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Barraclough ML, Diaz-Martinez JP, Knight A, Bingham K, Su J, Kakvan M, Grajales CM, Tartaglia MC, Ruttan L, Wither J, Choi MY, Bonilla D, Anderson N, Appenzeller S, Parker B, Katz P, Beaton D, Green R, Bruce IN, Touma Z. In-person versus virtual administration of the American College of Radiology gold standard cognitive battery in systemic lupus erythematosus: Are they interchangeable? Lupus 2023; 32:737-745. [PMID: 37036020 DOI: 10.1177/09612033231168477] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVE During the COVID-19 pandemic, many research studies were adapted, including our longitudinal study examining cognitive impairment (CI) in systemic lupus erythematosus (SLE). Cognitive testing was switched from in-person to virtual. This analysis aimed to determine if the administration method (in-person vs. virtual) of the ACR-neuropsychological battery (ACR-NB) affected participant cognitive performance and classification. METHODS Data from our multi-visit, SLE CI study included demographic, clinical, and psychiatric characteristics, and the modified ACR-NB. Three analyses were undertaken for cognitive performance: (1) all visits, (2) non-CI group visits only and (3) intra-individual comparisons. A retrospective preferences questionnaire was given to participants who completed the ACR-NB both in-person and virtually. RESULTS We analysed 328 SLE participants who had 801 visits (696 in-person and 105 virtual). Demographic, clinical, and psychiatric characteristics were comparable except for ethnicity, anxiety and disease-related damage. Across all three comparisons, six tests were consistently statistically significantly different. CI classification changed in 11/71 (15%) participants. 45% of participants preferred the virtual administration method and 33% preferred in-person. CONCLUSIONS Of the 19 tests in the ACR-NB, we identified one or more problems with eight (42%) tests when moving from in-person to virtual administration. As the use of virtual cognitive testing will likely increase, these issues need to be addressed - potentially by validating a virtual version of the ACR-NB. Until then, caution must be taken when directly comparing virtual to in-person test results. If future studies use a mixed administration approach, this should be accounted for during analysis.
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Affiliation(s)
- M L Barraclough
- Schroeder Arthritis Institute, Krembil Research Institute, 7989University Health Network, Toronto, ON, Canada
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, 5292The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - J P Diaz-Martinez
- Schroeder Arthritis Institute, Krembil Research Institute, 7989University Health Network, Toronto, ON, Canada
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, 7938University of Toronto Lupus Clinic, Toronto, ON, Canada
| | - A Knight
- Division of Rheumatology, 7979Hospital for Sick Children, Toronto, ON, Canada
- Neurosciences and Mental Health Program, SickKids Research Institute, Toronto, ON, Canada
| | - K Bingham
- Centre for Mental Health, 7989University Health Network, Toronto, ON, Canada
- Department of Psychiatry, 7938University of Toronto, Toronto, ON, Canada
| | - J Su
- Schroeder Arthritis Institute, Krembil Research Institute, 7989University Health Network, Toronto, ON, Canada
- Division of Rheumatology, 7979Hospital for Sick Children, Toronto, ON, Canada
| | - M Kakvan
- Schroeder Arthritis Institute, Krembil Research Institute, 7989University Health Network, Toronto, ON, Canada
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, 7938University of Toronto Lupus Clinic, Toronto, ON, Canada
| | - C Muñoz Grajales
- Schroeder Arthritis Institute, Krembil Research Institute, 7989University Health Network, Toronto, ON, Canada
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, 7938University of Toronto Lupus Clinic, Toronto, ON, Canada
| | - M C Tartaglia
- Krembil Research Institute, 7989University Health Network Memory Clinic, Toronto, ON, Canada
| | - L Ruttan
- 7961University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - J Wither
- Schroeder Arthritis Institute, Krembil Research Institute, 7989University Health Network, Toronto, ON, Canada
| | - M Y Choi
- Cumming School of Medicine, 70401University of Calgary, Calgary, AB, Canada
| | - D Bonilla
- Schroeder Arthritis Institute, Krembil Research Institute, 7989University Health Network, Toronto, ON, Canada
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, 7938University of Toronto Lupus Clinic, Toronto, ON, Canada
| | - N Anderson
- Schroeder Arthritis Institute, Krembil Research Institute, 7989University Health Network, Toronto, ON, Canada
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, 7938University of Toronto Lupus Clinic, Toronto, ON, Canada
| | - S Appenzeller
- Department of Orthopaedics, Rheumatology and Traumatology, 7938University of Campinas, São Paulo, Brazil
| | - B Parker
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, 5292The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - P Katz
- 8785University of California, San Francisco, CA, USA
| | - D Beaton
- Institute for Work and Health, 7966University of Toronto, Toronto, ON, Canada
| | - R Green
- Krembil Research Institute, 7989University Health Network Memory Clinic, Toronto, ON, Canada
| | - I N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, 5292The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Z Touma
- Schroeder Arthritis Institute, Krembil Research Institute, 7989University Health Network, Toronto, ON, Canada
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, 7938University of Toronto Lupus Clinic, Toronto, ON, Canada
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Aulakh A, Parker B, Sullivan B, Recsky M, Oliveira C, Richardson W, Hirschkorn P, Perini R, Bak A. A111 CLINICAL AND PATHOLOGICAL OUTCOMES BETWEEN WATER EXCHANGE AND AIR INSUFFLATION USING NON-SEDATED EXTENDED FLEXIBLE SIGMOIDOSCOPY FOR AVERAGE RISK COLORECTAL CANCER SCREENING: PRELIMINARY FINDINGS FROM A RANDOMIZED CONTROL TRIAL. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991151 DOI: 10.1093/jcag/gwac036.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Colorectal cancer (CRC) is Canada's third most common cancer type and represents approximately 11% of all cancer deaths. While sedated colonoscopy or flexible sigmoidoscopy (FS) continues to be considered for CRC screening, these modalities have limitations and risks. Another unevaluated screening modality, known as an extended FS (EFS), attempts to capitalize on the benefits of a FS while minimizing the risks involved with a sedated colonoscopy. EFS provides a scope-based examination up to the splenic flexure and then attempts to examine beyond, often to the point of the caecum. Providing the option for EFS may produce improvements in the patient experience and performance, which may improve the feasibility of using scope-based screening more broadly in screening programs. Purpose To determine the extent non-sedated EFS using the water exchange method (WE) is associated with a complete colon examination compared to the traditional air insufflation (AI) method using CO2 in an average-risk screening population. Method This randomized control trial included 90 non-sedated participants, screened by trained general surgery and gastroenterology clinicians at Kelowna General Hospital, British Columbia, Canada, using two different scope insufflation techniques, WE and AI. The primary outcome of interest was the cecal intubation rates (CIR), while secondary outcomes included the adenoma detection rate (ADR) and reported pain scores. Other metrics, such as patient satisfaction rates, sessile serrated adenoma detection rates (SSADR), and serrated lesion detection rates (SLDR) were also recorded. Result(s) The demographic characteristics between the WE and AI groups were statistically similar, with the mean age of participants being 58 and 57, respectively. During the study period, four endoscopists performed the EFS. There were higher initial satisfaction rates in the WE group vs the AI (95% vs 77%, satisfaction of ≥ 9/10 p = 0.028). CIR and ADR were similar between the WE and AI group (CIR = 93% vs 91%, p = 0.710), (ADR = 40% vs 34%, p = 0.660). The SSADR and SLDR were also similar between the WE and AI group (SSADR = 21% vs 14%, p = 0.408), (SLDR = 42% vs 36%, p = 0.528). Conclusion(s) EFS without sedation using either technique exceeds quality benchmarks recommended for sedated screening colonoscopy while maintaining adequate patient safety and comfort. The WE method optimizes a patient's overall experience making a strategy of average risk colorectal cancer screening with non-sedated WE EFS feasible. Please acknowledge all funding agencies by checking the applicable boxes below CAG, Other Please indicate your source of funding; Kelowna General Hospital, Interior Health Disclosure of Interest None Declared
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Affiliation(s)
- A Aulakh
- Faculty of Medicine , University of British Columbia
| | - B Parker
- Medicine , The Kelowna General Hospital , Kelowna,Provincial Health Services Authority, Vancouver
| | - B Sullivan
- Faculty of Medicine , University of British Columbia,Division of General Surgery, The Kelowna General Hospital , Kelowna
| | - M Recsky
- Faculty of Medicine , University of British Columbia,Division of General Surgery, The Kelowna General Hospital , Kelowna
| | - C Oliveira
- Medicine , The Kelowna General Hospital , Kelowna
| | - W Richardson
- Faculty of Medicine , University of British Columbia , Victoria
| | | | - R Perini
- Faculty of Medicine , University of British Columbia,Division of Gastroenterology, The Kelowna General Hospital , Kelowna, Canada
| | - A Bak
- Faculty of Medicine , University of British Columbia,Division of Gastroenterology, The Kelowna General Hospital , Kelowna, Canada
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Dyball S, Rodziewicz M, Sutton E, Parker B, Bruce IN. AB0513 COVID-19 PREVENTION IN PATIENTS WITH MODERATE-TO-SEVERE LUPUS DURING THE PANDEMIC: RESULTS FROM THE BILAG-BIOLOGICS REGISTER (BILAG-BR). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThere have been concerns over the susceptibility of SLE patients to severe COVID-19 illness since the beginning of the pandemic, and many patients were assigned ‘clinically extremely vulnerable’ according to the UK’s shielding guidance issued in March 2020. Here we report on vaccination and shielding behaviours of a moderate-to-severe SLE cohort with high immunosuppressant burden.ObjectivesTo review the shielding behaviours, and the safety and tolerability of COVID-19 vaccines in a real-world cohort of patients with moderate to severe SLE.MethodsThe British Isles Lupus Assessment Group Biologics Registry (BILAG-BR) is a national prospective registry of lupus patients from the UK (2010-21). Patients from the BILAG-BR were invited to complete a paper or online questionnaire which consisted of 17 questions to assess their self-reported shielding behaviour, vaccination status, and any adverse responses following COVID-19 vaccination. Questionnaires were completed between 9th Oct 2021 and 7th Jan 2022. Responses were linked with data collected in the BILAG-BR.ResultsData were collected from the first 202/1268 patients (186 [92.1%] women) to respond, with a median age of 51 (IQR 38-61) years from 37 UK centres. The majority of patients were Caucasian (78.1%, 150/192). Previous therapy included rituximab (165, 81.7%), belimumab (33, 16.3%) and cyclophosphamide (54, 26.7%). In the past 12 months, over two thirds of patients (138, 68.3%) had received oral prednisolone (current dose median 5mg [IQR 5-8mg, range 2-40mg] daily), and almost a third had received parental steroids (60, 29.7%).Shielding was reported in the first national lockdown (March-June 2020) by 93.6% (189/202) of patients, and of those in employment at the time, over half (58/100) were unable to work from home. The vast majority of patients complied with the UK government guidance (97.0%, 196/202) and did not socialise with other households indoors during this time period. Fifty-four percent of patients (109/202) reported attending a hospital or GP appointment during the first lockdown, and 24/202 (11.9%) reported regular appointments. During the first lockdown, 13/109 (11.9%) patients reported receiving rituximab infusions and 9/109 (8.3%) belimumab infusions.Ninety-seven percent (196/202) had received at least 1 COVID-19 vaccination (Oxford AstraZeneca 95/146, 65.1%; Pfizer/ BioNtech 50/146, 34.3%). Approximately half of patients (54.2%, 104/192) reported an adverse reaction to the vaccine (both vaccine doses in 45 (23.9%) patients). The majority of these included lethargy/ flu-like symptoms (82, 78.8%) or local site reactions (32, 30.8%). Six (3.0%) patients reported a lupus flare and 3 (1.5%) patients reported a hospital attendance due to vaccine side effects.ConclusionIn this cohort of moderate-to-severe SLE patients there was strong engagement with UK shielding guidance, however only half of patients attended a GP or hospital appointment during the earliest peak of the pandemic, highlighting disruptions to routine clinical care. There was high uptake of COVID-19 vaccination, which whilst generally well tolerated in this cohort, may be temporally associated with a flare, albeit in only a small number of patients. We recognise it may be difficult to distinguish between vaccine adverse events and lupus flares in patients with SLE, therefore this may be an overestimation. Of note, three patients reported a hospital attendance post-vaccination which warrants further investigation.AcknowledgementsSubmitted on behalf of the BILAG-biologics registerDisclosure of InterestsSarah Dyball Grant/research support from: UCB and Eli Lilly, Mia Rodziewicz Grant/research support from: UCB, Emily Sutton: None declared, Ben Parker Speakers bureau: Eli Lilly and Roche, Consultant of: Fresenius-Kabi and AbbVie, Grant/research support from: Genzyme/Sanofi and GSK, Ian N. Bruce Speakers bureau: AstraZeneca, GSK and UCB, Consultant of: AstraZeneca, Eli Lilly, GSK, Merck Serono, UCB and ILTOO, Grant/research support from: Genzyme/Sanofi, GSK, Roche and UCB
