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Qi Q, Cox A, McNeil S, Sumithran P. Obesity medications: A narrative review of current and emerging agents. Osteoarthr Cartil Open 2024; 6:100472. [PMID: 38737985 PMCID: PMC11088184 DOI: 10.1016/j.ocarto.2024.100472] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
The aim of this narrative review is to synthesize the available data describing the efficacy and safety of medications approved for obesity management and to provide an overview of upcoming agents in development. A literature search of PubMed, Medline, and Embase databases identified relevant articles describing medications approved in the U.S., Australia, U.K., and/or Europe. Papers were selected based on relevance and originality, with phase 3 clinical trials and meta-analyses preferentially included. Six medications are widely approved for long-term weight management in conjunction with lifestyle interventions in people with body mass index (BMI) ≥30 kg/m2 or BMI ≥27 kg/m2 and at least one medical condition related to excess weight. Compared with lifestyle interventions alone, all medications approved for obesity management are more effective for long-term weight loss and improvements in cardiometabolic risk factors. Older obesity medications are associated with mean weight losses in the range of 5-10%. The new generation of agents, including the injectable incretin analogues semaglutide and tirzepatide are associated with sustained mean weight reductions of 15-20%, along with substantial benefits on a range of health outcomes. Several novel agents are under development, with multi-hormone receptor agonists and oral formulations likely to become available in the coming years. As effective treatment options expand, cost and availability will need to be addressed to enable equitable access to treatment. Other important challenges for clinical practice and research include the need for long-term strategies to prevent and manage weight regain and loss of lean muscle and bone mineral density.
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Affiliation(s)
- Q.Y.D. Qi
- Department of Endocrinology and Diabetes, Alfred Health, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Victoria, Australia
| | - A. Cox
- Department of Endocrinology and Diabetes, Alfred Health, Victoria, Australia
| | - S. McNeil
- Department of Endocrinology and Diabetes, Alfred Health, Victoria, Australia
| | - P. Sumithran
- Department of Endocrinology and Diabetes, Alfred Health, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Victoria, Australia
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Cox A, Brown KC, Valentovic MA. The E-liquid flavoring vanillin alters energy and autophagic pathways in human proximal tubule (HK-2) epithelial cells. Chem Biol Interact 2024; 394:111003. [PMID: 38608998 DOI: 10.1016/j.cbi.2024.111003] [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] [Received: 03/08/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
The use of flavored e-liquids in electronic nicotine delivery systems (ENDS) has become very popular in recent years, but effects of these products have not been well characterized outside the lung. In this study, acute exposure to the popular flavoring vanillin (VAN) was performed on human proximal tubule (HK-2) kidney cells. Cells were exposed to 0-1000 μM VAN for 24 or 48 h and cellular stress responses were determined. Mitochondrial viability using MTT assay showed a significant decrease between the control and 1000 μM group by 48 h. Seahorse XFp analysis showed significantly increased basal respiration, ATP production, and proton leak after 24 h exposure. By 48 h exposure, these parameters remained significantly increased in addition to non-mitochondrial respiration and maximal respiration. Glycolytic activity after 24 h exposure showed significant decreases in glycolysis, glycolytic capacity, glycolytic reserve, and non-glycolytic acidification. The autophagy markers microtubule-associated protein 1A/1B light chain 3 (LC3B-I and LC3B-II) were probed via western blotting. The ratio of LC3B-II/LC3B-I was significantly increased after 24 h exposure to VAN, but by 48 h this ratio significantly decreased. The mitophagy marker PINK1 showed an increasing trend at 24 h, and its downstream target Parkin was significantly increased between the control and 750 μM group only. Finally, the oxidative stress marker 4-HNE was significantly decreased after 48 h exposure to VAN. These results indicate that acute exposure to VAN in the kidney HK-2 model can induce energy and autophagic changes within the cell.
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Affiliation(s)
- Ashley Cox
- Department of Biomedical Sciences, Toxicology Research Cluster, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, 25701, USA
| | - Kathleen C Brown
- Department of Biomedical Sciences, Toxicology Research Cluster, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, 25701, USA
| | - Monica A Valentovic
- Department of Biomedical Sciences, Toxicology Research Cluster, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, 25701, USA.
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Cox A, Brown KC, Bender C, Valentovic MA. The e-liquid flavoring cinnamaldehyde induces cellular stress responses in human proximal tubule (HK-2) kidney cells. Biomed Pharmacother 2024; 175:116666. [PMID: 38677246 DOI: 10.1016/j.biopha.2024.116666] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024] Open
Abstract
Flavored e-liquid use has become popular among e-cigarette users recently, but the effects of such products outside the lung are not well characterized. In this work, acute exposure to the popular flavoring cinnamaldehyde (CIN) was performed on human proximal tubule (HK-2) kidney cells. Cells were exposed to 0-100 µM CIN for 24-48 h and cellular stress responses were assessed. Mitochondrial viability via MTT assay was significantly decreased at 20 µM for 24 and 48 h exposure. Seahorse XFp analysis showed significantly decreased mitochondrial energy output at 20 µM by 24 h exposure, in addition to significantly reduced ATP Synthase expression. Seahorse analysis also revealed significantly decreased glycolytic function at 20 µM by 24 h exposure, suggesting inability of glycolytic processes to compensate for reduced mitochondrial energy output. Cleaved caspase-3 expression, a mediator of apoptosis, was significantly increased at the 24 h mark. C/EBP homologous protein (CHOP) expression, a mediator of ER-induced apoptosis, was induced by 48 h and subsequently lost at the highest concentration of 100 µM. This decrease was accompanied by a simultaneous decrease in its downstream target cleaved caspase-3 at the 48 h mark. The autophagy marker microtubule-associated protein 1 A/1B light chain 3 (LC3B-I and LC3B-II) expression was significantly increased at 100 µM by 24 h. Autophagy-related 7 (ATG7) protein and mitophagy-related proteins PTEN-induced putative kinase 1 (PINK1) and PARKIN expression were significantly reduced at 24 and 48 h exposure. These results indicate acute exposure to CIN in the kidney HK-2 model induces mitochondrial dysfunction and cellular stress responses.
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Affiliation(s)
- Ashley Cox
- Department of Biomedical Sciences, Toxicology Research Cluster, Marshall University Joan C. Edwards School of Medicine, Huntington, WV 25701, United States
| | - Kathleen C Brown
- Department of Biomedical Sciences, Toxicology Research Cluster, Marshall University Joan C. Edwards School of Medicine, Huntington, WV 25701, United States
| | - Christopher Bender
- Department of Biomedical Sciences, Toxicology Research Cluster, Marshall University Joan C. Edwards School of Medicine, Huntington, WV 25701, United States
| | - Monica A Valentovic
- Department of Biomedical Sciences, Toxicology Research Cluster, Marshall University Joan C. Edwards School of Medicine, Huntington, WV 25701, United States.
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Meredith-Jones KA, Haszard JJ, Graham-DeMello A, Campbell A, Stewart T, Galland BC, Cox A, Kennedy G, Duncan S, Taylor RW. Validation of actigraphy sleep metrics in children aged 8 to 16 years: considerations for device type, placement and algorithms. Int J Behav Nutr Phys Act 2024; 21:40. [PMID: 38627708 PMCID: PMC11020269 DOI: 10.1186/s12966-024-01590-x] [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] [Received: 10/16/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Actigraphy is often used to measure sleep in pediatric populations, despite little confirmatory evidence of the accuracy of existing sleep/wake algorithms. The aim of this study was to determine the performance of 11 sleep algorithms in relation to overnight polysomnography in children and adolescents. METHODS One hundred thirty-seven participants aged 8-16 years wore two Actigraph wGT3X-BT (wrist, waist) and three Axivity AX3 (wrist, back, thigh) accelerometers over 24-h. Gold standard measures of sleep were obtained using polysomnography (PSG; Embletta MPRPG, ST + Proxy and TX Proxy) in the home environment, overnight. Epoch by epoch comparisons of the Sadeh (two algorithms), Cole-Kripke (three algorithms), Tudor-Locke (four algorithms), Count-Scaled (CS), and HDCZA algorithms were undertaken. Mean differences from PSG values were calculated for various sleep outcomes. RESULTS Overall, sensitivities were high (mean ± SD: 91.8%, ± 5.6%) and specificities moderate (63.8% ± 13.8%), with the HDCZA algorithm performing the best overall in terms of specificity (87.5% ± 1.3%) and accuracy (86.4% ± 0.9%). Sleep outcome measures were more accurately measured by devices worn at the wrist than the hip, thigh or lower back, with the exception of sleep efficiency where the reverse was true. The CS algorithm provided consistently accurate measures of sleep onset: the mean (95%CI) difference at the wrist with Axivity was 2 min (-6; -14,) and the offset was 10 min (5, -19). Several algorithms provided accurate measures of sleep quantity at the wrist, showing differences with PSG of just 1-18 min a night for sleep period time and 5-22 min for total sleep time. Accuracy was generally higher for sleep efficiency than for frequency of night wakings or wake after sleep onset. The CS algorithm was more accurate at assessing sleep period time, with narrower 95% limits of agreement compared to the HDCZA (CS:-165 to 172 min; HDCZA: -212 to 250 min). CONCLUSION Although the performance of existing count-based sleep algorithms varies markedly, wrist-worn devices provide more accurate measures of most sleep measures compared to other sites. Overall, the HDZCA algorithm showed the greatest accuracy, although the most appropriate algorithm depends on the sleep measure of focus.
