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Jaumdally S, Tomasicchio M, Pooran A, Esmail A, Kotze A, Meier S, Wilson L, Oelofse S, van der Merwe C, Roomaney A, Davids M, Suliman T, Joseph R, Perumal T, Scott A, Shaw M, Preiser W, Williamson C, Goga A, Mayne E, Gray G, Moore P, Sigal A, Limberis J, Metcalfe J, Dheda K. Frequency, kinetics and determinants of viable SARS-CoV-2 in bioaerosols from ambulatory COVID-19 patients infected with the Beta, Delta or Omicron variants. Nat Commun 2024; 15:2003. [PMID: 38443359 PMCID: PMC10914788 DOI: 10.1038/s41467-024-45400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024] Open
Abstract
Airborne transmission of SARS-CoV-2 aerosol remains contentious. Importantly, whether cough or breath-generated bioaerosols can harbor viable and replicating virus remains largely unclarified. We performed size-fractionated aerosol sampling (Andersen cascade impactor) and evaluated viral culturability in human cell lines (infectiousness), viral genetics, and host immunity in ambulatory participants with COVID-19. Sixty-one percent (27/44) and 50% (22/44) of participants emitted variant-specific culture-positive aerosols <10μm and <5μm, respectively, for up to 9 days after symptom onset. Aerosol culturability is significantly associated with lower neutralizing antibody titers, and suppression of transcriptomic pathways related to innate immunity and the humoral response. A nasopharyngeal Ct <17 rules-in ~40% of aerosol culture-positives and identifies those who are probably highly infectious. A parsimonious three transcript blood-based biosignature is highly predictive of infectious aerosol generation (PPV > 95%). There is considerable heterogeneity in potential infectiousness i.e., only 29% of participants were probably highly infectious (produced culture-positive aerosols <5μm at ~6 days after symptom onset). These data, which comprehensively confirm variant-specific culturable SARS-CoV-2 in aerosol, inform the targeting of transmission-related interventions and public health containment strategies emphasizing improved ventilation.
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Affiliation(s)
- S Jaumdally
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - M Tomasicchio
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - A Pooran
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - A Esmail
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - A Kotze
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - S Meier
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - L Wilson
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - S Oelofse
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - C van der Merwe
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - A Roomaney
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - M Davids
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - T Suliman
- Department of Medical Biosciences, University of the Western Cape, Cape Town, South Africa
| | - R Joseph
- Division of Medical Virology, Wellcome Centre for Infectious Diseases in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - T Perumal
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - A Scott
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - M Shaw
- Department of Medical Biosciences, University of the Western Cape, Cape Town, South Africa
| | - W Preiser
- Division of Medical Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch Tygerberg Campus; Medical Virology, National Health Laboratory Service Tygerberg, Parow, Cape Town, South Africa
| | - C Williamson
- Division of Medical Virology, Wellcome Centre for Infectious Diseases in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- National Health Laboratory Service (NHLS), Cape Town, South Africa
| | - A Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - E Mayne
- Department of Immunology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - G Gray
- South African Medical Research Council, Cape Town, South Africa
| | - P Moore
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- SA MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A Sigal
- Africa Health Research Institute, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Max Planck Institute for Infection Biology, Berlin, Germany
| | - J Limberis
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Centre, University of California, San Francisco, San Francisco, CA, USA
| | - J Metcalfe
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Centre, University of California, San Francisco, San Francisco, CA, USA
| | - K Dheda
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa.
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa.
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Falkenberry E, Reeves M, Scott A, Myrick D, Fallini C, Bassell G, Katz D. LSD1/KDM1A is essential for neural stem cell differentiation in mice. bioRxiv 2023:2023.12.02.569711. [PMID: 38076951 PMCID: PMC10705553 DOI: 10.1101/2023.12.02.569711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
The proper regulation of neural stem cell differentiation is required for the proper specification of the central nervous system. Here we investigated the function of the H3K4me1/2 demethylase LSD1/KDM1A during neural stem differentiation in mice. Conditional deletion of LSD1 in nestin- positive neural stem cells results in 100% perinatal lethality after birth with severe motor coordination deficits, retarded growth and defects in brain morphology. Despite these severe defects, motor neuron progenitors and the initial motor neuron population are specified normally and motor neurons with normal morphology can be cultured from these mice in vitro. However, motor neurons cultured from mice lacking LSD1 in neural stem cells continue to inappropriately maintain critical neural stem cell proteins. Taken together these results suggest that, as in other mouse stem cell populations, LSD1 is required to deactivate the stem cell program to enable normal neural stem cell differentiation. However, unlike in other mouse stem cell populations, the inappropriate maintenance of the stem cell program during neural stem cell differentiation may compromise neuronal function rather than neuronal specification.
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Affiliation(s)
- E.C. Falkenberry
- Department of Cell Biology, Emory University School of Medicine, Atlanta GA 30322, USA
| | - M. Reeves
- Department of Cell Biology, Emory University School of Medicine, Atlanta GA 30322, USA
| | | | | | - C. Fallini
- Department of Cell and Molecular Biology, University of Rhode Island, Kingston, RI 02881, USA
| | - G.J. Bassell
- Department of Cell Biology, Emory University School of Medicine, Atlanta GA 30322, USA
| | - D.J. Katz
- Department of Cell Biology, Emory University School of Medicine, Atlanta GA 30322, USA
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Elaimy AL, Al-Holou W, Scott A, Marini BL, Pai A, Wen B, Wang L, Sun D, Heth JA, Umemura Y, Wahl DR. A Phase 0 Study Assessing the Intracranial Activity of a Metabolic Radiosensitizer in Patients with Glioblastoma. Int J Radiat Oncol Biol Phys 2023; 117:e102. [PMID: 37784629 DOI: 10.1016/j.ijrobp.2023.06.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Efforts to overcome treatment resistance in glioblastoma (GBM) have been unsuccessful due to tumor heterogeneity and poor intracranial drug penetration. Targeting altered metabolism is a promising approach to improve GBM therapy despite this heterogeneity. Mycophenolate mofetil (MMF) is an inhibitor of purine synthesis that sensitizes GBM to radiation and temozolomide (TMZ) in vitro and in vivo, but its ability to cross the blood brain barrier and inhibit GBM metabolism in patients is unknown. NCT04477200 is a phase 0/1 dose escalation study of MMF combined with radiation and temozolomide in GBM. Here we report the phase 0 results of this study assessing the intracranial activity of MMF. MATERIALS/METHODS Purine (GTP and IMP) and mycophenolic acid (MPA, the active metabolite of MMF) concentrations were determined using mass spectrometry in flash-frozen tumor (enhancing and non-enhancing) and normal cortex obtained from 8 patients with recurrent GBM who received MMF (500, 1000, 1500 and 2000 mg BID, N = 2 patients each dose level) for 1 week prior to re-resection and 5 control patients who did not receive MMF prior to re-resection. Plasma MPA concentration was similarly quantified to calculate the enhancing tumor, non-enhancing tumor and normal cortex to plasma MPA ratios. RESULTS Patients who received MMF had a mean MPA concentration of 2.2 ± 0.7 µM in the enhancing tumor samples, 1.2 ± 0.5 µM in the non-enhancing tumor samples and 1.3 ± 0.5 µM in normal cortex. MPA concentration was negligible in control patients. This corresponded to tissue/plasma MPA ratios of 0.31, 0.17 and 0.10 for enhancing tumor, non-enhancing tumor and normal cortex, respectively. The GTP/IMP ratio was decreased by 75% in enhancing tumor in MMF-treated patients compared to untreated controls (p = 0.009), indicating effective target engagement and inhibition of purine synthesis. The GTP/IMP ratio was also decreased in cortex and non-enhancing tumor, though a paucity of control samples prevented statistical analysis. CONCLUSION Twice daily MMF treatment yields intracranial drug concentrations above 1 µM and lowers the GTP/IMP ratio in GBMs, consistent with target engagement. As we have previously observed radiosensitization in vitro with MPA concentrations of 1 µM, these data suggest that MMF may achieve adequate CNS penetration for therapeutic benefit. The Phase 1 component of this study to determine the dose limiting toxicity and maximally tolerated dose of MMF when combined with reirradiation in recurrent GBM and radiation and TMZ in newly diagnosed GBM is ongoing.