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Dyball S, Reynolds J, Herrick A, Chinoy H, Haque S, Naz S, Bruce E, Bruce IN, Parker B. POS0756 DETERMINANTS OF HEALTH-RELATED QUALITY OF LIFE (HR-QoL) ACROSS THE SPECTRUM OF SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASES: RESULTS FROM THE LEAP COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPoor health-related quality of life (HR-QoL) is recognised in patients with established connective tissue diseases (CTDs), however it is not clear how it affects patients with undifferentiated CTD (UCTD) which has traditionally been associated with a mild or more benign profile.ObjectivesTo investigate HR-QoL in patients affected with a variety of CTDs (including UCTD) using the SF-36 questionnaire; and secondly, to review demographic and clinical factors predictive of a poor HR-QoLMethodsThe Lupus Extended Autoimmune Phenotype (LEAP) cohort is a multicentre prospective study of patients with a CTD. Rheumatologist diagnosis was used to classify patients into four groups: systemic lupus erythematosus (SLE), primary Sjögren’s syndrome (pSS), UCTD, and (combined because of low numbers) those with an idiopathic inflammatory myopathy (IIM), systemic sclerosis (SSc) or overlap syndrome. The SF-36 quality of life questionnaire was completed at enrolment and includes eight domains: physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE) and mental health (MH) which range from 0 to 100, with higher scores reflecting better HR-QoL. Physical (PCS) and mental component score (MCS) were calculated for each group, with a score below 50 representing a worse HR-QoL compared to the general UK population. Predictors for poor HR-QoL was chosen a priori, then tested using linear regression adjusted for age, gender and ethnicity. All statistical analysis was performed using STATA v14, with results expressed as beta coefficients with 95% confidence intervals (95%CI).ResultsData were collected from 309 patients (280 [90.6%] women, with a mean [SD] age of 48.9 [12.9] years) from three UK rheumatology centres. The majority of patients were Caucasian (n=235, 76.1%). By rheumatologist diagnosis, 115 (37.2%) had SLE, 56 (18.1%) pSS, 72 (23.3%) UCTD and 66 (21.4%) SSc, IIM or an overlap syndrome. Patients with UCTD, pSS and SSc/IIM spectrum disorders had a shorter median disease duration (3.8, 3.7 and 6.1 years respectively) compared with patients with those with SLE (11.0 years), p<0.001. Previous steroid and immunosuppressant use was highest in patients with SLE and SSc/IIM spectrum disorders (p<0.001). The most affected domains include VT, GH and BP (Figure 1), and the PCS is more impaired compared with the MCS, with similar scores across disease groups. Agnostic of disease group, factors associated with a lower PCS include increasing age (beta -0.15 [95%CI -0.26, -0.06], p=0.008), prednisolone use (-3.1 [-6.05, -0.19], p=0.037), c-reactive protein (-0.09 [-0.62, -0.10], p=0.007), fatigue (-2.00 [-3.79, -0.22], p=0.028), and sicca syndrome (-4.70 [-7.66, -1.74] p=0.002), and these remained significant in a multivariate model.Figure 1.radar diagrams of eight SF-36 domains, and MCS and PCS boxplots. SLE; systemic lupus erythematosus; UCTD, undifferentiated CTD; pSS, primary Sjögren’s syndrome; IIM, idiopathic inflammatory myopathy; SSc, systemic sclerosis; PF, physical function; RP, role physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotional; MH, mental healthConclusionPatients with UCTD exhibit similar impairment in physical components of HR-QoL compared with other established CTDs, despite perceived differences in disease severity. This study highlights sicca syndrome, fatigue, and steroid burden as key targets for improving HR-QoL in patients across the spectrum of CTDs.Disclosure of InterestsSarah Dyball Grant/research support from: UCB and Eli Lilly, John Reynolds: None declared, Ariane Herrick Speakers bureau: Janssen, Consultant of: Arena, Boehringer-Ingelheim, Camurus, CSL-Behring, and Gesynta, Grant/research support from: Gesynta, Hector Chinoy Speakers bureau: UCB, Biogen, Consultant of: Novartis, Eli Lilly, Orphazyme, Astra Zeneca, Grant/research support from: Eli Lilly and UCB, Sahena Haque: None declared, Sophia Naz: None declared, Ellen Bruce: None declared, Ian N. Bruce Speakers bureau: AstraZeneca, GSK and UCB, Consultant of: AstraZeneca, Eli Lilly, GSK, Merck Serono, UCB and ILTOO, Grant/research support from: Genzyme/Sanofi, GSK, Roche and UCB, Ben Parker Speakers bureau: Eli Lilly and Roche, Consultant of: Fresenius-Kabi and AbbVie, Grant/research support from: Genzyme/Sanofi and GSK
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Dyball S, Rodziewicz M, Sutton E, Parker B, Bruce IN. POS0757 COVID-19 INFECTION AND RECOVERY AMONGST PATIENTS WITH MODERATE-TO-SEVERE LUPUS DURING THE PANDEMIC: RESULTS FROM THE BILAG-BIOLOGICS REGISTER (BILAG-BR). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2897] [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: 11/04/2022]
Abstract
BackgroundPatients with systemic lupus erythematosus (SLE) are thought to be at greater risk of severe COVID-19 illness and associated complications due to a combination of inherent aberrant immune responses, immunosuppressive medications and co-morbidities.ObjectivesTo review COVID-19 infections, hospitalisation and recovery in a real-world cohort of patients with moderate to severe SLE and high immunosuppressant use.MethodsThe British Isles Lupus Assessment Group Biologics Registry (BILAG-BR) is a national prospective registry of lupus patients from the UK (2010-21) requiring significant immunosuppressive therapies. Patients from the BILAG-BR were invited to complete a paper or online questionnaire which consisted of 17 questions to assess prior COVID-19 infection and their recovery during the COVID-19 pandemic. Questionnaires were completed between 9th Oct 2021 and 7th Jan 2022. Responses were linked with data collected in the BILAG-BR. Mortality data were collected from study centres and the Office of National Statistics from Dec 2019-Jan 2022.ResultsData were collected from the first 202/1268 patients to respond. Patients were predominately female (186, 92.1%), had a median age of 51 (IQR 38-61) years and were from 37 UK centres. Previous therapy included rituximab (165, 81.7%), belimumab (33, 16.3%) and cyclophosphamide (54, 26.7%). In the past 12 months, over two thirds of patients (138, 68.3%) had received oral prednisolone (current median dose 5mg [IQR 5-8mg] daily), and almost a third had received parental steroids (60, 29.7%).Self-reported COVID-19 diagnosis occurred in 48 (23.8%) patients, of whom 20 reported a positive test. Eleven (55%) patients reported testing positive for COVID-19 after being vaccinated. Median reported recovery was 80% (IQR 60-100%), with subjective full recovery reported in 30% of patients (6/20) who had received a positive test. Of the 20 patients who tested positive for COVID-19, 5 were receiving belimumab, 1 tocilizumab, and in the prior 12 months, 2 had received cyclophosphamide and 4 rituximab.Of all respondents, three individuals were hospitalised with COVID-19, and one required an ICU admission. Of those hospitalised, two patients were unvaccinated prior to COVID-19 infection, and the other patient had received rituximab and cyclophosphamide prior to vaccination. Four/1387 patients registered in the BILAG-BR were confirmed to have died from COVID-19 since the beginning of the pandemic.ConclusionIn this cohort of moderate-to-severe SLE patients there was a low incidence of COVID-19 infection. Despite this, full recovery from PCR or lateral flow test proven COVID-19 infection was seen in only a third of patients. This raises concerns over the potential risk of long COVID in patients with SLE and warrants further investigation.AcknowledgementsSubmitted on behalf of the BILAG-biologics registerDisclosure of InterestsSarah Dyball Grant/research support from: UCB and Eli Lilly, Mia Rodziewicz Grant/research support from: UCB, Emily Sutton: None declared, Ben Parker Speakers bureau: Eli Lilly and Roche, Consultant of: Fresenius-Kabi and AbbVie, Grant/research support from: Genzyme/Sanofi and GSK, Ian N. Bruce Speakers bureau: AstraZeneca, GSK and UCB, Consultant of: AstraZeneca, Eli Lilly, GSK, Merck Serono, UCB and ILTOO, Grant/research support from: Genzyme/Sanofi, GSK, Roche and UCB
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Greaves GE, Yee B, Harding KG, Nguyen VC, Parker B, Perren J, Richardson W, Bak AW, Perini R, Jowhari F, Tai T. A95 OUTCOMES OF ERCP UNDER CONSCIOUS SEDATION COMPARED TO GENERAL ANESTHESIA: A PRE-POST RETROSPECTIVE COHORT REVIEW. J Can Assoc Gastroenterol 2022. [DOI: 10.1093/jcag/gwab049.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure used to address pathologies of the pancreatic and biliary systems. ERCP performed under conscious sedation (CS) is the current standard of care but is limited by patient movement and agitation, especially in the context of lengthy or technically complex cases. Recent literature suggests that general anesthesia (GA) may optimize patient comfort and safety while reducing complications such as pancreatitis, perforation, and mortality. In October 2017, Kelowna General Hospital (KGH) transitioned the standard anesthesia modality for ERCP from CS to GA.
Aims
To investigate differences in complications and patient outcomes for ERCP performed under CS (n=1334) before the practice change compared to GA (n=899) after the practice change.
Methods
Our study is a pre-post retrospective chart review of 2,233 patients who underwent ERCP between 2015 and 2020 at KGH. Demographic, clinical, procedural and outcome data were extracted from patient charts, and the data in CS and GA groups were compared using univariate statistical analysis.
Results
Preliminary results show rates of post-ERCP pancreatitis (6% vs. 4%; p=0.018) and rates of procedure failure (8% vs. 3%; p<0.001) were statistically significant and higher under CS before the practice change compared to under GA afterwards, respectively. The 30-day mortality rates, ICU transfer rates, return rates post-discharge, and rates of cholangitis were similar.
Our study showed improvements in several patient safety outcomes, including lower procedure failure rates and lower post-ERCP pancreatitis rates with ERCP performed under GA compared to CS.
Conclusions
Performing ERCP under GA rather than under CS is a valuable practice change that should be considered by ERCP-related programs across all health authorities due to its potential to optimize both patient comfort and safety significantly. The reduction in complication rates may have implications for net cost savings in the long term.
Funding Agencies
Kelowna General Hospital Foundation, Interior Health
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Affiliation(s)
- G E Greaves
- Faculty of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - B Yee
- Faculty of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - K G Harding
- Faculty of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - V C Nguyen
- Faculty of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - B Parker
- Kelowna General Hospital, Kelowna, BC, Canada
| | - J Perren
- Faculty of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - W Richardson
- Faculty of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - A W Bak
- Kelowna General Hospital, Kelowna, BC, Canada
| | - R Perini
- Kelowna General Hospital, Kelowna, BC, Canada
| | - F Jowhari
- Kelowna General Hospital, Kelowna, BC, Canada
| | - T Tai
- Faculty of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
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Acharya B, Alexandre J, Benes P, Bergmann B, Bertolucci S, Bevan A, Branzas H, Burian P, Campbell M, Cho YM, de Montigny M, De Roeck A, Ellis JR, Sawy ME, Fairbairn M, Felea D, Frank M, Gould O, Hays J, Hirt AM, Ho DLJ, Hung PQ, Janecek J, Kalliokoski M, Korzenev A, Lacarrère DH, Leroy C, Levi G, Lionti A, Maulik A, Margiotta A, Mauri N, Mavromatos NE, Mermod P, Millward L, Mitsou VA, Ostrovskiy I, Ouimet PP, Papavassiliou J, Parker B, Patrizii L, Păvălaş GE, Pinfold JL, Popa LA, Popa V, Pozzato M, Pospisil S, Rajantie A, de Austri RR, Sahnoun Z, Sakellariadou M, Santra A, Sarkar S, Semenoff G, Shaa A, Sirri G, Sliwa K, Soluk R, Spurio M, Staelens M, Suk M, Tenti M, Togo V, Tuszyn'ski JA, Upreti A, Vento V, Vives O. Search for magnetic monopoles produced via the Schwinger mechanism. Nature 2022; 602:63-67. [PMID: 35110756 DOI: 10.1038/s41586-021-04298-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022]
Abstract
Electrically charged particles can be created by the decay of strong enough electric fields, a phenomenon known as the Schwinger mechanism1. By electromagnetic duality, a sufficiently strong magnetic field would similarly produce magnetic monopoles, if they exist2. Magnetic monopoles are hypothetical fundamental particles that are predicted by several theories beyond the standard model3-7 but have never been experimentally detected. Searching for the existence of magnetic monopoles via the Schwinger mechanism has not yet been attempted, but it is advantageous, owing to the possibility of calculating its rate through semi-classical techniques without perturbation theory, as well as that the production of the magnetic monopoles should be enhanced by their finite size8,9 and strong coupling to photons2,10. Here we present a search for magnetic monopole production by the Schwinger mechanism in Pb-Pb heavy ion collisions at the Large Hadron Collider, producing the strongest known magnetic fields in the current Universe11. It was conducted by the MoEDAL experiment, whose trapping detectors were exposed to 0.235 per nanobarn, or approximately 1.8 × 109, of Pb-Pb collisions with 5.02-teraelectronvolt center-of-mass energy per collision in November 2018. A superconducting quantum interference device (SQUID) magnetometer scanned the trapping detectors of MoEDAL for the presence of magnetic charge, which would induce a persistent current in the SQUID. Magnetic monopoles with integer Dirac charges of 1, 2 and 3 and masses up to 75 gigaelectronvolts per speed of light squared were excluded by the analysis at the 95% confidence level. This provides a lower mass limit for finite-size magnetic monopoles from a collider search and greatly extends previous mass bounds.
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Affiliation(s)
- B Acharya
- Theoretical Particle Physics & Cosmology Group, Physics Department, King's College London, London, UK
| | - J Alexandre
- Theoretical Particle Physics & Cosmology Group, Physics Department, King's College London, London, UK
| | - P Benes
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - B Bergmann
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | | | - A Bevan
- School of Physics and Astronomy, Queen Mary University of London, London, UK
| | - H Branzas
- Institute of Space Science, Măgurele, Romania
| | - P Burian
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - M Campbell
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - Y M Cho
- Center for Quantum Spacetime, Sogang University, Seoul, Korea
| | - M de Montigny
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - A De Roeck
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - J R Ellis
- Theoretical Particle Physics & Cosmology Group, Physics Department, King's College London, London, UK.,Theoretical Physics Department, CERN, Geneva, Switzerland
| | - M El Sawy
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - M Fairbairn
- Theoretical Particle Physics & Cosmology Group, Physics Department, King's College London, London, UK
| | - D Felea
- Institute of Space Science, Măgurele, Romania
| | - M Frank
- Department of Physics, Concordia University, Montreal, Quebec, Canada
| | - O Gould
- University of Nottingham, Nottingham, UK.,Helsinki Institute of Physics, University of Helsinki, Helsinki, Finland
| | - J Hays
- School of Physics and Astronomy, Queen Mary University of London, London, UK
| | - A M Hirt
- Department of Earth Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - D L-J Ho
- Department of Physics, Imperial College London, London, UK
| | - P Q Hung
- Department of Physics, University of Virginia, Charlottesville, VA, USA
| | - J Janecek
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - M Kalliokoski
- Helsinki Institute of Physics, University of Helsinki, Helsinki, Finland
| | - A Korzenev
- Département de Physique Nucléaire et Corpusculaire, Université de Genève, Geneva, Switzerland
| | - D H Lacarrère
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - C Leroy
- Département de Physique, Université de Montréal, Montreal, Quebec, Canada
| | - G Levi
- INFN, Section of Bologna, Bologna, Italy.,Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - A Lionti
- Département de Physique Nucléaire et Corpusculaire, Université de Genève, Geneva, Switzerland
| | - A Maulik
- INFN, Section of Bologna, Bologna, Italy.,Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - A Margiotta
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - N Mauri
- INFN, Section of Bologna, Bologna, Italy
| | - N E Mavromatos
- Theoretical Particle Physics & Cosmology Group, Physics Department, King's College London, London, UK
| | - P Mermod
- Département de Physique Nucléaire et Corpusculaire, Université de Genève, Geneva, Switzerland
| | - L Millward
- School of Physics and Astronomy, Queen Mary University of London, London, UK
| | - V A Mitsou
- IFIC, Universitat de València, CSIC, Valencia, Spain
| | - I Ostrovskiy
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, AL, USA.
