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1.
Clin Exp Allergy ; 53(4): 405-416, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36385515

RESUMEN

BACKGROUND: Effector cells assays provide an overall measure of responsiveness to allergen, but the lack of reliable and high-throughput assays limits the clinical utility. We aimed to develop a high-throughput basophil activation test based on human progenitor cell-derived basophils (PCB) and investigate the role of PCB activation test (PCBAT) in allergic diseases. METHODS: Progenitor cell-derived basophils were differentiated from CD34+ progenitor cells and sensitized with sera from subjects sensitized to cat, peanut or atopic controls. Sensitized PCBs were stimulated with increasing concentrations of the corresponding allergens in vitro. Degranulation was assessed by measuring CD63 expression using flow cytometry. The correlations between PCBAT and clinical allergy were assessed. RESULTS: Following passive sensitization of the mature PCBs with serum and allergen stimulation, an allergen specific dose-dependent increase in CD63 expression was observed. Sera from subjects sensitized to cat (n = 35, of which 17 subjects had clinical reactivity quantified using inhaled allergen challenge), peanut allergic (n = 30, of which 15 subjects had clinical reactivity validated using double blind, placebo controlled food challenges [DBPCFC]), peanut-sensitized but tolerant subjects (n = 5) were used to sensitize PCBs. PCBAT area under the curve (AUC) correlated with sIgE (r2  = .49, p = .001) in subjects sensitized to cat (sIgE ≥ 0.35KU/L). The provocation concentration of inhaled cat allergen (PC20 ) correlated with PCBAT AUC (r2  = .33, p = .016). In subjects sensitized to peanut, PCBAT AUC was highly correlated with sIgE to Ara h 2 (r2  = .59, p < .0001). Peanut threshold cumulative dose during DBPCFC was negatively correlated with PCBAT AUC (r2  = .57, p = .001) and IgE to Ara h1 (r2  = .55, p = .007), but not with sIgE to whole peanut or Ara h2. All peanut-sensitized but tolerant subjects showed no reaction to peanut on PCBAT. CONCLUSION: Progenitor cell-derived basophils activation test is a high-throughput assay, which correlates with clinical allergy and may confer a powerful alternative tool in allergy testing.


Asunto(s)
Hipersensibilidad Inmediata , Hipersensibilidad al Cacahuete , Humanos , Basófilos , Inmunoglobulina E , Alérgenos , Antígenos de Plantas , Arachis , Hipersensibilidad Inmediata/metabolismo
2.
Respirology ; 26(3): 225-232, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33043552

RESUMEN

BACKGROUND AND OBJECTIVE: Non-selective beta-blockers impair the bronchodilator response to beta2 -agonists. Cardio-selective beta1 -blockers are less likely to cause this effect, yet they remain relatively contraindicated in asthma. We investigated whether the response to salbutamol is impaired during cardio-selective beta1 -blocker treatment in people with asthma. METHODS: A random-order, double-blind, placebo-controlled, non-inferiority, crossover study was conducted comparing up to 5 mg bisoprolol daily for 2 weeks with matching placebo, with an open-label extension of up to 10 mg bisoprolol daily. After each treatment period, mannitol was inhaled to induce bronchoconstriction with a 15% fall in forced expiratory volume in 1 s (FEV1 ). Immediately after mannitol challenge, salbutamol (100, 100 and 200 µg) was administered via spacer at 5-min intervals with repeated FEV1 measures. The FEV1 recovery with salbutamol was measured as an area under recovery curve (AUC). Based on earlier research, a clinically relevant non-inferiority limit of a 30% reduction in the AUC was set. RESULTS: A total of 19 adults with mild asthma and positive inhaled mannitol challenge completed the study. Adjusting for the FEV1 fall induced by mannitol and treatment sequence, the mean AUC response to salbutamol after bisoprolol was 5% lower than after placebo, with a one-sided 95% confidence interval (CI) of 26% lower. Thirteen participants completed the open-label extension up to 10 mg bisoprolol daily with mean AUC 11% higher after bisoprolol with a 95% CI of 5% lower. CONCLUSION: The bronchodilator response to rescue salbutamol after mannitol-induced bronchoconstriction is non-inferior during regular treatment with the cardio-selective beta1 -blocker, bisoprolol, compared to placebo. CLINICAL TRIAL REGISTRATION: ACTRN12618000306213 at https://www.anzctr.org.au.