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Affiliation(s)
- A L Elaimy
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - W Al-Holou
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - A Scott
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - B L Marini
- College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - A Pai
- College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - B Wen
- College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - L Wang
- College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - D Sun
- College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - J A Heth
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - Y Umemura
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - D R Wahl
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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Edwards DM, Hopkins A, Scott A, Mannan R, Cao X, Zhang L, Andren A, Heth JA, Muraszko K, Sagher O, Orringer D, Hollon T, Hervey-Jumper S, Venneti S, Camelo-Piragua S, Al-Holou W, Chinnaiyan A, Lyssiotis CA, Wahl DR. Identification of Excellent Prognosis IDH Wildtype Glioblastomas Using Genomic and Metabolic Profiling. Int J Radiat Oncol Biol Phys 2023; 117:e101. [PMID: 37784627 DOI: 10.1016/j.ijrobp.2023.06.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) High grade gliomas (HGGs) are aggressive brain tumors with altered cellular metabolism. HGGs can carry mutations in the tricarboxylic acid (TCA) cycle enzyme isocitrate dehydrogenase 1 (IDH1), conferring distinct biology and improved patient prognosis compared to IDH wildtype (wt) tumors. Using metabolomic analyses of tumor tissue, we previously showed that IDH wt and IDH mutant (IDH mut) tumors have unique metabolomic signatures that correlate with different survival outcomes. Among this cohort of 69 HGG samples, we identified two unique patient tumors that metabolically clustered with IDH mut tumors, but lacked both the IDH mutation and its product 2-hydroxyglutarate. We aimed to discover unique mutations in these two tumors that may impart an IDH mutant-like phenotype in the absence of an IDH1 or IDH2 mutation. MATERIALS/METHODS Whole exome sequencing (WES) was performed on frozen tumor samples from two patients diagnosed as glioblastoma (GBM), IDH wt via Agilent v5 + IncRNA platform. Alignment to the hg38 genome and variant calling were completed using an accelerated implementation of GATK's BWA and MuTect2 algorithms from Sentieon. Variants were filtered based on supporting reads and variant allele thresholds, with synonymous variants and common SNPs removed. High-confidence variants were further filtered by membership in the four KEGG pathways associated with IDH1 and IDH2. Identified variants were corroborated with metabolomics data from the two unique IDH wt tumors compared with classical GBM IDH wt, oligodendrogliomas IDH mut and astrocytomas IDH mut to identify putative drivers of an IDH mutant-like metabolomic phenotype in these unique IDH wt tumors. RESULTS Despite the lack of an IDH mutation, one patient survived 45.6 months and the other patient remains alive at last follow up 64 months post diagnosis, much longer than the 16-18-month median survival typical of patients with GBM IDH wt. WES of outlier IDH wt tumor samples revealed 65 unique mutations in the queried KEGG pathways, of which 34 had a variant allele frequency > = 0.15. These variants were processed in Gprofiler, confirming expected enrichment of the carboxylic acid metabolic biologic process, a functional gene set consisting of TCA genes, among these variants (p = 0.002, 3.6-fold enrichment). Accordingly, metabolite levels of intermediates of the TCA cycle, including malate and isocitrate were decreased in the outlier tumor samples compared to classic GBMs IDH wt (p<0.001). Presence of genetic alterations in key variants of the carboxylic acid metabolic biologic process (including ME1, GYP4F3, PTGIS, PFKL, PSPH, AKR1A1, HK2, NOS1) correlated with improved overall survival among GBM patients in the TCGA (p = 0.04). Laboratory validation of these findings in preclinical GBM models is ongoing. CONCLUSION Disruption of the TCA cycle independent of an IDH mutation is associated with favorable survival in GBM. Pharmacologic inhibition of these pathways may be a promising strategy to improve GBM outcomes.
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Affiliation(s)
- D M Edwards
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A Hopkins
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - A Scott
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - R Mannan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - X Cao
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - L Zhang
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
| | - A Andren
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
| | - J A Heth
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - K Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - O Sagher
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - D Orringer
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - T Hollon
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - S Hervey-Jumper
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - S Venneti
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | | | - W Al-Holou
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - A Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - C A Lyssiotis
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
| | - D R Wahl
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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Rieu R, Prestwich RJ, Paterson C, Vohra S, Swan A, Noble D, Srinivasan D, Dixon L, Chiu K, Scott A, Mendes R, Khan S, Pilar A, Thompson A, Nutting CM, McPartlin A. A Multicenter Study of Clinician and Patient Reported Acute and Late Toxicity after Radical (Chemo)Radiotherapy for Non-Endemic Nasopharyngeal Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e619. [PMID: 37785855 DOI: 10.1016/j.ijrobp.2023.06.2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Curative (chemo)radiotherapy ((CT)RT) for Nasopharyngeal cancers (NPC) achieves excellent disease control but is associated with significant late toxicities despite modern treatment delivery. Contemporary late toxicity data, including patient reported outcomes (PROs), is limited in the non-endemic population; we present a large contemporary series of toxicity outcomes and late PROs following treatment of non-endemic NPC. MATERIALS/METHODS Adult patients completing radical (CT)RT for primary NPC between February 2016 and 2020 at 7 large UK cancer centers were identified on institutional databases. Patients were excluded if they had prior head and neck cancer or prior therapeutic head and neck surgery (except neck dissection). Patients with an active other cancer were excluded from PRO assessment. Demographic, treatment, acute toxicity and outcome data were collected retrospectively from patient records. Disease-free patients were invited to complete an M.D. Anderson Dysphagia Index (MDADI) and University of Washington (UoW) Quality of Life (QoL) PROs questionnaires. RESULTS A total of 180 eligible patients were identified: 68% male, median age 54 years, 11% ≥70 years. EBV status was positive in 61% (unknown 12%). Patients had stage I (5%), II (22%), III (37%), IV (36%) disease; 95% were performance status ≤1 at baseline. Median follow-up was 31.2 months (range 0-68). A total of 54% received 70Gy in 33-35# and 43% received 65-66 Gy in 30-33#. 66% received induction and 65% received concurrent chemotherapy. 9.5% had residual disease at the first follow-up scan. Subsequent locoregional or distant recurrence occurred in 5% and 12% respectively. At last assessment, 84% patients were alive, 16% had died (of which 70% had active disease). Acute treatment toxicity included: 63% of patients required enteral support (median duration 98 days) with 9% a feeding tube at 1 year post treatment. 18% G3 dermatitis, 53% G3 mucositis. 82% requiring opioids and 40% admitted for symptom management. 90 patients completed the PROs (76% response rate) at a median of 37.8 months post treatment (Table 1). These demonstrate significant QoL detriment: 28% report significant pain, 24% require regular analgesia, and 59% report significant impact on daily activity. This was found to persist at different timepoints (not shown). CONCLUSION Excellent cancer survival outcomes are seen in a non-selected, non-endemic NPC population. However significant acute and late toxicity following radical treatment is identified which can profoundly negatively impact QoL in a relatively young cohort. This highlights the importance of ongoing efforts to reduce toxicity and supports the prospective evaluation of potential toxicity sparing technologies, such as proton beam radiotherapy.
