1
|
Uoti S, Nurminen N, Andersson S, Egan C, Tapiovaara L, Kytö V, Ilonen I. Postoperative Complications and Reoperative Surgery in the Treatment of Patients With Zenker Diverticulum. JAMA Otolaryngol Head Neck Surg 2023; 149:690-696. [PMID: 37347475 PMCID: PMC10288379 DOI: 10.1001/jamaoto.2023.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/21/2023] [Indexed: 06/23/2023]
Abstract
Importance The association of the surgical approach, surgical specialty, and other factors with the outcomes of surgical treatment of Zenker diverticulum (ZD) have been debated in the literature. Objectives To explore the outcomes of 3 different surgical methods used in the management of ZD and determine the associations between patient characteristics, such as preoperative comorbidities and treatment outcomes. Design, Setting, and Participants This retrospective, population-based cohort study examined patient records of patients who underwent surgical treatment for ZD from the Care Register for Healthcare database in Finland between January 1996 and December 2015. Data review and analysis were completed in 2021. Exposure Surgical treatment for ZD. Main Outcome and Measures Complications of surgical procedures used in the management of ZD. Results In this study, 1044 patients (median [IQR] age, 70.0 [22.0-98.0] years; 416 female individuals [39.8%]) surgically treated for ZD were identified. Most patients (606 [58.0%]) had no preoperative comorbidities. A total of 67 (6.4%) complications were recorded, with a mortality rate of 0.9%. The likelihood of complications was associated with patient age (t [1042] = 2.28; Cohen d, 0.29; 95%, CI 0.04, 0.54), surgical approach (Cramer V = 0.14 [95% CI 0.07-0.21]), and surgical specialty (Cramer V, 0.16; 95% CI, 0.06-0.28). The median (IQR) length of stay in association with the primary surgical intervention was 3.0 (0-85.0) days. Length of stay was associated with patient age (Cramer V, 0.14; 95% CI, 0.06-0.25), especially in patients older than 90 years, surgical approach (F [2, 466.2] = 26.9; ηp2 = 0.08; 95% CI, 0.05-0.11), and surgical specialty (F [4, 22.1] = 11.0; ηp2 = 0.07; 95% CI, 0.04-0.10). Reoperation was associated with the initial surgical approach (Cramer V, 0.18; 95% CI, 0.12-0.23) and surgical specialty (Cramer V, 0.14; 95% CI, 0.09-0.21). Conclusions and Relevance The results of this cohort study suggest that the outcomes of surgical management depended on the surgical approach, surgical specialty, and patient age. Overall, surgical treatment may be considered safe and may be considered for all patients with symptomatic ZD.
Collapse
Affiliation(s)
- Sandra Uoti
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Nelli Nurminen
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Saana Andersson
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Caitlin Egan
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Laura Tapiovaara
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Clinical Research Centre, Turku University Hospital, Turku, Finland
- Administrative Center, Hospital District of Southwest Finland, Turku, Finland
| | - Ilkka Ilonen
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
2
|
Egan C, Stefanova D, Thiesmeyer JW, Lee YJ, Greenberg J, Beninato T, Zarnegar R, Christos PJ, Klein IL, Fahey TJ, Finnerty BM. Proposed Risk Stratification and Patterns of Radioactive Iodine Therapy in Malignant Struma Ovarii. Thyroid 2022; 32:1101-1108. [PMID: 35765923 DOI: 10.1089/thy.2022.0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Malignant struma ovarii (MSO) is a rare thyroid cancer arising within an ovarian teratoma. While surgical excision of the primary tumor is widely accepted as standard of care, recommendations for adjuvant treatment of MSO-whether or not to administer radioactive iodine (RAI)-are based largely on case reports and remain debated. In this study, we aimed to propose a risk stratification and analyze RAI utilization patterns in MSO cases. Methods: The National Cancer Database (NCDB) was queried for patients with MSO between 2004 and 2016. Demographic, oncological, and clinicopathologic data were compared between groups using Fisher's exact test. Kaplan-Meier curves were used to estimate overall survival (OS), and variables associated with OS were assessed via univariate Cox regression. We adapted the 2015 American Thyroid Association risk guidelines for MSO patients. We stratified patients into low-, intermediate-, and high-risk groups using metastasis, extraovarian extension, lymphovascular invasion, lymph node status, surgical margins, tumor size, and grade. Risk stratification, demographic, oncological, and clinicopathologic data were compared between the groups receiving and not receiving RAI therapy. We then queried the Surveillance, Epidemiology, and End Results (SEER) 18 registry for patients with MSO between 2000 and 2018 to confirm our risk stratification analysis. Results: In the NCDB analysis, a total of 158 patients were identified, and 19 received RAI. RAI therapy was associated with distant metastasis (p = 0.005) and lymph node status (p = 0.012). Twenty-one NCDB patients were stratified as high risk, and 30% of high-risk patients received RAI. High-risk stratification was associated with decreased OS via univariate Cox regression (hazard ratio = 4.0 [95% confidence interval 1.11-14.26], p = 0.034). In our subsequent analysis using the SEER registry, there were 95 MSO patients, and 18 received RAI. Again, the majority of high-risk patients did not receive RAI, with only 41% of high-risk patients receiving RAI. Conclusions: MSO is a rare malignancy with apparently variable and inconsistent patterns of postoperative RAI administration. The risk stratification described here provides a framework to identify patients potentially at risk for mortality, and utilization of RAI in this group should be studied further.
Collapse
Affiliation(s)
- Caitlin Egan
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Dessislava Stefanova
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Jessica W Thiesmeyer
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Yeon Joo Lee
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Jacques Greenberg
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Toni Beninato
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rasa Zarnegar
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Paul J Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Irwin L Klein
- Department of Medicine, NYU School of Medicine, Melville, New York, USA
| | - Thomas J Fahey
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Brendan M Finnerty
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
3
|
Egan C, Turtle L, Thorpe M, Harrison EM, Semple MG, Docherty AB. Hospital admission for symptomatic COVID-19 and impact of vaccination: analysis of linked data from the Coronavirus Clinical Information Network and the National Immunisation Management Service. Anaesthesia 2022; 77:605-608. [PMID: 35178709 PMCID: PMC9111458 DOI: 10.1111/anae.15677] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/27/2022]
Affiliation(s)
- C. Egan
- University of EdinburghEdinburghUK
| | | | | | | | | | | | | |
Collapse
|
4
|
Zhang P, Atkinson KM, Bray GA, Chen H, Clark JM, Coday M, Dutton GR, Egan C, Espeland MA, Evans M, Foreyt JP, Greenway FL, Gregg EW, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Huckfeldt PJ, Jackson SD, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Killean T, Knowler WC, Korytkowski M, Lewis CE, Maruthur NM, Michaels S, Montez MG, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Redmon B, Rushing JT, Steinburg H, Wadden TA, Wing RR, Wyatt H, Yanovski SZ. Within-Trial Cost-Effectiveness of a Structured Lifestyle Intervention in Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Action for Health in Diabetes (Look AHEAD) Study. Diabetes Care 2021; 44:67-74. [PMID: 33168654 PMCID: PMC7783933 DOI: 10.2337/dc20-0358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared with standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. RESEARCH DESIGN AND METHODS Data were from 4,827 participants during their first 9 years of study participation from 2001 to 2012. Information on Health Utilities Index Mark 2 (HUI-2) and HUI-3, Short-Form 6D (SF-6D), and Feeling Thermometer (FT), cost of delivering the interventions, and health expenditures was collected during the study. CE was measured by incremental CE ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 U.S. dollars. RESULTS Over the 9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.07 and 0.15, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. CONCLUSIONS Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions.
Collapse
Affiliation(s)
- Ping Zhang
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen M Atkinson
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mace Coday
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Gareth R Dutton
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Caitlin Egan
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Frank L Greenway
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, Imperial College London, London, U.K
| | - Helen P Hazuda
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - James O Hill
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL
| | | | - Van S Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Peter J Huckfeldt
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | - Robert W Jeffery
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Karen C Johnson
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Steven E Kahn
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
| | - Tina Killean
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Mary Korytkowski
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Nisa M Maruthur
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Maria G Montez
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - David M Nathan
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
| | - Jennifer Patricio
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY
| | - Anne Peters
- Houston Methodist Research Institute, Baylor College of Medicine, Houston, TX
| | - Xavier Pi-Sunyer
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY
| | - Henry Pownall
- Division of Endocrinology and Diabetes, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Bruce Redmon
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Julia T Rushing
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Helmut Steinburg
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, University of Pennsylvania, Philadelphia, PA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
| | - Holly Wyatt
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | |
Collapse
|
5
|
Yeh HC, Bantle JP, Cassidy-Begay M, Blackburn G, Bray GA, Byers T, Clark JM, Coday M, Egan C, Espeland MA, Foreyt JP, Garcia K, Goldman V, Gregg EW, Hazuda HP, Hesson L, Hill JO, Horton ES, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Korytkowski M, Kure A, Lewis CE, Mantzoros C, Meacham M, Montez MG, Nathan DM, Pajewski N, Patricio J, Peters A, Xavier Pi-Sunyer F, Pownall H, Ryan DH, Safford M, Sedjo RL, Steinburg H, Vitolins M, Wadden TA, Wagenknecht LE, Wing RR, Wolff AC, Wyatt H, Yanovski SZ. Intensive Weight Loss Intervention and Cancer Risk in Adults with Type 2 Diabetes: Analysis of the Look AHEAD Randomized Clinical Trial. Obesity (Silver Spring) 2020; 28:1678-1686. [PMID: 32841523 PMCID: PMC8855671 DOI: 10.1002/oby.22936] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 01/09/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study was designed to determine whether intensive lifestyle intervention (ILI) aimed at weight loss lowers cancer incidence and mortality. METHODS Data from the Look AHEAD trial were examined to investigate whether participants randomized to ILI designed for weight loss would have reduced overall cancer incidence, obesity-related cancer incidence, and cancer mortality, as compared with the diabetes support and education (DSE) comparison group. This analysis included 4,859 participants without a cancer diagnosis at baseline except for nonmelanoma skin cancer. RESULTS After a median follow-up of 11 years, 684 participants (332 in ILI and 352 in DSE) were diagnosed with cancer. The incidence rates of obesity-related cancers were 6.1 and 7.3 per 1,000 person-years in ILI and DSE, respectively, with a hazard ratio (HR) of 0.84 (95% CI: 0.68-1.04). There was no significant difference between the two groups in total cancer incidence (HR, 0.93; 95% CI: 0.80-1.08), incidence of nonobesity-related cancers (HR, 1.02; 95% CI: 0.83-1.27), or total cancer mortality (HR, 0.92; 95% CI: 0.68-1.25). CONCLUSIONS An ILI aimed at weight loss lowered incidence of obesity-related cancers by 16% in adults with overweight or obesity and type 2 diabetes. The study sample size likely lacked power to determine effect sizes of this magnitude and smaller.
