.28). CONCLUSION Currently there is only silver level evidence (one small RCT) supporting the benefit of land-based therapeutic exercise for people with symptomatic hip OA in terms of reduced pain and improved physical function. The limited number and small sample size of the included RCTs restricts the confidence that can be attributed to these results.
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Affiliation(s)
- M Fransen
- Faculty of Health Sciences, Clinical and Rehabilitation Sciences Research Group, University of Sydney, Australia.
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Hanna REB, Edgar HWJ, McConnell S, Toner E, McConville M, Brennan GP, Devine C, Flanagan A, Halferty L, Meaney M, Shaw L, Moffett D, McCoy M, Fairweather I. Fasciola hepatica: histological changes in the reproductive structures of triclabendazole (TCBZ)-sensitive and TCBZ-resistant flukes after treatment in vivo with TCBZ and the related benzimidazole derivative, Compound Alpha. Vet Parasitol 2009; 168:240-54. [PMID: 20053501 DOI: 10.1016/j.vetpar.2009.11.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 11/17/2009] [Accepted: 11/20/2009] [Indexed: 10/20/2022]
Abstract
Twenty-four shed-reared lambs were each infected orally with 250 metacercariae of Fasciola hepatica, using either the triclabendazole (TCBZ)-sensitive Cullompton isolate or the TCBZ-resistant Sligo isolate. Twelve weeks after infection the lambs were treated with TCBZ (10mg/kg) or with the experimental fasciolicide, Compound Alpha (Cpd alpha), a benzimidazole derivative of TCBZ (15mg/kg). The lambs were euthanised 48, 72 and 96h after TCBZ treatment, or 24, 48 and 72h after Cpd alpha treatment, and flukes were collected from the liver and/or gall bladder of each animal. Untreated animals harbouring 12-week infections were euthanized 24h after administration of anthelmintic to the treatment groups, and the untreated flukes provided control material. A semi-quantitative assessment of the degree of histological change induced by the two drugs after different times of exposure was achieved by scoring the intensity of three well-defined lesions that developed in the testes and uteri of a representative sample of flukes from each lamb. In general, it was found that in those tissues where active meiosis and/or mitosis occurred (testis, ovary, and vitelline follicles), there was progressive loss of cell content due to apparent failure of cell division to keep pace with expulsion of the mature or effete products. Further, actively dividing cell types tended to become individualised, rounded and condensed, characteristic of apoptotic cell death. Protein synthetic activity was apparently inhibited in the Mehlis' secretory cells. In the uterus, where successful formation of shelled eggs represents the culmination of a complex sequence of cytokinetic, cytological and synthetic activity involving the vitelline follicles, the ovary and the Mehlis' gland, histological evidence indicating failure of ovigenesis was evident from 24h post-treatment onwards. The development of these lesions may be related to the known anti-tubulin activity of the benzimidazole class of anthelmintics, to the induction of apoptosis in cells where mitosis or meiosis has aborted due to failure of spindle formation, and to drug-induced inhibition of protein synthesis. The semi-quantitative findings indicated that Cpd alpha is slightly less efficacious than TCBZ itself in causing histological damage to the reproductive structures of TCBZ-sensitive flukes, and that, like TCBZ, it caused no histological damage in flukes of the TCBZ-resistant isolate. This study illustrates the potential utility of histological techniques for conveniently screening representative samples of flukes in field trials designed to validate instances of drug resistance or to test the efficacy of new products against known drug-resistant and drug-susceptible fluke isolates. It also provides reference criteria for drug-induced histopathological changes in fluke reproductive structures which may aid interpretation of TEM findings.
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Affiliation(s)
- R E B Hanna
- Veterinary Sciences Division, Agri-Food and Biosciences Institute, Stormont, Northern Ireland, United Kingdom.
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Hanna R, Edgar H, Moffett D, McConnell S, Fairweather I, Brennan G, Trudgett A, Hoey E, Cromie L, Taylor S, Daniel R. Fasciola hepatica: Histology of the testis in egg-producing adults of several laboratory-maintained isolates of flukes grown to maturity in cattle and sheep and in flukes from naturally infected hosts. Vet Parasitol 2008; 157:222-34. [DOI: 10.1016/j.vetpar.2008.07.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 07/16/2008] [Accepted: 07/21/2008] [Indexed: 10/21/2022]
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Abstract
School-age children have learning needs unique to their psychosocial and cognitive developmental stage. Teaching that requires the learner to master abstract concepts is particularly challenging. This article describes how the idea for an interactive doll/model evolved among a group of health care professionals at a day camp for children with asthma. How this group of educators designed, developed, and field-tested the model in clinic and classroom environments are presented and discussed. Strategies related to a class on key concepts of asthma education illustrate the various ways the model can be used to facilitate learning. Field testing has shown that this teaching aid enhances knowledge retention and has a high degree of learner satisfaction.
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Affiliation(s)
- Anne Meng
- School of Nursing, University of Texas Medical Branch, 310 University Boulevard, Galveston, TX 77555-1029, USA.
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Abstract
This article has described symptom perception and its relation to asthma management. Underestimation of airway obstruction in persons with asthma is a common and serious problem that is linked to fatalities in persons with asthma. Strategies to identify and manage the poor perceiver have been suggested.