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Affiliation(s)
- R Rieu
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - R J Prestwich
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - C Paterson
- Beatson West of Scotland Cancer Centre, Radiation Oncology Department, Glasgow, United Kingdom
| | - S Vohra
- Beaton West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - D Noble
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - D Srinivasan
- Western General Hospital, Edinburgh, United Kingdom
| | - L Dixon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, Sheffield, United Kingdom
| | - K Chiu
- Mount Vernon Cancer Centre, Department of Clinical Oncology, Northwood, United Kingdom
| | - A Scott
- Mount Vernon Hospital, Department of Clinical Oncology, Northwood, United Kingdom
| | - R Mendes
- University College London Hospital, London, United Kingdom
| | - S Khan
- University College London Hospital, London, United Kingdom
| | - A Pilar
- University College London Hospital, London, United Kingdom
| | - A Thompson
- North Middlesex University Hospital, Cambridge CB2 8AP, United Kingdom
| | - C M Nutting
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - A McPartlin
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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8
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Chakravarty PD, Ton T, Scott A, Doherty C, Douglas CM, Montgomery J. Outpatient secondary care pathways for head and neck cancer referral result in patient delays for cancer treatment. Ann R Coll Surg Engl 2023; 105:352-356. [PMID: 36260287 PMCID: PMC10066648 DOI: 10.1308/rcsann.2022.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION The majority of head and neck cancer referrals are received through primary care. A proportion of cancer referrals are received through secondary care specialties. Local delivery plan (LDP) targets in Scotland for cancer investigation are set at 31 days for diagnosis and 62 days to start treatment. The aim was to audit referrals made through non-primary care pathways compared with the standard primary care pathways against LDP targets. METHODS New head and neck cancer patients between 1 January 2014 and 1 January 2019 were included. Pathway points were recorded between referral to outpatient clinic, time to multidisciplinary team discussion (MDT) and finally MDT to treatment. RESULTS 1,276 new patient referrals were received over a 5-year period. Of these, 136 (10%) were referred via non-primary care pathways. The mean time for urgent suspicion of cancer (USoC) referrals to start treatment was 77 days (15 days over target) and for outpatient secondary care referrals was 102 days (40 days over target) (p<0.05). When treatment intent was considered, 841/1,131 (75%) of patients referred via primary care were treated curatively compared with 49/99 (49%) (p<0.05) of patients referred through the secondary outpatient pathway. CONCLUSION Patients with head and neck cancer referred from other outpatient specialties face delays commencing cancer treatment and are also associated with a greater likelihood of being treated with palliative intent.
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Affiliation(s)
| | - T Ton
- NHS Greater Glasgow and Clyde, UK
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9
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Ko A, Noel M, Chao J, Sohal D, Crow M, Oberstein P, Scott A, McRee A, Rocha Lima C, Fong L, Keenan B, Filbert E, Hsu F, Shankaran V. 1229P A multicenter phase II study of sotigalimab (CD40 agonist) in combination with neoadjuvant chemoradiation for resectable esophageal and gastroesophageal junction (GEJ) cancers. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Hegi-Johnson F, Akhurst T, Rudd S, Donnelly P, Scott A, Callahan J, Roselt P, John T, Sithara S, Wichmann C, Hanna G, MacManus M. MA09.05 Increased PD-L1 Tracer Uptake in Recently-irradiated Lesions in NSCLC: Preliminary Results of a Phase 0 Trial (ImmunoPET) of a Novel PET Tracer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Scott A, Call J, Chandana S, Borazanci E, Falchook G, Bordoni R, Richey S, Starodub A, Chung V, Lakhani N, Lam E, Schaffer K, Wang J, Shapiro G, Sachdev J, Beaupre D, Tolcher A. 451O Preliminary evidence of clinical activity from phase I and Ib trials of the CLK/DYRK inhibitor cirtuvivint (CIRT) in subjects with advanced solid tumors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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12
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Feng F, Ning Y, Xue Y, Friedl V, Hann D, Gibb B, Bergamaschi A, Guler G, Hazen K, Scott A, Phillips T, McCarthy E, Ellison C, Malta R, Nguyen A, Lopez V, Cavet R, Chowdhury S, Volkmuth W, Levy S. 69MO 5-Hydroxymethycytosine analysis reveals stable epigenetic changes in tumor tissue that enable cfDNA cancer predictions. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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Craine A, Scott A, Desai D, Alshawabkeh L, Adler E, Kim N, Contijoch F. 442 Myocardial Work Estimation With Ct Aids Evaluation Of Regional Right Ventricular Function. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Scott A, Kim P, Tran H, Kligerman S, Adler E, Contijoch F. 465 Free Wall And Septal Wall Right Ventricular Strain With Ct For Postoperative Right Ventricular Failure Risk. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Ward J, Gill S, Armstrong K, Fogarty T, Tan D, Scott A, Yahya A, Dhaliwal S, Jacques A, Tang C. PO-1384 Simethicone use to Reduce Rectal Variability During Prostate Cancer Radiotherapy, a Randomised Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Faniyi AA, Hughes MJ, Scott A, Belchamber KBR, Sapey E. Inflammation, Ageing and Diseases of the Lung: Potential therapeutic strategies from shared biological pathways. Br J Pharmacol 2021; 179:1790-1807. [PMID: 34826882 DOI: 10.1111/bph.15759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/07/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022] Open
Abstract
Lung diseases disproportionately affect elderly individuals. The lungs form a unique environment: a highly elastic organ with gaseous exchange requiring the closest proximity of inhaled air containing harmful agents and the circulating blood volume. The lungs are highly susceptible to senescence, with age and "inflammageing" creating a pro-inflammatory environment with a reduced capacity to deal with challenges. Whilst lung diseases may have disparate causes, the burden of ageing and inflammation provides a common process which can exacerbate seemingly unrelated pathologies. However, these shared pathways may also provide a common route to treatment, with increased interest in drugs which target ageing processes across respiratory diseases. In this review, we will examine the evidence for the increased burden of lung disease in older adults, the structural and functional changes seen with advancing age and assess what our expanding knowledge of inflammation and ageing pathways could mean for the treatment of lung disease.
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Affiliation(s)
- A A Faniyi
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
| | - M J Hughes
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
| | - A Scott
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
| | - K B R Belchamber
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
| | - E Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
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Vaios E, Grabowski M, Srinivasan E, Huie D, Sankey E, Otvos B, Olufawo M, Scott A, Kim A, Leuthardt E, Barnett G, Mohammadi A, Reitman Z, Floyd S, Kirkpatrick J, Fecci P. Combining Laser Interstitial Thermal Therapy With SRS Improves Time to Progression for Recurrent SRS-Treated Brain Metastases. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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St John ER, Bakri AC, Johanson E, Loughran D, Scott A, Chen ST, Joshi S, Darzi A, Leff DR. Assessment of the introduction of semi-digital consent into surgical practice. Br J Surg 2021; 108:342-345. [PMID: 33783479 DOI: 10.1093/bjs/znaa119] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/10/2020] [Indexed: 11/12/2022]
Abstract
In this study, paper-based surgical consent is demonstrated to have significant errors of omission and legibility. These errors were improved by the introduction of a procedure-specific, patient-bespoke, semi-digital consent form application. Patient-reported experience of their involvement in shared decision-making is described for paper-based consent and the implications of future digital consent are discussed.
