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1.
Nutr Metab Cardiovasc Dis ; 22(12): 1024-30, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21917432

RESUMO

BACKGROUND AND AIMS: A recent genome-wide association study identified rs2943641C > T, 500 kb from the insulin receptor substrate-1 gene (IRS1), as a type-2 diabetes (T2D) susceptibility locus. We aimed to replicate this association by meta-analysis and examine whether common variants within IRS1, present on the HumanCVD BeadChip, were associated with T2D risk. METHODS AND RESULTS: We genotyped rs2943641 in 2389 prevalent or incident T2D patients and 6494 controls from two prospective and three case studies based in UK and in the European Atherosclerosis Research Study-II (EARSII; n = 714). Thirty-three IRS1 variants had been genotyped in the prospective Whitehall-II study (n = 4752) using the HumanCVD BeadChip. In a fixed-effects meta-analysis of the UK study cohorts rs2943641T allele was associated with 6% lower risk of T2D (p = 0.18), with T-allele carriers having an odds ratio (OR) of 0.89 (95% confidence interval [CI]: 0.80-1.00, p = 0.056) compared to CC subjects. The T-allele was also associated with lower fasting insulin and homeostasis model assessment index of insulin resistance in Whitehall-II and with lower post-load insulin after an oral glucose tolerance test in EARSII (all p < 0.05). None of the IRS1 variants on the chip showed linkage disequilibrium with rs2943641. In silico analysis with follow-up genotyping (total n = 9313) identified that the rare allele of the IRS1 promoter variant rs6725556A > G showed association with reduced T2D risk (OR per G-allele: 0.82, 95%CI: 0.69-0.96, p = 0.015). CONCLUSIONS: We confirm the association of rs2943641T with T2D protection. There is a possible independent effect on risk of a putative IRS1 promoter variant.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/metabolismo , Estudo de Associação Genômica Ampla/métodos , Proteínas Substratos do Receptor de Insulina/genética , Polimorfismo de Nucleotídeo Único , Alelos , Estudos de Casos e Controles , Simulação por Computador , Europa (Continente) , Predisposição Genética para Doença , Genótipo , Teste de Tolerância a Glucose , Homeostase , Humanos , Proteínas Substratos do Receptor de Insulina/metabolismo , Resistência à Insulina/genética , Desequilíbrio de Ligação , Modelos Logísticos , Análise Multivariada , Razão de Chances , Prevalência , Regiões Promotoras Genéticas , Fatores de Risco , População Branca/genética
2.
Nutr Metab Cardiovasc Dis ; 22(5): 417-25, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-21185702

RESUMO

Glutathione peroxidase-1 (GPx-1) is an endogenous anti-oxidant enzyme. The T allele of the GPx-1 rs1050450 (C > T) gene variant is associated with reduced enzyme activity. Our aim was to examine the association between this gene variant and peripheral neuropathy in two cross-sectional samples of subjects with diabetes: (i) 773 Caucasian subjects were genotyped from the UCL Diabetes and Cardiovascular disease Study (UDACS) and (ii) 382 Caucasian subjects from the Ealing Diabetes Study (EDS). Peripheral neuropathy status (and oxidised-LDL [Ox-LDL:LDL] and plasma Total Ant-ioxidant Status [TAOS] in UDACS), were analysed in relation to genotype. We observed that: (i) In UDACS, the odds ratio (OR) for peripheral neuropathy in the T allele carriers compared to the CC genotype was 1.61 [1.10-2.28], p = 0.01. This remained significant after adjustment for other risk factors. Ox-LDL:LDL ratio was significantly elevated in T allele carriers (CC vs. CT/TT: 16.3 ± 2.4 v 18.0 ± 2.9 U/mmol LDL, p = 0.02). (ii) In EDS, the OR for peripheral neuropathy in the T allele carriers compared to the CC genotype was 1.95 [1.11-3.42], p = 0.02. This remained significant after adjustment for other risk factors. In conclusion, we observed a significant association between the T allele and peripheral neuropathy and LDL oxidation. This is the first paper to examine the rs1050450 variant in two samples of Caucasian subjects with diabetes. Prospective analysis of the gene variant is required in diabetic and healthy cohorts with measured plasma markers of oxidative stress to investigate the described association further.


