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Watkins R, Gamo A, Choi SH, Kumar M, Buckarma E, McCabe C, Tomlinson J, Pereya D, Lupse B, Geravandi S, Werneburg NW, Wang C, Starlinger P, Zhu S, Li S, Yu S, Surakattula M, Baguley T, Ardestani A, Maedler K, Roland J, Nguyen-Tran V, Joseph S, Petrassi M, Rogers N, Gores G, Chatterjee A, Tremblay M, Shen W, Smoot R. A small molecule MST1/2 inhibitor accelerates murine liver regeneration with improved survival in models of steatohepatitis. PNAS Nexus 2024; 3:pgae096. [PMID: 38528952 PMCID: PMC10962727 DOI: 10.1093/pnasnexus/pgae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
Dysfunctional liver regeneration following surgical resection remains a major cause of postoperative mortality and has no therapeutic options. Without targeted therapies, the current treatment paradigm relies on supportive therapy until homeostasis can be achieved. Pharmacologic acceleration of regeneration represents an alternative therapeutic avenue. Therefore, we aimed to generate a small molecule inhibitor that could accelerate liver regeneration with an emphasis on diseased models, which represent a significant portion of patients who require surgical resection and are often not studied. Utilizing a clinically approved small molecule inhibitor as a parent compound, standard medicinal chemistry approaches were utilized to generate a small molecule inhibitor targeting serine/threonine kinase 4/3 (MST1/2) with reduced off-target effects. This compound, mCLC846, was then applied to preclinical models of murine partial hepatectomy, which included models of diet-induced metabolic dysfunction-associated steatohepatitis (MASH). mCLC846 demonstrated on target inhibition of MST1/2 and reduced epidermal growth factor receptor inhibition. The inhibitory effects resulted in restored pancreatic beta-cell function and survival under diabetogenic conditions. Liver-specific cell-line exposure resulted in Yes-associated protein activation. Oral delivery of mCLC846 perioperatively resulted in accelerated murine liver regeneration and improved survival in diet-induced MASH models. Bulk transcriptional analysis of regenerating liver remnants suggested that mCLC846 enhanced the normal regenerative pathways and induced them following liver resection. Overall, pharmacological acceleration of liver regeneration with mCLC846 was feasible, had an acceptable therapeutic index, and provided a survival benefit in models of diet-induced MASH.
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Affiliation(s)
- Ryan Watkins
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Ana Gamo
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Seung Hyuk Choi
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Manoj Kumar
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - EeeLN Buckarma
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Chantal McCabe
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | | | - David Pereya
- Department of Surgery, Medical University of Vienna, General Hospital, Vienna 1090, Austria
| | - Blaz Lupse
- Centre for Biomolecular Interactions Bremen, University of Bremen, 28359 Bremen, Germany
| | - Shirin Geravandi
- Centre for Biomolecular Interactions Bremen, University of Bremen, 28359 Bremen, Germany
| | - Nathan W Werneburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Chen Wang
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - Patrick Starlinger
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Center of Physiology and Pharmacology, Medical University of Vienna, Vienna 1090, Austria
| | - Siying Zhu
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Sijia Li
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Shan Yu
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Murali Surakattula
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Tyler Baguley
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Amin Ardestani
- Centre for Biomolecular Interactions Bremen, University of Bremen, 28359 Bremen, Germany
- Biomedical Institute for Multimorbidity (BIM), Centre for Biomedicine, Hull York Medical School, University of Hull, Hull YO10 5DD, UK
| | - Kathrin Maedler
- Centre for Biomolecular Interactions Bremen, University of Bremen, 28359 Bremen, Germany
| | - Jason Roland
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Van Nguyen-Tran
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Sean Joseph
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Mike Petrassi
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Nikki Rogers
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Gregory Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Arnab Chatterjee
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Matthew Tremblay
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Weijun Shen
- Calibr at Scripps Research, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Rory Smoot
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
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Brar T, McCabe C, Miglani A, Marino M, Lal D. Tissue Eosinophilia is Superior to an Analysis by Polyp Status for the Chronic Rhinosinusitis Transcriptome: An RNA Study. Laryngoscope 2023; 133:2480-2489. [PMID: 36594502 DOI: 10.1002/lary.30544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/29/2022] [Accepted: 12/11/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE RNA sequencing (transcriptomics) is used to study biological pathways. However, the yield of data depends on comparing well-characterized cohorts. We compared tissue eosinophilia versus nasal polyp (NP) status as the metric to characterize transcriptomic mechanisms at play in eosinophilic and non-eosinophilic chronic rhinosinusitis (CRS) versus controls. METHODS RNA sequencing was conducted on sinonasal tissue samples of CRS and controls. Analyses were conducted based on polyp status [with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP)] as well as tissue eosinophil levels per high power field (eos/hpf)[non-eosinophilic (<10 eos/hpf, neCRS) or eosinophilic (≥10 eos/hpf, eCRS)]. The yield of differentially expressed genes (DEGs) and biological pathways through Ingenuity Pathway Analysis (IPA) were compared. RESULTS CRS tissue differed from controls by 736 statistically significant DEGs. Both NP status and tissue eosinophilia were effective in differentiating CRS from controls and into two distinct subgroups. Statistically significant DEGs identified when comparing CRS by NP status were 60, whereas 110 DEGs were identified using eosinophil cutoff ≥10 and <10 eos/hpf. Additionally, heatmaps showed greater homogeneity within each CRS subgroup when analyzed by tissue eosinophilia versus NP status. On IPA, the IL-17 signaling pathway was significantly different only by tissue eosinophilia status, not NP status, being higher in CRS <10 eos/hpf. CONCLUSION Tissue eosinophilia is superior to an analysis by NP status for the study of CRS transcriptome by RNA sequencing in identifying DEGs. Classification of CRS samples by eosinophil counts agnostic of NP status may offer advantageous insights into CRS pathogenetic mechanisms. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2480-2489, 2023.
