St Bartholomew's Hospital

About: St Bartholomew's Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Cancer. The organization has 11054 authors who have published 13229 publications receiving 501102 citations. The organization is also known as: St. Bartholomew's Hospital & The Royal Hospital of St Bartholomew.

First clinical experiences with a new ovine Fab Echis ocellatus snake bite antivenom in Nigeria: randomized comparative trial with Institute Pasteur Serum (Ipser) Africa antivenom.

Abstract: During the past decade, effective snake antivenoms have become scarce in northern Nigeria. As a result, many patients severely envenomed by the saw-scaled or carpet viper (Echis ocellatus), which is responsible for more than 95% of the snake bites in the region, did not receive effective treatment and mortality and morbidity increased. To combat this crisis, a new monospecific ovine Fab antivenom (EchiTab) is being developed. Its theoretical advantages over conventional equine F(ab')2 antivenom are a more rapid tissue penetration and larger apparent volume of distribution (the volume of [tissue] fluid in which the the antivenom would be uniformly distributed to achieve the observed plasma concentration). In a preliminary study, two vials (20 ml; 1.0 g of protein) of EchiTab rapidly and permanently restored blood coagulability and cleared venom antigenemia in seven envenomed patients. Four experienced early reactions that responded to epinephrine. In a randomized comparative trial of one vial (10 ml; 0.5 g protein) of EchiTab or four ampules (40 ml; 2.12 g of protein) of Institute Pasteur Serum (Ipser) Africa polyspecific F(ab')2 antivenom, there were fewer reactions, but only 36% and 35% of patients, respectively, showed permanent restoration of coagulability, with the remainder requiring further doses. This suggests that 0.5 g (one vial) of EchiTab is approximately equivalent to 2.12 g (four ampules) of Ipser Africa antivenom, and that a higher initial dose will be required for most patients. Measurements of circulating venom and antivenom levels reflected the clinical events.

Informed consent in medical research

Abstract: # Informed consent in medical research {#article-title-2} In the issue of 12 April 1997 the BMJ invited comment on the acceptable limits of informed consent in medical studies. In view of the large correspondence this generated, we invited the two original commentators, Len Doyal and Jeffrey Tobias, to revisit the subject. We also invited comments from three people who are not doctors, researchers, or medical ethicists: two of them represent the views of patients and potential patients # Informed consent—a response to recent correspondence {#article-title-3} Editorial by Smith and Personal views pp 1026-7 The publication of the debate between myself and Jeffrey Tobias about the acceptable limits of informed consent in medical research has generated an immense and varied number of letters to the BMJ .1–4 This in itself is gratifying, whether or not correspondents agree with my arguments. It provides ample evidence of widespread and serious deliberation about the moral boundaries of the rights of participants in research. Previous articles and comment on informed consent are available on our website (see Collections) Many correspondents either explicitly or implicitly endorse the hard line that I take in my paper on the right of competent people to an acceptable level of information before agreeing to participate in medical research. Other contributions confirm my emphasis on the moral importance of the principle of informed consent but, in light of the highly specific circumstances where I argue that the principle must be qualified, question the degree or clarity of my own commitment to it. What is important here is our shared belief in the moral imperative of respecting human autonomy in almost all circumstances. I still disagree with those authors who argue that it is not necessary to obtain informed consent if this will lead to the methodological compromise, or possible cancellation, of potentially beneficial studies involving clinical interventions that carry minimal risks. What these …

Role of Bacterial Intimin in Colonic Hyperplasia and Inflammation

Abstract: Enteropathogenic Escherichia coli (EPEC) cells adhere to gut epithelial cells through intimin α: the ligand for a bacterially derived epithelial transmembrane protein called the translocated intimin receptor. Citrobacter rodentium colonizes the mouse colon in a similar fashion and uses a different intimin: intimin β. Intimin α was found to costimulate submitogenic signals through the T cell receptor. Dead intimin β+ C. rodentium , intimin α–transfected C. rodentium or E. coli strain K12, and EPEC induced mucosal hyperplasia identical to that caused by C. rodentium live infection, as well as a massive T helper cell–type 1 immune response in the colonic mucosa. Mutation of cysteine-937 of intimin to alanine reduced costimulatory activity in vitro and prevented immunopathology in vivo. The mucosal changes elicited by C. rodentium were interferon-γ–dependent. Immunopathology induced by intimin enables the bacteria to promote conditions that are favorable for increased microbial colonization.

Presence of ghrelin in normal and adenomatous human pituitary.

Abstract: Recently, an endogenous ligand has been described for the growth hormone secretagogue receptor (GHS-R), named ghrelin. It was originally isolated from the stomach, but it is also present in the hypothalamus, where the highest concentration of GHS-R has been detected. It is well established that synthetic GHSs exert their effects on the growth hormone (GH) axis principally via the hypothalamus, although they are also able to stimulate GH release directly from the pituitary. We have previously demonstrated the presence of GHS-R mRNA expression in normal and abnormal human pituitary. We have therefore now investigated the expression of the newly recognized endogenous ligand in rat as well as in human pituitary. We readily detected ghrelin mRNA message in normal rat pituitary using reverse transcriptase polymerase chain reaction with published primers. We then designed primers to the corresponding region on the human ghrelin sequence and successfully detected mRNA message in normal human pituitary, as well as in somatotroph, lactotroph, corticotroph, thyrotroph, and nonfunctioning adenomas. We confirmed the expected polymerase chain reaction product by direct sequencing. In conclusion, we suggest that in addition to the probable hypothalamic effects of ghrelin, the peptide is synthesized locally within the pituitary gland, where it may influence the release of GH in an autocrine or paracrine manner.