| | - P-P Ouimet
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | | | - B Parker
- Institute for Research in Schools, Canterbury, UK
| | - L Patrizii
- INFN, Section of Bologna, Bologna, Italy
| | - G E Păvălaş
- Institute of Space Science, Măgurele, Romania
| | - J L Pinfold
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - L A Popa
- Institute of Space Science, Măgurele, Romania
| | - V Popa
- Institute of Space Science, Măgurele, Romania
| | - M Pozzato
- INFN, Section of Bologna, Bologna, Italy
| | - S Pospisil
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - A Rajantie
- Department of Physics, Imperial College London, London, UK
| | | | - Z Sahnoun
- INFN, Section of Bologna, Bologna, Italy
| | - M Sakellariadou
- Theoretical Particle Physics & Cosmology Group, Physics Department, King's College London, London, UK
| | - A Santra
- IFIC, Universitat de València, CSIC, Valencia, Spain
| | - S Sarkar
- Theoretical Particle Physics & Cosmology Group, Physics Department, King's College London, London, UK
| | - G Semenoff
- Department of Physics, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Shaa
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - G Sirri
- INFN, Section of Bologna, Bologna, Italy
| | - K Sliwa
- Department of Physics and Astronomy, Tufts University, Medford, MA, USA
| | - R Soluk
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - M Spurio
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - M Staelens
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - M Suk
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | | | - V Togo
- INFN, Section of Bologna, Bologna, Italy
| | - J A Tuszyn'ski
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - A Upreti
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, AL, USA
| | - V Vento
- IFIC, Universitat de València, CSIC, Valencia, Spain
| | - O Vives
- IFIC, Universitat de València, CSIC, Valencia, Spain
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Voges H, Parker B, Quaife-Ryan G, Friedmand C, Palpant N, Del Monte-Nieto G, Elliott D, Mills R, Porrello E, Hudson J. Development of a Vascularised Cardiac Organoid Platform Reveals a Regulatory Role for Extracellular Matrix Environment on Muscle Functionality. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.536] [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: 10/16/2022]
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Sergienko N, Kiriazis H, Donner D, Matsumoto A, Luo J, Molendijk J, Parker B, McMullen J, Weeks K. Adopting a Phosphoproteomics Approach to Investigate a Role for Protein Phosphatase 2A (PP2A) Regulatory Subunit B55α in Cardiac β-Adrenergic Receptor Signalling. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.534] [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: 10/16/2022]
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Velvet AJ, Vohra S, David T, Keavney B, Bruce I, Parker B, Bratis K. AB0291 PROGNOSTIC VALUE OF LATE GADOLINIUM ENHANCEMENT ON CARDIAC MAGNETIC RESONANCE IMAGING IN SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Cardiac Magnetic Resonance Imaging (CMRI) with Late Gadolinium Enhancement (LGE) has an established value in the diagnostic and prognostic assessment of ischaemic and non-ischaemic cardiomyopathies. Although CMRI is widely used for the detection of myocardial involvement in subclinical Systemic Lupus Erythematosus (SLE), its prognostic value has not been determined.Objectives:To determine the prognostic value of CMRI with LGE for major adverse cardiovascular events (MACE) in patients with SLE, and investigate its correlation with the severity of systemic inflammation.Methods:A retrospective tertiary single-centre review of patients with SLE who underwent a CMRI study at Manchester Foundation Trust between 2009-2020 was conducted. Patients were categorized into two groups; those who experienced a MACE (cardiac death, myocardial infarction (MI), stroke/TIA or heart failure) and those who did not. We compared cardiovascular (CV) risk factors, CMRI findings, SLE risk scores and biochemistry between the 2 groups.Results:We identified 20 female patients who underwent a CMRI, with a mean age of 46 years at the time of the scan. Indications for CMRI were assessment for worsening dyspnoea and new onset left ventricular systolic dysfunction. Table 1 demonstrates the clinical, laboratory and CMRI characteristics of the two groups. There were no significant differences in the clinical background and traditional CV risk factors between the 2 groups. 5/20 (25%) patients experienced a MACE. The SLEDAI-2K score was >12 in 2/5 (40%) of patients who suffered a MACE and they presented with a stroke within a year of CMRI study, suggesting that systemic inflammation contributes to poor vascular outcomes. 3/5 (60%) patients who reported a MACE demonstrated LGE on their CMRI study compared to 3/15 (20%) of those who did not (p-0.045). The LGE was predominantly diffuse, mid myocardial in distribution and not ischaemic in pattern, signifying a complex pathophysiological substrate in the development of myocardial pathology in SLE. Additionally, an increase in left ventricular end-diastolic, end-systolic volumes and left atrial diameter was noted in patients who had a MACE (p<0.05). Patients who had a MACE showed a higher incidence of valvular abnormalities and pericardial disease in their CMRI studies. On looking at the medications around the CMRI, the majority of MACE positive patients 4/5 (80%) were on conventional Disease Modifying Anti-Rheumatic Drugs (DMARDs) such as Mycophenolate, Tacrolimus, Cyclophosphamide, Methotrexate or hydroxychloroquine and none on biologics like Rituximab or Belimumab. While 9/15 of the MACE negative patients were on DMARDs and 4/15 were on biologics.Table 1.clinical, laboratory and CMRI characteristics of SLE patients with and without MACE. LVEDV-left ventricular end-diastolic volume, LVESV-left ventricular end-systolic volume, LA-left atrial, LVEF-Left ventricular ejection fraction, SLEDAI- SLE Disease Activity Index, +ve-positive.MACE+ (n = 5)MACE- (n = 15)Mean age of SLE diagnosis (years)35.634.4Mean duration to CMRI (years)8.811.71Lupus nephritis 20%20%Raynaud’s 40%27%Previous CV involvement02 SLEDAI-2K > 122(40%)11(73%)Lupus anticoagulant +ve20%27%Anticardiolipin +ve2(40%)2(14%)anti-dsDNA (iu/ml)+ve3(60%)6(40%)Low C3 (g/L)2(40%)6(40%)Mean prednisolone dose28.338.21 Conventional DMARDs4/5(80%)9/15(60%)Biologics0/54/15Mean LVEF (%)47.456.7CMR LGE3(60%)3(20%)Valvular abnormalities 2(40%) 4(27%)Mean LA area (cm2) 29.620.6Pericardial effusion 40%27%Conclusion:In our small SLE cohort, we add to existing knowledge that CMRI with LGE is an indispensable tool to investigate cardiac involvement in SLE and may indeed add important prognostic information. Larger scaled studies are required to confirm the use of CMRI with LGE as a predictor of MACE in patients with SLE.Disclosure of Interests:None declared
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Lin T, Tai T, Parker B, Taylor SA, Trasolini R, Perini R, Bak AW. A122 WATER EXCHANGE FACILITATES HIGH CECAL INTUBATION RATE FOLLOWING INCOMPLETE COLONOSCOPY. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Incomplete colonoscopy is a complex problem that negatively affects the success of colon cancer screening programs. Failure to intubate the cecum is associated with a significant risk of missed colorectal cancer and increases costs through missed diagnoses and salvage investigations. Water exchange (WE) colonoscopy is associated with a high rate of patient comfort and cecal intubation (CI) and may be of value in preventing and following up on incomplete colonoscopy.
Aims
To estimate effectiveness of WE colonoscopy as initial salvage of incomplete colonoscopy.
Methods
All patients referred to the Kelowna Gastroenterology group for incomplete colonoscopy between Jan 2010 to Dec 2019 were included. Demographic, clinical, procedural, and pathological information were collected via retrospective chart review. Patients underwent WE colonoscopy by a single endoscopist. The outcomes evaluated were CI rate, sedation requirements, and adenoma detection.
Results
116 patients met study criteria and underwent WE colonoscopy after a previously failed or incomplete colonoscopy for technical reasons. The mean age was 66 years (range 21–89). 83 (72%) patients were female. 53 (46%) patients had previous abdominal surgery, and 42 (36%) had previous pelvic surgery. 65 (56%) patients had previous bowel disease. 81 (70%) patients had previously incomplete conventional air insufflation (AI) colonoscopy, 9 (8%) patients had previously incomplete WE colonoscopy, and 5 (4%) patients underwent unsuccessful combination of WE and AI colonoscopy. 17 (15%) patients had previously incomplete flexible sigmoidoscopy, and 4 (3%) patients had previously incomplete water immersion colonoscopy. The most common cause of unsuccessful CI was redundant colon (n=39, 34%) followed by strictures/angulations (n=16, 14%). 105 (91%) patients underwent repeat WE colonoscopy only, while 7 (6%) patients had combination WE and AI colonoscopy and 4 (3%) patients had concurrent gastroscopy. CI was successful in 114 (98%) patients and unsuccessful in 2 (2%) patients. 87 (75%) study patients received conscious sedation, 16 (14%) opted for no sedation, and 7 (6%) attempted no sedation then switched to conscious sedation. 5 patients (4%) required general anesthesia. CI was achieved in all 16 unsedated patients. 236 polyps were identified in 79 (68%) patients, 2 (1%) of which were malignant.
Conclusions
There is no standardized approach to incomplete colonoscopy. In this cohort of patients with previous failed attempt at colonoscopy, WE as a primary technique was associated with a high success rate with minimal need for general anesthesia and a high rate of polyp detection. A significant rate of colon cancer was identified, similar to that seen in general screening populations.
Funding Agencies
None
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Affiliation(s)
- T Lin
- The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - T Tai
- The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - B Parker
- Kelowna General Hospital, Kelowna, BC, Canada
| | - S A Taylor
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - R Trasolini
- The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - R Perini
- Kelowna General Hospital, Kelowna, BC, Canada
| | - A W Bak
- Kelowna General Hospital, Kelowna, BC, Canada
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Acharya B, Alexandre J, Benes P, Bergmann B, Bernabéu J, Bevan A, Branzas H, Burian P, Campbell M, Cecchini S, Cho YM, de Montigny M, De Roeck A, Ellis JR, El Sawy M, Fairbairn M, Felea D, Frank M, Hays J, Hirt AM, Janecek J, Kalliokoski M, Korzenev A, Lacarrère DH, Leroy C, Levi G, Lionti A, Mamuzic J, Maulik A, Margiotta A, Mauri N, Mavromatos NE, Mermod P, Mieskolainen M, Millward L, Mitsou VA, Orava R, Ostrovskiy I, Ouimet PP, Papavassiliou J, Parker B, Patrizii L, Păvălaş GE, Pinfold JL, Popa LA, Popa V, Pozzato M, Pospisil S, Rajantie A, Ruiz de Austri R, Sahnoun Z, Sakellariadou M, Santra A, Sarkar S, Semenoff G, Shaa A, Sirri G, Sliwa K, Soluk R, Spurio M, Staelens M, Suk M, Tenti M, Togo V, Tuszyński JA, Upreti A, Vento V, Vives O, Wall A. First Search for Dyons with the Full MoEDAL Trapping Detector in 13 TeV pp Collisions. Phys Rev Lett 2021; 126:071801. [PMID: 33666471 DOI: 10.1103/physrevlett.126.071801] [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] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/10/2020] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
The MoEDAL trapping detector consists of approximately 800 kg of aluminum volumes. It was exposed during run 2 of the LHC program to 6.46 fb^{-1} of 13 TeV proton-proton collisions at the LHCb interaction point. Evidence for dyons (particles with electric and magnetic charge) captured in the trapping detector was sought by passing the aluminum volumes comprising the detector through a superconducting quantum interference device (SQUID) magnetometer. The presence of a trapped dyon would be signaled by a persistent current induced in the SQUID magnetometer. On the basis of a Drell-Yan production model, we exclude dyons with a magnetic charge ranging up to five Dirac charges (5g_{D}) and an electric charge up to 200 times the fundamental electric charge for mass limits in the range 870-3120 GeV and also monopoles with magnetic charge up to and including 5g_{D} with mass limits in the range 870-2040 GeV.