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Affiliation(s)
- Anne Meng
- School of Nursing, University of Texas Medical Branch, 310 University Boulevard, Galveston, TX 77555-1029, USA.
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Abstract
BACKGROUND Biomechanical factors, such as reduced muscle strength and joint mal-alignment, have an important role in the initiation and progression of osteoarthritis (OA) of the hip or knee. Currently, there is no known cure for OA, however, disease-related factors, such as impaired muscle function and reduced fitness, are potentially amenable to therapeutic exercise. OBJECTIVES To determine whether land-based therapeutic exercise is beneficial for people with OA of the hip or knee in terms of reduced joint pain, improved physical function and/or the patient's global assessment of therapeutic effectiveness. SEARCH STRATEGY Five databases (the Cochrane Controlled Trials Register, the Cochrane Musculoskeletal Group Trials Register, MEDLINE, CINAHL, PEDro) were searched up until November 2002. SELECTION CRITERIA All randomized controlled trials comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in the water) with a non-exercise group. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed methodological quality. All analyses were conducted on continuous outcomes. MAIN RESULTS Only 2 studies totaling about 100 participants, could potentially provide data on people with OA of the hip. However, for OA of the knee, 17 included studies provided data on 2562 participants. For pain, combining the results revealed a beneficial treatment effect (standardised mean difference) of.39 (95% confidence interval (CI).30 -.47) while for self-reported physical function a beneficial treatment effect of.31 (95% CI.23 -.39). Group format programs appeared to be as effective as treatments provided on a one-to-one basis. The results were sensitive to various aspects of study design methodology. REVIEWER'S CONCLUSIONS Land-based therapeutic exercise was shown to reduce pain and improve physical function for people with OA of the knee. There were insufficient data to provide useful guidelines on optimal exercise type or dosage. Supervised exercise classes appeared to be as beneficial as treatments provided on a one-to-one basis.
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Affiliation(s)
- M Fransen
- Musculo-skeletal Injuries, Institute for International Health, 144 Burren Street, Newtown, NSW, Australia
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Abstract
PURPOSE To learn how children with asthma and their parents make treatment-related decisions. DATA SOURCES Verbatim transcripts of focus group interviews of 28 school age children with asthma and their parents. Children had attended an educationally based asthma camp program. Questions related to choices parents and children made regarding implementation of their asthma treatment plans both, at home and at school. CONCLUSIONS Parents and children made many non-adherence decisions especially with respect to preventive aspects of the treatment plan. Symptoms were the driving force for children's decisions. Parents and children had concerns about implementing the management plan at school. Parents and children may not perceive asthma treatment options as true choices, thus affecting motivation for adherence. IMPLICATIONS Practitioners need to form partnerships with parents and children in developing treatment goals. Goals should focus on achievement of normal daily activities. Asthma education needs to be concrete and include school personnel. Practitioners need to give families positive, informational feedback.
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Affiliation(s)
- Anne Meng
- School of Nursing University of Texas Medical Branch, Galveston, TX, USA.
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McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum 2001. [PMID: 11642645 DOI: 10.1002/1529-0131(200110)45:5<453::aid-art365>3.0.co;2-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- S McConnell
- Division of Orthopaedic Surgery, Mount Sinai Hospital and the University of Toronto, Canada
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McConnell S, Horrocks M, Sinclair MI, Fairley CK. Changes in the incidence of gastroenteritis and the implementation of public water treatment. Int J Environ Health Res 2001; 11:299-303. [PMID: 11798417 DOI: 10.1080/09603120120070919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
There are few data available on the incidence of endemic waterborne disease in the developed world. This study aims to determine if there was a measurable decline in gastroenteritis related faecal specimens following the introduction of water treatment. The rate of faecal specimens for gastroenteritis was obtained for 17 communities one year before and after the introduction of water treatment in two states of Australia between 1992 and 1996. Of these 17 systems, 10 had filtration added to existing disinfection, while seven had both disinfection and filtration or disinfection alone added to no existing treatment. The rate of faecal sampling varied from a reduction of 55% to an increase of 198%. Large changes in water quality parameters occurred following treatment but there was no significant correlation between these changes and changes in the rate of faecal specimens. In this study there was no consistent change in gastrointestinal related faecal specimens despite marked changes in water quality. This suggests that the reduction in endemic gastrointestinal disease as a result of the introduction of water treatment was small as a percentage of all gastroenteritis. However, water treatment remains essential to protecting public health.
