North Bristol NHS Trust

About: North Bristol NHS Trust is a healthcare organization based out in Bristol, United Kingdom. It is known for research contribution in the topics: Population & Medicine. The organization has 2204 authors who have published 2811 publications receiving 61110 citations.

Management of malignant pleural effusions.

Abstract: Purpose of review Although malignant pleural effusions are a common medical problem, research into their optimal management remains sparse. The aim of this review is to summarise recent developments in this area. Recent findings Talc remains the most efficacious pleurodesis agent. However, concerns remain about its side effect profile, with a number of cases of acute respiratory distress syndrome documented in the literature. A recent trial showed that using calibrated talc particles reduced the risk of morbidity from this procedure. Work on novel pleurodesis agents, such as transforming growth factor-beta, appears to induce pleurodesis in animal models without any unwanted side effects. This is a promising development and human trials are awaited. With regard to mesothelioma, recent chemotherapy trials with pemetrexed/cisplatin and raltitrexed/cisplatin are encouraging and appear, for the first time, to offer a small but real survival advantage. Summary In the authors' opinion, the major developments in the management of malignant effusions during the past year are the development of safer pleurodesis agents and the promise of better combination chemotherapy agents for the treatment of mesothelioma.

Improving quality in the preanalytical phase through innovation, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE)

Abstract: It is now undeniable that laboratory testing is vital for the diagnosis, prognostication and therapeutic monitoring of human disease. Despite the many advances made for achieving a high degree of q ...

Outcome of laparoscopic ventral mesh rectopexy for external rectal prolapse.

Abstract: Aim The study assessed the efficacy of laparoscopic ventral mesh rectopexy (LVMR) for full thickness external rectal prolapse (ERP), including recurrent prolapse. Method A prospective database identified all patients undergoing LVMR for ERP over the 16-year period to December 2013. Clinical outcome, Cleveland Clinic Incontinence Score (CCIS), quality of life (QOL) and patient-reported outcome were evaluated. Results In total, 190 LVMRs (87% women) were performed during the study period, with a median active follow-up of 29 (1–196) months; 120 had a follow-up > 5 years and 16 > 10 years. The median time from surgery was 73 (1–196) months. The 60-day mortality, recurrence and mesh-related complication rates were 1%, 3% and 3.7%. The mean improvement in CCIS was 8 (P < 0.0001). Sixty-two patients returned a complete sequence of QOL scores (Birmingham Bowel and Urinary Symptoms Questionnaire 22), which had improved by 46% at year 1 and were sustained at a median of 4 years (P < 0.001). Mean patient-reported outcome measures for satisfaction at final review in 119 responders was 9.1/10. Thirty-nine patients underwent LVMR for recurrent ERP following perineal repair. Of these, full thickness recurrence occurred in one and there were no mesh complications. The same sustained improvement in QOL was observed. Conclusion LVMR for ERP is associated with low morbidity and recurrence and a long-term improvement in function and QOL. LVMR achieves the same benefits after a failed perineal procedure.

Pharmacodynamics of Ceftaroline against Staphylococcus aureus Studied in an In Vitro Pharmacokinetic Model of Infection

Abstract: An in vitro single-compartment dilutional pharmacokinetic model was used to study the pharmacodynamics of ceftaroline against Staphylococcus aureus (both methicillin-susceptible S. aureus [MSSA] and methicillin-resistant S. aureus [MRSA]). Mean serum free concentrations of ceftaroline (the active metabolite of the prodrug ceftaroline fosamil) dosed in humans at 600 mg every 12 h (q12h) were simulated, and activities against 12 S. aureus strains (3 MSSA strains and 9 MRSA strains, 3 of which had a vancomycin-intermediate phenotype) were determined. Ceftaroline produced 2.5- to 4.0-log10-unit reductions in viable counts by 24 h with all strains and a 0.5- to 4.0-log-unit drop in counts at 96 h. The antibacterial effect could not be related to the strain MIC across the ceftaroline MIC range from 0.12 to 2.0 μg/ml. In dose-ranging studies, the cumulative percentage of a 24-h period that the free drug concentration exceeded the MIC under steady-state pharmacokinetic conditions (fT(MIC)) of 24.5% ± 8.9% was associated with a 24-h bacteriostatic effect, one of 27.8% ± 9.5% was associated with a -1-log-unit drop, and one of 32.1% ± 8.1% was associated with a -2-log-unit drop. The MSSA and MRSA strains had similar fT(MIC) values. fT(MIC) values increased with increasing duration of exposure up to 96 h. Changes in ceftaroline population analysis profiles were related to fT(MIC). fT(MIC)s of <50% were associated with growth on 4× MIC recovery plates at 96 h of drug exposure. These data support the use of ceftaroline fosamil at doses of 600 mg q12h to treat S. aureus strains with MICs of ≤ 2 μg/ml. An fT(MIC) of 25 to 30% would make a suitable pharmacodynamic index target, but fTMIC values of ≥ 50% are needed to suppress the emergence of resistance and require clinical evaluation.

Vascular Endothelial Growth Factor (VEGF) isoform expression and activity in human and murine lung injury.

Abstract: Background The properties of vascular endothelial growth factor (VEGF) as a potent vascular permogen and mitogen have led to investigation of its potential role in lung injury. Alternate spliced VEGF transcript generates several isoforms with potentially differing functions. The purpose of this study was to determine VEGF isoform expression and source in normal and ARDS subjects and investigate the expression and regulation of VEGF isoforms by human alveolar type 2 (ATII) cells.