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Affiliation(s)
- B Acharya
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College, London, United Kingdom
| | - J Alexandre
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College, London, United Kingdom
| | - P Benes
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - B Bergmann
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - J Bernabéu
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - A Bevan
- School of Physics and Astronomy, Queen Mary University of London, London, United Kingdom
| | - H Branzas
- Institute of Space Science, Bucharest, Măgurele, Romania
| | - P Burian
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - M Campbell
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - S Cecchini
- INFN, Section of Bologna, Bologna, Italy
| | - Y M Cho
- Center for Quantum Spacetime, Sogang University, Seoul, Korea
| | - M de Montigny
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - A De Roeck
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - J R Ellis
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College, London, United Kingdom
- Theoretical Physics Department, CERN, Geneva, Switzerland
| | - M El Sawy
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - M Fairbairn
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College, London, United Kingdom
| | - D Felea
- Institute of Space Science, Bucharest, Măgurele, Romania
| | - M Frank
- Department of Physics, Concordia University, Montréal, Québec, Canada
| | - J Hays
- School of Physics and Astronomy, Queen Mary University of London, London, United Kingdom
| | - A M Hirt
- Department of Earth Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - J Janecek
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - M Kalliokoski
- Physics Department, University of Helsinki, Helsinki, Finland
| | - A Korzenev
- Département de Physique Nucléaire et Corpusculaire, Université de Genève, Geneva, Switzerland
| | - D H Lacarrère
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - C Leroy
- Département de Physique, Université de Montréal, Québec, Canada
| | - G Levi
- INFN, Section of Bologna and Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - A Lionti
- Département de Physique Nucléaire et Corpusculaire, Université de Genève, Geneva, Switzerland
| | - J Mamuzic
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - A Maulik
- INFN, Section of Bologna, Bologna, Italy
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - A Margiotta
- INFN, Section of Bologna and Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - N Mauri
- INFN, Section of Bologna, Bologna, Italy
| | - N E Mavromatos
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College, London, United Kingdom
| | - P Mermod
- Département de Physique Nucléaire et Corpusculaire, Université de Genève, Geneva, Switzerland
| | - M Mieskolainen
- Physics Department, University of Helsinki, Helsinki, Finland
| | - L Millward
- School of Physics and Astronomy, Queen Mary University of London, London, United Kingdom
| | - V A Mitsou
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - R Orava
- Physics Department, University of Helsinki, Helsinki, Finland
| | - I Ostrovskiy
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama, USA
| | - P-P Ouimet
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | | | - B Parker
- Institute for Research in Schools, Canterbury, United Kingdom
| | - L Patrizii
- INFN, Section of Bologna, Bologna, Italy
| | - G E Păvălaş
- Institute of Space Science, Bucharest, Măgurele, Romania
| | - J L Pinfold
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - L A Popa
- Institute of Space Science, Bucharest, Măgurele, Romania
| | - V Popa
- Institute of Space Science, Bucharest, Măgurele, Romania
| | - M Pozzato
- INFN, Section of Bologna, Bologna, Italy
| | - S Pospisil
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - A Rajantie
- Department of Physics, Imperial College London, United Kingdom
| | | | - Z Sahnoun
- INFN, Section of Bologna, Bologna, Italy
| | - M Sakellariadou
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College, London, United Kingdom
| | - A Santra
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - S Sarkar
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College, London, United Kingdom
| | - G Semenoff
- Department of Physics, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Shaa
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - G Sirri
- INFN, Section of Bologna, Bologna, Italy
| | - K Sliwa
- Department of Physics and Astronomy, Tufts University, Medford, Massachusetts, USA
| | - R Soluk
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - M Spurio
- INFN, Section of Bologna and Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - M Staelens
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - M Suk
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | | | - V Togo
- INFN, Section of Bologna, Bologna, Italy
| | - J A Tuszyński
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - A Upreti
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama, USA
| | - V Vento
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - O Vives
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - A Wall
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama, USA
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Parker B, Jennings S. 380TF Mixed Asynchronous/Didactic ECG Curriculum to Increase Resident Competency. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.396] [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: 11/26/2022]
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Dyball S, Collinson S, Sutton E, Mccarthy E, Parker B, Bruce IN. SAT0168 ONLY ONE THIRD OF REAL WORLD LUPUS PATIENTS MEET ELIGIBILITY CRITERIA FOR CLINICAL TRIALS: IMPLICATIONS FOR TRIAL VALIDITY AND GENERALISABILITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Despite unprecedented drug development in SLE, the paucity of approved therapies remains a significant challenge. Recent trials have highlighted the need for minimising heterogeneity within SLE populations; however, there is concern this results in the recruitment of patients that are not representative of the SLE population.Objectives:Our aim was to apply published trial eligibility criteria to patients with non-renal SLE in a large UK-wide register to quantify how accurately these clinical trials represent a real-world cohort.Methods:A literature review of all major published double-blinded randomised phase III trials in non-renal SLE was performed (n=12). Inclusion and exclusion criteria common across the majority of clinical trials were applied to all patients recruited to the BILAG-BR (BILAG biologics register) starting either biological therapy or standard of care (SOC). We applied available data to common inclusion criteria including age ≥18 years, ACR 1997 SLE classification criteria, positive anti-dsDNA or ANA antibodies, active disease (defined as a BILAG A in 1 domain or a BILAG B in ≥2 domains, or a SLEDAI ≥6); and common exclusion criteria including restricted medication rules, active renal or neurological SLE (defined as a BILAG A in either domain), a history of hepatitis B or C, a history of malignancy (excluding basal cell carcinoma), CKD stage 4 or 5, a UPCR ≥100mg/mmol, and cytopenias (defined as neutrophils <1.0 x109/L, platelets <10 x109/L or Hb <70g/L). Baseline variables were compared using chi-squared test.Results:As of July 2018, 837 patients were recruited to the BILAG-BR starting either SOC (n=125) or a biologic therapy (n=712). The commonest biologic and SOC therapy was rituximab (n=662, 93%) and mycophenolate (n=64, 51%) respectively. Patients taking SOC were more likely to have inactive disease, as well as having higher steroid doses and less exposure to previous cyclophosphamide or B cell therapy. In the biologic and SOC groups, 476 (67%) and 71 (57%) respectively met all inclusion criteria (table 1). One or more exclusion criteria were met by 324 (46%) of the biologics group and 46 (37%) of the SOC group. As such, 562 (67%) patients were not eligible to enrol in a clinical trial. The patients not eligible to participate were similar in age (P=1.0), gender (P=0.7) and ethnicity (p=0.5) to those who were eligible. Median disease duration was longer in patients eligible to participate (2.9 vs. 5.1 years, p<0.01).Table 1.Patients from the BILAG-BR who meet eligibility criteria for major SLE clinical trialsInclusion criteriaBiologic (n=712)SOC (n=125)P valueAge ≥18 years7061220.1Meet ACR criteria for SLE6751160.4Antibody positive567990.9Active disease62697<0.01Total meeting all inclusion criteria476710.03Exclusion criteriaBiologic (n=712)SOC (n=125)P valueSteroids >40mg prednisolone98<0.001Active CNS SLE3971.0Active renal SLE138280.4Hepatitis B or C2010.2Malignancy5250.2Cyclophosphamide <90 days before entry370<0.01B cell therapy <1 year before entry500<0.01CKD 4/ 52230.7UPCR ≥100mg/mmol92201.0Low blood counts2510.1Pregnancy310.6Total number of patients excluded324460.1TotalNOT*eligible for clinical trial(n)562/837 (67%)1.0Conclusion:In a large national register of SLE patients, we found that two thirds of patients would not be eligible for recruitment to clinical trials using published inclusion and exclusion criteria. These results suggest that clinical trial recruits are not fully representative of the target disease population. This limits the generalisability of clinical trial results and supports the need for evidence from real world studies to fully understand the effectiveness of new therapies.Disclosure of Interests: :Sarah Dyball: None declared, Sophie Collinson: None declared, Emily Sutton: None declared, Eoghan McCarthy: None declared, Ben Parker Grant/research support from: GSK and Sanofi Genzyme, Consultant of: GSK, AstraZenaca, UCV, Abbvie, Pfizer, BMS, Celltrion, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GSK, and UCB, Consultant of: Eli Lilly, AstraZeneca, UCB, Iltoo, and Merck Serono, Speakers bureau: UCB
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Barraclough M, Parker B, Mckie S, Pemberton P, Jackson A, Elliott R, Bruce IN. AB0402 DISEASE ACTIVITY AND OBSESSIVE-COMPULSIVE DISORDER IN SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Obsessive-compulsive disorder (OCD) is more prevalent in systemic autoimmune diseases when compared to healthy controls. This is in part due to inflammatory mechanisms, common across both conditions. Neuroinflammation and specifically problems within the basal ganglia are associated with OCD.Objectives:The primary objective of this analysis was to investigate the effects of disease activity in systemic lupus erythematosus (SLE) on OCD. Other variables investigated included psychiatric aspects, inflammatory biomarkers and structural brain abnormalities.Methods:SLE patients who met ACR or SLICC criteria were recruited. Demographic and clinical data were collected and data measuring disease activity (BILAG and SLEDAI-2K), disease damage (SLICC-DI), depression (MADRS, BDI-II, HADS), anxiety (HADS, STAI), fatigue (FSMC), quality of life (LupusQoL and EQ5D), inflammatory and endothelial activation (EA) biomarkers (IL-6, ESR, TNF-α, MCP-1, hsCRP, BLyS, VCAM-1, VEGF, EMVs) and OCD (OCI-R). MRI FLAIR structural scans were also used to examine signal hyperintensities in the brain. Participants with active disease (SLE-F) also had a 2ndvisit approx. 4 months later. Non-parametric correlations with the OCI-R were undertaken for all SLE participants and for the change over time scores for the SLE-F participants (n=11).Results:39 participants were included in the analysis and were typical for a SLE population. 6 (23%) patients had scores above the threshold for OCD. OCI-R significantly correlated with disease activity, quality of life, fatigue, depression and anxiety measures for all the SLE participants. Change in monocyte chemoattractant protein-1 (MCP-1) correlated with the OCI-R for the within SLE-F group analysis (Table 1). No significant correlations were found with the full SLE group for inflammatory or EA biomarkers or with either group for the structural brain analysis.Table 1.Significant correlations with the OCI-R for: a) all SLE participants; b) the SLE-F group only (visit 1 minus visit 2).Variablersp-valuea)All SLE participants, n=39Disease activity: BILAG global score0.4080.01Quality of life: LupusQoL – Physical-0.4950.001 – Pain-0.535<0.001 – Planning-0.586<0.001 – Intimate-0.3420.03 – Burden-0.5040.001 – Emotion-0.3970.01 – Fatigue-0.4710.002 EQ5D: VAS-0.4180.01 total-0.3590.03Fatigue measures (FSMC): Cognitive0.5210.001 Motor0.4480.004Depression measures: MADRS0.4670.003 HADS – D0.545<0.001Anxiety measure: HADS-A0.3750.02b)SLE-F group (v1-v2), n=11Inflammatory marker: MCP-10.7710.006BILAG The British Isles Lupus Assessment Group index, LupusQoL Lupus quality of life, EQ5D European quality of life, VAS visual analogue scale, FSMC Fatigue scale for motor and cognitive function, MADRS Montgomery Asberg depression rating scale, HADS Hospital anxiety and depression scale, D-depression, A-anxiety score, MCP-1 monocyte chemoattractant protein-1Conclusion:OCD in lupus is strongly related to other psychological co-morbidities, fatigue and quality of life. Our results also support a role for inflammatory pathways in mediating some of these changes and so obsessive-compulsive features should be assessed in SLE patients who flare. A larger study is underway to better understand the mechanisms underlying these associations.Acknowledgments:This study was partially funded by an unrestricted grant from Sanofi Genzyme and supported by the NIHR Manchester Biomedical Research Centre.Disclosure of Interests: :Michelle Barraclough Grant/research support from: This study was partially funded by an unrestricted grant from Sanofi Genzyme., Ben Parker Grant/research support from: GSK and Sanofi Genzyme, Consultant of: GSK, AstraZenaca, UCV, Abbvie, Pfizer, BMS, Celltrion, Shane McKie: None declared, Philip Pemberton: None declared, Alan Jackson: None declared, Rebecca Elliott: None declared, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GSK, and UCB, Consultant of: Eli Lilly, AstraZeneca, UCB, Iltoo, and Merck Serono, Speakers bureau: UCB
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Dyball S, Reynolds J, Mccarthy E, Haque S, Herrick A, Chinoy H, Bruce E, Parker B, Bruce IN. OP0094 EULAR-ACR 2019 CLASSIFICATION CRITERIA FOR SLE: CAN WE CLASSIFY USING LABORATORY TESTS ALONE? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.851] [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: 11/04/2022]
Abstract
Background:The EULAR-ACR 2019 (EULAR19) classification criteria for systemic lupus erythematosus (SLE) were developed to improve the sensitivity and specificity of previous criteria. Notably, both the EULAR19 and existing SLICC-SLE 2012 (SLICC12) criteria can classify patients as having SLE by the presence of immunology and haematological abnormalities in the absence of any signs or symptoms.Objectives:To validate the EULAR19 criteria, with comparison to existing criteria, in a large cohort of patients with an established systemic autoimmune rheumatic disease (SARD).Methods:We recruited 227 adult patients who were ANA positive with ≥1 clinical feature suggestive of a SARD, from three hospitals in the North West of England. Clinician diagnosis was used as gold standard; we then applied the EULAR19, SLICC12 and the ACR-SLE 1997 (ACR97) criteria.Results:Of the 227 patients recruited, by clinician diagnosis, 89 patients (36%) had SLE, 43 (17%) primary Sjögren’s (pSS), 62 (25%) undifferentiated CTD (UCTD), 25 (10%) systemic sclerosis (SSc) and 8 (3%) an inflammatory myositis. The characteristics of these patients and the breakdown of the EULAR19 criteria are outlined in figure 1.Figure 1.Baseline characteristics and classification criteria compared across five SARD diagnoses.The sensitivity and specificity of the EULAR19 is similar to ACR97 (sensitivity 84% (95% CI 75-91%) vs. 87% (95% CI 78-93%) and specificity 78% (95% CI 70-84%) vs. 76% (95% CI 68-83%) respectively). The SLICC12 criteria by contrast are more sensitive (94% (95% CI 87-98%)) and less specific (61% (95% CI 52-69%)) in this cohort.Figure 2 illustrates patients with a clinician diagnosis of SLE or UCTD who meet each of the classification criteria. Of the 89 patients with a clinician diagnosis of SLE, 39 (44%) patients would have sufficient points to meet EULAR19 criteria on blood test results alone in the absence of clinical symptoms. Four pSS patients and 4 UCTD patients would also meet EULAR19 criteria from positive blood results alone.Figure 2.Venn diagrams illustrating patients with SLE and UCTD who meet the EULAR19, ACR97 and SLICC12 classification criteria. No criteria refers to the patients not meeting any of the three SLE classification criteria.Conclusion:These results suggest that the EULAR19 criteria perform comparably to the ACR97 criteria when applied to an established cohort of SARDs. Similar to SLICC12, it is possible to classify patients as having SLE using the EULAR19 criteria by haematological and other laboratory tests. To what extent haematological abnormalities can be potentially used as the sole ‘clinical criteria’ needs consideration.SLE n=89pSS n=43UCTD n=62SSc n=25Myositis n=8Female N (%)82 (92)42 (98)53 (85)24 (96)8 (100)Age, mean (SD) /years44 (13)52 (12)47 (13)60 (9)53 (7)Disease duration, mean (SD) /years12 (10)6 (5)5 (7)9 (11)3 (3)SLE classification criteriaEULAR SLE 2019, N (%)75 (84)10 (23)20 (32)1 (4)0ACR SLE 1997, N (%)77 (87)9 (21)21 (34)2 (8)1 (13)SLICC SLE 2012, N (%)84 (94)15 (35)33 (53)4 (16)2 (25)EULAR-ACR 2019 criteriaConstitutional, N (%)10 (11)2 (5)1 (2)01 (13)Neuropsychiatric, N (%)3 (3)01 (2)1 (4)0Mucocutaneous, N (%)71 (80)13 (30)27 (44)2 (8)2 (25)Serosal, N (%)13 (15)1 (2)2 (3)00Musculoskeletal, N (%)52 (58)14 (33)22 (35)3 (12)3 (38)Renal, N (%)30 (34)001 (4)0Haematological, N (%)44 (49)12 (28)10 (16)3 (12)0Antiphospholipid antibodies, N (%)43 (48)7 (16)17 (27)4 (16)0Low complement, N (%)48 (54)10 (23)10 (16)3 (12)1 (13)Anti-Sm, N (%)19 (21)2 (5)4 (6)1 (4)0Anti-dsDNA, N (%)50 (56)8 (19)12 (19)01 (13)Disclosure of Interests:Sarah Dyball: None declared, John Reynolds: None declared, Eoghan McCarthy: None declared, Sahena Haque: None declared, Ariane Herrick: None declared, Hector Chinoy: None declared, Ellen Bruce: None declared, Ben Parker Grant/research support from: GSK and Sanofi Genzyme, Consultant of: GSK, AstraZenaca, UCV, Abbvie, Pfizer, BMS, Celltrion, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GSK, and UCB, Consultant of: Eli Lilly, AstraZeneca, UCB, Iltoo, and Merck Serono, Speakers bureau: UCB
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Darlington O, GARCIA SANCHEZ J, Sörstadius E, Parker B, McEwan P. SAT-142 THE ECONOMIC AND PATIENT BURDEN OF CHRONIC KIDNEY DISEASE (CKD): RESULTS FROM AN INTERNATIONAL CKD POLICY EVALUATION. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Taylor SA, Bak AW, Lin T, Jowhari F, Savard M, Parker B, Dick J, Perini R. A273 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN A TERTIARY CANADIAN HOSPITAL: OPTIMIZING TISSUE SAMPLING TECHNIQUES. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pancreatic and biliary cancer can be difficult to definitively diagnose, and tissue diagnosis defines clinical management in both early and late disease. The majority of patients with pancreaticobiliary malignancy present with late disease and only 30% have resectable tumours, contributing to poor prognosis and outcome. Endoscopic retrograde cholangiopancreatography (ERCP) is a mainstay for diagnosing and treating conditions of the bile and pancreatic duct.
