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Andronikou S, Arthur S, Simpson E, Chopra M. Selective duodenography for controlled first-pass bolus distention of the duodenum in neonates and young children with bile-stained vomiting. Clin Radiol 2018; 73:506.e1-506.e8. [PMID: 29397912 DOI: 10.1016/j.crad.2017.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
AIM To compare "selective duodenograms" performed through nasogastric tubes advanced into the proximal duodenum against traditional contrast studies regarding visualisation of a first-pass bolus distention of the duodenum and frequency of inconclusive results. MATERIALS AND METHODS Retrospective comparison of "selective duodenograms" and traditional upper gastrointestinal contrast studies in neonates with bile-stained vomiting, regarding demonstration of the duodenal C-loop, first-pass bolus capture, degree of distention of the duodenum, and number of inconclusive studies. Statistical comparison was performed using the two-tailed Fishers exact and chi-squared tests. RESULTS There were 31 "selective duodenograms" and 70 traditional studies. The C-loop was demonstrated in 93% of traditional studies versus 100% in "selective duodenograms" and was demonstrated significantly more often during the first-pass (94% versus 73%; p=0.018) and more often with distention of the duodenum for "selective duodenography" (94% versus 56%, p<0.001). There were more inconclusive traditional studies (7% versus 3%; non-significant). CONCLUSION Emergency upper gastrointestinal tract studies performed in neonates using the "selective duodenogram" technique demonstrated the duodenum with 100% success, with significantly more frequent first-pass bolus visualisation and duodenal distention than traditional studies. The five (7%) inconclusive traditional studies, present a significant diagnostic conundrum in the emergency setting because emergency surgery must be contemplated without proof.
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van Schaik IN, Bril V, van Geloven N, Hartung HP, Lewis RA, Sobue G, Lawo JP, Praus M, Mielke O, Durn BL, Cornblath DR, Merkies ISJ, Sabet A, George K, Roberts L, Carne R, Blum S, Henderson R, Van Damme P, Demeestere J, Larue S, D'Amour C, Bril V, Breiner A, Kunc P, Valis M, Sussova J, Kalous T, Talab R, Bednar M, Toomsoo T, Rubanovits I, Gross-Paju K, Sorro U, Saarela M, Auranen M, Pouget J, Attarian S, Le Masson G, Wielanek-Bachelet A, Desnuelle C, Delmont E, Clavelou P, Aufauvre D, Schmidt J, Zschuentssch J, Sommer C, Kramer D, Hoffmann O, Goerlitz C, Haas J, Chatzopoulos M, Yoon R, Gold R, Berlit P, Jaspert-Grehl A, Liebetanz D, Kutschenko A, Stangel M, Trebst C, Baum P, Bergh F, Klehmet J, Meisel A, Klostermann F, Oechtering J, Lehmann H, Schroeter M, Hagenacker T, Mueller D, Sperfeld A, Bethke F, Drory V, Algom A, Yarnitsky D, Murinson B, Di Muzio A, Ciccocioppo F, Sorbi S, Mata S, Schenone A, Grandis M, Lauria G, Cazzato D, Antonini G, Morino S, Cocito D, Zibetti M, Yokota T, Ohkubo T, Kanda T, Kawai M, Kaida K, Onoue H, Kuwabara S, Mori M, Iijima M, Ohyama K, Baba M, Tomiyama M, Nishiyama K, Akutsu T, Yokoyama K, Kanai K, van Schaik I, Eftimov F, Notermans N, Visser N, Faber C, Hoeijmakers J, Rejdak K, Chyrchel-Paszkiewicz U, Casanovas Pons C, Alberti Aguiló M, Gamez J, Figueras M, Marquez Infante C, Benitez Rivero S, Lunn M, Morrow J, Gosal D, Lavin T, Melamed I, Testori A, Ajroud-Driss S, Menichella D, Simpson E, Chi-Ho Lai E, Dimachkie M, Barohn R, Beydoun S, Johl H, Lange D, Shtilbans A, Muley S, Ladha S, Freimer M, Kissel J, Latov N, Chin R, Ubogu E, Mumfrey S, Rao T, MacDonald P, Sharma K, Gonzalez G, Allen J, Walk D, Hobson-Webb L, Gable K. Subcutaneous immunoglobulin for maintenance treatment in chronic inflammatory demyelinating polyneuropathy (PATH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 2018; 17:35-46. [DOI: 10.1016/s1474-4422(17)30378-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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De Bruin-Weller M, Gadkari A, Simpson E, Cork M, Puig L, Girolomoni G, Wollenberg A, Chen Z, Radin A, Shumel B, Ardeleanu M, Plaum S, Eckert L. P479 Dupilumab improves patient-reported outcomes in atopic dermatitis patients inadequately controlled, intolerant, or inadvisable for cyclosporine-A. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tilche A, Simpson E. On trusting ethnography: serendipity and the reflexive return to the fields of Gujarat. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2017. [DOI: 10.1111/1467-9655.12695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liu Y, Wang Z, De La Torre R, Barling A, Hornick N, Hanifin J, Simpson E, Kulesz-Martin M. 640 Enhancement of Th2 polarization by Trim32 deficiency. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bolton E, Ferguson A, Simpson B, Al-naqeeb J, Simpson E. 420 The effects of bathing, showering and petrolatum on skin barrier function. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sacotte R, Vakharia P, Chopra R, Patel N, Immaneni S, White T, Kantor R, Hsu D, Simpson E, Silverberg J. 383 Establishing severity strata for 5 different patient-reported outcomes in adults with atopic dermatitis. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Al-naqeeb J, Danner S, Fagnan L, Ramsey K, Michaels L, Mitchell J, Branca K, Morris C, Nease D, Zittleman L, Levy B, Daly J, Hahn D, Dolor R, Hanifin J, Tofte S, Zuckerman K, Hansis K, Gundersen M, Dillon K, Block J, Karr F, Dunbrasky S, Lapidus J, Siebe K, Simpson E. 195 The burden of childhood atopic dermatitis in U.S. primary care settings. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Spuls P, Gerbens L, Simpson E, Apfelbacher C, Chalmers J, Thomas K, Prinsen C, von Kobyletzki L, Singh J, Williams H, Schmitt J. Patient-Oriented Eczema Measure (POEM), a core instrument to measure symptoms in clinical trials: a Harmonising Outcome Measures for Eczema (HOME) statement. Br J Dermatol 2017; 176:979-984. [DOI: 10.1111/bjd.15179] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 12/25/2022]
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Celestino-Soper PBS, Simpson E, Tumbleson Brink D, Lynnes TC, Dlouhy S, Vatta M, Yeley J, Brown C, Bai S. Intragenic CFTR Duplication and 5T/12TG Variant in a Patient with Non-Classic Cystic Fibrosis. Sci Rep 2016; 6:38776. [PMID: 27996019 PMCID: PMC5172161 DOI: 10.1038/srep38776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 11/10/2016] [Indexed: 11/09/2022] Open
Abstract
Cystic fibrosis (CF) is an autosomal recessive disorder characterized by the accumulation of sticky and heavy mucus that can damage several organs. CF shows variable expressivity in affected individuals, but it typically causes respiratory and digestive complications as well as congenital bilateral absence of the vas deferens in males. Individuals with classic CF usually have variants that produce a defective protein from both alleles of the CFTR gene. Individuals with other variants may present with classic, non-classic, or milder forms of CF due to lower levels of functional CFTR protein. This article reports the genetic analysis of a female with features of asthma and mild or non-classic CF. CFTR sequencing demonstrated that she is a carrier for a maternally derived 5T/12TG variant. Deletion/duplication analysis by multiplex ligation-dependent probe amplification (MLPA) showed the presence of an intragenic paternally derived duplication involving exons 7-11 of the CFTR gene. This duplication is predicted to result in the production of a truncated CFTR protein lacking the terminal part of the nucleotide-binding domain 1 (NBD1) and thus is likely to be a non-functioning allele. The combination of this large intragenic duplication and 5T/12TG is the probable cause of the mild or non-classic CF features in this individual.