Assuntos
Neuropatias Diabéticas/genética , Glutationa Peroxidase/genética , Polimorfismo de Nucleotídeo Único , Idoso , Alelos , Antioxidantes/análise , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos Transversais , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/etnologia , Neuropatias Diabéticas/metabolismo , Feminino , Frequência do Gene , Estudos de Associação Genética , Glutationa Peroxidase/metabolismo , Humanos , Lipoproteínas LDL/sangue , Londres , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo , População Branca , Glutationa Peroxidase GPX1
3.
Methods Mol Biol ; 787: 145-53, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21898234

RESUMO

The enzyme-linked immunosorbent assay (ELISA) is an immunological technique which is used to determine the presence or quantity of an antigen within a sample. ELISAs rely on the use of at least one antibody (Ab) specific for the antigen being measured. This antibody is covalently linked to an enzyme which is detected through the use of an enzymatic substrate, which can be colorimetric, fluorogenic, or chemiluminescent. The ELISA for Hsp72 described here is a typical indirect sandwich ELISA, which can be used for measuring Hsp72 from cellular/tissue extracts, tissue culture supernatant, and serum. Typically, a 96-well ELISA plate is coated with a specific antibody which captures Hsp72 from the sample, and another antibody specific for a different Hsp72 epitope is used to detect Hsp72. An enzyme-labelled species-specific antibody conjugate is then applied which is consequently detected using a colorimetric enzyme substrate. The quantity of Hsp72 present in the samples is interpolated using a standard curve of known amounts of pure Hsp72.


Assuntos
Ensaio de Imunoadsorção Enzimática/métodos , Proteínas de Choque Térmico HSP72/análise , Animais , Anticorpos/imunologia , Extratos Celulares/química , Extratos Celulares/imunologia , Células Cultivadas , Proteínas de Choque Térmico HSP72/química , Proteínas de Choque Térmico HSP72/imunologia , Proteínas de Choque Térmico HSP72/metabolismo
4.
J Thromb Haemost ; 8(11): 2394-403, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20735728

RESUMO

BACKGROUND: Evidence for the associations of single nucleotide polymorphisms (SNPs) in the F7 gene and factor (F)VII levels and with risk of coronary heart disease (CHD) is inconsistent. We examined whether F7 tagging SNPs (tSNPs) and haplotypes were associated with FVII levels, coagulation activation markers (CAMs) and CHD risk in two cohorts of UK men. METHODS: Genotypes for eight SNPs and baseline levels of FVIIc, FVIIag and CAMs (including FVIIa) were determined in 2773 healthy men from the Second Northwick Park Heart Study (NPHS-II). A second cohort, Whitehall II study (WH-II, n = 4055), was used for replication analysis of FVIIc levels and CHD risk. RESULTS: In NPHS-II the minor alleles of three SNPs (rs555212, rs762635 and rs510317; haplotype H2) were associated with higher levels of FVIIag, FVIIc and FVIIa, whereas the minor allele for two SNPs (I/D323 and rs6046; haplotype H5) was associated with lower levels. Adjusted for classic risk factors, H2 carriers had a CHD hazard ratio of 1.34 [95% confidence interval (CI): 1.12-1.59; independent of FVIIc], whereas H5 carriers had a CHD risk of 1.29 (95% CI: 1.01-1.56; not independent of FVIIc) and significantly lower CAMs. Effects of haplotypes on FVIIc levels were replicated in WH-II, as was the association of H5 with higher CHD risk [pooled-estimate odds ratio (OR) 1.16 (1.00-1.36), P = 0.05], but surprisingly, H2 exhibited a reduced risk for CHD. CONCLUSION: tSNPs in the F7 gene strongly influence FVII levels. The haplotype associated with low FVIIc level, with particularly reduced functional activity, was consistently associated with increased risk for CHD, whereas the haplotype associated with high FVIIc level was not.


Assuntos
Doença das Coronárias/sangue , Doença das Coronárias/genética , Fator VII/genética , Genótipo , Haplótipos , Polimorfismo de Nucleotídeo Único , Alelos , Coagulação Sanguínea , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Reino Unido
5.
Cancer Lett ; 296(2): 257-67, 2010 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-20462687

RESUMO

Treatment of chronic lymphocytic leukemia (CLL) remains a challenge due to the frequency of drug resistance amongst patients. Improving the delivery of chemotherapeutic agents while reducing the expression of anti-apoptotic Heat Shock Proteins (HSPs) within the cancer cells may facilitate in overcoming this drug resistance. We demonstrate for the first time that sub-lethal doses of chemotherapeutic agents can be combined with membrane fluidizing treatments to produce a significant increase in drug efficacy and apoptosis in vitro. We show that fluidizers result in a transient decrease in intracellular HSPs, resulting in increased tumor-cell sensitivity and a membrane-associated induction of HSP gene expression.


