St thomasHospital

London, United Kingdom

St thomasHospital

London, United Kingdom
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Rogozinska E.,Queen Mary, University of London | Marlin N.,Blizard Institute | Jackson L.,University of Birmingham | Rayanagoudar G.,Queen Mary, University of London | And 58 more authors.
Health Technology Assessment | Year: 2017

Background: Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes. Objectives: To assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions. Data sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search). Review methods: Researchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions. Results: Diet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI-0.92 to-0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate-0.10 kg, 95% CI-0.14 to-0.06 kg) and multiparity (summary estimate-0.73 kg, 95% CI-1.24 to-0.23 kg). Limitations: The findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies. Conclusion: Diet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes. Future work: The differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation. Study registration: This study is registered as PROSPERO CRD42013003804. © Queen’s Printer and Controller of HMSO 2017.

Santos A.F.,St thomasHospital | Santos A.F.,and Asthma Center in Allergic Mechanisms of Asthma | Santos A.F.,University of Coimbra | Du Toit G.,St thomasHospital | And 11 more authors.
Journal of Allergy and Clinical Immunology | Year: 2015

Background The management of peanut allergy relies on allergen avoidance and epinephrine autoinjector for rescue treatment in patients at risk of anaphylaxis. Biomarkers of severity and threshold of allergic reactions to peanut could significantly improve the care for patients with peanut allergy.Objective We sought to assess the utility of the basophil activation test (BAT) to predict the severity and threshold of reactivity to peanut during oral food challenges (OFCs).Methods The severity of the allergic reaction and the threshold dose during OFCs to peanut were determined. Skin prick tests, measurements of specific IgE to peanut and its components, and BATs to peanut were performed on the day of the challenge.Results Of the 124 children submitted to OFCs to peanut, 52 (median age, 5 years) reacted with clinical symptoms that ranged from mild oral symptoms to anaphylaxis. Severe reactions occurred in 41% of cases, and 57% reacted to 0.1 g or less of peanut protein. The ratio of the percentage of CD63+ basophils after stimulation with peanut and after stimulation with anti-IgE (CD63 peanut/anti-IgE) was independently associated with severity (P =.001), whereas the basophil allergen threshold sensitivity CD-sens (1/EC50 × 100, where EC50 is half maximal effective concentration) value was independently associated with the threshold (P =.020) of allergic reactions to peanut during OFCs. Patients with CD63 peanut/anti-IgE levels of 1.3 or greater had an increased risk of severe reactions (relative risk, 3.4; 95% CI, 1.8-6.2). Patients with a CD-sens value of 84 or greater had an increased risk of reacting to 0.1 g or less of peanut protein (relative risk, 1.9; 95% CI, 1.3-2.8).Conclusions Basophil reactivity is associated with severity and basophil sensitivity is associated with the threshold of allergic reactions to peanut. CD63 peanut/anti-IgE and CD-sens values can be used to estimate the severity and threshold of allergic reactions during OFCs. © 2014 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma and Immunology.

Shafi S.,King's College London | Vantourout P.,King's College London | Vantourout P.,Cancer Research UK Research Institute | Wallace G.,University of Birmingham | And 7 more authors.
Science Translational Medicine | Year: 2011

DNA damage or other physicochemical stresses may increase the expression of major histocompatibility complex class I-related stress antigens, which then activate lymphocytes. This lymphoid stress surveillance (LSS) not only can limit tumor formation but may also promote immunopathology. MICA is a highly polymorphic human stress antigen implicated in tumor surveillance, inflammation, and transplant rejection. However, LSS has not been conclusively demonstrated in humans, and the functional role for MICA polymorphisms remains to be established. We show that MICA coding sequence polymorphisms substantially affected RNA and protein expression. All donors tested showed LSS responses of γδ T and natural killer cells, but unexpectedly, each was individually "tuned."Hence, some responded optimally to highly expressed alleles, whereas others responded better to lower MICA expression, challenging the orthodoxy that higher stress antigen levels promote greater responsiveness. These individual variations in LSS tuning may help explain patient-specific differences in tumor immune surveillance, transplant rejection, and inflammation, as well as provide insight into immune evasion and immunosuppression.