Aims
This study aimed to provide data on the diagnostic performance of ERCP utilizing conventional methods for tissue acquisition particularly in the setting of an indeterminate stricture. In particular, this was a quality assurance review to determine our centre’s baseline performance as a reference so new methods of tissue acquisition such as SpyglassTM can be benchmarked against.
Methods
In a tertiary care hospital, 3723 ERCP procedures were performed between 2013 and 2017. Demographic and clinical information was retrospectively collected. Demographic and clinical information was collected. Three ERCP techniques of tissue sampling were analyzed: brushing alone (BiA), biopsy alone (BrA), and brushing and biopsy dual-modality approach (BrBi). The diagnostic performances (sensitivity, specificity, and accuracy) were calculated with data from post-sampling clinical reports, surgical pathological reports, and diagnostic imaging reports.
Results
222 patients (285 ERCP procedure) met the study criteria and received fluoroscopy-guided ERCP sampling with cytology brushing and/or tissue biopsies. 36 (13%) patients had BiA, 85 (29%) patients had BrA, and 164 (58%) patients had BrBi. The sensitivities, specificities, and accuracies of the three sampling techniques respectively were: 56%, 93%, and 85% for BiA; 73%, 96%, and 83% for BrA; and 79%, 94%, and 86% for BrBi.
Conclusions
Our retrospective analysis of fluoroscopic-guided tissue acquisition shows accuracy as high as current published data on direct visualization cholangiosopy guided techniques. A prospective study looking not only at clinical yield but a cost analysis should be put in place prior to a commitment to purchase new equipment such as the SpyglassTM.
Funding Agencies
None
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Affiliation(s)
- S A Taylor
- University of Toronto, Toronto, ON, Canada
| | - A W Bak
- Kelowna General Hospital, Kelowna, BC, Canada
| | - T Lin
- Faculty of Medicine, UBC, Vancouver, BC, Canada
| | - F Jowhari
- Gastroenterology, Queen’s University, Ottawa, ON, Canada
| | - M Savard
- Faculty of Medicine, UBC, Vancouver, BC, Canada
| | - B Parker
- Faculty of Medicine, UBC, Vancouver, BC, Canada
| | - J Dick
- Faculty of Medicine, UBC, Vancouver, BC, Canada
| | - R Perini
- Faculty of Medicine, UBC, Vancouver, BC, Canada
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Petrou S, Parker B, Masters J, Achten J, Bruce J, Lamb SE, Parsons N, Costa ML. Cost-effectiveness of negative-pressure wound therapy in adults with severe open fractures of the lower limb: evidence from the WOLLF randomized controlled trial. Bone Joint J 2019; 101-B:1392-1401. [DOI: 10.1302/0301-620x.101b11.bjj-2018-1228.r2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Aims The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe open fractures of the lower limb. Patients and Methods An economic evaluation was conducted from the perspective of the United Kingdom NHS and Personal Social Services, based on evidence from the 460 participants in the Wound Management of Open Lower Limb Fractures (WOLLF) trial. Economic outcomes were collected prospectively over the 12-month follow-up period using trial case report forms and participant-completed questionnaires. Bivariate regression of costs (given in £, 2014 to 2015 prices) and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained associated with NPWT dressings. Sensitivity and subgroup analyses were undertaken to assess the impacts of uncertainty and heterogeneity, respectively, surrounding aspects of the economic evaluation. Results The base case analysis produced an incremental cost-effectiveness ratio of £267 910 per QALY gained, reflecting higher costs on average (£678; 95% confidence interval (CI) -£1082 to £2438) and only marginally higher QALYS (0.002; 95% CI -0.054 to 0.059) in the NPWT group. The probability that NPWT is cost-effective in this patient population did not exceed 27% regardless of the value of the cost-effectiveness threshold. This result remained robust to several sensitivity and subgroup analyses. Conclusion This trial-based economic evaluation suggests that NPWT is unlikely to be a cost-effective strategy for improving outcomes in adult patients with severe open fractures of the lower limb. Cite this article: Bone Joint J 2019;101-B:1392–1401.
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Affiliation(s)
- S. Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - B. Parker
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - J. Masters
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Achten
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - S. E. Lamb
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N. Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - M. L. Costa
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
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Acharya B, Alexandre J, Baines S, Benes P, Bergmann B, Bernabéu J, Bevan A, Branzas H, Campbell M, Cecchini S, Cho YM, de Montigny M, De Roeck A, Ellis JR, El Sawy M, Fairbairn M, Felea D, Frank M, Hays J, Hirt AM, Janecek J, Kim DW, Korzenev A, Lacarrère DH, Lee SC, Leroy C, Levi G, Lionti A, Mamuzic J, Margiotta A, Mauri N, Mavromatos NE, Mermod P, Mieskolainen M, Millward L, Mitsou VA, Orava R, Ostrovskiy I, Papavassiliou J, Parker B, Patrizii L, Păvălaş GE, Pinfold JL, Popa V, Pozzato M, Pospisil S, Rajantie A, Ruiz de Austri R, Sahnoun Z, Sakellariadou M, Santra A, Sarkar S, Semenoff G, Shaa A, Sirri G, Sliwa K, Soluk R, Spurio M, Staelens M, Suk M, Tenti M, Togo V, Tuszyński JA, Vento V, Vives O, Vykydal Z, Wall A, Zgura IS. Magnetic Monopole Search with the Full MoEDAL Trapping Detector in 13 TeV pp Collisions Interpreted in Photon-Fusion and Drell-Yan Production. Phys Rev Lett 2019; 123:021802. [PMID: 31386510 DOI: 10.1103/physrevlett.123.021802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Indexed: 06/10/2023]
Abstract
MoEDAL is designed to identify new physics in the form of stable or pseudostable highly ionizing particles produced in high-energy Large Hadron Collider (LHC) collisions. Here we update our previous search for magnetic monopoles in Run 2 using the full trapping detector with almost four times more material and almost twice more integrated luminosity. For the first time at the LHC, the data were interpreted in terms of photon-fusion monopole direct production in addition to the Drell-Yan-like mechanism. The MoEDAL trapping detector, consisting of 794 kg of aluminum samples installed in the forward and lateral regions, was exposed to 4.0 fb^{-1} of 13 TeV proton-proton collisions at the LHCb interaction point and analyzed by searching for induced persistent currents after passage through a superconducting magnetometer. Magnetic charges equal to or above the Dirac charge are excluded in all samples. Monopole spins 0, ½, and 1 are considered and both velocity-independent and-dependent couplings are assumed. This search provides the best current laboratory constraints for monopoles with magnetic charges ranging from two to five times the Dirac charge.
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Affiliation(s)
- B Acharya
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College London, United Kingdom
| | - J Alexandre
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College London, United Kingdom
| | - S Baines
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College London, United Kingdom
| | - P Benes
- IEAP, Czech Technical University in Prague, Czech Republic
| | - B Bergmann
- IEAP, Czech Technical University in Prague, Czech Republic
| | - J Bernabéu
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - A Bevan
- School of Physics and Astronomy, Queen Mary University of London, United Kingdom
| | - H Branzas
- Institute of Space Science, Bucharest-Măgurele, Romania
| | - M Campbell
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - S Cecchini
- INFN, Section of Bologna, Bologna, Italy
| | - Y M Cho
- Physics Department, Konkuk University, Seoul, Korea
| | - M de Montigny
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - A De Roeck
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - J R Ellis
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College London, United Kingdom
- Theoretical Physics Department, CERN, Geneva, Switzerland
| | - M El Sawy
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - M Fairbairn
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College London, United Kingdom
| | - D Felea
- Institute of Space Science, Bucharest-Măgurele, Romania
| | - M Frank
- Department of Physics, Concordia University, Montréal, Québec, Canada
| | - J Hays
- School of Physics and Astronomy, Queen Mary University of London, United Kingdom
| | - A M Hirt
- Department of Earth Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland-Associate member
| | - J Janecek
- IEAP, Czech Technical University in Prague, Czech Republic
| | - D-W Kim
- Physics Department, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - A Korzenev
- Département de Physique Nucléaire et Corpusculaire, Université de Genève, Geneva, Switzerland
| | - D H Lacarrère
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - S C Lee
- Physics Department, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - C Leroy
- Département de Physique, Université de Montréal, Québec, Canada
| | - G Levi
- INFN, Section of Bologna and Department of Physics and Astronomy, University of Bologna, Italy
| | - A Lionti
- Département de Physique Nucléaire et Corpusculaire, Université de Genève, Geneva, Switzerland
| | - J Mamuzic
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - A Margiotta
- INFN, Section of Bologna and Department of Physics and Astronomy, University of Bologna, Italy
| | - N Mauri
- INFN, Section of Bologna, Bologna, Italy
| | - N E Mavromatos
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College London, United Kingdom
| | - P Mermod
- Département de Physique Nucléaire et Corpusculaire, Université de Genève, Geneva, Switzerland
| | - M Mieskolainen
- Physics Department, University of Helsinki, Helsinki, Finland
| | - L Millward
- School of Physics and Astronomy, Queen Mary University of London, United Kingdom
| | - V A Mitsou
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - R Orava
- Physics Department, University of Helsinki, Helsinki, Finland
| | - I Ostrovskiy
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama, USA
| | | | - B Parker
- Institute for Research in Schools, Canterbury, United Kingdom
| | - L Patrizii
- INFN, Section of Bologna, Bologna, Italy
| | - G E Păvălaş
- Institute of Space Science, Bucharest-Măgurele, Romania
| | - J L Pinfold
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - V Popa
- Institute of Space Science, Bucharest-Măgurele, Romania
| | - M Pozzato
- INFN, Section of Bologna, Bologna, Italy
| | - S Pospisil
- IEAP, Czech Technical University in Prague, Czech Republic
| | - A Rajantie
- Department of Physics, Imperial College London, United Kingdom
| | | | - Z Sahnoun
- INFN, Section of Bologna, Bologna, Italy
| | - M Sakellariadou
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College London, United Kingdom
| | - A Santra
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - S Sarkar
- Theoretical Particle Physics and Cosmology Group, Physics Department, King's College London, United Kingdom
| | - G Semenoff
- Department of Physics, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Shaa
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - G Sirri
- INFN, Section of Bologna, Bologna, Italy
| | - K Sliwa
- Department of Physics and Astronomy, Tufts University, Medford, Massachusetts, USA
| | - R Soluk
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - M Spurio
- INFN, Section of Bologna and Department of Physics and Astronomy, University of Bologna, Italy
| | - M Staelens
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - M Suk
- IEAP, Czech Technical University in Prague, Czech Republic
| | | | - V Togo
- INFN, Section of Bologna, Bologna, Italy
| | - J A Tuszyński
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - V Vento
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - O Vives
- IFIC, Universitat de València-CSIC, Valencia, Spain
| | - Z Vykydal
- IEAP, Czech Technical University in Prague, Czech Republic
| | - A Wall
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama, USA
| | - I S Zgura
- Institute of Space Science, Bucharest-Măgurele, Romania
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Chauhan A, Lalor T, Watson S, Adams D, Farrah TE, Anand A, Kimmitt R, Mills NL, Webb DJ, Dhaun N, Kalla R, Adams A, Vatn S, Bonfliglio F, Nimmo E, Kennedy N, Ventham N, Vatn M, Ricanek P, Halfvarson J, Soderhollm J, Pierik M, Torkvist L, Gomollon F, Gut I, Jahnsen J, Satsangi J, Body R, Almashali M, McDowell G, Taylor P, Lacey A, Rees A, Dayan C, Lazarus J, Nelson S, Okosieme O, Corcoran D, Young R, Ciadella P, McCartney P, Bajrangee A, Hennigan B, Collison D, Carrick D, Shaukat A, Good R, Watkins S, McEntegart M, Watt J, Welsh P, Sattar N, McConnachie A, Oldroyd K, Berry C, Parks T, Auckland K, Mentzer AJ, Kado J, Mirabel MM, Kauwe JK, Robson KJ, Mittal B, Steer AC, Hill AVS, Akbar M, Forrester M, Virlan AT, Gilmour A, Wallace C, Paterson C, Reid D, Siebert S, Porter D, Liversidge J, McInnes I, Goodyear C, Athwal V, Pritchett J, Zaitoun A, Irving W, Guha IN, Hanley NA, Hanley KP, Briggs T, Reynolds J, Rice G, Bondet V, Bruce E, Crow Y, Duffy D, Parker B, Bruce I, Martin K, Pritchett J, Aoibheann Mullan M, Llewellyn J, Athwal V, Zeef L, Farrow S, Streuli C, Henderson N, Friedman S, Hanley N, Hanley KP. Scientific Business Abstracts of the 112th Annual Meeting of the Association of Physicians of Great Britain and Ireland. QJM 2018; 111:920-924. [PMID: 31222346 DOI: 10.1093/qjmed/hcy193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - T Lalor
- From the University of Birmingham
| | - S Watson
- From the University of Birmingham
| | - D Adams
- From the University of Birmingham
| | - T E Farrah
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - A Anand
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - R Kimmitt
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - N L Mills
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - D J Webb
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - N Dhaun
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - R Kalla
- From the University of Edinburgh
| | - A Adams
- From the University of Edinburgh
| | - S Vatn
- Akerhshus University Hospital
| | | | - E Nimmo
- From the University of Edinburgh
| | | | | | | | | | | | | | - M Pierik
- Maastricht University Medical Centre
| | | | | | | | | | | | - R Body
- From the University of Manchester
| | - M Almashali
- Manchester University Hospitals Foundation NHS Trust
| | | | | | | | - A Rees
- From the Cardiff University
| | | | | | | | | | - D Corcoran
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - R Young
- Robertson Centre for Biostatistics, University of Glasgow
| | - P Ciadella
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - P McCartney
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - A Bajrangee
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - B Hennigan
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - D Collison
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - D Carrick
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - A Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - R Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - S Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - M McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - J Watt
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - P Welsh
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - N Sattar
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - A McConnachie
- Robertson Centre for Biostatistics, University of Glasgow
| | - K Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - C Berry
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - T Parks
- From the London School of Hygiene and Tropical Medicine
- University of Oxford
| | | | | | - J Kado
- Fiji Islands Ministry of Health and Medical Services
| | - M M Mirabel
- French National Institute of Health and Medical Research
| | | | | | - B Mittal
- Babasaheb Bhimrao Ambedkar University
| | - A C Steer
- Murdoch Children's Research Institute
| | | | - M Akbar
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - M Forrester
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - A T Virlan
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - A Gilmour
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - C Wallace
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - C Paterson
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - D Reid
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - S Siebert
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - D Porter
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - J Liversidge
