Sussex Medical School Research Articles

Irbesartan improves arterial compliance more than lisinopril

Antihypertensive agents can reduce arterial stiffness. We hypothesized that an angiotensin receptor blocker (ARB) irbesartan and an angiotensin converting enzyme inhibitor (ACEI) lisinopril improved arterial compliance. A randomized, double-blind, double-dummy, controlled crossover trial. Fifteen hypertensive patients, mean age 65.5 +/- 8.9 years (mean +/- SD) were given irbesartan (150 to 300 mg/day) or lisinopril (10 to 20 mg/day) for 12 weeks and then crossed over for 12 weeks. Pulse wave velocity (PWV) in the carotid-femoral (CF), carotid-radial (CR), and femoral dorsalis-pedis (FD) were measured using a Complior((R)) PWV system. After 12 weeks, systolic blood pressure (SBP) decreased from 162.4 +/- 12.9 to 134.5 +/- 14.8 with irbesartan and to 145.2 +/- 25 mmHg with lisinopril. Irbesartan and lisinopril reduced PWV (CF) in the elastic arterial system from 15.1 +/- 5 to 13.3 +/- 2.6 (p < 0.005) and to 14 +/- 4.7 (p < 0.05) m/s respectively (p = 0.345). Irbesartan reduced PWV (CR) and PWV (FD), whereas lisinopril did not. The difference between treatments was significant after SBP adjustment (p = 0.037 for PWV (CR) and p < 0.001 for PWV (FD)). Irbesartan improved arterial compliance in elastic and muscular arteries, whereas lisinopril improved it only in elastic arteries.

Developmental stages of Coturnix coturnix japonica, the Japanese quail

Coturnix coturnix japonica (Japanese Quail) is an avian species that has been extensively used in developmental studies for many years. Unlike the domestic chicken, Gallus gallus domesticus, the development of the quail has not been accurately staged, despite being used as an important developmental tool. The chick was accurately staged over 50 years ago in a seminal paper by Hamburger and Hamilton and although there have been several papers looking at developmental stages of the quail, the process has not been comprehensive or definitive and therefore researchers have often used the chick staging criteria. One of the most obvious and dramatic differences between quail and chick is hatching times, with the quail hatching some 4‐5 days before the chick. This more rapid developmental cycle means that the use of the Hamburger and Hamilton stage series for all quail developmental studies may not be advantageous. Therefore, we have constructed a comprehensive stage series of quail embryo development, which covers the whole incubation period. It is hoped that such a series will provide researchers with an accessible manual, when using the quail model. Funded by Brighton &amp; Sussex Medical School.

Exploring the Chondrocytic Potential of Cranial Neural Crest Cells

Osteoarthritis is a degenerative joint disease where the joint cartilage becomes damaged. Despite the ability of cranial neural crest cells (CNCC) to form cartilage in the embryo, this population of cells has been overlooked when designing cell‐based therapies for osteoarthritis and associated diseases We have begun to explore the potential of CNCC in developing tissues. A LacZ‐encoded replication‐deficient retrovial vector was used to tag explants of CNCC excised from stage 10 chick embryos before injecting into the joint regions of developing limbs of stage 18‐28 embryos. Tagged chondrocytes were subsequently identified in the developing cartilage, particularly in the region of the developing joints. The results appear to demonstrate that cranial neural crest derived cells (CNCDC) retain their ability to give rise to cartilage when implanted into the developing limb and are restricted to particular regions of the limb. The chondrocytic potential of CNCC is now being refined to investigate the integrative properties of these cells in developing and regenerating cartilage. Funded by Brighton &amp; Sussex Medical School.

Liver failure as initial presentation of autoimmune hepatitis: Clinical characteristics, predictors of response to steroid therapy, and outcomes #