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Affiliation(s)
- K A Meredith-Jones
- Department of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - J J Haszard
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - A Graham-DeMello
- Department of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - A Campbell
- WellSleep Centre, University of Otago, Wellington, New Zealand
| | - T Stewart
- School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - B C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - A Cox
- Department of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - G Kennedy
- Fuzzy Systems Ltd, Dunedin, New Zealand
| | - S Duncan
- School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - R W Taylor
- Department of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
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Gil N, Cox A, Whitaker KL, Kerrison RS. Cancer risk-factor and symptom awareness among adults with intellectual disabilities, paid and unpaid carers, and healthcare practitioners: a scoping review. J Intellect Disabil Res 2024; 68:193-211. [PMID: 38057951 DOI: 10.1111/jir.13110] [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] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The physical health of people with intellectual disabilities (ID) has been identified as an area of ongoing concern and priority. Research has increasingly focused on cancer, with studies indicating that people with ID are at an increased risk of cancer and of mortality, compared with the general population. This review aims to systematically identify and synthesise the published academic literature exploring cancer risk-factor and symptom awareness among people with IDs, carers and healthcare professionals. METHODS In line with Arksey and O'Malley's (2005) framework for scoping reviews, five incremental stages were followed: (1) identifying research question, (2) identifying relevant studies, (3) study selection, (4) extracting and charting of data, and (5) collating, summarising and reporting results. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews (PRISMA-Scr). RESULTS The search strategy identified 352 records, 16 records met all eligibility criteria and were included for review. The studies address a range of areas including knowledge and awareness of cancer risk-factors and symptoms and interventions to promote awareness of cancer. CONCLUSIONS Cancer risk-factor and symptom awareness is low among adults with ID, paid and unpaid carers and healthcare practitioners (HCPs). Theoretically underpinned, co-designed tools and interventions to improve awareness are lacking. There is uncertainty surrounding how to best support people with ID in raising cancer awareness, even within the professional healthcare environment. There is a predominance of research on breast cancer awareness. Future studies focusing on other cancers are needed to build a complete picture of awareness among adults with IDs, paid and unpaid carers, and HCPs.
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Affiliation(s)
- N Gil
- School of Health Sciences, University of Surrey, Guildford, UK
| | - A Cox
- School of Health Sciences, University of Surrey, Guildford, UK
| | - K L Whitaker
- School of Health Sciences, University of Surrey, Guildford, UK
| | - R S Kerrison
- School of Health Sciences, University of Surrey, Guildford, UK
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Abou Samra S, Cox A, Bhojani N. Gender disparity within the Canadian Urological Association A comparison with the Quebec Urological Association. Can Urol Assoc J 2024; 18:E1-E6. [PMID: 37812791 PMCID: PMC10766335 DOI: 10.5489/cuaj.8436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
INTRODUCTION The aim of this study was to examine gender diversity within the Canadian Urological Association (CUA) and to compare it with the Quebec Urological Association (QUA). METHODS A retrospective review of women's representation regarding membership, committees' composition, awards, grants, and conferences between 2012 and 2022 was performed. Data and gender were extracted from databases and annual meeting programs provided by the CUA and the QUA. RESULTS In 2022, females accounted for 18% (256/1431) of the membership at the CUA and 23% (52/228) at the QUA. The female proportion of committee members at the CUA increased from 9% (63/676) from 2012-2016 to 14% (177/1230) from 2017-2022 (p≤0.0001). In 2022, the QUA had a significantly higher proportion of female committee members than the CUA, with 39% (15/38) vs. 22% (50/225) women (p=0.0226), respectively. Moreover, from 2012-2022, 11% (5/46) of the CUA awards were given to women, whereas 38% (13/34) of the award winners at the QUA were women over the same time period (p=0.0038). Between 2012 and 2022, there were 16% (20/126) female CUA grant recipients and 44% (14/32) at the QUA (p=0.0095). The proportion of grants awarded to women at the CUA increased from 13% (5/39) in 2012-2016 to 17% (15/87) in 2017-2022. Two percent (1/53) of the plenary invited speakers at the CUA annual meetings from 2012-2016 were women, compared with 21% (14/66) from 2017-2022 (p=0.0016). In 2022, 53% (9/17) of invited plenary faculty were women at the QUA annual conference, compared to 23% (3/13) at the CUA annual meeting (p=0.0980). CONCLUSIONS Over the past 10 years, there has been an increase in women's representation at the CUA and the QUA; however, data show that the increase in female representation at the QUA has outpaced that of the CUA.
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Affiliation(s)
| | - Ashley Cox
- Dalhousie University, Halifax, NS, Canada
- Officer, CUA EDIA Committee
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Gilmour AM, MacDonald MJ, Cox A, Fairclough SJ, Tyler R. Investigating Ecological Momentary Assessed Physical Activity and Core Executive Functions in 18- to 24-Year-Old Undergraduate Students. Int J Environ Res Public Health 2023; 20:6944. [PMID: 37887683 PMCID: PMC10606779 DOI: 10.3390/ijerph20206944] [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] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
Although evidence for young children (<10) and older adults (>64) highlights an association between physical activity (PA) and executive functions (EFs), there is a paucity of research on adolescents aged 18-24 years. Thus, this study examined the associations between PA and EF and the difference in EF between individuals who achieve the moderate-to-vigorous (MVPA) guidelines and those who do not. Forty-seven participants engaged in a Stroop task, a reverse Corsi-block test, and a task-switching test, to measure inhibition, working memory, and cognitive flexibility, respectively. An ecological momentary assessment (EMA) was used to determine the participant's MVPA and step count, through the "Pathverse" app. Multiple regressions were run to predict the task-switch cost, the Stroop effect, and the backward Corsi span from time spent in MVPA. A two-way ANCOVA examined the effects of achieving the MVPA guidelines on EF. MVPA and step count did not significantly predict EF. There were no significant differences in EF between participants achieving the MVPA guidelines and those that did not. Time spent in MVPA and step count were not significantly associated with working memory, cognitive flexibility, or inhibition in adolescents. Further research is warranted to understand other factors that may significantly affect EF, within and outside an individual's control.
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Affiliation(s)
- Ayva-Mae Gilmour
- Movement Behaviours, Health, and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk L39 4QP, UK; (M.J.M.); (S.J.F.)
| | - Mhairi J. MacDonald
- Movement Behaviours, Health, and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk L39 4QP, UK; (M.J.M.); (S.J.F.)
| | - Ashley Cox
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK;
| | - Stuart J. Fairclough
- Movement Behaviours, Health, and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk L39 4QP, UK; (M.J.M.); (S.J.F.)
| | - Richard Tyler
- Movement Behaviours, Health, and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk L39 4QP, UK; (M.J.M.); (S.J.F.)
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Cox A, Siemens DR. Reflections on equity, diversity, inclusivity, and accessibility in Canadian urology. Can Urol Assoc J 2023; 17:298. [PMID: 37851908 PMCID: PMC10581728 DOI: 10.5489/cuaj.8561] [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: 10/20/2023]
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Nguyen ALV, Nguyen DD, Cox A, Bhojani N. Editorial Comment. J Urol 2023:101097JU000000000000353701. [PMID: 37203141 DOI: 10.1097/ju.0000000000003537.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Anna-Lisa V Nguyen
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David-Dan Nguyen
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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Cox A, Stevens M, Kallon D, Gupta A, White E. Comparative evaluation of Luminex based assays for detection of SARS-CoV-2 antibodies in a transplantation laboratory. J Immunol Methods 2023; 517:113472. [PMID: 37059296 PMCID: PMC10091782 DOI: 10.1016/j.jim.2023.113472] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Detection of SARS-CoV-2 antibodies is essential in establishing the parameters of an individual's immune response to COVID-19, from both natural infection and vaccination. Despite this, there is currently limited clinical guidance or recommendations for serological methods for their measurement. Here, we evaluate and compare four Luminex-based assays for the multiplex detection of IgG SARS-CoV-2 antibodies. METHODS The four assays tested were Magnetic Luminex Assay, MULTICOV-AB Assay, Luminex xMAP SARS-CoV-2 Multi-Antigen IgG Assay and LABScreen COVID Plus Assay. Each assay's ability to detect antibodies to SARS-CoV-2 Spike (S), Nucleocapsid (N) and Spike-Receptor Binding Domain (RBD) was evaluated using 50 test samples (25 positive, 25 negative), previously tested by a widely used ELISA technique. RESULTS The MULTICOV-AB Assay had the highest clinical performance detecting antibodies to S trimer and RBD in 100% (n = 25) of known positive samples. Both the Magnetic Luminex Assay and LABScreen COVID Plus Assay showed significant diagnostic accuracy with sensitivities of 90% and 88% respectively. The Luminex xMAP SARS-CoV-2 Multi-Antigen IgG Assay demonstrated limited detection of antibodies to the S antigen resulting in a sensitivity of 68%. CONCLUSION Luminex-based assays provide a suitable serological method for multiplex detection of SARS-CoV-2 specific antibodies, with each assay able to detect antibodies to a minimum of 3 different SARS-CoV-2 antigens. Assay comparison identified there is moderate performance variability between manufacturers and further inter-assay variation of antibodies detected to different SARS-CoV-2 antigens.
