David Kingsmore - Academia.edu (original) (raw)
Papers by David Kingsmore
PLOS ONE, 2016
Delayed graft function is a prevalent clinical problem in renal transplantation for which there i... more Delayed graft function is a prevalent clinical problem in renal transplantation for which there is no objective system to predict occurrence in advance. It can result in a significant increase in the necessity for hospitalisation post-transplant and is a significant risk factor for other post-transplant complications. The importance of microRNAs (miRNAs), a specific subclass of small RNA, have been clearly demonstrated to influence many pathways in health and disease. To investigate the influence of miRNAs on renal allograft performance post-transplant, the expression of a panel of miRNAs in pre-transplant renal biopsies was measured using qPCR. Expression was then related to clinical parameters and outcomes in two independent renal transplant cohorts. Here we demonstrate, in two independent cohorts of pre-implantation human renal allograft biopsies, that a novel pre-transplant renal performance scoring system (GRPSS), can determine the occurrence of DGF with a high sensitivity (>90%) and specificity (>60%) for donor allografts pre-transplant, using just three senescence associated microRNAs combined with donor age and type of organ donation. These results demonstrate a relationship between pre-transplant microRNA expression levels, cellular biological ageing pathways and clinical outcomes for renal transplantation. They provide for a simple, rapid quantitative molecular pre-transplant assay to determine post-transplant allograft function and scope for future intervention. Furthermore, these results demonstrate the involvement of senescence pathways in ischaemic injury during the organ transplantation process and an indication of accelerated bio-ageing as a consequence of both warm and cold ischaemia.
Journal of Vascular Surgery, 2015
Continuous suturing techniques have conventionally been used for the end-to-side anastomoses of r... more Continuous suturing techniques have conventionally been used for the end-to-side anastomoses of radiocephalic fistulas (RCFs); however, primary patency rates are poor. Only 50% to 60% of RCFs ever achieve functional patency. We hypothesized that a hybrid interrupted-continuous suturing technique (as used in many microsurgical procedures) may improve outcomes in fistulas constructed from small vessels. A randomized controlled trial comparing hybrid interrupted-continuous (n = 42) with continuous (n = 36) suturing techniques for RCF was undertaken. Patients were excluded if vessels were <1.8 mm in diameter or if previous ipsilateral fistula had been attempted. A priori power calculation indicated that a sample size of 78 patients was required to detect an improvement in patency from 50% to 80% (α = .05, β = .8). The primary end point was primary patency at 6 weeks (assessed by a blinded observer for the presence of thrill and bruit). Secondary end points were immediate patency, functional patency (assessed clinically and by ultrasound) at 6 weeks, and presence of anastomotic stenosis. Groups were comparable for basic patient demographics, operating surgeon, and vessel diameter as measured on preoperative ultrasound (mean age, 58.9 ± 13 years; 68% male). Primary patency at 6 weeks was higher in the hybrid interrupted-continuous suturing technique group (71% vs 47%; P = .01). Immediate patency was also higher in the hybrid interrupted-continuous suturing technique group (93% vs 67%; P < .001). There was no significant difference in functional patency at 6 weeks (52% vs 36%; P = .18). Three patients developed an anastomotic stenosis. All were in the hybrid interrupted-continuous suturing technique group. One patient from the interrupted suturing technique cohort required re-exploration for bleeding. A hybrid interrupted-continuous suturing technique yielded higher immediate and 6-week primary patency rates for RCF. The hybrid interrupted-continuous suturing technique may improve anastomotic compliance and reduce the narrowing and puckering that can occur on suture tightening in small-caliber vessels. Based on these findings, consideration should be given to performing hybrid interrupted-continuous anastomoses for RCFs.