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - I McInnes
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - C Goodyear
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - V Athwal
- From the Manchester University Foundation NHS Trust
- University of Manchester
| | | | | | | | | | - N A Hanley
- From the Manchester University Foundation NHS Trust
- University of Manchester
| | | | - T Briggs
- From the Manchester Centre of Genomic Medicine, University of Manchester
| | - J Reynolds
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - G Rice
- From the Manchester Centre of Genomic Medicine, University of Manchester
| | - V Bondet
- Immunobiology of Dendritic Cells, Institut Pasteur
| | - E Bruce
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - Y Crow
- Laboratory of Neurogenetics and Neuroinflammation, INSERM UMR1163, Institut Imagine
| | - D Duffy
- Immunobiology of Dendritic Cells, Institut Pasteur
| | - B Parker
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - I Bruce
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - K Martin
- From the University of Manchester
| | | | | | | | - V Athwal
- From the University of Manchester
| | - L Zeef
- From the University of Manchester
| | - S Farrow
- From the University of Manchester
- Respiratory Therapy Area, GlaxoSmithKline
| | | | | | | | - N Hanley
- From the University of Manchester
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Keefe J, Taylor D, Parker B, Tay L, Cook H. INCLUDING FAMILY CAREGIVERS IN CANADIAN LONG TERM CARE: AMBIGUITY BETWEEN POLICY AND PRACTICE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1478] [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: 11/14/2022] Open
Affiliation(s)
- J Keefe
- Mount Saint Vincent University
| | | | | | - L Tay
- Mount Saint Vincent University
| | - H Cook
- Office of the Seniors Advocate, British Columbia
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Parker B, Petrou S, Masters JPM, Achana F, Costa ML. Economic outcomes associated with deep surgical site infection in patients with an open fracture of the lower limb. Bone Joint J 2018; 100-B:1506-1510. [DOI: 10.1302/0301-620x.100b11.bjj-2018-0308.r1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to estimate economic outcomes associated with deep surgical site infection (SSI) in patients with an open fracture of the lower limb. Patients and Methods A total of 460 patients were recruited from 24 specialist trauma hospitals in the United Kingdom Major Trauma Network. Preference-based health-related quality-of-life outcomes, assessed using the EuroQol EQ-5D-3L and the 6-Item Short-Form Health Survey questionnaire (SF-6D), and economic costs (£, 2014/2015 prices) were measured using participant-completed questionnaires over the 12 months following injury. Descriptive statistics and multivariate regression analysis were used to explore the relationship between deep SSI and health utility scores, quality-adjusted life-years (QALYs), and health and personal social service (PSS) costs. Results Deep SSI was associated with lower EQ-5D-3L derived QALYs (adjusted mean difference -0.102, 95% confidence interval (CI) -0.202 to 0.001, p = 0.047) and increased health and social care costs (adjusted mean difference £1950; 95% CI £1383 to £5285, p = 0.250) versus patients without deep SSI over the 12 months following injury. Conclusion Deep SSI may lead to significantly impaired health-related quality of life and increased economic costs. Our economic estimates can be used to inform clinical and budgetary service planning and can act as reference data for future economic evaluations of preventive or treatment interventions. Cite this article: Bone Joint J 2018;100-B:1506–10.
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Affiliation(s)
- B. Parker
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - S. Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - J. P. M. Masters
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - F. Achana
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - M. L. Costa
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK; The Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
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Naeim A, Sepucha K, Wenger N, Eklund M, Annette S, Madlensky L, van't Veer L, Parker B, Yau C, Cink T, Anton-Culver H, Borowsky A, Petruse A, Sarrafan S, Stover-Fiscalini A, LaCroix A, Adduci K, Laura E. Abstract PD2-14: Participation in a personalized breast cancer screening trial does not increase anxiety at baseline. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd2-14] [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: 11/16/2022]
Abstract
Abstract
Introduction: The purpose of this study is to examine whether participation in a personalized screening trial is associated with anxiety or breast cancer worry. The Patient Centered Outcomes Research Institute recently funded WISDOM (Women Informed to Screen Depending On Measures of risk), which is a randomized trial that tests the safety and efficacy of basing starting age, stopping age, frequency and modality of breast cancer screening on individual risk (Clinical Trials Identifier NCT02620852).
Methods: In WISDOM, participants can be randomized to annual screening or personalized screening arm, or self-select an arm an observational cohort. This interim analysis examined the first 1817 participants to determine if the personalized risk arm is acceptable and to explore whether baseline anxiety was associated with study arm. For acceptability our target was to have >60% of participants agree to randomization. Participants completed questions about their Risk Perception, the PROMIS Anxiety short form 8a (total scores 8-40 with higher scores indicating more anxiety), and Breast Cancer Risk Worry (BCRW) survey (total scores 5-20) with higher scores indicating more worry) at baseline and before they were given information on their personal risk or study assignment. For the purposes of these analyses, we defined high anxiety to be the percentage of participants scoring =>22 on the PROMIS and >8 on the BCRW.
Results: The participants were recruited from three sites (UCSD, UCSF, Sanford Health). Of the 1817 initial participants, 1643 completed the baseline questionnaire. Participants has a mean age of 57 years (SD 9). 15.8% felt their chances of developing breast cancer was high, 19.5% felt their chance of developing breast cancer was greater than the average women, and 56.6% felt their lifetime risk of developing breast cancer was >25. Risk perception was not significantly different between women who opted to be randomized versus the observational arm.
The majority of participants were willing to be randomly assigned to an arm (1071/1643, 65.1%). Of those who joined the observational cohort, the majority selected personalized risk arm (474/572, 82.9%). Overall, PROMIS anxiety scores were low at baseline (14.0 MEAN (SD 4.6)) as were the Breast Cancer Risk Worry scores (5.7 MEAN (SD 1.05)). Less than 8% of participants had PROMIS scores >22 and that did not vary across the randomized or observational groups (P=0.2)). About 2% of participants had a BCRW scores >8. Women who worried with breast cancer were more likely to select to be in the observational (3.5%) than randomized (1.7%) arm of the study (P=0.02).
Conclusions: For the women approached to participate in Wisdom, personalized screening was acceptable alternative to annual mammography. Participants in general overestimated their lifetime risk of breast cancer, had very low anxiety and low breast cancer worry. Those who were worried about breast cancer opted more often for the observational arm of the study to allow them to choose between the personalized versus annual arm. Future analyses will follow participants prospectively to determine adherence to assigned or selected arm, and whether anxiety changes after receipt of their personalized risk information.
Citation Format: Naeim A, Sepucha K, Wenger N, Eklund M, Annette S, Madlensky L, van't Veer L, Parker B, Yau C, Cink T, Anton-Culver H, Borowsky A, Petruse A, Sarrafan S, Stover-Fiscalini A, LaCroix A, Adduci K, Wisdom Advocate Partners, Laura E. Participation in a personalized breast cancer screening trial does not increase anxiety at baseline [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-14.
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Affiliation(s)
- A Naeim
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - K Sepucha
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - N Wenger
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - M Eklund
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - S Annette
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - L Madlensky
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - L van't Veer
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - B Parker
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - C Yau
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - T Cink
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - H Anton-Culver
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - A Borowsky
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - A Petruse
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - S Sarrafan
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - A Stover-Fiscalini
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - A LaCroix
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - K Adduci
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
| | - E Laura
- David Geffen UCLA School of Medicine; Harvard Medical School; Karolinski Institute; University of California, San Diego; University of California, San Franscisco; Sanford Health; University of California, Irvine; University of California, Davis
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Acerbi I, Abihider K, Ling J, Layton T, DeRosa D, Madlensky L, Tice J, Shieh Y, Ziv E, Sarrafan S, Firouzian R, Tong B, Blanco A, Lee V, Heditsian D, Brain S, Kaplan C, Borowsky A, Anton-Culver H, Naeim A, Cink T, Stover Fiscalini A, Parker B, van 't Veer L, LaCroix A, Esserman L. Abstract OT3-03-01: Preference-Tolerant randomized trial of risk-based vs. annual breast cancer screening: WISDOM study in progress. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-03-01] [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: 11/16/2022]
Abstract
Abstract
Purpose: Women Informed to Screen Depending on Measures of risk (WISDOM) trial is a pragmatic study comparing two real world approaches to clinical care for breast screening: annual screening versus personalized screening. The novelty of the personalized arm of the study is that we are combining known risk factors (age, family history, history of breast disease, ethnicity, BIRADS breast density, and genetics) into a single risk assessment model. All components of the model have been tested and established, but have never been used jointly.
The goal of the WISDOM study is to examine the effectiveness of personalized breast cancer screening and to bring objective recommendations to the current mammography screening debate.
Methods: The WISDOM trial will enroll 100,000 women with a preference-tolerant design that will determine if risk-based screening vs. annual screening, is as safe, less morbid, enables prevention, and is preferred by women. Women 40 - 74 years of age with no history of breast cancer or DCIS, and no previous double mastectomy can join the study from the WISDOM Study website (wisdomstudy.org). All participants sign up, elect randomization or self-select the study arm, provide electronic consent using DocuSign (eConsent), and sign a Medical Release Form. For all participants, 5-year risk of developing breast cancer is calculated according to the Breast Cancer Screening Consortium (BCSC) model. For participants in the personalized arm, the overall 5-year risk BCSC score is combined with a Polygenic Risk Score, based on a genetic test including mutations in 9 genes (BRCA1, BRCA2, TP53, PTEN, STK11, CDH1, ATM, PALB2, and CHEK2) and a panel of 75 common single nucleotide polymorphisms known to increase breast cancer risk. Risk stratification will determine frequency of screening. The study is registered on ClinicalTrials.gov as NCT02620852.
Results: As of June 12th 2017, the WISDOM study is live at all UC medical centers and recruitment is open to all eligible women in California. Up to date 4,769 eligible women registered at all sites. 2,823 women have consented in the trial. 64% were randomized and 36% chose their screening arm. A pilot was conducted to test the logistics of online participation and examine the acceptance of the study design and approach. We are partnering with health insurance companies and self-insured companies to reach our recruitment goal.
Conclusions: Enrollment will be completed by end of 2018.
Acknowledgment: support by the Patient-Centered Outcomes Research Institute (PCORI), PCS-1402-10749 to L.J.E.
(*) Authors equally contributed to this work.
Citation Format: Acerbi I, Abihider K, Ling J, Layton T, DeRosa D, Madlensky L, Tice J, Shieh Y, Ziv E, Sarrafan S, Firouzian R, Tong B, Blanco A, Lee V, Heditsian D, Brain S, Kaplan C, Borowsky A, Anton-Culver H, Naeim A, Cink T, Stover Fiscalini A, Parker B, van 't Veer L, Wisdom Study and Athena Breast Health Network Investigators and Advocate Partners, LaCroix A, Esserman L. Preference-Tolerant randomized trial of risk-based vs. annual breast cancer screening: WISDOM study in progress [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-03-01.
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Affiliation(s)
- I Acerbi
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - K Abihider
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - J Ling
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - T Layton
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - D DeRosa
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - L Madlensky
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - J Tice
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - Y Shieh
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - E Ziv
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - S Sarrafan
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - R Firouzian
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - B Tong
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - A Blanco
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - V Lee
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - D Heditsian
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - S Brain
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - C Kaplan
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - A Borowsky
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - H Anton-Culver
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - A Naeim
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - T Cink
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - A Stover Fiscalini
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - B Parker
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - L van 't Veer
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - A LaCroix
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
| | - L Esserman
- University of California, San Francisco, San Francisco, CA; University of California, San Diego, San Diego, CA; University of California, Davis, Sacramento, CA; University of California, Irvine, Irvine, CA; University of California, Los Angeles, Los Angeles, CA; Sanford Health, Sioux Falls, SD
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Shieh Y, Ziv E, Eklund M, Sabacan L, Firouzian R, Madlensky L, Anton-Culver H, Borowsky A, LaCroix A, Naeim A, Parker B, van't Veer L, Esserman L, Tice J. Abstract P3-09-02: Risk stratification using clinical risk factors and genetic variants in a personalized screening trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-09-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Tailoring breast cancer screening according to individual risk may represent an improvement over the current practice of age-based screening. WISDOM (Women Informed to Screen Depending on Measures of Risk) is an ongoing randomized trial comparing the safety, efficacy, cost, and patient acceptability of personalized versus annual screening. Women in the personalized arm receive screening recommendations based on sequencing of 9 genes associated with hereditary breast cancer and a 5-year risk estimate from the Breast Cancer Surveillance Consortium (BCSC) risk model modified by a polygenic risk score (PRS) comprised of 75 single nucleotide polymorphisms. WISDOM represents the first-ever use of a PRS to prospectively modify risk estimates and allows comparison of risk model performance in a population-based setting. Thus, we evaluated the risk estimates generated by: 1) the Breast Cancer Risk Assessment Tool (BCRAT) based on the Gail model, 2) the BCSC model, and 3) the BCSC model modified by the PRS (BCSC-PRS).
