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1.
Rheumatology (Oxford) ; 62(6): 2325-2329, 2023 06 01.
Article in English | MEDLINE | ID: mdl-36651676

ABSTRACT

OBJECTIVES: Nailfold capillaroscopy is key to timely diagnosis of SSc, but is often not used in rheumatology clinics because the images are difficult to interpret. We aimed to develop and validate a fully automated image analysis system to fill this gap. METHODS: We mimicked the image interpretation strategies of SSc experts, using deep learning networks to detect each capillary in the distal row of vessels and make morphological measurements. We combined measurements from multiple fingers to give a subject-level probability of SSc.We trained the system using high-resolution images from 111 subjects (group A) and tested on images from subjects not in the training set: 132 imaged at high-resolution (group B); 66 imaged with a low-cost digital microscope (group C). Roughly half of each group had confirmed SSc, and half were healthy controls or had primary RP ('normal'). We also estimated the performance of SSc experts. RESULTS: We compared automated SSc probabilities with the known clinical status of patients (SSc versus 'normal'), generating receiver operating characteristic curves (ROCs). For group B, the area under the ROC (AUC) was 97% (94-99%) [median (90% CI)], with equal sensitivity/specificity 91% (86-95%). For group C, the AUC was 95% (88-99%), with equal sensitivity/specificity 89% (82-95%). SSc expert consensus achieved sensitivity 82% and specificity 73%. CONCLUSION: Fully automated analysis using deep learning can achieve diagnostic performance at least as good as SSc experts, and is sufficiently robust to work with low-cost digital microscope images.


Subject(s)
Deep Learning , Scleroderma, Systemic , Humans , Nails/diagnostic imaging , Nails/blood supply , Sensitivity and Specificity , ROC Curve , Capillaries/diagnostic imaging , Microscopic Angioscopy/methods
2.
Exp Eye Res ; 232: 109508, 2023 07.
Article in English | MEDLINE | ID: mdl-37230289

ABSTRACT

Emmetropization can be altered by temporal visual stimulation and the spectral properties of the visual environment. The goal of the current experiment is to test the hypothesis that there is an interaction between these properties and autonomic innervation. For that purpose, selective lesions of the autonomic nervous system were performed in chickens followed by temporal stimulation. Parasympathetic lesioning involved transection of both the ciliary ganglion and the pterygopalatine ganglion (PPG_CGX; n = 38), while sympathetic lesioning involved transection of the superior cervical ganglion (SCGX; n = 49). After one week of recovery, chicks were then exposed to temporally modulated light (3 days, 2 Hz, Mean: 680 lux) that was either achromatic (with blue [RGB], or without blue [RG]), or chromatic (with blue [B/Y] or without blue [R/G]). Control birds with lesions, or unlesioned, were exposed to white [RGB] or yellow [RG] light. Ocular biometry and refraction (Lenstar and a Hartinger refractometer) was measured before and after exposure to light stimulation. Measurements were statistically analyzed for the effects of a lack of autonomic input and the type of temporal stimulation. In PPG_CGX lesioned eyes, there was no effect of the lesions one-week post-surgery. However, after exposure to achromatic modulation, the lens thickened (with blue) and the choroid thickened (without blue) but there was no effect on axial growth. Chromatic modulation thinned the choroid with R/G. In the SGX lesioned eye, there was no effect of the lesion 1-week post-surgery. However, after exposure to achromatic modulation (without blue), the lens thickened and there was a reduction in vitreous chamber depth and axial length. Chromatic modulation caused a small increase in vitreous chamber depth with R/G. Both autonomic lesion and visual stimulation were necessary to affect the growth of ocular components. The bidirectional responses observed in axial growth and in choroidal changes suggest that autonomic innervation combined with spectral cues from longitudinal chromatic aberration may provide a mechanism for homeostatic control of emmetropization.