Assuntos
Antineoplásicos/uso terapêutico , Membrana Celular/fisiologia , Proteínas de Choque Térmico/metabolismo , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Caspase 3/metabolismo , Linhagem Celular Tumoral , Resistencia a Medicamentos Antineoplásicos , Ensaio de Imunoadsorção Enzimática , Citometria de Fluxo , Proteínas de Choque Térmico HSP72/metabolismo , Proteínas de Choque Térmico/genética , Humanos , Leucemia Linfocítica Crônica de Células B/metabolismo , Leucócitos/fisiologia , Fluidez de Membrana/fisiologia , Reação em Cadeia da Polimerase , Transporte Proteico
6.
J Leukoc Biol ; 87(3): 467-76, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20007907

RESUMO

Mechanisms behind carcinogenesis and resistance of tumor cells to treatment regimes remain elusive. The major stress proteins Hsp72, Hsp90, and Hsp27 are credible candidates to provide this resistance, as their overexpression in many cancer types is well documented. In addition to being present inside tumor cells, where they confer resistance to apoptosis, Hsp72, in particular, is presented externally, embedded in the cell membrane of cancer cells. This study aimed to investigate the localization of Hsp72, Hsp90, and Hsp27 in leukocytes from patients with CLL and age-matched control subjects. CLL patients were found to express significantly higher levels of iHsp90 (CLL=2463 MFI; control=748 MFI) and iHsp27 (CLL=2190 MFI; control=1031 MFI) in lymphocytes than that expressed by lymphocytes from control subjects. Furthermore, expression of iHsp90 was shown to be related to stage of disease, and expression of iHsp27 correlated with levels of active caspase-3. Patients were found to express very high levels or very low levels of sHsp72 and iHsp72 in CD5(+)/CD19(+) cells, although surface and intracellular datasets did not correlate. Levels of extracellular Hsp72 circulating in the serum were found to correlate with internal levels of Hsp72 and were also found to be significantly lower in patients receiving corticosteroid treatment than in patients not receiving corticosteroid treatment. Finally, analysis of the number of circulating Tregs revealed significantly elevated numbers in CLL patients compared with control subjects.


Assuntos
Proteínas de Choque Térmico/metabolismo , Leucemia Linfocítica Crônica de Células B/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos CD19/metabolismo , Contagem de Linfócito CD4 , Antígenos CD5/metabolismo , Estudos de Casos e Controles , Caspase 3/metabolismo , Membrana Celular/metabolismo , Progressão da Doença , Ativação Enzimática , Espaço Extracelular/metabolismo , Feminino , Proteínas de Choque Térmico HSP27/metabolismo , Proteínas de Choque Térmico HSP72/sangue , Proteínas de Choque Térmico HSP72/metabolismo , Proteínas de Choque Térmico HSP90/metabolismo , Humanos , Espaço Intracelular/metabolismo , Leucemia Linfocítica Crônica de Células B/sangue , Leucemia Linfocítica Crônica de Células B/enzimologia , Leucemia Linfocítica Crônica de Células B/imunologia , Masculino , Pessoa de Meia-Idade , Transporte Proteico , Linfócitos T Reguladores/enzimologia , Linfócitos T Reguladores/patologia
7.
Forensic Sci Int ; 190(1-3): 91-7, 2009 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-19576708

RESUMO

The detection and confirmation of bloodstains as being human in origin is important in crime scene investigations. There are a number of blood detection methods currently available. The aim of this work was to develop an assay capable of detecting the presence of human blood from both liquid blood samples and dried bloodstains. A simple, direct competitive ELISA was developed utilising a polyclonal antibody against human IgG. Once optimised, the ELISA was found to be specific for human IgG, with no cross-reaction observed with pig, sheep, cow, goat, horse and rabbit IgG. The assay was also found to be sensitive, with a detection limit of 0.1 microg/mL. This compares favourably with leading blood detection methods. The assay was able to confirm the presence of human blood in blood mixtures, in stains on a variety of surfaces and also gave positive results with bloodstains that were up to 1 year old. The assay was simple to use, rapid and highly reproducible. The ELISA performance makes it suitable for development as a kit to rival currently used methods for the routine detection of human blood at crime scenes. Further applications of the anti-human IgG antibody are reported, including immunodot assays and a sandwich ELISA format. The methods described here are simple, reliable assays for the identification of human blood and are presented as viable alternatives to existing techniques for blood detection.


