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Biomedical subjects

J J Sands

Publications and source records attributed to J J Sands.

At least 19 recordsLinked to original sources
PubMed2006

Dedicated outpatient vascular access center decreases hospitalization and missed outpatient dialysis treatments.

Dedicated outpatient vascular access centers (VAC) specializing in percutaneous interventions (angiography, thrombectomy, angioplasty and catheter placement) provide outpatient therapy that can obviate the need for hospitalization. This paper reports the impact of one VAC staffed by interventional nephrologists on vascular access-related hospitalization and missed outpatient dialysis treatments. We performed a retrospective analysis of vascular access-related hospitalized days and missed vascular access-related outpatient dialysis treatments from 1995 to 2002 in 21 Phoenix Arizona Facilities (5928 cumulative patients) and 1275 cumulative Fresenius Medical Care North America (FMCNA) facilities (289,454 cumulative patients) to evaluate the impact of the introduction of a VAC in Phoenix. Vascular access-related hospitalized days/patient year and missed dialysis treatments/patient year declined from 1997 to 2002 across all access types. The decline was greater in Phoenix and coincided with the creation of a VAC in 1998. By 2002, there were 0.57 fewer hospitalized days/patient year and 0.29 fewer missed treatments/patient year than in the national sample (P<0.01). In 2002, the relative risk for vascular access hospitalized days was 0.38 (95% confidence interval (CI) 0.27-0.5) (P<0.01) and for vascular access-related missed outpatient dialysis treatments was 0.34 (95% CI 0.24-0.49) (P<0.01) in Phoenix vs FMCNA after adjustment for age, gender, diabetic status duration of dialysis and access type. VAC development was associated with a significant decrease in vascular access-related hospitalization and missed outpatient dialysis treatments. Further studies are necessary to demonstrate this effect in other communities.

Adult↗
PubMed2006

Disease management improves ESRD outcomes.

Renal disease management organizations have reported achieving significant decreases in mortality and hospitalization in conjunction with cost savings, improved patient satisfaction and quality of life. Disease management organizations strive to fill existing gaps in care delivery through the standardized use of risk assessment, predictive modeling, evidence based guidelines and process and outcomes measurement. Patient self-management education and the provision of individual nurse care managers are also key program components. As we more fully measure clinical outcomes and total health-care costs including payments from all insurance and government entities, pharmacy costs and out-of-pocket expenditures, the full implications of disease management can be better defined. The results of this analysis will have a profound influence on United States healthcare policy. At present, current data suggests that the promise of disease management, improved care at reduced cost, can and is being realized in ESRD.

Cost Control↗
PubMed2000

Antibodies to topical bovine thrombin correlate with access thrombosis.

Bovine thrombin is often used topically to promote hemostasis during vascular surgery, including dialysis-access placement. Patients frequently develop antibodies to bovine thrombin preparations, and some may develop antiphospholipid antibodies. We evaluated 88 hemodialysis patients for the presence of antibodies to topical bovine thrombin to determine if elevated antibody levels correlated with vascular access thrombosis. Twenty-seven patients (30.7%) had elevated antibody levels to topical bovine thrombin. More patients with elevated antibody levels had prior vascular access thrombosis than patients with normal antibody levels (13 of 27 versus 5 of 61 patients; P < 0.001). This difference was almost entirely the result of greater levels of thrombosis in patients with polytetrafluoroethylene (PTFE) grafts and elevated antibody levels. In these patients, 11 of 13 patients (84.6%) with elevated antibody levels had a previous thrombosis compared with 2 of 15 patients (13. 3%) with normal antibody levels (P < 0.001). Patients with elevated antibody levels and PTFE grafts also had more prior thromboses (1.92 +/- 1.60 versus 0.133 +/- 0.35 thromboses; P < 0.01) and a greater thrombosis rate (66.89 +/- 63.71 versus 4.65 +/- 12.05 thromboses/100 patient-years; P < 0.01) than patients with normal antibody levels. There were no differences in the frequency of myocardial infarction, coronary artery bypass, access age, presence of diabetes mellitus, platelet counts, anticardiolipin antibody, albumin, lactate dehydrogenase, or C-reactive protein levels. In conclusion, patients with PTFE grafts and elevated antibody levels to topical bovine thrombin had significantly more vascular access thrombosis.

Aged↗
PubMed1999

Assessment of hemodialysis access performance by color-flow Doppler ultrasound.