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Affiliation(s)
- S McConnell
- Environmental Protection Authority, Victoria, Australia
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McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum 2001; 45:453-61. [PMID: 11642645 DOI: 10.1002/1529-0131(200110)45:5<453::aid-art365>3.0.co;2-w] [Citation(s) in RCA: 653] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- S McConnell
- Division of Orthopaedic Surgery, Mount Sinai Hospital and the University of Toronto, Canada
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Badros A, Barlogie B, Siegel E, Roberts J, Langmaid C, Zangari M, Desikan R, Shaver MJ, Fassas A, McConnell S, Muwalla F, Barri Y, Anaissie E, Munshi N, Tricot G. Results of autologous stem cell transplant in multiple myeloma patients with renal failure. Br J Haematol 2001; 114:822-9. [PMID: 11564069 DOI: 10.1046/j.1365-2141.2001.03033.x] [Citation(s) in RCA: 230] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Data are presented on 81 multiple myeloma (MM) patients with renal failure (creatinine > 176.8 micromol/l) at the time of autologous stem cell transplantation (auto-SCT), including 38 patients on dialysis. The median age was 53 years (range: 29-69) and 26% had received more than 12 months of prior chemotherapy. CD34+ cells were mobilized with granulocyte colony-stimulating factor (G-CSF) alone (n = 51) or chemotherapy plus G-CSF (n = 27), yielding medians of 10 and 16 x 106 CD34+ cells/kg respectively (P = 0.003). Sixty patients (27 on dialysis) received melphalan 200 mg/m2 (MEL-200). Because of excessive toxicity, the subsequent 21 patients (11 on dialysis) received MEL 140 mg/m2 (MEL-140). Thirty-one patients (38%) completed tandem auto-SCT, including 11 on dialysis. Treatment-related mortality (TRM) was 6% and 13% after the first and second auto-SCT. Median times to absolute neutrophil count (ANC) > 0.5 x 109/l and to platelets > 50 x 109/l were 11 and 41 d respectively. Non-haematological toxicities included mucositis, pneumonitis, dysrhythmias and encephalopathy. At a median follow up of 31 months, 30 patients have died. Complete remission (CR) was achieved in 21 patients (26%) after first SCT and 31 patients (38%) after tandem SCT. Two patients discontinued dialysis after SCT. Median durations of complete remission (CR) and overall survival (OS) have not been reached; probabilities of event-free survival (EFS) and OS at 3 years were 48% and 55% respectively. Dialysis dependence and MEL dose did not affect EFS or OS. Sensitive disease prior to SCT, normal albumin level and younger age were independent prognostic factors for better OS. In conclusion, renal failure had no impact on the quality of stem cell collections and did not affect engraftment. MEL-140 had an acceptable toxicity and appeared equally effective as MEL-200. In the setting of renal failure, the role of auto-SCT early in the disease course and benefits of tandem SCT require further evaluation.
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Affiliation(s)
- A Badros
- Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Steel RM, Bastin ME, McConnell S, Marshall I, Cunningham-Owens DG, Lawrie SM, Johnstone EC, Best JJ. Diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopy (1H MRS) in schizophrenic subjects and normal controls. Psychiatry Res 2001; 106:161-70. [PMID: 11382538 DOI: 10.1016/s0925-4927(01)00080-4] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Several proton magnetic resonance spectroscopy (1H MRS) studies in schizophrenia have found reduced N-acetyl aspartate (NAA) concentrations in pre-frontal and temporal regions of the brain. Reductions in NAA may reflect abnormalities of neuronal structure (e.g. reduced neuronal density or viability) or abnormalities of neuronal function. Diffusion tensor imaging (DTI) measures diffusion anisotropy, an indicator of the structural integrity of a neuronal tract. Both techniques were used to examine the anatomical basis of pre-frontal dysfunction in schizophrenia. Ten patients with DSM-IV schizophrenia were compared with 10 healthy controls. 1H MRS and DTI were performed on a clinical MR system and analysed with a region of interest approach. NAA concentrations and diffusion anisotropy were measured in the same pre-frontal white matter region. Diffusion anisotropy was also measured in a control region (occipital white matter). 1H MRS revealed non-significant but consistently reduced NAA concentrations (by 10-15%) in the pre-frontal white matter in schizophrenic subjects. Diffusion anisotropy measures revealed no such differences between schizophrenics and controls. It is concluded that the abnormalities of 'connectivity' reported in brain-imaging studies of schizophrenia may not be attributable to structural abnormalities of white matter and that reduced NAA in the pre-frontal white matter may reflect abnormal function of structurally intact neurons.
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Affiliation(s)
- R M Steel
- University of Edinburgh, Department of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, EH10 5HF, Edinburgh, UK.
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Abstract
We compared the performance of Paracheck-Pf, a new and cheap rapid malaria test, with ICT-Pf/PvR and microscopy in two malaria surveys in Thai villages on the Thai-Burmese border. The specificity, sensitivity, predictive positive and negative values of the Paracheck-PfR and ICT-PfR tests were calculated taking microscopy results as the gold standard. The 294 ICT-Pf/Pv tests resulted in two invalid (no control line) and 11 doubtful results. Both the ICT-Pf/PvR and Paracheck-PfR tests reliably detected P. falciparum infections. However, Paracheck-PfR failed to detect three P. falciparum cases and likewise, ICT-Pf/PvR failed to detect the same three cases and an additional four cases. These seven cases were detected by microscopy and had a parasitaemia under 150 parasites/microl. At a cost of c. US $1.00, the Paracheck-PfR test, based on the detection of the P. falciparum specific HRP-2 protein, is a reliable, easy to use and affordable tool for the diagnosis of P. falciparum malaria.
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Affiliation(s)
- S Proux
- Shoklo Malaria Research Unit, Mae Sod, Thailand.