Assuntos
Anticorpos , Manchas de Sangue , Ensaio de Imunoadsorção Enzimática , Imunoglobulina G/imunologia , Animais , Secreções Corporais/química , Bovinos , Medicina Legal/métodos , Cabras , Cavalos , Humanos , Imunoglobulina G/análise , Coelhos , Ovinos , Especificidade da Espécie , Suínos
8.
Aliment Pharmacol Ther ; 28(3): 294-303, 2008 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-19086235

RESUMO

BACKGROUND: Bleeding from ectopic varices is uncommon but can be difficult to manage. AIM: To report our experience of the use of transjugular intrahepatic portosystemic stent shunts (TIPSS) in the management of uncontrolled bleeding from ectopic varices. METHODS: A retrospective study of patients who had TIPSS for bleeding ectopic varices. Patients were selected from a dedicated data base. RESULTS: Over 14 years, of 750 TIPSS insertions, 28 patients had TIPSS for bleeding ectopic varices (Child-Pugh score: 8.8 +/- 1.8). Varices were rectal (12), stomal (8), duodenal (4) and at other sites (4). Concomitant variceal embolization was performed in five. Portal pressure gradient fell from 18.2 +/- 6.4 to 7.2 +/- 3.5 mmHg. TIPSS achieved haemostasis in six of nine patients who presented with active bleeding. Five patients rebled from ectopic varices. This was related to shunt dysfunction in two and responded to shunt interventions. Three patients rebled despite a functional shunt. Of these, thrombin controlled bleeding in one. Eight patients developed hepatic encephalopathy post-TIPSS. CONCLUSIONS: Transjugular intrahepatic portosystemic stent shunt is a safe and effective treatment for bleeding ectopic varices. Rebleeding from ectopic varices related to shunt dysfunction responds to shunt intervention. A significant proportion of patients have rebleeding despite a patent shunt, when other adjunctive measures like thrombin injection may be tried.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Hipertensão Portal/cirurgia , Cirrose Hepática/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Stents , Adulto , Idoso , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/mortalidade , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Recidiva , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
9.
J Thromb Haemost ; 6(2): 259-67, 2008 02.
Artigo em Inglês | MEDLINE | ID: mdl-17973650

RESUMO

OBJECTIVE: To determine whether activation of coagulation increases in parallel with inflammation and whether coagulation activation markers (CAMs) are independently associated with coronary heart disease (CHD), in the prospective study, NPHSII. METHODS: Surveillance of 2997 men between 50 and 63 years yielded 314 first CHD events during 36507 person-years of observation. The plasma levels of activated factor XII (FXIIa), the peptides released upon activation of factor X (FXpep) and factor IX (FIXpep), activated factor VII (FVIIa), prothrombin fragment 1 + 2 (F1 + 2) and fibrinopeptide A (FpA) served as indices of activity along the coagulation pathway. C reactive protein (CRP) provided a marker of inflammatory activity. RESULTS: While borderline or significant correlations were identified for each CAM with inflammation, as determined by CRP levels, these did not reach as high a numerical value as was shown for fibrinogen with CRP. FVIIa and FIXpep possessed independent associations with CHD: a one SD increase in adjusted FIXpep and FVIIa level was associated with a relative hazard of 1.20 (95% CI 1.00-1.43) and 0.70 (CI 0.58-0.86), respectively, using a group including all CHD events, compared with 'no-event'. CONCLUSIONS: Inflammation has significant but minimal impact upon CAMs of the extrinsic coagulation pathway. Reduced FVIIa and increased FIXpep levels were found to be significant, independent, predictors of CHD.