Asunto(s)
Albuterol , Asma , Administración por Inhalación , Agonistas Adrenérgicos beta/uso terapéutico , Adulto , Albuterol/farmacología , Albuterol/uso terapéutico , Asma/tratamiento farmacológico , Bisoprolol/farmacología , Bisoprolol/uso terapéutico , Broncodilatadores/farmacología , Broncodilatadores/uso terapéutico , Estudios Cruzados , Método Doble Ciego , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos
4.
J Pathol ; 234(1): 74-85, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24870556

RESUMEN

The X-linked transcription factor FOXP3 is expressed by epithelial cells of organs including the breast, where it is considered a tumour suppressor. The chemokine receptor CXCR4 also regulates the development of breast cancer by stimulating cell migration towards CXCL12-expressing sites of metastatic spread. During activation, human T cells show reciprocal regulation of FOXP3 and CXCR4. This study was designed to examine the role FOXP3 plays in metastatic breast cancer, with a particular focus on its potential to regulate CXCR4. Human breast cancer samples showed significantly decreased FOXP3 protein expression but an increased number of CXCR4 transcripts. In comparison with normal primary breast epithelial cells, FOXP3 was down-regulated at both transcript and protein levels in the breast cancer cell lines MCF-7 and MDA-MB-231. In the invasive MDA-MB-231 cells, the remaining FOXP3 was located predominately within the cytoplasm. Following stable FOXP3 overexpression in MDA-MB-231 cells, significant decreases were observed in the expression of ErbB2/HER2, SKP2, c-MYC, and CXCR4. In contrast, an increase in p21 expression led to inhibition of cell proliferation, with a greater proportion in the G1 phase of the cell cycle suggesting the induction of senescence. Specific knockdown of FOXP3 in normal human breast epithelial cells with siRNA significantly increased ErbB2/HER2, SKP2, c-MYC, and CXCR4, and decreased p21 expression. These cells also showed a significantly increased chemotactic response towards CXCL12, consistent with a role for FOXP3 in the regulation of cell migration. Results from this study are consistent with FOXP3 functioning as an important tumour suppressor in breast cancer. Indeed, the potential functions of FOXP3 in breast epithelium can now be extended to include regulation of CXCR4 expression and response to the pro-metastatic chemokine CXCL12.


Asunto(s)
Neoplasias de la Mama/patología , Quimiocina CXCL12/genética , Factores de Transcripción Forkhead/genética , Regulación Neoplásica de la Expresión Génica , Receptores CXCR4/genética , Mama/metabolismo , Mama/patología , Neoplasias de la Mama/metabolismo , Ciclo Celular , Línea Celular Tumoral , Proliferación Celular , Quimiocina CXCL12/metabolismo , Quimiotaxis , Regulación hacia Abajo , Células Epiteliales/metabolismo , Células Epiteliales/patología , Femenino , Factores de Transcripción Forkhead/metabolismo , Expresión Génica , Técnicas de Silenciamiento del Gen , Humanos , Invasividad Neoplásica , Metástasis de la Neoplasia , ARN Interferente Pequeño , Receptores CXCR4/metabolismo
5.
J Allergy Clin Immunol Pract ; 12(3): 714-723.e5, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37940090