Collapse
Affiliation(s)
- Hsin-Chieh Yeh
- Departments of Medicine, Epidemiology, and Oncology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - John P Bantle
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Maria Cassidy-Begay
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | - George Blackburn
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Tim Byers
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeanne M Clark
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Caitlin Egan
- Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Katelyn Garcia
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Valerie Goldman
- Diabetes Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Helen P Hazuda
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Louise Hesson
- Center for Weight and Eating Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James O Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Edward S Horton
- Department of Medicine, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert W Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Steven E Kahn
- Department of Medicine, VA Puget Sound Health Care System / University of Washington, Seattle, Washington, USA
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | - Mary Korytkowski
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne Kure
- Department of Medicine, VA Puget Sound Health Care System / University of Washington, Seattle, Washington, USA
| | - Cora E Lewis
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Maria Meacham
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | - Maria G Montez
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - David M Nathan
- Diabetes Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicholas Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Anne Peters
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Henry Pownall
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Donna H Ryan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Monika Safford
- Department of Medicine, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Rebecca L Sedjo
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Helmut Steinburg
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mara Vitolins
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rena R Wing
- Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Antonio C Wolff
- Department of Oncology, The Johns Hopkins Sydney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - Holly Wyatt
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
6
|
Lewis CE, Bantle JP, Bertoni AG, Blackburn G, Brancati FL, Bray GA, Cheskin LJ, Curtis JM, Egan C, Evans M, Foreyt JP, Ghazarian S, Gibbs BB, Glasser S, Gregg EW, Hazuda HP, Hesson L, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Kitabchi AE, Kitzman D, Knowler WC, Lipkin E, Michaels S, Montez MG, Nathan DM, Nyenwe E, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Ryan DH, Wadden TA, Wagenknecht LE, Wyatt H, Wing RR, Yanovski SZ. History of Cardiovascular Disease, Intensive Lifestyle Intervention, and Cardiovascular Outcomes in the Look AHEAD Trial. Obesity (Silver Spring) 2020; 28:247-258. [PMID: 31898874 PMCID: PMC6980987 DOI: 10.1002/oby.22676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/19/2019] [Accepted: 09/11/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the effects of an intensive lifestyle intervention (ILI) on cardiovascular disease (CVD), the Action for Health in Diabetes (Look AHEAD) trial randomized 5,145 participants with type 2 diabetes and overweight/obesity to a ILI or diabetes support and education. Although the primary outcome did not differ between the groups, there was suggestive evidence of heterogeneity for prespecified baseline CVD history subgroups (interaction P = 0.063). Event rates were higher in the ILI group among those with a CVD history (hazard ratio 1.13 [95% CI: 0.90-1.41]) and lower among those without CVD (hazard ratio 0.86 [95% CI: 0.72-1.02]). METHODS This study conducted post hoc analyses of the rates of the primary composite outcome and components, adjudicated cardiovascular death, nonfatal myocardial infarction (MI), stroke, and hospitalization for angina, as well as three secondary composite cardiovascular outcomes. RESULTS Interaction P values for the primary and two secondary composites were similar (0.060-0.064). Of components, the interaction was significant for nonfatal MI (P = 0.035). This interaction was not due to confounding by baseline variables, different intervention responses for weight loss and physical fitness, or hypoglycemic events. In those with a CVD history, statin use was high and similar by group. In those without a CVD history, low-density lipoprotein cholesterol levels were higher (P = 0.003) and statin use was lower (P ≤ 0.001) in the ILI group. CONCLUSIONS Intervention response heterogeneity was significant for nonfatal MI. Response heterogeneity may need consideration in a CVD-outcome trial design.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jeffrey M. Curtis
- Southwestern American Indian Center, Phoenix, AZ; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ; St. Joseph’s Hospital and Medical Center, Phoenix
| | - Caitlin Egan
- The Miriam Hospital, Brown Medical School; Providence, RI
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| | | | | | | | | | | | - Helen P. Hazuda
- University of Texas Health Science Center at San Antonio; San Antonio, TX
| | | | - James O. Hill
- University of Colorado Anschutz Medical Campus; Aurora, CO
| | | | - Van S. Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| | | | | | | | - Steven E. Kahn
- VA Puget Sound Health Care System, University of Washington; Seattle, WA
| | | | | | - William C. Knowler
- Southwestern American Indian Center, Phoenix; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Edward Lipkin
- VA Puget Sound Health Care System, University of Washington; Seattle, WA
| | | | - Maria G. Montez
- University of Texas Health Science Center at San Antonio; San Antonio, TX
| | | | | | - Jennifer Patricio
- St. Luke’s Roosevelt Hospital Center, Columbia University; New York, NY
| | - Anne Peters
- University of Southern California; Los Angeles, CA
| | - Xavier Pi-Sunyer
- St. Luke’s Roosevelt Hospital Center, Columbia University; New York, NY
| | | | | | - Donna H. Ryan
- Pennington Biomedical Research Center; Baton Rouge, LA
| | | | | | - Holly Wyatt
- University of Colorado Anschutz Medical Campus; Aurora, CO
| | - Rena R. Wing
- The Miriam Hospital, Brown Medical School; Providence, RI
| | - Susan Z. Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| |
Collapse
|
7
|
Houston DK, Neiberg RH, Miller ME, Hill JO, Jakicic JM, Johnson KC, Gregg EW, Hubbard VS, Pi-Sunyer X, Rejeski WJ, Wing RR, Bantle JP, Beale E, Berkowitz RI, Cassidy-Begay M, Clark JM, Coday M, Delahanty LM, Dutton G, Egan C, Foreyt JP, Greenway FL, Hazuda HP, Hergenroeder A, Horton ES, Jeffery RW, Kahn SE, Kure A, Knowler WC, Lewis CE, Martin CK, Michaels S, Montez MG, Nathan DM, Patricio J, Peters A, Pownall H, Regensteiner J, Steinburg H, Wadden TA, White K, Yanovski SZ, Zhang P, Kritchevsky SB. Physical Function Following a Long-Term Lifestyle Intervention Among Middle Aged and Older Adults With Type 2 Diabetes: The Look AHEAD Study. J Gerontol A Biol Sci Med Sci 2019; 73:1552-1559. [PMID: 29053861 DOI: 10.1093/gerona/glx204] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Indexed: 01/26/2023] Open
Abstract
Background Lifestyle interventions have been shown to improve physical function over the short term; however, whether these benefits are sustainable is unknown. The long-term effects of an intensive lifestyle intervention (ILI) on physical function were assessed using a randomized post-test design in the Look AHEAD trial. Methods Overweight and obese (body mass index ≥ 25 kg/m2) middle-aged and older adults (aged 45-76 years at enrollment) with type 2 diabetes enrolled in Look AHEAD, a trial evaluating an ILI designed to achieve weight loss through caloric restriction and increased physical activity compared to diabetes support and education (DSE), underwent standardized assessments of performance-based physical function including a 4- and 400-m walk, lower extremity physical performance (expanded Short Physical Performance Battery, SPPBexp), and grip strength approximately 11 years postrandomization and 1.5 years after the intervention was stopped (n = 3,783). Results Individuals randomized to ILI had lower odds of slow gait speed (<0.8 m/s) compared to those randomized to DSE (adjusted OR [95% CI]: 0.84 [0.71 to 0.99]). Individuals randomized to ILI also had faster gait speed over 4- and 400-m (adjusted mean difference [95% CI]: 0.019 [0.007 to 0.031] m/s, p = .002, and 0.023 [0.012 to 0.034] m/sec, p < .0001, respectively) and higher SPPBexp scores (0.037 [0.011 to 0.063], p = .005) compared to those randomized to DSE. The intervention effect was slightly larger for SPPBexp scores among older versus younger participants (0.081 [0.038 to 0.124] vs 0.013 [-0.021 to 0.047], p = .01). Conclusions An intensive lifestyle intervention has modest but significant long-term benefits on physical function in overweight and obese middle-aged and older adults with type 2 diabetes. ClinicalTrials.gov Identifier NCT00017953.
