Richard Wenstone | University of Liverpool (original) (raw)
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Papers by Richard Wenstone
Canadian Journal Of Anesthesia/journal Canadien D'anesthésie, May 1, 1994
<b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of ... more <b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of GM-CSF on transcription, surface expression and shedding"International Journal of Medical Sciences 2004;1(3):126-136.Published online 10 Jul 2004PMCID:PMC1074707.© Ivyspring International Publisher. This is an open access article. Distribution or copying is permitted, provided that the article is in whole, unmodified, and properly cited. * denotes significance between septic patients and healthy controls on days 0 and 3, p < 0.05, Mann Whittney U test. n=12 (septic patients) n=8 (healthy controls)
<b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of ... more <b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of GM-CSF on transcription, surface expression and shedding"International Journal of Medical Sciences 2004;1(3):126-136.Published online 10 Jul 2004PMCID:PMC1074707.© Ivyspring International Publisher. This is an open access article. Distribution or copying is permitted, provided that the article is in whole, unmodified, and properly cited. P=0.014, healthy controls survivors and non-survivors (Kruskall Wallis test for 3 independent samples).
<b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of ... more <b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of GM-CSF on transcription, surface expression and shedding"International Journal of Medical Sciences 2004;1(3):126-136.Published online 10 Jul 2004PMCID:PMC1074707.© Ivyspring International Publisher. This is an open access article. Distribution or copying is permitted, provided that the article is in whole, unmodified, and properly cited. (b) The fluorescent image of a section though healthy control PBMC showing the surface expression of HLA-DR. (c) Fluorescent image of intracellular staining for HLA-DR of a section through PBMC from a septic patient. (d) shows the weak surface staining of HLA-DR in the same patients' PBMC.
<b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of ... more <b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of GM-CSF on transcription, surface expression and shedding"International Journal of Medical Sciences 2004;1(3):126-136.Published online 10 Jul 2004PMCID:PMC1074707.© Ivyspring International Publisher. This is an open access article. Distribution or copying is permitted, provided that the article is in whole, unmodified, and properly cited. A value above 1 shows a higher intracellular expression of HLA-DR compared to surface expression. Septic patients show a significantly higher number of PBMC expressing HLA-DR when intracellular expression is measured, compared to surface expression, p=0.01. (MFI: Median Fluorescent intensity)
Anaesthesia, 2007
connected to a pressure gauge (such as a blood pressure gauge). thc oxygen Rotameter i s slowly o... more connected to a pressure gauge (such as a blood pressure gauge). thc oxygen Rotameter i s slowly opened and adjusted to maintain a pressure of 16 kPa in the backbar. The oxygcn flow i s an indication of the leakage and more than 200-300 ml/minute is considered unacceptable. (This docs not measure the absolute leak flow under working conditions.) The oxygen flow in the machine in question would probably have been in the order of litrcsiminute with this method. This test i s sensitive, reliable, rapidly and siniply performed with equipment that i s readily available in the anaesthetic room and might usefully be added to the protocol li)r testing anaesthetic machines. I . J . €3. JACXSOK P.J. M c Q r I I I A N
Nursing Times
In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation ... more In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation was high and that this could contribute to the failure to wean patients from mechanical ventilation (Mostafa et al, 2003). A protocol was introduced to standardise the assessment and management of constipation. This article explores why patients in intensive care are at risk of constipation and presents the results of a second audit, carried out after the protocol was introduced, to assess its impact on patients.
Blood reviews, 2002
The 'biphasic transmittance waveform' (BTW) refers to a decrease in light transmittance t... more The 'biphasic transmittance waveform' (BTW) refers to a decrease in light transmittance that often occurs prior to clotting in coagulation assays of critically ill patient plasmas. It correlates with disseminated intravascular coagulation and mortality. The present work shows that the BTW is due to the rapid formation of a precipitate and a coincident change in turbidity in re-calcified plasma. The precipitate was isolated from patient plasma and contained lipids typical of very low density lipoprotein (VLDL), plus the proteins apolipoprotein B-100 and C-reactive protein (CRP). Precipitation also occurred in normal plasma supplemented with CRP. In addition, CRP precipitated with VLDL and intermediate density lipoprotein, but not low density lipoprotein or high density lipoprotein. The Kd value for the CRP/VLDL interaction is 340 nM. The IC50 value of Ca2+ for complex formation is 5.0 mM, and epsilon-aminocaproic acid inhibits the process. In 15 plasmas with the BTW from crit...
Nursing times, 2008
In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation ... more In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation was high and that this could contribute to the failure to wean patients from mechanical ventilation (Mostafa et al, 2003). A protocol was introduced to standardise the assessment and management of constipation. This article explores why patients in intensive care are at risk of constipation and presents the results of a second audit, carried out after the protocol was introduced, to assess its impact on patients.