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Affiliation(s)
- E R St John
- Department of Breast Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Concentric Health, Tramshed Tech, Cardiff, Wales, UK.,Academic Surgical Unit, Division of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, UK
| | - A C Bakri
- Academic Surgical Unit, Division of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, UK
| | - E Johanson
- School of Medicine, Neuadd Meirionnydd, Cardiff University, Cardiff, UK
| | - D Loughran
- Concentric Health, Tramshed Tech, Cardiff, Wales, UK
| | - A Scott
- Academic Surgical Unit, Division of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, UK.,Department of General Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital and St Mary's Hospital, London, UK
| | - S-T Chen
- Department of General Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital and St Mary's Hospital, London, UK
| | - S Joshi
- Department of Breast Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - A Darzi
- Academic Surgical Unit, Division of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, UK
| | - D R Leff
- Department of Breast Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Academic Surgical Unit, Division of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, UK
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19
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Waugh CM, Scott A. Substantial Achilles adaptation following strength training has no impact on tendon function during walking. PLoS One 2021; 16:e0255221. [PMID: 34324575 PMCID: PMC8320898 DOI: 10.1371/journal.pone.0255221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/12/2021] [Indexed: 11/18/2022] Open
Abstract
Tendons are responsive to mechanical loading and their properties are often the target of intervention programs. The tendon's mechanical properties, particularly stiffness, also govern its function, therefore changes to these properties could have substantial influence on energy-saving mechanisms during activities utilizing the stretch-shortening cycle. We investigated Achilles tendon (AT) function in vivo during walking with respect to a training intervention that elicited significant increases in AT stiffness. 14 men and women completed 12-weeks of isometric plantarflexor strength training that increased AT stiffness, measured during isometric MVC, by ~31%. Before and after the intervention, participants walked shod at their preferred velocity on a fully-instrumented treadmill. Movement kinematics, kinetics and displacement of the gastrocnemius medialis muscle-tendon junction were captured synchronously using 3D motion capture and ultrasound imaging, respectively. A MANOVA test was used to examine changes in AT force, stress, strain, stiffness, Young's modulus, hysteresis and strain energy, measured during walking, before and following strength training. All were non-significant for a main effect of time, therefore no follow-up statistical tests were conducted. Changes in joint kinematics, tendon strain, velocity, work and power and muscle activity during the stance phase were assessed with 1D statistical parametric mapping, all of which also demonstrated a lack of change in response to the intervention. This in vivo examination of tendon function in walking provides an important foundation for investigating the functional consequences of training adaptations. We found substantial increases in AT stiffness did not impact on tendon function during walking. AT stiffness measured during walking, however, was unchanged with training, which suggests that increases in stiffness may not be evident across the whole force-elongation relation, a finding which may help explain previously mixed intervention results and guide future investigations in the functional implications of tendon adaptation.
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Affiliation(s)
- C. M. Waugh
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - A. Scott
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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20
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Liew D, Poon A, Mcmaster C, Owen C, Leung J, Frauman A, Cebon J, Scott A, Buchanan R. OP0194 GENERALIZED IMMUNE ACTIVATION IN STRUCTURES RELATED TO PMR OR GCA ON PET/CT ASSESSMENT DOES NOT OCCUR IN IMMUNE CHECKPOINT INHIBITOR-TREATED PATIENTS WHO DO NOT GO ON TO DEVELOP RHEUMATIC IMMUNE-RELATED ADVERSE EVENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The pathogenesis of rheumatic immune-related adverse events (irAEs) from checkpoint inhibitor cancer immunotherapy directed against programmed cell death protein 1 (PD-1) and programmed death ligand 1 (PD-L1) remains unknown, even though they are a consequence of pharmacologic inhibition of a specific immune mechanism. Given that some irAEs resemble polymyalgia rheumatica (PMR) or giant cell arteritis (GCA), a disease whose pathogenesis is poorly understood, observations regarding the pathogenesis of PMR-like or GCA-like irAEs are of significant interest. One proposed pathogenic mechanism involves generalized immune activation leading to a spectrum of subclinical disease. Interrogation of this hypothesis may be aided by PET/CT, which is frequently utilized for oncological staging purposes but is also useful in classical PMR or GCA diagnosis. If PMR or GCA irAEs merely represent a spectrum of generalized immune activation, low-grade subclinical PMR or GCA-related changes on PET/CT might be expected to be seen in patients who receive immunotherapy, irrespective of whether they develop clinically evident rheumatic irAEs.Objectives:This study investigated whether such changes occurred in patients receiving immunotherapy who did not develop clinically evident rheumatic irAEs.Methods:Consecutive patients exposed to PD-1 or PD-L1 inhibitor immunotherapy at a single center had scintigraphic uptake calculated by a nuclear medicine physician experienced in assessment of vasculitis. Patients were included if they had had 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging both within the two weeks prior to immunotherapy initiation and after at least eleven weeks of immunotherapy. Patients who went on to develop a rheumatic irAE were excluded, as were patients with scintigraphic evidence of liver metastases owing to their potential influence on scoring of uptake. Quantification of 18F-FDG uptake by maximum standardized uptake values (maximum standard unit value, SUVmax) was performed at sites relevant to PMR or GCA (17 sites relevant to PMR, 17 sites relevant to GCA) in paired scans, and the difference calculated.Results:Twenty-four patients receiving nivolumab, pembrolizumab or avelumab met the inclusion criteria, primarily for melanoma, non-small cell lung cancer, or lymphoma. The mean age was 67 at the time of the first scan, 71% were male, and 66% had a complete or partial oncological response at best response. No statistically or clinically significant difference in SUVmax was noted at any PMR or GCA-relevant anatomical site interrogated. Latent class analysis did not reveal clusters identifiable by cancer type, best response, or presence of combination therapy.Conclusion:Patients treated with PD-1/PD-L1 inhibitors without clinically evident rheumatic irAEs do not develop subclinical PMR or GCA-like changes on PET/CT. This supports the proposition that PMR-like and GCA-like irAEs are a distinct entity with stochastic onset, and do not simply represent generalized immune activation induced by immunotherapy.Acknowledgements:David Liew is the recipient of the Ronald John Gleghorn Bursary from the University of Melbourne.Disclosure of Interests:David Liew: None declared, Aurora Poon: None declared, Christopher McMaster: None declared, Claire Owen Speakers bureau: Roche, Jessica Leung Speakers bureau: GIlead, Novartis, Albert Frauman: None declared, Jonathan Cebon: None declared, Andrew Scott: None declared, Russell Buchanan: None declared
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Abstract
The NICE Guidelines published in 2015 state that testosterone supplementation can be considered for menopausal women with low sexual desire if hormone replacement therapy alone is not effective. There is however, no detail on what to prescribe, how much to prescribe or whether monitoring is required. At the time of conception of this project, there was no national guideline or official advice from the British Menopause Society. We decided to ask menopause experts from around the UK to see if a consensus could be reached about good prescribing practice. The method and results as discussed below may be helpful in future recommendations and guidance.
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Affiliation(s)
- A Scott
- Essex Private Doctors, Shenfield, Essex, UK
| | - D Holloway
- Guys and St Thomas' NHS Trust, London, UK
| | - J Rymer
- GKT School of Medical Education Faculty of Life Sciences and Medicine, King's College, London, UK
| | - D Bruce
- GKT School of Medical Education Faculty of Life Sciences and Medicine, King's College, London, UK
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22
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Scott A, Hernandez-Hernandez D, Adler E, Kim P, Kligerman S, Contijoch F. Synthesis of CT Imaging and Right Heart Catheterization Enables Single-Beat RV-PA Coupling Estimations in Heart Failure Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Nielles-Vallespin S, Ferreira P, Scott A, Rajakulasingam R, Sehmi J, Gorodezky M, Kellman P, Xue H, Pennell D, Firmin D, Arai A, De Silva R. Diffusion tensor cardiovascular magnetic resonance predicts adverse remodelling after myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Changes in myocardial microstructure that underlie post-myocardial infarction (MI) left ventricular (LV) remodelling may contribute to progressive deterioration in cardiac function and increased risk of adverse clinical events. Diffusion Tensor Cardiovascular Magnetic Resonance (DT-CMR) derived parameters provide in vivo measures of helix angle (HA) and sheetlet angle (SA), which allow non-invasive characterization of microstructural dynamics associated with cardiac contraction.
Purpose
To evaluate the relationship between DT-CMR metrics of myocardial microstructure with the development of adverse LV remodelling and to determine the relationship between DT-CMR and strain post- MI.
Methods
We performed a longitudinal pre-clinical CMR study whereby DT-CMR, cine imaging and strain were acquired pre-MI and 3 days and 16 weeks post- MI in a pig model. HA (E1A), SA (E2A), and sheetlet angle mobility (ΔE2A = E2Asystole– E2Adiastole), as well as circumferential (Ecc) and radial (Err) strain were calculated at each timepoint and related to change in left ventricular end-diastolic volume (ΔLVEDV) and change in left ventricular end-systolic volume (ΔLVESV) between 3 days post-MI and 16 weeks post-MI. The translational value of this preclinical study was further assessed in six patients with chronic MI.