Collapse
Affiliation(s)
| | | | | | - James O Hill
- University of Colorado Denver School of Medicine, Aurora
| | | | | | | | - Van S Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | | | | - Rena R Wing
- Brown University and Miriam Hospital, Providence, Rhode Island
| | | | - Elizabeth Beale
- Keck School of Medicine of University of Southern California, Los Angeles
| | | | | | | | - Mace Coday
- University of Tennessee Health Science Center, Memphis
| | | | - Gareth Dutton
- University of Alabama at Birmingham School of Medicine
| | - Caitlin Egan
- Weight Control and Diabetes Research Center, Providence, Rhode Island
| | | | | | - Helen P Hazuda
- University of Texas Health Science Center at San Antonio
| | | | - Edward S Horton
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | - Cora E Lewis
- University of Alabama at Birmingham School of Medicine
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | | | - Maria G Montez
- University of Texas Health Science Center at San Antonio
| | | | | | - Anne Peters
- Keck School of Medicine of University of Southern California, Los Angeles
| | | | | | | | - Thomas A Wadden
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Karen White
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Ping Zhang
- Centers for Disease Control, Atlanta, Georgia
| | | |
Collapse
|
8
|
Müller I, Ramis-Zaldívar J, Schmidt J, Egan C, Gonzalez-Farre B, Salmeron-Villalobos J, Mattern S, Szablewski V, Dojcinov S, Chott A, Copie-Bergman C, Bonzheim I, Campo E, Fend F, Jaffe E, Salaverria I, Quintanilla de Fend L. GENOME WIDE-ANALYSIS OF T(14;18)-NEGATIVE FOLLICULAR LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.102_2629] [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: 11/06/2022]
Affiliation(s)
- I. Müller
- Institute of Pathology; University Hospital Tübingen, Eberhard-Karls-University of Tübingen; Tübingen Germany
| | - J. Ramis-Zaldívar
- Hematopathology Unit; Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERONC, Universitat de Barcelona; Barcelona Spain
| | - J. Schmidt
- Institute of Pathology; University Hospital Tübingen, Eberhard-Karls-University of Tübingen; Tübingen Germany
| | - C. Egan
- Laboratory of Pathology; Center for Cancer Research, National Cancer Institute, National Institutes of Health; Maryland United States
| | - B. Gonzalez-Farre
- Hematopathology Unit; Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERONC, Universitat de Barcelona; Barcelona Spain
| | - J. Salmeron-Villalobos
- Hematopathology Unit; Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERONC, Universitat de Barcelona; Barcelona Spain
| | - S. Mattern
- Institute of Pathology; University Hospital Tübingen, Eberhard-Karls-University of Tübingen; Tübingen Germany
| | - V. Szablewski
- Département de Biopatholog Cellulaire et Tissulaire des Tumeurs; CHU Montpellier, Hôpital Gui De Chauliac; Montpellier France
| | - S. Dojcinov
- Department of Pathology; University Hospital of Wales; Cardiff United Kingdom
| | - A. Chott
- Institute of Pathology and Microbiology; Wilhelminenspital; Vienna Austria
| | - C. Copie-Bergman
- Department of Pathology; Henri Mondor Hospital, APHP, INSERM U955, Université Paris-Est; Créteil France
| | - I. Bonzheim
- Institute of Pathology; University Hospital Tübingen, Eberhard-Karls-University of Tübingen; Tübingen Germany
| | - E. Campo
- Hematopathology Unit; Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERONC, Universitat de Barcelona; Barcelona Spain
| | - F. Fend
- Institute of Pathology; University Hospital Tübingen, Eberhard-Karls-University of Tübingen; Tübingen Germany
| | - E.S. Jaffe
- Laboratory of Pathology; Center for Cancer Research, National Cancer Institute, National Institutes of Health; Maryland United States
| | - I. Salaverria
- Hematopathology Unit; Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERONC, Universitat de Barcelona; Barcelona Spain
| | - L. Quintanilla de Fend
- Institute of Pathology; University Hospital Tübingen, Eberhard-Karls-University of Tübingen; Tübingen Germany
| |
Collapse
|
9
|
Beattie WS, Wijeysundera DN, Chan MTV, Peyton PJ, Leslie K, Paech MJ, Sessler DI, Wallace S, Myles PS, Galagher W, Farrington C, Ditoro A, Baulch S, Sidiropoulos S, Bulach R, Bryant D, O’Loughlin E, Mitteregger V, Bolsin S, Osborne C, McRae R, Backstrom M, Cotter R, March S, Silbert B, Said S, Halliwell R, Cope J, Fahlbusch D, Crump D, Thompson G, Jefferies A, Reeves M, Buckley N, Tidy T, Schricker T, Lattermann R, Iannuzzi D, Carroll J, Jacka M, Bryden C, Badner N, Tsang MWY, Cheng BCP, Fong ACM, Chu LCY, Koo EGY, Mohd N, Ming LE, Campbell D, McAllister D, Walker S, Olliff S, Kennedy R, Eldawlatly A, Alzahrani T, Chua N, Sneyd R, McMillan H, Parkinson I, Brennan A, Balaji P, Nightingale J, Kunst G, Dickinson M, Subramaniam B, Banner-Godspeed V, Liu J, Kurz A, Hesler B, Fu AY, Egan C, Fiffick AN, Hutcherson MT, Turan A, Naylor A, Obal D, Cooke E. Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival. Anesth Analg 2018. [DOI: 10.1213/ane.0000000000003310] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
10
|
Abstract
Slipped upper femoral epiphysis (SUFE) is one of the most common orthopaedic conditions in adolescents. SUFE typically presents as hip pain and limping, but it may present deceptively as knee pain or contralateral hip pain. We discuss a case of a child with a deceptive presentation of SUFE resulting in delayed diagnosis.
Collapse
Affiliation(s)
- M N Baig
- Trauma & Orthopaedic Surgery, Galway University Hospital, Galway, IRL
| | - Orna A Glynn
- Trauma & Orthopaedic Surgery, Galway University Hospital, Galway, IRL
| | - C Egan
- Trauma & Orthopaedic Surgery, Galway University Hospital, Galway, IRL
| |
Collapse
|
11
|
Wynn J, Ottman R, Duong J, Wilson AL, Ahimaz P, Martinez J, Rabin R, Rosen E, Webster R, Au C, Cho MT, Egan C, Guzman E, Primiano M, Shaw JE, Sisson R, Klitzman RL, Appelbaum PS, Lichter-Konecki U, Anyane-Yeboa K, Iglesias A, Chung WK. Diagnostic exome sequencing in children: A survey of parental understanding, experience and psychological impact. Clin Genet 2018; 93:1039-1048. [PMID: 29266212 DOI: 10.1111/cge.13200] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 12/21/2022]
Abstract
Clinical exome sequencing (CES) is increasingly being used as an effective diagnostic tool in the field of pediatric genetics. We sought to evaluate the parental experience, understanding and psychological impact of CES by conducting a survey study of English-speaking parents of children who had diagnostic CES. Parents of 192 unique patients participated. The parent's interpretation of the child's result agreed with the clinician's interpretation in 79% of cases, with more frequent discordance when the clinician's interpretation was uncertain. The majority (79%) reported no regret with the decision to have CES. Most (65%) reported complete satisfaction with the genetic counseling experience, and satisfaction was positively associated with years of genetic counselor (GC) experience. The psychological impact of CES was greatest for parents of children with positive results and for parents with anxiety or depression. The results of this study are important for helping clinicians to prepare families for the possible results and variable psychological impact of CES. The frequency of parental misinterpretation of test results indicates the need for additional clarity in the communication of results. Finally, while the majority of patients were satisfied with their genetic counseling, satisfaction was lower for new GCs, suggesting a need for targeted GC training for genomic testing.
Collapse
Affiliation(s)
- J Wynn
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - R Ottman
- G.H. Sergievsky Center and Departments of Epidemiology and Neurology, Columbia University Medical Center and NY State Psychiatric Institute, New York, New York
| | - J Duong
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - A L Wilson
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York
| | - P Ahimaz
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - J Martinez
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - R Rabin
- College of Liberal Arts and Sciences, Long Island University - Post Campus, Brookville, New York
| | - E Rosen
- College of Liberal Arts and Sciences, Long Island University - Post Campus, Brookville, New York
| | - R Webster
- Columbia University Medical School, New York, New York
| | - C Au
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York
| | - M T Cho
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York.,GeneDx, Gaithersburg, Maryland
| | - C Egan
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York
| | - E Guzman
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York
| | - M Primiano
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York
| | - J E Shaw
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York
| | - R Sisson
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York
| | - R L Klitzman
- Department of Psychiatry, Columbia University Medical Center and NY State Psychiatric Institute, New York, New York
| | - P S Appelbaum
- Department of Psychiatry, Columbia University Medical Center and NY State Psychiatric Institute, New York, New York
| | - U Lichter-Konecki
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - K Anyane-Yeboa
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - A Iglesias
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - W K Chung
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York.,Department of Medicine, Columbia University Medical Center, New York, New York
| |
Collapse
|
12
|
Ryan CW, Bishop K, Blaney DD, Britton SJ, Cantone F, Egan C, Elrod MG, Frye CW, Maxted AM, Perkins G. Public health response to an imported case of canine melioidosis. Zoonoses Public Health 2018; 65:420-424. [PMID: 29451368 DOI: 10.1111/zph.12450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 12/01/2022]
Abstract
Melioidosis in humans presents variably as fulminant sepsis, pneumonia, skin infection and solid organ abscesses. It is caused by Burkholderia pseudomallei, which in the United States is classified as a select agent, with "potential to pose a severe threat to both human and animal health, to plant health or to animal and plant products" (Federal Select Agent Program, http://www.selectagents.gov/, accessed 22 September 2016). Burkholderia pseudomallei is found in soil and surface water in the tropics, especially South-East Asia and northern Australia, where melioidosis is endemic. Human cases are rare in the United States and are usually associated with travel to endemic areas. Burkholderia pseudomallei can also infect animals. We describe a multijurisdictional public health response to a case of subclinical urinary B. pseudomallei infection in a dog that had been adopted into upstate New York from a shelter in Thailand. Investigation disclosed three human contacts with single, low-risk exposures to the dog's urine at his residence, and 16 human contacts with possible exposure to his urine or culture isolates at a veterinary hospital. Contacts were offered various combinations of symptom/fever monitoring, baseline and repeat B. pseudomallei serologic testing, and antibiotic post-exposure prophylaxis, depending on the nature of their exposure and their personal medical histories. The dog's owner accepted recommendations from public health authorities and veterinary clinicians for humane euthanasia. A number of animal rescue organizations actively facilitate adoptions into the United States of shelter dogs from South-East Asia. This may result in importation of B. pseudomallei into almost any community, with implications for human and animal health.