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Affiliation(s)
- Tripti Brar
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Chantal McCabe
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Amar Miglani
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Michael Marino
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Devyani Lal
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
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Haskins A, McCabe C, Kennedy R, McWade R, Lennon AB, Chandar D. A novel method of determining the active drag profile in swimming via data manipulation of multiple tension force collection methods. Sci Rep 2023; 13:10896. [PMID: 37407631 DOI: 10.1038/s41598-023-37595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023] Open
Abstract
A novel method aimed at evaluating the active drag profile during front-crawl swimming is proposed. Fourteen full trials were conducted with each trial using a stationary load cell set-up and a commercial resistance trainer to record the tension force in a rope, caused by an athlete swimming. Seven different stroke cycles in each experiment were identified for resampling time dependent data into position dependent data. Active drag was then calculated by subtracting resistance trainer force data away from the stationary load cell force data. Mean active drag values across the stroke cycle were calculated for comparison with existing methods, with mean active drag values calculated between 76 and 140 N depending on the trial. Comparing results with established active drag methods, such as the Velocity Perturbation Method (VPM), shows agreement in the magnitude of the mean active drag forces. Repeatability was investigated using one athlete, repeating the load cell set-up experiment, indicating results collected could range by 88 N depending on stroke cycle position. Variation in results is likely due to inconsistencies in swimmer technique and power output, although further investigation is required. The method outlined is proposed as a representation of the active drag profile over a full stroke cycle.
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Affiliation(s)
- A Haskins
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, BT9 5AH, UK.
| | - C McCabe
- School of Sport, Ulster University, Belfast, BT15 1AP, UK
| | - R Kennedy
- School of Sport, Ulster University, Belfast, BT15 1AP, UK
| | - R McWade
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, BT9 5AH, UK
| | - A B Lennon
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, BT9 5AH, UK
| | - D Chandar
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, BT9 5AH, UK
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Lyons C, Felton PJ, McCabe C. Female cricket pace bowling: kinematic and anthropometric relationships with ball release speed. S Afr J Sports Med 2023; 35:v35i1a15080. [PMID: 38249765 PMCID: PMC10798603 DOI: 10.17159/2078-516x/2023/v35i1a15080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Background Despite an increase in the professionalism and participation of female cricket, the coaching of female pace bowling is still reliant on male-derived knowledge. Objectives To investigate the association between key male-derived kinematic and anthropometric parameters and ball release speed (BRS) in female pace bowlers. Methods Eleven female pace bowlers participated in this study. BRS, and four anthropometric and five kinematic parameters were determined. Stepwise linear regression and Pearson Product Moment correlations were used to identify anthropometric and kinematic parameters linked to BRS. Results The best predictor of BRS explaining 89% of the observed variance was the bowling shoulder angle at ball release. The best anthropometric predictor of BRS was height explaining 53% of the observed variance. Other parameters correlated with BRS included: run-up speed (r = 0.75, p = 0.013) and arm length (r = 0.61, p = 0.046). When height was controlled for, the front knee angle at front foot contact was also correlated to BRS (r = 0.68, p = 0.044). No relationship was found between trunk flexion and BRS. Conclusion Faster BRS were characterised by faster run-up speeds, straighter front knees, and delayed arm circumduction similar to male pace bowlers. The lack of relationship between trunk flexion and BRS may highlight female pace bowlers adopting a bowling technique where BRS is contributed to by trunk rotation as well as trunk flexion. This knowledge is likely to be useful in the talent identification and coaching of female pace bowlers.