Methods: We analyzed participants in the personalized screening arm of the WISDOM Study (NCT02620852). The trial opened in October 2016 and is enrolling participants aged 40-74 years. Participants' self-reported demographic and risk factor information were collected through an online portal. Genotyping of participants in the personalized arm was done using a custom panel from Color Genomics. 5-year risk estimates were generated using the BCRAT (2011 version), BCSC, and BCSC-PRS models. In the latter, the PRS was used as a Bayesian likelihood ratio to modify the BCSC 5-year risk estimate. We compared the distributions of BCRAT, BCSC, and BCSC-PRS risk estimates around a low-risk (<1%) and moderately high-risk (≥3%) threshold using a paired statistical test (McNemar).
Results: To date, WISDOM has enrolled 2,065 participants, of whom 1,157 are in the personalized arm and 830 have completed risk assessment. The median age was 57 years (interquartile range, IQR 49-64). 83% were Caucasian, 2% African-American, and 7% Asian. 8% self-reported as Hispanic. The median 5-year risk was 1.7% (IQR 1.1-2.3%) using the BCRAT, 1.6% (IQR 1.1-2.3%) using the BCSC model, and 1.5% (IQR 0.9-2.7%) using the BCSC-PRS model. The BCSC-PRS model classified more women into the low (<1%) and moderately high (≥3%) risk categories compared with the BCRAT (p < 0.001) and BCSC model (p < 0.001), Table.
5-year risk classification according to the BCRAT, BCSC and BCSC-PRS models <1%1-3%≥3% n (%)n (%)n (%)Gail161 (19)556 (67)113 (14)BCSC159 (19)568 (68)103 (12)BCSC-PRS275 (33)379 (46)176 (21)
Discussion: Adding a PRS to the BCSC model categorized significantly more women below the low-risk threshold and above the moderately high-risk threshold compared with the BCSC model and BCRAT. Furthermore, the BCSC and BCRAT generated similar distributions of risk estimates. Follow-up with incident breast cancer data is needed to determine whether the reclassification provided by the PRS improves risk stratification and clinical outcomes. However, our preliminary findings suggest that incorporating genetic variants into a validated clinical model is feasible and could enhance risk prediction.
Citation Format: Shieh Y, Ziv E, Eklund M, Sabacan L, Firouzian R, Madlensky L, Anton-Culver H, Borowsky A, LaCroix A, Naeim A, Parker B, van't Veer L, Esserman L, Tice J, WISDOM Study and Athena Network Investigators WS. Risk stratification using clinical risk factors and genetic variants in a personalized screening trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-09-02.
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Affiliation(s)
- Y Shieh
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - E Ziv
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - M Eklund
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - L Sabacan
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - R Firouzian
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - L Madlensky
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - H Anton-Culver
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - A Borowsky
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - A LaCroix
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - A Naeim
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - B Parker
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - L van't Veer
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - L Esserman
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
| | - J Tice
- University of California San Francisco, San Francisco, CA; Karolinska Institutet, Stockholm, Sweden; University of California San Diego, San Diego, CA; University of California Irvine, Irvine, CA; University of California Davis, Sacramento, CA; University of California Los Angeles, Los Angeles, CA; WISDOM Study and Athena Network Investigators
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Taylor D, Keefe J, Tay L, Parker B, Delaney K, Cook H. FINDING RABBIT HOLES WITHOUT FALLING IN: NAVIGATING PALLIATIVE CARE POLICY IN CANADIAN LONG-TERM CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2119] [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: 11/12/2022] Open
Affiliation(s)
- D. Taylor
- Research, Interior Health Authority, Kelowna, British Columbia, Canada,
- Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - J. Keefe
- Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - L. Tay
- Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - B. Parker
- Research, Interior Health Authority, Kelowna, British Columbia, Canada,
| | - K. Delaney
- Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - H. Cook
- Research, Interior Health Authority, Kelowna, British Columbia, Canada,
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Yan HP, Roberts LJ, Davies SS, Pohlmann P, Parl FF, Estes S, Maeng J, Parker B, Mernaugh R. Isolevuglandins as a gauge of lipid peroxidation in human tumors. Free Radic Biol Med 2017; 106:62-68. [PMID: 28189846 PMCID: PMC5376360 DOI: 10.1016/j.freeradbiomed.2017.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/14/2017] [Accepted: 02/07/2017] [Indexed: 11/17/2022]
Abstract
The cellular production of free radicals or reactive oxygen species (ROS) can lead to protein, lipid or DNA modifications and tumor formation. The cellular lipids undergo structural changes through the actions of enzymes (e.g. cyclooxygenases) or free radicals to form a class of compounds called Isolevuglandins (IsoLGs). The recruitment and continued exposure of tissue to ROS and IsoLGs causes increased cell proliferation, mutagenesis, loss of normal cell function and angiogenesis. The elevated concentration of ROS in cancerous tissues suggests that these mediators play an important role in cancer development. We hypothesized that tumors with elevated ROS levels would similarly possess an increased concentration of IsoLGs when compared with normal tissue. Using D11, an ScFv recombinant antibody specific for IsoLGs, we utilized immunohistochemistry to visualize the presence of IsoLG in human tumors compared to normal adjacent tissue (NAT) to the same tumor. We found that IsoLG concentrations were elevated in human breast, colon, kidney, liver, lung, pancreatic and tongue tumor cells when compared to NAT and believe that IsoLGs can be used as a gauge indicative of lipid peroxidation in tumors.
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Affiliation(s)
- H P Yan
- Department of Radiation Oncology at Washington University in St. Louis, Washington 63110, United States
| | - L J Roberts
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, United States; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - S S Davies
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - P Pohlmann
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - F F Parl
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - S Estes
- Biomedical Research Education and Training (BRET), Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - J Maeng
- Biomedical Research Education and Training (BRET), Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - B Parker
- Biomedical Research Education and Training (BRET), Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - R Mernaugh
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN 37232, United States; Biomedical Research Education and Training (BRET), Vanderbilt University School of Medicine, Nashville, TN 37232, United States.
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Keirns J, Desai A, Kowalski D, Lademacher C, Mujais S, Parker B, Schneidkraut MJ, Townsend R, Wojtkowski T, Yamazaki T, Yen M, Kowey PR. QT Interval Shortening With Isavuconazole: In Vitro and In Vivo Effects on Cardiac Repolarization. Clin Pharmacol Ther 2017; 101:782-790. [PMID: 28074556 PMCID: PMC5485736 DOI: 10.1002/cpt.620] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 01/17/2023]
Abstract
The effects of isavuconazole (active moiety of isavuconazonium sulfate) on cardiac ion channels in vitro and cardiac repolarization clinically were assessed in a phase I, randomized, double‐blind study in healthy individuals who received isavuconazole (after 2‐day loading dose), at therapeutic or supratherapeutic doses daily for 11 days, moxifloxacin (400 mg q.d.), or placebo. A post‐hoc analysis of the phase III SECURE trial assessed effects on cardiac safety. L‐type Ca2+ channels were most sensitive to inhibition by isavuconazole. The 50% inhibitory concentrations for ion channels were higher than maximum serum concentrations of nonprotein‐bound isavuconazole in vivo. In the phase I study (n = 161), isavuconazole shortened the QT interval in a dose‐ and plasma concentration‐related manner. There were no serious treatment‐emergent adverse events; palpitations and tachycardia were observed in placebo and supratherapeutic isavuconazole groups; no cardiac safety signals were detected in the SECURE study (n = 257). Isavuconazole was associated with a shortened cardiac QT interval.
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Affiliation(s)
- J Keirns
- Astellas Pharma Global Development, Inc, Northbrook, Illinois, USA
| | - A Desai
- Astellas Pharma Global Development, Inc, Northbrook, Illinois, USA
| | - D Kowalski
- Astellas Pharma Global Development, Inc, Northbrook, Illinois, USA
| | - C Lademacher
- Astellas Pharma Global Development, Inc, Northbrook, Illinois, USA
| | - S Mujais
- Astellas Pharma Global Development, Inc, Northbrook, Illinois, USA
| | - B Parker
- Astellas Pharma Global Development, Inc, Northbrook, Illinois, USA
| | - M J Schneidkraut
- Astellas Pharma Global Development, Inc, Northbrook, Illinois, USA
| | - R Townsend
- Astellas Pharma Global Development, Inc, Northbrook, Illinois, USA
| | - T Wojtkowski
- Astellas Pharma Global Development, Inc, Northbrook, Illinois, USA
| | - T Yamazaki
- Astellas Pharma Global Development, Inc, Northbrook, Illinois, USA
| | - M Yen
- PAREXEL, Glendale, California, USA
| | - P R Kowey
- Lankenau Medical Center and Institute for Medical Research, Main Line Health System, Wynnewood, Pennsylvania, USA.,Jefferson Medical College, Philadelphia, Pennsylvania, USA
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Acharya B, Alexandre J, Baines S, Benes P, Bergmann B, Bernabéu J, Branzas H, Campbell M, Caramete L, Cecchini S, de Montigny M, De Roeck A, Ellis JR, Fairbairn M, Felea D, Flores J, Frank M, Frekers D, Garcia C, Hirt AM, Janecek J, Kalliokoski M, Katre A, Kim DW, Kinoshita K, Korzenev A, Lacarrère DH, Lee SC, Leroy C, Lionti A, Mamuzic J, Margiotta A, Mauri N, Mavromatos NE, Mermod P, Mitsou VA, Orava R, Parker B, Pasqualini L, Patrizii L, Păvălaş GE, Pinfold JL, Popa V, Pozzato M, Pospisil S, Rajantie A, Ruiz de Austri R, Sahnoun Z, Sakellariadou M, Sarkar S, Semenoff G, Shaa A, Sirri G, Sliwa K, Soluk R, Spurio M, Srivastava YN, Suk M, Swain J, Tenti M, Togo V, Tuszyński JA, Vento V, Vives O, Vykydal Z, Whyntie T, Widom A, Willems G, Yoon JH, Zgura IS. Search for Magnetic Monopoles with the MoEDAL Forward Trapping Detector in 13 TeV Proton-Proton Collisions at the LHC. Phys Rev Lett 2017; 118:061801. [PMID: 28234515 DOI: 10.1103/physrevlett.118.061801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Indexed: 06/06/2023]
Abstract
MoEDAL is designed to identify new physics in the form of long-lived highly ionizing particles produced in high-energy LHC collisions. Its arrays of plastic nuclear-track detectors and aluminium trapping volumes provide two independent passive detection techniques. We present here the results of a first search for magnetic monopole production in 13 TeV proton-proton collisions using the trapping technique, extending a previous publication with 8 TeV data during LHC Run 1. A total of 222 kg of MoEDAL trapping detector samples was exposed in the forward region and analyzed by searching for induced persistent currents after passage through a superconducting magnetometer. Magnetic charges exceeding half the Dirac charge are excluded in all samples and limits are placed for the first time on the production of magnetic monopoles in 13 TeV pp collisions. The search probes mass ranges previously inaccessible to collider experiments for up to five times the Dirac charge.
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Affiliation(s)
- B Acharya
- Physics Department, Theoretical Particle Physics & Cosmology Group, King's College, London, United Kingdom
- International Centre for Theoretical Physics, Trieste, Italy
| | - J Alexandre
- Physics Department, Theoretical Particle Physics & Cosmology Group, King's College, London, United Kingdom
| | - S Baines
- Formerly at School of Physics and Astronomy, The University of Manchester, Manchester, United Kingdom
| | - P Benes
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - B Bergmann
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - J Bernabéu
- IFIC, Universitat de València, CSIC, Valencia, Spain
| | - H Branzas
- Institute of Space Science, Bucharest, Măgurele, Romania
| | - M Campbell
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - L Caramete
- Institute of Space Science, Bucharest, Măgurele, Romania
| | - S Cecchini
- INFN, Section of Bologna, Bologna, Italy
| | - M de Montigny
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - A De Roeck
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - J R Ellis
- Physics Department, Theoretical Particle Physics & Cosmology Group, King's College, London, United Kingdom
- Theoretical Physics Department, CERN, Geneva, Switzerland
| | - M Fairbairn
- Physics Department, Theoretical Particle Physics & Cosmology Group, King's College, London, United Kingdom
| | - D Felea
- Institute of Space Science, Bucharest, Măgurele, Romania
| | - J Flores
- Formerly at Department of Physics and Astronomy, Stony Brook University, New York, New York, USA
| | - M Frank
- Department of Physics, Concordia University, Montréal, Québec, Canada
| | - D Frekers
- Physics Department, University of Muenster, Muenster, Germany
| | - C Garcia
- IFIC, Universitat de València, CSIC, Valencia, Spain
| | - A M Hirt
- Department of Earth Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - J Janecek
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | | | - A Katre
- Section de Physique, Université de Genève, Geneva, Switzerland
| | - D-W Kim
- Physics Department, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - K Kinoshita
- Physics Department, University of Cincinnati, Cincinnati, Ohio, USA
| | - A Korzenev
- Section de Physique, Université de Genève, Geneva, Switzerland
| | - D H Lacarrère
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - S C Lee
- Physics Department, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - C Leroy
- Département de physique, Université de Montréal, Québec, Canada
| | - A Lionti
- Section de Physique, Université de Genève, Geneva, Switzerland
| | - J Mamuzic
- IFIC, Universitat de València, CSIC, Valencia, Spain
| | - A Margiotta
- INFN, Section of Bologna & Department of Physics & Astronomy, University of Bologna, Bologna, Italy
| | - N Mauri
- INFN, Section of Bologna, Bologna, Italy
| | - N E Mavromatos
- Physics Department, Theoretical Particle Physics & Cosmology Group, King's College, London, United Kingdom
| | - P Mermod
- Section de Physique, Université de Genève, Geneva, Switzerland
| | - V A Mitsou
- IFIC, Universitat de València, CSIC, Valencia, Spain
| | - R Orava
- Physics Department, University of Helsinki, Helsinki, Finland
| | - B Parker
- The Institute for Research in Schools, Canterbury, United Kingdom
| | - L Pasqualini
- INFN, Section of Bologna & Department of Physics & Astronomy, University of Bologna, Bologna, Italy
| | - L Patrizii
- INFN, Section of Bologna, Bologna, Italy
| | - G E Păvălaş
- Institute of Space Science, Bucharest, Măgurele, Romania
| | - J L Pinfold
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - V Popa
- Institute of Space Science, Bucharest, Măgurele, Romania
| | - M Pozzato
- INFN, Section of Bologna, Bologna, Italy
| | - S Pospisil
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - A Rajantie
- Department of Physics, Imperial College, London, United Kingdom
| | | | - Z Sahnoun
- INFN, Section of Bologna, Bologna, Italy
- Centre for Astronomy, Astrophysics and Geophysics, Algiers, Algeria
| | - M Sakellariadou
- Physics Department, Theoretical Particle Physics & Cosmology Group, King's College, London, United Kingdom
| | - S Sarkar
- Physics Department, Theoretical Particle Physics & Cosmology Group, King's College, London, United Kingdom
| | - G Semenoff
- Department of Physics, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Shaa
- Formerly at Department of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
| | - G Sirri
- INFN, Section of Bologna, Bologna, Italy
| | - K Sliwa
- Department of Physics and Astronomy, Tufts University, Medford, Massachusetts, USA
| | - R Soluk
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - M Spurio
- INFN, Section of Bologna & Department of Physics & Astronomy, University of Bologna, Bologna, Italy
| | - Y N Srivastava
- Physics Department, Northeastern University, Boston, Massachusetts, USA
| | - M Suk
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - J Swain
- Physics Department, Northeastern University, Boston, Massachusetts, USA
| | | | - V Togo
- INFN, Section of Bologna, Bologna, Italy
| | - J A Tuszyński
- Physics Department, University of Alberta, Edmonton, Alberta, Canada
| | - V Vento
- IFIC, Universitat de València, CSIC, Valencia, Spain
| | - O Vives
- IFIC, Universitat de València, CSIC, Valencia, Spain
| | - Z Vykydal
- IEAP, Czech Technical University in Prague, Prague, Czech Republic
| | - T Whyntie
- The Institute for Research in Schools, Canterbury, United Kingdom
- Queen Mary University of London, London, United Kingdom
| | - A Widom
- Physics Department, Northeastern University, Boston, Massachusetts, USA
| | - G Willems
- Physics Department, University of Muenster, Muenster, Germany
| | - J H Yoon
- Physics Department, Konkuk University, Seoul, Korea
| | - I S Zgura
- Institute of Space Science, Bucharest, Măgurele, Romania
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Onofrei M, Wee MY, Parker B, Wee N, Hill S. Bacterial contamination of saline used for epidural procedures in an obstetric setting: a randomised comparison of two drawing-up techniques. Int J Obstet Anesth 2016; 29:45-49. [PMID: 27884664 DOI: 10.1016/j.ijoa.2016.10.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/30/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is little evidence to inform practice regarding the optimum aseptic technique of drawing up saline for epidural insertion. Our regional practice is to draw up saline from a non-sterile packaged plastic ampoule, therefore introducing the risk of bacterial contamination. Usually, the anaesthetist draws up saline directly from the vial held by an assistant using a needle (needle technique). Alternatively, the saline vial is emptied onto a sterile tray by an assistant and then drawn up by the anaesthetist (tray technique). We hypothesised that the latter will lead to an increase in the number of contaminated saline samples as they are exposed to the environment. METHODS In labour rooms and before epidural catheter insertion, 110 samples of saline 20mL were randomly drawn up using our hospital's recommended epidural aseptic precautions, using either the needle or the tray technique. Equal amounts of saline were inoculated into aerobic and anaerobic blood culture bottles. RESULTS Eleven percent of samples in the needle arm and 24% of samples in the tray arm grew commensal micro-organisms including coagulase-negative Staphylococcus, Micrococcus luteus and Streptococcus viridans. A two-sided Fisher's exact test for categorical unpaired data showed no statistical difference between the two arms of the trial (P=0.13). CONCLUSION The difference in the saline contamination rate between the two techniques did not reach statistical significance. As bacterial contamination occurred with both techniques, we recommend using sterile saline pre-packaged in the epidural tray or individually wrapped sterile glass saline ampoules.