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Sadick N, Bohnert K, Papp K, Simpson E, Beck L, Blauvelt A, Gooderham M, Wu R, Graham N, Pirozzi G, Sutherland E, Ardeleanu M. Efficacité et tolérance du dupilumab dans la dermatite atopique modérée à sévère chez l’adulte : analyse poolée de deux essais cliniques de phase 2. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Simpson E, Guttman-Yassky E, Margolis D, Feldman S, Qureshi A, Hata T, Chao J, Mastey V, Gadkari A, Eckert L, Arnold R, Yu T, Wei W. O060 Cross-sectional study of disease control among adults with atopic dermatitis and impact on patient-reported burden. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simpson E, Paller A, Boguniewicz M, Eichenfield L, Feldman S, Silverberg J, Chamlin S, Zane L. O063 Crisaborole demonstrates improvement in quality of life in patients with mild to moderate atopic dermatitis. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wilson NJ, Cole C, Kroboth K, Hunter WN, Mann JA, McLean WHI, Kernland Lang K, Beltraminelli H, Sabroe RA, Tiffin N, Sobey GJ, Borradori L, Simpson E, Smith FJD. Mutations in POGLUT1 in Galli-Galli/Dowling-Degos disease. Br J Dermatol 2016; 176:270-274. [PMID: 27479915 PMCID: PMC5324688 DOI: 10.1111/bjd.14914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Hamilton J, Hamon S, Simpson E, Chaudhry U, Swanson B, Zhang R, Graham N, Pirozzi G, Ardeleanu M, Rizova E. 372 The effect of dupilumab on biomarkers in a randomized phase 2b clinical trial in adults with moderate-to-severe atopic dermatitis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stewart MJ, Simpson E. Prognosis in Paracetamol Self-Poisoning: The Use of Plasma Paracetamol Concentration in a Region without a Poisoning Treatment Centre. Ann Clin Biochem 2016. [DOI: 10.1177/000456327301000161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Published criteria for prognosis following self-poisoning with paracetamol have been applied to 30 cases in a region without centralised facilities for investigation of the poisoned patient. The results show that, despite difficulties in collection and transport of specimens, useful prognostic indices can be provided by a central laboratory. The biochemical assessment of liver damage is discussed and one of two fatal cases is presented in detail.
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Abstract
In 2002, Gujarat, a state in the west of India, was home to one of the worst rounds of religious violence the country had seen for decades. The victims were mostly Muslims. In this article, I argue, as others have done, that this violence was a product of the growing influence of a Hindu nationalist agenda at state and national levels. However, I also suggest that the violence emerged from the related patterns of neo-liberal reform which are radically altering the structures of society and governance in Gujarat. Economic and political liberalization has created ambiguous zones between the state and society in which the possibility of religious violence has been incubated, sometimes deliberately, but by no means always so. To demonstrate how I arrived at this conclusion, I examine the creation of images of Muslims in Hindu society and how these images are recreated through the actions of Hindu nationalist organizations and the government. By doing so, I demonstrate how the organizations of Hindu nationalism have set about re-imagining the shape and purpose of the state. Furthermore, by isolating Muslims from economic resources and political representation, the organizations of Hindu nationalism enliven their own foundational myths, which state that the Hindu majority is in need of protection from the troublesome, isolationist and secretive Muslim minority.
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Chalmers J, Simpson E, Apfelbacher C, Thomas K, Kobyletzki L, Schmitt J, Singh J, Svensson Å, Williams H, Abuabara K, Aoki V, Ardeleanu M, Awici‐Rasmussen M, Barbarot S, Berents T, Block J, Bragg A, Burton T, Bjerring Clemmensen K, Creswell‐Melville A, Dinesen M, Drucker A, Eckert L, Flohr C, Garg M, Gerbens L, Graff A, Hanifin J, Heinl D, Humphreys R, Ishii H, Kataoka Y, Leshem Y, Marquort B, Massuel M, Merhand S, Mizutani H, Murota H, Murrell D, Nakahara T, Nasr I, Nograles K, Ohya Y, Osterloh I, Pander J, Prinsen C, Purkins L, Ridd M, Sach T, Schuttelaar MA, Shindo S, Smirnova J, Sulzer A, Synnøve Gjerde E, Takaoka R, Vestby Talmo H, Tauber M, Torchet F, Volke A, Wahlgren C, Weidinger S, Weisshaar E, Wollenberg A, Yamaga K, Zhao C, Spuls P. Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative). Br J Dermatol 2016; 175:69-79. [DOI: 10.1111/bjd.14773] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 12/24/2022]
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Abstract
This article is a contribution to the growing literature that suggests that
the methodological and writing practices of anthropology are out of kilter with the
times. The processual structures and regulative mechanisms that produce anthropological
knowledge were formed when objection and engagement were not the
almost-inevitable consequence of publication. Those who inform anthropological
research now frequently object to the ways they are represented. My argument
here focuses particularly on the relationship between the ethical structures of anthropology
and the nature of objection. Thus far, the consistent response from anthropologists
has been to explain away objections as differences in epistemology.
In this light, I draw on an objection to my own research on postdisaster reconstruction
in India to ask why there should not be disagreement between anthropologists
and those who inform research. I also illustrate why the epistemological
explanation is now insufficient and why new structures of research and writing
might be required to make the leap from an age of objection.