Collapse
Affiliation(s)
- C W Ryan
- Broome County Health Department, Binghamton, NY, USA
| | - K Bishop
- Tompkins County Health Department, Ithaca, NY, USA
| | - D D Blaney
- Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S J Britton
- Broome County Health Department, Binghamton, NY, USA.,New York Medical College, Valhalla, NY, USA
| | - F Cantone
- Office of Emergency Management, Environmental Health and Safety, Cornell University, Ithaca, NY, USA
| | - C Egan
- New York State Department of Health, Biodefense Laboratory, Wadsworth Center, New York, NY, USA
| | - M G Elrod
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C W Frye
- Sports Medicine and Rehabilitation and Resident in Clinical Nutrition, Cornell University Hospital for Animals, Ithaca, NY, USA
| | - A M Maxted
- New York State Department of Health, Bureau of Communicable Disease Control, New York, NY, USA
| | - G Perkins
- College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| |
Collapse
|
13
|
Abstract
Introduction Paediatric patient bone fractures are the source of a large number of orthopaedic outpatient visits, especially for fracture clinics. The National Institute for Health and Care Excellence (NICE) guideline NG38 provides guidance on assessing and managing non-complex fractures, such as buckle (i.e., torus) fractures in paediatric patients. Objective We retrospectively audited outpatient records of children younger than 12 years presenting with distal radius buckle fractures for May and June 2017. We compared our practice against the NICE guideline standards. We made certain changes in our practice and then repeated the exercise prospectively for two months from July 15 to September 15, 2017. Material and Methods We identified 31 patients who fit our inclusion criteria. After instituting changes based on the NICE guidelines, the number of children included in the prospective data collection was 33 patients. Results For the 31 children treated according to our older protocol, we had 59 outpatient visits, with an average of 1.90 visits for every child. After the NICE-driven changes were made to our management, 33 patients were treated in 39 visits with an average of 1.2 visits per child. Conclusion Introducing NICE guidelines allowed for considerable improvement in the management and treatment of paediatric patient bone fractures. It is important to fully implement the NICE guidelines not only in fracture clinics but also in other departments, such as accident and emergency departments.
Collapse
Affiliation(s)
- M N Baig
- Trauma & Orthopaedics, Galway University Hospital
| | - C Egan
- Trauma & Orthopaedics, Galway University Hospital
| |
Collapse
|
14
|
Mastropasqua R, Luo YHL, Cheah YS, Egan C, Lewis JJ, da Cruz L. Black patients sustain vision loss while White and South Asian patients gain vision following delamination or segmentation surgery for tractional complications associated with proliferative diabetic retinopathy. Eye (Lond) 2017; 31:1468-1474. [PMID: 28574495 DOI: 10.1038/eye.2017.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/12/2017] [Indexed: 12/15/2022] Open
Abstract
PurposeThis retrospective comparative case series aims to determine whether patient ethnicity (White versus South Asian versus Black) is related to the outcome of surgical treatment for traction complications of severe proliferative diabetic retinopathy (PDR).SettingMoorfields Eye Hospital London, UK.MethodsAll patients who underwent vitrectomy with, delamination and/or segmentation for PDR over a 5-year period (2009-2014) were reviewed retrospectively. Patients were divided into White, South Asian or Black groups, and their age, gender, HbA1C and type of diabetes were recorded. A total of 484 patients (253 White, 117 South Asian, 114 Black) were included. Twenty-one patients were excluded due to inadequate documentation.OutcomesLogMAR Visual acuity (converted from Snellen) (VA), was recorded pre-operatively and ~6 months post surgery (range 5-8 months). Surgical outcome was classified according to the type and duration of tamponade required post-operatively.ResultsPre-operative VA and HbA1C values were similar across all three ethnic groups (P=0.64 and 0.569, respectively). Change in VA (mean±SD) was 0.41±0.78, 0.14±0.76 and -0.26±0.57 in White, South Asian and Black patient groups respectively (P<0.001). Multiple regression analysis showed that post-op VA was significantly related to race and pre-op VA only (both P<0.001). The Black patient group were more likely to require silicone oil tamponade (P<0.001) and long-term retention of silicone oil (P<0.001) than the White and South Asian patient groups.ConclusionsThis study demonstrates that Black patients on average lose vision following delamination surgery for traction complications of PDR while White and South Asian patients gain vision. The same group is also at higher risk of retaining silicone more than 6 months after surgery. This difference remains even when corrected for glycaemic control. The higher risk of visual loss and long-term retention of silicone oil in black patients requires further investigation. If these results are confirmed, surgeons should consider their patients' ethnicity before proceeding with surgical treatment of diabetic tractional detachment.
Collapse
Affiliation(s)
- R Mastropasqua
- Vitreo-Retinal Department, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Y H-L Luo
- Vitreo-Retinal Department, Moorfields Eye Hospital, NHS Foundation Trust, London, UK.,Department of Ocular Biology and Therapeutics, Institute of Ophthalmology, University College of London, London, UK.,National Institute for Health Research, Moorfields Biomedical Research Centre, London, UK
| | - Y S Cheah
- Department of Diabetic Medicine, King's College Hospital, NHS Foundation Trust, London, UK
| | - C Egan
- Vitreo-Retinal Department, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - J J Lewis
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - L da Cruz
- Vitreo-Retinal Department, Moorfields Eye Hospital, NHS Foundation Trust, London, UK.,Department of Ocular Biology and Therapeutics, Institute of Ophthalmology, University College of London, London, UK.,National Institute for Health Research, Moorfields Biomedical Research Centre, London, UK
| |
Collapse
|
15
|
Schmidt J, Ramis-Záldivar J, Nadeu F, Gonzalez-Farre B, Navarro A, Dojcinov S, Rosenwald A, Ott G, Campo E, Fend F, Egan C, Jaffe E, Salaverria I, Quintanilla-Martinez L. INTEGRATIVE MUTATIONAL ANALYSIS OF PEDIATRIC-TYPE FOLLICULAR LYMPHOMA REVEALS TNFRSF14
AND MAP2K1
AS THE MOST FREQUENTLY MUTATED GENES. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_1] [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: 11/06/2022]
Affiliation(s)
- J. Schmidt
- Institute of Pathology; University Hospital Tübingen; Tübingen Germany
| | - J. Ramis-Záldivar
- Institut d'Investigacions Biomèdiques August Pi iSunyer; Hospital Clínic; Barcelona Spain
| | - F. Nadeu
- Institut d'Investigacions Biomèdiques August Pi iSunyer; Hospital Clínic; Barcelona Spain
| | - B. Gonzalez-Farre
- Institut d'Investigacions Biomèdiques August Pi iSunyer; Hospital Clínic; Barcelona Spain
| | - A. Navarro
- Institut d'Investigacions Biomèdiques August Pi iSunyer; Hospital Clínic; Barcelona Spain
| | - S. Dojcinov
- Department of Pathology, All Wales Lymphoma Panel; University Hospital Wales; Cardiff UK
| | - A. Rosenwald
- Institute of Pathology; University of Würzburg; Würzburg Germany
| | - G. Ott
- Department of Clinical Pathology; Robert-Bosch Hospital; Stuttgart Germany
| | - E. Campo
- Institut d'Investigacions Biomèdiques August Pi iSunyer; Hospital Clínic; Barcelona Spain
| | - F. Fend
- Institute of Pathology; University Hospital Tübingen; Tübingen Germany
| | - C. Egan
- Laboratory of Pathology; National Cancer Institute; Bethesda USA
| | - E. Jaffe
- Laboratory of Pathology; National Cancer Institute; Bethesda USA
| | - I. Salaverria
- Institut d'Investigacions Biomèdiques August Pi iSunyer; Hospital Clínic; Barcelona Spain
| | | |
Collapse
|
16
|
Daly A, Hoban A, Egan C, Moore D, Kiely P. The Implications of Delayed Access to MRI Imaging: A 3-month Historical Prospective Study. Ir Med J 2017; 110:524. [PMID: 28657268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- A Daly
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - A Hoban
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - C Egan
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - D Moore
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - P Kiely
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| |
Collapse
|
17
|
Taylor C, Tuddenham N, Egan C. Increased dorsiflexion a risk factor for lower limb injury in junior elite Australian football players. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.164] [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: 10/20/2022]
|
18
|
Gregg E, Jakicic J, Blackburn G, Bloomquist P, Bray G, Clark J, Coday M, Curtis J, Egan C, Evans M, Foreyt J, Foster G, Hazuda H, Hill J, Horton E, Hubbard V, Jeffery R, Johnson K, Kitabchi A, Knowler W, Kriska A, Lang W, Lewis C, Montez M, Nathan D, Neiberg R, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Redmon B, Regensteiner J, Rejeski J, Ribisl P, Safford M, Stewart K, Trence D, Wadden T, Wing R, Yanovski S. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2016; 4:913-921. [PMID: 27595918 PMCID: PMC5094846 DOI: 10.1016/s2213-8587(16)30162-0] [Citation(s) in RCA: 397] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Findings from the Look AHEAD trial showed no significant reductions in the primary outcome of cardiovascular disease incidence in adults with type 2 diabetes randomly assigned to an intensive lifestyle intervention for weight loss compared with those randomly assigned to diabetes support and education (control). We examined whether the incidence of cardiovascular disease in Look AHEAD varied by changes in weight or fitness. METHODS Look AHEAD was a randomised clinical trial done at 16 clinical sites in the USA, recruiting patients from Aug 22, 2001, to April 30, 2004. In the trial, 5145 overweight or obese adults aged 45-76 years with type 2 diabetes were assigned (1:1) to an intensive lifestyle intervention or diabetes support and education. In this observational, post-hoc analysis, we examined the association of magnitude of weight loss and fitness change over the first year with incidence of cardiovascular disease. The primary outcome of the trial and of this analysis was a composite of death from cardiovascular causes, non-fatal acute myocardial infarction, non-fatal stroke, or admission to hospital for angina. The secondary outcome included the same indices plus coronary artery bypass grafting, carotid endartectomy, percutaneous coronary intervention, hospitalisation for congestive heart failure, peripheral vascular disease, or total mortality. We adjusted analyses for baseline differences in weight or fitness, demographic characteristics, and risk factors for cardiovascular disease. The Look AHEAD trial is registered with ClinicalTrials.gov, number NCT00017953. FINDINGS For the analyses related to weight change, we excluded 311 ineligible participants, leaving a population of 4834; for the analyses related to fitness change, we excluded 739 participants, leaving a population of 4406. In analyses of the full cohort (ie, combining both study groups), over a median 10·2 years of follow-up (IQR 9·5-10·7), individuals who lost at least 10% of their bodyweight in the first year of the study had a 21% lower risk of the primary outcome (adjusted hazard ratio [HR] 0·79, 95% CI 0·64-0·98; p=0·034) and a 24% reduced risk of the secondary outcome (adjusted HR 0·76, 95% CI 0·63-0·91; p=0·003) compared with individuals with stable weight or weight gain. Achieving an increase of at least 2 metabolic equivalents in fitness change was associated with a significant reduction in the secondary outcome (adjusted HR 0·77, 95% CI 0·61-0·96; p=0·023) but not the primary outcome (adjusted HR 0·78, 0·60-1·03; p=0·079). In analyses treating the control group as the reference group, participants in the intensive lifestyle intervention group who lost at least 10% of their bodyweight had a 20% lower risk of the primary outcome (adjusted HR 0·80, 95% CI 0·65-0·99; p=0·039), and a 21% lower risk of the secondary outcome (adjusted HR 0·79, 95% CI 0·66-0·95; p=0·011); however, change in fitness was not significantly associated with a change in the primary outcome. INTERPRETATION The results of this post-hoc analysis of Look AHEAD suggest an association between the magnitude of weight loss and incidence of cardiovascular disease in people with type 2 diabetes. These findings suggest a need to continue to refine approaches to identify individuals who are most likely to benefit from lifestyle interventions and to develop strategies to improve the magnitude of sustained weight loss with lifestyle interventions. FUNDING US National Institute of Diabetes and Digestive and Kidney Diseases.