Journal of Vascular Surgery, 2015
Continuous suturing techniques have conventionally been used for the end-to-side anastomoses of r... more Continuous suturing techniques have conventionally been used for the end-to-side anastomoses of radiocephalic fistulas (RCFs); however, primary patency rates are poor. Only 50% to 60% of RCFs ever achieve functional patency. We hypothesized that a hybrid interrupted-continuous suturing technique (as used in many microsurgical procedures) may improve outcomes in fistulas constructed from small vessels. A randomized controlled trial comparing hybrid interrupted-continuous (n = 42) with continuous (n = 36) suturing techniques for RCF was undertaken. Patients were excluded if vessels were <1.8 mm in diameter or if previous ipsilateral fistula had been attempted. A priori power calculation indicated that a sample size of 78 patients was required to detect an improvement in patency from 50% to 80% (α = .05, β = .8). The primary end point was primary patency at 6 weeks (assessed by a blinded observer for the presence of thrill and bruit). Secondary end points were immediate patency, functional patency (assessed clinically and by ultrasound) at 6 weeks, and presence of anastomotic stenosis. Groups were comparable for basic patient demographics, operating surgeon, and vessel diameter as measured on preoperative ultrasound (mean age, 58.9 ± 13 years; 68% male). Primary patency at 6 weeks was higher in the hybrid interrupted-continuous suturing technique group (71% vs 47%; P = .01). Immediate patency was also higher in the hybrid interrupted-continuous suturing technique group (93% vs 67%; P < .001). There was no significant difference in functional patency at 6 weeks (52% vs 36%; P = .18). Three patients developed an anastomotic stenosis. All were in the hybrid interrupted-continuous suturing technique group. One patient from the interrupted suturing technique cohort required re-exploration for bleeding. A hybrid interrupted-continuous suturing technique yielded higher immediate and 6-week primary patency rates for RCF. The hybrid interrupted-continuous suturing technique may improve anastomotic compliance and reduce the narrowing and puckering that can occur on suture tightening in small-caliber vessels. Based on these findings, consideration should be given to performing hybrid interrupted-continuous anastomoses for RCFs.
The Journal of Rheumatology
Collagenous colitis is an uncommon cause of chronic watery diarrhea, characterized by colonic dep... more Collagenous colitis is an uncommon cause of chronic watery diarrhea, characterized by colonic deposition of collagen. Nonerosive, oligoarticular, peripheral arthritis has previously been noted in about 7% of patients with collagenous colitis. We describe a patient with collagenous colitis who concurrently developed erosive, seronegative spondyloarthropathy affecting peripheral and axial joints. Synovial histology was characterized by a conspicuous inflammatory infiltrate comprised of histiocytes, lymphocytes and plasma cells. Collagenous colitis is suggested to be a systemic autoimmune disorder, with extraintestinal features such as thyroiditis and arthritis.
Journal of the Neurological Sciences, 2001
Creatine supplementation in humans has been reported to enhance power and strength both in normal... more Creatine supplementation in humans has been reported to enhance power and strength both in normal subjects and in patients with various neuromuscular diseases. The purpose of this study was to examine the effects of supplementation on exercise performance and maximal voluntary isometric muscular contraction (MVIC) in Amyotrophic Lateral Sclerosis (ALS) patients. We report the results obtained in 28 patients with probable/definite ALS. In each patient we acquired the dynamometric measurement of MVIC in 10 muscle groups of upper and lower limbs and a measure of fatigue by means of an high-intensity intermittent protocol in elbow flexors and knee extensors muscles. All patients completed the protocols at the baseline and after supplementation of 20 g per day for 7 days and after supplementation of 3 g per day for 3 and 6 months. MVIC increased after 7 days of supplementation in 20 patients (70%) in knee extensors and in 15 (53%) of them also in elbow flexors. A statistically significant difference between pre and post-treatment mean values of MVIC was found both in elbow flexors (P<0.05) and knee extensors (p<0.04). The analysis of the slopes of fatigue test showed a statistically significant improvement after 7 days of supplementation in 11 patients (39%) in elbow flexors and in 9 patients (32%) also in knee extensors muscles. During the 6-month follow-up period all the examined parameters showed a linear progressive decline. In conclusion, our preliminary results have demonstrated that supplementation temporary increases maximal isometric power in ALS patients so it may be of potential benefit in situations such as high intensity activity and it can be proposed as a symptomatic treatment.