Results
ΔE2A over the whole LV (global ΔE2A) at 3 days post-MI correlated significantly with ΔLVEDV (R2=0.89, p=0.0013, Fig.1A;) and ΔLVESV (R2=0.81, p=0.0055, Fig.1B). Global Ecc at 3 days post-MI also correlated with both ΔLVEDV (R2=0.75, p=0.012, Fig.1C) and ΔLVESV (R2=0.71, p=0.018, Fig.1D). Global Err at 3 days post-MI did not show significant correlation with either ΔLVEDV (R2=0.32, p=0.19, Fig.1E) or ΔLVESV (R2=0.35, p=0.17, Fig.1F). Global ΔE2A correlated strongly with global Ecc 3 days post-MI (R2=0.9, p=0.00099, Fig.1G) but less strongly with global Err 3 days post-MI (R2=0.57, p=0.049, Fig.1H). Global ΔE2A at the chronic stage correlated significantly with ejection Fraction (EF), in both clinical (R2=0.87, p=0.007) and preclinical data (R2=0.87, p=0.0024). Global ΔE2A correlated well with LVEDV (clinical: R2=0.72, p=0.033; preclinical: R2=0.8, p=0.0066) and LVESV (clinical: R2=0.78, p=0.020; preclinical: R2=0.89, p=0.0013). In vivo E1A maps at 16 weeks post-MI and ex vivo DT-CMR demonstrated reduced right-handed helix angles in the endocardium of the infarct region.
Conclusion
ΔE2A measured at 3 day post-reperfused MI is strongly correlated with the development of increased end-systolic and end-diastolic volumes, and may therefore serve as a novel CMR early predictor of adverse LV remodelling after reperfused MI. Strong correlations between ΔE2A, LV volumes and EF in a small cohort of stable patients with remodelled hearts after chronic MI confirm the feasibility of performing these measurements in patients and the plausibility of further evaluation of ΔE2A as a predictor of adverse remodelling after reperfused MI.
Sheetlet mobility predicts volume change
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Institutes of Health by the Division of Intramural Research (NHLBI, NIH, DHHS); British Heart Foundation
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Affiliation(s)
| | | | - A Scott
- Imperial College London, London, United Kingdom
| | | | - J Sehmi
- Imperial College London, London, United Kingdom
| | - M Gorodezky
- Imperial College London, London, United Kingdom
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - D.J Pennell
- Imperial College London, London, United Kingdom
| | - D.N Firmin
- Imperial College London, London, United Kingdom
| | - A.E Arai
- Imperial College London, London, United Kingdom
| | - R De Silva
- Imperial College London, London, United Kingdom
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Khoo C, Scott A, Peters M, Maynard W, Chamberlain G, Fooks P, Hrouda D, Minhas S. A contemporary analysis of radical orchidectomy for testis cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Scott A, Kim P, Adler E, Kligerman S, Tran H, Pretorius V, Contijoch F. Pre-LVAD CT-Derived Measures of RV Size and Function May Be Strong Identifiers of Right Ventricular Failure. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Graif A, Scott A, Zimmermann T, Kimbiris G, Grilli C, Putnam S, Paik H, Nwosu U, Leung D. 4:12 PM Abstract No. 263 Temporal analysis of heart rate during catheter-directed thrombolysis for acute pulmonary embolism. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Metcalf P, Baker J, Scott A, Wild C, Scragg R, Dryson E. Albuminuria in People At Least 40 Years Old: Effect of Obesity, Hypertension, and Hyperlipidemia. Clin Chem 2019. [DOI: 10.1093/clinchem/38.9.1802] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Concentrations of urinary albumin and the albumin:creatinine ratio were measured in early-morning urine specimens from 5670 people older than 40 years who participated in a health screening survey of a local workforce. Sex-specific reference intervals were determined in a subgroup of 3597 people after excluding 2073 individuals with Albustix-positive proteinuria; diabetes mellitus; bacteriuria; current hypertension; body mass index greater than or equal to 30 kg/m2; or serum triglyceride greater than or equal to 2.5 mmol/L. The 97.5 percentile concentration for urinary albumin was 28 mg/L in men and 29 mg/L in women; for the albumin:creatinine ratio this was 2.3 g/mol in men and 2.8 g/mol in women. In the study population, the degree of albuminuria showed piecewise log-linear relationships with diastolic blood pressure (P = 0.0001) and body mass index (P = 0.0001), log-linear relationships with hypertriglyceridemia (P = 0.0001) and hypercholesterolemia (P = 0.0001), and a negative piecewise linear relationship with high-density lipoprotein (HDL) cholesterol (P = 0.0461).
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Affiliation(s)
- P Metcalf
- Department of Mathematics and Statistics, University of Auckland, New Zealand
| | - J Baker
- Department of Mathematics and Statistics, University of Auckland, New Zealand
| | - A Scott
- Department of Mathematics and Statistics, University of Auckland, New Zealand
| | - C Wild
- Department of Mathematics and Statistics, University of Auckland, New Zealand
| | - R Scragg
- Department of Mathematics and Statistics, University of Auckland, New Zealand
| | - E Dryson
- Department of Mathematics and Statistics, University of Auckland, New Zealand
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Scott A, Gartner A. 9 Low fidelity simulation in a high fidelity world. Postgrad Med J 2019. [DOI: 10.1136/postgradmedj-2019-fpm.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionAll aspects of medical training have experienced an exponential acceleration in the application of technology for learning needs.1 Research promotes the use of high fidelity models and ever more complex training methods with organisations keen to adopt and implement new technology. Models are utilised to minimise potential risks to patients through bedside learning and refine established technique.2 Simulation practice can also be used to develop non-technical skills pertinent to safe clinical practice.2–4 Simulation training can be employed from early stages of undergraduate education through to use in professional postgraduate exams giving a large scope of use in a multiplicity of environments.1 4 5MethodsForty Foundation Year 1 Doctors were taught clinical skills utilising Low fidelity part task training models. Four clinical skills were selected from pre-determined postgraduate curricula. Self assessment pre and post procedure were recorded with qualitative feedback sought as a secondary measure.ResultsGlobal increases are seen across 4 sampled clinical skills. Participants self-reported increased confidence and competence. A high value was placed upon trainees perceived value in training.ConclusionFidelity has been shown to play an integral role in simulation.4 The authors conclude that simple part task trainers, low fidelity models, still have a valuable part to play in medical education. They remain cost effective, adaptable and accessible training tools in the era of increasing complexity.1 5 Simulation provides a safe space to develop both technical and non-technical aspects.3 4 Low fidelity simulation can be used to underpin the learning objectives of trainees through effective feedback in real time, access to repetitive practice and remain a feasible training tool for trainers and trainees alike.2 4 High fidelity simulation should not be excluded completely however appears to be best suited to defined roles in more complex moulage.1 4Take home messageTechnology has the ability to improve and evolve medical education. With the potential for increased feedback, self and peer assessment along with pragmatic assessment, simulation has firmly entrenched itself in medical education. Care should be taken however not to disregard lower fidelity models as they still provide proven effective learning, enable the teaching of non-technical skills and facilitate knowledge delivery.ReferencesSarmah P, et al. Low vs. high fidelity: the importance of ‘realism’ in the simulation of a stone treatment procedure. Curr Opin Urol 2017;27(4):316–322.Naik VN, Brein SE. Review article: simulation: a means to address and improve patient safety. Can J Anaesth 2013;60(2):192–200.Aebersold M. The history of simulation and its impact on the future. AACN Adv Crit Care 2016;27(1):56–61.Lewis R, Strachan A, Smith MM. Is high fidelity simulation the most effective method for the development of non-technical skills in nursing? A review of the current evidence. Open Nurs J 2012;6:82–89.Aggarwal R, et al. Training and simulation for patient safety. Qual Saf Health Care 2010;19(Suppl 2):i34–i43.