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Barbarot S, Abuabara K, Aubert H, Chalmers J, Flohr C, Hanifin J, Naldi L, Margolis D, Paul C, Rogers N, Ridd M, Schuttelaar ML, Simpson E, Tauber M, Volke A, Weidinger S, Wilkes S, Wollenberg A, Thomas K. Comment évaluer le contrôle à long terme de la dermatite atopique dans les essais randomisés ? Une revue systématique. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Keall P, Ng J, Caillet V, Huang C, Colvill E, Simpson E, Poulsen P, Kneebone A, Eade T, Booth J. Sub-mm Accuracy Results Measured From the First Prospective Clinical Trial of a Novel Real-Time IGRT System, Kilovoltage Intrafraction Monitoring (KIM). Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wailoo AJ, Stevenson M, Tosh J, Hernández M, Stevens JW, Archer R, Simpson E, Everson HE, Scott D, Young A, Paisley S, Williams K. The Cost-Effectiveness of Biologic Dmards in Patients With Severe or Mild-To-Severe Rheumatoid Arthritis After Conventional Dmards. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A380. [PMID: 27200840 DOI: 10.1016/j.jval.2014.08.2611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Simpson E. Ghassem-Fachandi, Parvis. Pogrom in Gujarat: Hindu nationalism and anti-Muslim violence in India. ii, 335 pp., illus., bibliogr. Oxford, Princeton: Princeton Univ. Press, 2012. £19.95 (paper). JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2014. [DOI: 10.1111/1467-9655.12087_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stevens JW, Simpson E, Harnan S, Squires H, Meng Y, Thomas S, Michaels J, Stansby G. Authors' reply: Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication ( Br J Surg 2012; 99: 1630–1638). Br J Surg 2013; 100:1838-9. [DOI: 10.1002/bjs.9358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Currell K, Simpson E, Mears S, James L. FLUID BALANCE IN ELITE SHORT TRACK SPEED SKATERS. Br J Sports Med 2013. [DOI: 10.1136/bjsports-2013-093073.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Simpson E. Hastrup, Frida. Weathering the world: recovery in the wake of the tsunami in a Tamil fishing village. viii, 150 pp., illus., bibliogr. Oxford, New York: Berghahn Books, 2011. £42.00 (cloth). JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2013. [DOI: 10.1111/1467-9655.12042_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Foster E, Hawkins A, Simpson E, Adamson AJ. Developing an interactive portion size assessment system (IPSAS) for use with children. J Hum Nutr Diet 2013; 27 Suppl 1:18-25. [DOI: 10.1111/jhn.12127] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liu P, Cranmer-Sargison G, Ralston A, Gajewski R, Simpson E, Weston S, Thwaites D, McKenzie D, Suchowerska N. OC-0065: Small field dosimetry in flattening filter free (FFF) beams: comparison of diode, film and scintillation dosimeters. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stevens JW, Simpson E, Harnan S, Squires H, Meng Y, Thomas S, Michaels J, Stansby G. Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication. Br J Surg 2012; 99:1630-8. [PMID: 23034699 DOI: 10.1002/bjs.8895] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND A systematic review and network meta-analysis was undertaken to consider the evidence for the efficacy and tolerability of placebo, cilostazol, naftidrofuryl oxalate and pentoxifylline in patients with intermittent claudication due to peripheral arterial disease (PAD). METHODS MEDLINE, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Conference Proceedings, BIOSIS, National Research Register and MetaRegister databases were searched. Eligible studies were randomized controlled trials (RCTs) and published systematic reviews of patients with intermittent claudication due to PAD and whose symptoms persisted despite a period of conservative management. Study selection was conducted by one reviewer with involvement from a clinician. Data were extracted by one reviewer with no blinding to authors or journal, and checked by a second reviewer. Outcome measures were maximum walking distance (MWD) and pain-free walking distance (PFWD). RESULTS The review identified 1876 citations; 26 RCTs met the inclusion criteria for the systematic review. Eleven trials provided data relevant for the meta-analysis. Naftidrofuryl oxalate was ranked first for both MWD and PFWD (probability of 0·947 and 0·987, respectively, of being the best treatment) followed by cilostazol and pentoxifylline. For naftidrofuryl oxalate, cilostazol and pentoxifylline, MWD increased by 60 (95 per cent credible interval 20 to 114) per cent, 25 (11 to 40) per cent and 11 (-1 to 24) per cent respectively relative to placebo, and PFWD increased by 49, 13 and 9 per cent. CONCLUSION Naftidrofuryl oxalate and cilostazol are both effective treatments for claudication; naftidrofuryl oxalate is likely to be the most effective, with minimal serious adverse events.