RESUMEN

BACKGROUND: Approximately 10% of the global population identify themselves as penicillin allergic, yet 90% are not truly allergic and could safely tolerate penicillin. There is no simple way to identify these people. Current in vitro diagnostics include specific immunoglobulin E (with a sensitivity of 19% and specificity of 97%) and a basophil activation test (BAT) with undefined sensitivity and specificity. OBJECTIVE: To define the sensitivity and specificity of BAT in the diagnosis of penicillin allergy METHODS: We searched PubMed and EMBASE from inception to April 2, 2023, for original studies evaluating the performance characteristics of BAT for penicillin allergy in adults. Study selection, data extraction, risk of bias, assessment with QUADAS-2 tool, certainty assessment with Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology were performed independently, in duplicate. Meta-analysis was performed using Reitsma methodology. RESULTS: Twenty-two studies fulfilled the inclusion criteria. Twelve used the same positive threshold giving a summary point sensitivity 51% (95% confidence interval [95% CI]46%-56%) and specificity 89% (95% CI 85%-93%). Significant risk of bias was identified owing to patient selection. GRADE certainty of evidence rated sensitivity very low due to imprecision and specificity as low. There was great heterogeneity in methods used. Use of 1,000 basophils per test did not improve performance above 500 basophils. CONCLUSIONS: BAT sensitivity is highly variable across studies and remains too low to be considered as a routine element of clinical practice. BAT specificity is not as good as specific immunoglobulin E in penicillin allergy diagnosis. Significant further work is required in this field before clinical application of BAT in routine practice.


Asunto(s)
Hipersensibilidad a las Drogas , Hipersensibilidad , Adulto , Humanos , Prueba de Desgranulación de los Basófilos/métodos , Basófilos , Hipersensibilidad/diagnóstico , Hipersensibilidad a las Drogas/diagnóstico , Inmunoglobulina E , Sensibilidad y Especificidad , Penicilinas/efectos adversos
6.
EClinicalMedicine ; 76: 102813, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39296585

RESUMEN

Background: Considerable variability exists between asthma diagnostic guidelines. We tested the performance characteristics of the European Respiratory Society (ERS), the National Institute for Health and Care Excellence (NICE) and the Global Initiative for Asthma (GINA) guidelines for the diagnosis of asthma in adults. Methods: In this prospective observational study (ISRCTN-11676160, May 2019-June 2022), participants referred from primary care with clinician-suspected asthma underwent comprehensive investigation including: spirometry, bronchodilator reversibility, fractional exhaled nitric oxide, peak expiratory flow variability, bronchial challenge testing with methacholine and mannitol, and responsiveness to inhaled corticosteroid therapy. Results were reviewed by a panel of asthma specialists to determine asthma diagnosis (reference standard) and compared to each diagnostic test and the ERS, NICE and GINA diagnostic algorithms (index tests). The sensitivity, specificity, positive predictive and negative predictive values were calculated. Findings: One hundred and forty adults were enrolled and 118 given a definitive diagnostic outcome [75 female; mean (SD) age 36 (12) years; 70 (59%) with asthma] and included in the analysis. Sensitivity of individual tests was poor (15-62%), but they provided good specificity at the most stringent thresholds (range: 88-100%). The sensitivity/specificity of ERS, NICE and GINA was 81/85%, 41/100% and 47/100%, respectively. Concordance between guidelines was only moderate (Cohen's Kappa 0.45-0.51). Interpretation: Current guidelines for the diagnosis of asthma in adults provide either excellent specificity but low sensitivity (GINA and NICE) or only reasonable sensitivity and specificity (ERS). All guidelines therefore have limitations with regards to their clinical application; new guidelines are needed but should be tested prospectively before roll out. Funding: This work was supported by the Manchester NIHR Biomedical Research Centre (BRC) (grant no. BRC-1215-20007, and NIHR203308), Asthma UK/Innovate (grant no. AUK-PG-2018-406), GSK ID 212474 and North West Lung Centre Charity.

