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Salek J, Clayton F, Vinson L, Saffari H, Pease LF, Boynton K, Fang J, Cox K, Peterson KA. Endoscopic appearance and location dictate diagnostic yield of biopsies in eosinophilic oesophagitis. Aliment Pharmacol Ther 2015; 41:1288-95. [PMID: 25898774 DOI: 10.1111/apt.13201] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 12/16/2014] [Accepted: 03/26/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Acknowledging that eosinophilic esophagitis (EoE) is a disease with variable involvement throughout the oesophagus, studies have suggested a minimum of five biopsies to diagnose EoE. Although it is accepted that furrows and exudates appear to represent areas of inflammation, no research to date has looked specifically at EoE endoscopic findings to see if eosinophilic infiltrate correlates with specific endoscopic findings. AIM To evaluate the distribution of eosinophils in EoE and determine whether endoscopic appearances predict the degree of eosinophilia at various locations of the oesophagus. METHODS We performed a prospective cross sectional study of EoE (treated and untreated) patients to study the distribution of eosinophils according to endoscopic findings. The oesophagus of 10 EoE patients were biopsied up to 32 times in a circumferential manner. The mucosal changes were documented at the site of each biopsy. Histological determination of eosinophil counts and related histopathology of the oesophagus were then correlated with endoscopic findings. Similar biopsy assessments were made in treated (resolved) EoE patients (n = 6) to determine the permanence of specific endoscopic appearances. RESULTS A total of 16 patients were biopsied (10 EoE, 6 treated EoE). A total of 432 biopsies were obtained in all with 294 biopsies from 10 EoE subjects. Eosinophil density was increased distally in the majority of EoE patients. Biopsies performed in areas of exudates and furrows demonstrated higher eosinophil counts. Lines and normal-appearing oesophagi in EoE subjects were not commonly associated with elevated eosinophil counts (>15 eos/HPF). Rings alone without associated furrows or plaques did not demonstrate elevated eosinophil counts and were seen in resolved EoE (Rx-EoE) as well as in active EoE patients. CONCLUSIONS Eosinophilic esophagitis remains a variable disease with some patients manifesting extensive disease throughout the oesophagus. Characteristics of furrows and exudates found during endoscopy are associated with higher peak eosinophil counts, requiring fewer biopsies to make a diagnosis. Lines and otherwise normal appearances of the oesophagus suggest a milder mucosal eosinophilia, requiring substantial biopsies to adequately identify fields with diagnostic eosinophil counts.
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Lowery JW, Intini G, Gamer L, Lotinun S, Salazar VS, Ote S, Cox K, Baron R, Rosen V. Loss of BMPR2 leads to high bone mass due to increased osteoblast activity. Development 2015. [DOI: 10.1242/dev.124669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cox K, Beilin L, Burke V. Predictors of physical activity and fitness in a 6-month, home-based physical activity program for older adults: MOVES. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.300] [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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Parks R, Hall L, Tang SW, R.L., Winterbottom L, Morgan D, Porock D, Cox K, Cheung KL. Comparison of quality of life (QOL) score following initial treatment of surgery or non-surgery in older women with primary operable breast cancer. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bindels J, Cox K, Widdershoven G, van Schayck CP, Abma TA. Stimulating program implementation via a Community of Practice: a responsive evaluation of care programs for frail older people in the Netherlands. EVALUATION AND PROGRAM PLANNING 2014; 46:115-121. [PMID: 24974372 DOI: 10.1016/j.evalprogplan.2014.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/04/2014] [Accepted: 06/10/2014] [Indexed: 06/03/2023]
Abstract
Evaluation is often used as a vehicle to improve program implementation. To evaluate the implementation of programs that provide care for frail older people a Community of Practice (CoP) was developed in the Netherlands. The purpose of this paper is to describe and reflect on the role of a CoP in the implementation of these programs. Using a responsive evaluation approach this study was based on interviews with participating stakeholders and transcripts of the CoP meetings with 13 professionals, project managers and patient representatives. Findings showed that CoP members had unanticipated concerns regarding the pro-active approach of the programs and older people not being open to receiving care. The heterogenic composition was appreciated and fostered learning. A social infrastructure was created for active learning inside and outside the CoP. We conclude that a CoP is a useful strategy as part of an evaluation aimed at improving program implementation. Lessons learned include the importance of creating ownership among CoP members by sharing responsibilities and paying attention to the heterogenic group composition and professional language spoken to involve all members.