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Miller T, Smith R, Pestronk A, David W, Rothstein J, Simpson E, Andres P, Mahoney K, Allred P, Alexander K, Bishop K, Schoenfeld D, Macklin E, Norris D, Bennett C, Cudkowicz M. Results of a Phase 1, Double-Blind, Placebo-Controlled, Dose-Escalation Study of the Safety, Tolerability, and Pharmacokinetics of ISIS 333611 Administered Intrathecally to Patients with Familial ALS Due to SOD1 Gene Mutations (S25.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s25.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Squires H, Simpson E, Meng Y, Harnan S, Stevens J, Wong R, Thomas S, Michaels J, Stansby G. A systematic review and economic evaluation of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease. Health Technol Assess 2012; 15:1-210. [PMID: 22142554 DOI: 10.3310/hta15400] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is a condition in which there is blockage or narrowing of the arteries that carry blood to the legs and arms. It is estimated to affect around 4.5% of people aged between 55 and 74 years within the UK. The most common symptom of PAD is intermittent claudication (IC), characterised by pain in the legs on walking that is relieved with rest. OBJECTIVE To assess the effectiveness and cost-effectiveness of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate, compared with no vasoactive drugs, for IC due to PAD in adults whose symptoms continue despite a period of conventional management. DATA SOURCE Electronic bibliographic databases were searched during April to June 2010 (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Conference Proceedings Citation Index, BIOSIS Previews). REVIEW METHODS Effectiveness outcomes sought were maximal walking distance (MWD), pain-free walking distance (PFWD), ankle-brachial pressure index, cardiovascular events, mortality, adverse events (AEs) and health-related quality of life (HRQoL). A narrative synthesis was provided for all outcomes and a network meta-analysis was undertaken for the walking distance outcomes. A Markov model was developed to assess the relative cost-effectiveness of the interventions from a NHS perspective over a lifetime. The model has three states: vasoactive drug treatment, no vasoactive drug treatment and death. Each 1-week cycle, patients may continue with the drug, discontinue the drug or die. Regression analysis was undertaken to model the relationship between MWD and utility so that a cost per quality-adjusted life-year (QALY) outcome measure could be presented. Univariate and probabilistic sensitivity analyses were undertaken. All costs and outcomes were discounted at 3.5%. RESULTS Twenty-six randomised controlled trials were identified that met the inclusion criteria for the clinical effectiveness review. There was evidence that walking distance outcomes were significantly improved by both cilostazol and naftidrofuryl oxalate; the 95% credible intervals for the difference from placebo in the logarithm mean change MWD from baseline were 0.108 to 0.337 and 0.181 to 0.762, respectively. It was not possible to include inositol nicotinate within the meta-analysis of MWD and PFWD owing to the lack of 24-month data; however, the shorter-term data did not suggest a significant effect. AEs were minor for all drugs and included headaches and gastrointestinal difficulties. The incidence of serious adverse events (SAEs), including cardiovascular events and mortality, was not increased by the vasoactive drugs compared with placebo; however, most studies had a relatively short follow-up time to address this outcome. HRQoL data were limited. Two studies of limited quality were identified within the review of cost-effectiveness. The de novo model developed suggests that naftidrofuryl oxalate dominates cilostazol and pentoxifylline and has a cost per QALY gained of around £6070 compared with no vasoactive drug. This result is reasonably robust to changes within the key model assumptions. Inositol nicotinate was not included within the main analysis owing to lack of data. However, it is unlikely to be considered to be cost-effective due to its high acquisition cost (£900 vs £100-500 per year for the other drugs). CONCLUSIONS Naftidrofuryl oxalate and cilostazol both appear to be effective treatments for this patient population, with minimal SAEs. However, naftidrofuryl oxalate is the only treatment that is likely to be considered cost-effective. The long-term effectiveness is uncertain and hence a trial comparing cilostazol, naftidrofuryl oxalate and placebo beyond 24 weeks would be beneficial. Outcomes associated with naftidrofuryl oxalate could also be compared with those associated with supervised exercise programmes and angioplasty.
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Simpson E. Are epidermal defects the key initiating factors in the development of atopic dermatitis? Br J Dermatol 2011; 163:1147-8. [PMID: 21137113 DOI: 10.1111/j.1365-2133.2010.10115.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Watson CA, Littlefair SP, Diamond C, Cameron AC, Fitzsimmons A, Simpson E, Moulds V, Pollacco D. On the alignment of debris discs and their host stars’ rotation axis - implications for spin-orbit misalignment in exoplanetary systems. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1745-3933.2011.01036.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Goldenberg S, Simpson E, French G. Optical density cut-off values for Clostridium difficile enzyme immunoassays. J Hosp Infect 2011; 77:169-70. [DOI: 10.1016/j.jhin.2010.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 08/31/2010] [Indexed: 10/18/2022]
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Jawaid A, Poon M, Strutt AM, Rice LK, McDowell EJ, Salamone AR, Qureshi SU, Simpson E, Appel SH, York MK, Schulz PE. Does apolipoprotein E genotype modify the clinical expression of ALS? Eur J Neurol 2010; 18:618-24. [PMID: 20880000 DOI: 10.1111/j.1468-1331.2010.03225.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The presence of the apolipoprotein E (ApoE) 4 genotype is associated with an earlier age of onset for Alzheimer's disease (AD) and several other neurodegenerative disorders. The objective of this study was to investigate the effect of ApoE genotypes on the clinical course of amyotrophic lateral sclerosis (ALS). METHODS Eight hundred and fifty-two consecutive patients with sporadic ALS evaluated at a tertiary care center were investigated for the effect of ApoE genotype on age of onset, rate of motor disease progression, cognitive functioning, and survival in ALS. RESULTS The frequencies of individual ApoE genotypes did not differ between patients with ALS and ALS-free Caucasian populations. Patients with different ApoE genotypes did not differ in the age of onset for ALS (years) (ApoE2 = 57.8 ± 13.7, ApoE3 = 57.3 ± 13.7, ApoE4 = 57.7 ± 13.2; P = 0.97), the rate of disease progression (Appel ALS score/month) (ApoE2 = 2.91 ± 2.66, ApoE3 = 2.67 ± 2.66, ApoE4 = 2.61 ± 2.47; P = 0.89), cognitive status (% cognitively impaired) (ApoE2 = 31.7, ApoE3 = 26.8, ApoE4 = 34.3, P = 0.28), or survival in years (ApoE2 = 3.79 ± 3.70, ApoE3 = 3.17 ± 2.27, ApoE4 = 3.05 ± 1.75; P = 0.85). CONCLUSIONS Our results suggest that ApoE genotype does not modify clinical course of sporadic ALS, in stark contrast to the influence of ApoE genotype on the disease course of AD and other neurodegenerative disorders.
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Yang YH, Ngo D, Jones M, Simpson E, Fritzemeier KH, Morand EF. Endogenous estrogen regulation of inflammatory arthritis and cytokine expression in male mice, predominantly via estrogen receptor alpha. ACTA ACUST UNITED AC 2010; 62:1017-25. [PMID: 20131258 DOI: 10.1002/art.27330] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE A number of experimental observations have associated elevated estrogen levels with amelioration of inflammation. The involvement of estrogen and estrogen receptor (ER) isotypes in the regulation of inflammation in males is not well understood. In this study, we used specific ERalpha and ERbeta agonists in male mice deficient in estrogen because of a deletion of aromatase (aromatase-knockout [ArKO] mice) to investigate ER isotype utilization in estrogen regulation of inflammation. METHODS Lipopolysaccharide (LPS)-induced cytokine expression and antigen-induced arthritis (AIA) were investigated in male ArKO and WT littermate mice, as well as in response to selective agonists of ERalpha (16alpha-LE2) and ERbeta (8beta-VE2). The therapeutic effect of selective ER agonists was also examined in mice with collagen-induced arthritis (CIA). RESULTS Estrogen deficiency in ArKO mice was associated with significant increases in LPS-induced serum interleukin-6 (IL-6), tumor necrosis factor, monocyte chemotactic protein 1, and interferon-gamma levels, which were significantly abrogated by administration of 16alpha-LE2, but not 8beta-VE2. In contrast, both 16alpha-LE2 and 8beta-VE2 significantly increased LPS-induced IL-10 levels. Estrogen deficiency was also associated with significant exacerbation of AIA and antigen-specific T cell proliferation, which was reversed by administration of either 16alpha-LE2 or 8beta-VE2. ArKO mice showed increased antigen-specific T cell proliferation in response to immunization with type II collagen (CII). Administration of 16alpha-LE2, but not 8beta-VE2, significantly reduced the severity of CIA, which was associated with inhibition of anti-CII-specific IgG. CONCLUSION These data indicate that endogenous estrogen plays an essential inhibitory role in inflammation in male mice and that ERalpha is the dominant receptor that mediates these effects.