7.
BMJ Open ; 14(10): e083908, 2024 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-39461867

RESUMEN

INTRODUCTION: The diagnosis of asthma is often based on characteristic patterns of symptoms in the absence of an alternative explanation, resulting in over and under diagnosis. Therefore, diagnostic guidelines usually recommend including confirmation of variable airflow obstruction. Some recommend using a sequence of objective tests; however the tests used, the specific cut-off values and the specified order are yet to be validated. We aimed to determine the optimal cut-off values and series of investigations to diagnose asthma. We also explore the potential for novel tests of small airways function and biomarkers, which could be incorporated into future diagnostic pathways. METHODS AND ANALYSIS: The Rapid Access Diagnostics for Asthma study is an observational study of 300 symptomatic patients with 'clinician-suspected asthma' and healthy controls (aged ≥3 to <70 years), recruited from primary and secondary care in Greater Manchester, UK. Symptomatic participants will undergo four core visits and one optional visit. Participants will complete two baseline visits and undergo a series of established (spirometry, bronchodilator reversibility, exhaled nitric oxide, home peak flow monitoring and bronchial challenge testing) and novel tests. Following visit 2, participants will receive monitored medium-dose inhaled corticosteroid therapy for 6-8 weeks, after which they will return for repeat testing. Patients will be diagnosed with asthma by 'expert panel' opinion (minimum two respiratory specialists) on review of all data (excluding novel tests) pre and post treatment. Healthy controls will attend two visits to establish reference intervals and calculate repeatability coefficients for novel tests where there is a lack of evidence on what threshold constitutes a 'normal' set of values. The primary end point is to determine the optimum diagnostic pathway for diagnosing asthma. ETHICS AND DISSEMINATION: The study was approved by Greater Manchester East Research Ethics Committee (18/NW/0777). All participants or parents/guardians are required to provide written informed consent and children to provide written assent. The results will be published in peer-review journals and disseminated widely at conferences and with the help of Asthma and Lung UK (www.asthmaandlung.org.uk). TRIAL REGISTRATION NUMBER: ISRCTN11676160.


Asunto(s)
Asma , Espirometría , Humanos , Asma/diagnóstico , Estudios Prospectivos , Niño , Adulto , Adolescente , Persona de Mediana Edad , Femenino , Masculino , Espirometría/métodos , Adulto Joven , Preescolar , Anciano , Pruebas de Provocación Bronquial/métodos , Biomarcadores/análisis , Reino Unido , Pruebas de Función Respiratoria/métodos , Estudios de Casos y Controles , Broncodilatadores
8.
J Intensive Care Soc ; 23(2): 109-116, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35615236

RESUMEN

Background: Cerebral oximetry using near-infrared spectroscopy (NIRS) has been shown to reduce neurological dysfunction and hospital length-of-stay after adult cardiac surgery in some but not all studies. We audited maintaining cerebral saturations at or above baseline and showed improved neurological and length-of-stay outcomes. Our hypothesis for this study was that our NIRS protocol would improve neurological and length-of-stay outcomes. Methods: This prospective, single centre, double-blinded controlled study randomized 182 consecutive patients, scheduled for cardiac surgery using cardiopulmonary bypass. Participants were randomized by concealed envelope prior to anaesthesia. NIRS study group were managed perioperatively using our NIRS protocol of 8 interventions, increase cardiac output, normocapnia, increase mean arterial pressure, increase inspired oxygen, depth of anaesthesia, blood transfusion, correction of bypass cannula, change of surgical plan to restore levels equal to or above baseline. The control group had standard management without NIRS. Primary outcomes were neurological impairment (early and late) and hospital length-of-stay. Secondary outcomes were ventilation times, intensive care length-of-stay, major organ dysfunction and mortality. Results: 91 patients entered each group. There was a significant improvement in self-reported six-month general functionality in the NIRS group (p = 0.016). Early neurological dysfunction and hospital length-of-stay was the same in both groups. Of the secondary outcomes only Intensive Care length-of-stay was statistically significant, being shorter in the NIRS group (p = 0.026). Conclusion: Maintaining cerebral saturations above baseline reduces time spent in Intensive Care and may improve long term functional recovery but not stroke, major organ dysfunction and mortality.