Katritsis D.G.,Athens Euroclinic | Efstathopoulos E.P.,National and Kapodistrian University of Athens | Pantos I.,Athens Euroclinic | Pantos I.,National and Kapodistrian University of Athens | And 7 more authors.
Coronary Artery Disease | Year: 2011

Objective: To derive a model for the identification of left anterior descending (LAD) coronary artery stenoses predisposed to plaque rupture and thrombosis. Methods: Coronary angiograms of 186 consecutive patients (original sample) with an anterior ST elevation myocardial infarction (STEMI) and a recanalized LAD were reconstructed in the three-dimensional space. Culprit lesions were compared with 293 stable LAD coronary stenoses on the same patients. A model for predicting stenoses with a high probability of thrombosis was derived and validated in 50 subsequent patients with STEMI, and 50 patients with stable lesions (validation sample). Results: The majority of culprit lesions occurred between 20 and 40 mm from the LAD ostium, whereas the majority of stable lesions were found in a distance of more than 60 mm (P<0.001). Culprit lesions were statistically significantly longer than stable ones (23.2±10.4 mm vs. 14.7±7.2 mm; P<0.001). Bifurcations on culprit lesions were significantly more frequent (86.6%) compared with stable lesions (41.3%, P<0.001). Lesion angulation was significantly sharper in culprit lesions, which were symmetrical whereas stable lesions resided in the inner vessel wall in respect to the local vessel curvature. A simple additive tool was developed by using these parameters in a multiple regression model. The discriminating ability of the proposed index was high in both the original [area under the receiver operating characteristic curve: 0.88 (95% confidence interval: 0.85-0.91)] and validation sample [area under the receiver operating characteristic curve: 0.69 (95% confidence interval: 0.59-0.78)]. Conclusion: Specific anatomic characteristics of LAD segments associated with STEMI can be identified on coronary angiograms and assist the risk stratification of coronary stenoses. © 2011 Wolters Kluwer Health. Lippincott Williams & Wilkins.

Williams T.M.,University of California at Santa Cruz | Fuiman L.A.,University of Texas at Austin | Kendall T.,University of California at Santa Cruz | Berry P.,Epcots the Seas Walt Disney World Resorts | And 7 more authors.
Nature Communications | Year: 2015

Unlike their terrestrial ancestors, marine mammals routinely confront extreme physiological and physical challenges while breath-holding and pursuing prey at depth. To determine how cetaceans and pinnipeds accomplish deep-sea chases, we deployed animal-borne instruments that recorded high-resolution electrocardiograms, behaviour and flipper accelerations of bottlenose dolphins (Tursiops truncatus) and Weddell seals (Leptonychotes weddellii) diving from the surface to >200 €‰m. Here we report that both exercise and depth alter the bradycardia associated with the dive response, with the greatest impacts at depths inducing lung collapse. Unexpectedly, cardiac arrhythmias occurred in >73% of deep, aerobic dives, which we attribute to the interplay between sympathetic and parasympathetic drivers for exercise and diving, respectively. Such marked cardiac variability alters the common view of a stereotypic € dive reflex'in diving mammals. It also suggests the persistence of ancestral terrestrial traits in cardiac function that may help explain the unique sensitivity of some deep-diving marine mammals to anthropogenic disturbances. © 2015 Macmillan Publishers Limited. All rights reserved.

Chan E.,St Thomas Hospital | Shah A.N.,St Thomas Hospital | Obrart D.P.S.,St Thomas Hospital | Obrart D.P.S.,St ThomasHospital
Cornea | Year: 2011

PURPOSE:: To describe a novel technique for using amniotic membrane in the management of corneal perforations. METHODS:: Interrupted 10-0 nylon sutures are passed across the perforation site. A roll of amniotic membrane is then placed across the row of preplaced sutures, and the sutures are tied to secure the membrane. An amniotic membrane patch is placed over the graft, which is then protected by a bandage contact lens. RESULTS:: We illustrate the results of our 2 most recent patients. CONCLUSIONS:: Amniotic membrane has been widely used in ocular surgery. We recommend the "Swiss roll" amniotic membrane graft technique in cases of severe corneal thinning or localized perforations.

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