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Jawaid A, Salamone AR, Strutt AM, Murthy SB, Wheaton M, McDowell EJ, Simpson E, Appel SH, York MK, Schulz PE. ALS disease onset may occur later in patients with pre-morbid diabetes mellitus. Eur J Neurol 2010; 17:733-9. [PMID: 20074230 DOI: 10.1111/j.1468-1331.2009.02923.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several metabolic derangements associated with diabetes mellitus type 2 (DM) have been associated with a better outcome in amyotrophic lateral sclerosis (ALS), including hyperlipidemia and obesity. Here, we tested the hypothesis that DM would have a positive effect on the motor and cognitive findings of ALS. METHODS We compared data from ALS patients with pre-morbid DM (ALS-DM; n = 175) versus without DM (ALS; n = 2196) with regard to the age of onset, rate of motor progression, survival, and neuropsychological test performance. RESULTS The age of onset was later for women, Caucasians and patients with bulbar-onset ALS. However, we also found that after adjusting for gender, ethnicity and site of onset, DM was associated with a 4-year later onset of ALS (ALS = 56.3, ALS-DM = 60.3, P < 0.05). CONCLUSION Diabetes mellitus type 2 may delay the onset of motor symptoms in ALS. These findings support other studies suggesting a relationship between the pathophysiology of ALS and metabolic derangements. Further investigations are needed to ascertain whether manipulating metabolic parameters would improve outcomes in ALS.
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Scott N, Cameron V, Simpson E, Richards M, Ellmers L. Metabolic Syndrome Alters Expression Levels of Metabolic Disease Risk Loci Genes. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brown K, Brown K, Simpson E, Simpson E. Metformin Inhibits Aromatase Expression in Primary Human Breast Adipose Stromal Cells. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-3132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
There is good epidemiological evidence that obesity is linked to an increased risk of cancers such as colon and breast. Given the obesity problem worldwide, it is now believed that tens of millions more women may contract breast cancer in their senior years than was previously thought. After menopause, when the ovaries have ceased to produce estrogens, it is the local expression of aromatase, the enzyme responsible for converting androgens to estrogens, within the breast adipose that is believed to be responsible for the increased proliferation of breast cancer cells.We have recently demonstrated that the LKB1/AMPK pathway is inhibitory of aromatase expression in primary human breast adipose stromal cells by inhibiting the nuclear entry of CRTC2, a CREB co-activator. Factors produced in obesity, such as leptin, and by tumors, such as PGE2, were shown to inhibit LKB1 expression and activity and cause the nuclear translocation of CRTC2, resulting in the increased expression of aromatase. Conversely, a factor produced in lean individuals, adiponectin, and the drug AICAR, known to activate AMPK, inhibited the PGE2-mediated expression of aromatase.There is growing evidence that the action of metformin, an oral anti-diabetic drug which has been used for many years, is mediated primarily by stimulation of AMPK, in association with interaction with its upstream kinase LKB1. In the present study, we aimed to examine the effect of metformin on aromatase expression and on the LKB1/AMPK pathway within the breast. Primary human breast adipose stromal cells obtained from breast reduction surgeries were treated with increasing amounts of 1,1-dimethylbiguanide hydrochloride (metformin) and aromatase transcript expression was quantified using real-time PCR. Interestingly, 24 hour treatment with metformin resulted in the dose-dependent inhibition of aromatase expression at concentrations of 10 and 50 uM. LKB1 activity was measured by examining the phosphorylation of AMPK by Western blotting and consistent with the proposed role of LKB1/AMPK in aromatase expression, metformin caused a significant increase in AMPK phosphorylation.Phase III aromatase inhibitors are proving highly successful as endocrine therapy for breast cancer in post-menopausal women, replacing Tamoxifen as frontline, second line and neoadjuvant therapy. However long-term contraindications such as bone loss, arthralgia, adverse cardiovascular effects and possibly cognitive defects may limit the use of these compounds in the prevention setting. Moreover, aromatase expression may be only one of several pathways whereby obesity influences breast cancer development. This study suggests that using a drug such as metformin which increases insulin sensitivity, causes weight loss and decreases the local biosynthesis of estrogens, may provide a multi-facetted approach at preventing and treating obesity-related postmenopausal estrogen-dependent breast cancer.Work supported by NHMRC project grant 494819 and the Terry Fox Foundation
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3132.
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Knower K, To S, To S, Simpson E, Simpson E, Clyne C, Clyne C. Epigenetic Control of Estrogen Synthesis in Human Preadipocytes and Breast Cancer Cells. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Estrogen plays a significant role in the development and progression of breast cancer (BC). Cytochrome aromatase p450, encoded by the gene CYP19, is the key enzyme catalyzing the synthesis of estrogens from androgens. In post-menopausal women, adipose tissue becomes the major site for estrogen production and an increase in CYP19 expression in mammary adipose is strongly linked to the hormone-dependent progression of BC. Therefore, understanding CYP19 regulation in BC is critical for the development of therapeutic measures. Previous studies of CYP19 regulation in BC have mainly focussed on hormone-induced regulation of transcription via upstream tissue- and promoter-specific regulatory regions. While this is clearly important, it is increasingly evident that epigenetic regulation of expression, such as DNA methylation, is also a common factor in the progression of cancers. The aim of this study was to investigate whether CYP19 expression is under epigenetic regulation and to determine if such mechanisms contribute to the tissue- and promoter-specific expression of CYP19 observed in BC.CYP19 transcripts in cancer-free primary human breast adipose fibroblasts (BAFs) stimulated with cytokines and glucocorticoids (e.g. TNFα and dexamethasone) are derived from the distal promoter 1.4, whereas breast tumour-derived factors (e.g. prostaglandin E2) induce a regulatory switch to proximal promoters 1.3 and II. DNA from BAFs maintained under these two conditions was treated with sodium bisulfite allowing for methylation analysis of CpG dinucleotides. Methylation mapping revealed a stochastic heterogeneous level of methylation among 9 CpG sites (promoter 1.4) and 11 CpG sites (promoters 1.3 and II) in untreated BAFs.No correlation was observed between promoter methylation and promoter activation after response to stimuli. However, treatment of BAFs with 5-aza-2'-deoxycytidine, a DNA methylation inhibitor, increased total CYP19 mRNA expression up to 40-fold, primarily via promoter 1.4 thorugh up-regulation of trans-acting factors, suggesting CYP19 is under tonic inhibition by methylation in BAFs. Similar results were also obtained in four BC cell lines. Ongoing work has elucidated trans-acting factors of CYP19 epigenetically silenced in BAFs. These studies uncover a new layer of complexity in the regulation of aromatase expression in BC and may identify new targets for epigenetic therapy, including DNA methylation inhibitors. These findings will translate to BC by determining the methylation state of CYP19 in clinical BC specimens, and by correlation with clinicopathological parameters such as steroid receptor status, grade and stage.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1147.