Hemodialysis access failure is a major cause of morbidity for patients with end stage renal disease with costs in excess of $743 million annually. Color-flow doppler ultrasound is the only mobile noninvasive technique that provides direct visual imaging of the access and measurement of access flow. Doppler ultrasound can identify patients at increased risk of future thrombosis and allow preventive intervention. Prospective trials show that ultrasound-based access management programs can decrease thrombosis rates, prolong access longevity, and decrease the cost of hemodialysis access management. It should be included as part of a coordinated program of hemodialysis management.

Biocompatible Materials↗
PubMed1998

A novel approach to the detection of classical swine fever virus by RT-PCR with a fluorogenic probe (TaqMan).

Detection of classical swine fever virus (CSFV) and its discrimination from other pestiviruses can be achieved by virus isolation (VI) in cell cultures, antigen detection, or molecular analysis. To simplify the latter, a 5'-nuclease assay (TaqMan) was developed for the rapid and specific detection of CSFV with the minimum of downstream PCR processing. A pair of 5'-non-coding region, panpestivirus-specific PCR primers were assessed in a one-step reverse transcription-PCR with each of 36 diverse pestiviruses. The PCR products were subsequently reamplified, in conjunction with a CSFV-specific fluorogenic probe, in a nested-PCR with a second set of panpestivirus PCR primers. During nested PCR, when the target of interest was present, the CSFV probe annealed to the amplicon between the forward and reverse primers and was subsequently cleaved via the 5'-3' nucleolytic activity of the DNA polymerase resulting in the release of the fluorescent reporter dye. Each PCR tube was then placed directly into a luminescence spectrometer to monitor for any increase in fluorescence due to cleavage of the probe. This assay detected representatives of all genetic sub-groups of CSFV, but gave negative results for other pestiviruses. A preliminary assessment showed that the method could be used to detect CSFV RNA extracted from infected pig blood with a sensitivity greater than that of VI.

Age Factors↗
PubMed1996

Identifying a new reality: zero vascular access recirculation using ultrasound dilution.

Access recirculation measurements by blood urea nitrogen (BUN) sampling methods have come under recent criticism regarding their reliability especially at low levels of recirculation. New methods have shown that the majority of patients have much less recirculation than previously suspected. However, some of these methods are prone to the same factors that limit BUN measurement accuracy. A new method, ultrasound dilution, was studied that avoids these problems and supports a new clinical reality--zero access recirculation. Information on the relationship of recirculation to access flow was also obtained which supports the assumption that patients with adequate vascular access flows have no recirculation.

Adult↗
PubMed1995

Identification of herd-specific bovine viral diarrhoea virus isolates from infected cattle and sheep.

Thirteen pestiviruses isolated from ruminants on four different farms in Sweden were compared antigenically and genetically. On two farms, viruses were isolated from both cattle and sheep, a third farm contained only sheep and a fourth only cattle. Seven viruses were isolated from six different cattle and six viruses were isolated from five different sheep. Epitope conservation between the viruses was studied with a panel of 32 monoclonal antibodies, revealing that all of the isolates were BVDV-like. However, certain epitopes present in isolates from cattle were lost following virus transmission to sheep. In vitro amplification of the 5'-untranslated region of the 13 isolates by the polymerase chain reaction (PCR) and subsequent analyses of amplified products with restriction enzymes also indicated that all 13 isolates belong to the BVDV group of pestiviruses. A fragment of the E2 (gp53) gene of each virus was amplified by PCR and a comparison of the amplified sequence of 188 nucleotides separated the isolates into four groups each of which could be identified with a particular farm of origin. The 13 isolates were thus herd-specific rather than species-specific demonstrating that BVDV is readily transmitted between cattle and sheep.

Animals↗
PubMed1995

Production, characterization and reactivity of monoclonal antibodies to porcine reproductive and respiratory syndrome virus.

This report describes the preparation of six monoclonal antibodies (MAbs) raised against a British isolate of porcine reproductive and respiratory syndrome virus (PRRSV), their characterization in terms of protein specificity and their reactivity with different PRRS viruses from Europe and the USA. Radioimmunoprecipitation and Western blotting studies of MAb reactivity with proteins from cell lysates of infected cells and purified virus revealed that four of the six MAbs (WBE1 and WBE4-6) precipitated a 15 kDa viral protein. Further studies using in vitro translated products of the Lelystad virus genome showed that this protein was the product of ORF7, the putative nucleocapsid protein. The specificity of another MAb, WBE2, was found to be for a 45 kDa protein, determined to be the product of ORF3 and demonstrated to be present in purified virion preparations. The protein specificity of the sixth MAb, WBE3 could not be determined. Thirty-three PRRSV isolates from Europe and the USA were grown in alveolar macrophages and examined by immunoperoxidase staining, using the panel of six MAbs. All European isolates were recognized by the four MAbs specific for the putative nucleocapsid, but the viruses showed different patterns of reactivity with WBE2 and WBE3. Furthermore, these two MAbs stained only a small proportion of the cells infected with certain isolates, suggesting that a single isolate may be antigenically heterogeneous. No MAbs bound to US isolates, indicating a consistent antigenic difference between the putative nucleocapsid of US and European isolates. Detergent extraction of cell lysate antigen abrogated the binding of WBE1-3, suggesting that the epitopes are conformation dependent.