9.
ERJ Open Res ; 8(3)2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-36105153

RESUMEN

Background: The normal range of fractional exhaled nitric oxide (F ENO) is influenced by demographic factors. However, single, fixed cut-off values are used for clinical interpretation in children despite rapid growth. We aimed to define the normal range of F ENO during childhood and evaluate its utility in a diagnostic setting. Method: F ENO percentile charts were developed using data from nonasthmatic children in a population-based birth cohort (Manchester Asthma and Allergy Study). Children were skin prick tested, F ENO measured at the ages of 8, 11, 13-16 and 18 years and clinical information collected. This chart was externally validated in the Study of Eczema and Asthma to Observe the Influence of Nutrition (SEATON) cohort before being prospectively tested in symptomatic, treatment-naïve patients with suspected asthma in a diagnostic setting (Rapid Access Diagnostics for Asthma study). Results: Height, weight, body mass index and age were predictive of F ENO in univariate analysis using 1220 F ENO measurements. Only height remained significant after adjustment in the overall, nonatopic and atopic populations, and was included in the predictive equations for 50th, 75th 90th and 98th percentiles. The proposed percentile lines corresponded to the 57th (95% CI 53rd-61st), 80th (76th-83rd), 90th (87th-92nd) and 98th (96th-99th) percentiles in the SEATON cohort (660 measurements). When tested in 73 symptomatic treatment-naïve children and young adults (median (interquartile range) age: 11 (8-14) years), an F ENO >90th percentile gave a 96% specificity and positive predictive value of 97%, identifying 59% of children who were subsequently diagnosed with asthma after extensive testing. Conclusion: We developed a height-based F ENO percentile chart which quantifies the probability of asthma in symptomatic children and merits further validation towards clinical implementation.

10.
BMJ Open Respir Res ; 9(1)2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35701071

RESUMEN

BACKGROUND: The COVID-19 pandemic has presented substantial new challenges to clinical and research teams. Our objective was to analyse the experience of investigators and research delivery staff regarding the research response to COVID-19 in order to identify these challenges as well as solutions for future pandemic planning. METHODS: We conducted a survey of diverse research staff involved in delivery of COVID-19 clinical trials across the UK. This was delivered online across centres linked to the NIHR Respiratory Translational Research Collaboration. Responses were analysed using a formal thematic analysis approach to identify common themes and recommendations. RESULTS: 83 survey participants from ten teaching hospitals provided 922 individual question responses. Respondents were involved in a range of research delivery roles but the largest cohort (60%) was study investigators. A wide range of research experiences were captured, including early and late phase trials. Responses were coded into overarching themes. Among common observations, complex protocols without adaptation to a pandemic were noted to have hampered recruitment. Recommendations included the need to develop and test pandemic-specific protocols, and make use of innovations in information technology. Research competition needs to be avoided and drug selection processes should be explicitly transparent. CONCLUSIONS: Delivery of clinical trials, particularly earlier phase trials, in a pandemic clinical environment is highly challenging, and was reactive rather than anticipatory. Future pandemic studies should be designed and tested in advance, making use of pragmatic study designs as far as possible and planning for integration between early and later phase trials and regulatory frameworks.


Asunto(s)
COVID-19 , Recolección de Datos , Humanos , Pandemias , Proyectos de Investigación
11.
Cureus ; 13(11): e19675, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34976463

RESUMEN

Diphtheria is a highly contagious and potentially life-threatening infection. Cases in the United Kingdom are rare due to widespread vaccination. However, in recent years, there has been a notable increase in cases in the United Kingdom. We present the case of a 76-year-old British Caucasian female who presented to the Emergency Department with shortness of breath and "chest tightness." She reported a five-day history of worsening sore throat, odynophagia, and aphonia. On inspection, she had noisy, laboured breathing with the use of her accessory muscles. Flexible laryngoscopy revealed purulent, thick yellow discharge in the nasal cavity, oropharynx, and supraglottis, with oedema of the subglottic mucosa. She became increasingly breathless and was peri-arrest when emergency orotracheal intubation was performed. She was transferred to the Intensive Care Unit for ventilatory support and intravenous antibiotics. Four days after presentation, her microbiology results confirmed toxigenic Corynebacterium ulcerans. Public Health England was informed immediately. The patient was isolated and contact tracing was commenced. Thirty staff members were required to self-isolate and take prophylactic antibiotics due to close patient contact. It was particularly noteworthy that our patient was a UK national with no recent history of foreign travel. This case demonstrates the importance of remaining vigilant to atypical causes of airway obstruction secondary to infection. Early suspicion and prompt patient isolation may prevent community and occupational transmission and minimise the impact of contact tracing on hospital staffing. Migration from endemic countries and declining childhood vaccination rates may lead to a further rise in UK cases of diphtheria in the future.