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Affiliation(s)
- C Lyons
- School of Sport, Ulster University, Belfast, Northern
Ireland
| | - PJ Felton
- School of Science & Technology, Nottingham Trent University,
England
| | - C McCabe
- School of Sport, Ulster University, Belfast, Northern
Ireland
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5
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Koslow M, Zhu P, McCabe C, Xu X, Lin X. Kidney transcriptome and cystic kidney disease genes in zebrafish. Front Physiol 2023; 14:1184025. [PMID: 37256068 PMCID: PMC10226271 DOI: 10.3389/fphys.2023.1184025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/20/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction: Polycystic kidney disease (PKD) is a condition where fluid filled cysts form on the kidney which leads to overall renal failure. Zebrafish has been recently adapted to study polycystic kidney disease, because of its powerful embryology and genetics. However, there are concerns on the conservation of this lower vertebrate in modeling polycystic kidney disease. Methods: Here, we aim to assess the molecular conservation of zebrafish by searching homologues polycystic kidney disease genes and carrying transcriptome studies in this animal. Results and Discussion: We found that out of 82 human cystic kidney disease genes, 81 have corresponding zebrafish homologs. While 75 of the genes have a single homologue, only 6 of these genes have two homologs. Comparison of the expression level of the transcripts enabled us to identify one homolog over the other homolog with >70% predominance, which would be prioritized for future experimental studies. Prompted by sexual dimorphism in human and rodent kidneys, we studied transcriptome between different sexes and noted significant differences in male vs. female zebrafish, indicating that sex dimorphism also occurs in zebrafish. Comparison between zebrafish and mouse identified 10% shared genes and 38% shared signaling pathways. String analysis revealed a cluster of genes differentially expressed in male vs. female zebrafish kidneys. In summary, this report demonstrated remarkable molecular conservation, supporting zebrafish as a useful animal model for cystic kidney disease.
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Affiliation(s)
- Matthew Koslow
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, United States
| | - Ping Zhu
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, United States
| | - Chantal McCabe
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Xiaolei Xu
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, United States
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Xueying Lin
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, United States
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Starlinger P, Brunnthaler L, McCabe C, Pereyra D, Santol J, Steadman J, Hackl M, Skalicky S, Hackl H, Gronauer R, O’Brien D, Kain R, Hirsova P, Gores GJ, Wang C, Gruenberger T, Smoot RL, Assinger A. Transcriptomic landscapes of effective and failed liver regeneration in humans. JHEP Rep 2023; 5:100683. [PMID: 36950091 PMCID: PMC10025111 DOI: 10.1016/j.jhepr.2023.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/19/2022] [Accepted: 01/08/2023] [Indexed: 03/24/2023] Open
Abstract
Background & Aims Although extensive experimental evidence on the process of liver regeneration exists, in humans, validation is largely missing. However, liver regeneration is critically affected by underlying liver disease. Within this project, we aimed to systematically assess early transcriptional changes during liver regeneration in humans and further assess how these processes differ in people with dysfunctional liver regeneration. Methods Blood samples of 154 patients and intraoperative tissue samples of 46 patients undergoing liver resection were collected and classified with regard to dysfunctional postoperative liver regeneration. Of those, a matched cohort of 21 patients were used for RNA sequencing. Samples were assessed for circulating cytokines, gene expression dynamics, intrahepatic neutrophil accumulation, and spatial transcriptomics. Results Individuals with dysfunctional liver regeneration demonstrated an aggravated transcriptional inflammatory response with higher intracellular adhesion molecule-1 induction. Increased induction of this critical leukocyte adhesion molecule was associated with increased intrahepatic neutrophil accumulation and activation upon induction of liver regeneration in individuals with dysfunctional liver regeneration. Comparing baseline gene expression profiles in individuals with and without dysfunctional liver regeneration, we found that dual-specificity phosphatase 4 (DUSP4) expression, a known critical regulator of intracellular adhesion molecule-1 expression in endothelial cells, was markedly reduced in patients with dysfunctional liver regeneration. Mimicking clinical risk factors for dysfunctional liver regeneration, we found liver sinusoidal endothelial cells of two liver disease models to have significantly reduced baseline levels of DUSP4. Conclusions Exploring the landscape of early transcriptional changes of human liver regeneration, we observed that people with dysfunctional regeneration experience overwhelming intrahepatic inflammation. Subclinical liver disease might account for DUSP4 reduction in liver sinusoidal endothelial cells, which ultimately primes the liver for an aggravated inflammatory response. Impact and implications Using a unique human biorepository, focused on liver regeneration (LR), we explored the landscape of circulating and tissue-level alterations associated with both functional and dysfunctional LR. In contrast to experimental animal models, people with dysfunctional LR demonstrated an aggravated transcriptional inflammatory response, higher intracellular adhesion molecule-1 (ICAM-1) induction, intrahepatic neutrophil accumulation and activation upon induction of LR. Although inflammatory responses appear rapidly after liver resection, people with dysfunctional LR have exaggerated inflammatory responses that appear to be related to decreased levels of LSEC DUSP4, challenging existing concepts of post-resectional LR.