Collapse
|
19
|
O’Keeffe O, Kavanagh H, Egan C, Murphy N, Harbison J. An observational study of physical activity levels on the acute stroke unit of a large teaching hospital in Dublin, Ireland. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.2010] [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: 10/23/2022]
|
20
|
De La Harpe Golden P, Egan C, Leader M, Murphy PT, Quinn J. Hodgkin lymphoma in a patient with chronic lymphocytic leukaemia--a rare presentation of Richter's transformation. Ir Med J 2015; 108:120-121. [PMID: 26016306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Richter's transformation of chronic lymphocytic leukaemia (CLL) to high-grade B-cell Non-Hodgkin lymphoma occurs in < 5% of CLL cases. Transformation of CLL to Hodgkin Lymphoma is a much rarer event and here we describe a patient who developed Richter's transformation into a Hodgkin Lymphoma presenting as rapidly progressive hepatosplenomegaly.
Collapse
|
21
|
Carty K, Guidon M, Egan C. A neuromuscular respiratory outpatient clinic: Patient profile and experience (Beaumont Hospital). BMC Proc 2015. [PMCID: PMC4306028 DOI: 10.1186/1753-6561-9-s1-a28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
22
|
Gratrix J, Singh AE, Bergman J, Egan C, Plitt SS, McGinnis J, Bell CA, Drews SJ, Read R. Evidence for Increased Chlamydia Case Finding After the Introduction of Rectal Screening Among Women Attending 2 Canadian Sexually Transmitted Infection Clinics. Clin Infect Dis 2014; 60:398-404. [DOI: 10.1093/cid/ciu831] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
23
|
Espeland MA, Glick HA, Bertoni A, Brancati FL, Bray GA, Clark JM, Curtis JM, Egan C, Evans M, Foreyt JP, Ghazarian S, Gregg EW, Hazuda HP, Hill JO, Hire D, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Killean T, Kitabchi AE, Knowler WC, Kriska A, Lewis CE, Miller M, Montez MG, Murillo A, Nathan DM, Nyenwe E, Patricio J, Peters AL, Pi-Sunyer X, Pownall H, Redmon JB, Rushing J, Ryan DH, Safford M, Tsai AG, Wadden TA, Wing RR, Yanovski SZ, Zhang P. Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes. Diabetes Care 2014; 37:2548-56. [PMID: 25147253 PMCID: PMC4140155 DOI: 10.2337/dc14-0093] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 03/06/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the relative impact of an intensive lifestyle intervention (ILI) on use and costs of health care within the Look AHEAD trial. RESEARCH DESIGN AND METHODS A total of 5,121 overweight or obese adults with type 2 diabetes were randomly assigned to an ILI that promoted weight loss or to a comparison condition of diabetes support and education (DSE). Use and costs of health-care services were recorded across an average of 10 years. RESULTS ILI led to reductions in annual hospitalizations (11%, P = 0.004), hospital days (15%, P = 0.01), and number of medications (6%, P < 0.001), resulting in cost savings for hospitalization (10%, P = 0.04) and medication (7%, P < 0.001). ILI produced a mean relative per-person 10-year cost savings of $5,280 (95% CI 3,385-7,175); however, these were not evident among individuals with a history of cardiovascular disease. CONCLUSIONS Compared with DSE over 10 years, ILI participants had fewer hospitalizations, fewer medications, and lower health-care costs.
Collapse
Affiliation(s)
- Mark A Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Henry A Glick
- Weight and Eating Disorder Program, University of Pennsylvania, Philadelphia, PA
| | - Alain Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - George A Bray
- Pennington Biomedical Research Center, Baton Rouge, LA
| | | | - Jeffrey M Curtis
- Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM
| | - Caitlin Egan
- Weight Control and Diabetes Research Center, Brown Medical School/The Miriam Hospital, Providence, RI
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | | | | | - Helen P Hazuda
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - James O Hill
- Anschutz Health and Wellness Center, University of Colorado Health Sciences Center, Aurora, CO
| | - Don Hire
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Edward S Horton
- Department of Clinical Epidemiology, Joslin Diabetes Center, Boston, MA
| | - Van S Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - John M Jakicic
- Diabetes Unit, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | - Robert W Jeffery
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN
| | - Steven E Kahn
- Department of Medicine, University of Washington, Seattle, WA
| | - Tina Killean
- Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM
| | - Abbas E Kitabchi
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN
| | - William C Knowler
- Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM
| | - Andrea Kriska
- Diabetes Unit, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | - Cora E Lewis
- Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Marsha Miller
- Anschutz Health and Wellness Center, University of Colorado Health Sciences Center, Aurora, CO
| | - Maria G Montez
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Anne Murillo
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Ebenezer Nyenwe
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN
| | - Jennifer Patricio
- Division of and Department of Medicine, St. Luke's-Roosevelt Hospital, New York, NY
| | | | - Xavier Pi-Sunyer
- Division of and Department of Medicine, St. Luke's-Roosevelt Hospital, New York, NY
| | - Henry Pownall
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - J Bruce Redmon
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Julia Rushing
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Donna H Ryan
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Monika Safford
- Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Adam G Tsai
- Division of Internal Medicine, University of Colorado Health Sciences Center, Aurora, CO
| | - Thomas A Wadden
- Weight and Eating Disorder Program, University of Pennsylvania, Philadelphia, PA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, Brown Medical School/The Miriam Hospital, Providence, RI
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Ping Zhang
- Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
24
|
Rubin RR, Wadden TA, Bahnson JL, Blackburn GL, Brancati FL, Bray GA, Coday M, Crow SJ, Curtis JM, Dutton G, Egan C, Evans M, Ewing L, Faulconbridge L, Foreyt J, Gaussoin SA, Gregg EW, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Lang W, Lewis CE, Montez MG, Murillo A, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Rejeski WJ, Rosenthal RH, Ruelas V, Toledo K, Van Dorsten B, Vitolins M, Williamson D, Wing RR, Yanovski SZ, Zhang P. Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD Trial. Diabetes Care 2014; 37:1544-53. [PMID: 24855155 PMCID: PMC4030096 DOI: 10.2337/dc13-1928] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the effects of an intensive lifestyle intervention (ILI), compared with a diabetes support and education (DSE) control intervention, on long-term changes in depression symptoms, antidepressant medication (ADM) use, and health-related quality of life (HRQoL) in overweight/obese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Look AHEAD was a multisite randomized controlled trial of 5,145 overweight/obese participants assigned to ILI (designed to produce weight loss) or DSE and followed for a median of 9.6 years. The Beck Depression Inventory (BDI) was administered at baseline, annually at years 1-4, and again at year 8. Mean BDI scores and incidence of BDI scores ≥10, indicative of likely mild or greater depression, were examined. Annually through year 10, participants reported their ADM use and completed the Medical Outcomes Study Short Form 36 (SF-36) questionnaire, which yields physical component summary (PCS) and mental component summary (MCS) scores. RESULTS ILI significantly reduced the incidence of mild or greater depression symptoms (BDI scores ≥10) compared with DSE (hazard ratio [HR] = 0.85; 95% CI 0.75-0.97; P = 0.0145). Although SF-36 PCS scores worsened over time in both groups, ILI participants reported better physical function than DSE throughout the first 8 years (all P values <0.01). There were no significant differences between treatment arms in the proportion of participants who used ADMs or in SF-36 MCS scores. CONCLUSIONS ILI for overweight/obese patients with type 2 diabetes may reduce the risk of developing clinically significant symptoms of depression and preserve physical HRQoL. These findings should be considered when evaluating the potential benefits of ILIs.