12.
ERJ Open Res ; 7(1)2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33681344

RESUMEN

INTRODUCTION: Beta-blockers are key in the management of cardiovascular diseases but blocking airway ß2-receptors can cause severe and sometimes fatal bronchoconstriction in people with asthma. Although cardioselective ß1-blockers may be safer than non-selective ß-blockers, they remain relatively contraindicated and under-prescribed. We review the evidence of the risk associated with cardioselective ß1-blocker use in asthma. METHODS: We searched "asthma" AND "beta-blocker" in PubMed and EmbaseOvid from start to May 2020. The World Health Organization (WHO) global database of individual case safety reports (VigiBase) was searched for reports of fatal asthma or bronchospasm and listed cardioselective ß1-blocker use (accessed February 2020). Reports were examined for evidence of pre-existing asthma. RESULTS: PubMed and EmbaseOvid searches identified 304 and 327 publications, respectively. No published reports of severe or fatal asthma associated with cardioselective ß1-blockers were found. Three large observational studies reported no increase in asthma exacerbations with cardioselective ß1-blocker treatment. The VigiBase search identified five reports of fatalities in patients with pre-existing asthma and reporting asthma or bronchospasm during cardioselective ß1-blocker use. Four of these deaths were unrelated to cardioselective ß1-blocker use. The circumstances of the fifth death were unclear. CONCLUSIONS: There were no published reports of cardioselective ß1-blockers causing asthma death. Observational data suggest that cardioselective ß1-blocker use is not associated with increased asthma exacerbations. We found only one report of an asthma death potentially caused by cardioselective ß1-blockers in a patient with asthma in a search of VigiBase. The reluctance to use cardioselective ß1-blockers in people with asthma is not supported by this evidence.

13.
Cureus ; 13(3): e14031, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33898119

RESUMEN

Objective Post-operative infection after cardiac surgery causes prolonged hospital stay and increased mortality. In patients with diabetes, peri-operative and pre-operative glycemic control have been associated with increased risk of post-operative infection. Saudi Arabia is the 7th highest country in the world for the prevalence of diabetes. In our surgical population the incidence of diabetes is 77%. We were aware of a high incidence of post-operative infections in our institution. The aim of this work was to assess how peri-operative and pre-operative glycemic control was related to the six-week incidence of post-operative infection. Method We retrospectively collected data for 174 adult patients with diabetes undergoing cardiac surgery between January 2017 and June 2019. For group analysis of peri-operative glycemic control, a mean value of ≤10 mmol/l was categorized as optimal control and a mean value of >10 mmol/l as sub-optimal control. The admission glucose value, the maximum glucose value and glycosylated hemoglobin A1c (HbA1c) were separately recorded. Admission HbA1c was used for optimal long-term control group (HbA1c ≤ 7%) and sub-optimal long-term control group (HbA1c > 7%). Results Of the 174 patients 60 (34%) developed infection in the six-week post-operative period. No statistically significant difference in infections was seen in the optimal peri-operative control group (n = 24, 14%) compared to sub-optimal peri-operative control group (n = 36, 21%; p = 0.113). However, patients with infection had a significantly higher mean glucose (10.4 mmol/l versus 9.9 mmol/l, p = 0.0316) than no infection. Grouping according to their HbA1c: well controlled group (41, 24.0%) and poor control group (130, 76.0%) showed no difference in infections. However, patients with lower HbA1c had better glycemic control as measured by: initial glucose (r = 0.52, p=<0.001); mean peri-operative glucose (r = 0.45, p=<0.001); maximum recorded glucose (r = 0.41, p=<0.001). Conclusion The majority of our patients presented with sub-optimal long-term glycemic control which we linked to poor stress glycemic control perioperatively. Patients with post-operative infections had higher mean peri-operative blood glucose. With the high incidence of diabetes in Saudi Arabia we have demonstrated the importance of good pre-operative assessment which allows tighter peri-operative glycemic control to reduce post-operative morbidity.