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Tappenden P, Jackson R, Cooper K, Rees A, Simpson E, Read R, Nicholson K. Amantadine, oseltamivir and zanamivir for the prophylaxis of influenza (including a review of existing guidance no. 67): a systematic review and economic evaluation. Health Technol Assess 2009; 13:iii, ix-xii, 1-246. [PMID: 19215705 DOI: 10.3310/hta13110] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the clinical effectiveness and incremental cost-effectiveness of amantadine, oseltamivir and zanamivir for seasonal and post-exposure prophylaxis of influenza. DATA SOURCES A MEDLINE search strategy was used and searches were carried out in July 2007. REVIEW METHODS An independent health economic model was developed based on a review of existing cost-effectiveness models and clinical advice.The model draws together a broad spectrum of evidence relating to the costs and consequences associated with influenza and its prevention. Where direct evidence concerning the effectiveness of prophylaxis within specific model subgroups was lacking, the model uses estimates from mixed subgroups or extrapolates from other mutually exclusive subgroups. RESULTS Twenty-six published references relating to 22 randomised controlled trials (RCTs) were included in the clinical effectiveness review, along with one unpublished report. Eight, six and nine RCTs were included for amantadine, oseltamivir and zanamivir respectively. The study quality was variable and gaps in the evidence base limited the assessment of the clinical effectiveness of the interventions. For seasonal prophylaxis, there was limited evidence for the efficacy of amantadine in preventing symptomatic, laboratory-confirmed influenza (SLCI) in healthy adults [relative risk (RR) 0.40, 95% confidence interval (CI) 0.08-2.03]. Oseltamivir was effective in preventing SLCI, particularly when used in at-risk elderly subjects (RR 0.08, 95% CI 0.01-0.63). The preventative efficacy of zanamivir was most notable in at-risk adults and adolescents (RR 0.17, 95% CI 0.07-0.44), and healthy and at-risk elderly subjects (RR 0.20, 95% CI 0.02-1.72). For post-exposure prophylaxis, data on the use of amantadine were again limited: in adolescents an RR of 0.10 (95% CI 0.03-0.34) was reported for the prevention of SLCI. Oseltamivir was effective in households of mixed composition (RR 0.19, 95% CI 0.08-0.45). The efficacy of zanamivir in post-exposure prophylaxis within households was also reported (RR 0.21, 95% CI 0.13-0.33). Interventions appeared to be well tolerated. Limited evidence was available for the effectiveness of the interventions in preventing complications and hospitalisation and in minimising length of illness and time to return to normal activities. No clinical effectiveness data were identified for health-related quality of life or mortality outcomes. With the exception of at-risk children, the incremental cost-utility of seasonal influenza prophylaxis is expected to be in the range 38,000-428,000 pounds per QALY gained (depending on subgroup). The cost-effectiveness ratios for oseltamivir and zanamivir as post-exposure prophylaxis are expected to be below 30,000 pounds per QALY gained in healthy children, at-risk children, healthy elderly and at-risk elderly individuals. Despite favourable clinical efficacy estimates, the incorporation of recent evidence of viral resistance to amantadine led to it being dominated in every economic comparison. CONCLUSIONS All three interventions showed some efficacy for seasonal and post-exposure prophylaxis. However, weaknesses and gaps in the clinical evidence base are directly relevant to the interpretation of the health economic model and rendered the use of advanced statistical analyses inappropriate. These data limitations should be borne in mind in interpreting the findings of the review.
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Sutcliffe P, Hummel S, Simpson E, Young T, Rees A, Wilkinson A, Hamdy F, Clarke N, Staffurth J. Use of classical and novel biomarkers as prognostic risk factors for localised prostate cancer: a systematic review. Health Technol Assess 2009; 13:iii-iv, ix-xii, 1-315. [PMID: 19128541 DOI: 10.3310/hta13050] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To provide an evidence-based perspective on the prognostic value of novel markers in localised prostate cancer and to identify the best prognostic model including the three classical markers and investigate whether models incorporating novel markers are better. DATA SOURCES Eight electronic bibliographic databases were searched during March-April 2007. The reference lists of relevant articles were checked and various health services research-related resources consulted via the internet. The search was restricted to publications from 1970 onwards in the English language. METHODS Selected studies were assessed, data extracted using a standard template, and quality assessed using an adaptation of published criteria. Because of the heterogeneity regarding populations, outcomes and study type, meta-analyses were not undertaken and the results are presented in tabulated format with a narrative synthesis of the results. RESULTS In total 30 papers met the inclusion criteria, of which 28 reported on prognostic novel markers and five on prognostic models. A total of 21 novel markers were identified from the 28 novel marker studies. There was considerable variability in the results reported, the quality of the studies was generally poor and there was a shortage of studies in some categories. The marker with the strongest evidence for its prognostic significance was prostate-specific antigen (PSA) velocity (or doubling time). There was a particularly strong association between PSA velocity and prostate cancer death in both clinical and pathological models. In the clinical model the hazard ratio for death from prostate cancer was 9.8 (95% CI 2.8-34.3, p < 0.001) in men with an annual PSA velocity of more than 2 ng/ml versus an annual PSA velocity of 2 ng/ml or less; similarly, the hazard ratio was 12.8 (95% CI 3.7-43.7, p < 0.001) in the pathological model. The quality of the prognostic model studies was adequate and overall better than the quality of the prognostic marker studies. Two issues were poorly dealt with in most or all of the prognostic model studies: inclusion of established markers and consideration of the possible biases from study attrition. Given the heterogeneity of the models, they cannot be considered comparable. Only two models did not include a novel marker, and one of these included several demographic and co-morbidity variables to predict all-cause mortality. Only two models reported a measure of model performance, the C-statistic, and for neither was it calculated in an external data set. It was not possible to assess whether the models that included novel markers performed better than those without. CONCLUSIONS This review highlighted the poor quality and heterogeneity of studies, which render much of the results inconclusive. It also pinpointed the small proportion of models reported in the literature that are based on patient cohorts with a mean or median follow-up of at least 5 years, thus making long-term predictions unreliable. PSA velocity, however, stood out in terms of the strength of the evidence supporting its prognostic value and the relatively high hazard ratios. There is great interest in PSA velocity as a monitoring tool for active surveillance but there is as yet no consensus on how it should be used and, in particular, what threshold should indicate the need for radical treatment.