PLOS ONE, 2016
Delayed graft function is a prevalent clinical problem in renal transplantation for which there i... more Delayed graft function is a prevalent clinical problem in renal transplantation for which there is no objective system to predict occurrence in advance. It can result in a significant increase in the necessity for hospitalisation post-transplant and is a significant risk factor for other post-transplant complications. The importance of microRNAs (miRNAs), a specific subclass of small RNA, have been clearly demonstrated to influence many pathways in health and disease. To investigate the influence of miRNAs on renal allograft performance post-transplant, the expression of a panel of miRNAs in pre-transplant renal biopsies was measured using qPCR. Expression was then related to clinical parameters and outcomes in two independent renal transplant cohorts. Here we demonstrate, in two independent cohorts of pre-implantation human renal allograft biopsies, that a novel pre-transplant renal performance scoring system (GRPSS), can determine the occurrence of DGF with a high sensitivity (>90%) and specificity (>60%) for donor allografts pre-transplant, using just three senescence associated microRNAs combined with donor age and type of organ donation. These results demonstrate a relationship between pre-transplant microRNA expression levels, cellular biological ageing pathways and clinical outcomes for renal transplantation. They provide for a simple, rapid quantitative molecular pre-transplant assay to determine post-transplant allograft function and scope for future intervention. Furthermore, these results demonstrate the involvement of senescence pathways in ischaemic injury during the organ transplantation process and an indication of accelerated bio-ageing as a consequence of both warm and cold ischaemia.
British Journal of Cardiology, May 1, 2009
... Authors: Gavin J Bryce, Christopher J Payne, Simon C Gibson, David B Kingsmore, Dominique S B... more ... Authors: Gavin J Bryce, Christopher J Payne, Simon C Gibson, David B Kingsmore, Dominique S Byrne. Gavin J Bryce Vascular Research Fellow. ... Eur J Vasc Endovasc Surg 2006;31:63741. Eagle KA, Coley CM, Newell JB et al. ...
ABSTRACT The effects of three—fluid-loading “strategies combining creatine (Cr) and glycerol (Gly... more ABSTRACT The effects of three—fluid-loading “strategies combining creatine (Cr) and glycerol (Gly) on fluid retention and distribution were examined. Three 7-day Cr and Gly loading protocols (LP) were examined: LP1-10 g Cr and 75 g of glucose in 1 litre (L) of ...
Medicine & Science in Sports & Exercise
International journal of sport nutrition and exercise metabolism
The effects of creatine (Cr) supplementation on cardiovascular, metabolic, and thermoregulatory r... more The effects of creatine (Cr) supplementation on cardiovascular, metabolic, and thermoregulatory responses, and on the capacity of trained humans to perform prolonged exercise in the heat was examined. Endurance-trained males (n = 21) performed 2 constant-load exercise tests to exhaustion at 63 +/- 5 % VO(2max) in the heat (ambient temperature: 30.3 +/- 0.5 C) before and after 7 d of Cr (20 g x d (-1 ) Cr + 140 g x d (-1 ) glucose polymer) or placebo. Cr increased intracellular water and reduced thermoregulatory and cardiovascular responses (e.g., heart rate, rectal temperature, sweat rate) but did not significantly increase time to exhaustion (47.0 +/-4.7 min vs. 49.7 +/- 7.5 min, P =0.095). Time to exhaustion was increased significantly in subjects whose estimated intramuscular Cr levels were substantially increased ("responders" : 47.3 +/- 4.9 min vs. 51.7 +/- 7.4 min, P = 0.031). Cr-induced hyperhydration can result in a more efficient thermoregulatory response during prolonged exercise in the heat.