14.
Cureus ; 13(8): e17123, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34548962

RESUMEN

INTRODUCTION: Cardiac surgery is associated with significant morbidity and longer length-of-stay (LOS) than most other surgeries. Regional cerebral oximetry (rSO2) using near-infrared spectroscopy (NIRS) on the patient's forehead monitors cerebral oxygenation during surgery and cardiopulmonary bypass (CPB). Its purpose is to detect and manage periods of cerebral hypoxia which may otherwise go undetected, thereby reducing morbidity. But outcomes have been inconsistent, and not all cardiac departments have adopted this non-invasive, simple-to-use technology. We aimed to study the efficacy of our use of rSO2 by recording seven outcomes for each patient according to their preoperative rSO2, the mean intraoperative rSO2, and four ischemic thresholds during surgery. METHOD: This is a retrospective audit of cardiac surgical patients in whom a protocol was used to maintain rSO2 above the preoperative value and studied seven major morbidity outcomes. Cerebral oximetry data were recorded for each patient and analyzed for six variables: preoperative baseline rSO2, mean intraoperative rSO2, and four ischemic thresholds defined as an area under the curve (AUC) in minutes% below the baseline rSO2,minus 10% below the baseline, minus 20% the below baselineand minus 50% below baseline. Outcomes examined were: delirium, stroke, postoperative rise in creatinine of 50 mmol, absolute creatinine of 200 mmol, need for new renal replacement therapy (RRT), hospital LOS and inpatient mortality. RESULTS: Complete data were available for 166 patients. Lower mean preoperative rSO2 was associated with stroke (p=0.031), mild and severe renal dysfunction (p=0.045 and p=0.036), death-in-hospital (p=0.027) and prolonged hospital LOS (p=0.005). Lower mean intraoperative rSO2 during surgery was associated with the outcomes of renal dysfunction, mild (p=0.027), moderate (p=0.003) or severe (p=0.002), death-in-hospital (p=0.003) and prolonged hospital LOS (p=0.015). Of the four ischemic thresholds defined, only new RRT occurring at minus 20% and minus 50% below baseline was significant. CONCLUSION: Lower preoperative rSO2 and mean intraoperative rSO2 were associated with poor outcomes, notably leading to a significant increase in hospital LOS. Mild degrees of cerebral ischemia below the baseline and minus 10% of the baseline during surgery were well tolerated.

15.
J Am Chem Soc ; 132(11): 3980-8, 2010 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-20192267

RESUMEN

An S = 3/2, high-anisotropy building unit, trans-[ReCl(4)(CN)(2)](2-), representing the first paramagnetic complex with a mixture of just cyanide and halide ligands, has been synthesized through the reaction of (Bu(4)N)CN with ReCl(4)(THF)(2). This species is characterized in detail and employed in directing the formation of a series of one-dimensional coordination solids of formula (DMF)(4)MReCl(4)(CN)(2) (M = Mn (2), Fe (3), Co (4), Ni (5)). Variable-temperature dc magnetic susceptibility measurements demonstrate the presence of intrachain antiferromagnetic (2) and ferromagnetic (3-5) exchange coupling within these solids. In addition, probing the ac magnetic susceptibility as a function of both temperature and frequency reveals that all of the chain compounds exhibit slow relaxation of the magnetization. The relaxation time is shown to be thermally activated, with energy barriers to relaxation of Delta(tau) = 31, 56, 17, and 20 cm(-1) for 2-5, respectively. Notably, the field-dependent magnetization of the iron congener exhibits a significant hysteresis effect at low temperature, with a coercive field of H(C) = 1.0 T, thus demonstrating magnetlike behavior in this one-dimensional system. Finally, the magnetization dynamics of all solids occur within the finite-size regime, where the magnetic domain growth is limited due to physical defects along the chains within the crystals.

