• Are urological patients at increased risks of developing haemostatic complications following shock wave lithotripsy (SWL) for solitary unilateral kidney stones?

      Thomas-Wright, S. J.; Banwell, Joseph; Mushtaq, Sohail; Williams, R.; Abdulmajed, I.; Shergill, Iqbal; Hughes, Stephen F.; University of Chester; Wrexham Maelor Hospital (Elsevier, 2014-04-01)
      INTRODUCTION & OBJECTIVES: During the past two years there has been an increase in the number of patients undergoing shock wave lithotripsy (SWL) in Welsh hospitals (United Kingdom) for solitary unilateral kidney stones. Serious complications of SWL include haematuria, acute kidney injury and sepsis. Currently, there are no simple blood tests available, which can predict complications following SWL. Here we have tested the hypothesis that SWL will result in changes to haemostatic function, increase endothelial and haemostatic involvement postoperatively. MATERIAL & METHODS: In this pilot study, ten patients undergoing SWL for solitary unilateral kidney stones, were recruited (n=10). From patients (6 male and 4 female) aged between 31-70 years (mean=50 years), venous blood samples were collected pre-operatively (baseline), at 30 minutes, 120 minutes and 240 minutes postoperatively. Specific haemostatic biomarkers [D-dimer, von Willebrand Factor (vWF), Prothrombin time and sE-selectin] were measured. RESULTS: D-dimer and vWF concentrations were significantly increased from baseline at 240 minutes postoperatively (p=0.05 and <0.01 respectively). Prothrombin time and sE-selectin parameters were not significantly changed following SWL. CONCLUSIONS: The observed increase in D-dimer and vWF concentrations suggests that these markers would provide a more clinically relevant assessment of the extent of haemostatic involvement due to surgery. Analysis of such markers, have the potential to improve the detection of complications occurring postoperatively, such as haematuria and acute kidney injury.
    • The effects of physical contact type on the internal and external demands during a rugby league match simulation protocol.

      Norris, Jonathan; Highton, Jamie M.; Hughes, Stephen F.; Twist, Craig; University of Chester (Taylor and Francis, 2016-02-09)
      This study investigated how the type of contact influences physiological, perceptual and locomotive demands during a simulated rugby league match. Eleven male university rugby league players performed two trials of the rugby league movement simulation protocol for forwards (RLMSP-i) with a traditional soft tackle bag (BAG) and a weighted tackle sled (SLED) to replicate contact demands. Locomotive rate, sprint speed, tackle intensity, heart rate, rating of perceived exertion and blood lactate concentration were analysed in four periods during the first and second bout of both trials. Countermovement jump (CMJ) was measured before and immediately after each trial. More time was spent in heart rate zone between 90 – 100% HRpeak during the first (effect size ± 95% confidence interval: 0.44 ± 0.49) and second bout (0.44 ± 0.43), and larger (0.6 ± 0.69) decrements in CMJ performance were observed during SLED (5.9, s = 4.9%) compared to BAG (2.6, s = 5.4%). Sprint into contact speed was faster during BAG compared to SLED in the first (1.10 ± 0.92) and second bout (0.90 ± 0.90), which impaired high intensity running ability but did not increase physiological strain. Changing the type of contact during the match simulation subtly altered both the internal and external load on participants. These findings indicate that tackle training apparatus should be considered regarding the outcome of a training session.
    • Impact of vitamin D supplementation on endothelial and inflammatory markers in adults: A systematic review.

      Agbalalah, Tari; Hughes, Stephen F.; Freeborn, Ellen J.; Mushtaq, Sohail; University of Chester (Elsevier, 2017-01-23)
      This systematic review aims to evaluate randomised controlled trials (RCTs) investigating the effect of vitamin D supplementation on endothelial function and inflammation in adults. An electronic search of published randomised controlled trials, using Cochrane, Pubmed and Medline databases was conducted, with the search terms related to vitamin D and endothelial function. Inclusion criteria were RCTs in adult humans with a measure of vitamin D status using serum/plasma 25(OH)D and studies which administered the intervention through the oral route. Among the 1107 studies retrieved, 29 studies met the full inclusion criteria for this systematic review. Overall, 8 studies reported significant improvements in the endothelial/inflammatory biomarkers/parameters measured. However, in 2 out of the 8 studies, improvements were reported at interim time points, but improvements were absent post-intervention. The remaining 21 trial studies did not show significant improvements in the markers of interest measured. Evidence from the studies included in this systematic review did not demonstrate that vitamin D supplementation in adults, results in an improvement in circulating inflammatory and endothelial function biomarkers/parameters. This systematic review does not therefore support the use of vitamin D supplementation as a therapeutic or preventative measure for CVD in this respect.
    • Interleukin-17 Expression in the Barrett’s Metaplasia-Dysplasia-Adenocarcinoma Sequence