Subject(s)
Chickens , Lens, Crystalline , Animals , Chickens/physiology , Eye , Refraction, Ocular , Choroid/pathology , Vision, Ocular
3.
Proc Natl Acad Sci U S A ; 117(22): 12481-12485, 2020 06 02.
Article in English | MEDLINE | ID: mdl-32424092

ABSTRACT

Extensive and recurrent severe wildfires present complex challenges for policy makers. This is highlighted by extensive wildfires around the globe, ranging from western North America and Europe to the Amazon and Arctic, and, most recently, the 2019-2020 fires in eastern Australia. In many jurisdictions, discussions after significant losses of life, property, and vegetation are sometimes conducted in the absence of nuanced debates about key aspects of climate, land, and resource management policy. Improved insights that have significant implications for policies and management can be derived from spatial and temporal analyses of fires. Here, we demonstrate the importance of such analyses using a case study of large-scale, recurrent severe wildfires over the past two decades in the Australian state of Victoria. We overlaid the location of current and past fires with ecosystem types, land use, and conservation values. Our analyses revealed 1) the large spatial extent of current fires, 2) the extensive and frequent reburning of recently and previously fire-damaged areas, 3) the magnitude of resource loss for industries such as timber and pulplog production, and 4) major impacts on high conservation value areas and biodiversity. These analyses contain evidence to support policy reforms that alter the mode of forest management, target the protection of key natural assets including unburnt areas, manage repeatedly damaged and potentially collapsed ecosystems, and expand the conservation estate. Our mapping approach should have applicability to other environments subject to large-scale fires, although the particular details of policy reforms would be jurisdiction, ecosystem, and context specific.

4.
Rheumatology (Oxford) ; 62(1): 335-340, 2022 12 23.
Article in English | MEDLINE | ID: mdl-35640131

ABSTRACT

OBJECTIVES: To identify barriers to the use of nailfold capillaroscopy as a diagnostic tool for patients presenting with Raynaud's phenomenon in UK rheumatology centres and to obtain rheumatologists' views on a proposed internet-based standardized system for clinical reporting of nailfold capillaroscopy images. METHODS: An online survey was developed using expert opinion from clinicians, scientists and health service researchers. The survey was piloted and sent to UK-based rheumatologists using established electronic mailing lists between October 2020 and March 2021. Survey data were analysed using descriptive statistics. RESULTS: A total of 104 rheumatologists representing rheumatology centres across the UK responded to the survey. Wide variations in terms of workloads and practices were described. Thirty-four (33%) respondents reported using nailfold capillaroscopy only at their own centre, 33 (32%) referred to other centres, 9 (9%) did both and 28 (27%) did not use capillaroscopy at all. Of the 43 respondents using capillaroscopy on site, 25 (58%) used either a dermatoscope or universal serial bus microscope and 9 (21%) used videocapillaroscopy. Among the 61 respondents not undertaking capillaroscopy on site, barriers included lack of equipment (85%), lack of experience in acquiring images (69%) and lack of expertise in interpreting images (67%). Sixty-six respondents (63%) expressed interest in an internet-based, standardized automated system for reporting images. CONCLUSION: Most UK rheumatologists currently do not perform nailfold capillaroscopy on site. An internet-based nailfold capillaroscopy system for use with low-cost microscopes as well as with videocapillaroscopy could help increase uptake of capillaroscopy and thereby facilitate early diagnosis of SSc across the UK.


Subject(s)
Raynaud Disease , Scleroderma, Systemic , Humans , Microscopic Angioscopy/methods , Rheumatologists , Raynaud Disease/diagnosis , Surveys and Questionnaires , United Kingdom , Nails/diagnostic imaging , Capillaries
5.
Exp Eye Res ; 217: 108964, 2022 04.
Article in English | MEDLINE | ID: mdl-35120871

ABSTRACT

Emmetropization is affected by the temporal parameters of visual stimulation and the spectral composition of light, as well as by autonomic innervation. The goal of the current experiments is to test the hypothesis that different types of visual stimulation interact with ocular innervation in the process of emmetropization. For that, selective lesions of the autonomic nervous system were performed in chickens: involving transection of parasympathetic input to the eye from either the ciliary ganglion, innervating accommodation and pupil responses (CGX; n = 32), or pterygopalatine ganglion, innervating choroidal blood vessels and cornea (PPGX; n = 26). After 1 week of recovery, chicks were exposed to sinusoidally modulated light (3 days, 2 Hz, 680 lux) that was either achromatic (black to white [RGB], or black to yellow [RG]), or chromatic (blue to yellow [B/Y] or red to green [R/G]). Exposure to light stimulation was followed by ocular biometry (Lenstar and a Hartinger refractometer). Surgical conditions revealed a small reduction in anterior chamber depth with CGX but no other significant changes in ocular biometry/refraction under standard light conditions. With RGB achromatic stimulation, CGX eyes produced an effect on ocular components, with a further reduction in anterior chamber depth and an increase in vitreous chamber depth, while RG stimulation showed no effect. No effect was detected in PPGX under both achromatic protocols. With chromatic stimulation, CGX with R/G modulation increased eye length, while PPGX with B/Y modulation decreased eye length. We conclude that the two different types of parasympathetic innervations have antagonistic effects on eye growth and the anterior eye when challenged with the appropriate stimulus, with possible implications for the role of choroidal blood flow in emmetropization.