In a recent study, we had reported the impact of ethnicity on the natural history of autoimmune hepatitis (AIH).1 We did a further subgroup analysis of those with initial presentation with liver failure (LF), defined as either international normalized ratio (INR) ≥ 2 and or any degree of hepatic encephalopathy. Twenty patients (20/101, 19.8%) presented with LF, and they were more likely to be black (70% versus 7.4%, P = 0.001), require referral for liver transplantation (LT) (70% versus 24.6%, P < 0.0001), and have a higher mortality (45% versus 4.9%, P < 0.0001), compared to those without LF. Of the 14 (70%) patients with LF who were treated medically with steroids, seven (50%) responded (Table 1). Responders had a Model for End-Stage Liver Disease (MELD) score at admission ≤ 28 and were more likely to have cirrhosis (71.1% versus 28.5%); they showed a stable trend in serum bilirubin (mg/dL) (15.2 ± 13.2 versus 14.1 ± 14.1) and INR (1.8 ± 0.4 versus 1.8 ± 0.5) after a mean of 3.7 ± 0.6 days of steroid therapy. In contrast, nonresponders showed a worsening of serum bilirubin (22.5 ± 4.2 versus 23.1 ± 5.6) and INR (3.0 ± 1.5 versus 3.6 ± 2.1). All responders survived without need for a LT, whereas all nonresponders had a fatal outcome (of whom one died after LT). Six patients (30%) with LF were not treated medically, of whom five had submassive necrosis on liver biopsy. Five of these six patients underwent transplantation and all but one survived. One could not undergo transplantation due to development of fatal cholangitis. In conclusion, about 20% of patients with AIH have LF at initial presentation. A lower MELD score at admission (≤ 28), more severe hepatic fibrosis, and an early (within 4 days of steroid therapy) improvement or stabilization in serum bilirubin and INR identify those who are likely to respond to steroid therapy, and thus survive without LT. Our observations need further corroboration, but if confirmed, such a stratification strategy could optimize care of patients with AIH who present with LF. Sumita Verma*, Anurag Maheshwari , Paul Thuluvath , * Gastroenterology/Hepatology, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK, Gastroenterology and Hepatology, Johns Hopkins University Hospitals, Baltimore, MD, Mercy Medical Center, Institute for Digestive Health and Liver Diseases, Baltimore, MD.

An organ for change

An organ for change

Phenomenology of Obsessive Compulsive Disorder in Patients with Temporal Lobe Epilepsy or Tourette Syndrome

Phenomenology of Obsessive Compulsive Disorder in Patients with Temporal Lobe Epilepsy or Tourette Syndrome

Phenomenology of Obsessive Compulsive Disorder in Patients with Temporal Lobe Epilepsy or Tourette Syndrome

Phenomenology of comorbid obsessive-compulsive disorder was compared in nine patients with temporal lobe epilepsy and 15 with Tourette syndrome. Content of obsessive-compulsive themes focuses on sexuality and impulsiveness in Tourette syndrome and existential thoughts in temporal lobe epilepsy.

A67 Can rapid access to PET be achieved with a mobile service?

aBrighton & Sussex University Hospitals NHS Trust bBrighton & Sussex Medical School, UK Abstracts of the 34th Annual Meeting of the British Nuclear Medicine Society Manchester International Conference Centre, UK, 27–29 March 2006

Provision of anatomical teaching in a new British medical school: Getting the right mix

In response to a government report, which recommended a substantial increase in the number of medical students in the United Kingdom by 2005, several new medical schools have been set up throughout the country. One such school, the Brighton and Sussex Medical School (BSMS), recently opened its doors to new students. BSMS offers a 5-year medical curriculum that uses an integrated systems-based approach to cultivate academic knowledge and clinical experience. Anatomy is one of the core elements of the program and, as such, features strongly within the modular curriculum. The challenge for the anatomy faculty has been to decide how best to integrate anatomy into the new curriculum and what teaching modalities should be used. A multidisciplinary approach has been taken using both traditional and contemporary teaching methods. Unlike most of the other new medical schools, BSMS uses cadaveric dissection as the cornerstone of its teaching, as the faculty believes that dissection still provides the most powerful technique for demonstrating anatomy as well as enhancing communication and teamwork skills. The dissection experience is handled using an understanding and professional way. However, to ensure that our students do not become detached from the process of patient-focused care, emphasis in the dissecting room environment is also placed on respect and compassion. To enhance conceptual understanding of structure and function and provide further clinical relevance, we are using imaging technology to demonstrate living anatomy. Unique to the BSMS curriculum is the teaching of the anatomy in the later years of the program. During specialist rotations, students will return to the dissecting room to study the anatomy relevant to that area. Such vertical integration ensures that core anatomical knowledge is gained at the most appropriate level relative to a student's clinical experience.