Clinical Infection in Practice
Objectives: Severe lower respiratory tract infection caused by adenovirus is well described in im... more Objectives: Severe lower respiratory tract infection caused by adenovirus is well described in immunocompromised hosts and can cause significant morbidity and mortality. We compare and contrast the clinical presentation, radiological, and virological features of two rare cases in immunocompetent adults admitted to an intensive care unit in a large, teaching hospital in North West England. We then provide a concise, comprehensive literature review. Methods: The first case was a 35-year old female asthmatic who presented with respiratory distress and pneumonitis during peak influenza season, and recovered after a prolonged hospital stay. The second case was a 73-year old male who presented with diarrhoea, vomiting, and general malaise outside of influenza season, developed respiratory compromise, and died. Adenovirus type 7 was identified in bronchoalveolar lavages and plasma samples of both patients, each of whom received cidofovir. No other infectious aetiology was identified. Results: Clinical and radiological features of severe lower respiratory tract adenoviral infection are similar to other infectious causes of pneumonia and ARDS, including severe influenza. This can create diagnostic uncertainty, especially during influenza season. Positive adenovirus polymerase chain reaction results can support a diagnosis of severe lower respiratory tract adenovirus infection in patients with a clinically compatible syndrome and no other identified aetiology, with higher viral loads being associated with worse prognosis. Although treatment is predominantly supportive, early use of cidofovir may improve outcomes. Conclusions: These rare cases highlight that severe lower respiratory tract adenoviral infection should be considered in the differential diagnoses of immunocompetent patients presenting with pneumonia and ARDS.
Intensive Care Medicine, 2003
To determine if the rapid waveform profile of the activated partial thromboplastin time (aPTT) as... more To determine if the rapid waveform profile of the activated partial thromboplastin time (aPTT) assay, which detects lipoprotein-complexed C reactive protein (LCCRP) formation, predicts sepsis and mortality in critically ill patients. Observational, cohort study. General intensive therapy unit (ITU) of a tertiary care hospital. A total of 1187 consecutive patients admitted to the ITU. Activated partial thromboplastin time transmittance waveform analysis was performed within the first hour of admission to the ITU. The degree of change causing a biphasic waveform was quantified through the drop in light transmittance level. Three hundred forty-six patients had a biphasic waveform on admission to the ITU with a mortality rate of 44% compared with 26% for those with normal waveforms. Logistic regression models showed direct correlation between the likelihood for sepsis and in-patient mortality with increasing waveform abnormalities. The mortality fraction was 0.3 with normal waveforms versus 0.6 when the light transmittance decreased by 30%. The odds ratio (OR) for mortality and sepsis were 4.5 and 11, respectively, from the most abnormal to normal aPTT waveforms. These were comparable with APACHE II scores and superior to those estimated by CRP for mortality (OR 2.3) / sepsis (OR 6.4) prediction. Waveform analysis within the first hour of ITU admission is a single, simple and rapid method of identifying the risks of mortality and sepsis. Its measure of LCCRP formation shows superior prediction over CRP alone and it warrants further assessment as a tool to triage and target prompt, appropriate treatment in the ITU.
Intensive Care Medicine, 2011
Critical Care Medicine, Mar 1, 2003
Nursing times
In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation ... more In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation was high and that this could contribute to the failure to wean patients from mechanical ventilation (Mostafa et al, 2003). A protocol was introduced to standardise the assessment and management of constipation. This article explores why patients in intensive care are at risk of constipation and presents the results of a second audit, carried out after the protocol was introduced, to assess its impact on patients.
Intensive care medicine, 2003
To determine if the rapid waveform profile of the activated partial thromboplastin time (aPTT) as... more To determine if the rapid waveform profile of the activated partial thromboplastin time (aPTT) assay, which detects lipoprotein-complexed C reactive protein (LCCRP) formation, predicts sepsis and mortality in critically ill patients. Observational, cohort study. General intensive therapy unit (ITU) of a tertiary care hospital. A total of 1187 consecutive patients admitted to the ITU. Activated partial thromboplastin time transmittance waveform analysis was performed within the first hour of admission to the ITU. The degree of change causing a biphasic waveform was quantified through the drop in light transmittance level. Three hundred forty-six patients had a biphasic waveform on admission to the ITU with a mortality rate of 44% compared with 26% for those with normal waveforms. Logistic regression models showed direct correlation between the likelihood for sepsis and in-patient mortality with increasing waveform abnormalities. The mortality fraction was 0.3 with normal waveforms ve...