Collapse
|
25
|
Affiliation(s)
- A. Turan
- Department of Outcomes Research, Quantitative Health Sciences and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - C. Egan
- Department of Outcomes Research, Quantitative Health Sciences and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - J. You
- Department of Outcomes Research, Quantitative Health Sciences and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - D. Sessler
- Department of Outcomes Research, Quantitative Health Sciences and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - B. Abdelmalak
- Department of Outcomes Research, Quantitative Health Sciences and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
- Department of General Anesthesiology and Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
26
|
Shaffiey S, Sodhi C, Jia H, Good M, Neal M, Branca M, Ma C, Yamaguchi Y, Egan C, Weyandt S, Lu P, Hackam D. A Novel Role of Autophagy in Intestinal Epithelial Stem Cell Proliferation and Renewal. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
27
|
Gratrix J, Bergman J, Egan C, Singh AE, Drews S, Read RR. P3.016 Prevalence and Correlates of Rectal-Only Chlamydia Infection at Two Canadian STI Clinics. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0476] [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]
|
28
|
O'Sullivan MD, McAnena KS, Egan C, Waters PS, McCann PJ, Kerin MJ. Enlarging neck masses in the elderly - Histological and surgical considerations. Int J Surg Case Rep 2013; 4:378-81. [PMID: 23500736 DOI: 10.1016/j.ijscr.2012.12.012] [Citation(s) in RCA: 2] [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] [Received: 12/14/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Anaplastic carcinoma of the thyroid is a rare but aggressive malignancy which can present with a rapidly enlarging neck mass or compressive sequelae of cough, dyspnoea, dysphagia and hoarseness. Treatment of such tumours is commonly palliative however they occasionally represent surgical challenges due to their rapid growth, diagnostic difficulty and locoregional spread. PRESENTATION OF CASE A 75 year-old retired veterinary surgeon was referred with a 2 month history of a painless, enlarging neck mass. The patient denied any secondary compressive symptoms or general symptoms of malignancy. On examination a large right-sided neck mass measuring 7cm×5cm was appreciated which was fixed, hard and irregular with associated adenopathy. DISCUSSION We discuss the diagnostic challenges posed by anaplastic carcinoma of the thyroid and the difficulties in selecting the appropriate intervention in this aggressive disease process. CONCLUSION Anaplastic carcinoma of the thyroid is encountered infrequently in clinical practice and can generate diagnostic and therapeutic challenges.
Collapse
Affiliation(s)
- M D O'Sullivan
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
| | | | | | | | | | | |
Collapse
|
29
|
Rahman W, Errera MH, Egan C. Un cas rare de maculopathie cystoïde. J Fr Ophtalmol 2013; 36:e33-6. [DOI: 10.1016/j.jfo.2012.03.011] [Citation(s) in RCA: 3] [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] [Received: 01/15/2012] [Revised: 03/08/2012] [Accepted: 03/13/2012] [Indexed: 11/25/2022]
|
30
|
Abstract
We investigated block heights that anaesthetists considered adequate for caesarean section to proceed under spinal anaesthesia. During 3 months, 15 obstetric anaesthetists recorded block height to touch, pinprick or cold when spinal anaesthesia was considered satisfactory for caesarean section to proceed. Median (IQR [range]) block height for touch, pinprick, first cold and icy were: T10 (T7-T12 [T3-L1]); T5 (T4-T6 [C7-L1]); T5 (T4-T6 [C7-L1]); and T3 (T2-T4 [C7-L1]), respectively. Modalities were significantly correlated for: touch and cold, p = 0.0001; touch and icy, p = 0.0007; touch and pinprick, p = 0.0018; cold and icy, p < 0.0001; cold and pinprick, p = 0.0001; icy and pinprick, p < 0.0001. Pairwise comparisons showed differences between all modalities (p < 0.001) apart from pinprick and first cold (p = 0.94). All women had satisfactory anaesthesia despite 76 (81%) having a block to touch below T6. Single modality assessment of block height, particularly using touch, may erroneously indicate inadequate anaesthesia for caesarean section.
Collapse
Affiliation(s)
- R Ousley
- Department of Women's Anaesthesia, Women's & Children's Hospital, Adelaide, Australia
| | | | | | | |
Collapse
|
31
|
Cernik R, Egan C, Jacques S. Hyperspectral X-ray imaging using scattered radiation. Acta Crystallogr A 2012. [DOI: 10.1107/s0108767312095487] [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: 11/11/2022] Open
|
32
|
Egan C, Elliott R, Fleming P. European Working Time Directive and the use of simulators and models in Irish orthopaedics. Ir J Med Sci 2011; 181:143-6. [DOI: 10.1007/s11845-011-0750-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 08/17/2011] [Indexed: 10/17/2022]
|
33
|
Cernik RJ, Jacques SM, Egan C. The development of rapid tomographic energy-dispersive diffraction imaging TEDDI. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311097996] [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: 11/10/2022] Open
|
34
|
|
35
|
Abdelmalak BB, Bernstein E, Egan C, Abdallah R, You J, Sessler DI, Doyle DJ. GlideScope® vs flexible fibreoptic scope for elective intubation in obese patients*. Anaesthesia 2011; 66:550-5. [DOI: 10.1111/j.1365-2044.2011.06659.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
36
|
Egan C, Willis A, Wincenciak J. The effects of a distractor on the visual gaze behavior of children at signalized road crossings. J Vis 2010. [DOI: 10.1167/9.8.371] [Citation(s) in RCA: 2] [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: 11/24/2022] Open
|
37
|
McNulty AM, Egan C, Wand H, Donovan B. The behaviour and sexual health of young international travellers (backpackers) in Australia. Sex Transm Infect 2010; 86:247-50. [PMID: 20237395 DOI: 10.1136/sti.2009.038737] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To study the demographics, risk behaviours and morbidity of young long-term international travellers (backpackers) attending a sexual health service in Sydney, Australia. METHODS Data on new patients were extracted from the Sydney Sexual Health Centre database for the period 1998 to 2006. The sexual risk behaviours and morbidity of the backpackers were compared with other patients of a similar age. RESULTS The 5698 backpackers who attended the centre reported higher numbers of sexual partners (three or more partners in the past 3 months, 18% vs 12%, p<0.001) and a greater proportion drank alcohol at hazardous levels (22%) than the comparison group (9%, p<0.001). Rates of consistent (100%) condom use in the past 3 months were low in both backpackers (22%) and the comparison population (19%). Backpackers had higher rates of genital chlamydia infection (7% vs 5%, p<0.001) and reported higher rates of previous sexually transmitted infections (15% vs 10%, p<0.001). CONCLUSIONS Backpackers should be a priority population for sexual health promotion and access to services.
Collapse
Affiliation(s)
- A M McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia.
| | | | | | | |
Collapse
|
38
|
Moore JE, Buckley TC, Millar BC, Gibson P, Cannon G, Egan C, Cosgrove H, Stanbridge S, Anzai T, Matsuda M, Murphy PG. Molecular surveillance of the incidence of Taylorella equigenitalis and Pseudomonas aeruginosa from horses in Ireland by sequence-specific PCR [SS-PCR]. Equine Vet J 2010; 33:319-22. [PMID: 11352356 DOI: 10.2746/042516401776249750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J E Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Harnett MM, Kean DE, Boitelle A, McGuiness S, Thalhamer T, Steiger CN, Egan C, Al-Riyami L, Alcocer MJ, Houston KM, Gracie JA, McInnes IB, Harnett W. The phosphorycholine moiety of the filarial nematode immunomodulator ES-62 is responsible for its anti-inflammatory action in arthritis. Ann Rheum Dis 2008; 67:518-23. [PMID: 17704067 DOI: 10.1136/ard.2007.073502] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE In countries where parasitic infections are endemic, autoimmune disease is relatively rare, leading to the hypothesis that parasite-derived immunomodulators may protect against its development. Consistent with this, we have previously demonstrated that ES-62, a 62 kDa phosphorylcholine (PC)-containing glycoprotein that is secreted by filarial nematodes, can exert anti-inflammatory action in the murine collagen-induced arthritis (CIA) model and human rheumatoid arthritis-derived synovial tissue cultures. As a first step to developing ES-62-based drugs, the aim of this study was to determine whether the PC-moiety of ES-62 was responsible for its anti-inflammatory actions. METHODS We compared the anti-inflammatory activity of a PC-free form of recombinant ES-62 (rES-62) and a synthetic PC-ovalbumin conjugate (OVA-PC) with that of native ES-62 in the CIA model and synovial tissues from patients with rheumatoid arthritis. RESULTS The anti-inflammatory actions of ES-62 in CIA appear to be dependent on the PC moiety as indicated by the reduction in severity of disease and also suppression of collagen-specific T helper 1 cytokine production observed when testing OVA-PC, but not rES-62. Interestingly, the anti-inflammatory activity of PC did not correlate with a reduction in anti-collagen IgG2a levels. Also, the ES-62-mediated suppression of interferon-gamma from human patient tissues could be mimicked by OVA-PC but not rES-62 or ovalbumin. CONCLUSIONS In countries where filariasis is endemic the reduced detection of inflammatory diseases, such as rheumatoid arthritis may be because of the anti-inflammatory action of the PC moieties of ES-62. PC may thus provide the starting point for the development of novel, safe immunomodulatory therapies.