Assuntos
Fatores de Coagulação Sanguínea/análise , Coagulação Sanguínea/fisiologia , Doença das Coronárias/epidemiologia , Inflamação/sangue , Biomarcadores , Proteína C-Reativa/análise , Estudos de Coortes , Comorbidade , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/epidemiologia , Doença das Coronárias/sangue , Gorduras na Dieta/farmacologia , Suscetibilidade a Doenças , Ativação Enzimática/efeitos dos fármacos , Fator IX/análise , Fator VIIa/análise , Hemofilia B/epidemiologia , Humanos , Inflamação/epidemiologia , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco
10.
J Leukoc Biol ; 83(3): 489-92, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18156188

RESUMO

Molecules that behave as danger signals are produced when the body is perceived to be under attack, and they alert the immune system to the problem. The immune system can then mount an appropriate response. Two molecules that have received attention as potential danger signals are heat shock protein 72 (Hsp72) and high mobility group box 1 (HMGB1), which are intracellular proteins but are released when cells are under stress, in particular, when necrosis occurs. This review considers the similarities between these two molecules and then contrasts their mechanism of action and problems that can arise when they are overpresented in the extracellular environment. It is proposed that Hsp72 and HMGB1 are members of a suite of danger molecules that provide a fingerprint of the threat, or stressor, to tissue or organism integrity.


Assuntos
Proteína HMGB1/análise , Proteínas de Choque Térmico HSP72/análise , Imunidade Inata , Inflamação/fisiopatologia , Animais , Biomarcadores , Humanos , Inflamação/diagnóstico
11.
Methods ; 43(3): 176-83, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17920513

RESUMO

Heat shock proteins have been shown to be secreted from a number of cell types. Necrotic cells release heat shock proteins in a passive manner, whereas we, and others, have shown that viable cells secrete Hsp70 and Hsp60 through an active mechanism involving lysosomal vesicles and lipid rafts. This release of Hsp70 and Hsp60 is regulated, for example by being increased by elevated temperature. This article outlines procedures, using Hsp70 as the example, to: ensure the status of cells (viable, apoptotic or necrotic); identify the heat shock protein secreted; and quantify the secreted protein. Hsp70 has previously been quantified by ELISA, but newer methods are now being adopted, such as BIAcore and bead-based assays for use by FACS. These methods have the advantages of being more sensitive and requiring less sample than ELISA. The BIAcore has the potential to analyse Hsp70 ligands and provide affinity constants. The FACS bead assay system can be used to run multiplex assays.


Assuntos
Fenômenos Fisiológicos Celulares , Proteínas de Choque Térmico/metabolismo , Animais , Membrana Celular/patologia , Sobrevivência Celular , Citometria de Fluxo , Humanos , Cinética , Linfócitos/citologia , Linfócitos/fisiologia , Microscopia de Fluorescência , Modelos Biológicos , Necrose , Termodinâmica
12.
Eur J Surg Oncol ; 33(1): 55-60, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17095181

RESUMO

AIM: The aim of this study was to assess the value of a defined follow-up protocol for patients undergoing potentially curative hepatic resection for colorectal hepatic metastases. METHODS: A standard protocol for the duration of the study consisted of clinical assessment, serum carcinoembryonic antigen (CEA) and computed tomography. Patterns of recurrence, method and timing of diagnosis and outcome were recorded. RESULTS: One hundred and ninety-one patients underwent potentially curative resection from 1989 to 2004 of whom 103 developed recurrence. The median (inter-quartile range) follow-up was 24.4 (6.5-42.3) months. The median (IQR) time to recurrence and overall survival was 25.0 (10 -not yet reached) and 45.2 (21-123) months, respectively. Seventeen patients (8.9%) underwent further surgery with curative intent. Fifty-five patients (57.9%) had recurrence diagnosed at routine follow-up with 71% (44/62) being diagnosed by CEA and CT. The CEA was elevated in 85.7% (72/84 patients) at the time of diagnosis of recurrence. CONCLUSION: Although the detection of recurrent disease is common during follow-up after hepatic resection for colorectal metastases, few patients will be suitable for further intervention with curative intent. The exact nature of the follow-up protocol remains to be determined but if it is going to be performed it should be most intensive within the first 3 years.