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Affiliation(s)
- A Cox
- Clinical Transplantation Laboratory, 3rd Floor Pathology & Pharmacy Building, 80 Newark Street, London E1 2ES, United Kingdom; The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - M Stevens
- Immunology Laboratory, Royal Sussex County Hospital Barry, Eastern Rd, Brighton BN2 5BE, United Kingdom
| | - D Kallon
- Clinical Transplantation Laboratory, 3rd Floor Pathology & Pharmacy Building, 80 Newark Street, London E1 2ES, United Kingdom
| | - A Gupta
- Clinical Transplantation Laboratory, 3rd Floor Pathology & Pharmacy Building, 80 Newark Street, London E1 2ES, United Kingdom
| | - E White
- Clinical Transplantation Laboratory, 3rd Floor Pathology & Pharmacy Building, 80 Newark Street, London E1 2ES, United Kingdom
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Kim SSY, MacNevin W, Rendon RA, Bell DG, Duplisea J, Bailly G, Cox A, Mason RJ. Examining the impact of postoperative opioid use on length of hospital stay following radical cystectomy. Can Urol Assoc J 2023:cuaj.8167. [PMID: 36952303 DOI: 10.5489/cuaj.8167] [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: 03/24/2023]
Abstract
INTRODUCTION Radical cystectomy is associated with high rates of morbidity, prolonged hospital stay, and increased opioid use for postoperative pain management; however, the relationship between postoperative opioid use and length of stay remains uncharacterized. This study serves to investigate the association between postoperative opioid use and length of hospital stay after radical cystectomy. The relationship between patient and surgical factors on length of stay was also characterized. METHODS We retrospectively reviewed all patients between 2009 and 2019 who underwent radical cystectomy at our institution. Patient and perioperative variables were analyzed to determine the relationship between postoperative opioid use and length of stay using multivariable linear regression analysis. RESULTS We identified 240 patients for study inclusion with a median age of 70.0 years. Median length of hospital stay was 10.0 days, with median daily mg morphine equivalent use of 57.5 for patients. Daily mg morphine equivalent use was significantly associated with an increased length of stay, as were previous pelvic radiation, postoperative ileus, and higher Clavien-Dindo grade complication during admission (all p<0.05). Median length of stay increased by one day for each increase of 13.2 daily mg morphine equivalents received. CONCLUSIONS Increased daily opioid use was associated with increased length of hospital stay after radical cystectomy. Non-opioid-based pain management approaches may be effective in reducing length of stay after radical cystectomy.
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Affiliation(s)
| | - Wyatt MacNevin
- Department Urology, Dalhousie University, Halifax, NS, Canada
| | | | - David G Bell
- Department Urology, Dalhousie University, Halifax, NS, Canada
| | - Jon Duplisea
- Department Urology, Dalhousie University, Halifax, NS, Canada
| | - Greg Bailly
- Department Urology, Dalhousie University, Halifax, NS, Canada
| | - Ashley Cox
- Department Urology, Dalhousie University, Halifax, NS, Canada
| | - Ross J Mason
- Department Urology, Dalhousie University, Halifax, NS, Canada
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Whalen S, Rendon RA, Bell D, Macdonald M, Duplisea J, Cox A, Bailly G, Mason R. Clinical utility of routine postoperative serial hemoglobin measurements in patients undergoing radical cystectomy for urothelial carcinoma. Can Urol Assoc J 2023; 17:34-38. [PMID: 36218314 PMCID: PMC9970640 DOI: 10.5489/cuaj.8012] [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: 11/19/2022]
Abstract
INTRODUCTION Routine measurements of serum hemoglobin (sHgb) are common after abdominal surgery; however, prolonged measurements may be associated with patient anxiety, increased costs, and longer hospitalization without clinical benefit. The objective of this study was to determine the utility of routine sHgb measurements after radical cystectomy (RC) and factors associated with transfusion of packed red blood cell (pRB C) beyond postoperative day (POD ) 2. METHODS We retrospectively reviewed patients who underwent RC between 2009 and 2019 at a single academic tertiary care center. The number of sHgb measurements for each patient was examined and pRB C transfusion rates were calculated. Multivariable logistic regression was used to determine factors associated with transfusion beyond POD 2. RESULTS The median number of sHgb measurements per patient during admission was nine (interquartile range [IQR] 7, 25). Overall, 69/240 (28.7%) patients received a postoperative transfusion, including 46/240 (19.2%) patients receiving a transfusion beyond POD 2. Among patients with a sHgb ≥100 g/L on POD 2, 7/85 (8.2%) went on to receive a transfusion beyond this day compared with 39/155 (25.2%) patients with sHgb <100 g/L. On multivariable analysis, risk factors associated with pRB C transfusion beyond POD 2 included older age, lower sHgb on POD 2, and longer length of stay in hospital. CONCLUSIONS Transfusion of pRB Cs beyond POD 2 was found to be common; however, patients with sHgb ≥100 g/L on POD 2 were at low risk of requiring subsequent transfusion. Discontinuing further routine sHgb checks in these patients may serve to decrease patient anxiety, healthcare costs, and delays in hospital discharge.
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Cox A, Klümper N, Stein J, Sikic D, Breyer J, Bolenz C, Roghmann F, Erben P, Wirtz R, Wullich B, Ritter M, Hölzel M, Schwamborn K, Horn T, Gschwend J, Hartmann A, Weichert W, Erlmeier F, Eckstein M. Intrinsic molecular urothelial cancer subtypes remain stable during metastatic evolution. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01209-5] [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: 02/12/2023]
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Doiron RC, Cox A, Nadeau G. Interstitial cystitis/bladder pain syndrome clinical recipes for success: A tasty reference for all urologists. Can Urol Assoc J 2022; 16:399. [PMID: 36656696 PMCID: PMC9851222 DOI: 10.5489/cuaj.8157] [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: 11/24/2022]
Affiliation(s)
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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15
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MacNevin W, Bitcon C, Cox A. Social Disparities in the Diagnosis and Care of Lower Urinary Tract Dysfunction. Curr Bladder Dysfunct Rep 2022. [DOI: 10.1007/s11884-022-00673-4] [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: 11/21/2022]
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16
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Cox A, Noonan RJ, Fairclough SJ. The Feasibility and Acceptability of an Online CPD Programme to Enhance PE Teachers' Knowledge of Muscular Fitness Activity. Int J Environ Res Public Health 2022; 19:12132. [PMID: 36231430 PMCID: PMC9566237 DOI: 10.3390/ijerph191912132] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Schools provide an opportunity to enhance muscular fitness of English youth during physical education (PE). Continued professional development (CPD) among teachers may improve muscular fitness activity delivery in schools. This study sought to assess the feasibility and acceptability of an online CPD programme to enhance PE teachers' knowledge of muscular fitness activity. METHODS Co-production of an online CPD platform was undertaken with five secondary school PE teachers. A quasi-experimental pre-post control group design for the CPD was adopted (CPD group n = 76, control n = 32). Upon CPD completion feedback was solicited for qualitative analysis. RESULTS Pre-and-post CPD knowledge quiz data were available from 65 participants (55.4% male). The median knowledge quiz change score was significantly higher in the CPD group than in the wait list control group (CPD score vs. control score; U =37, z = -5.96, p < 0.01). Three primary themes reflecting factors associated with the acceptability and feasibility were (1) practical application, (2) support and resources, and (3) knowledge and confidence. CONCLUSIONS Co-production of an online CPD programme can improve knowledge and affect practice. PE teachers that completed the CPD reported the online platform was beneficial to overcoming the limitations of face-to-face CPD such as time and financial constraints and suggested the content covered was beneficial and appropriate to their teaching. Future work is required to establish links between teachers' learning following CPD, the translation into PE practice and student MF outcomes.