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Groudine SB, Fragen RJ, Kharasch ED, Eisenman TS, Frink EJ, McConnell S. Comparison of renal function following anesthesia with low-flow sevoflurane and isoflurane. J Clin Anesth 1999; 11:201-7. [PMID: 10434215 DOI: 10.1016/s0952-8180(99)00027-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To evaluate postoperative renal function after patients were administered sevoflurane under conditions designed to generate high concentrations of compound A. STUDY DESIGN AND SETTING A multicenter (11 sites), multinational, open-label, randomized, comparative study of perioperative renal function in patients who have received low-flow (< or = 1 L/min) sevoflurane or isoflurane. PATIENTS 254 ASA physical status I, II and III patients requiring endotracheal intubation for elective surgery lasting more than 2 hours. INTERVENTIONS After induction, low-flow anesthesia was initiated at a flow rate < or = 1 L/min. Blood and urine samples were studied to assess postoperative renal function. MEASUREMENTS AND MAIN RESULTS Measurements of serum BUN and creatinine, and urine glucose, protein, pH, and specific gravity were used to assess renal function preoperatively and up to 3 days postoperatively. Serum inorganic fluoride ion concentration was measured at preinduction, emergence, and 2, 24 and 72 hours postoperatively. Compound A concentrations were measured at two sites for those patients receiving sevoflurane. Adverse experience data were analyzed. One hundred eighty-eight patients were considered evaluable (98 sevoflurane and 90 isoflurane). Peak serum fluoride concentrations were significantly higher after sevoflurane (40 +/- 16 microM) than after isoflurane (3 +/- 2 microM). Serum creatinine and BUN decreased in both groups postoperatively; glucosuria and proteinuria occurred in 15% to 25% of patients. There were no clinically significant differences in BUN, creatinine, glucosuria, and proteinuria between the low-flow sevoflurane and low-flow isoflurane patients. CONCLUSIONS There were no statistically significant differences in the renal effects of sevoflurane or isoflurane in surgical patients undergoing low-flow anesthesia for up to 8 hours. Low-flow sevoflurane anesthesia under clinical conditions expected to produce high levels of compound A appears as safe as low-flow isoflurane anesthesia.
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Affiliation(s)
- S B Groudine
- Department of Anesthesiology, Albany Medical College, NY 12208, USA
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McConnell S. Five minutes with Steve McConnell. Interview by Elise Nakhnikian. Contemp Longterm Care 1998; 21:96. [PMID: 10185950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- S McConnell
- Alzheimer's Association, Washington, DC, USA
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Dawson D, McConnell S, Wardle A, Gibbs M, Burke T. Characterization and mapping of 15 novel chicken microsatellite loci. Anim Genet 1998; 29:159-60. [PMID: 9699289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- D Dawson
- Department of Biology, University of Leicester, UK
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Kennedy S, McConnell S, Anderson H, Kennedy DG, Young PB, Blanchflower WJ. Histopathologic and ultrastructural alterations of white liver disease in sheep experimentally depleted of cobalt. Vet Pathol 1997; 34:575-84. [PMID: 9396138 DOI: 10.1177/030098589703400605] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Many cobalt-deficient sheep develop liver lesions known as ovine "white liver" disease, but the etiology of these changes is controversial. It has been suggested that cofactors are required for development of liver damage in cobalt-deficient sheep. In this study, one group of lambs (n = 5) was fed a diet low in cobalt (4.5 micrograms/kg) while a group of control lambs (n = 4) received the same diet after it had been supplemented with cobalt (1000 micrograms/kg). All cobalt-depleted lambs had reduced growth rate, anorexia, lacrimation, and alopecia, and they eventually became emaciated (mean body weight at end of study: 83% of initial body weight). Plasma concentrations of bilirubin and serum activity of glutamate-oxaloacetate transferase were elevated in these animals, while plasma concentrations of vitamin B12 were reduced (less than 220 pmol/L from day 42). Fatty degeneration of the liver associated with reduced concentrations of vitamin B12 (14.5 pmol/g) was seen in these animals at necropsy at 196 days. Microscopic liver lesions included accumulation of lipid droplets and lipofuscin particles in hepatocytes, dissociation and necrosis of hepatocytes, and sparse infiltration by neutrophils, macrophages, and lymphocytes. Ultrastructural hepatocytic alterations included swelling, condensation and proliferation of mitochondria, hypertrophy of smooth endoplasmic reticulum, vesiculation and loss of arrays of rough endoplasmic reticulum, and accumulation of lipid droplets and lipofuscin granules in cytoplasm of hepatocytes. No liver lesions were seen in control lambs. The results of this study indicate that cofactors are not a prerequisite to development of hepatic damage in cobalt-deficient sheep. Reduced activities of the vitamin B12-dependent enzymes, methylmalonyl CoA mutase and methionine synthase, and lipid peroxidation are of likely pathogenetic importance in the development of the lesions.
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Affiliation(s)
- S Kennedy
- Veterinary Sciences Division, Department of Agriculture for Northern Ireland, Stormont, Belfast, Northern Ireland.