Assuntos
Neoplasias Colorretais/cirurgia , Hepatectomia , Neoplasias Hepáticas/cirurgia , Idoso , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Inglaterra/epidemiologia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Prevalência , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
13.
Eur J Surg Oncol ; 33(3): 341-5, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17175127

RESUMO

AIM: The aim of this study was to evaluate the outcome of different techniques of palliation for patients with hilar cholangiocarcinoma. METHOD: All patients treated with palliative intent between 1988 and 2004 at the Royal Infirmary of Edinburgh were reviewed. Patients were analysed on an intention to treat basis. Demographics, procedure and outcome (including re-admissions) were recorded. RESULTS: Two hundred and thirty-three patients underwent palliative treatment for suspected hilar cholangiocarcinoma. The diagnosis was confirmed histologically in 109 patients. The procedure related morbidity and mortality was 54/225 and 18/207 respectively. Seventy-one patients required re-admission. Twenty patients underwent surgical biliary bypass for jaundice. Those undergoing surgical palliation had a longer median (95% CI) time to re-admission (16 (0-36) vs.7 (2-12) weeks, p=0.001). Endoscopic retrograde cholangio-pancreatography (ERCP) and stenting was only successful in 28 patients and was associated with a significantly higher re-admission rate compared to patients in whom ERCP was not performed (60/179 vs. 4/27, p=0.050). The overall median (95% CI) survival was 145 (124-185) days. CONCLUSION: Current options for palliation of hilar cholangiocarcinoma provide good short term success but are all associated with significant early and late morbidity. Due to its low success and association with an increased re-admission rate, ERCP for definitive palliation should not be used in the first line staging and management of these patients.


Assuntos
Neoplasias dos Ductos Biliares/terapia , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma/terapia , Cuidados Paliativos , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Estudos Prospectivos , Taxa de Sobrevida , Resultado do Tratamento
14.
Gut ; 55(11): 1617-23, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16571635

RESUMO

BACKGROUND: Post-transjugular intrahepatic portosystemic stent shunt (TIPSS) hepatic encephalopathy (HE) can occur in up to one third of patients. In 5%, this can be refractory to optimal medical treatment and may require shunt modification. The efficacy of shunt modification has been poorly studied. AIMS: To evaluate the efficacy of and natural history following TIPSS modification for treatment of refractory HE. METHODS: From a dedicated database, we selected and further studied patients who had TIPSS modification for refractory HE. RESULTS: Over a 14 year period, of 733 TIPSS insertions, 211(29%) patients developed HE post-TIPSS. In 38 patients, shunt modification (reduction (n = 9) and occlusion (n = 29)) was performed for refractory HE. Indications for TIPSS were: variceal bleeding (n = 32), refractory ascites (n = 5), and other (n = 1). Child's grades A, B, and C were noted in 11%, 47%, and 42% of cases, respectively. HE improved in 58% of patients and remained unchanged or worsened in 42%, with similar results for occlusions and reductions. Following shunt modification, variceal bleeding recurred in three patients and ascites in three. Twenty five patients have died (liver related in 15) at a median duration of 10.2 months. Three patients died due to procedure related complications following shunt occlusions (mesenteric infarction (n = 2) and septicaemia (n = 1)). Median survival of patients whose HE did not improve following shunt modification was 79 days compared with 278 days in patients whose did (p<0.05). No variables independently predicted response to shunt modification. CONCLUSIONS: TIPSS modification is a useful option for patients with refractory HE following TIPSS insertion. Due to the significant risk of iatrogenic complications with shunt occlusions, shunt reduction is a safer and preferred option.


Assuntos
Encefalopatia Hepática/etiologia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/cirurgia , Métodos Epidemiológicos , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Recidiva , Índice de Gravidade de Doença , Stents , Resultado do Tratamento
15.
Atherosclerosis ; 183(2): 283-92, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15921688

