John Radcliffe Hospital

About: John Radcliffe Hospital is a healthcare organization based out in Oxford, Oxfordshire, United Kingdom. It is known for research contribution in the topics: Population & Antigen. The organization has 14491 authors who have published 23670 publications receiving 1459015 citations.

Major effects of delayed graft function and cold ischaemia time on renal allograft survival

Abstract: Background. There is mounting evidence fromexperimental and clinical studies that the quality oforgans from cadaver donors may be influenced byevents occurring around the time of brain death, andthat these may affect transplant outcome. The aim ofthis study is to investigate the influence of donorfactors on renal allograft outcome in a homogeneouscohort of 518 patients transplanted in a single centreover a 9 year period.Methods. Endpoints of the study were delayed graftfunction (DGF), acute rejection (AR), 1 year graftsurvival and long-term survival of those grafts thatreached 1 year. Multivariate analysis was performed todetermine factors that may have influenced the graftoutcome indicators.Results: DGF was the major predictor of graft failureoverall with cold ischaemia time (CIT) as an importantindependent factor. The level of histocompatibility didnot influence graft survival. DGF was the majorfactor affecting 1 year graft survival (P<0.0005) witheffects persisting beyond 1 year. DGF was significantlyinfluenced by CIT, donor age, female kidney into malerecipient and donor creatinine (P<0.05). Other donorfactors and factors associated with donor managementwere not risk factors for DGF, rejection episodesor graft survival. The risk factors for a number ofAR episodes were HLA–DR mismatch and DGF(P<0.005). When grafts surviving for 1 year wereconsidered, only CIT, recipient age and creatinine at1 year (P<0.05) were found to affect graft survivalsignificantly.Conclusions. The results of this analysis of well-matched transplant recipients show that CIT andDGF are the most important predictors of poorshort and long-term graft survival. Therefore, inorder to improve the long-term survival of renalallografts efforts should focus on limiting CIT andthe damage that occurs during this period and onimproving our understanding of DGF.Keywords: cold ischaemia time; delayed graftfunction; donor factors; outcome;renal transplantation

Eating habits, body weight, and insulin misuse. A longitudinal study of teenagers and young adults with type 1 diabetes.

Abstract: OBJECTIVE: To examine disordered eating, insulin misuse, weight change, and their relationships with glycemic control and diabetic complications in adolescents with type 1 diabetes followed up over eight years. RESEARCH DESIGN AND METHODS: Of 76 adolescents (43 male, 33 female) with type 1 diabetes aged 11-18 years at the first assessment, 65 were interviewed as young adults (aged 20-28 years). Eating habits were assessed using a standardized Eating Disorder Examination. Height and weight were determined and BMI calculated. Three consecutive urine specimens were collected for measurement of albumin/creatinine ratio and other significant diabetic complications were recorded. Glycemic control was assessed by glycated hemoglobin. RESULTS: Weight and BMI increased from adolescence to young adulthood. Females were overweight as adolescents and both sexes were overweight as young adults. Concern over weight and shape increased significantly for both sexes from adolescence to young adulthood. This increase in concern was reflected in increased levels of dietary restraint. Features of disordered eating were apparent in females at both assessments, but no patients met the criteria for anorexia nervosa or bulimia nervosa at either assessment. A total of 10 (30%) females, but none of the males admitted underusing insulin to control weight. Five (45%) females with microvascular complications had intentionally misused insulin to prevent weight gain. CONCLUSIONS: An increase in BMI from adolescence to adulthood was associated with higher levels of concern over shape and weight and more intense dietary restraint, especially among females. Overt eating disorders were no more prevalent in these patients than in the general population, but milder forms of disordered eating were common and had implications for diabetes management. Insulin omission for weight control was frequent among females and may contribute to poor glycemic control and to risk of complications.

Prediction of Staphylococcus aureus Antimicrobial Resistance by Whole-Genome Sequencing

Abstract: Whole-genome sequencing (WGS) could potentially provide a single platform for extracting all the information required to predict an organism's phenotype. However, its ability to provide accurate predictions has not yet been demonstrated in large independent studies of specific organisms. In this study, we aimed to develop a genotypic prediction method for antimicrobial susceptibilities. The whole genomes of 501 unrelated Staphylococcus aureus isolates were sequenced, and the assembled genomes were interrogated using BLASTn for a panel of known resistance determinants (chromosomal mutations and genes carried on plasmids). Results were compared with phenotypic susceptibility testing for 12 commonly used antimicrobial agents (penicillin, methicillin, erythromycin, clindamycin, tetracycline, ciprofloxacin, vancomycin, trimethoprim, gentamicin, fusidic acid, rifampin, and mupirocin) performed by the routine clinical laboratory. We investigated discrepancies by repeat susceptibility testing and manual inspection of the sequences and used this information to optimize the resistance determinant panel and BLASTn algorithm. We then tested performance of the optimized tool in an independent validation set of 491 unrelated isolates, with phenotypic results obtained in duplicate by automated broth dilution (BD Phoenix) and disc diffusion. In the validation set, the overall sensitivity and specificity of the genomic prediction method were 0.97 (95% confidence interval [95% CI], 0.95 to 0.98) and 0.99 (95% CI, 0.99 to 1), respectively, compared to standard susceptibility testing methods. The very major error rate was 0.5%, and the major error rate was 0.7%. WGS was as sensitive and specific as routine antimicrobial susceptibility testing methods. WGS is a promising alternative to culture methods for resistance prediction in S. aureus and ultimately other major bacterial pathogens.