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Abstract
An optimised indirect peroxidase-anti-peroxidase immunohistochemical technique was used to detect endogenous biotin in frozen tissue sections from biotin-supplemented and biotin-depleted pigs and chickens. A monoclonal anti-biotin antibody was used as primary antibody in this technique. Immunoreactive biotin was detected in many tissues of both species including liver, kidney, pancreas, adipose tissue, adrenal gland, testis, brain, choroid plexus, cardiac and skeletal muscle, epithelium of the respiratory and digestive systems, skin and lymphoid tissues. The specificity of immunostaining for biotin was confirmed by the finding of reduced staining intensities in tissues of biotin-depleted animals compared to those of biotin-supplemented animals. The results of this study suggest that biotin has metabolic functions in a wider range of tissues than previously known. They also indicate that endogenous tissue biotin should be considered as a source of false-positive staining when immunohistochemical or histochemical techniques which use avidin or streptavidin reagents or anti-biotin antibodies as components of the detection system, are applied to tissue sections.
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Affiliation(s)
- K M Cooper
- Department of Agriculture for Northern Ireland, Stormont, Belfast, Northern Ireland
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Yannelli JR, Hyatt C, McConnell S, Hines K, Jacknin L, Parker L, Sanders M, Rosenberg SA. Growth of tumor-infiltrating lymphocytes from human solid cancers: summary of a 5-year experience. Int J Cancer 1996; 65:413-21. [PMID: 8621219 DOI: 10.1002/(sici)1097-0215(19960208)65:4<413::aid-ijc3>3.0.co;2-#] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Between 1989 and 1993, 255 tumor biopsies representing 4 tumor histologies (melanoma, breast cancer, colon cancer and renal cell cancer) were received by the Surgery Branch of the National Cancer Institute. Tumor-infiltrating lymphocytes (TIL) were grown from single-cell suspensions of tumor biopsies over the course of 30-45 days. The TIL were grown in medium containing IL-2. To obtain numbers suitable for therapy (>10(11)), TIL were expanded using a large-scale system of cell culture and harvesting. While the largest number of biopsies was obtained from melanoma patients, TIL were successfully grown from 160 of 255 tumor biopsies representing all 4 histologies. Under the culture conditions employed, several characteristics of TIL expansion were observed. The cell surface phenotype of TIL which grew out from the tumor biopsies was generally a mix of CD3+/CD4+ or CD3+/CD8+ lymphocytes. Only TIL from melanoma biopsies were found to be consistently cytolytic and, in many cases, lysed autologous tumor cells preferentially. Interestingly, TIL derived from extra-nodal sites of metastatic melanoma biopsies (subcutaneous, lung, bowel; 36 of 67, 54%) were more likely to have these cytolytic characteristics than TIL derived from tumor-involved lymph node biopsies (7 of 39, 18%). The present study summarizes 5 years of laboratory effort and validates the technologies developed for the large-scale growth and harvesting of TIL. In addition, it summarizes the laboratory effort supporting previously published clinical reports on TIL from our group.
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Affiliation(s)
- J R Yannelli
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Yannelli JR, McConnell S, Parker L, Nishimura M, Robbins P, Yang J, el Gamil M, Kawakami Y. Melanoma tumor-infiltrating lymphocytes derived from four distinct anatomic sites obtained from a single patient: comparison of functional reactivity and melanoma antigen recognition. J Immunother Emphasis Tumor Immunol 1995; 18:263-71. [PMID: 8680654 DOI: 10.1097/00002371-199511000-00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Tumor-infiltrating lymphocytes (TILs) were grown from four distinct anatomic sites from a patient with metastatic melanoma. The metastatic sites included a tumor-involved lymph node, a subcutaneous lesion obtained from the chest wall, a portion of bowel, and adrenal gland. TILs grown from each anatomic site over the course of 20 days in the presence of 6,000 IU/ml recombinant interleukin-2 exhibited comparable growth rates. Between days 30 and 45, the TILs were a mixture of CD3+ CD4+ and CD3+ CD8+ lymphocytes expressing the alpha beta form of the T-cell receptor. TILs derived from each anatomic site specifically lysed autologous tumor obtained from all four anatomic sites. In fine specificity analysis, the TILs exhibited human leukocyte antigen (HLA-A2)-restricted lysis of fresh tumor targets and cultured melanoma cell lines. Each TIL recognized a product of the MART-1 gene, and specifically, the monomer peptide MART-1(27-35). Thus lymphocytes reactive with the MART-1 melanoma antigen appeared to be widely distributed in diverse metastases in this patient. This information, along with previous data on the reactivity of multiple patients to this antigen, attests to its dominance in the immune reactivity of humans to melanoma.
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Affiliation(s)
- J R Yannelli
- National Cancer Institute, Surgery Branch, Bethesda, Maryland, USA
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Affiliation(s)
- P McNamee
- Veterinary Sciences Division, Omagh, County Tyrone, Northern Ireland
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McConnell S. What's special about special care? Con. Provider 1994; 20:64, 62. [PMID: 10172199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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McConnell S. Policy issues surrounding special care units. Caring 1994; 13:30-3. [PMID: 10171926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
What is specialized care for Alzheimer's patients? Is it really specialized, or could that word simply be a marketing ploy? Home care agencies that care for patients with Alzheimer's disease will face these questions with their patients and undergo the same questions that the nursing home industry faces.
