Lancet
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Up to 40% of patients with rheumatoid arthritis treated with anti-tumour necrosis factor (TNF) drugs do not respond because of primary inefficacy or loss of response. Although one explanation is that immunogenicity leads to the development of anti-drug antibodies and low drug concentrations, the clinical usefulness of pharmacological monitoring is debated. Our aim was to assess whether the presence of anti-drug antibodies and non-trough drug concentrations could predict treatment response in patients with rheumatoid arthritis treated with anti-TNF drugs. ⋯ MJ is a MRC Clinical Training Fellow supported by the North West England Medical Research Council Fellowship Scheme in Clinical Pharmacology and Therapeutics, which is funded by the UK Medical Research Council (grant number G1000417/94909), ICON, GlaxoSmithKline, AstraZeneca, and the Medical Evaluation Unit. Arthritis Research UK (grant ref 20385).
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Exercise capacity in chronic obstructive pulmonary disease (COPD) is limited by both breathlessness and leg muscle fatigue. Neural respiratory drive, measured as diaphragm electromyogram (EMGdi) activity expressed as a proportion of maximum (EMGdi%max), quantifies the mechanical load on the respiratory muscles and relates closely to breathlessness. We tested the hypothesis that end-exercise EMGdi%max would be higher in patients stopping because of breathlessness than in those limited by leg fatigue. ⋯ None.
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Memory T cells are known to reside in peripheral non-lymphoid tissue, but how their presence within solid organ allografts affects transplant outcomes is not known. We have previously described how graft-versus-host (GVH) allorecognition by passenger CD4 T cells within MHC class II-mismatched bm12 heart grafts provokes antinuclear humoral autoimmunity in C57BL/6 recipient mice. Here we aimed to examine how such GVH recognition affects the alloresponse to allografts with greater mismatching. ⋯ Wellcome Trust Clinical Research Training Fellowship.
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Implementation of the National Early Warning Score in the National Health Service (NHS) has renewed focus on prompt identification and referral of the deteriorating ward patient. A large body of published work suggests that delay in both referral and admission to critical care can be associated with poor outcomes. We sought to explore factors associated with early provision of respiratory support in a cohort of deteriorating ward patients referred to the critical care team. ⋯ Wellcome Trust, National Institute for Health Service Support Costs, Intensive Care National Audit & Research Centre.
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Cutaneous squamous cell carcinoma is the most common malignancy in renal transplant recipients and a major cause of morbidity and mortality. Various measures have been proposed to identify recipients at increased risk of developing this cancer to allow targeted intervention. CD57 expression might represent a marker of T-cell exhaustion; we hypothesised that expression could predict development of squamous cell carcinoma in renal transplant recipients, and undertook a prospective cohort study to assess its predictive value. ⋯ Wellcome Trust, Oxford University Hospitals Research Services Committee.