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Affiliation(s)
- Ashley Cox
- Movement Behaviours, Health, and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk L39 4QP, UK
| | - Robert J. Noonan
- Appetite and Obesity Research Group, Department of Psychology, University of Liverpool, Liverpool L1 8JX, UK
- Faculty of Health and Wellbeing, University of Bolton, Bolton BL3 5AB, UK
| | - Stuart J. Fairclough
- Movement Behaviours, Health, and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk L39 4QP, UK
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17
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Mulcaire J, O'Brien P, Sheehan M, Vincent-Kuruvila V, Cox A, Salter N. An Ambulatory Pathway for the Investigation of Patients with Suspected Pulmonary Embolism. Ir Med J 2022; 115:654. [PMID: 36305557] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Aims The aim of this project was to provide an ambulatory pathway for diagnosis and management of patients with suspected Pulmonary Embolism (PE) with "low-risk" features. Methods A structured algorithm for the management of suspected PE was designed and implemented in April 2021. This involved the development of local guidelines to identify those "low-risk" patients with suspected PE, through the use of modified sPESI and Hestia criteria. This pathway was audited monthly to establish effect on admission and hospital length of stay. Results 51 CT PAs were performed by the Emergency Department in April 2021. Total number of CT confirmed PEs in April was 7(11%). 12 "low-risk" patients with suspected PE were identified and placed on the "Ambulatory Suspected Pulmonary Embolism Pathway". One (8.3%) patient on this pathway had a confirmed PE. Patients placed on this pathway spent significantly less time in the Emergency Department and in hospital with greater satisfaction by physicians using this pathway. Conclusion This pathway has succeeded in significantly decreasing length of stay both in the ED and in hospital for patients with suspected and confirmed PE.
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Affiliation(s)
- J Mulcaire
- Emergency Department, St. Vincent's University Hospital
| | - P O'Brien
- Emergency Department, St. Vincent's University Hospital
| | - M Sheehan
- Emergency Department, St. Vincent's University Hospital
| | | | - A Cox
- Emergency Department, St. Vincent's University Hospital
| | - N Salter
- Emergency Department, St. Vincent's University Hospital
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18
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Bakr D, Reid A, Flaherty K, Holdich A, Jones C, Tarrant R, Cox A, Goodwill L, Lewis J, Girardi M, Whittaker S, Mitchell T. POT1 gene dysfunction in primary cutaneous T-cell lymphoma. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00551-2] [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]
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19
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Preble KM, Nichols A, Cox A. Working With Survivors of Human Trafficking: Results From a Needs Assessment in a Midwestern State, 2019. Public Health Rep 2022; 137:111S-118S. [PMID: 35775911 DOI: 10.1177/00333549221089254] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES While the needs of human trafficking survivors have been documented in the academic discourse, the saliency of such needs is understudied. This study aimed to reveal the critical needs of service provision for human trafficking survivors in a Midwestern state as perceived by multidisciplinary service providers. METHODS Targeting health care, social service, law enforcement, public health, and other service providers involved in anti-human trafficking service delivery, we disseminated a survey using purposive and snowball sampling. Drawing from survey responses collected in 2019 from 107 service providers working with 422 survivors of human trafficking in the previous 12 months in a Midwestern state, we examined the saliency of needs from the perspective of service providers in the health care, criminal justice, and social service sectors. RESULTS Respondents indicated on a Likert scale (1-5) the level of need for 37 social, health care, and legal services in their communities. The top-indicated needs statewide were mental health care, shelter/housing, peer mentorship programs, legal services, transportation, and provider training in juvenile courts, schools, law enforcement, and health care settings on human trafficking. CONCLUSION The results suggest the need for statewide responses, such as legal assistance networks, telemental health options, and enhanced training collaborations between interpersonal violence and anti-human trafficking service providers. The study findings are generalizable beyond the study site in 3 ways that can guide strategic action: (1) they provide a framework for state-level analysis and strategic planning that parallels the results; (2) they show that regional variation is possible and should be accounted for in state-level study design, analysis, and strategic planning; and (3) the implications for housing assistance, legal assistance, mental health/substance use disorder-related health care, and training are scalable.
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Affiliation(s)
- Kathleen M Preble
- School of Social Work, University of Missouri-Columbia, Columbia, MO, USA
| | - Andrea Nichols
- Department of Women, Gender, and Sexuality Studies, Washington University, St. Louis, MO, USA
| | - Ashley Cox
- Department of Criminology, University of Missouri-St. Louis, St. Louis, MO, USA
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20
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Nguyen LN, Randhawa H, Nadeau G, Cox A, Hickling D, Campeau L, Li J, Welk B, Carlson K. Canadian Urological Association best practice report: Diagnosis and management of nocturia. Can Urol Assoc J 2022; 16:E336-E349. [PMID: 35819914 PMCID: PMC9328849 DOI: 10.5489/cuaj.7970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Affiliation(s)
- Laura N. Nguyen
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Harkanwal Randhawa
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Geneviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec, QC, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Lysanne Campeau
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Juliana Li
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Blayne Welk
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Kevin Carlson
- Department of Surgery, University of Calgary, Calgary, AB, Canada
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21
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Valentovic MA, Brown KC, Murphy R, Cremeans B, McGuffey R, Cox A. Cellular and Mitochondrial Damage by the Antiviral agent Tenofovir in Renal Epithelial Cells. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.l7795] [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: 11/11/2022]
Affiliation(s)
| | - Kathleen C. Brown
- Biomedical SciencesMarshall University School of MedicineHuntingtonWV
| | - Rachel Murphy
- Biomedical SciencesMarshall University School of MedicineHuntingtonWV
| | - Brad Cremeans
- Biomedical SciencesMarshall University School of MedicineHuntingtonWV
| | - Rachel McGuffey
- Biomedical SciencesMarshall University School of MedicineHuntingtonWV
| | - Ashley Cox
- Biomedical SciencesMarshall University School of MedicineHuntingtonWV
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22
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Cox A, Brown KC, Valentovic MA. Cytotoxicity in Human Kidney HK‐2 Cells of the Flavoring Aldehydes Cinnamaldehyde and Vanillin. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4871] [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: 11/11/2022]
Affiliation(s)
- Ashley Cox
- Biomedical SciencesMarshall University School of MedicineHuntingtonWV
| | - Kathleen C. Brown
- Biomedical SciencesMarshall University School of MedicineHuntingtonWV
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23
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Bitcon C, Whalen S, Coleman J, Rendon R, Bailly G, Bell D, Cox A, Duplisea J, Tenankore K, Mason R. ASO Visual Abstract: Examining the Utility of Postoperative Serial Renal Function Monitoring in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma. Ann Surg Oncol 2022. [PMID: 35552925 DOI: 10.1245/s10434-022-11731-w] [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: 11/18/2022]
Affiliation(s)
| | | | | | | | | | - David Bell
- Dalhousie University, Halifax, NS, Canada
| | - Ashley Cox
- Dalhousie University, Halifax, NS, Canada
| | | | | | - Ross Mason
- Dalhousie University, Halifax, NS, Canada
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24
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Bitcon C, Whalen S, Coleman J, Rendon R, Bailly G, Bell D, Cox A, Duplisea J, Tenankore K, Mason R. Utility of Postoperative Serial Renal Function Monitoring in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma. Ann Surg Oncol 2022; 29:5333-5337. [PMID: 35381936 DOI: 10.1245/s10434-022-11667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study is to examine the rates of clinical actions (CAs) as a result of serial creatinine (SCr) values and to examine postoperative SCr trends to assess the utility of SCr measurements in radical cystectomy (RC) patients. METHODS We performed a retrospective chart review using our institution's database on all patients who underwent radical cystectomy for urothelial carcinoma (UC) from 2009 to 2019. Preoperative and all postoperative inpatient creatinine values were recorded. Minor CAs included fluid boluses, fluid rate changes, and medication changes. Major CAs included OR take-backs for stent repositioning, nephrostomy tube placement, nephrology consultation, and hemodialysis. RESULTS A total of 238 RCs were performed with a resultant 2952 SCr measurements. The median number of SCr measurements per patient was 9 (interquartile range, IQR 7) with median length of hospital stay of 10 days (IQR 9 days). There were 92 minor and 12 major CAs as a result of 3% and 0.44% of SCr measurements, respectively. All major CAs were seen in patients experiencing complicated postoperative course. The median postoperative day with the highest creatinine was day 2. Predictors of postoperative CAs included preoperative renal dysfunction and obesity. CONCLUSION SCr measurements remain a clinically valuable tool in postoperative management. Nonetheless, this present study suggests that prolonged SCr monitoring is of limited clinical utility. As such, discontinuing SCr checks after postoperative day 3 in patients experiencing uncomplicated postoperative course is safe and may lead to both cost savings and decreased patient discomfort.
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Affiliation(s)
| | | | | | | | | | - David Bell
- Dalhousie University, Halifax, NS, Canada
| | - Ashley Cox
- Dalhousie University, Halifax, NS, Canada
| | | | | | - Ross Mason
- Dalhousie University, Halifax, NS, Canada
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25
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Nguyen AXL, Zorigbaatar A, Bouhadana D, Deyirmendjian C, Nguyen DD, Cox A, Bhojani N. Gender disparity on editorial boards of major urology journals. Can Urol Assoc J 2022; 16:E328-E332. [DOI: 10.5489/cuaj.7690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Not applicable
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26
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McCauley N, Rashid M, Wilson J, Carter A, Cox A. 1016 The Impact Of COVID-19 On Prostate Cancer: Is This the Calm Before the Storm? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.489] [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: 11/14/2022]
Abstract
Abstract
Aim
Cancer treatment targets were halted in the COVID-era due to a major re-organisation of services and coincided with a drop in prostate cancer (PCa) referrals, investigations, and diagnoses. This study measures the impact of the pandemic on a PCa diagnostic pathway in a major cancer centre.