Value in Health, 2014
ture. We assumed re-intervention and septicaemia rates of ecAVG were equivalent to standard AVGs.... more ture. We assumed re-intervention and septicaemia rates of ecAVG were equivalent to standard AVGs. Resource use was based on hospital practice and unit costs from published National Health Service datasets. Results: Over a 6 month period, total treatment costs per patient were £5,882 in the TCVC strategy and £4,954 in the ecAVG strategy, delivering potential savings of £927 per patient. Although ecAVG's had higher procedure and re-intervention costs reflecting longer procedure time and device costs (£3,014 vs £1,836), these were offset by significant reductions in septicaemia treatment costs (£1,322 vs £2,176) and in-patient waiting time bed costs (£619 vs £1,870). ConClusions: Adopting ecAVG's as an alternative to TCVCs can potentially deliver cost savings in this hospital. The two treatment strategies will now be assessed in a RCT.
Transplantation Proceedings, 2015
ABSTRACT
British Journal of Surgery
Therapeutic drug monitoring
Prosthetic graft infection is a devastating complication of vascular surgery that occurs in 3%-5%... more Prosthetic graft infection is a devastating complication of vascular surgery that occurs in 3%-5% of clean prosthetic procedures. Staphylococci are the most frequently isolated pathogens, and thus surgical prophylaxis regimens often include vancomycin. However, the efficacy of these regimens in ensuring a required concentration of antibiotic is uncertain. This study aimed to determine if a continuous vancomycin infusion regimen administered perioperatively as surgical prophylaxis for vascular procedures maintained an adequate serum concentration. Thirty-four consecutive patients undergoing a vascular procedure requiring a prosthetic graft or patch were given vancomycin prophylaxis. Each patient received a loading dose calculated according to body weight 12 hours before surgery. A 24-hour continuous infusion was then started, based on calculated creatinine clearance. Serum vancomycin concentrations were checked on induction of anesthesia, 2 hours postoperatively, and at the end of th...
Arteriovenous fistulae (AVF) are the modality of choice for haemodialysis. 1 However, dys-functio... more Arteriovenous fistulae (AVF) are the modality of choice for haemodialysis. 1 However, dys-functional AVF represents one of the leading causes of morbidity in the haemodialysis population ; 2 venous stenosis-related dysfunction being the most common underlying problem. 3 Forty per cent of venous stenoses occur within the first few centimetres of the anastomosis. 4 However, the cephalic arch has been increasingly recognised as a site where venous stenosis readily occurs. Cephalic arch stenosis (CAS) is a novel and discrete clinical entity, presenting at a site remote from venous trauma, such as dialysis needle, central venous catheter or surgical trauma sites. It occurs frequently: CAS is seen in up to 77% of dysfunctional brachiocephalic fistulae (BCF) 5 and in 15% of dysfunctional AVF, overall. 6 Despite this, there has been limited research into what is a distinct clinical problem in maintaining vascular access. With a growing haemodialysis population , 7 and initiatives to increas...
Vascular Pharmacology, 2015
Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the... more Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the modality of choice. However neointimal hyperplasia and loss of the luminal compartment result in AVF patency rates of ~60% at 12 months. The exact cause of neointimal hyperplasia in the AVF is poorly understood. Vascular trauma has long been associated with hyperplasia.
Clinical transplants, 2012
In January 2007, our centre changed from a cyclosporin (CyA)/azathioprine (Aza)/ prednisolone (Pr... more In January 2007, our centre changed from a cyclosporin (CyA)/azathioprine (Aza)/ prednisolone (Pred) primary immunosuppression regimen (with basiliximab induction and mycophenolate mofetil [MMF] for those at immunologically high risk) to a tacrolimus (Tac) (low dose)/MMF/Pred regimen with basiliximab induction, following presentation of Symphony trial results. This analysis assesses the impact of this change on 5-year outcomes. Three hundred consecutive renal-only transplants were identified: 140 from the 2005-06 era and 160 from the 2007-08 era. The proportions of living donor (37.5 vs. 22.9%; p = 0.04) and donors after circulatory death (11.9 vs. 5.0%; p = 0.03) were higher in the 2007-08 cohort. Five-year actuarial patient survival was higher in the 2007-08 cohort (96.8 vs. 87.1%; p = 0.003), with a trend toward higher 5-year transplant survival (84.7 vs. 76.3%; p = 0.08). Estimated glomerular filtration rate (eGFR) was higher than in the 2005-06 era at 1 (53.5 vs. 44.5 ml/min/1....