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Abstract
To test the hypothesis that newborn pigs with pseudorabies virus (PRV) colostral antibodies might be actively immunized with a PRV glycoprotein gIII-deleted vaccine (Omnimark-PRV), 23 piglets were obtained from four sows that had been immunized 4 weeks and 2 weeks before farrowing with this vaccine. Thirteen piglets were immunized with Omnimark-PRV when they were less than 3 days old and ten piglets served as non-vaccinated controls. Piglets were weaned at 28 days of age and challenged with virulent PRV (Shope) when they were 49 days old, at which time the vaccinated and control pigs were seronegative for PRV virus neutralizing (VN) and gIII antibodies, and all control pigs and ten vaccinees were seronegative for PRV antibodies by the latex agglutination test (LAT). Two vaccinees were LAT(+) and one was LAT(+/-). Central nervous system signs and/or respiratory disease signs were observed in six of ten control pigs with the death of one control, while two of 13 vaccinees showed only very mild and transient clinical disease signs and there were no fatalities. Non-vaccinees lost weight until postchallenge day (PCD) 6 and did not regain prechallenge weight until PCD 8. All vaccinees gained weight after challenge and at PCD 11 had mean weight gains nearly twice that of the controls. On PCD 11, the geometric mean titre for VN antibodies of non-vaccinees was 9.3, while that of vaccinees was 49.0, indicating that the vaccinated group had been immunologically primed.
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Affiliation(s)
- B Lawhorn
- Texas A&M College of Veterinary Medicine, College Station
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Kit S, McConnell S, Kit M, Lawhorn B. Circumvention of maternal antibody interference by immunization of newborn pigs with glycoprotein gIII-deleted marker vaccine. Immunol Cell Biol 1993; 71 ( Pt 5):421-30. [PMID: 8270271 DOI: 10.1038/icb.1993.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Maternal antibodies interfere with the immunization of swine by modified live-virus pseudorabies virus (PRV) vaccines. To test the hypothesis that a PRV vaccine attenuated by deletions in the thymidine kinase (TK) and gIII genes might reduce interference by maternal antibodies, pigs with moderate to low levels of colostral PRV antibodies were immunized with the TK- gIII-OMNIMARK-PRV vaccine. Vaccinates and non-vaccinates were challenged intranasally with virulent PRV at 7 weeks of age. In support of the hypothesis, it was found that central nervous system (CNS) and/or respiratory disease developed in six out of 10 controls with a fatal outcome in one, while two out of 13 vaccinates showed only very mild and transient CNS or respiratory disease signs with no fatalities. All vaccinates gained weight while non-vaccinates initally lost weight. At post-challenge day (PCD) 11, vaccinates showed 4.5 lb/pig greater weight gain than non-vaccinates. Virus neutralization (VN) analyses before and after challenge showed that vaccinates had been primed immunologically. In another experiment, newborn pigs from a pseudorabies disease-quarantined herd with high VN antibody titres were vaccinated, respectively, with the gIII-TK-OMNIMARK-PRV vaccine, a TK-gI-gX-vaccine, or no vaccine and challenged with virulent PRV at 14 weeks of age when VN titres were < 1:2. By PCD 9, the TK-gIII-group had outgained the TK-gI-gX- and the control groups, respectively, by 6.0 and 3.2 lb per pig.
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Affiliation(s)
- S Kit
- NovaGene Inc., Houston, Texas 77024
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Kennedy S, Di Guardo G, McConnell S, Moffett D, Agrimi U. Histological, histochemical and ultrastructural features of hyaline inclusions in hepatocytes of striped dolphins (Stenella coeruleoalba). J Comp Pathol 1993; 109:179-85. [PMID: 7504003 DOI: 10.1016/s0021-9975(08)80261-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Many striped dolphins (Stenella coeruleoalba) which died in the recent morbillivirus epizootic in the Mediterranean Sea had hyaline inclusions in hepatocytes. We investigated the histological, histochemical and ultrastructural features of these inclusions in two affected dolphins. Histochemical tests indicated that they contained glycoprotein but not lipid. Ultrastructurally, they consisted of granular, moderately electron-dense material, bounded by a membrane. A central or eccentric core of highly electron-dense material was usually apparent. The inclusions were probably of lysosomal origin.
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Affiliation(s)
- S Kennedy
- Department of Pathology, Department of Agriculture for Northern Ireland, Stormont, Belfast
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Ilia R, Cabin H, McConnell S, Cleman M, Remetz M. Coronary angioplasty with gradual versus rapid balloon inflation: initial results and complications. Cathet Cardiovasc Diagn 1993; 29:199-202. [PMID: 8402842 DOI: 10.1002/ccd.1810290305] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Although a variety of coronary angioplasty balloon inflation protocols are employed, prior studies have not evaluated the relation of rate of inflation to the type and extent of arterial damage produced by angioplasty. We randomized 103 patients to either a gradual (gradual, incremental increase to peak inflation pressure) or rapid inflation protocol (rapid increase to peak inflation pressure). Fifty-one patients with 72 lesions underwent gradual and 52 patients with 73 lesions received rapid inflation protocols. There were no significant group differences with regard to age, sex, artery dilated, number of diseased vessels, presence of unstable angina and lesion morphological characteristics except for more lesions located on a bend in the gradual inflation group (p < 0.02). Although there was a tendency towards a higher success rate in patients with gradual inflation, the complete success rates were high in both groups (100% vs. 93%, p < 0.08). The dissection rate was higher in patients with rapid inflation (43/73 [59%] vs. 26/72 [36%], p < 0.01). The collective complication rate was higher in patients with rapid inflation (19% vs. 6%, p < 0.03). No deaths occurred in either group. Thus a gradual compared to rapid coronary angioplasty balloon inflation protocol reduces the frequency of dissection despite similar inflation pressure and balloon/vessel diameter ratio. Gradual inflations may reduce the frequency of procedure-related complications.