Method
Data was collected during the onset of COVID-19 (March to June 2020) and the same months in 2019 for urgent suspected prostate cancer (USPC) referrals. All referrals, PSA tests, multiparametric MRI's of prostate (mpMRI-P), and TRUS-guided biopsy of the prostate (TBP) were recorded.
Results
USPC referrals reduced by 65% from a mean 315 referrals per month to 110 during the pandemic. During March-June 2019 a total of 10,404 PSA tests were conducted in the healthcare trust, which reduced by 39% during COVID-19. Multiparametric MRI of prostate was reduced by 45%. TRUS biopsies were down by 65%, from a mean of 31 to 11 biopsies per month, with only 3 biopsies being conducted in April 2020.
Conclusions
The reduction in PCa referrals and workload in our centre in the COVID-era has been significant. The uncertainty associated with such a drop in demand poses concerns for meeting future cancer targets when prostate cancer referrals return to baseline.
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Affiliation(s)
- N McCauley
- Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - M Rashid
- Royal Gwent Hospital, Newport, United Kingdom
| | - J Wilson
- Royal Gwent Hospital, Newport, United Kingdom
| | - A Carter
- Royal Gwent Hospital, Newport, United Kingdom
| | - A Cox
- Royal Gwent Hospital, Newport, United Kingdom
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27
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Sultana S, Berger G, Cox A, Kelly MEM, Lehmann C. Rodent models of ketamine-induced cystitis. Neurourol Urodyn 2021; 40:1704-1719. [PMID: 34350618 DOI: 10.1002/nau.24763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/30/2021] [Revised: 06/25/2021] [Accepted: 07/19/2021] [Indexed: 02/03/2023]
Abstract
AIMS Long-term or recreational use of ketamine affects the urinary system and can result in ketamine-induced cystitis (KIC). Rodent models of KIC are important to study KIC pathophysiology and are paramount to the future development of therapies for this painful condition. This review aims to provide a summary of rodent models of KIC, focusing on disease induction, experimental methods, and pathological features of the model. METHOD A literature search was performed using the National Center for Biotechnology Information (NCBI) Pubmed database up to March 2021. 20 articles met the inclusion criteria and were finally selected. RESULTS There are considerable variations in the rodent models used for studying KIC in terms of the strain of the animal being used; dose, duration, and route of ketamine administration to induce KIC, and assessment of pathological features. CONCLUSION KIC remains difficult to fully recapitulate in humans. Improved characterization of KIC models and the experimental parameters and meticulous discussion on translational limitations are required to improve the translational value of research using rodent models of KIC.
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Affiliation(s)
- Saki Sultana
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Geraint Berger
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melanie E M Kelly
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christian Lehmann
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
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28
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Nguyen LN, Cox A. Practice-changing publications in functional urology: A case-based approach. Can Urol Assoc J 2021; 15:E330-E334. [PMID: 34264814 DOI: 10.5489/cuaj.7468] [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: 11/19/2022]
Affiliation(s)
- Laura N Nguyen
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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29
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Gerassi LB, Nichols AJ, Cox A, Goldberg KK, Tang C. Examining Commonly Reported Sex Trafficking Indicators From Practitioners' Perspectives: Findings From a Pilot Study. J Interpers Violence 2021; 36:NP6281-NP6303. [PMID: 30484358 DOI: 10.1177/0886260518812813] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Commonly reported sex trafficking indicators have been disseminated widely by government and non-governmental organizations in trainings aimed to increase identification and referral to resources. However, very little research evaluates such indicators. Drawing from survey responses of 86 social service providers, health care practitioners, and justice system officials in a Midwestern City, this pilot study aimed to examine: (a) the pervasiveness of the commonly reported indicators, (b) the salience of domains of indicators, and (c) the extent to which indicators differ across service populations (U.S.-born minors, U.S.-born adults, foreign born minors, and foreign born adults). The most commonly identified indicators included mental health symptoms of depression (M = 3.82); low self-esteem (M = 3.59); anxiety (M = 3.55); low levels of interpersonal trust (M = 3.52); sense of fear (M = 3.36); feelings of shame or guilt (M =3.34); isolation from family, friends, and communities (M = 3.3); and fear/distrust of law enforcement (M = 3.80). The least commonly identified indicators included exhibiting low English proficiency (M = 1.62), previous history of loitering charges (M = 1.74), presenting false documents (M = 1.85), presence of tattoos or branding (M = 1.89), presenting delayed cognitive development (M = 1.91), being unaware of one's location (M = 1.94), owing large debt (M = 1.95), previous history of prostitution or drug charges (M = 1.98, M = 2.01), and physical evidence of torture (M = 2.07). The mental health domain was identified as especially common among U.S.-born adults (M = 3.07). Criminal justice involvement was identified as less common among foreign-born minors (M = 1.82) and foreign-born adults (M = 1.96). The most commonly identified indicators, according to the service providers, health care workers, and justice system officials who work with them, are inconsistent with many of the indicators that are used frequently across governmental and community trainings. Trainings focusing on diverse case examples of trafficking may be important in strengthening identification of sex trafficked individuals, as well as accounting for regional contexts.
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Choksi IN, Cox A, Robinson C, Bale A, Carpenter TO. Novel homozygous variant in BMP1 associated with a rare osteogenesis imperfecta phenotype. Osteoporos Int 2021; 32:1239-1244. [PMID: 33624138 DOI: 10.1007/s00198-021-05838-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/08/2021] [Indexed: 02/01/2023]
Abstract
Osteogenesis imperfecta (OI) is characterized by bone fragility and increased fracture susceptibility. BMP1 variants have been reported in the rare OI type XIII, specifically referred to herein as BMP1-associated autosomal recessive (AR) OI. We report the clinical presentation and diagnostic evaluation of a patient found to have a novel homozygous variant in BMP1. We also provide an overview of reported BMP1 variants to date, with discussion focusing on the use of bisphosphonate therapy in these patients. A 7-year-old male with speech and motor delay sustained five bilateral tibial fractures with minimal trauma since age 2.5 years. At age 6, he developed severe back pain after a fall. Diffuse spinal osteopenia and multiple vertebral compression fractures (VCF) at T9, L1, L3, and L5 were identified. Total hip BMD was generous (adjusted Z-score* = 1.76), and femoral neck BMD was high (adjusted Z-score* = 2.67). VCFs precluded assessment of lumbar spine BMD. Genetic analysis identified a homozygous missense variant in exon 4 of BMP1 (c.C505T; p.Arg169Cys). Unlike most forms of OI, patients with BMP1-associated AR OI may have normal or paradoxically increased BMD, making BMD and fracture risk correlation difficult. While bisphosphonates (BP) may help reduce recurrent fractures and provide symptomatic relief, the broad phenotypic spectrum and underlying bone pathology, often in the setting of increased BMD, complicate management. HR-pQCT assessment of bone microarchitecture and quality may aid in the decision of BP therapy and subsequent monitoring. Evidence is limited with respect to the effectiveness of BP in this rare form of OI. *Z-score was adjusted for height Z-score.
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Affiliation(s)
- I N Choksi
- Department of Pediatrics, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA.