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Greenlaw RE, Gardner NJ, Farrar CA, Shariff H, Sacks SH, Yagita H, Simpson E, Jurcevic S. An antibody combination that targets activated T cells extends graft survival in sensitized recipients. Am J Transplant 2008; 8:2272-82. [PMID: 18785958 DOI: 10.1111/j.1600-6143.2008.02393.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Memory T cells are the very essence of adaptive immunity with their rapid and efficient response to antigen rechallenge and long-term persistence. However, it is becoming increasingly evident that when primed with self or transplanted tissue, these cells play a key role in causing and perpetuating tissue damage. Furthermore, current treatments, which efficiently control the naive response, have limited effects on primed T cells. We have used a treatment based on a combination of antibodies specific for molecules expressed by activated T lymphocytes to selectively remove these cells. This approach, which we termed multi-hit therapy, leads to cumulative binding of antibodies to the target T cells and a striking prolongation of skin graft survival in presensitized recipients in a stringent skin transplant model. The findings are consistent with the depletion of graft-specific CD4+ and CD8+ T cells, although other modes of action, such as T-cell regulation and altered migration could play a role. In conclusion, our therapeutic strategy controls primed T cells which are a major driving force in the pathology of many autoimmune diseases and in transplant rejection.
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Simpson E. Peasant pasts: history and memory in western India - By Vinayak Chaturvedi. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2008. [DOI: 10.1111/j.1467-9655.2008.00525_12.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Simpson E, de Alwis M. Remembering natural disaster: Politics and culture of memorials in Gujarat and Sri Lanka. ANTHROPOLOGY TODAY 2008. [DOI: 10.1111/j.1467-8322.2008.00599.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ward S, Simpson E, Davis S, Hind D, Rees A, Wilkinson A. Taxanes for the adjuvant treatment of early breast cancer: systematic review and economic evaluation. Health Technol Assess 2008; 11:1-144. [PMID: 17903394 DOI: 10.3310/hta11400] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To estimate the clinical effectiveness and cost-effectiveness of docetaxel and paclitaxel compared with non-taxane, anthracycline-containing chemotherapy regimens, for the adjuvant treatment of women with early-stage breast cancer. DATA SOURCES Major electronic databases were searched between October 2005 and February 2006. REVIEW METHODS A systematic review of the literature on adjuvant taxane versus anthracycline non-taxane chemotherapy for women with early breast cancer was undertaken. A mathematical model was developed to synthesise the available data on costs, disease-free survival and health-related quality of life (HRQoL) of patients receiving taxane-containing chemotherapy versus non-taxane-containing chemotherapy. RESULTS Eight of the 11 selected trials (six docetaxel and five paclitaxel) reported a significant improvement in disease-free survival (DFS) or time to recurrence (TTR) for taxanes over comparator regimens. Docetaxel was associated with more adverse events than paclitaxel, most notably febrile neutropenia. Taxanes produced cardiotoxicity, although this was not reported to be greater than for anthracycline comparator arms in all trials. Treatment-related deaths were uncommon. Where reported, all chemotherapy regimens caused HRQoL to deteriorate during treatment. Following treatment, there were no clinically significant differences between taxane and comparator treatment groups. There were few data available comparing licensed regimens of taxanes with chemotherapy regimens commonly used in the UK. The three trials selected as the basis for the economic analysis were those that used the taxanes in accordance with current UK marketing authorisation and had also reported in full. The estimated incremental cost-effectiveness ratio for docetaxel compared to FAC6, based on the BCIRG 001 study, is 12,000 pounds (7000-39,000 pounds) and for paclitaxel compared with Adriamycin/cyclophosphamide, based on the NSABP B28 and CALGB 9344 studies, is 43,000 pounds (16,000 pounds-dominated) and 39,000 pounds (12,000 pounds-dominated), respectively. However, the comparators used in these trials restrict the generalisability of the results, as they do not conform to current standard care in the UK, typically FEC6 and E4-CMF4. An exploratory indirect comparison shows that the benefits of taxane containing regimens compared to regimens in current use in the UK is subject to large uncertainty due to the lack of direct trial comparisons between these interventions. Assumptions regarding the benefits in the taxane arm after the trial follow-up period and the annual rate of recurrence in this period have the most significant influence on the ICER. CONCLUSIONS There is a large degree of heterogeneity in the evidence base for the effectiveness of taxane- compared with non-taxane-containing regimens in terms of the interventions, comparators and populations. Eight of the 11 trials providing effectiveness data reported a significant improvement in DFS or TTR for taxanes over comparator regimens. The remaining three trials found no significant differences between the groups in DFS/TTR. The cost-effectiveness results suggest that the cost per quality-adjusted life-year for taxane- compared with non-taxane-containing chemotherapy varies between 12,000 pounds and 43,000 pounds, depending on the taxane under consideration and the specific trial used as the basis of the analysis. However, the comparators used in these trials do not conform to current standard care in the UK. More research is needed, comparing taxanes used in line with their current UK marketing authorisation and with anthracycline-containing regimens commonly used in the UK. The on-going TACT trial is expected to provide useful data. There are currently few data on the effectiveness of taxanes for the over-70s. Further research is required into the long-term outcomes of taxane therapy, such as whether there are any long-term adverse events that significantly impact on overall survival or quality of life and whether the increases in DFS will translate into increases in overall survival.
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Simpson E, Gillett G, Makris M. Liver transplantation for factor XI deficiency: cure before diagnosis. Haemophilia 2008; 14:649-50. [PMID: 18336546 DOI: 10.1111/j.1365-2516.2008.01673.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Walker K, Badawi N, Hamid CH, Vora A, Halliday R, Taylor C, Shi E, Roy GT, Simpson E, Holland AJA. A population-based study of the outcome after small bowel atresia/stenosis in New South Wales and the Australian Capital Territory, Australia, 1992-2003. J Pediatr Surg 2008; 43:484-8. [PMID: 18358286 DOI: 10.1016/j.jpedsurg.2007.10.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to describe the incidence, epidemiology, and survival of infants with small bowel atresia/stenosis in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia. METHODS A population-based cohort study was conducted of infants diagnosed with small bowel atresia/stenosis in NSW and the ACT from 1992 to 2003. Data were obtained from the prospectively collated NSW and ACT Neonatal Intensive Care Units' data collection. Individual risk factors for mortality were assessed using the chi(2) test. RESULTS The incidence of small bowel atresia/stenosis in NSW and the ACT was 2.9 per 10,000 births. Of 299 infants identified with small bowel atresia, 13 were stillborn. Of the 286 live born infants, most (52%) were delivered preterm (<37 weeks' gestation) with an 87% survival, whereas 48% were term with a 98% survival. More than half the infants (54%) had an associated birth defect. The overall mortality was 8%. Prematurity and low birth weight were identified as independent risk factors for mortality (P < .001). CONCLUSIONS This study of small bowel atresia/stenosis provides population-based outcomes for clinicians and families. It is important to investigate infants with small bowel atresia for associated birth defects. Although the mortality rate has decreased over the last 50 years, it remains substantial at 8% and is higher in premature and low birth weight infants.