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Chia P, Cao D, Gan H, Reilly E, Phillips A, John T, Scott A. P2.06-10 ABT-806 Derived Antibody Drug Conjugates (ADCs) Inhibit Growth of Malignant Mesothelioma In-Vivo. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Coombes B, Tucker K, Hug F, Scott A, Cox E, Gajanand T, Coombes J. Supervised exercise training and Achilles tendon properties in people with Type 2 Diabetes. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Scott A, Laprade R, Harmon K, Filardo G, Kon E, Villa SD, Bahr R, Moksnes H, Torgalsen T, Dragoo J, Engebretsen L. Platelet-rich plasma (PRP) for patellar tendinopathy: a randomized controlled trial of leukocyte-rich PRP or leukocyte-poor PRP vs. saline. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fullam S, Scott A, Garvey JF. Status Cataplecticus Following Abrupt Withdrawal of Clomipramine. Ir Med J 2019; 112:991. [PMID: 31650824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Presentation This is a case of a 31 year old gentleman who suffered an attack of status cataplecticus following abrupt withdrawal of clomipramine. Diagnosis Clomipramine was temporarily discontinued in order to confirm a suspected diagnosis of narcolepsy using Multiple Sleep Latency Testing. This precipitated an episode of status cataplecticus which resolved with re-introduction of therapy. A diagnosis of narcolepsy was later confirmed with undetectable levels of hypocretin/orexin in the CSF. Treatment Re-introduction of clomipramine led to resolution of status cataplecticus. The patient now remains stable with regards to his cataplexy on clomipramine 30mg. Discussion There have been a total of 4 case reports of status cataplecticus following withdrawal of antidepressant therapy. In all cases, reintroduction of anti-cataplectic therapy led to resolution of attacks. The abrupt discontinuation of an SSRI is believed to precipitate cataplexy attacks due to reduction in noradrenergic tone.
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Affiliation(s)
- S Fullam
- St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - A Scott
- St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - J F Garvey
- St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
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Coombes B, Tucker K, Hug F, Scott A, Geytenbeek M, Cox E, Gajanand T, Coombes J. Relationships between cardiovascular disease risk factors and Achilles tendon structural and mechanical properties in people with Type 2 Diabetes. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2019.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- B.K. Coombes
- The University of Queensland, School of Biomedical Sciences, Otto Hirschfeld Building, St Lucia, Brisbane 4072, Australia
| | - K. Tucker
- The University of Queensland, School of Biomedical Sciences, Otto Hirschfeld Building, St Lucia, Brisbane 4072, Australia
| | - F. Hug
- The University of Queensland, NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, Therapies Building, St Lucia, Brisbane 4072, Australia
- Laboratory “Movement, Interactions, Performance” (EA 4334), University of Nantes, Nantes 44000, France
- Institut Universitaire de France (IUF), Paris, France
| | - A. Scott
- The University of British Columbia, Department of Physical Therapy, 2177 Wesbrook Mall, Vancouver, V6T1Z3, Canada
| | - M. Geytenbeek
- The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Connell Building, St Lucia, Brisbane 4072, Australia
| | - E.R. Cox
- The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Connell Building, St Lucia, Brisbane 4072, Australia
| | - T. Gajanand
- The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Connell Building, St Lucia, Brisbane 4072, Australia
| | - J.S. Coombes
- The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Connell Building, St Lucia, Brisbane 4072, Australia
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Ackermann U, Rigopoulos A, Scott A. 68Ga labelling of a 12-mer peptide selective for tissue transglutaminase 2. Nucl Med Biol 2019. [DOI: 10.1016/s0969-8051(19)30301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Scott A, Warner P, Delaney M. Disseminated intravascular coagulation reaction to granulocytes in a patient with human leukocyte antigen sensitisation. Transfus Med 2019; 29:287-289. [PMID: 31090120 DOI: 10.1111/tme.12602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/24/2019] [Accepted: 04/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- A Scott
- Medical Division, Bloodworks Northwest, Seattle, Washington, USA
| | - P Warner
- Medical Division, Bloodworks Northwest, Seattle, Washington, USA
| | - M Delaney
- Medical Division, Bloodworks Northwest, Seattle, Washington, USA.,Department of Laboratory Medicine and Pediatrics, University of Washington, Seattle, Washington, USA.,Department of Pathology and Laboratory Medicine, Children's National Medical Center, Washington, District of Columbia, USA
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Bhatia A, Husaini M, Lin C, LeClair J, De Togni E, Becker N, Scott A, Terng M, Acevedo-Cintron J, Schilling J. How Dynamic are Hemodynamics?: Short-Term Changes in Hemodynamic Measures and Indices among Heart Failure Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Scott A, Kim P, Tran H, Brambatti M, Ignatyeva Y, Rosenberg S, Kligerman S, Hsiao A, Pretorius V, Adler E, Contijoch F. Cardiac CT Provides Complementary Parameters of Right Ventricle Function in LVAD Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Glass K, Barnes B, Scott A, Toribio JA, Moloney B, Singh M, Hernandez-Jover M. Modelling the impact of biosecurity practices on the risk of high pathogenic avian influenza outbreaks in Australian commercial chicken farms. Prev Vet Med 2019; 165:8-14. [PMID: 30851932 DOI: 10.1016/j.prevetmed.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 01/29/2023]
Abstract
As of 2018, Australia has experienced seven outbreaks of highly pathogenic avian influenza (HPAI) in poultry since 1976, all of which involved chickens. There is concern that increases in free-range farming could heighten HPAI outbreak risk due to the potential for greater contact between chickens and wild birds that are known to carry low pathogenic avian influenza (LPAI). We use mathematical models to assess the effect of a shift to free-range farming on the risk of HPAI outbreaks of H5 or H7 in the Australian commercial chicken industry, and the potential for intervention strategies to reduce this risk. We find that a shift of 25% of conventional indoor farms to free-range farming practices would result in a 6-7% increase in the risk of a HPAI outbreak. Current practices to treat water are highly effective, reducing the risk of outbreaks by 25-28% compared to no water treatment. Halving wild bird presence in feed storage areas could reduce risk by 16-19% while halving wild bird access of potential bridge-species to sheds could reduce outbreak risk by 23-25%, and relatively small improvements in biosecurity measures could entirely compensate for increased risks due to the increasing proportion of free-range farms in the industry. The short production cycle and cleaning practices for chicken meat sheds considerably reduce the risk that an introduced low pathogenic avian influenza virus is maintained in the flock until it is detected as HPAI through increased mortality of chickens. These findings help explain HPAI outbreak history in Australia and suggest practical changes in biosecurity practices that could reduce the risk of future outbreaks.
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Affiliation(s)
- K Glass
- Research School of Population Health, Australian National University, Australia.