| | - A Cox
- DNA Diagnostic Laboratory, Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - C Robinson
- Department of Pediatrics, Division of Endocrinology and Diabetes, Icahn School of Medicine, New York, NY, USA
| | - A Bale
- DNA Diagnostic Laboratory, Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - T O Carpenter
- Department of Pediatrics, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
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Stairs J, Maguire F, Lehmann C, Cox A. Cannabinoid Therapy in Female Pelvic Medicine and Reconstructive Surgery: Current Evidence and Future Directions. Curr Bladder Dysfunct Rep 2021. [DOI: 10.1007/s11884-021-00632-5] [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: 10/21/2022]
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32
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Watson N, Cox A, Sanmugarajah J, Dzienis M, Hughes I. Safety and efficacy of telephone clinics during the COVID-19 pandemic in the provision of care for patients with cancer. Intern Med J 2021; 51:1414-1419. [PMID: 33961726 PMCID: PMC8242722 DOI: 10.1111/imj.15340] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Due to the COVID-19 pandemic, telephone clinics have been utilised to reduce the risk of transmission. Evidence supporting its quality and safety is required. AIMS Assess the efficacy and safety of telephone clinics in delivering care to established oncology patients and assess patient and health professionals' preference (telephone vs face-to-face clinics). METHODS Retrospective chart audit in the month preceding and month following introduction of telephone clinics at the Gold Coast University hospital and a patient and health professional questionnaire. RESULTS In total, 1212 clinical encounters occurred in the month post the introduction of telephone clinics (vs 1208 encounters prior). There were no statistically significant differences in 24-h (18 vs 22, p = 0.531) or 7-day admissions (50 vs 46, p = 0.665) comparing encounters in the month prior to the introduction of telephone clinics vs the month post, but there was a statistically significant difference in 30-day mortality post systemic therapy in favour of the post-telephone clinic period (7 vs 0 patients, p = 0.008). Of the 222 patients who undertook the questionnaire, 42.3% preferred telephone clinics (95% CI 35.97-48.97), 25.2% preferred face-to-face clinics (95% CI 19.92-31.39) and 32.4% did not prefer one method over another. Of the 24 health professionals who undertook the questionnaire, 70.8% felt patients preferred phone clinics. CONCLUSIONS Generally, patients and clinicians viewed telephone clinics favourably. Nevertheless, a large portion of patients still prefer face-to-face clinics. Services should be tailored to individual preferences. Although there were no 'red flags' in terms of mortality or admission rates, further longitudinal research is required. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- N Watson
- Gold Coast University Hospital Health service
| | - A Cox
- Gold Coast University Hospital Health service
| | - J Sanmugarajah
- Gold Coast University Hospital Health service.,School of Medicine- Griffith University
| | - M Dzienis
- Gold Coast University Hospital Health service
| | - I Hughes
- Gold Coast University Hospital Health service.,School of Medicine- Griffith University
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Cox A, Fairclough SJ, Noonan RJ. "It's Just Not Something We Do at School". Adolescent Boys' Understanding, Perceptions, and Experiences of Muscular Fitness Activity. Int J Environ Res Public Health 2021; 18:4923. [PMID: 34063097 PMCID: PMC8125655 DOI: 10.3390/ijerph18094923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND English youth typically do not sufficiently engage in the types and intensities of physical activity that develop muscular fitness. The aim of this study was to use a combination of qualitative techniques to explore adolescent boys' understanding, perceptions, and experiences of physical activity and the role muscular fitness plays within boys' physically active lifestyles. METHODS Focus group interviews with a write, draw, show, and tell activity were conducted with 32 adolescent boys aged 14-16 years from 3 secondary schools. Three separate sources of data (frequency counts, verbatim transcripts, and visual data) were generated and were pooled together and triangulated. Data were analysed deductively, first using the Youth Physical Activity Promotion model as a thematic framework, and then inductively. RESULTS Physical activity was frequently associated with organised sport, and most boys were unaware of current UK physical activity guidelines. Co-participation was frequently reported as a reinforcing factor to physical activity. CONCLUSIONS There was a perceived lack of opportunity to participate in muscular fitness activities, particularly in school, and knowledge of how to conduct muscular fitness activities was limited. The contribution of physical education was highlighted as being key to facilitating exposure to muscular fitness activities.
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Affiliation(s)
- Ashley Cox
- Movement Behaviours, Health, and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk L39, UK;
| | - Stuart J. Fairclough
- Movement Behaviours, Health, and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk L39, UK;
| | - Robert J. Noonan
- Appetite and Obesity Research Group, Department of Psychology, University of Liverpool, Liverpool L1, UK;
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Onofre J, Geenen L, Cox A, Van Der Auwera I, Willendrup F, Andersen E, Campo R, Dhont N, Ombelet W. Simplified sperm testing devices: a possible tool to overcome lack of accessibility and inconsistency in male factor infertility diagnosis. An opportunity for low- and middle- income countries. Facts Views Vis Obgyn 2021; 13:79-93. [PMID: 33889864 PMCID: PMC8051200 DOI: 10.52054/fvvo.13.1.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Manual semen assessment (MSA) is a key component in a male’s fertility assessment. Clinicians rely on it to make diagnostic and treatment decisions. When performed manually, this routine laboratory test is prone to variability due to human intervention which can lead to misdiagnosis and consequently over- or under- treatment. For standardisation, continuous training, quality control (QC) programs and pricy Computer-Assisted Sperm Analysis (CASA) systems have been proposed, yet, without resolving intra- and inter-laboratory variability. In response, promising simplified sperm testing devices, able to provide cost-effective point-of-care male infertility diagnosis are prospected as a plausible solution to resolve variability and increase access to sperm testing. Materials and methods A throughout literature research for semen testing, sperm analysis, smart-phone assisted semen analysis, ‘at-home’ semen testing, male infertility, infertility in developing countries, infertility in low- and middle-income countries (LMIC) and quantitative sperm analysis was performed. A total of 14 articles, specific to ‘at-home’ simplified sperm assessment, were included to treat the core subject. Results Continuous training and consistent QC, are sine qua none conditions to achieve accurate and comparable MSA. Compliance does not rule-out variability, nevertheless. Emerging simplified sperm assessment devices are an actual alternative to resolve the lack of standardisation and accessibility to sperm analysis. YO ® , SEEM ® , and ExSeed ® are commercially available, user-friendly smartphone-based devices which can accurately measure volume, sperm concentration (millions/ml) and total motile sperm count. More broadly, by cost-effectiveness, availability, accuracy and convenient application, these devices could effectively select patients for first-line artificial reproduction treatments such as intrauterine insemination. Conclusions Accuracy and cost-effectiveness make smart-phone based sperm testing devices a practical and realistic solution to overcome variability in MSA. Importantly, these tools represent an actual opportunity to standardise and improve male subfertility diagnosis and treatment, especially in LMIC. However, before clinical application is possible, guidelines, further testing with special attention on accuracy in washed sperm, availability, cost-benefit and reliability are required.
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Affiliation(s)
- J Onofre
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - L Geenen
- University of Hasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - A Cox
- Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - I Van Der Auwera
- Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | | | | | - R Campo
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - N Dhont
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - W Ombelet
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
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White J, Ory J, Morris H, Rendon RA, Mason R, Cox A. Urological outcomes in nonagenarians with prostate cancer. Can Urol Assoc J 2021; 15:E393-E396. [PMID: 33410737 DOI: 10.5489/cuaj.6805] [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: 11/19/2022]
Abstract
INTRODUCTION Nonagenarians represent a growing patient population. Herein, we report on the largest cohort of Canadian nonagenarian patients, to our knowledge, with prostate cancer. METHODS A retrospective chart of 44 nonagenarian men diagnosed with localized or metastatic prostate cancer between 2006 and 2019 was performed. Diagnoses were based on pathological specimens or the presence of a high prostate-specific antigen (PSA >20) or abnormal digital rectal exam (DRE) in the setting of metastatic disease on imaging. Patient demographics, presenting complaints, and treatments required were included in the analysis. A descriptive statistical analysis was performed. RESULTS The median patient age at time of referral was 91.1 years (interquartile range [IQR] 90.2-92.9). The median PSA at time of referral was 54.0 (IQR 18.2-142.6). Metastatic disease was present in 55% of patients at time of diagnosis (n=24). Most patients required at least one urological intervention (n=35). There were 56.8% of patients who received androgen deprivation therapy (ADT) as part of their treatment regime (n=25). Half (50%) of patients were managed with androgen receptor axis-targeted agents (ARAT), as well as ADT (n=22). Five patients (11.4%) underwent surgical castration. Death due to any cause was noted in 52.3% of patients (n=23) throughout the study period, with the median age at death being 94.4 years (IQR 92.3-97.0). Death due to prostate cancer was noted in 18.2% of patients (n=8). CONCLUSIONS This study highlights common presenting complaints for nonagenarian patients with prostate cancer and that many require urological intervention despite advanced age. Future studies should address patient-reported quality-of-life outcomes in the nonagenarian population with prostate cancer.
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Affiliation(s)
- Josh White
- Department of Urology, Dalhousie University; Halifax, NS, Canada
| | - Jesse Ory
- Department of Urology, Dalhousie University; Halifax, NS, Canada
| | - Heather Morris
- Department of Urology, Dalhousie University; Halifax, NS, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University; Halifax, NS, Canada
| | - Ross Mason
- Department of Urology, Dalhousie University; Halifax, NS, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University; Halifax, NS, Canada
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Gandhi S, Gajewski JB, Koziarz A, Almutairi S, Ali A, Cox A. Long-term outcomes of sacral neuromodulation for lower urinary tract dysfunction: A 23-year experience. Neurourol Urodyn 2020; 40:461-469. [PMID: 33232534 DOI: 10.1002/nau.24583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022]
Abstract
AIMS To evaluate the long-term outcomes of sacral neuromodulation (SNM), and patient characteristics that may predict long-term success or complications. METHODS A single-center retrospective cohort study was performed of all patients who underwent SNM testing and implantation. Outcome results, resolution of symptoms, and device removal were reported. Multivariable logistic regression was used to identify predictors of success. Cox proportional hazards model was used to identify predictors for device removal. RESULTS Four hundred and thrity four patients underwent SNM test phase of which 241 (median age 48.0 years, 91.7% [221/241] female) had device implantation and were followed up for median [range] time of 4.0 (3 months-20.5 years) years. Multivariable logistic regression showed that male gender (odds ratio: 0.314; 95% confidence interval: 0.164-0.601, p = .0005) was independently associated with decreased peripheral nerve evaluation success. At final follow-up for patients who originally had device implantation, median (interquartile range) percent of symptoms resolution of all patients was 60.0% (0%-90%) and 69.3% (167/241) had SNM successful outcomes. Cox proportional hazards model showed no difference for time to SNM device removal with respect to patient age, gender, or diagnosis. 69.3% (167/241) patients had at least 1 surgical re-intervention. The most common reason at first surgical re-intervention was lead change only (26.3%, 44/167). CONCLUSION SNM is a minimally invasive procedure with good long-term success rates. There is a high revision rate but overall, SNM has a good safety profile and excellent long-term outcomes.