      Bannister, Jim R.; Khan, Abdul L.; Eccleston, David W.; Deol-Poonia, Ranjeev K.; Hughes, Stephen F.; University of Chester; Aintree University Hospital (Hindawi Publishing Corporation, 2012-12-30)
      Introduction. This pilot study evaluated the expression of the proinflammatory cytokine IL-17 along the Barrett’s metaplasia-dysplasia-adenocarcinoma sequence by establishing the expression levels of IL-17 in columnar epithelium, intestinal metaplastic cells, and dysplastic/glandular neoplastic cells. Immunohistochemical techniques were used to examine the accumulation of the proinflammatory cytokine IL-17 in forty () formalin-fixed, paraffin-embedded oesophageal archived specimens across a range of endoscopic diagnostic categories, and a highly significant difference was found, where , in IL-17 expression (Kruskall Wallis and Mann-Whitney ) between all the cell types examined. There was also a strong positive correlation (Spearman's rank correlation) between disease progression and IL-17 expression (, , ), IL-17 expression was absent or absent/weak in columnar epithelium, weak to moderate in columnar metaplastic cells, and moderate to strong in dysplastic/neoplastic cells, which demonstrated that the elevation of IL-17 expression occurs in the progression of the disease. Understanding the differential expression of IL-17 between benign and malignant tissue potentially has a significant diagnostic, prognostic, and therapeutic value. Ultimately, this selective biomarker may be employed in routine clinical practice for the screening of oesophageal adenocarcinoma.
    • Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers, including selective clinical outcome measures

      Hughes, Stephen F.; Hendricks, Beverly D.; Edwards, David R.; Bastawrous, Salah S.; Middleton, Jim F.; University of Chester; Keele University; Glan Clwyd Hospital; Gwynedd Hospital; University of Bristol (BioMed Central, 2013-11-09)
      Background: With an aging society and raised expectations, joint replacement surgery is likely to increase significantly in the future. The development of postoperative complications following joint replacement surgery (for example, infection, systemic inflammatory response syndrome and deep vein thrombosis) is also likely to increase. Despite considerable progress in orthopaedic surgery, comparing a range of biological markers with the ultimate aim of monitoring or predicting postoperative complications has not yet been extensively researched. The aim of this clinical pilot study was to test the hypothesis that lower limb orthopaedic surgery results in changes to coagulation, non-specific markers of inflammation (primary objective) and selective clinical outcome measures (secondary objective). Methods Test subjects were scheduled for elective total hip replacement (THR) or total knee replacement (TKR) orthopaedic surgery due to osteoarthritis (n = 10). Platelet counts and D-dimer concentrations were measured to assess any changes to coagulation function. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured as markers of non-specific inflammation. Patients were monitored regularly to assess for any signs of postoperative complications, including blood transfusions, oedema (knee swelling), wound infection, pain and fever. Results THR and TKR orthopaedic surgery resulted in similar changes of coagulation and non-specific inflammatory biomarkers, suggestive of increased coagulation and inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in an increase in platelet (P = 0.013, THR) and D-dimer (P = 0.009, TKR) concentrations. Evidence of increased inflammation was demonstrated by an increase in CRP and ESR (P ≤ 0.05, THR and TKR). Four patients received blood transfusions (two THR and two TKR patients), with maximal oedema, pain and aural temperatures peaking between days 1 and 3 postoperatively, for both THR and TKR surgery. None of the patients developed postoperative infections. Conclusions The most noticeable changes in biological markers occur during days 1 to 3 postoperatively for both THR and TKR surgery, and these may have an effect on such postoperative clinical outcomes as oedema, pyrexia and pain. This study may assist in understanding the postoperative course following lower limb orthopaedic surgery, and may help clinicians in planning postoperative management and patient care.
    • A Pilot Study to Evaluate Haemostatic Function, following Shock Wave Lithotripsy (SWL) for the Treatment of Solitary Kidney Stones