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Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- CASH, chemotherapy associated steatohepatitis
- DLR, dysfunctional LR
- DUSP-4
- DUSP4, dual-specificity phosphatase 4
- FDR, false discovery rate
- FLR, functional LR
- FPKM, fragments per kilobase of transcript per million mapped reads
- Human
- ICAM-1, intracellular adhesion molecule-1
- IPA, Ingenuity Pathway Analysis
- IVCL, inferior vena cava ligation
- Inflammation
- LPS, lipopolysaccharide
- LR, liver regeneration
- LSEC, liver sinusoidal endothelial cell
- Liver regeneration
- MFI, mean fluorescence intensity
- MPO, myeloperoxidase
- NASH, non-alcoholic steatohepatitis
- Neutrophils
- PCA, principal component analysis
- POD1, 1 day after liver resection
- POD5, 5 days after liver resection
- STRING, Search Tool for the Retrieval of Interacting Genes/Proteins
- TMM, trimmed mean of M values
- TNF, tumour necrosis factor
- logCPM, log counts per million
- pTPM, protein-coding transcripts per million
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Affiliation(s)
- Patrick Starlinger
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
- Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Corresponding authors. Addresses: Department of HPB Surgery, Mayo Clinic, 200 First Street SW, Rochester 55905, MN, USA; Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. Tel.: +43-1-40400-5621.
| | - Laura Brunnthaler
- Center of Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Chantal McCabe
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - David Pereyra
- Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Jonas Santol
- Department of Surgery, HPB Center, Viennese Health Network, Clinic Favoriten and Sigmund Freud Private University, Vienna, Austria
| | - Jessica Steadman
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Hubert Hackl
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Raphael Gronauer
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel O’Brien
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Renate Kain
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Petra Hirsova
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Gregory J. Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Chen Wang
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Thomas Gruenberger
- Department of Surgery, HPB Center, Viennese Health Network, Clinic Favoriten and Sigmund Freud Private University, Vienna, Austria
| | - Rory L. Smoot
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
- Department of Surgery, Mayo Clinic, 200 First Street SW, 55905 Rochester, MN, USA. Tel.: +1-507-284-1529; fax: +1-507-284-5196.
| | - Alice Assinger
- Center of Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
- Institute of Physiology, Medical University of Vienna, Schwarzspanierstraße 17, 1090 Vienna, Austria. Tel.: +43-1-40160-31405.
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Karia N, Howard L, Johnson M, Kiely D, Lordan J, McCabe C, Ong R, Pepke-Zaba J, Preiss M, Muthurangu V, Coghlan G. Mortality rates and cause of mortality in patients with mildly elevated pulmonary pressures versus PH: insights from the retrospective EVIDENCE-PAH study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Normal mean pulmonary artery pressure (mPAP) does not exceed 20 mmHg and normal pulmonary vascular resistance (PVR) does not exceed 2 Wood Units (WU). The thresholds used to define pre-capillary pulmonary hypertension (PH) – mPAP ≥25 mmHg and PVR >3 WU – are being evaluated. It is unclear if treatment would benefit patients with mildly elevated mPAP (≥21–<25 mmHg).
Purpose
The EVIDENCE-PAH study aims to describe mortality and hospitalisation outcomes, clinical characteristics, therapies, and quality of life during long-term follow-up of a national cohort of patients with different levels of mPAP and PVR. We report preliminary analyses focusing on mortality and its cause in patients stratified by their baseline (BL) mPAP.
Methods
This retrospective analysis included PAH-treatment-naïve patients with suspected PH who received a first right heart catheterisation (RHC) between 2009 and 2017 at any of the 7 UK tertiary PH centres, which assess all PH patients in the UK. A sample of patients with BL mPAP ≥25 mmHg (stratified by PVR and treatable versus non-treatable PH) was used as a control in this analysis. Baseline characteristics, mortality and cause of mortality were stratified by mPAP (<21, ≥21–<25, ≥25 mmHg) at BL (first RHC). Mortality was also stratified by BL PVR (<1, 1–<2, 2–<3, 3–<6, ≥6 WU). Mortality analysis was done without matching cohorts. Mortality data were obtained from the Office for National Statistics, NHS Digital.
Results
In total, 2926 patients were analysed (968, 689 and 1269 with mPAP <21, ≥21–<25, ≥25 mmHg, respectively). Mean observation was 6.1 years. BL characteristics are in Table. Survival worsened with increasing mPAP (p<0.0001) and increasing PVR (p<0.01) (Figure). After 5 years of follow-up, 187 (27.1%) patients with mPAP ≥21–<25 mmHg had died, compared with 162 (16.7%) and 595 (46.9%) patients in the lower and higher mPAP groups, respectively. In patients with mPAP ≥21–<25 mmHg, the most common main cause of death was respiratory disease (36.4%) – with scleroderma lung disease and interstitial lung disease accounting for 69.1% of these deaths – followed by cardiac disease (16.6%) and malignancy (15.0%) (Table). PH was the main cause of death for only 1.6% of patients with mildly elevated mPAP and it was a contributor to death in 6.8% (BL mPAP <21 mmHg), 10.2% (≥21–<25 mmHg), and 40.2% (≥25 mmHg) of cases.