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Affiliation(s)
- Shreyas Gandhi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alex Koziarz
- Division of Urology, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sulaiman Almutairi
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Abdullah Ali
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
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MacDonald L, Ory J, Rendon RA, Bailly G, Skinner T, Cox A, Langille G, Bell D. Using GoPro to create an educational database of open urological procedures for residents. Can Urol Assoc J 2020; 15:207-209. [PMID: 33212004 DOI: 10.5489/cuaj.6768] [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: 11/19/2022]
Affiliation(s)
- Landan MacDonald
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Jesse Ory
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Gregory Bailly
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Thomas Skinner
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Gavin Langille
- Department of Urology, Dalhousie University, Halifax, NS, Canada.,Horizon Health Network, Saint John, NB, Canada
| | - David Bell
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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MacDonald L, Cox A, Jarvi K, Martin P, French C, Wang Y, Braga LH, Leveridge M. Navigating urology's new normal and mitigating the effects of a second wave of COVID-19. Can Urol Assoc J 2020; 14:E543-E548. [PMID: 33007189 PMCID: PMC7673836 DOI: 10.5489/cuaj.6976] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The initial wave of the COVID-19 crisis forced immediate and seismic changes on urological practice, patient care, and education — collateral damage to the upending of societal and global economic norms. Lockdowns and limitations curtailed access to the physical spaces of the clinic and operating room, and slashed remuneration secondarily. As the curves flattened and healthcare infrastructure was deemed secure, we have begun opening our societies and clinical lives again. Remote care, in particular, has remained the default model of care, with attendant changes in how urological experience and education are obtained. As the colder weather looms, so does uncertainty about repeated waves of infection, the sustainability of the businesses that sustain our economy and the ability to provide high-quality, uninterrupted care outside of emergencies. To this end, we have compiled perspective and advice from previous authors and contributors to the CUA and CUAJ’s educational and research output, with a view to the future, to second waves, and ever-altered clinical landscapes.
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Affiliation(s)
- Landan MacDonald
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Christopher French
- Department of Surgery, Division of Urology, Memorial University, St. John’s, NL, Canada
| | - Yuding Wang
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Luis H. Braga
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
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Abstract
Urological issues in the pregnant patient present a unique clinical dilemma. These patients may be challenging to treat due to risks associated with medications and surgical procedures. This review aims to provide an update on the physiological changes and surgical risks in pregnancy. In addition, we review the approach for management of urolithiasis and urinary tract infections in pregnancy. Lastly, we highlight the importance of a multidisciplinary approach to placenta percreta, a condition not commonly addressed in urological education.
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Affiliation(s)
- Joshua White
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Jesse Ory
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | | | - Michael Ordon
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Jamie Kroft
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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Cox A, Wood K, Coleman G, Stewart AJ, Bertin FR, Owen H, Suen WW, Medina-Torres CE. Essential oil spray reduces clinical signs of insect bite hypersensitivity in horses. Aust Vet J 2020; 98:411-416. [PMID: 32761617 DOI: 10.1111/avj.12963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/04/2019] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the efficacy of an herbal spray combining various essential oils, with a claim of mast cell stabilisation, antipruritic, anti-inflammatory, and insect repellent effects on the clinical presentation of insect bite hypersensitivity (IBH) in horses. DESIGN Double-blinded, placebo-controlled, randomised, cross-over clinical trial. METHODS Twenty adult horses with clinical IBH were treated with a daily application of herbal spray or placebo for 28 days in a randomised, cross-over fashion, separated by a>28-day washout period. Horses were examined and scored prior to and after the completion of each treatment. Histopathology was performed on four horses. Owners kept daily diaries of observations. RESULTS The herbal spray significantly reduced the severity of all assessed parameters (pruritus, excoriations, lichenification and alopecia; P < 0.05) compared with baseline values (pretreatment) and with placebo. Owners reported improvement of pruritus in 19/20 horses (95%) with complete resolution in 17 horses (85%) following treatment. Skin biopsies showed resolution of orthokeratosis in 4/4 horses, reduced thickness of the stratum spinosum in 2/4 horses and complete resolution of histopathological abnormalities in 1/4 horses after treatment, compared with either no change or deterioration of histopathologic lesions after placebo. No side effects were observed. CONCLUSIONS The tested herbal spray may be an effective treatment for the management of equine IBH.
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Affiliation(s)
- A Cox
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - K Wood
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia.,School of Integrative Biology, University of Liverpool, Bishoftu, Ethiopia
| | - G Coleman
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - A J Stewart
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - F-R Bertin
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - H Owen
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia.,Vetnostics, QML Pathology, Mansfield, Queensland, Australia
| | - W W Suen
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia.,CSIRO Australian Animal Health Laboratory, Geelong, Victoria, Australia
| | - C E Medina-Torres
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
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Vorobeychik G, Black D, Cooper P, Cox A. Multiple sclerosis and related challenges to young women's health: Canadian expert review. Neurodegener Dis Manag 2020; 10:1-13. [PMID: 32372725 DOI: 10.2217/nmt-2020-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Multiple sclerosis (MS) is among the most common chronic neurological diseases, with a highly variable degree of disability during its long-term course. The majority of patients develop significant permanent disability later in life. MS is often diagnosed in women of childbearing age, with a 3:1 ratio of young women to young men with MS. Comorbidities such as depression, anxiety, migraines and reproductive, urological and bowel issues are common and negatively impact patients' quality of life. The objective of this supplement is to review the most common comorbidities occurring in young women with MS, and to propose a multidisciplinary, holistic approach to management.
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Affiliation(s)
- Galina Vorobeychik
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9.,Fraser Health Multiple Sclerosis Clinic, Burnaby Hospital, Burnaby, BC V5G 2X6
| | - Denise Black
- Seine River Medical Centre, Winnipeg, MB R2N 0A5
| | - Paul Cooper
- Department of Clinical Neurological Sciences, Western University, London, ON N6A 3K7.,Schulich School of Medicine & Dentistry, London, ON N6A 5C1
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS B3H 1Y6
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Martin-Smith R, Cox A, Buchan DS, Baker JS, Grace F, Sculthorpe N. High Intensity Interval Training (HIIT) Improves Cardiorespiratory Fitness (CRF) in Healthy, Overweight and Obese Adolescents: A Systematic Review and Meta-Analysis of Controlled Studies. Int J Environ Res Public Health 2020; 17:ijerph17082955. [PMID: 32344773 PMCID: PMC7215828 DOI: 10.3390/ijerph17082955] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 12/21/2022]
Abstract
Background: High Intensity Interval Training (HIIT) is a sustainable and effective method for improving Cardiorespiratory Fitness (CRF) in adolescents. HIIT is proven to produce equal or greater improvements in CRF when compared to moderate intensity continuous exercise (MICE) in adolescents. Methods: The studies included were considered eligible if: (1) Participants were adolescents (11–18 years old); (2) Examined changes in CRF measured either directly or indirectly; (3) Included a non-exercising control group or MICE comparison group; (4) Participants were matched at enrolment; (5) Reported HIIT protocol information; (6) Provided HIIT intensity. A meta-analysis was conducted to determine the effect of HIIT on CRF. Meta-regression and moderator analyses were performed out to quantitatively examine moderators of protocol design on CRF improvements. Results: HIIT displays a moderate effect to improve CRF (g = 0.86, 95% CI 0.518–1.106, p < 0.001). Neither study duration (weeks), nor total or weekly accumulated HIIT volume (min) displayed any significant moderation effect on pooled improvement on CRF (p > 0.05). Conclusions: HIIT is an effective method to improve CRF in adolescents, irrespective of body composition. Notably, meta regression analysis identified that prolonged high volume HIIT programs are similarly effective to short term low volume HIIT programs. This becomes of particular interest for those involved in school curricula, where short HIIT exercise may provide a pragmatic adjunct to the health benefits of Physical Education (PE) lessons.
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Affiliation(s)
- Rhona Martin-Smith
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, Lancashire L39 4QP, UK;
- Correspondence:
| | - Ashley Cox
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, Lancashire L39 4QP, UK;
| | - Duncan S. Buchan
- Institute of Clinical Exercise and Health Science, University of the West of Scotland Lanarkshire Campus Lanarkshire, Scotland G72 0LH, UK; (D.S.B.); (N.S.)
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China;
| | - Fergal Grace
- School of Health & Life Sciences, Federation University, Mt Helen, Ballarat, VIC 3350, Australia;
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Science, University of the West of Scotland Lanarkshire Campus Lanarkshire, Scotland G72 0LH, UK; (D.S.B.); (N.S.)