PLOS ONE, 2016
Delayed graft function is a prevalent clinical problem in renal transplantation for which there i... more Delayed graft function is a prevalent clinical problem in renal transplantation for which there is no objective system to predict occurrence in advance. It can result in a significant increase in the necessity for hospitalisation post-transplant and is a significant risk factor for other post-transplant complications. The importance of microRNAs (miRNAs), a specific subclass of small RNA, have been clearly demonstrated to influence many pathways in health and disease. To investigate the influence of miRNAs on renal allograft performance post-transplant, the expression of a panel of miRNAs in pre-transplant renal biopsies was measured using qPCR. Expression was then related to clinical parameters and outcomes in two independent renal transplant cohorts. Here we demonstrate, in two independent cohorts of pre-implantation human renal allograft biopsies, that a novel pre-transplant renal performance scoring system (GRPSS), can determine the occurrence of DGF with a high sensitivity (>90%) and specificity (>60%) for donor allografts pre-transplant, using just three senescence associated microRNAs combined with donor age and type of organ donation. These results demonstrate a relationship between pre-transplant microRNA expression levels, cellular biological ageing pathways and clinical outcomes for renal transplantation. They provide for a simple, rapid quantitative molecular pre-transplant assay to determine post-transplant allograft function and scope for future intervention. Furthermore, these results demonstrate the involvement of senescence pathways in ischaemic injury during the organ transplantation process and an indication of accelerated bio-ageing as a consequence of both warm and cold ischaemia.
Journal of Vascular Surgery, 2015
Continuous suturing techniques have conventionally been used for the end-to-side anastomoses of r... more Continuous suturing techniques have conventionally been used for the end-to-side anastomoses of radiocephalic fistulas (RCFs); however, primary patency rates are poor. Only 50% to 60% of RCFs ever achieve functional patency. We hypothesized that a hybrid interrupted-continuous suturing technique (as used in many microsurgical procedures) may improve outcomes in fistulas constructed from small vessels. A randomized controlled trial comparing hybrid interrupted-continuous (n = 42) with continuous (n = 36) suturing techniques for RCF was undertaken. Patients were excluded if vessels were <1.8 mm in diameter or if previous ipsilateral fistula had been attempted. A priori power calculation indicated that a sample size of 78 patients was required to detect an improvement in patency from 50% to 80% (α = .05, β = .8). The primary end point was primary patency at 6 weeks (assessed by a blinded observer for the presence of thrill and bruit). Secondary end points were immediate patency, functional patency (assessed clinically and by ultrasound) at 6 weeks, and presence of anastomotic stenosis. Groups were comparable for basic patient demographics, operating surgeon, and vessel diameter as measured on preoperative ultrasound (mean age, 58.9 ± 13 years; 68% male). Primary patency at 6 weeks was higher in the hybrid interrupted-continuous suturing technique group (71% vs 47%; P = .01). Immediate patency was also higher in the hybrid interrupted-continuous suturing technique group (93% vs 67%; P < .001). There was no significant difference in functional patency at 6 weeks (52% vs 36%; P = .18). Three patients developed an anastomotic stenosis. All were in the hybrid interrupted-continuous suturing technique group. One patient from the interrupted suturing technique cohort required re-exploration for bleeding. A hybrid interrupted-continuous suturing technique yielded higher immediate and 6-week primary patency rates for RCF. The hybrid interrupted-continuous suturing technique may improve anastomotic compliance and reduce the narrowing and puckering that can occur on suture tightening in small-caliber vessels. Based on these findings, consideration should be given to performing hybrid interrupted-continuous anastomoses for RCFs.