Subject(s)
Chickens , Emmetropia , Accommodation, Ocular , Animals , Chickens/physiology , Choroid/pathology , Eye , Refraction, Ocular
6.
Rheumatology (Oxford) ; 60(5): 2054-2065, 2021 05 14.
Article in English | MEDLINE | ID: mdl-33493310

ABSTRACT

We review the exciting potential (and challenges) of quantitative nailfold capillaroscopy, focusing on its role in systemic sclerosis. Quantifying abnormality, including automated analysis of nailfold images, overcomes the subjectivity of qualitative/descriptive image interpretation. First we consider the rationale for quantitative analysis, including the potential for precise discrimination between normal and abnormal capillaries and for reliable measurement of disease progression and treatment response. We discuss nailfold image acquisition and interpretation, and describe how early work on semi-quantitative and quantitative analysis paved the way for semi-automated and automated analysis. Measurement of red blood cell velocity is described briefly. Finally we give a personal view on 'next steps'. From a clinical perspective, increased uptake of nailfold capillaroscopy by general rheumatologists could be achieved via low-cost hand-held devices with cloud-based automated analysis. From a research perspective, automated analysis could facilitate large-scale prospective studies using capillaroscopic parameters as possible biomarkers of systemic sclerosis-spectrum disorders.


Subject(s)
Microscopic Angioscopy , Nails/blood supply , Scleroderma, Systemic/physiopathology , Disease Progression , Humans , Scleroderma, Systemic/diagnostic imaging
7.
Rheumatology (Oxford) ; 60(8): 3862-3867, 2021 08 02.
Article in English | MEDLINE | ID: mdl-33232464

ABSTRACT

OBJECTIVES: Universal serial bus (USB) microscopy (capillaroscopy) could provide all rheumatologists with an easy-to-use, low-cost tool to examine the nailfold capillaries to facilitate early diagnosis of SSc. The objectives of this pilot study were to examine the feasibility of acquiring and analysing images using USB microscopy and to compare results to videocapillaroscopy. METHODS: Videocapillaroscopy and USB microscope images were obtained from the right and left ring fingers of 20 patients with SSc and 20 healthy control subjects. In addition to generating panoramic capillary mosaics from across the whole nailbed, custom software made fully automated measurements of vessel structure including capillary width and density. The area under the receiver operating characteristic curve (AZ) was used to measure separation between the SSc and healthy control groups. RESULTS: High quality images could be generated from the USB microscope, with reconstructed USB images comparing very favourably with those obtained using videocapillaroscopy. Using USB microscope images, the receiver operating characteristic curve AZ for group separation based on mean width was 0.81 (standard error 0.120) compared with 0.81 (standard error 0.095) for the (gold standard) videocapillaroscopy. The receiver operating characteristic curve AZ for group separation using capillary density was 0.48 (standard error 0.16) for USB microscope images, compared with 0.70 (standard error 0.10) for videocapillaroscopy. CONCLUSION: In this pilot study, USB capillaroscopy was able to discriminate between patients with SSc and controls as well as videocapillaroscopy on the basis of capillary width. This finding, together with the high-quality images obtained, highlights the potential of USB capillaroscopy as a low-cost, easily accessible clinical and research tool.


Subject(s)
Microscopic Angioscopy/instrumentation , Scleroderma, Systemic/diagnostic imaging , Adult , Aged , Case-Control Studies , Feasibility Studies , Female , Humans , Male , Microscopic Angioscopy/economics , Microscopic Angioscopy/methods , Middle Aged , Pilot Projects
8.
Neurourol Urodyn ; 40(2): 714-721, 2021 02.
Article in English | MEDLINE | ID: mdl-33508155