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Affiliation(s)
- Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, and CUAJ Consulting Editor
| | - D. Robert Siemens
- Department of Urology, Queen’s University, Kingston, ON, Canada, and CUAJ Editor-in-Chief
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Cox A, Fairclough SJ, Kosteli MC, Noonan RJ. Efficacy of School-Based Interventions for Improving Muscular Fitness Outcomes in Adolescent Boys: A Systematic Review and Meta-analysis. Sports Med 2020; 50:543-560. [PMID: 31729638 PMCID: PMC7018678 DOI: 10.1007/s40279-019-01215-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND It has been reported that boys' and girls' physical activity (PA) levels decline throughout adolescence. Boys are at risk of physical inactivity during adolescence; however, in intervention research, they are an under-represented group relative to girls. It is suggested that the school environment may be central to developing interventions that support adolescents in meeting the current PA guidelines. The aim of this systematic review and meta-analysis was to investigate the efficacy of school-based physical activity interventions for improving muscular fitness (MF) in adolescent males. METHODS This systematic review and meta-analysis followed the preferred reporting systems for meta-analyses guidelines and was registered on PROSPERO (Registration number: CRD42018091023). Eligible studies were published in English within peer-reviewed articles. Searches were conducted in three databases, with an additional grey literature search in Google Scholar. Studies investigating MF outcomes were included. RESULTS There were 43 data sets identified across 11 studies, from seven countries. Overall methodological quality of the studies was moderate-to-strong. Interventions targeting MF evidenced a small-to-medium effect (g = 0.32, CI 0.17, 0.48, p < 0.00). Subgroup analyses of MF delivery method resulted in small-to-medium effects: upper limb MF measures (g = 0.28, 95% CI - 0.02, 0.58, p = 0.07), lower limb MF measures (g = 0.28, 95% CI 0.09, 0.68, p = 0.03), combined MF activities (g = 0.24, 95% CI - 0.04 to 0.49, p = 0.05), plyometric activities (g = 0.39, 95% CI 0.09, 0.68, p = 0.01), body weight (g = 0.27, 95% CI - 0.10, 0.65, p = 0.15), and traditional MF methods (g = 0.43, 95% CI 0.09, 0.78, p = 0.01). CONCLUSIONS School-based interventions which aimed to increase MF outcomes in adolescent boys demonstrated small-to-moderate effects. Traditional and plyometric methods of resistance training appear to be the most effective form of PA delivery in adolescent males. More quality research is required to assess the impact of MF delivered in the school environment to inform future intervention design.
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Affiliation(s)
- Ashley Cox
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK.
| | - Stuart J Fairclough
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Maria-Christina Kosteli
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Robert J Noonan
- Appetite and Obesity Research Group, Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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45
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Bitcon C, White J, Cox A, Skinner TAA. Case - Tension hydrocele: A rare cause of acute scrotal pain. Can Urol Assoc J 2020; 14:E341-E342. [PMID: 32017692 DOI: 10.5489/cuaj.6363] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Ashley Cox
- Dalhousie University, Halifax, NS, Canada
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Cox A, Tolkach Y, Kristiansen G, Ritter M, Ellinger J. The lncRNA Fer1L4 is an adverse prognostic parameter in clear-cell renal-cell carcinoma. Clin Transl Oncol 2020; 22:1524-1531. [PMID: 31965534 PMCID: PMC7381450 DOI: 10.1007/s12094-020-02291-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/06/2020] [Indexed: 01/10/2023]
Abstract
Purpose Long non-coding RNAs (lncRNA) are involved in oncogenesis and tumor progression in various tumor entities. At present, little is known about the role in tumor biology of the lncRNA Fer-1 like family member 4 (Fer1L4) in clear-cell renal-cell carcinoma (ccRCC). The aim of this study is to evaluate the expression of Fer1L4 in patients with ccRCC, its association with clinicopathological parameters, and value as prognostic biomarker. Material and methods The expression of Fer1L4 was analyzed in the TCGA ccRCC cohort (n = 603; ccRCC n = 522, normal n = 81) and subsequently validated by quantitative real-time PCR in an independent cohort (n = 103, ccRCC n = 69, normal n = 34). Expression profiles were statistically correlated with clinicopathological and survival data. Results Fer1L4 lncRNA is overexpressed in ccRCC compared to adjacent normal tissues. Increased expression significantly correlates with tumor aggressiveness: high expression levels of Fer1L4 RNA were found in higher grade, higher stage, and metastatic tumors. Furthermore, Fer1L4 overexpression is an independent prognostic factor for overall, cancer-specific, and progression-free survival of patients with ccRCC. Conclusion Fer1L4 expression significantly correlates with aspects of tumor aggressiveness. Based on this impact on tumor progression and its influence as an independent prognostic factor, Fer1L4 appears to exert properties as an oncogene in ccRCC. As a prognostic tissue biomarker, further functional investigations are warranted to investigate Fer1L4 as a potential therapeutic target.
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Affiliation(s)
- A Cox
- Department of Urology, University Hospital Bonn, Bonn, Germany.
| | - Y Tolkach
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - G Kristiansen
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - M Ritter
- Department of Urology, University Hospital Bonn, Bonn, Germany
| | - J Ellinger
- Department of Urology, University Hospital Bonn, Bonn, Germany
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Alkis M, Cox A, Nitsche J, Heine P, Brost B. Ampicillin and metabolites in vaginal transudates after intravenous administration of ampicillin. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.10.015] [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]
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Alkis M, Cox A, Nitsche J, Heine P, Brost B. Distribution of ampicillin in vaginal transudates on anterior and posterior fornix sampling. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.10.016] [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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Berger G, Arora N, Burkovskiy I, Xia Y, Chinnadurai A, Westhofen R, Hagn G, Cox A, Kelly M, Zhou J, Lehmann C. Experimental Cannabinoid 2 Receptor Activation by Phyto-Derived and Synthetic Cannabinoid Ligands in LPS-Induced Interstitial Cystitis in Mice. Molecules 2019; 24:molecules24234239. [PMID: 31766439 PMCID: PMC6930590 DOI: 10.3390/molecules24234239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 12/22/2022] Open
Abstract
Interstitial cystitis (IC) is a chronic bladder disorder with unclear etiology. The endocannabinoid system has been identified as a key regulator of immune function, with experimental evidence for the involvement of cannabinoid receptors in bladder inflammation. This study used intravital microscopy (IVM) and behavioral testing in lipopolysaccharide-induced IC, to investigate the anti-inflammatory analgesic effects of a natural dietary sesquiterpenoid, beta-caryophyllene (BCP), which is present in cannabis among other plants, and has reported agonist actions at the cannabinoid 2 receptor (CB2R). BCP’s anti-inflammatory actions were compared to the synthetic CB2R-selective cannabinoid, HU308, and to an FDA-approved clinical treatment (dimethyl sulfoxide: DMSO). IVM data revealed that intravesical instillation of BCP and/or HU308 significantly reduces the number of adhering leukocytes in submucosal bladder venules and improves bladder capillary perfusion. The effects of BCP were found to be comparable to that of the selective CB2R synthetic cannabinoid, HU308, and superior to intravesical DMSO treatment. Oral treatment with BCP was also able to reduce bladder inflammation and significantly reduced mechanical allodynia in experimental IC. Based on our findings, we believe that CB2R activation may represent a viable therapeutic target for IC, and that drugs that activate CB2R, such as the generally regarded as safe (GRAS) dietary sesquiterpenoid, BCP, may serve as an adjunct and/or alternative treatment option for alleviating symptoms of inflammation and pain in the management of IC.
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Affiliation(s)
- Geraint Berger
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.B.); (N.A.); (I.B.); (Y.X.); (A.C.); (R.W.); (G.H.); (M.K.); (J.Z.)
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Nipun Arora
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.B.); (N.A.); (I.B.); (Y.X.); (A.C.); (R.W.); (G.H.); (M.K.); (J.Z.)
- Department of Microbiology & Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Ian Burkovskiy
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.B.); (N.A.); (I.B.); (Y.X.); (A.C.); (R.W.); (G.H.); (M.K.); (J.Z.)
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Yanfang Xia
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.B.); (N.A.); (I.B.); (Y.X.); (A.C.); (R.W.); (G.H.); (M.K.); (J.Z.)
| | - Anu Chinnadurai
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.B.); (N.A.); (I.B.); (Y.X.); (A.C.); (R.W.); (G.H.); (M.K.); (J.Z.)
| | - Robert Westhofen
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.B.); (N.A.); (I.B.); (Y.X.); (A.C.); (R.W.); (G.H.); (M.K.); (J.Z.)
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Georg Hagn
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.B.); (N.A.); (I.B.); (Y.X.); (A.C.); (R.W.); (G.H.); (M.K.); (J.Z.)
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Melanie Kelly
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.B.); (N.A.); (I.B.); (Y.X.); (A.C.); (R.W.); (G.H.); (M.K.); (J.Z.)
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Juan Zhou
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.B.); (N.A.); (I.B.); (Y.X.); (A.C.); (R.W.); (G.H.); (M.K.); (J.Z.)
- Department of Microbiology & Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.B.); (N.A.); (I.B.); (Y.X.); (A.C.); (R.W.); (G.H.); (M.K.); (J.Z.)
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Microbiology & Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Correspondence: ; Tel.: +1-(902)-423-9454
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Passby L, Silva S, Brock I, Wells G, Cox A, Danson S. Assessing melanoma BRAF status through ddPCR of cfDNA. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.055] [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: 11/12/2022] Open
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