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Foster M, Cox K. 206: Intranasal Fentanyl and Midazolam Use in a Pediatric Emergency Department. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gonzales‐Pacheco D, Cox K, Murray‐Krezan C. Gestational weight gain in women receiving prenatal care in rural midwifery clinics (LB313). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.lb313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Parks R, Howard P, Hall L, Tang SW, Lakshmanan R, Winterbottom L, Morgan D, Porock D, Cox K, Cheung KL. Decision making in older women with primary operable breast cancer. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Furber L, Cox K, Murphy R, Steward W. Investigating communication in cancer consultations: what can be learned from doctor and patient accounts of their experience? Eur J Cancer Care (Engl) 2013; 22:653-62. [DOI: 10.1111/ecc.12074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2013] [Indexed: 11/28/2022]
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Cox K, Sever A, Jones S, Weeks J, Mills P, Devalia H, Fish D, Jones P. Validation of a technique using microbubbles and contrast enhanced ultrasound (CEUS) to biopsy sentinel lymph nodes (SLN) in pre-operative breast cancer patients with a normal grey-scale axillary ultrasound. Eur J Surg Oncol 2013; 39:760-5. [PMID: 23632319 DOI: 10.1016/j.ejso.2013.03.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 03/24/2013] [Accepted: 03/27/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In patients with breast cancer, grey-scale ultrasound often fails to identify lymph node (LN) metastases. We aimed to validate the technique of contrast-enhanced ultrasound (CEUS) as a test to identify sentinel lymph node (SLN) metastases and reduce the numbers of patients requiring a completion axillary node clearance (ANC). METHODS 371 patients with breast cancer and a normal axillary ultrasound were recruited. Patients received periareolar intra-dermal injection of microbubble contrast agent. Breast lymphatics were visualised by CEUS and followed to identify and biopsy axillary SLN. Patients then underwent standard tumour excision and either SLN excision (benign biopsy) or axillary clearance (malignant biopsy) with subsequent histopathological analysis. RESULTS The technique failed in 46 patients, 6 patients had indeterminate biopsy results and 24 patients were excluded. In 295 patients with a conclusive SLN biopsy, the sensitivity of the technique was 61% and specificity 100%. Given a benign SLN biopsy result, the post-test probability that a patient had SLN metastases was 8%. 35 patients were found to have SLN metastases and had a primary ANC (29 macrometastases and 6 micrometastases/ITC). There were 22 false negative results (10 macrometastases and 12 micrometastases). Macrometastases in core biopsy specimens correlated with LN macrometastases on surgical excision. CONCLUSION Pre-operative biopsy of SLN reduced the numbers of patients requiring completion ANC. Despite the low sensitivity, only 22 patients (8%) with a benign SLN biopsy were subsequently found to have LN metastases. Without the confirmation of macrometastases on core biopsy specimens, patients with micrometastases/ITC may be inadvertently selected for primary ANC.
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Parks⁎ R, Howard P, Tang SW, Hall L, Lakshmanan R, Winterbottom L, Morgan D, Cox K, Cheung KL. Assessment of changes of quality of life (QOL) following initial treatment of older women with primary operable breast cancer. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.10.017] [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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Hafner J, Perkins B, Korosac J, Aldag J, Cox K, Parrigin S, Tomblin C. 246 Comprehensive Comparison of Intubation Performance Using Direct, Indirect Laryngoscopy and Airway Adjunct Devices, In a Simulated Helicopter Emergency Medical Services Setting. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Li L, Wozniak LJ, Rodder S, Heish S, Talisetti A, Wang Q, Esquivel C, Cox K, Chen R, McDiarmid SV, Sarwal MM. A common peripheral blood gene set for diagnosis of operational tolerance in pediatric and adult liver transplantation. Am J Transplant 2012; 12:1218-28. [PMID: 22300520 DOI: 10.1111/j.1600-6143.2011.03928.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To identify biomarkers of operational tolerance in pediatric and adult liver transplant recipients, transcriptional profiles were examined from 300 samples by microarrays and Q-PCR measurements of blood specimens from pediatric and adult liver transplant recipients and normal tissues. Tolerance-specific genes were validated in independent samples across two different transplant programs and validated by Q-PCR. A minimal set of 13 unique genes, highly expressed in natural killer cells (p = 0.03), were significantly expressed in both pediatric and adult liver tolerance, irrespective of different clinical and demographic confounders. The performance of this gene set by microarray in independent samples was 100% sensitivity and 83% specificity and the AUC was 0.988 for only three genes by Q-PCR. 26% of adults and 64% of children with excellent liver allograft function, on minimal or dual immunosuppression, showed high prediction scores for tolerance. Novel peripheral transcriptional profiles can be identified in operational tolerance in pediatric and adult recipients of liver allografts, suggesting a high incidence of a pro-tolerogenic phenotype in stable patients on chronic immunosuppression. Given the high incidence of viral infections and malignancies in liver transplant recipients, this gene set provides an important monitoring tool that can move the field toward personalized and predictive medicine in organ transplantation.