ABSTRACT

AIMS: Sacral neuromodulation (SNM) is a guideline-recommended treatment with proven therapeutic benefit for urinary urgency incontinence (UUI) patients. The Axonics® System is the first Food and Drug Administration-approved rechargeable SNM system and is designed to deliver therapy for a minimum of 15 years. The ARTISAN-SNM study was designed to evaluate UUI participants treated with the Axonics System. Two-year follow-up results are presented. METHODS: One hundred and twenty-nine UUI participants underwent implantation with the Axonics System. Therapeutic response rate, participant quality of life (QoL), and satisfaction were determined using 3-day voiding diaries, ICIQ-OABqol, and satisfaction questionnaires. Participants were considered responders if they had a 50% or greater reduction in UUI episodes post-treatment. As-treated and Completers analyses are presented. RESULTS: At 2 years, 93% of the participants (n = 121 Completers at 2 years) were therapy responders, of which 82% achieved ≥ 75% reduction in UUI episodes and 37% were dry (100% reduction). Daily UUI episodes reduced from 5.6 ± 0.3 at baseline to 1.0 ± 0.2 at 2 years. Statistically significant improvements in ICIQ-OABqol were reported. All participants were able to recharge their device and 94% of participants reported that the recharging frequency and duration were acceptable. Participant demographics nor condition severity were correlated with clinical outcomes or recharging experience. No unanticipated or serious device-related adverse events occurred. CONCLUSIONS: At 2 years, participants treated with the Axonics System demonstrated sustained safety and efficacy, high levels of satisfaction with therapy and recharging. Participant-related factors were not associated with efficacy or recharging outcomes, indicating the reported results are applicable to a diverse population.


Subject(s)
Electric Stimulation Therapy/methods , Quality of Life/psychology , Sacrum/physiopathology , Urinary Incontinence, Urge/therapy , Female , Follow-Up Studies , Humans , Male , Time Factors , Treatment Outcome
9.
J Urol ; 203(1): 185-192, 2020 01.
Article in English | MEDLINE | ID: mdl-31347955

ABSTRACT

PURPOSE: Sacral neuromodulation is a guideline recommended treatment of urinary dysfunction and fecal incontinence in patients in whom conservative treatments have failed. Historically sacral neuromodulation has been delivered using a nonrechargeable device with an average life span of 4.4 years. Surgery is required to replace the implanted neurostimulator due to battery depletion. Implantation of a long-lived implanted neurostimulator can eliminate the need for replacement surgeries, potentially reducing patient surgical risks and health care costs. The Axonics r-SNM System™ is a miniaturized, rechargeable sacral neuromodulation system designed to deliver therapy for at least 15 years. The ARTISAN-SNM (Axonics® Sacral Neuromodulation System for Urinary Urgency Incontinence Treatment) study is a pivotal study using rechargeable sacral neuromodulation therapy to treat urinary urgency incontinence. Six-month results are presented. MATERIALS AND METHODS: A total of 129 eligible patients with urinary urgency incontinence were treated. All participants were implanted with a tined lead and the rechargeable sacral neuromodulation system in a nonstaged procedure. Efficacy data were collected using a 3-day bladder diary, the validated ICIQ-OABqol (International Consultation on Incontinence Questionnaire Overactive Bladder quality of life) questionnaire and a participant satisfaction questionnaire. Therapy responders were identified as participants with a 50% or greater reduction in urinary urgency incontinence episodes compared to baseline. We performed an as-treated analysis in all implanted participants. RESULTS: At 6 months 90% of participants were therapy responders. The mean ± SE number of urinary urgency incontinence episodes per day was reduced from 5.6 ± 0.3 at baseline to 1.3 ± 0.2. Participants experienced a clinically meaningful 34-point improvement on the ICIQ-OABqol questionnaire. There were no serious device related adverse events. CONCLUSIONS: The Axonics r-SNM System is safe and effective with 90% of participants experiencing clinically and statistically significant improvements in urinary urgency incontinence symptoms.


Subject(s)
Implantable Neurostimulators , Urinary Incontinence, Urge/therapy , Adult , Aged , Aged, 80 and over , Electric Power Supplies , Female , Humans , Male , Middle Aged , Patient Satisfaction , Quality of Life , Sacrum , Urinary Incontinence, Urge/physiopathology
10.
Neurourol Urodyn ; 39(5): 1482-1488, 2020 06.
Article in English | MEDLINE | ID: mdl-32339339