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Rogers A, Simpson E, Atherstone A. Adenocarcinoma in a retrorectal cystic hamartoma: a case report and literature review. S AFR J SURG 2007; 45:148-150. [PMID: 18069583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Retrorectal cystic hamartomas are rare congenital lesions derived from the vestigial portion of the embryonic hindgut. These lesions present in a vague manner and so mimic the presentation of more common mass lesions in the pelvic region. They most frequently afflict middle-aged women, causing vague pelvic pains, discomfort with defaecation or sitting, and altered bowel function. Malignant transformation within these lesions is extremely rare. We describe a case of adenocarcinoma within a retrorectal cystic hamartoma, initially manifesting in a 54-year-old woman and recurring over a'5-year period. A computed tomography (CT) scan and pathology reports are included in the study, and findings at operations are discussed. We also include a comprehensive review of the literature.
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Hind D, Ward S, De Nigris E, Simpson E, Carroll C, Wyld L. Hormonal therapies for early breast cancer: systematic review and economic evaluation. Health Technol Assess 2007; 11:iii-iv, ix-xi, 1-134. [PMID: 17610808 DOI: 10.3310/hta11260] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To establish the clinical and cost-effectiveness of aromatase inhibitors (AIs) anastrozole, letrozole and exemestane compared with tamoxifen in the adjuvant treatment of early oestrogen receptor-positive breast cancer in postmenopausal women. DATA SOURCES Major electronic databases and three trials registers were searched from May to June 2005. Three conference abstract databases were searched in December 2005. Industry submissions. REVIEW METHODS Studies evaluating the clinical effectiveness of AIs against 5 years' tamoxifen treatment were included and critically appraised. The review of the health economics of AIs in early breast cancer in comparison with standard therapies included a review of existing economic evaluations of the relevant therapies, a critique of each of the economic evaluations submitted to the National Institute for Health and Clinical Excellence (NICE) by pharmaceutical manufacturers and a detailed explanation of the methodologies and results of the authors' economic model. The three treatment strategies (primary adjuvant therapy, unplanned switch therapy and extended adjuvant therapy) were considered separately within the authors' economic analysis. RESULTS A meta-analysis of three trials found a significant difference in overall survival when an unplanned anastrozole switching strategy was compared with 5 years' tamoxifen. Significant improvements in overall survival are yet to be demonstrated in other strategies. Compared with 5 years' tamoxifen, disease-free survival (disease recurrence or death from any cause) was significantly improved in the primary adjuvant setting with anastrozole and letrozole, and with an exemestane switching strategy. Other trials did not report this outcome. Breast cancer recurrence (censoring death as an event) was significantly improved with primary adjuvant anastrozole and letrozole, anastrozole switching, extended adjuvant anastrozole or letrozole. The AIs and tamoxifen have different side-effect profiles, with tamoxifen responsible for small but statistically significant increases in endometrial cancer and, sometimes, thromboembolic events and stroke. AIs show a trend towards increases in osteoporosis, the statistical significance of which increases with follow-up time. The absence of tamoxifen treatment also increases the risk of hypercholesterolaemia and cardiac events in postmenopausal women. There was no significant difference in overall health-related quality of life between standard treatment and either primary adjuvant anastrozole and extended adjuvant letrozole strategies. The cost-effectiveness results for AIs compared with tamoxifen in the primary adjuvant setting, are estimated to be between 21,000 pounds and 32,000 pounds per quality-adjusted life-year (QALY) based on an analysis over 35 years. There is currently no trial evidence for exemestane in this setting. The cost-effectiveness results for anastrozole and exemestane, compared with tamoxifen in the unplanned switching setting, are estimated to be 23,200 pounds and 19,200 pounds per QALY, respectively, based on an analysis over 35 years. There is currently no trial evidence for letrozole in this setting. In the extended adjuvant setting, the cost per QALY for letrozole compared with placebo is estimated to be 9800 pounds, based on an analysis over 35 years. All these results are considered to be conservative. In the base case it is assumed that the benefits of AIs over tamoxifen or placebo seen during the therapy period are gradually lost during the following 10 years. An alternative scenario, the 'benefits maintained' scenario, is tested in sensitivity analysis. Here it is assumed that following the treatment period the annual rate of recurrence in both arms is the same. This reduces the cost-effectiveness ratio by over 50%, to around 10,000-12,000 pounds, 5000 pounds and 3000 pounds in the primary adjuvant, unplanned switching and extended adjuvant setting, respectively. The limited evidence to date of benefits after the therapy period suggests that the 'benefits maintained' scenario may be realistic. The results from the economic analyses within the industry submissions are generally lower than the results from the authors' model and are close to or below 12,000 pounds in all three settings. The authors' analyses generally produce a lower estimate of QALY gain for the aromatase inhibitors, due to the more conservative assumption regarding benefits, along with differences in the utility values used in the their analysis. CONCLUSIONS On the basis of the current data and within their licensed indications, AIs can be considered clinically effective compared with standard tamoxifen treatment. However, their long-term effects, in terms of both benefits and harms, remain unclear. Under the conservative assumption that benefits gained by AIs during the treatment period are gradually lost over the following 10 years, the cost per QALY for AIs compared with tamoxifen is estimated to be between 21,000 pounds and 32,000 pounds in the primary adjuvant setting and around 20,000 pounds in the unplanned switch setting. The cost per QALY for AIs compared with placebo in the extended adjuvant setting is estimated to be around 10,000 pounds. Under the less conservative assumption that rates of recurrence are the same in both arms after the therapy period is complete, the incremental cost-effectiveness ratios are typically at least 50% lower, suggesting that AIs are likely to be considered cost-effective in all three settings. Understanding of the long-term treatment effects on cost-effectiveness is, however, incomplete. Data on the impact of AIs on survival are awaited from the majority of the trials to confirm whether or not the benefits seen in disease-free survival and recurrence rates are translated into overall survival benefit in the medium to long-term.
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