Leicester Royal Infirmary

About: Leicester Royal Infirmary is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Carotid endarterectomy. The organization has 5300 authors who have published 6204 publications receiving 208464 citations.

Sympathoadrenal responses to anaesthesia and surgery

Abstract: Nociceptive surgical stimulation is accompanied by increased hypothalamopituitary activity which is generally referred to as the stress response to injury. This is manifest by a release of trophic hormones from the hypothalamus which in turn stimulate release of ACTH, TSH, GH, FSH, luteinizing hormone and prolactin in addition to ADH from the pituitary. Consequently, there is increased secretion of cortisol and thyroxine with suppression of insulin and increase in blood sugar concentrations. These responses may be partly attenuated by large doses of opioid analgesic drugs and some local anaesthetic techniques used during general anaesthesia. These endocrine changes have recently been reviewed elsewhere (Kaufman 1982, 1984; Weatherill and Spence, 1984). In addition, increased hypothalamic activity induced by nociceptive stimulation is accompanied by increased traffic in sympathetic efferent tracts. This is manifest by the well known signs which are conventionally used to diagnose unduly light levels of anaesthesia — notably dilatation of the pupils, sweating, tachycardia and hypertension. Thus measurements of heart rate, arterial pressure and skin resistance have been used as indirect indices of the level of sympathetic activity to assess both the efficacy of premedication and depth of anaesthesia. Increased sympathetic tone involves augmented release of noradrenaline by presynaptic sympathetic fibres and also increased secretion of catecholamines from the adrenal medulla. Thus attempts have been made for a number of years to assess sympathetic activity \"directly\" by measurement of plasma catecholamine concentrations. Until recently, assays were not available with sufficient sensitivity to measure resting concentrations of plasma catecholamines. However, with the advent of radioenzymatic assay (REA) and, over the past 5-6 years, high pressure liquid chromatography (HPLC) techniques for measurement of catecholamines in plasma, there has been a large

Chronic lymphocytic leukemic cells exhibit apoptotic signaling via TRAIL-R1.

Abstract: Clinical trials have been initiated with Apo2L/TRAIL (Genentech) and agonistic mAbs to TRAIL receptors, -R1 and -R2 (Human Genome Sciences). The apoptosis-inducing ability of these mAbs and different TRAIL preparations, in the presence or absence of histone deacetylase inhibitors (HDACi), varied markedly against primary chronic lymphocytic leukaemia (CLL) cells and various tumor cell lines, demonstrating an unanticipated preferential apoptotic signaling via either TRAIL-R1 or -R2. Contrary to literature reports that TRAIL-induced apoptosis occurs primarily via signaling through TRAIL-R2, CLL cells, in the presence of HDACi, undergo predominantly TRAIL-R1-mediated apoptosis. Consequently, Apo2L/TRAIL, which signals primarily through TRAIL-R2, is virtually devoid of activity against CLL cells. To maximize therapeutic benefit, it is essential to ascertain whether a primary tumor signals via TRAIL-R1/-R2, prior to initiating therapy. Thus combination of an agonistic TRAIL-R1 Ab and an HDACi, such as the anticonvulsant sodium valproate, could be of value in treating CLL.

The efficacy, side-effects and continuation rates in women with symptomatic endometriosis undergoing treatment with an intra-uterine administered progestogen (levonorgestrel): a 3 year follow-up

Abstract: BACKGROUND Side-effects and choice of drugs influence compliance during treatment for endometriosis. Progestogen administered by a device with a 5-year lifespan, has been shown to be an effective medical alternative with several advantages. The aims of this study were to investigate its efficacy, continuation rates and side-effects in women with endometriosis over a 3-year period. METHODS Thirty-four women with laparoscopically confirmed minimal to moderate symptomatic endometriosis offered insertion of an intrauterine device at diagnostic laparoscopy were followed up at 1, 3 and 6 months, and then every 6 months for 3 years. A symptom diary for side-effects, documentation of symptoms on a visual analogue scale (VAS), a verbal rating scale (VRS) and quantified menstrual loss using the pictorial blood loss chart was used to assess response to treatment. RESULTS The continuation rates were respectively 85%, 68%, 62% and 56% at, 6, 12, 24 and 36 months. Discontinuation rates were highest at <12 months, and most of these were for irregular and intolerable bleeding and persistent pain. An improvement in symptoms was observed throughout the 36 months. The greatest changes in pain assessed by either the VAS or VRS were between the pretreatment scores and those after 12 months (7.7 +/- 1.3 versus 3.5 +/- 1.8 for VAS, P < 0.001; and 25 +/- 13.8 versus 14 +/- 9.4 for VRS, P < 0.002). The monthly quantified blood loss fell from 204 (196) pretreatment to 60 (50) at 12 months (P < 0.001) and then to 70 (30) after 36 months. The most common side-effects were bleeding irregularities (14.7%), one-sided abdominal pain (11.8%) and weight gain (8.8%). CONCLUSIONS Intrauterine progestogen is effective in symptom control throughout the 3 years on the device, and discontinuation is greatest between 3 and 6 months. For those patients with improvement in symptoms, it is an acceptable long-term alternative.

Diabetes education in children and adolescents.

Abstract: Karin Langea, Peter Swiftb, Ewa Pankowskac and Thomas Danned aDepartment of Medical Psychology, Hannover Medical School, OE 5430, 30625, Hannover, Germany; bChildrens Hospital, Leicester Royal Infirmary, Leicester, LE1 5WW, UK; cThe Institute of Diabetology, ul. Żeganska 46a, 04-736, Warszawa, Poland; and dDiabetes Centre for Children and Adolescents at the Kinderund Jugendkrankenhaus, Auf der Bult, Janusz-Korczak-Allee 12, 30173, Hannover, Germany

Sialic acid receptor specificity on erythrocytes affects detection of antibody to avian influenza haemagglutinin

Abstract: Haemagglutination-inhibition tests (HI) are used to detect increases in influenza antibody in serum. However, they are relatively insensitive for the detection of human antibody responses to avian haemagglutinin, even in the presence of high titres of neutralising antibody after confirmed infection or vaccination. Human influenza viruses bind preferentially sialic acid containing N-acetylneuraminic acid alpha2,6-galactose (SAalpha2,6Gal) linkages while avian and equine viruses bind preferentially those containing N-acetylneuraminic acid alpha2,3-galactose (SAalpha2,3Gal) linkages. Increasing the proportion of SAalpha2,3Gal linkages on the erythrocytes used, by enzymatic modification or change of species, improves the ability of erythrocytes to bind to avian influenza strains and thereby improves the sensitivity of detection of antibody to avian and equine HA in a range of mammalian and human sera using HI tests.