ABSTRACT

AIMS: Sacral neuromodulation (SNM) is a guideline-recommended treatment for voiding dysfunction including urgency, urge incontinence, and nonobstructive retention as well as fecal incontinence. The Axonics® System is a miniaturized, rechargeable SNM system designed to provide therapy for at least 15 years, which is expected to significantly reduce revision surgeries as it will not require replacement as frequently as the non-rechargeable SNM system. The ARTISAN-SNM study is a pivotal study designed to treat patients with urinary urgency incontinence (UUI). Clinical results at 1-year are presented. METHODS: A total of 129 eligible UUI patients were treated. All participants were implanted with a quadripolar tined lead and neurostimulator in a single procedure. Efficacy data were collected using a 3-day bladder diary, a validated quality of life questionnaire (ICIQ-OABqol), and a participant satisfaction questionnaire. Therapy responders were defined as participants with ≥50% reduction in UUI episodes compared to baseline. Data were analyzed on all 129 participants. RESULTS: At 1 year, 89% of the participants were therapy responders. The average UUI episodes per day reduced from 5.6 ± 0.3 at baseline to 1.4 ± 0.2. Participants experienced an overall clinically meaningful improvement of 34 points on the ICIQ-OABqol questionnaire. All study participants (100%) were able to recharge their device at 1 year, and 96% of participants reported that the frequency and duration of recharging was acceptable. There were no serious device-related adverse events. CONCLUSIONS: The Axonics System is safe and effective at 1 year, with 89% of participants experiencing clinically and statistically significant improvements in UUI symptoms.


Subject(s)
Electric Stimulation Therapy/instrumentation , Electrodes, Implanted , Lumbosacral Plexus/surgery , Urinary Incontinence, Urge/therapy , Urologic Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , Electric Stimulation Therapy/adverse effects , Electric Stimulation Therapy/methods , Electrodes, Implanted/adverse effects , Fecal Incontinence/complications , Fecal Incontinence/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Satisfaction , Prostheses and Implants , Quality of Life , Surveys and Questionnaires , Treatment Outcome , Urinary Incontinence, Urge/psychology , Urinary Retention/complications , Urinary Retention/therapy , Young Adult
11.
Nucleic Acids Res ; 46(21): 11592-11604, 2018 11 30.
Article in English | MEDLINE | ID: mdl-30256975

ABSTRACT

RNA G-quadruplexes (rG4s) are secondary structures in mRNAs known to influence RNA post-transcriptional mechanisms thereby impacting neurodegenerative disease and cancer. A detailed knowledge of rG4-protein interactions is vital to understand rG4 function. Herein, we describe a systematic affinity proteomics approach that identified 80 high-confidence interactors that assemble on the rG4 located in the 5'-untranslated region (UTR) of the NRAS oncogene. Novel rG4 interactors included DDX3X, DDX5, DDX17, GRSF1 and NSUN5. The majority of identified proteins contained a glycine-arginine (GAR) domain and notably GAR-domain mutation in DDX3X and DDX17 abrogated rG4 binding. Identification of DDX3X targets by transcriptome-wide individual-nucleotide resolution UV-crosslinking and affinity enrichment (iCLAE) revealed a striking association with 5'-UTR rG4-containing transcripts which was reduced upon GAR-domain mutation. Our work highlights hitherto unrecognized features of rG4 structure-protein interactions that highlight new roles of rG4 structures in mRNA post-transcriptional control.


Subject(s)
DEAD-box RNA Helicases/metabolism , G-Quadruplexes , Genes, ras/genetics , 5' Untranslated Regions , Cytoplasm/genetics , Cytoplasm/metabolism , DEAD-box RNA Helicases/genetics , HeLa Cells , Humans , Protein Domains , RNA, Messenger/genetics , RNA, Messenger/metabolism , Reproducibility of Results
12.
J Immunol ; 198(10): 3989-3998, 2017 05 15.
Article in English | MEDLINE | ID: mdl-28320831

ABSTRACT

Staphylococcal enterotoxin B (SEB) is a bacterial superantigen that binds the receptors in the APC/T cell synapse and causes increased proliferation of T cells and a cytokine storm syndrome in vivo. Exposure to the toxin can be lethal and cause significant pathology in humans. The lack of effective therapies for SEB exposure remains an area of concern, particularly in scenarios of acute mass casualties. We hypothesized that blockade of the T cell costimulatory signal by the CTLA4-Ig synthetic protein (abatacept) could prevent SEB-dependent pathology. In this article, we demonstrate mice treated with a single dose of abatacept 8 h post SEB exposure had reduced pathology compared with control SEB-exposed mice. SEB-exposed mice showed significant reductions in body weight between days 4 and 9, whereas mice exposed to SEB and also treated with abatacept showed no weight loss for the duration of the study, suggesting therapeutic mitigation of SEB-induced morbidity. Histopathology and magnetic resonance imaging demonstrated that SEB mediated lung damage and edema, which were absent after treatment with abatacept. Analysis of plasma and lung tissues from SEB-exposed mice treated with abatacept demonstrated significantly lower levels of IL-6 and IFN-γ (p < 0.0001), which is likely to have resulted in less pathology. In addition, exposure of human and mouse PBMCs to SEB in vitro showed a significant reduction in levels of IL-2 (p < 0.0001) after treatment with abatacept, indicating that T cell proliferation is the main target for intervention. Our findings demonstrate that abatacept is a robust and potentially credible drug to prevent toxic effects from SEB exposure.