Conclusion
Long-term survival in patients with mPAP ≥21–<25 mmHg was worse than in those with normal mPAP, and better than in those with the current definition of PH. While the main cause of death was mostly unrelated to PH and further analysis is needed to understand the impact of underlying disease, mildly elevated mPAP appears to confer a worse prognosis and should be closely monitored. These data show the relevant disease burden in patients with mPAP ≥21–<25 mmHg and the need to understand if they could benefit from treatment. PVR may be key in determining patients who might benefit.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Actelion Pharmaceuticals Ltd., a Janssen pharmaceutical company of Johnson & Johnson.
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Affiliation(s)
- N Karia
- Royal Free Hospital , London , United Kingdom
| | - L Howard
- Hammersmith Hospital, National Pulmonary Hypertension Service , London , United Kingdom
| | - M Johnson
- Golden Jubilee National Hospital, Scottish Pulmonary Vascular Unit , Glasgow , United Kingdom
| | - D Kiely
- Sheffield Teaching Hospitals NHS Trust, Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital , Sheffield , United Kingdom
| | - J Lordan
- Freeman Hospital , Newcastle upon Tyne , United Kingdom
| | - C McCabe
- Royal Brompton Hospital , London , United Kingdom
| | - R Ong
- Actelion Pharmaceuticals Ltd. , Allschwil , Switzerland
| | - J Pepke-Zaba
- Royal Papworth Hospital NHS Foundation Trust, Pulmonary Vascular Disease Unit , Cambridge , United Kingdom
| | - M Preiss
- Actelion Pharmaceuticals Ltd. , Allschwil , Switzerland
| | - V Muthurangu
- University College London, Institute of Cardiovascular Science , London , United Kingdom
| | - G Coghlan
- Royal Free Hospital , London , United Kingdom
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McCabe C, Hatch D, Chohan A. An evaluation of effectiveness of the Musculoskeletal Health Questionnaire (MSK-HQ) as a measure for adults following a pain management programme. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.170] [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: 10/19/2022]
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Wustmann K, Constantine A, Davies J, Li W, Pennell D, Wort S, Kempny A, Price L, McCabe C, Mohiaddin R, Francis D, Gatzoulis M, Dimopoulos K. Prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100199] [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: 01/09/2023] Open
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10
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McCabe C, Bryson E, Harvey R. Dose derivation of oral anticancer agents: Tolerability in late phase registration trials. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nelson A, Kalyuzhnyi Y, Patsahan T, McCabe C. Liquid-vapor phase equilibrium of a simple liquid confined in a random porous media: Second-order Barker-Henderson perturbation theory and scaled particle theory. J Mol Liq 2020. [DOI: 10.1016/j.molliq.2019.112348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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McCabe C, Ivanac Vranesic I, Castro Verdes M, Kempny A, Khan U, Price L, Gatzoulis M, Dimopoulos K, Wort S, Li W. Reply to Echocardiographic predictors of outcome in PAH. Int J Cardiol 2019; 294:58. [DOI: 10.1016/j.ijcard.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
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Mawer D, Byrne F, Drake S, Brown C, Prescott A, Warne B, Bousfield R, Skittrall JP, Ramsay I, Somasunderam D, Bevan M, Coslett J, Rao J, Stanley P, Kennedy A, Dobson R, Long S, Obisanya T, Esmailji T, Petridou C, Saeed K, Brechany K, Davis-Blue K, O'Horan H, Wake B, Martin J, Featherstone J, Hall C, Allen J, Johnson G, Hornigold C, Amir N, Henderson K, McClements C, Liew I, Deshpande A, Vink E, Trigg D, Guilfoyle J, Scarborough M, Scarborough C, Wong THN, Walker T, Fawcett N, Morris G, Tomlin K, Grix C, O'Cofaigh E, McCaffrey D, Cooper M, Corbett K, French K, Harper S, Hayward C, Reid M, Whatley V, Winfield J, Hoque S, Kelly L, King I, Bradley A, McCullagh B, Hibberd C, Merron M, McCabe C, Horridge S, Taylor J, Koo S, Elsanousi F, Saunders R, Lim F, Bond A, Stone S, Milligan ID, Mack DJF, Nagar A, West RM, Wilcox MH, Kirby A, Sandoe JAT. Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea. J Hosp Infect 2019; 103:200-209. [PMID: 31077777 DOI: 10.1016/j.jhin.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.
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Affiliation(s)
- D Mawer
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.