| | - B Barnes
- Research School of Population Health, Australian National University, Australia
| | - A Scott
- Sydney School of Veterinary Science, University of Sydney, Australia
| | - J-A Toribio
- Sydney School of Veterinary Science, University of Sydney, Australia
| | - B Moloney
- New South Wales Department of Primary Industries, Australia
| | - M Singh
- Sydney School of Veterinary Science, University of Sydney, Australia
| | - M Hernandez-Jover
- School of Animal and Veterinary Sciences and Graham Centre for Agricultural Innovation, Charles Sturt University, Australia
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Hirschman KB, Scott A, Oyewole-Eletu S, Li J, Nguyen HQ, Mitchell S, Hudson SM, Williams MV. UNDERSTANDING FACILITATORS AND BARRIERS TO CARE TRANSITIONS: HEALTH SYSTEM AND COMMUNITY PARTNER PERSPECTIVES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K B Hirschman
- NewCourtland Center for Transitions and Health, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, United States
| | - A Scott
- University of Kentucky, Department of Communication, Lexington, KY, USA
| | - S Oyewole-Eletu
- Center for Health Services Research, University of Kentucky, Lexington, KY, USA
| | - J Li
- Center for Health Services Research, University of Kentucky, Lexington, KY, USA
| | - H Q Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - S Mitchell
- Family Medicine at Boston University School of Medicine/ Boston Medical Center, Boston, MA, USA
| | - S M Hudson
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - M V Williams
- Univeristy of Kentucky, Lexinton, KY, USA; Center for Health Services Research, University of Kentucky, Lexington, LY, USA
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Chia P, Russell P, Asadi K, Murone C, Walkiewicz M, Eriksson U, Scott A, John T. MA12.11 Analysis of Angiogenic and Stromal Biomarkers in a Large Malignant Mesothelioma Cohort. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Taylor-Rowan M, Quinn T, Smith P, Ellis G, Keir R, McAlpine C, Marsh G, Murtagh J, McElroy M, Mitchell L, Waddell G, Williams A, Duffy L, Oswald S, Myles A, Bann A, Rodger K, Reid J, Kellichan L, Docharty D, Marshall T, McGurn B, Ritchie C, Wells A, Talbot A, McInnes C, Reynish E, Coleman D, Flynn B, Scott A, Coull A, Dingwall L. 53ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE HIS “THINK FRAILTY” TOOL. Age Ageing 2018. [DOI: 10.1093/ageing/afy127.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - T Quinn
- New Lister Building, Glasgow Royal Infirmary
| | - P Smith
- New Lister Building, Glasgow Royal Infirmary
| | - G Ellis
- New Lister Building, Glasgow Royal Infirmary
| | - R Keir
- New Lister Building, Glasgow Royal Infirmary
| | - C McAlpine
- New Lister Building, Glasgow Royal Infirmary
| | - G Marsh
- New Lister Building, Glasgow Royal Infirmary
| | - J Murtagh
- New Lister Building, Glasgow Royal Infirmary
| | - M McElroy
- New Lister Building, Glasgow Royal Infirmary
| | - L Mitchell
- New Lister Building, Glasgow Royal Infirmary
| | - G Waddell
- New Lister Building, Glasgow Royal Infirmary
| | - A Williams
- New Lister Building, Glasgow Royal Infirmary
| | - L Duffy
- New Lister Building, Glasgow Royal Infirmary
| | - S Oswald
- New Lister Building, Glasgow Royal Infirmary
| | - A Myles
- New Lister Building, Glasgow Royal Infirmary
| | - A Bann
- New Lister Building, Glasgow Royal Infirmary
| | - K Rodger
- New Lister Building, Glasgow Royal Infirmary
| | - J Reid
- New Lister Building, Glasgow Royal Infirmary
| | - L Kellichan
- New Lister Building, Glasgow Royal Infirmary
| | - D Docharty
- New Lister Building, Glasgow Royal Infirmary
| | - T Marshall
- New Lister Building, Glasgow Royal Infirmary
| | - B McGurn
- New Lister Building, Glasgow Royal Infirmary
| | - C Ritchie
- New Lister Building, Glasgow Royal Infirmary
| | - A Wells
- New Lister Building, Glasgow Royal Infirmary
| | - A Talbot
- New Lister Building, Glasgow Royal Infirmary
| | - C McInnes
- New Lister Building, Glasgow Royal Infirmary
| | - E Reynish
- New Lister Building, Glasgow Royal Infirmary
| | - D Coleman
- New Lister Building, Glasgow Royal Infirmary
| | - B Flynn
- New Lister Building, Glasgow Royal Infirmary
| | - A Scott
- New Lister Building, Glasgow Royal Infirmary
| | - A Coull
- New Lister Building, Glasgow Royal Infirmary
| | - L Dingwall
- New Lister Building, Glasgow Royal Infirmary
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Ominde M, Sande J, Ooko M, Bottomley C, Benamore R, Park K, Ignas J, Maitland K, Bwanaali T, Gleeson F, Scott A. Reliability and validity of the World Health Organization reading standards for paediatric chest radiographs used in the field in an impact study of Pneumococcal Conjugate Vaccine in Kilifi, Kenya. PLoS One 2018; 13:e0200715. [PMID: 30044834 PMCID: PMC6059459 DOI: 10.1371/journal.pone.0200715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Radiologically-confirmed pneumonia (RCP) is a specific end-point used in trials of Pneumococcal Conjugate Vaccine (PCV) to estimate vaccine efficacy. However, chest radiograph (CXR) interpretation varies within and between readers. We measured the repeatability and reliability of paediatric CXR interpretation using percent agreement and Cohen's Kappa and the validity of field readings against expert review in a study of the impact of PCV on pneumonia. METHODS CXRs were obtained from 2716 children admitted between 2006 and 2014 to Kilifi County Hospital, Kilifi, Kenya, with clinically-defined severe or very-severe pneumonia. Five clinicians and radiologists attended a three-day training course on CXR interpretation using a WHO standard. All CXRs were read once by two local primary readers. Discordant readings and 13% of concordant readings were arbitrated by a panel of three expert radiologists. To assess repeatability, a 5% median random sample was presented twice. Sensitivity and specificity of the primary readers' interpretations was estimated against the 'gold-standard' of the arbitrators' results. RESULTS Of 2716 CXRs, 2 were uninterpretable and 159 were evaluated twice. The percent agreement and Kappa for RCP were 89% and 0.68 and ranged between 84-97% and 0.19-0.68, respectively, for all pathological findings. Intra-observer repeatability was similar to inter-observer reliability. Sensitivities of the primary readers to detect RCP were 69% and 73%; specificities were 96% and 95%. CONCLUSION Intra- and inter-observer agreements on interpretations of radiologically-confirmed pneumonia are fair to good. Reasonable sensitivity and high specificity make radiologically-confirmed pneumonia, determined in the field, a suitable measure of relative vaccine effectiveness.
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Affiliation(s)
- M. Ominde
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Aga Khan University Hospital, Nairobi, Kenya
| | - J. Sande
- Aga Khan University Hospital, Nairobi, Kenya
| | - M. Ooko
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - C. Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - R. Benamore
- Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom
| | - K. Park
- Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom
| | - J. Ignas
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - K. Maitland
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Imperial College, London, United Kingdom
| | - T. Bwanaali
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - F. Gleeson
- Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom
- Oxford University, Oxford, United Kingdom
| | - A. Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Oxford University, Oxford, United Kingdom
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Binns‐Hall O, Selvarajah D, Sanger D, Walker J, Scott A, Tesfaye S. One-stop microvascular screening service: an effective model for the early detection of diabetic peripheral neuropathy and the high-risk foot. Diabet Med 2018; 35:887-894. [PMID: 29608799 PMCID: PMC6033008 DOI: 10.1111/dme.13630] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 01/10/2023]
Abstract
AIMS To evaluate the feasibility of a one-stop microvascular screening service for the early diagnosis of diabetic distal symmetrical polyneuropathy, painful distal symmetrical polyneuropathy and the at-risk diabetic foot. METHODS People with diabetes attending retinal screening in hospital and community settings had their feet examined by a podiatrist. Assessment included: Toronto Clinical Neuropathy Score evaluation; a 10-g monofilament test; and two validated, objective and quick measures of neuropathy obtained using the point-of-care devices 'DPN-Check', a hand-held device that measures sural nerve conduction velocity and amplitude, and 'Sudoscan', a device that measures sudomotor function. The diagnostic utility of these devices was assessed against the Toronto Clinical Neuropathy Score as the 'gold standard'. RESULTS A total of 236 consecutive people attending the retinal screening service, 18.9% of whom had never previously had their feet examined, were evaluated. The prevalence of distal symmetrical polyneuropathy, assessed using the Toronto Clinical Neuropathy Score, was 30.9%, and was underestimated by 10-g monofilament test (14.4%). The prevalence of distal symmetrical polyneuropathy using DPN-check was 51.5% (84.3% sensitivity, 68.3% specificity), 38.2% using Sudoscan foot electrochemical skin conductance (77.4% sensitivity, 68.3% specificity), and 61.9% using abnormality in either of the results (93.2% sensitivity, 52.8% specificity). The results of both devices correlated with Toronto Clinical Neuropathy Score (P<0.001). A new diagnosis of painful distal symmetrical polyneuropathy was made in 59 participants (25%), and 56.6% had moderate- or high-risk foot. Participants rated the service very highly. CONCLUSIONS Combined, eye, foot and renal screening is feasible, has a high uptake, reduces clinic visits, and identifies painful distal symmetrical polyneuropathy and the at-risk foot. Combined large- and small-nerve-fibre assessment using non-invasive, quantitative and quick point-of-care devices may be an effective model for the early diagnosis of distal symmetrical polyneuropathy.