Subject(s)
Abatacept/therapeutic use , Antigen-Presenting Cells/immunology , Enterotoxins/toxicity , Staphylococcal Infections/drug therapy , T-Lymphocytes/immunology , Abatacept/administration & dosage , Abatacept/pharmacology , Animals , Body Weight , Cytokines/immunology , Enterotoxins/pharmacology , Humans , Interferon-gamma/blood , Interleukin-2/biosynthesis , Interleukin-2/immunology , Interleukin-6/blood , Lung/pathology , Mice , Monocytes/immunology , Staphylococcal Infections/immunology
14.
Microvasc Res ; 118: 173-177, 2018 07.
Article in English | MEDLINE | ID: mdl-29605552

ABSTRACT

OBJECTIVES: Despite increasing interest in nailfold capillaroscopy, objective measures of capillary structure and blood flow have been little studied. We aimed to test the hypothesis that structural measurements, capillary flow, and a combined measure have the predictive power to separate patients with systemic sclerosis (SSc) from those with primary Raynaud's phenomenon (PRP) and healthy controls (HC). METHODS: 50 patients with SSc, 12 with PRP, and 50 HC were imaged using a novel capillaroscopy system that generates high-quality nailfold images and provides fully-automated measurements of capillary structure and blood flow (capillary density, mean width, maximum width, shape score, derangement and mean flow velocity). Population statistics summarise the differences between the three groups. Areas under ROC curves (AZ) were used to measure classification accuracy when assigning individuals to SSc and HC/PRP groups. RESULTS: Statistically significant differences in group means were found between patients with SSc and both HC and patients with PRP, for all measurements, e.g. mean width (µm) ±â€¯SE: 15.0 ±â€¯0.71, 12.7 ±â€¯0.74 and 11.8 ±â€¯0.23 for SSc, PRP and HC respectively. Combining the five structural measurements gave better classification (AZ = 0.919 ±â€¯0.026) than the best single measurement (mean width, AZ = 0.874 ±â€¯0.043), whilst adding flow further improved classification (AZ = 0.930 ±â€¯0.024). CONCLUSIONS: Structural and blood flow measurements are both able to distinguish patients with SSc from those with PRP/HC. Importantly, these hold promise as clinical trial outcome measures for treatments aimed at improving finger blood flow or microvascular remodelling.


Subject(s)
Capillaries/pathology , Capillaries/physiopathology , Microcirculation , Microscopic Angioscopy/methods , Nails/blood supply , Raynaud Disease/diagnosis , Scleroderma, Systemic/diagnosis , Adult , Aged , Aged, 80 and over , Automation , Blood Flow Velocity , Case-Control Studies , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Raynaud Disease/pathology , Raynaud Disease/physiopathology , Regional Blood Flow , Reproducibility of Results , Scleroderma, Systemic/pathology , Scleroderma, Systemic/physiopathology , Young Adult
15.
AIDS Care ; 30(12): 1586-1594, 2018 12.
Article in English | MEDLINE | ID: mdl-30114950

ABSTRACT

Our aim was to review the evidence related to the impact of co-morbid severe mental illness SMI (schizophrenia, schizoaffective and bipolar disorder) and HIV upon mental health, physical health and social outcomes. We carried out a systematic review of scientific evidence, searching online databases (MEDLINE, PsychInfo, EMBASE, Global Health and Scopus) for studies between 1983 and 2017 using search terms for SMI and HIV. Studies were included if they compared health or social outcomes between people living with co-morbid SMI and HIV and people living with either: a) HIV only; or b) SMI only. Outcomes of interest were: mortality, health service use, HIV/SMI-related, co-morbidities, and social outcomes. We identified 20 studies which met our inclusion criteria. Although studies were generally high quality, there was heterogeneity in both selection of outcomes and choice of measure. It was therefore difficult to draw strong conclusions regarding the impact of co-morbid SMI and HIV across any outcome. We found little evidence that co-morbid SMI and HIV were associated with lower levels of treatment, care or poorer clinical outcomes compared to people living with SMI or HIV alone. However, mortality appeared to be higher among the co-morbid group in three out of four analyses identified. Physical and mental co-morbidities and social outcomes were rarely measured. Limited data mean that the impact of co-morbid SMI and HIV is uncertain. In order to develop evidence-based guidelines, there is an urgent need for further research. This may be realized by exploring opportunities for using data from existing cohort studies, routinely collected data and data linkage to investigate important questions relating to this neglected but potentially important area.