Collapse
Affiliation(s)
- M M Harnett
- Division of Immunology, Infection and Inflammation, Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Kim M, Egan C, Alain T, Urbanski SJ, Lee PW, Forsyth PA, Johnston RN. Acquired resistance to reoviral oncolysis in Ras-transformed fibrosarcoma cells. Oncogene 2007; 26:4124-34. [PMID: 17213803 DOI: 10.1038/sj.onc.1210189] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reovirus shows considerable potential as an oncolytic agent for Ras-activated tumors and is currently in clinical trials. Here we ask whether such tumor cell lines can acquire resistance to reoviral oncolysis. We challenged human HT1080 fibrosarcoma cells that carry a Ras mutation by prolonged exposure to reovirus, thereby yielding highly virus-resistant HTR1 cells. These cells are persistently infected with reovirus, exhibit high Ras activity and retain the original Ras gene mutation, showing that resistance to reovirus can be displayed in cells with active Ras. The HTR1 cells also exhibit reduced cellular cathepsin B activity, which normally contributes to viral entry and activation. Persistently infected HTR1 cells were not tumorigenic in vivo, whereas immunologically cured virus-free HTR1 cells were highly tumorigenic. Thus, acquisition of resistance to reovirus may constrain therapeutic strategies. To determine whether reoviral resistance is associated with a general reduction in apoptotic potential, we challenged the HTR1 cells with apoptotic inducers and E1B-defective adenovirus, resulting in significant apoptosis and cell death following both approaches. Therefore, even if resistance to reoviral oncolysis should arise in tumor cells in vivo, other therapeutic strategies may nevertheless remain effective.
Collapse
Affiliation(s)
- M Kim
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | | |
Collapse
|
41
|
Solomon DH, Polinski JM, Truppo C, Egan C, Jan S, Patel M, Weiss TW, Chen YT, Brookhart MA. Access to bone mineral density testing in patients at risk for osteoporosis. Osteoporos Int 2006; 17:1749-54. [PMID: 16855862 DOI: 10.1007/s00198-006-0180-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 05/15/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Prior studies have documented suboptimal diagnosis and treatment for osteoporosis in many settings. Consistent predictors of suboptimal management include patient age, physician training, and physician gender. We assessed whether access to bone mineral density (BMD) testing was a predictor of osteoporosis management in an at-risk population of patients from New Jersey. METHODS Based on health care claims data, we identified three groups of at-risk beneficiaries, including women >or=65 (n=8,283), men and women >or=45 with a fracture (n=740), and men and women >or=45 taking chronic oral glucocorticoids (n=616). As the outcome of interest, we determined whether beneficiaries had undergone a BMD test and/or filled a prescription for a medicine used for osteoporosis (alendronate, calcitonin, hormone therapy, etidronate, risedronate, raloxifene, teriparatide) during the period 1 September 2002-31 August 2004. We assessed the relationship between this outcome and access to BMD testing. Access was characterized using two different measures: (1) the estimated driving time between each beneficiary's residence and the nearest BMD testing center ("driving time") and (2) the number of persons >or=65 years of age per BMD testing machine ("BMD scanner ratio") for each of the 21 counties in New Jersey. RESULTS Of the 9,640 beneficiaries, we found that 3,104 (32%) had undergone a BMD test, 2,893 (30%) had filled a prescription for an osteoporosis medication, and 4,364 (45%) had one or both. Across the 21 counties of New Jersey, the percentage of at-risk patients who had a BMD test and/or medication for osteoporosis ranged from 38 to 52%. In models adjusted for patient factors and the clustering of patients in counties, driving time was not associated with patients being screened or treated for osteoporosis. The BMD scanner ratio was a weak predictor of osteoporosis management. CONCLUSION Among beneficiaries of one large health insurer in New Jersey, two different measures of access to BMD testing were not important predictors of receiving testing and/or medications for osteoporosis.
Collapse
Affiliation(s)
- D H Solomon
- Division of Pharmacoepidemiology, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Shone C, Ferreira J, Boyer A, Cirino N, Egan C, Evans E, Kools J, Sharma S. The 5th International Conference on Basic and Therapeutic Aspects of Botulinum and Tetanus Neurotoxins. Workshop review: assays and detection. Neurotox Res 2006; 9:205-16. [PMID: 16785119 DOI: 10.1007/bf03033940] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The development of diagnostic tests for the botulinum neurotoxins is complicated by their extremely high potencies and the considerable diversity observed within the neurotoxin family. Current approaches for the detection of the toxins and the organism include amplified immunoassays and PCR techniques. Assays which exploit the biological activities within the botulinum toxins are also in development. These are based on both antibody and mass spectrometric techniques which measure the endopeptidase activities of the neurotoxins. This overview of the Assays and Detection Workshop of the 5th International Conference of on Basic and Therapeutic Aspects of Botulinum and Tetanus Neurotoxins discusses recent progress in the development of these assay systems and the issues that need to be overcome prior to their implementation.
Collapse
Affiliation(s)
- C Shone
- Health Protection Agency, Centre for Emergency Preparedness and Response, Porton Down, Salisbury, Wiltshire, UK
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Goodridge HS, Marshall FA, Else KJ, Houston KM, Egan C, Al-Riyami L, Liew FY, Harnett W, Harnett MM. Immunomodulation via novel use of TLR4 by the filarial nematode phosphorylcholine-containing secreted product, ES-62. J Immunol 2005; 174:284-93. [PMID: 15611251 DOI: 10.4049/jimmunol.174.1.284] [Citation(s) in RCA: 181] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Filarial nematodes, parasites of vertebrates, including humans, secrete immunomodulatory molecules into the host environment. We have previously demonstrated that one such molecule, the phosphorylcholine-containing glycoprotein ES-62, acts to bias the immune response toward an anti-inflammatory/Th2 phenotype that is conducive to both worm survival and host health. For example, although ES-62 initially induces macrophages to produce low levels of IL-12 and TNF-alpha, exposure to the parasite product ultimately renders the cells unable to produce these cytokines in response to classic stimulators such as LPS/IFN-gamma. We have investigated the possibility that a TLR is involved in the recognition of ES-62 by target cells, because phosphorylcholine, a common pathogen-associated molecular pattern, appears to be responsible for many of the immunomodulatory properties of ES-62. We now demonstrate that ES-62-mediated, low level IL-12 and TNF-alpha production by macrophages and dendritic cells is abrogated in MyD88 and TLR4, but not TLR2, knockout, mice implicating TLR4 in the recognition of ES-62 by these cells and MyD88 in the transduction of the resulting intracellular signals. We also show that ES-62 inhibits IL-12 induction by TLR ligands other than LPS, bacterial lipopeptide (TLR2) and CpG (TLR9), via this TLR4-dependent pathway. Surprisingly, macrophages and dendritic cells from LPS-unresponsive, TLR4-mutant C3H/HeJ mice respond normally to ES-62. This is the first report to demonstrate that modulation of cytokine responses by a pathogen product can be abrogated in cells derived from TLR4 knockout, but not C3H/HeJ mice, suggesting the existence of a novel mechanism of TLR4-mediated immunomodulation.
Collapse
Affiliation(s)
- Helen S Goodridge
- Division of Immunology, Infection, and Inflammation, University of Glasgow, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, Scotland, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abbas Z, Nolan L, Landry L, Galanis E, Egan C. Investigation of an outbreak of Legionnaires' disease in a hospital under construction: Ontario, September-October 2002. Can Commun Dis Rep 2003; 29:145-52. [PMID: 14526691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
|
45
|
Taylor AH, Fox-Robichaud AE, Egan C, Dionne J, Lawless DE, Raymond J, Romney J, Wong NC. Oestradiol decreases rat apolipoprotein AI transcription via promoter site B. J Mol Endocrinol 2000; 25:207-19. [PMID: 11013347 DOI: 10.1677/jme.0.0250207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Oestrogens protect against ischaemic heart disease in the post-menopausal female by increasing serum concentrations of apolipoprotein (apo) AI and the abundance of high-density lipoprotein particles. In men and experimental male animals, the administration of oestrogen has variable effects on apo AI expression. As the major mode of oestrogen action on target genes involves regulating promoter activity and hence transcription, oestrogen is expected to alter transcription of the apo AI gene. To test this hypothesis, the effect of 17beta-oestradiol (E(2)), on rat apo AI promoter activity in male hepatoma HuH-7 cells, was tested by co-transfecting a reporter template, pAI.474.CAT containing-474 to-7 of the rat apo AI promoter and an oestrogen receptor (ER) expression vector, pCMV-ER. Transfected cells exposed to E(2) showed a dose-dependent decrease in chloramphenicol acetyltransferase (CAT)-activity, with a maximum 91+/-1.5% reduction at 1 microM E(2). Deletional analysis of the promoter localized the inhibitory effect of ER and E(2) to site B (-170 to-144) with an adjacent 5' contiguous motif, site S (-186 to-171) acting as an amplifier. HuH-7 cell nuclear extracts showed binding activities with both sites S and B, but recombinant human ER did not. Furthermore, nuclear extracts from E(2)-treated HuH-7 cells showed weaker binding activity to site B, but not to site S. In summary, the inhibitory effect of ER and E(2) on rat apo AI gene activity is mediated by a promoter element, site B. This inhibitory effect arises from a mechanism that does not involve direct ER binding to the B-element. The conclusion that E(2) inhibits apo AI transcription was confirmed in vivo. Treatment of male adult Sprague-Dawley rats with up to 200 microg E(2) for 7 days decreased apo AI protein and hepatic mRNA by 72+/-21% and 68+/-1.4% respectively. Results of 'run-on' transcription of the apo AI gene in isolated hepatic nuclei showed a 55% decrease in hormone-treated male rats. These findings suggest that E(2) exerts primarily an inhibitory effect within male hepatic nuclei.