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Affiliation(s)
- M Onofrei
- Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK.
| | - M Y Wee
- Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - B Parker
- Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - N Wee
- Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - S Hill
- Department of Microbiology, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
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McCarthy EM, Moreno-Martinez D, Wilkinson FL, McHugh NJ, Bruce IN, Pauling JD, Alexander MY, Parker B. Microparticle subpopulations are potential markers of disease progression and vascular dysfunction across a spectrum of connective tissue disease. BBA Clin 2016; 7:16-22. [PMID: 28053878 PMCID: PMC5199156 DOI: 10.1016/j.bbacli.2016.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/05/2016] [Accepted: 11/07/2016] [Indexed: 01/25/2023]
Abstract
Objective Microparticles (MPs) are membrane-bound vesicles derived from vascular and intravascular cells such as endothelial cells (EMPs) and platelets (PMPs). We investigated EMP and PMP numbers across a spectrum of autoimmune rheumatic diseases (AIRDs) with the aim of comparing the levels of, and relationship between, EMPs and PMPs. Methods Patients with Systemic Lupus Erythematosus (SLE) (n = 24), Systemic Sclerosis (SSc) (n = 24), Primary Raynauds Phenomenon (RP) (n = 17) and “other CTD” (n = 15) (Primary Sjogrens Syndrome, UCTD or MCTD) as well as 15 healthy controls were recruited. EMPs and PMPs were quantified using flow cytometry. Associations between MP levels and objective functional vascular assessments were evaluated. Results SLE patients had significantly higher EMPs compared with healthy controls and SSc patients. Higher PMP levels were noted in SSc and primary RP when compared to healthy controls and ‘other CTD’ patients. A modest correlation was noted between EMP and PMP levels in healthy controls (Spearman r = 0.6, p = 0.017). This relationship appeared stronger in SLE (r = 0.72, p < 0.0001) and other CTD patients (r = 0.75, p < 0.0001). The association between EMPs and PMPs was notably less strong in SSc (r = 0.45, p = 0.014) and RP (r = 0.37, p = 0.15). A significantly lower EMP/PMP ratio was detected in SSc/RP patients in comparison to both healthy controls and SLE/other CTD patients. Higher EMP and PMP levels were associated with higher digital perfusion following cold challenge in SSc. In contrast, higher PMP (but not EMP) levels were associated with lower digital perfusion at both baseline and following cold challenge in primary RP. Higher PMP levels were associated with greater endothelial-independent dilation in patients with SLE. Conclusion MP populations differ across the spectrum of AIRDS, possibly reflecting differences in vascular cell injury and activation. MP levels are associated with functional assessments of vascular function and might have a role as novel vascular biomarkers in AIRDs. Significance and innovations Levels of circulating endothelial and platelet microparticles differ between SSc/primary RP compared with SLE and other CTDs (UCTD, MCTD and Primary Sjogrens). MP release may occur within different vascular sites across these disease groups (macrovascular and microvascular). The association between circulating MP levels and objective assessment of macro- and microvascular dysfunction within these disease areas suggests that MPs might have a useful role as novel circulating biomarkers of vascular disease within the CTDs. Levels of circulating EMPs and PMPs differ between SSc/primary RP compared with other CTDs including SLE. Circulating MP levels are associated with objective assessments of macro- and microvascular dysfunction. MPs may have a useful role as novel circulating biomarkers of vascular disease within the CTDs.
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Affiliation(s)
- E M McCarthy
- Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, United Kingdom; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, United Kingdom; Healthcare Science Research Institute, Manchester Metropolitan University, Manchester, United Kingdom
| | - D Moreno-Martinez
- Healthcare Science Research Institute, Manchester Metropolitan University, Manchester, United Kingdom
| | - F L Wilkinson
- Healthcare Science Research Institute, Manchester Metropolitan University, Manchester, United Kingdom
| | - N J McHugh
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom; Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - I N Bruce
- Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, United Kingdom; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - J D Pauling
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom; Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - M Y Alexander
- Healthcare Science Research Institute, Manchester Metropolitan University, Manchester, United Kingdom
| | - B Parker
- Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, United Kingdom; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, United Kingdom
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Karzai F, Zimmer A, Lipkowitz S, Annunziata C, Parker B, Houston N, Ekwede I, Kohn E, Lee JM. A phase II study of the cell cycle checkpoint kinases 1 and 2 (CHK1/2) inhibitor (LY2606368; prexasertib) in sporadic triple negative breast cancer (TNBC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee JM, Karzai F, Zimmer A, Annunziata C, Lipkowitz S, Parker B, Houston N, Ekwede I, Kohn E. A phase II study of the cell cycle checkpoint kinases 1 and 2 inhibitor (LY2606368; Prexasertib monomesylate monohydrate) in sporadic high-grade serous ovarian cancer (HGSOC) and germline BRCA mutation-associated ovarian cancer (gBRCAm+ OvCa). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Barraclough M, Bruce I, McKie S, Parker B, Elliott R. SAT0281 Compensatory Brain Mechanisms To Maintain Cognitive Function in Systemic Lupus Erythematosus. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2382] [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: 11/03/2022]
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Little J, Lunt M, Parker B, Bruce I. THU0294 An International Consensus Exercise To Classify SLE Damage Items According To Their Likely Association with Steroids: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1470] [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: 11/04/2022]
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Mendoza Pinto C, Pirone C, Parker B, Bruce I. AB0407 Can We Identify Who Benefits from Mycophenolate Mofetil in Systemic Lupus Erythematosus? A Systematic Review. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3562] [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: 11/03/2022]
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Little J, Lunt M, Parker B, Bruce I. OP0043 Corticosteroid Use over Time in The Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort - A Descriptive Analysis: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1473] [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: 11/04/2022]
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Mody S, Panelli D, Hulugalle A, Su H, Parker B, Gorman J. Contraceptive use and counseling among breast cancer patients: a cross-sectional study. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barraclough M, Elliott R, McKie S, Parker B, Bruce IN. Cognitive dysfunction and functional magnetic resonance imaging in systemic lupus erythematosus. Lupus 2015; 24:1239-47. [PMID: 26124237 DOI: 10.1177/0961203315593819] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 02/05/2015] [Accepted: 05/05/2015] [Indexed: 01/04/2023]
Abstract
Cognitive dysfunction is a common aspect of systemic lupus erythematosus (SLE) and is increasingly reported as a problem by patients. In many cases the exact cause is unclear. Limited correlations between specific autoantibodies or structural brain abnormalities and cognitive dysfunction in SLE have been reported. It may be that the most appropriate biomarkers have yet to be found. Functional magnetic resonance imaging (fMRI) is a technique used in many other conditions and provides sensitive measures of brain functionality during cognitive tasks. It is now beginning to be employed in SLE studies. These studies have shown that patients with SLE often perform similarly to healthy controls in terms of behavioural measures on cognitive tasks. However, SLE patients appear to employ compensatory brain mechanisms, such as increased response in fronto-parietal regions, to maintain adequate cognitive performance. As there have been only a few studies using fMRI in SLE to investigate cognitive dysfunction, many questions remain unanswered. Further research could, however, help to identify biomarkers for cognitive dysfunction in SLE.
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Affiliation(s)
- M Barraclough
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - R Elliott
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK Neuroscience and Psychiatry Unit, Institute of Brain and Behaviour and Mental Health, The University of Manchester, UK and Manchester Academic Health Science Centre
| | - S McKie
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK Neuroscience and Psychiatry Unit, Institute of Brain and Behaviour and Mental Health, The University of Manchester, UK and Manchester Academic Health Science Centre
| | - B Parker
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - I N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
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Barraclough M, Elliott R, McKie S, Parker B, Bruce I. SAT0411 Cognitive and Emotional Processing in Systemic Lupus Erythematosus: An FMRI Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1654] [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: 11/04/2022]
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Parker B, Marra G, Johnson LAM, Margolis HS, Webster SA, Wright L, Lea SN, Gill P, Bayvel P. Transportable cavity-stabilized laser system for optical carrier frequency transmission experiments. Appl Opt 2014; 53:8157-8166. [PMID: 25608055 DOI: 10.1364/ao.53.008157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report the design and performance of a transportable laser system at 1543 nm, together with its application as the source for a demonstration of optical carrier frequency transmission over 118 km of an installed dark fiber network. The laser system is based around an optical reference cavity featuring an elastic mounting that bonds the cavity to its support, enabling the cavity to be transported without additional clamping. The cavity exhibits passive fractional frequency insensitivity to vibration along the optical axis of 2.0×10(-11) m(-1) s(2). With active fiber noise cancellation, the optical carrier frequency transmission achieves a fractional frequency instability, measured at the user end, of 2.6×10(-16) at 1 s, averaging down to below 3×10(-18) after 20,000 s. The fractional frequency accuracy of the transfer is better than 3×10(-18). This level of performance is sufficient for comparison of state-of-the-art optical frequency standards and is achieved in an urban fiber environment.
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Moreno-Martinez D, Wilkinson FL, Parker B, Pieri M, Barraclough M, Bruce I, Alexander MY. ENDOTHELIAL MICROPARTICLES: COMPLEX STRUCTURES THAT HAVE POTENTIAL TO ATTENUATE OSTEOGENIC DIFFERENTIATION OF HUMAN SMOOTH MUSCLE CELLS. Heart 2014. [DOI: 10.1136/heartjnl-2014-306916.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Parker B, Marco C, Duncan B, Rockey H. 165 Health Literacy Regarding Diagnostic Testing in the Emergency Department. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.191] [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: 10/24/2022]
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Zen M, Parker B, Urowitz M, Bruce I. FRI0426 High Prevalence of Overweight and Obesity in Recently Diagnosed Systemic Lupus Erythematosus Patients in an International Registry: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Court L, Aristophanous M, Bellezza D, Followill D, Kirsner S, Kisling K, Massingill B, Papanikolaou N, Parker B, Pidikiti R, Wong P, Zhen H, Balter P. SU-E-J-189: Credentialing of IGRT Equipment and Processes for Clinical Trials. Med Phys 2014. [DOI: 10.1118/1.4888242] [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: 11/07/2022] Open
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Trbojevic D, Parker B, Pullia M. 198: Large Momentum Acceptance NS-FFAG superconducting gantry for Carbon Ion Cancer Therapy for PAVIA. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)34219-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Metabolic syndrome (MetS) is a recently defined clustering of cardiovascular risk factors associated with insulin resistance and an increased risk of future type II diabetes mellitus and cardiovascular disease (CVD). Systemic lupus erythematosus (SLE) patients have an increased prevalence of MetS and an increased prevalence of insulin resistance. Chronic inflammation may predispose to these complications in SLE and there is also evidence that corticosteroid therapy also contributes, although this finding has not been as consistent as would be predicted from the known metabolic effects of corticosteroids. MetS may represent a good model in which to begin to understand how SLE drives an increased risk of CVD. For now, the utility of identifying MetS in patients is to identify a subset in which more focused lifestyle interventions should be targeted and in whom medication review and adjustment (especially corticosteroid doses) should be considered to help modify future CVD risk.
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Affiliation(s)
- B Parker
- Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, UK
| | - IN Bruce
- Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, and Kellgren Centre for Rheumatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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Parker B, Urowitz M, Lunt M, Bruce I. THU0163 Predictors of metabolic syndrome at enrolment into a multicentre international inception cohort of patients with SLE:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2128] [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: 11/03/2022]
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