Animals↗
PubMed1995

A proposed division of the pestivirus genus using monoclonal antibodies, supported by cross-neutralisation assays and genetic sequencing.

Sixty-six pestiviruses from ruminant and porcine hosts were analysed with a panel of 76 monoclonal antibodies raised against 9 different viruses. Reactivity was used to construct epitope similarity maps for all of the viruses. Four principal virus subgroups were demonstrated. One subgroup equated to classical swine fever virus (CSFV) and included most porcine pestiviruses but none from ruminants. A second subgroup contained mainly viruses of bovine origin, including reference bovine viral diarrhoea viruses (BVDV) such as NADL; however viruses from pigs and sheep were also represented. A third subgroup represented by reference strains of border disease virus (BDV) comprised mainly ovine isolates, but also viruses from pigs. The fourth and most recently defined subgroup contained no reference strains of CSFV, BVDV or BDV, but included atypical viruses from cattle, sheep and pigs. The subgrouping scheme was supported by genetic comparisons between representative viruses from the 4 subgroups and by virus neutralisation with polyclonal sera.

Animals↗
PubMed1995

Prolongation of hemodialysis access survival with elective revision.

153 hemodialysis accesses (56 fistulas and 97 PTFE grafts) were followed from placement to see if elective intervention prolonged access survival. The mean follow-up was 772 days (minimum 14 days, maximum 2755 days). Patients who expired, were transplanted or transferred were excluded. The groups of fistulas and grafts were subdivided into those whose first intervention was an episode of clotting versus those whose first intervention was an elective revision (either surgical repair or angioplasty of an area of stenosis within the access or run-off). These groups were compared to see whether electively revising an access prior to clotting would change the ultimate longevity of the access when compared to repairing the access after clotting. PTFE grafts with an initial elective intervention had an improved survival compared to grafts that clotted first (1023 days vs 689 days, p = 0.01). The electively revised grafts had fewer subsequent clotting episodes (1.1 clots per patient year vs 3.6, p = 0.02) and fewer interventions (1.8 interventions per patient year vs 3.7, p = 0.06). In fistulas, an initial elective revision increased access longevity when compared to repair after the fistula clotted (999 days vs 358 days, p = 0.005). Clotting episodes were decreased in those electively revised (0.5 clots per patient year vs 4.8, p = 0.014). Total interventions per patient year were also lower in those electively revised (1.2 vs 5.3, p = 0.028). In conclusion, elective correction of abnormalities in PTFE grafts and in AV fistulas prolongs access life when compared to repair after an initial episode of clotting. Elective revision also decreased the subsequent number of clotting episodes per patient year and the total number of interventions (revisions and declottings) per patient year in both grafts and fistulas.

Arteriovenous Shunt, Surgical↗
PubMed1994

Border disease virus: delineation by monoclonal antibodies.

Many ovine pestiviruses from Britain and a number of atypical porcine isolates are largely unrecognised by monoclonal antibodies (mAbs) specific for reference strains of classical swine fever virus and bovine viral diarrhoea virus (BVDV). Additional mAbs have therefore been produced using some of these "unreactive" pestiviruses. Two of the viruses used were atypical porcine isolates (strains 87/6 and Vosges), whilst another had been isolated from a sheep (59386). Thirty-three mAbs were selected, none of which recognised two reference strains of BVDV, but three of which recognised the Alfort strain of classical swine fever. On the basis of radioimmunoprecipitation they were considered to be directed at one of three different pestivirus proteins (gp 53, gp 48 or p 125). Three virus subgroups were evident when the mAbs were used to type 16 ovine and two atypical porcine pestiviruses. One subgroup contained the Vosges and 59386 viruses and four ovine field isolates. The second subgroup comprised the 87/6 virus, the Moredun and Aveyron reference strains of border disease virus and four further ovine field isolates. Three of four ovine viruses making up the third subgroup had been previously categorised as BVDV-like and were largely unrecognised by the new mAbs. The findings were in agreement with previous attempts to segregate some of the same viruses using partial genomic comparisons or cross-neutralization tests.