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Affiliation(s)
- R Ilia
- Department of Internal Medicine, Yale University, School of Medicine, New Haven, Connecticut
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40
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McConnell S, Smith A, Thomas S. The mechanical energy requirements during the Canadian aerobic fitness test. J Biomech 1993. [DOI: 10.1016/0021-9290(93)90453-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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41
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Affiliation(s)
- B Gloersen
- Department of Psychiatry, Emory University, Atlanta, GA
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Butler RN, Brame JB, Kahn C, McConnell S, Myers RJ, Pollack R, Rowland D. Health care for all: long-term care, the missing piece. A roundtable discussion: Part 3. Geriatrics (Basel) 1992; 47:53-4, 57-61. [PMID: 1427113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Long-term care has been described as the "missing piece" in many healthcare reform proposals. Yet the cost of nursing home care often exceeds that of acute care, especially for the elderly with Alzheimer's disease. In this final installment of a three-part roundtable discussion, panelists discuss the options for providing long-term care, such as social insurance, a single-payer system, play or pay, or private insurance models. Alternatives to nursing home care, such as community service centers and home care, are discussed. The panelists conclude with an examination of how these proposed reforms might affect the practices of physicians and the U.S. economy.
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Butler RN, Brame JB, Kahn C, McConnell S, Myers RJ, Pollack R, Rowland D. Health care for all: comparing proposals for reform. A roundtable discussion: Part 2. Geriatrics (Basel) 1992; 47:38-40, 43-6. [PMID: 1427105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Part 1 of this roundtable discussion [Geriatrics 1992; 47(Sept):34-48] examined the flaws in our current healthcare system and factors that are interfering with our nation's ability to achieve reforms. This month, the panelists discuss the benefits and drawbacks of the major healthcare reform proposals, including managed care, single-payer systems, and so-called "play or pay." The practical aspects of any redistribution of healthcare resources are considered as each panelist outlines a favored approach. The influence of special interests, such as the insurance industry, is also discussed.
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Abstract
In vitro autoradiography and test-tube assay of the sodium-dependent binding of D-[3H]aspartate were used to localize and quantify the uptake site for the excitatory amino acid neurotransmitters glutamate and aspartate in the cerebellar cortex of human cerebellar hemispheres. Autoradiograms revealed a pronounced heterogeneity in the distribution of D-[3H]aspartate binding in cortex from adult brains, with the highest binding density corresponding to the Purkinje cell layer, high binding in molecular layer and low binding in granule cell layer. In contrast, cerebellar cortex from infants at term (40 weeks gestation) had only low binding of the ligand in both the molecular and the Purkinje cell layers. Both methods employed for measuring D-[3H]aspartate binding showed that the number of binding sites in Purkinje and molecular layers increased rapidly from term to 20 weeks postnatal age and achieved levels higher than those found in adult cerebellum. It is concluded that a substantial increase in the numbers of glutamate/aspartate uptake sites takes place in the human cerebellum during the early postnatal period. It is deduced that the excess uptake sites are eliminated as the cerebellum matures.
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Affiliation(s)
- P Slater
- Department of Physiological Sciences, Medical School University of Manchester, UK
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Slater P, McConnell S, D'Souza SW, Barson AJ, Simpson MD, Gilchrist AC. Age-related changes in binding to excitatory amino acid uptake site in temporal cortex of human brain. Brain Res Dev Brain Res 1992; 65:157-60. [PMID: 1315225 DOI: 10.1016/0165-3806(92)90174-u] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The binding of D-[3H]aspartate to the specific uptake site for the excitatory amino acids glutamate and aspartate was measured in homogenates of temporal lobe cortex taken at postmortem from 76 human infant and adult brains. Binding levels were very low in brains of preterm and term infants but increased rapidly during the first 20 postnatal weeks to reach levels which exceeded those in adult brains. Linear regression analysis which compared the amount of D-[3H]aspartate binding with the age of the infant, showed a positive correlation up to 25 postnatal weeks. Saturation analysis showed that the maximum number of D-[3H]aspartate binding sites (Bmax) in temporal cortex from infants aged 20 postnatal weeks was 3 times greater than the number of sites in adult brain. The findings show that the number of excitatory amino acid uptake sites, which may be associated in part with presynaptic terminals, increase in number rapidly after birth. Furthermore, the data may indicate that a slow regression of excitatory amino acid terminals occurs during the later stages of brain development.
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Affiliation(s)
- P Slater
- Department of Physiological Sciences, Manchester University Medical School, U.K
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46
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McConnell S, Rusio D. Alzheimer's disease. Getting on the federal agenda. Caring 1991; 10:4-8, 10. [PMID: 10170885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Eleven years ago, a handful of family caregivers started a grassroots movement that has raised the nation's awareness of Alzheimer's disease and captured the attention of government policymakers.