Subject(s)
HIV Infections/complications , Mental Disorders/complications , Comorbidity , HIV Infections/physiopathology , HIV Infections/psychology , Humans , Mental Disorders/physiopathology , Mental Disorders/psychology
16.
Thorax ; 72(8): 760-762, 2017 08.
Article in English | MEDLINE | ID: mdl-28265032

ABSTRACT

Hyperpolarised 3He ventilation-MRI, anatomical lung MRI, lung clearance index (LCI), low-dose CT and spirometry were performed on 19 children (6-16 years) with clinically stable mild cystic fibrosis (CF) (FEV1>-1.96), and 10 controls. All controls had normal spirometry, MRI and LCI. Ventilation-MRI was the most sensitive method of detecting abnormalities, present in 89% of patients with CF, compared with CT abnormalities in 68%, LCI 47% and conventional MRI 22%. Ventilation defects were present in the absence of CT abnormalities and in patients with normal physiology, including LCI. Ventilation-MRI is thus feasible in young children, highly sensitive and provides additional information about lung structure-function relationships.


Subject(s)
Cystic Fibrosis/diagnosis , Early Diagnosis , Lung/physiopathology , Magnetic Resonance Imaging/methods , Respiration, Artificial/methods , Adolescent , Child , Cystic Fibrosis/physiopathology , Female , Forced Expiratory Volume/physiology , Humans , Lung/diagnostic imaging , Male , Spirometry/methods , Tomography, X-Ray Computed
17.
J Surg Res ; 209: 112-121, 2017 03.
Article in English | MEDLINE | ID: mdl-28032547

ABSTRACT

BACKGROUND: Intestinal obstruction in newborns is associated with intestinal motility disorders after surgery. Alterations in the enteric nervous system (ENS) might cause abnormal peristalsis, which may then result in intestinal motility disorders. We aimed to quantify alterations in the myenteric plexus after a ligation and to test if these alterations were reversible. METHODS: Small intestines of chicken embryos were ligated in ovo at embryonic day (ED) 11 for either 4 d (ED 11-15) or 8 d (ED 11-19). Both treated groups and control group were sacrificed and intestinal segments examined by means of both light and electron microscopy. RESULTS: The number of proximal myenteric ganglia increased (ED 19, 30.7 ± 3.16 versus 23.1 ± 2.03; P < 0.001) in the 8-d ligature group but had values similar to the control group in the 4-d ligature group. The size distribution was skewed toward small ganglia in the 8-d ligature group (ED 19, 83.71 ± 11.60% versus 3.88 ± 4.74% in the control group; P < 0.001) but comparable with the control group in the 4-d ligature group. Subcellular alterations in the 4-d ligature group were reversible. CONCLUSIONS: The pathologic alterations in the ENS were fully reversible in the 4-d ligature group. This reversibility might be linked to the degree of immaturity of the ENS.


Subject(s)
Enteric Nervous System/embryology , Nerve Regeneration , Animals , Chick Embryo , Enteric Nervous System/ultrastructure
18.
Rapid Commun Mass Spectrom ; 31(15): 1239-1249, 2017 Aug 15.
Article in English | MEDLINE | ID: mdl-28494122

ABSTRACT

RATIONALE: Coal tars are a mixture of organic and inorganic compounds that were produced as a by-product from the manufactured gas and coke making industries. The composition of the tar produced varies depending on many factors; these include the temperature of production and the type of retort used. As different production processes produce different tars, a comprehensive database of the compounds present within coal tars from different production processes is a valuable resource. Such a database would help to understand how their chemical properties differ and what hazards the compounds present within these tars might pose. This study focuses on the aliphatic and aromatic compounds present in a database of 16 different tars from five different production processes. METHODS: Samples of coal tar were extracted using accelerated solvent extraction (ASE) and derivatised post-extraction using N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA) with 1% trimethylchlorosilane (TMCS). The derivatised samples were analysed using two-dimensional gas chromatography combined with time-of-flight mass spectrometry (GCxGC/TOFMS). RESULTS: A total of 198 individual aliphatic and 951 individual aromatic compounds were detected within 16 tar samples produced by five different production processes. The polycyclic aromatic hydrocarbon (PAH) content of coal tars varies greatly depending on the production process used to obtain the tars and this is clearly demonstrated within the results. The aliphatic composition of the tars provided an important piece of analytical information that would have otherwise been missed with the detection of petrogenic compounds such as alkyl cyclohexanes. CONCLUSIONS: The aromatic compositions of the tar samples varied greatly between the different production processes investigated and useful analytical information was obtained about the individual production process groups. Alkyl cyclohexanes were detected in all samples from sites known to operate Carbureted Water Gas plants and not detected in those that did not. This suggests that petrogenic material may be expected at many UK gaswork sites.