17.
J Crohns Colitis ; 12(10): 1191-1199, 2018 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-29912405

RESUMEN

BACKGROUND: Recent findings suggest that αE expression is enriched on effector T cells and that intestinal αE+ T cells have increased expression of inflammatory cytokines. αE integrin expression is a potential predictive biomarker for response to etrolizumab, a monoclonal antibody against ß7 integrin that targets both α4ß7 and αEß7. We evaluated the prevalence and localization of αE+ cells as well as total αE gene expression in healthy and inflammatory bowel disease patients. METHODS: αE+ cells were identified in ileal and colonic biopsies by immunohistochemistry and counted using an automated algorithm. Gene expression was assessed by quantitative reverse-transcriptase polymerase chain reaction. RESULTS: In both healthy and inflammatory bowel disease patients, significantly more αE+ cells were present in the epithelium and lamina propria of ileal compared with colonic biopsies. αE gene expression levels were also significantly higher in ileal compared with colonic biopsies. Paired biopsies from the same patient showed moderate correlation of αE expression between the ileum and colon. Inflammation did not affect αE expression, and neither endoscopy nor histology scores correlated with αE gene expression. αE expression was not different between patients based on concomitant medication use except 5-aminosalicylic acid. CONCLUSION: αE+ cells, which have been shown to have inflammatory potential, are increased in the ileum in comparison with the colon in both Crohn's disease and ulcerative colitis, as well as in healthy subjects. In inflammatory bowel disease patients, αE levels are stable, regardless of inflammatory status or most concomitant medications, which could support its use as a biomarker for etrolizumab.


Asunto(s)
Colon , Íleon , Enfermedades Inflamatorias del Intestino , Adulto , Antígenos CD , Biopsia/métodos , Colon/inmunología , Colon/patología , Correlación de Datos , Endoscopía del Sistema Digestivo/métodos , Femenino , Perfilación de la Expresión Génica , Humanos , Íleon/inmunología , Íleon/patología , Inmunohistoquímica , Inflamación/inmunología , Inflamación/patología , Enfermedades Inflamatorias del Intestino/inmunología , Enfermedades Inflamatorias del Intestino/patología , Cadenas alfa de Integrinas , Mucosa Intestinal/inmunología , Mucosa Intestinal/patología , Masculino , Persona de Mediana Edad
18.
Chem Commun (Camb) ; 49(44): 5049-51, 2013 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-23625074

RESUMEN

The [(Cl3Ga)3N](3-) (1) anion, which is the sole example of a discrete chemical species containing a µ3-N atom bound only to gallium, was isolated from the reaction of Cl3Ga·N(SnMe3)3 with [GaCl4](1-). The analogous reaction of [GaCl4](1-) with (Me3Sn)3N afforded [(Cl3Ga)2NSnMe3](2-) (2), which is also an unprecedented anion containing a single µ3-N atom bound to only gallium and tin.

20.
Dalton Trans ; (23): 2829-34, 2006 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-16751891

RESUMEN

The diamagnetic complex [Re(CN)8]3- is shown to react with Mn2+ ions in methanol to generate the centered, face-capped octahedral cluster (CH3OH)24Mn9Re6(CN)48, which is structurally analogous to (CH3OH)24Mn9Mo6(CN)48. Related reactions involving stoichiometric mixtures of octacyanometalate complexes generate the substituted species (CH3OH)24Mn9Mo5Re(CN)48, (CH3OH)24Co9Mo5Re(CN)48, (CH3OH)24Mn9Mo3Re3(CN)48, (CH3OH)24Mn9W5Re(CN)48 and (CH3OH)24Co9W5Re(CN)48, in which the O(h) symmetry of the cluster core is broken. Reassessment of the magnetic properties of the Mn9Mo6(CN)48 cluster confirm that it possesses a ground state spin of S = 39/2, but does not exhibit single-molecule-magnet behavior. Lowering the symmetry of the molecule by substitutions of ReV at one or three of the MoV sites does not lead to an overall increase in the magnetic anisotropy, as probed by ac magnetic susceptibility measurements. A similar result occurs for the other substituted species, with the important exception of the new single-molecule magnet (CH3OH)24Co9W5Re(CN)48, for which the spin reversal barrier is significantly reduced relative to that observed previously in (CH3OH)24Co9W6(CN)48.

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