| | - F Byrne
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - S Drake
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - C Brown
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - A Prescott
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - B Warne
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - R Bousfield
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - J P Skittrall
- Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK
| | - I Ramsay
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - D Somasunderam
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - M Bevan
- Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - J Coslett
- Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - J Rao
- Department of Microbiology, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK
| | - P Stanley
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - A Kennedy
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - R Dobson
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - S Long
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - T Obisanya
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - T Esmailji
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - C Petridou
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Saeed
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Brechany
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Davis-Blue
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - H O'Horan
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - B Wake
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - J Martin
- Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK
| | - J Featherstone
- Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK
| | - C Hall
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - J Allen
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - G Johnson
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - C Hornigold
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - N Amir
- Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
| | - K Henderson
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - C McClements
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - I Liew
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - A Deshpande
- Department of Microbiology, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - E Vink
- Department of Microbiology, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - D Trigg
- Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J Guilfoyle
- Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - M Scarborough
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - C Scarborough
- Nuffield Department of Medicine, University of Oxford, OX3 7FZ, UK
| | - T H N Wong
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - T Walker
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - N Fawcett
- Department of Medicine, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - G Morris
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - K Tomlin
- Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - C Grix
- Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - E O'Cofaigh
- Department of Medicine, Friarage Hospital, South Tees Hospital NHS Foundation Trust, Northallerton, DL6 1JG, UK
| | - D McCaffrey
- Department of Infection Prevention & Control, James Cook University Hospital, South Tees Hospital NHS Foundation Trust, Middlesborough, TS4 3BW, UK
| | - M Cooper
- Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - K Corbett
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - K French
- Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - S Harper
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - C Hayward
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - M Reid
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - V Whatley
- Corporate Support Services, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - J Winfield
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - S Hoque
- Department of Microbiology, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - L Kelly
- Department of Infection Prevention & Control, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - I King
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - A Bradley
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - B McCullagh
- Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - C Hibberd
- Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - M Merron
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - C McCabe
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - S Horridge
- Department of Microbiology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK
| | - J Taylor
- Department of Virology and Molecular Pathology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK
| | - S Koo
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - F Elsanousi
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - R Saunders
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - F Lim
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - A Bond
- Department of Microbiology, York Teaching Hospital NHS Foundation Trust, York, YO31 8HE, UK
| | - S Stone
- Royal Free Campus, University College Medical School, London, NW3 2QG, UK
| | - I D Milligan
- Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - D J F Mack
- Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - A Nagar
- Department of Microbiology, Antrim Area Hospital, Northern Health and Social Care Trust, Bush Road, Antrim, BT41 2RL, UK
| | - R M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - M H Wilcox
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - A Kirby
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
| | - J A T Sandoe
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
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Kempny A, Dimopoulos K, Fraisse AE, Diller GP, Price LC, Rafiq I, McCabe C, Wort SJ, Gatzoulis MA. 4971Blood viscosity and its relevance to the diagnosis and management of pulmonary hypertension: a new elephant in the cathlab. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pulmonary vascular resistance (PVR) is an essential parameter assessed during cardiac catheterization. It is used to confirm pulmonary vascular disease, to assess response to targeted pulmonary hypertension (PH) therapy and to determine the possibility of surgery, such as closure of intra-cardiac shunt or transplantation. While PVR is believed to mainly reflect the properties of the pulmonary vasculature, it is also related to blood viscosity (BV).
Objectives
We aimed to assess the relationship between measured (mPVR) and viscosity-corrected PVR (cPVR) and its impact on clinical decision-making.
Methods
We assessed consecutive PH patients undergoing cardiac catheterization. BV was assessed using the Hutton method.
Results
We included 465 patients (56.6% female, median age 63y). The difference between mPVR and cPVR was highest in patients with abnormal Hb levels (anemic patients: 5.6 [3.4–8.0] vs 7.8Wood Units (WU) [5.1–11.9], P<0.001; patients with raised Hb: 10.8 [6.9–15.4] vs. 7.6WU [4.6–10.8], P<0.001, respectively). Overall, 33.3% patients had a clinically significant (>2.0WU) difference between mPVR and cPVR, and this was more pronounced in those with anemia (52.9%) or raised Hb (77.6%). In patients in the upper quartile for this difference, mPVR and cPVR differed by 4.0WU [3.4–5.2].
Adjustment of PVR required
Conclusions
We report, herewith, a clinically significant difference between mPVR and cPVR in a third of contemporary patients assessed for PH. This difference is most pronounced in patients with anemia, in whom mPVR significantly underestimates PVR, whereas in most patients with raised Hb, mPVR overestimates it. Our data suggest that routine adjustment for BV is necessary.
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Affiliation(s)
- A Kempny
- Royal Brompton Hospital, London, United Kingdom
| | | | - A E Fraisse
- Royal Brompton Hospital, London, United Kingdom
| | - G P Diller
- Royal Brompton Hospital, London, United Kingdom
| | - L C Price
- Royal Brompton Hospital, London, United Kingdom
| | - I Rafiq
- Royal Brompton Hospital, London, United Kingdom
| | - C McCabe
- Royal Brompton Hospital, London, United Kingdom
| | - S J Wort
- Royal Brompton Hospital, London, United Kingdom
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15
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Stein RC, Hughes-Davies L, Makris A, Macpherson IR, Conefrey C, Rooshenas L, Pinder SE, Thomas J, Hall PS, Cameron DA, Earl HM, Naume B, Poole CJ, Rea DW, MacIntosh SA, Harmer V, Morgan A, Hulme C, McCabe C, Stallard N, Higgins H, Donovan JL, Bartlett JM, Marshall A, Dunn JA. Abstract OT1-05-02: OPTIMA: A prospective randomized trial to validate the clinical utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in high clinical risk early breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-05-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Multi-parameter tumour gene expression assays (MPAs) are widely used to estimate individual patient residual risk and to guide chemotherapy use in hormone-sensitive, HER2-negative early breast cancer. The TAILORx trial supports MPA use in a node-negative population. Evidence for MPA use in node-positive breast cancer is limited. OPTIMA (Optimal Personalised Treatment of early breast cancer usIng Multi-parameter Analysis) (ISRCTN42400492) aims to validate MPAs as predictors of chemotherapy sensitivity in a largely node-positive breast cancer population where prospective RCT (Randomised Controlled Trial) evidence is lacking.