Animals↗
PubMed1994

Classical swine fever: genetic detection and analysis of differences between virus isolates.

Two pairs of oligonucleotide primers were designed that specifically amplified regions of the classical swine fever virus genome. These products, corresponding to a 671 bp portion of the genes encoding the E1 and E2 (gp33 and gp55) proteins and a 1090 bp portion of the putative polymerase gene, were amplified from eight virus isolates which had been responsible for a series of classical swine fever outbreaks in Italy involving both domestic pigs and wild boar. For each virus the fragments were partially sequenced to give 475 bp of the E1/E2 glycoprotein and 212 bp of the putative polymerase gene sequences. The data from each set of fragments were compared with one another and with reference strains. This allowed us confidently to assign most of the viruses to one of three subgroups. An analysis of the same viruses with a panel of monoclonal antibodies was much less informative. The subgrouping of the isolates suggested that, in this region of Italy, there had been at least two separate introductions of classical swine fever over a 7 year period and that virus had been transmitted between domestic pigs and wild boar. A consensus nucleotide sequence derived from the glycoprotein fragments of all the viruses examined revealed conservation at the wobble position of some codons.

Animals↗
PubMed1991

BVD monoclonal antibodies: relationship between viral protein specificity and viral strain specificity.

Seventeen monoclonal antibodies raised against bovine viral diarrhoea virus were divided into three groups on the basis of radioimmunoprecipitation results. Seven monoclonal antibodies precipitated a polypeptide of 80kD and defined four domains, all of which showed considerable conservation amongst the 180 pestivirus strains and isolates examined. Nine monoclonal antibodies, including six with virus neutralizing activity, precipitated a 53kD polypeptide and all appeared to be directed towards a single domain of clustered epitopes. Several of these epitopes were present in many ruminant virus strains and isolates, but not in hog cholera viruses. A single monoclonal antibody precipitated a 48kD polypeptide, defining an epitope that was also present on many ruminant viruses, but not hog cholera viruses. Most pestiviruses from cattle and some from sheep shared a number of epitopes located on three different proteins.

Animals↗
PubMed1990

Immunocytochemical localization of border disease virus in the spinal cord of fetal and newborn lambs.

The peroxidase-antiperoxidase technique was used to determine the cellular localization of Border Disease (BD) virus in cryostat sections of fetal and newborn lamb spinal cord following experimental infection by maternal inoculation in early gestation. Viraemic fetuses and lambs with hypomyelinogenesis showed BD viral antigen in neurons, glia, ependymal cells, vascular endothelial cells and fibrocytes within the dura mater. Double immunolabelling demonstrated co-expression of BD viral antigen and glial fibrillary acidic protein (GFAP) or myelin basic protein (MBP) in both fetal and newborn lamb glia. In fetal lambs there was a pia-associated population of glia in which viral antigen was also co-expressed with GFAP or MBP. The results suggest that BD virus infects myelinating oligodendroglia, astroglia and probably also transitional cells and pluripotential glioblasts. The relationship between infection of specific cell types and hypomyelinogenesis was not resolved but infection of transitional cells and oligodendroglia may affect oligodendroglial function and permit morphologically inapparent perturbations leading to hypomyelinogenesis. A single nonviraemic lamb with a precolostral antibody titre to BD virus and cystic cerebral cavities but no hypomyelinogenesis showed BD viral antigen confined to glia of the spinal cord white matter. This suggests that oligodendroglia may require to be infected before a critical period in their development or factors additional to oligodendroglia infection are necessary for hypomyelinogenesis.

Animals↗
PubMed1990

Antigenic comparisons of hog cholera virus isolates from Europe, America and Asia using monoclonal antibodies.

Nineteen monoclonal antibodies (MAbs) with specificity for hog cholera virus (HCV) were prepared. They were used in an immune binding (peroxidase linked) assay to determine the reaction patterns of HCV isolates from Europe, Brazil, USA, Japan and Malaysia, as well as laboratory reference strains of the virus. A further panel of 17 MAbs raised against bovine virus diarrhoea virus (BVDV) was included in the study, together with 5 MAbs raised against a non-HCV pestivirus of porcine origin. All the MAbs were also tested against representative strains of BVDV and border disease virus. Six MAbs were HCV-specific, reacting with all isolates of HCV and none of the ruminant viruses. Among the other HCV MAbs geographical variation in reaction patterns was observed. There was evidence of antigenic distinction between recent European isolates, and archive material originally isolated more than 10 years ago.

Animals↗