A Practical Handbook, 2014
Canadian Journal Of Anesthesia/journal Canadien D'anesthésie, May 1, 1994
<b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of ... more <b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of GM-CSF on transcription, surface expression and shedding"International Journal of Medical Sciences 2004;1(3):126-136.Published online 10 Jul 2004PMCID:PMC1074707.© Ivyspring International Publisher. This is an open access article. Distribution or copying is permitted, provided that the article is in whole, unmodified, and properly cited. * denotes significance between septic patients and healthy controls on days 0 and 3, p < 0.05, Mann Whittney U test. n=12 (septic patients) n=8 (healthy controls)
<b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of ... more <b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of GM-CSF on transcription, surface expression and shedding"International Journal of Medical Sciences 2004;1(3):126-136.Published online 10 Jul 2004PMCID:PMC1074707.© Ivyspring International Publisher. This is an open access article. Distribution or copying is permitted, provided that the article is in whole, unmodified, and properly cited. P=0.014, healthy controls survivors and non-survivors (Kruskall Wallis test for 3 independent samples).
<b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of ... more <b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of GM-CSF on transcription, surface expression and shedding"International Journal of Medical Sciences 2004;1(3):126-136.Published online 10 Jul 2004PMCID:PMC1074707.© Ivyspring International Publisher. This is an open access article. Distribution or copying is permitted, provided that the article is in whole, unmodified, and properly cited. (b) The fluorescent image of a section though healthy control PBMC showing the surface expression of HLA-DR. (c) Fluorescent image of intracellular staining for HLA-DR of a section through PBMC from a septic patient. (d) shows the weak surface staining of HLA-DR in the same patients' PBMC.
<b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of ... more <b>Copyright information:</b>Taken from "HLA-DR regulation and the influence of GM-CSF on transcription, surface expression and shedding"International Journal of Medical Sciences 2004;1(3):126-136.Published online 10 Jul 2004PMCID:PMC1074707.© Ivyspring International Publisher. This is an open access article. Distribution or copying is permitted, provided that the article is in whole, unmodified, and properly cited. A value above 1 shows a higher intracellular expression of HLA-DR compared to surface expression. Septic patients show a significantly higher number of PBMC expressing HLA-DR when intracellular expression is measured, compared to surface expression, p=0.01. (MFI: Median Fluorescent intensity)
Anaesthesia, 2007
connected to a pressure gauge (such as a blood pressure gauge). thc oxygen Rotameter i s slowly o... more connected to a pressure gauge (such as a blood pressure gauge). thc oxygen Rotameter i s slowly opened and adjusted to maintain a pressure of 16 kPa in the backbar. The oxygcn flow i s an indication of the leakage and more than 200-300 ml/minute is considered unacceptable. (This docs not measure the absolute leak flow under working conditions.) The oxygen flow in the machine in question would probably have been in the order of litrcsiminute with this method. This test i s sensitive, reliable, rapidly and siniply performed with equipment that i s readily available in the anaesthetic room and might usefully be added to the protocol li)r testing anaesthetic machines. I . J . €3. JACXSOK P.J. M c Q r I I I A N
Nursing Times
In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation ... more In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation was high and that this could contribute to the failure to wean patients from mechanical ventilation (Mostafa et al, 2003). A protocol was introduced to standardise the assessment and management of constipation. This article explores why patients in intensive care are at risk of constipation and presents the results of a second audit, carried out after the protocol was introduced, to assess its impact on patients.
Blood reviews, 2002
The 'biphasic transmittance waveform' (BTW) refers to a decrease in light transmittance t... more The 'biphasic transmittance waveform' (BTW) refers to a decrease in light transmittance that often occurs prior to clotting in coagulation assays of critically ill patient plasmas. It correlates with disseminated intravascular coagulation and mortality. The present work shows that the BTW is due to the rapid formation of a precipitate and a coincident change in turbidity in re-calcified plasma. The precipitate was isolated from patient plasma and contained lipids typical of very low density lipoprotein (VLDL), plus the proteins apolipoprotein B-100 and C-reactive protein (CRP). Precipitation also occurred in normal plasma supplemented with CRP. In addition, CRP precipitated with VLDL and intermediate density lipoprotein, but not low density lipoprotein or high density lipoprotein. The Kd value for the CRP/VLDL interaction is 340 nM. The IC50 value of Ca2+ for complex formation is 5.0 mM, and epsilon-aminocaproic acid inhibits the process. In 15 plasmas with the BTW from crit...
Nursing times, 2008
In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation ... more In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation was high and that this could contribute to the failure to wean patients from mechanical ventilation (Mostafa et al, 2003). A protocol was introduced to standardise the assessment and management of constipation. This article explores why patients in intensive care are at risk of constipation and presents the results of a second audit, carried out after the protocol was introduced, to assess its impact on patients.