Journal of Vascular Surgery, 2015
Continuous suturing techniques have conventionally been used for the end-to-side anastomoses of r... more Continuous suturing techniques have conventionally been used for the end-to-side anastomoses of radiocephalic fistulas (RCFs); however, primary patency rates are poor. Only 50% to 60% of RCFs ever achieve functional patency. We hypothesized that a hybrid interrupted-continuous suturing technique (as used in many microsurgical procedures) may improve outcomes in fistulas constructed from small vessels. A randomized controlled trial comparing hybrid interrupted-continuous (n = 42) with continuous (n = 36) suturing techniques for RCF was undertaken. Patients were excluded if vessels were <1.8 mm in diameter or if previous ipsilateral fistula had been attempted. A priori power calculation indicated that a sample size of 78 patients was required to detect an improvement in patency from 50% to 80% (α = .05, β = .8). The primary end point was primary patency at 6 weeks (assessed by a blinded observer for the presence of thrill and bruit). Secondary end points were immediate patency, functional patency (assessed clinically and by ultrasound) at 6 weeks, and presence of anastomotic stenosis. Groups were comparable for basic patient demographics, operating surgeon, and vessel diameter as measured on preoperative ultrasound (mean age, 58.9 ± 13 years; 68% male). Primary patency at 6 weeks was higher in the hybrid interrupted-continuous suturing technique group (71% vs 47%; P = .01). Immediate patency was also higher in the hybrid interrupted-continuous suturing technique group (93% vs 67%; P < .001). There was no significant difference in functional patency at 6 weeks (52% vs 36%; P = .18). Three patients developed an anastomotic stenosis. All were in the hybrid interrupted-continuous suturing technique group. One patient from the interrupted suturing technique cohort required re-exploration for bleeding. A hybrid interrupted-continuous suturing technique yielded higher immediate and 6-week primary patency rates for RCF. The hybrid interrupted-continuous suturing technique may improve anastomotic compliance and reduce the narrowing and puckering that can occur on suture tightening in small-caliber vessels. Based on these findings, consideration should be given to performing hybrid interrupted-continuous anastomoses for RCFs.
The Journal of Rheumatology
Collagenous colitis is an uncommon cause of chronic watery diarrhea, characterized by colonic dep... more Collagenous colitis is an uncommon cause of chronic watery diarrhea, characterized by colonic deposition of collagen. Nonerosive, oligoarticular, peripheral arthritis has previously been noted in about 7% of patients with collagenous colitis. We describe a patient with collagenous colitis who concurrently developed erosive, seronegative spondyloarthropathy affecting peripheral and axial joints. Synovial histology was characterized by a conspicuous inflammatory infiltrate comprised of histiocytes, lymphocytes and plasma cells. Collagenous colitis is suggested to be a systemic autoimmune disorder, with extraintestinal features such as thyroiditis and arthritis.
Journal of the Neurological Sciences, 2001
Creatine supplementation in humans has been reported to enhance power and strength both in normal... more Creatine supplementation in humans has been reported to enhance power and strength both in normal subjects and in patients with various neuromuscular diseases. The purpose of this study was to examine the effects of supplementation on exercise performance and maximal voluntary isometric muscular contraction (MVIC) in Amyotrophic Lateral Sclerosis (ALS) patients. We report the results obtained in 28 patients with probable/definite ALS. In each patient we acquired the dynamometric measurement of MVIC in 10 muscle groups of upper and lower limbs and a measure of fatigue by means of an high-intensity intermittent protocol in elbow flexors and knee extensors muscles. All patients completed the protocols at the baseline and after supplementation of 20 g per day for 7 days and after supplementation of 3 g per day for 3 and 6 months. MVIC increased after 7 days of supplementation in 20 patients (70%) in knee extensors and in 15 (53%) of them also in elbow flexors. A statistically significant difference between pre and post-treatment mean values of MVIC was found both in elbow flexors (P<0.05) and knee extensors (p<0.04). The analysis of the slopes of fatigue test showed a statistically significant improvement after 7 days of supplementation in 11 patients (39%) in elbow flexors and in 9 patients (32%) also in knee extensors muscles. During the 6-month follow-up period all the examined parameters showed a linear progressive decline. In conclusion, our preliminary results have demonstrated that supplementation temporary increases maximal isometric power in ALS patients so it may be of potential benefit in situations such as high intensity activity and it can be proposed as a symptomatic treatment.