Methods: OPTIMA is a partially blinded multi-center RCT with an adaptive two-stage design. The main eligibility criteria are women and men age 40 or older with resected ER-positive, HER2-negative invasive breast cancer and up to 9 involved axillary lymph nodes. Randomisation is to standard management (chemotherapy and endocrine therapy) or to MPA-directed treatment using the Prosigna (PAM50) test. Those with a Prosigna tumour score (ROR_PT) >60 receive standard management whilst those with a low score (≤60) are treated with endocrine therapy alone. Endocrine therapy for pre-menopausal women includes ovarian suppression. The co-primary outcomes are (1) Invasive Disease Free Survival (IDFS) and (2) cost-effectiveness of test-directed treatment. Secondary outcomes include IDFS in patients with low-score tumours and quality of life. An integrated qualitative recruitment study addresses challenges to consent and recruitment and will build on experience from the feasibility study that a multidisciplinary approach at sites is important for recruitment success. Tumour blocks will be banked to allow evaluation of additional MPA technologies. Recruitment of 4500 patients over 5 years will permit demonstration of 3% non-inferiority of test-directed treatment, assuming 5-year IDFS of 85% with standard management, equivalent to a HR of 1.22. Inclusion of patients from the feasibility study will increase the power to test for non-inferiority.
Results: The OPTIMA main trial opened in January 2017. Overall recruitment (including the feasibility study) will reach 1000 in August 2018. Recruitment in Norway will commence in July 2018. Characteristics of the OPTIMA main participants recruited to 31st May 2018 are shown in the table.
Main study patient characteristicsCharacteristic %Median age in years (range)57 (40-80) Menopause statusPre34 Post66 Male1Tumour size<30mm58 >=30mm42Node statuspN04 pN1mi(sn)7 pN1(sn)20 pN155 pN214Historic grade16 258 336
Conclusion: OPTIMA is one of two large scale prospective trials validating the use of test-guided chemotherapy decisions in node-positive early breast cancer. It is expected to have a global impact on breast cancer treatment. Experience from the preliminary study and close engagement with centres will aid trial success.
Funding: OPTIMA is funded by the UK NIHR HTA Programme (10/34/501). Views expressed are those of the authors and not those of the HTA Programme, NIHR, NHS or the DoH.
Citation Format: Stein RC, Hughes-Davies L, Makris A, Macpherson IR, Conefrey C, Rooshenas L, Pinder SE, Thomas J, Hall PS, Cameron DA, Earl HM, Naume B, Poole CJ, Rea DW, MacIntosh SA, Harmer V, Morgan A, Hulme C, McCabe C, Stallard N, Higgins H, Donovan JL, Bartlett JM, Marshall A, Dunn JA. OPTIMA: A prospective randomized trial to validate the clinical utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in high clinical risk early breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-05-02.
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Affiliation(s)
- RC Stein
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - L Hughes-Davies
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - A Makris
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - IR Macpherson
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - C Conefrey
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - L Rooshenas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - SE Pinder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - J Thomas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - PS Hall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - DA Cameron
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - HM Earl
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - B Naume
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - CJ Poole
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - DW Rea
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - SA MacIntosh
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - V Harmer
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - A Morgan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - C Hulme
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - C McCabe
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - N Stallard
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - H Higgins
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - JL Donovan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - JM Bartlett
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - A Marshall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - JA Dunn
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
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Hulme C, Hall P, Shinkins B, Chehadah F, McCabe C, Hiller L, Dunn J, Earl H. PERSEPHONE: 6 versus 12 months (m) of adjuvant trastuzumab in patients (pts) with HER2 positive (+) early breast cancer (EBC): Cost effectiveness analysis results. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Favoccia C, Kempny A, Price LC, McCabe C, Wort SJ, Dimopoulos K. 3019The emPHasis-10 quality of life score for pulmonary hypertension is a strong predictor of mortality. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Favoccia
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - A Kempny
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - L C Price
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - C McCabe
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - S J Wort
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - K Dimopoulos
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
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Ivanac Vranesic I, McCabe C, Kempny A, Price L, Dimopoulos K, Wort SJ, Li W. P4537Prolonged right ventricular systolic to diastolic duration ratio predicts mortality in idiopathic pulmonary arterial hypertension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4537] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I Ivanac Vranesic