Collapse
Affiliation(s)
- A H Taylor
- Gynaecology Research Group, Department of Obstetrics and Gynaecology, Faculty of Medicine and Biological Sciences, University of Leicester, PO Box 65, Liecester LE2 7LX, UK
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Dowd CS, Herrick-Davis K, Egan C, DuPre A, Smith C, Teitler M, Glennon RA. 1-[4-(3-Phenylalkyl)phenyl]-2-aminopropanes as 5-HT(2A) partial agonists. J Med Chem 2000; 43:3074-84. [PMID: 10956215 DOI: 10.1021/jm9906062] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Phenylalkylamines such as 1-(4-bromo-2, 5-dimethoxyphenyl)-2-aminopropane (DOB; 1a) and its corresponding iodo derivative DOI (2) are commonly used 5-HT(2) serotonin agonists. Previous studies have established that the 2,5-dimethoxy substitution pattern found in these compounds is optimal for high affinity at 5-HT(2A) receptors and that substituents at the 4-position can modulate affinity over a wide range. We have previously shown, however, that when the 4-position is substituted with a 3-phenylpropyl substituent (i.e., 3), the compound binds with an affinity comparable to that of 1a but that it possesses 5-HT(2A) antagonist character. The present study examined the structure-affinity relationships of 3, and the results were very much unexpected. That is, the 2,5-dimethoxy substitution pattern of 3 is not required for high affinity. Either of the two methoxy groups can be removed without untoward effect on affinity, and relocation of the methoxy substituents actually enhances affinity by as much as an order of magnitude. None of the compounds displayed more than 20-fold selectivity for 5-HT(2A) over 5-HT(2C) receptors. In addition, several were demonstrated to act as 5-HT(2A) partial agonists. As such, the results of this study suggest that the structure-affinity relationships of phenylalkylamines as 5-HT(2A) ligands now be reinvestigated in greater detail.
Collapse
Affiliation(s)
- C S Dowd
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia 23298-0540, USA
| | | | | | | | | | | | | |
Collapse
|
47
|
Glennon RA, Dukat M, Grella B, Hong S, Costantino L, Teitler M, Smith C, Egan C, Davis K, Mattson MV. Binding of beta-carbolines and related agents at serotonin (5-HT(2) and 5-HT(1A)), dopamine (D(2)) and benzodiazepine receptors. Drug Alcohol Depend 2000; 60:121-32. [PMID: 10940539 DOI: 10.1016/s0376-8716(99)00148-9] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A large series of beta-carbolines was examined for their ability to bind at [3H]agonist-labeled 5-HT(2A) serotonin receptors. Selected beta-carbolines were also examined at 5-HT(2C) serotonin receptors, 5-HT(1A) serotonin receptors, dopamine D(2) receptors, and benzodiazepine receptors. Indolealkylamines and phenylisopropylamines were also evaluated in some of these binding assays. The beta-carbolines were found to bind with modest affinity at 5-HT(2A) receptors, and affinity was highly dependent upon the presence of ring substituents and ring saturation. The beta-carbolines displayed little to no affinity for 5-HT(1A) serotonin receptors, dopamine D(2) receptors and, with the exception of beta-CCM, for benzodiazepine receptors. Examples of beta-carbolines, indolealkylamines (i.e. N,N-dimethyltryptamine analogs), and phenylisopropylamines have been previously shown to produce common stimulus effects in animals trained to discriminate the phenylisopropylamine hallucinogen DOM (i.e. 1-(2, 5-dimethoxy-4-methylphenyl)-2-aminopropane) from vehicle. Although the only common receptor population that might account for this action is 5-HT(2A), on the basis of a lack of enhanced affinity for agonist-labeled 5-HT(2A) receptors, as well as on their lack of agonist action in the PI hydrolysis assay, it is difficult to conclude that the beta-carbolines behave in a manner consistent with that of other classical hallucinogens.
Collapse
Affiliation(s)
- R A Glennon
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, Box 980540, Richmond, VA 23298-0540, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Egan C, Grinde E, Dupre A, Roth BL, Hake M, Teitler M, Herrick-Davis K. Agonist high and low affinity state ratios predict drug intrinsic activity and a revised ternary complex mechanism at serotonin 5-HT(2A) and 5-HT(2C) receptors. Synapse 2000; 35:144-50. [PMID: 10611640 DOI: 10.1002/(sici)1098-2396(200002)35:2<144::aid-syn7>3.0.co;2-k] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The ternary complex model as applied to G-protein coupled receptors (GPCR) predicts that an agonist binds with low affinity (K(L)) to the free receptor (R), leading to an agonist/receptor/G-protein complex. This ternary complex displays high agonist affinity (K(H)), resulting in signal transduction. Classical dogma states that the ratio K(L)/K(H) predicts intrinsic activity of drugs: the higher the ratio the higher the intrinsic activity. This model was based on studies in which K(L) and K(H) were indirectly determined by computer analyses of antagonist radioligand binding data. In order to investigate the relationship of K(L), K(H), and intrinsic activity for agonists at 5-HT(2A) and 5-HT(2C) receptors, we utilized (3)H-agonist and (3)H-antagonist radioligands to directly determine K(H) and K(L). Comparisons of the log K(L)/K(H) ratios and intrinsic activities of drugs for stimulating intracellular phosphatidylinositol (PI) hydrolysis revealed a strong correlation for 5-HT(2A) (r(2) = 0.92) and 5-HT(2C) (r(2) = 0.96) receptors. The data were fit to computer simulations based on the original ternary complex model and the revised ternary complex model in which an activated state of the receptor (R*) exists in equilibrium with the resting state of the receptor (R). Data produced for both 5-HT(2A) and 5-HT(2C) receptors were better-fitted to a revised ternary complex model, rather than the classical ternary complex model. These data support a revised model for the molecular events coupling GPCR to activation of G-proteins and indicate that a strong correlation between the K(L)/K(H) ratio and intrinsic activity for agonist action at GPCR is consistent with the existence of R*.
Collapse
Affiliation(s)
- C Egan
- Department of Pharmacology & Neuroscience, Albany Medical College, Albany, New York 12208, USA
| | | | | | | | | | | | | |
Collapse
|
49
|
Lee M, Kemp JA, Canning A, Egan C, Tataronis G, Farraye FA. A randomized controlled trial of an enhanced patient compliance program for Helicobacter pylori therapy. Arch Intern Med 1999; 159:2312-6. [PMID: 10547171 DOI: 10.1001/archinte.159.19.2312] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine whether an enhanced compliance program (ECP) improves patient compliance with bismuth subsalicylate, metronidazole, and tetracycline hydrochloride (BMT) triple therapy for the treatment of Helicobacter pylori infection and to identify factors that affect compliance with therapy. DESIGN A randomized controlled trial conducted in 4 staff-model health centers of a health maintenance organization in Massachusetts. PATIENTS AND METHODS A total of 125 patients 18 years of age or older with peptic ulcer disease or dyspepsia whose clinicians prescribed BMT triple therapy for 14 days were randomized to a control group or to the ECP group. The ECP group received medication counseling (written and oral) from a pharmacist, along with a medication calendar and a minipillbox, as well as a follow-up telephone call after initiation of therapy. Compliance was assessed by a pill count, and factors affecting adherence to the regimen were identified by patients' reports. RESULTS There was no statistically significant difference between the 2 groups in the number of patients taking more than 60% of the medications (89% of the control group vs 95% of the ECP group; P>.30). However, there was a statistically significant difference in the number of patients taking more than 90% of the medications (67% of the control group vs 89% of the ECP group; P<.01). An intention-to-treat analysis confirmed these results. The most frequently reported adverse effect was gastrointestinal intolerance. Other factors reported to affect compliance included the frequency of dosing and the number of pills. CONCLUSIONS These findings suggest that although adverse effects were common, most patients were able to complete 60% or more of the 2-week regimen. An ECP further improved the percentage of medications taken.
Collapse
Affiliation(s)
- M Lee
- Pharmacy Department, Harvard Vanguard Medical Associates, Brookline, Mass 02445, USA
| | | | | | | | | | | |
Collapse
|
50
|
Berguer R, Bravo N, Bowyer M, Egan C, Knolmayer T, Ferrick D. Major surgery suppresses maximal production of helper T-cell type 1 cytokines without potentiating the release of helper T-cell type 2 cytokines. Arch Surg 1999; 134:540-4. [PMID: 10323427 DOI: 10.1001/archsurg.134.5.540] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Major surgery is known to suppress T-cell function; however, its differential effects on the production of helper T-cell type 1 (T(H)1) and type 2 (T(H)2) cytokines remains unknown. OBJECTIVE To measure the production patterns of T(H)1 (interleukin 2 [IL-2] and interferon gamma) and T(H)2 (IL-4 and IL-10) cytokines following major surgery. DESIGN, SETTING, AND PATIENTS A cohort study of patients (both active and former members of the armed forces) at a military hospital. INTERVENTION Aortic surgery or carotid endarterectomy and measurement of serum IL-6 levels by enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES Unstimulated and stimulated intracellular levels of IL-2, IL-4, IL-10, and interferon gamma in CD4+, CD8+, and gammadelta+ T cells and serum IL-6 levels immediately before and for 2 days after aortic surgery or carotid endarterectomy. RESULTS No unstimulated production of T(H) or T(H)2 cytokines was detected. Stimulated intracellular levels of IL-2 and interferon gamma were significantly depressed during the postoperative period in all T-cell subsets in both patient groups. There were no postoperative increases in stimulated IL-4 or IL-10 levels. CONCLUSION Major surgery suppresses the potential responses of T(H)1 cytokines without enhancing production of T(H)2 cytokines.
Collapse
Affiliation(s)
- R Berguer
- Department of Surgery, University of California, Davis, USA.
| | | | | | | | | | | |
Collapse
|