PLOS ONE, 2016
Delayed graft function is a prevalent clinical problem in renal transplantation for which there i... more Delayed graft function is a prevalent clinical problem in renal transplantation for which there is no objective system to predict occurrence in advance. It can result in a significant increase in the necessity for hospitalisation post-transplant and is a significant risk factor for other post-transplant complications. The importance of microRNAs (miRNAs), a specific subclass of small RNA, have been clearly demonstrated to influence many pathways in health and disease. To investigate the influence of miRNAs on renal allograft performance post-transplant, the expression of a panel of miRNAs in pre-transplant renal biopsies was measured using qPCR. Expression was then related to clinical parameters and outcomes in two independent renal transplant cohorts. Here we demonstrate, in two independent cohorts of pre-implantation human renal allograft biopsies, that a novel pre-transplant renal performance scoring system (GRPSS), can determine the occurrence of DGF with a high sensitivity (>90%) and specificity (>60%) for donor allografts pre-transplant, using just three senescence associated microRNAs combined with donor age and type of organ donation. These results demonstrate a relationship between pre-transplant microRNA expression levels, cellular biological ageing pathways and clinical outcomes for renal transplantation. They provide for a simple, rapid quantitative molecular pre-transplant assay to determine post-transplant allograft function and scope for future intervention. Furthermore, these results demonstrate the involvement of senescence pathways in ischaemic injury during the organ transplantation process and an indication of accelerated bio-ageing as a consequence of both warm and cold ischaemia.
British Journal of Cardiology, May 1, 2009
... Authors: Gavin J Bryce, Christopher J Payne, Simon C Gibson, David B Kingsmore, Dominique S B... more ... Authors: Gavin J Bryce, Christopher J Payne, Simon C Gibson, David B Kingsmore, Dominique S Byrne. Gavin J Bryce Vascular Research Fellow. ... Eur J Vasc Endovasc Surg 2006;31:63741. Eagle KA, Coley CM, Newell JB et al. ...
ABSTRACT The effects of three—fluid-loading “strategies combining creatine (Cr) and glycerol (Gly... more ABSTRACT The effects of three—fluid-loading “strategies combining creatine (Cr) and glycerol (Gly) on fluid retention and distribution were examined. Three 7-day Cr and Gly loading protocols (LP) were examined: LP1-10 g Cr and 75 g of glucose in 1 litre (L) of ...
Medicine & Science in Sports & Exercise
International journal of sport nutrition and exercise metabolism
The effects of creatine (Cr) supplementation on cardiovascular, metabolic, and thermoregulatory r... more The effects of creatine (Cr) supplementation on cardiovascular, metabolic, and thermoregulatory responses, and on the capacity of trained humans to perform prolonged exercise in the heat was examined. Endurance-trained males (n = 21) performed 2 constant-load exercise tests to exhaustion at 63 +/- 5 % VO(2max) in the heat (ambient temperature: 30.3 +/- 0.5 C) before and after 7 d of Cr (20 g x d (-1 ) Cr + 140 g x d (-1 ) glucose polymer) or placebo. Cr increased intracellular water and reduced thermoregulatory and cardiovascular responses (e.g., heart rate, rectal temperature, sweat rate) but did not significantly increase time to exhaustion (47.0 +/-4.7 min vs. 49.7 +/- 7.5 min, P =0.095). Time to exhaustion was increased significantly in subjects whose estimated intramuscular Cr levels were substantially increased ("responders" : 47.3 +/- 4.9 min vs. 51.7 +/- 7.4 min, P = 0.031). Cr-induced hyperhydration can result in a more efficient thermoregulatory response during prolonged exercise in the heat.
Value in Health, 2014
ture. We assumed re-intervention and septicaemia rates of ecAVG were equivalent to standard AVGs.... more ture. We assumed re-intervention and septicaemia rates of ecAVG were equivalent to standard AVGs. Resource use was based on hospital practice and unit costs from published National Health Service datasets. Results: Over a 6 month period, total treatment costs per patient were £5,882 in the TCVC strategy and £4,954 in the ecAVG strategy, delivering potential savings of £927 per patient. Although ecAVG's had higher procedure and re-intervention costs reflecting longer procedure time and device costs (£3,014 vs £1,836), these were offset by significant reductions in septicaemia treatment costs (£1,322 vs £2,176) and in-patient waiting time bed costs (£619 vs £1,870). ConClusions: Adopting ecAVG's as an alternative to TCVCs can potentially deliver cost savings in this hospital. The two treatment strategies will now be assessed in a RCT.