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Bellande B, Winicur Z, Gallo B, Turner M, Saulino M, Heath S, Bennett S, Nelson ME, Reese C, Larson A, Dawidowicz S, Boche J, Cox K. Competency-Based Curricula in DBS and ITB Therapies for Movement Disorders (P06.022). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cox K, Kane E, Burke V, Beilin L. Effects of education and motivational interviewing on short and long-term participation in a home-based physical activity program. J Sci Med Sport 2011. [DOI: 10.1016/j.jsams.2011.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Whisker L, Ledwidge S, Burgess P, Cox K, Baildam A. The Fleur-de-Lys Modification for Latissimus Dorsi (LD) Breast Reconstruction. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Cox K, Vanden Broeck A, Van Calster H, Mergeay J. Temperature-related natural selection in a wind-pollinated tree across regional and continental scales. Mol Ecol 2011; 20:2724-38. [PMID: 21623981 DOI: 10.1111/j.1365-294x.2011.05137.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Adaptive genetic variation is a key factor in evolutionary biology, but the detection of signatures of natural selection remains challenging in nonmodel organisms. We used a genome scan approach to detect signals of natural selection in the Black alder (Alnus glutinosa), a widespread wind-pollinated tree. Gene flow through pollen dispersal is believed to be high in this species, and we therefore expected to find a clear response to natural selection. In combination with two different landscape genetic approaches, we determined which environmental variables were most associated with the inferred selection. This analysis was performed on a regional scale (northern Belgium) and on a continental scale (Europe). Because climate-related differences are much more pronounced at the continental scale, we expected to find more selection-sensitive genetic markers across Europe than across northern Belgium. At both spatial scales, a substantial number of genetic loci were considered outliers, with respect to neutral expectations, and were therefore identified as selective. Based on results from our combined approach, four putative selective loci (or 2.5%) were recovered with high statistical support. Although these loci seemed to be associated with different environmental variables, they were mainly temperature-related. Our study demonstrates that the use of complementary methods in landscape genetics allows the discovery of selective loci which otherwise might stay hidden. In combination with a genome scan, the selective loci can be verified and the nature of the selection pressure can be identified.
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Parks RM, Hall L, Tang S, Lakshmanan R, Hurria A, Winterbottom L, Kennedy H, Morgan DAL, Porock D, Cox K, Cheung K. Evaluation of a cancer-specific comprehensive geriatric assessment (CGA) tool in older women with newly diagnosed primary breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sever A, Broillet A, Schneider M, Cox K, Jones S, Mills P, Weeks J, Jones P. Intradermal microbubbles and contrast-enhanced ultrasound can dynamically visualise lymphatic channels and sentinel lymph nodes in a swine model and patients with breast cancer. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cox K, Sever A, Jones S, Weeks J, Mills P, Fish D, Broillet A, Schneider M, Jones P. 352 Sentinel lymph node detection using intradermal microbubbles and contrast-enhanced ultrasound in a swine model and patients with breast cancer. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70378-5] [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] Open
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Cox K, Kane E, Beilin L, Burke V. Identifying the values of older Australians as a basis for motivational interviewing -a strategy for the promotion of physical activity. The MOVES study. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rohrig TP, Gamble M, Cox K. Identification and quantitation of ketamine in biological matrices using gas chromatography-mass spectrometry (GC-MS). Methods Mol Biol 2010; 603:317-326. [PMID: 20077083 DOI: 10.1007/978-1-60761-459-3_30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Ketamine hydrochloride, a Schedule III drug under the Controlled Substances Act, is a dissociative anesthetic that has a combination of stimulant, depressant, hallucinogenic, and analgesic properties. This procedure utilizes solid phase extraction of blood, tissue, or urine samples to isolate ketamine (special K) and its metabolite norketamine. The extract is then assayed using selected ion monitoring gas chromatography/mass spectrometry for absolute structural confirmation of the compound and the compounds quantified by comparing responses of the unknown samples to the responses of standards.
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Sever A, Jones S, Cox K, Weeks J, Mills P, Jones P. Preoperative localization of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasonography in patients with breast cancer. Br J Surg 2009; 96:1295-9. [PMID: 19847869 DOI: 10.1002/bjs.6725] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is the standard procedure for axillary staging in early breast cancer. Lymphatic imaging after intraparenchymal microbubble injection has been reported in animal models. The aim of this study was to identify and localize SLNs before surgery by contrast-enhanced ultrasonography after intradermal injection of microbubbles in patients with breast cancer. METHODS Fifty-four consecutive, consenting patients with primary breast cancer were recruited. Patients received a periareolar intradermal injection of microbubble contrast agent. Breast lymphatics were visualized by ultrasonography and followed to identify putative axillary SLNs. A guidewire was deployed to localize the SLN. The next day, patients underwent standard tumour excision and SLN biopsy. RESULTS SLNs were identified and guidewires inserted in 48 patients. In these patients operative findings confirmed that the wired lymph nodes were SLNs. The sensitivity of SLN detection, compared with radioisotope and blue dye, was 89 per cent. Five patients were found to have metastases in SLNs. In these patients the SLNs were identified correctly and localized before surgery with guidewires. CONCLUSION SLNs may be identified and localized before surgery using contrast-enhanced ultrasonography after injection of microbubbles.
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Hutnick N, Carnathan D, Dubey S, Cox K, Ratcliffe S, Robertson MN, Casimiro DR, Ertl HC, Betts MR. P16-09. Adenovirus 5 vector HIV vaccination does not affect mucosal homing markers on Ad5-specific CD4+ T-cells in humans. Retrovirology 2009. [PMCID: PMC2767735 DOI: 10.1186/1742-4690-6-s3-p238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Sever A, Jones S, Cox K, Weeks J, Mills P, Fish D, Jones P. 5185 Identification and localisation of sentinel lymph nodes using microbubble enhanced ultrasound in pre-operative breast cancer patients. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71077-8] [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] Open
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