RESUMO

We have progressively analysed three studies of coronary heart disease (CHD) for a variant in EPCR (Ser219Gly). Initially, in a prospective study, NPHSII, while no overall CHD-risk was identified in heterozygotes, homozygotes for 219Gly exhibited a three-fold elevated risk (HR 3.3, CI 1.22-8.96). In diabetics within NPHSII, there was a suggestion that 219Gly+ was associated with elevated CHD-risk (HR 1.89, CI 0.39-9.06) although numbers were small. To further assess the effect of the variant in diabetes, a case-control study of MI, HIFMECH, was used, in which previous analysis had defined a group with metabolic syndrome, by factor analysis. A significant CHD-risk interaction was identified between genotype and the 'metabolic syndrome' factor (interaction p=0.009). To further assess CHD-risk for this variant in type-2 diabetes and to assess the effect of the variant upon thrombin generation and plasma levels of soluble EPCR, a cross-sectional study of type-2 diabetes was used. A significant CHD-risk was identified for European Whites (OR 2.84, CI 1.38-5.85) and Indian Asians in this study (OR 1.6, CI 1.00-2.57) and the frequency of 219Gly was two-fold higher in Indian Asians. Soluble EPCR levels were strongly associated with genotype, with homozygotes for 219Gly having four-fold higher levels (p<0.0001). In vitro studies of EPCR-transfected cells suggested increased basal release of sEPCR from cells expressing the 219Gly EPCR phenotype. Furthermore, in base-line samples from NPHSII and in the diabetic study, a significant increase in prothrombin F1+2 level was observed for 219Gly. The increased CHD-risk and thrombin generation appears to be acting through increased shedding of the Gly allele from the cell surface.


Assuntos
Antígenos/sangue , Doença das Coronárias/sangue , Glicoproteínas/sangue , Fragmentos de Peptídeos/sangue , Receptores de Superfície Celular/sangue , Animais , Antígenos/genética , Antígenos CD , Fatores de Coagulação Sanguínea/genética , Doença das Coronárias/etiologia , Doença das Coronárias/genética , Cricetinae , Estudos Transversais , DNA/genética , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/genética , Receptor de Proteína C Endotelial , Endotélio Vascular/metabolismo , Endotélio Vascular/patologia , Feminino , Citometria de Fluxo , Seguimentos , Expressão Gênica , Genótipo , Glicoproteínas/genética , Humanos , Imunoensaio , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/genética , Prognóstico , Estudos Prospectivos , Protrombina/genética , Receptores de Superfície Celular/genética , Fatores de Risco , Transfecção
17.
J Agric Food Chem ; 52(26): 7804-8, 2004 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-15612759

RESUMO

Gum arabic from Acacia senegal is commonly used as an additive in foodstuffs. Adulteration of gum arabic by other gums is a potential problem for reasons of safety and quality. This study aimed to develop and evaluate the use of enzyme-linked immunosorbent assays (ELISAs) for the detection of potential adulterants of gum arabic. Indirect competitive ELISAs (IC-ELISAs) were developed using the monoclonal antibodies SY CC7 (A. senegal), SY HH3 (Acacia seyal), and SY J1A1 (Combretum erythrophyllum). All IC-ELISAs had a working range of 0.005-10 mg/mL. The antibodies used were tested using the IC-ELISAs for cross-reactivity with other Acacia species and other gums. The antibodies were very specific for their respective antigens. Significant cross-reactivity was found for SY CC7 (between A. senegal and A. melliferae) and SY J1A1 (between C. erythrophyllum and A. seyal). The IC-ELISA was adapted further to test confectionery samples for the presence of gum arabic, which was successful, although recovery rates were reduced. Both IC- and plate trapped antigen ELISA (PTA-ELISA) formats were able to distinguish an adulterated sample of gum arabic when blended with either A. seyal or C. erythrophyllum. The PTA-ELISA was more sensitive for A. seyal than the IC-ELISA, but both were equally sensitive for C. erythrophyllum. The results suggest that the antibodies SY CC7, SY HH3, and SY J1A1 could be used in combination with each other for the detection of potential adulterants of A. senegal and the detection of gum arabic in foodstuffs.


Assuntos
Acacia/química , Ensaio de Imunoadsorção Enzimática/métodos , Goma Arábica/análise , Goma Arábica/classificação , Anticorpos Monoclonais , Sensibilidade e Especificidade , Especificidade da Espécie
18.
Atherosclerosis ; 177(1): 97-104, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15488871