Transplantation Proceedings, 2015
ABSTRACT
British Journal of Surgery
Therapeutic drug monitoring
Prosthetic graft infection is a devastating complication of vascular surgery that occurs in 3%-5%... more Prosthetic graft infection is a devastating complication of vascular surgery that occurs in 3%-5% of clean prosthetic procedures. Staphylococci are the most frequently isolated pathogens, and thus surgical prophylaxis regimens often include vancomycin. However, the efficacy of these regimens in ensuring a required concentration of antibiotic is uncertain. This study aimed to determine if a continuous vancomycin infusion regimen administered perioperatively as surgical prophylaxis for vascular procedures maintained an adequate serum concentration. Thirty-four consecutive patients undergoing a vascular procedure requiring a prosthetic graft or patch were given vancomycin prophylaxis. Each patient received a loading dose calculated according to body weight 12 hours before surgery. A 24-hour continuous infusion was then started, based on calculated creatinine clearance. Serum vancomycin concentrations were checked on induction of anesthesia, 2 hours postoperatively, and at the end of th...
Arteriovenous fistulae (AVF) are the modality of choice for haemodialysis. 1 However, dys-functio... more Arteriovenous fistulae (AVF) are the modality of choice for haemodialysis. 1 However, dys-functional AVF represents one of the leading causes of morbidity in the haemodialysis population ; 2 venous stenosis-related dysfunction being the most common underlying problem. 3 Forty per cent of venous stenoses occur within the first few centimetres of the anastomosis. 4 However, the cephalic arch has been increasingly recognised as a site where venous stenosis readily occurs. Cephalic arch stenosis (CAS) is a novel and discrete clinical entity, presenting at a site remote from venous trauma, such as dialysis needle, central venous catheter or surgical trauma sites. It occurs frequently: CAS is seen in up to 77% of dysfunctional brachiocephalic fistulae (BCF) 5 and in 15% of dysfunctional AVF, overall. 6 Despite this, there has been limited research into what is a distinct clinical problem in maintaining vascular access. With a growing haemodialysis population , 7 and initiatives to increas...
Vascular Pharmacology, 2015
Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the... more Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the modality of choice. However neointimal hyperplasia and loss of the luminal compartment result in AVF patency rates of ~60% at 12 months. The exact cause of neointimal hyperplasia in the AVF is poorly understood. Vascular trauma has long been associated with hyperplasia.
Clinical transplants, 2012
In January 2007, our centre changed from a cyclosporin (CyA)/azathioprine (Aza)/ prednisolone (Pr... more In January 2007, our centre changed from a cyclosporin (CyA)/azathioprine (Aza)/ prednisolone (Pred) primary immunosuppression regimen (with basiliximab induction and mycophenolate mofetil [MMF] for those at immunologically high risk) to a tacrolimus (Tac) (low dose)/MMF/Pred regimen with basiliximab induction, following presentation of Symphony trial results. This analysis assesses the impact of this change on 5-year outcomes. Three hundred consecutive renal-only transplants were identified: 140 from the 2005-06 era and 160 from the 2007-08 era. The proportions of living donor (37.5 vs. 22.9%; p = 0.04) and donors after circulatory death (11.9 vs. 5.0%; p = 0.03) were higher in the 2007-08 cohort. Five-year actuarial patient survival was higher in the 2007-08 cohort (96.8 vs. 87.1%; p = 0.003), with a trend toward higher 5-year transplant survival (84.7 vs. 76.3%; p = 0.08). Estimated glomerular filtration rate (eGFR) was higher than in the 2005-06 era at 1 (53.5 vs. 44.5 ml/min/1....