19.
Rapid Commun Mass Spectrom ; 31(15): 1231-1238, 2017 Aug 15.
Article in English | MEDLINE | ID: mdl-28488792

ABSTRACT

RATIONALE: Coal tars are a mixture of organic and inorganic compounds that were by-products from the manufactured gas and coke making industries. Different manufacturing processes have resulted in the production of distinctly different tar compositions. This study presents a comprehensive database of compounds produced using two-dimensional gas chromatography combined with time-of-flight mass spectrometry (GCxGC/TOFMS), analysing 16 tar samples produced by five distinct production processes. METHODS: Samples of coal tar were extracted using accelerated solvent extraction (ASE) and derivatised post-extraction using N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA) with 1% trimethylchlorosilane (TMCS). The derivatised samples were analysed using two-dimensional gas chromatography combined with time-of-flight mass spectrometry (GCxGC/TOFMS). RESULTS: A total of 16 tar samples originating from five different production processes: Low Temperature Horizontal Retorts, Horizontal Retorts, Vertical Retorts, Carbureted Water Gas and Coke Ovens, were analysed. A total of 2369 unique compounds were detected with 948 aromatic compounds, 196 aliphatic compounds, 380 sulfur-containing compounds, 209 oxygen-containing compounds, 262 nitrogen-containing compounds and 15 mixed heterocycles. Derivatisation allowed the detection of 359 unique compounds, the majority in the form of hydroxylated polycyclic aromatic hydrocarbons, many of which would not have been detected without derivatisation. Of the 2369 unique compounds detected, 173 were found to be present within all samples. CONCLUSIONS: A unique comprehensive database of compounds detected within 16 tar samples from five different production processes was produced. The 173 compounds identified within every sample may be of particular importance from a regulatory standpoint. This initial study indicates that different production processes produce tars with different chemical signatures and it can be further expanded upon by in-depth analysis of the different compound types. The number of compounds presented within this database clearly demonstrates the analytical power of GCxGC/TOFMS.

20.
Rapid Commun Mass Spectrom ; 31(15): 1250-1260, 2017 Aug 15.
Article in English | MEDLINE | ID: mdl-28514513

ABSTRACT

RATIONALE: Coal tars are a mixture of organic and inorganic compounds that were by-products from the manufactured gas and coke making industries. The tar compositions varied depending on many factors such as the temperature of production and the type of retort used. For this reason a comprehensive database of the compounds found in different tar types is of value to understand both how their compositions differ and what potential chemical hazards are present. This study focuses on the heterocyclic and hydroxylated compounds present in a database produced from 16 different tars from five different production processes. METHODS: Samples of coal tar were extracted using accelerated solvent extraction (ASE) and derivatized post-extraction using N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA) with 1% trimethylchlorosilane (TMCS). The derivatized samples were analysed using two-dimensional gas chromatography combined with time-of-flight mass spectrometry (GCxGC/TOFMS). RESULTS: A total of 865 heterocyclic compounds and 359 hydroxylated polycyclic aromatic hydrocarbons (PAHs) were detected in 16 tar samples produced by five different processes. The contents of both heterocyclic and hydroxylated PAHs varied greatly with the production process used, with the heterocyclic compounds giving information about the feedstock used. Of the 359 hydroxylated PAHs detected the majority would not have been be detected without the use of derivatization. CONCLUSIONS: Coal tars produced using different production processes and feedstocks yielded tars with significantly different heterocyclic and hydroxylated contents. The concentrations of the individual heterocyclic compounds varied greatly even within the different production processes and provided information about the feedstock used to produce the tars. The hydroxylated PAH content of the samples provided important analytical information that would otherwise not have been obtained without the use of derivatization and GCxGC/TOFMS.

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