Clinical Infection in Practice
Objectives: Severe lower respiratory tract infection caused by adenovirus is well described in im... more Objectives: Severe lower respiratory tract infection caused by adenovirus is well described in immunocompromised hosts and can cause significant morbidity and mortality. We compare and contrast the clinical presentation, radiological, and virological features of two rare cases in immunocompetent adults admitted to an intensive care unit in a large, teaching hospital in North West England. We then provide a concise, comprehensive literature review. Methods: The first case was a 35-year old female asthmatic who presented with respiratory distress and pneumonitis during peak influenza season, and recovered after a prolonged hospital stay. The second case was a 73-year old male who presented with diarrhoea, vomiting, and general malaise outside of influenza season, developed respiratory compromise, and died. Adenovirus type 7 was identified in bronchoalveolar lavages and plasma samples of both patients, each of whom received cidofovir. No other infectious aetiology was identified. Results: Clinical and radiological features of severe lower respiratory tract adenoviral infection are similar to other infectious causes of pneumonia and ARDS, including severe influenza. This can create diagnostic uncertainty, especially during influenza season. Positive adenovirus polymerase chain reaction results can support a diagnosis of severe lower respiratory tract adenovirus infection in patients with a clinically compatible syndrome and no other identified aetiology, with higher viral loads being associated with worse prognosis. Although treatment is predominantly supportive, early use of cidofovir may improve outcomes. Conclusions: These rare cases highlight that severe lower respiratory tract adenoviral infection should be considered in the differential diagnoses of immunocompetent patients presenting with pneumonia and ARDS.
Intensive Care Medicine, 2003
To determine if the rapid waveform profile of the activated partial thromboplastin time (aPTT) as... more To determine if the rapid waveform profile of the activated partial thromboplastin time (aPTT) assay, which detects lipoprotein-complexed C reactive protein (LCCRP) formation, predicts sepsis and mortality in critically ill patients. Observational, cohort study. General intensive therapy unit (ITU) of a tertiary care hospital. A total of 1187 consecutive patients admitted to the ITU. Activated partial thromboplastin time transmittance waveform analysis was performed within the first hour of admission to the ITU. The degree of change causing a biphasic waveform was quantified through the drop in light transmittance level. Three hundred forty-six patients had a biphasic waveform on admission to the ITU with a mortality rate of 44% compared with 26% for those with normal waveforms. Logistic regression models showed direct correlation between the likelihood for sepsis and in-patient mortality with increasing waveform abnormalities. The mortality fraction was 0.3 with normal waveforms versus 0.6 when the light transmittance decreased by 30%. The odds ratio (OR) for mortality and sepsis were 4.5 and 11, respectively, from the most abnormal to normal aPTT waveforms. These were comparable with APACHE II scores and superior to those estimated by CRP for mortality (OR 2.3) / sepsis (OR 6.4) prediction. Waveform analysis within the first hour of ITU admission is a single, simple and rapid method of identifying the risks of mortality and sepsis. Its measure of LCCRP formation shows superior prediction over CRP alone and it warrants further assessment as a tool to triage and target prompt, appropriate treatment in the ITU.
Intensive Care Medicine, 2011
Critical Care Medicine, Mar 1, 2003
Nursing times
In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation ... more In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation was high and that this could contribute to the failure to wean patients from mechanical ventilation (Mostafa et al, 2003). A protocol was introduced to standardise the assessment and management of constipation. This article explores why patients in intensive care are at risk of constipation and presents the results of a second audit, carried out after the protocol was introduced, to assess its impact on patients.
Intensive care medicine, 2003
To determine if the rapid waveform profile of the activated partial thromboplastin time (aPTT) as... more To determine if the rapid waveform profile of the activated partial thromboplastin time (aPTT) assay, which detects lipoprotein-complexed C reactive protein (LCCRP) formation, predicts sepsis and mortality in critically ill patients. Observational, cohort study. General intensive therapy unit (ITU) of a tertiary care hospital. A total of 1187 consecutive patients admitted to the ITU. Activated partial thromboplastin time transmittance waveform analysis was performed within the first hour of admission to the ITU. The degree of change causing a biphasic waveform was quantified through the drop in light transmittance level. Three hundred forty-six patients had a biphasic waveform on admission to the ITU with a mortality rate of 44% compared with 26% for those with normal waveforms. Logistic regression models showed direct correlation between the likelihood for sepsis and in-patient mortality with increasing waveform abnormalities. The mortality fraction was 0.3 with normal waveforms ve...
A Practical Handbook, 2014