      Hughes, Stephen F.; Thomas-Wright, Samantha J.; Banwell, Joseph; Williams, Rachel; Moyes, Alyson J.; Mushtaq, Sohail; Abdulmajed, Mohamed; Shergill, Iqbal; University of Chester; BCUHB Wrexham Maelor Hospital (Public Library of Science, 2015-05-04)
      Purpose: The number of patients undergoing shock wave lithotripsy (SWL) in the UK for solitary unilateral kidney stones is increasing annually. The development of postoperative complications such as haematuria and sepsis following SWL is likely to increase. Comparing a range of biological markers with the aim of monitoring or predicting postoperative complications following SWL has not been extensively researched. The main purpose of this pilot-study was to test the hypothesis that SWL results in changes to haemostatic function. Subsequently, this pilot-study would form a sound basis to undertake future investigations involving larger cohorts. Methods: Twelve patients undergoing SWL for solitary unilateral kidney stones were recruited. From patients (8 male and 4 females) aged between 31–72 years (median—43 years), venous blood samples were collected pre-operatively (baseline), at 30, 120 and 240 minutes postoperatively. Specific haemostatic biomarkers [platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, von Willebrand Factor (vWF), sE-selectin and plasma viscosity (PV)] were measured. Results: Platelet counts and fibrinogen concentration were significantly decreased following SWL (p = 0.027 and p = 0.014 respectively), while D-dimer and vWF levels significantly increased following SWL (p = 0.019 and p = 0.001 respectively). PT, APTT, sE-selectin and PV parameters were not significantly changed following SWL (p>0.05). Conclusions: Changes to specific biomarkers such as plasma fibrinogen and vWF suggest that these represent a more clinically relevant assessment of the extent of haemostatic involvement following SWL. Analysis of such markers, in the future, may potentially provide valuable data on “normal” response after lithotripsy, and could be expanded to identify or predict those patients at risk of coagulopathy following SWL. The validation and reliability will be assessed through the assessment of larger cohorts.
    • Total hip and knee replacement surgery results in changes in leukocyte and endothelial markers

      Hughes, Stephen F.; Hendricks, Beverly D.; Edwards, David R.; Maclean, Kirsty M.; Bastawrous, Salah S.; Middleton, Jim F.; University of Chester; North Wales (Central) NHS Trust; Keele University (BioMed Central, 2010-01-19)
      BACKGROUND: It is estimated that over 8 million people in the United Kingdom suffer from osteoarthritis. These patients may require orthopaedic surgical intervention to help alleviate their clinical condition. Investigations presented here was to test the hypothesis that total hip replacement (THR) and total knee replacement (TKR) orthopaedic surgery result in changes to leukocyte and endothelial markers thus increasing inflammatory reactions postoperatively. METHODS: During this 'pilot study', ten test subjects were all scheduled for THR or TKR elective surgery due to osteoarthritis. Leukocyte concentrations were measured using an automated full blood count analyser. Leukocyte CD11b (Mac-1) and CD62L cell surface expression, intracellular production of H(2)O(2 )and elastase were measured as markers of leukocyte function. Von Willebrand factor (vWF) and soluble intercellular adhesion molecule-1 (sICAM-1) were measured as markers of endothelial activation. RESULTS: The results obtained during this study demonstrate that THR and TKR orthopaedic surgery result in similar changes of leukocyte and endothelial markers, suggestive of increased inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in a leukocytosis, this being demonstrated by an increase in the total leukocyte concentration following surgery. Evidence of leukocyte activation was demonstrated by a decrease in CD62L expression and an increase in CD11b expression by neutrophils and monocytes respectively. An increase in the intracellular H(2)O(2 )production by neutrophils and monocytes and in the leukocyte elastase concentrations was also evident of leukocyte activation following orthopaedic surgery. With respect to endothelial activation, increases in vWF and sICAM-1 concentrations were demonstrated following surgery. CONCLUSION: In general it appeared that most of the leukocyte and endothelial markers measured during these studies peaked between days 1-3 postoperatively. It is proposed that by allowing orthopaedic surgeons access to alternative laboratory markers such as CD11b, H(2)O(2 )and elastase, CD62L, vWF and sICAM-1, an accurate assessment of the extent of inflammation due to surgery per se could be made. Ultimately, the leukocyte and endothelial markers assessed during this investigation may have a role in monitoring potential infectious complications that can occur during the postoperative period.