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Bryson DG, McConnell S, McAliskey M, McNulty MS. Ultrastructural features of alveolar lesions in induced respiratory syncytial virus pneumonia of calves. Vet Pathol 1991; 28:286-92. [PMID: 1949507 DOI: 10.1177/030098589102800404] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ultrastructural changes occurred in alveolar epithelium in the acute and repair stages of induced respiratory syncytial virus pneumonia induced in eight calves (calf Nos. 1-7, 3 to 6 days old and calf No. 8, 2 weeks old), using a bovine strain of respiratory syncytial virus. Five of the calves were Friesians, three were Hereford x Friesians, and all were male. Tissues from three mock-infected control calves (two Friesian, one Hereford x Friesian) were also examined. Evidence of respiratory syncytial virus infection was observed in both type I and type II pneumocytes from day 4 to day 8 after infection. Infection of type I pneumocytes frequently resulted in necrosis. The response of type II pneumocytes to respiratory syncytial virus infection varied and included hypertrophy, hyperplasia, and syncytial formation. In some infected type II pneumocytes, there were numerous irregular projections of the cell surface, associated with viral budding. Hypertrophy and hyperplasia of type II pneumocytes, epithelial syncytium formation, and irregular cytoplasmic projections from epithelial cells caused considerable thickening of respiratory membrane and occlusion of alveolar lumina. Neutrophils were frequently observed in close association with virus-infected epithelial cells, but evidence of respiratory syncytial virus infection and replication was not observed in alveolar macrophages or neutrophils. Proliferation of type II pneumocytes appeared to play a major role in maintaining the integrity of the alveolar epithelium during the acute stage of the experimental pneumonia. Increased numbers of type II pneumocytes were present on alveolar walls, particularly from 4 to 8 days after infection, and some alveoli were lined entirely by this cell type. In some areas, however, squamous epithelial cells were also involved in covering exposed alveolar basement membrane.
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Affiliation(s)
- D G Bryson
- Veterinary Research Laboratories, Stormont, Belfast, Northern Ireland, United Kingdom
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Bryson DG, Platten MF, McConnell S, McNulty MS. Ultrastructural features of lesions in bronchiolar epithelium in induced respiratory syncytial virus pneumonia of calves. Vet Pathol 1991; 28:293-9. [PMID: 1949508 DOI: 10.1177/030098589102800405] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ultrastructural changes were observed in bronchioles in acute and repair stages of respiratory syncytial virus pneumonia induced in eight young calves (calf Nos. 1-8) using a bovine strain of respiratory syncytial virus. Five of the calves were Friesians and three were Hereford x Friesians and all were male. Tissues from three mock-infected control calves (two Friesian, one Hereford x Friesian) were also examined. Calves were from 3 to 6 days old at the time of first inoculation, with the exception of calf No. 8, which was 2 weeks old. In the acute stage of the induced pneumonia, evidence of respiratory syncytial virus replication and release was demonstrable in both ciliated and non-ciliated bronchiolar epithelial cells, with the virus-releasing process most obvious at 4 and 5 days after infection. Respiratory syncytial virus infection of bronchiolar epithelium was associated with various changes, including hypertrophy, hyperplasia, and formation of syncytia. Necrosis of epithelial cell structures usually appeared to be preceded by their desquamation from bronchiolar walls. Respiratory syncytial virus infection resulted in considerable damage to the bronchiolar ciliary apparatus. Such damage was seen as early as 1 day post-infection and was still obvious at 10 days post-infection. Neutrophils were closely associated with respiratory syncytial virus infected epithelial cells and evidence of neutrophil fusion with infected epithelial cells was seen. These observations suggest that neutrophils may be involved in killing respiratory syncytial virus infected cells and that neutrophils might play an important role in early antiviral defense against respiratory syncytial virus at a time when antibody levels are low and other cellular defenses are not fully in play. Bronchiolar repair was evident from 6 days after infection and was well advanced at 10 and 13 days after infection.
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Affiliation(s)
- D G Bryson
- Veterinary Research Laboratories, Stormont, Belfast, Northern Ireland, United Kingdom
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Affiliation(s)
- J A Smyth
- Pathology Department, Veterinary Research Laboratories, Stormont, Belfast, Northern Ireland
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50
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Cornick J, Martens J, Martens R, Crandell R, McConnell S, Kit S. Safety and efficacy of a thymidine kinase negative equine herpesvirus-1 vaccine in young horses. Can J Vet Res 1990; 54:260-6. [PMID: 2162730 PMCID: PMC1255647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A drug induced equine herpesvirus-1 (EHV-1) mutant lacking thymidine kinase inducing activity was developed and evaluated as a vaccine. The safety and effectiveness of the vaccine to protect against experimentally induced EHV-1 respiratory disease were evaluated in weanling horses free of EHV-1 neutralizing antibody. The vaccine was safe when administered either intramuscularly or intravenously, and EHV-1 was not shed intranasally during the 12 days following administration. Intranasal challenge with virulent EHV-1 was used to evaluate vaccine efficacy. Following challenge, there was a significantly (p less than 0.05) greater increase in peak body temperatures and duration of nasal virus shedding in the nonvaccinates, and a significant (p less than 0.05) increase in serum neutralizing antibody titers in the vaccinates.
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Affiliation(s)
- J Cornick
- Large Animal Medicine and Surgery, Texas Veterinary Medical Diagnostic Laboratory, Texas A&M University, College Station 77843-4475
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