RESUMO

In a previous case control study of myocardial infarction (MI), we identified risk associated with the combination of two variants in the thrombomodulin (TM) gene (-1208-1209TTdelTT and A455V) and an interaction with increased body mass index (BMI). The rare alleles at these two common variant sites in the TM gene occur in most individuals on the same allele (V/delTT) and are in strong linkage disequilibrium (Delta=0.67, P <0.0005). We have extended these findings in a prospective study of 2700 UK middle age men; the second Northwick Park Heart Study (NPHSII), in which 227 coronary heart disease (CHD) events have been reported to date. Risk was analysed by tertile of BMI, systolic blood pressure (SBP) and triglyceride. The strongest risk for the V/delTT haplotype was in the mid- and top-tertile of triglyceride; RR 1.95 (CI 1.12-3.40) and 1.77 (CI 1.02-3.09), respectively, compared to non-carriers in the lowest tertile (after adjusting for age, practice, smoking, SBP, BMI; interaction P=0.016). No significant risk was identified for increased triglyceride levels in those with the common TM haplotype. There was a suggestion for greater inflammatory response (C-reactive protein levels, CRP) in those with V/delTT compared to those with the common allele, as triglyceride levels increased. Overall, these findings may suggest that the common TM allele confers protection against the adverse CHD effect of either plasma triglyceride-containing lipoproteins, or the underlying atherosclerotic mechanism of the metabolic syndrome, and that this process is defective in carriers of V/delTT.


Assuntos
Doença das Coronárias/genética , Trombomodulina/genética , Doença das Coronárias/epidemiologia , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
19.
Biomarkers ; 9(2): 139-55, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15370872

RESUMO

Heat shock proteins (Hsps) are known to be induced in response to short-term stress. The present study aimed to evaluate the potential of Hsp70 as a biomarker of stress produced by increased temperature, osmotic pressure, and exposure to cadmium and sodium chloride in marine macroalgae and fresh water plant species. An indirect competitive enzyme-linked immunosorbent assay (IC-ELISA) was developed with a working range of 0.025-10 microg ml(-1) using a monoclonal antibody raised against purified Hsp70 of Phaseolus aureus (mung bean). Fucus serratus (toothed wrack), Chondrus crispus (Stackhouse or Carrageen moss), Ulva lactuca (sea lettuce) and Lemna minor (common duckweed) sample extracts were stressed for up to 24 h and then tested in the IC-ELISA. The presence of Hsp70 and cross-reactivity of the monoclonal antibody was confirmed by Western blot. The heat shock response was confirmed in each species using a 2-h 42 degrees C treatment. Following heat shock, Hsp70 concentrations increased to a peak at 2 h (F. serratus) or 4 h (L. minor), after which concentrations decreased. Osmotic and cadmium stresses also resulted in elevated Hsp70 concentrations in samples of F. serratus and L. minor when compared with unstressed controls. In both, osmotic and metal stress, the production of Hsp70 increased to a maximum and subsequently decreased as the stressor levels increased. Results suggest that Hsp70 IC-ELISA could potentially be applied to the detection of stress in these aquatic species, although it would probably be most effective when used in conjunction with other measurements to provide a stressor-specific biomarker profile or fingerprint.


Assuntos
Araceae , Monitoramento Ambiental/métodos , Fucus , Proteínas de Choque Térmico HSP70/análise , Anticorpos Monoclonais , Biomarcadores/análise , Cádmio/farmacologia , Ensaio de Imunoadsorção Enzimática , Metais/farmacologia , Pressão Osmótica , Proteínas de Plantas/análise , Poluição da Água
20.
J Dairy Sci ; 87(3): 543-9, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15202637

RESUMO

The aim of this work was to develop an assay capable of detecting adulteration of high premium milk with milk from cheaper sources. An indirect, competitive ELISA was developed for the rapid detection of cows' milk in the milk of goat, sheep, and buffalo. The assay uses a monoclonal antibody produced against bovine IgG. This antibody recognizes a species-specific epitope on the heavy chain of both bovine IgG1 and IgG2. A peroxidase-conjugated anti-mouse IgG antibody was used to detect bound monoclonal antibody and subsequent enzymatic conversion of substrate resulted in clear differences in absorbance when assaying different mixtures of milks adulterated with cows' milk. Once optimized, the ELISA was found to be highly specific. Detection limits of the assay are 1.0 microg/mL of bovine IgG, or 0.1% (vol/vol) adulteration with cows' milk. The assay was highly reproducible (CV < 10%) and performed equally well when used to detect bovine IgG in mixtures with the 3 types of milk tested. The ELISA performance makes it suitable for development as a kit, for use in the field as a high throughput screening ELISA.


Assuntos
Bovinos/imunologia , Ensaio de Imunoadsorção Enzimática/métodos , Contaminação de Alimentos/análise , Imunoglobulina G/análise , Leite/imunologia , Animais , Búfalos , Cabras , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ovinos
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