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Affiliation(s)
- O. Binns‐Hall
- Department of Podiatry ServicesSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - D. Selvarajah
- Department of DiabetesSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - D. Sanger
- Department of Podiatry ServicesSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - J. Walker
- Department of Podiatry ServicesSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - A. Scott
- Department of Oncology and Human MetabolismUniversity of SheffieldSheffieldUK
| | - S. Tesfaye
- Department of Oncology and Human MetabolismUniversity of SheffieldSheffieldUK
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Abstract
Data on 570 mothers and their children whose development was personally assessed from birth to four years were analysed. Strong associations were found between the incidence of fetal distress during labour, birth asphyxia, and delivery by emergency caesarean section. At the age of four years girls and children in the non-manual social classes were more advanced, developmentally, than boys and children in the manual classes. No associations were found between perinatal factors and total developmental scores; but highly significant differences were found between ‘at risk’ pregnancy groups according to their method of developmental scores. In only one of seven handicapped children could the handicap possibly have been attributable to delivery factors. Case histories of two children illustrate the dangers and difficulties of associating cause and effect in individual patients.
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45
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Gaida JE, Alfredson H, Scott A, Mousavizadeh R, Forsgren S. Apolipoprotein A1 distribution pattern in the human Achilles tendon. Scand J Med Sci Sports 2018; 28:1506-1513. [PMID: 29315811 DOI: 10.1111/sms.13051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 11/27/2022]
Abstract
Metabolic factors such as cholesterol appear to play an important role in the development of Achilles tendinopathy. There is, however, no morphologic proof explaining the link between high cholesterol and tendinopathy. As apolipoprotein A1 (Apo-A1) is essential for reverse cholesterol transport, it may be related to cholesterol overload in tendon. Nothing is known about Apo-A1 expression in tendon tissue. We examined the distribution of Apo-A1 protein in biopsies from normal and tendinopathy-affected human Achilles tendons, and APOA1 mRNA production from cultured human hamstring tenocytes. Specific immunoreactions for Apo-A1 were detected. The tenocytes showed specific Apo-A1 immunoreactions. These reactions were usually distinct in the tendinopathy specimens. While the tendinopathy specimens often showed granular/small deposit reactions, the slender tenocytes of control specimens did not show this pattern. The magnitude of Apo-A1 immunoreactivity was especially marked in the tendinopathy specimens, as there is a high number of tenocytes. Reactions were also seen in the walls of blood vessels located within the tendon tissue proper of both the normal and tendinopathy tendons and within the peritendinous/fatty tissue of the tendinopathy tendons. The reactions were predominantly in the form of deposit reactions within the smooth muscle layer of the vessel walls. Cultured hamstring tenocytes produced APOA1 mRNA. We demonstrated the presence of Apo-A1 in human tendon tissue. This suggests there may be a link between Achilles tendinopathy and cholesterol metabolism. We hypothesize that Apo-A1 may be important for tenocyte and blood vessel function within tendons.
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Affiliation(s)
- J E Gaida
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, ACT, Australia.,Discipline of Physiotherapy, University of Canberra, Canberra, ACT, Australia.,Department of Integrative Medical Biology, Anatomy Section, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå University, Umeå, Sweden
| | - H Alfredson
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,Institute of Sport Exercise and Health, University College Hospital London, London, UK
| | - A Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - R Mousavizadeh
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - S Forsgren
- Department of Integrative Medical Biology, Anatomy Section, Umeå University, Umeå, Sweden
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46
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Herweijer G, Johannsen H, Smith A, Batchelor M, Scott A, Ryan L, Ziegler C. P37: CARERS STRESSED AND BURDENED BY THEIR FOOD ALLERGIC CHILD’S ANAPHYLAXIS RISK. Intern Med J 2017. [DOI: 10.1111/imj.37_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- G Herweijer
- Flinders University of South Australia; Adelaide Australia
| | - H Johannsen
- Flinders University of South Australia; Adelaide Australia
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - A Smith
- Flinders University of South Australia; Adelaide Australia
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - M Batchelor
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - A Scott
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - L Ryan
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - C Ziegler
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
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47
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Herweijer G, Johannsen H, Smith A, Batchelor M, Scott A, Ryan L, Ziegler C. P36: ADVERSE IMPACT OF CHILD FOOD ALLERGIES ON CARER RELATIONSHIPS AND SOCIAL ACTIVITIES. Intern Med J 2017. [DOI: 10.1111/imj.36_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G Herweijer
- Flinders University of South Australia; Adelaide Australia
| | - H Johannsen
- Flinders University of South Australia; Adelaide Australia
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - A Smith
- Flinders University of South Australia; Adelaide Australia
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - M Batchelor
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - A Scott
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - L Ryan
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - C Ziegler
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
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48
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Herweijer G, Johannsen H, Smith A, Batchelor M, Scott A, Ryan L, Ziegler C. P38: HELP THE CHILD, HELP THE CARER: THE PSYCHOLOGICAL IMPACT OF CARING FOR A CHILD WITH FOOD ALLERGIES. Intern Med J 2017. [DOI: 10.1111/imj.38_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G Herweijer
- Flinders University of South Australia; Adelaide Australia
| | - H Johannsen
- Flinders University of South Australia; Adelaide Australia
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - A Smith
- Flinders University of South Australia; Adelaide Australia
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - M Batchelor
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - A Scott
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - L Ryan
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - C Ziegler
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
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49
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Herweijer G, Johannsen H, Smith A, Batchelor M, Scott A, Ryan L, Ziegler C. P39: PARENTS STRESSED BY THEIR CHILD’S RISK OF ALLERGIC REACTIONS IN THE CARE OF OTHERS. Intern Med J 2017. [DOI: 10.1111/imj.39_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Herweijer
- Flinders University of South Australia; Adelaide Australia
| | - H Johannsen
- Flinders University of South Australia; Adelaide Australia
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - A Smith
- Flinders University of South Australia; Adelaide Australia
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - M Batchelor
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - A Scott
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - L Ryan
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
| | - C Ziegler
- Flinders Medical Centre (Southern Adelaide Local Health Network), Adelaide; Australia
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50
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Waugh CM, Alktebi T, de Sa A, Scott A. Impact of rest duration on Achilles tendon structure and function following isometric training. Scand J Med Sci Sports 2017; 28:436-445. [PMID: 28603874 DOI: 10.1111/sms.12930] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 12/14/2022]
Abstract
Intervention programs are often sought to strengthen the Achilles tendon (AT) due to its high injury rate. Long rest periods between loading cycles have been found to increase collagen synthesis by tenocytes, suggesting rest duration may be important for tendon adaptation in vivo; however, exercise programs comparing long and short rest duration have not been directly compared. Fourteen adults completed a 12-week progressive training intervention; training sessions consisted of 5×10 isometric plantarflexion contractions each of 3-s duration performed at 90% of MVC three times weekly. Each leg was randomly allocated to long (LRT, 10-s rest) or short rest training (SRT, 3-s rest). We hypothesized that the leg allocated to LRT would demonstrate superior AT collagen organization compared to the leg receiving SRT, which would be related to improved biomechanical function. AT collagen organization and morphology were measured using ultrasound tissue characterization. AT properties were assessed before and after the intervention using a combination of dynamometry, ultrasound imaging, EMG, and motion capture. Contrary to our hypothesis, collagen organization did not improve following either training protocol; conversely, an unexpected decrease in echotype I proportion was seen after SRT (P<.001) but not LRT (P=.58), indicating an apparent protective effect of rest on collagen organization during isometric training. In contrast, AT adaptation was not appreciably enhanced by increasing intercycle rest duration; both protocols were equally effective at inducing significant strength gains and AT mechanical and material adaptation (P≤.001). Further research is necessary to identify optimal loading characteristics for injury prevention and rehabilitation.
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Affiliation(s)
- C M Waugh
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - T Alktebi
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - A de Sa
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - A Scott
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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