- Royal Brompton Hospital and Imperial College London, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - C McCabe
- Royal Brompton Hospital and Imperial College London, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - A Kempny
- Royal Brompton Hospital and Imperial College London, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - L Price
- Royal Brompton Hospital and Imperial College London, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - K Dimopoulos
- Royal Brompton Hospital and Imperial College London, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - S J Wort
- Royal Brompton Hospital and Imperial College London, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - W Li
- Royal Brompton Hospital and Imperial College London, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
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Read M, Modasia B, Fletcher A, Thompson R, Baker K, Boelaert K, Turnell A, Smith V, Mehanna H, McCabe C. PO-124 PTTG and PBF functionally interact with P53 and predict overall survival in head and neck cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.165] [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] Open
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Beilman CL, Ma C, McCabe C, Fedorak R, Halloran BP. A73 COST-EFFECTIVENESS OF INFLIXIMAB BIOSIMILAR COMPARED TO ORIGINATOR INFLIXIMAB FOR THE MANAGEMENT OF CROHN’S DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.073] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C L Beilman
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - C Ma
- Medicine, University of Calgary, Calgary, AB, Canada
| | - C McCabe
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Beilman CL, Kirwin E, Ma C, McCabe C, Fedorak R, Halloran BP. A103 EARLY INITIATION OF ANTI-TNF THERAPY IS COST-SAVING COMPARED TO LATE INITIATION FOR PATIENTS WITH CROHN’S DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - E Kirwin
- Alberta Health, Edmonton, AB, Canada
| | - C Ma
- University of Calgary, Calgary, AB, Canada
| | - C McCabe
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
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Beilman CL, Ma C, McCabe C, Fedorak R, Halloran BP. A104 COST-EFFECTIVENESS OF INFLIXIMAB BIOSIMILAR FOR THE MANAGEMENT OF CROHN’S DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - C Ma
- University of Calgary, Calgary, AB, Canada
| | - C McCabe
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
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Stein RC, Makris A, Hughes-Davies L, Macpherson IR, Hall PS, Cameron DA, Earl HM, Pinder SE, Poole CJ, Rea DW, McIntosh S, Harmer V, Morgan A, Rooshenas L, Conefrey C, Donovan JL, Hulme C, McCabe C, Stallard N, Campbell A, Higgins H, Bartlett JMS, Marshall A, Dunn JA. Abstract OT1-06-01: OPTIMA: A prospective randomized trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in early breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-06-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Multi-parameter gene expression assays (MPAs) are widely used to estimate individual patient residual risk in hormone-sensitive HER2-negative node-negative early breast cancer, allowing patients with low risk to safely avoid chemotherapy. Evidence for MPA use in node-positive breast cancer is limited. OPTIMA (Optimal Personalised Treatment of early breast cancer usIng Multi-parameter Analysis) aims to validate MPA's as predictors of chemotherapy sensitivity in a largely node-positive breast cancer population.
Methods: OPTIMA is a partially blinded multi-center, phase 3 randomized controlled trial with an adaptive two-stage design. The main eligibility criteria are women or men aged 40 or older with resected ER-positive, HER2-negative breast cancer and up to 9 involved axillary lymph nodes. Randomization is to standard management (chemotherapy and endocrine therapy) or to MPA-directed treatment. Those with a “high risk” tumor MPA score receive standard management whilst those at “low risk” are treated with endocrine therapy alone. The preliminary phase (OPTIMA prelim) evaluated the performance of several MPAs to select a test to be used in the main efficacy trial based on economic analysis, and assessed the feasibility and acceptability of a large UK trial. OPTIMA prelim used Oncotype DX as the primary discriminator; the main trial will use Prosigna (PAM50) with Prosigna Score ≤60 defined as “low-risk”. The co-primary outcomes are (1) Invasive Disease Free Survival (IDFS) and (2) cost-effectiveness of test-directed therapy. Secondary outcomes include IDFS in “low-risk” patients, quality of life and additional survival measures. An integrated qualitative recruitment study will identify and address challenges to recruitment and informed consent. Tumor blocks from all consenting participants will be banked allowing the performance of alternative MPA technologies to be evaluated. Recruitment of 4500 patients will permit demonstration of 3% non-inferiority of test-directed treatment, with 5% significance and 85% power, assuming 3 years follow-up and a control arm 5-year IDFS of at least 85%. The addition of patients from OPTIMA prelim will allow non-inferiority to be assessed with 2.5% significance.
Results: OPTIMA-prelim recruited 412 patients in 23 months from 35 sites with a 47% acceptance rate. The main study opened in January 2017. Early progress indicates that the recruitment target is achievable in the intended 46-month timescale through the participation of >100 sites
Conclusion: OPTIMA, as one of two large scale prospective trials validating the use of test-guided chemotherapy decisions in node-positive early breast cancer, is expected to have a global impact on breast cancer treatment. Experience from OPTIMA prelim showed that patient advocate support and close engagement with sites will aid trial success.
Funding: The project is funded in the UK by the NIHR HTA Programme (10/34/501). Views expressed are those of the authors and not those of the HTA Programme, NIHR, NHS or the DoH.
Citation Format: Stein RC, Makris A, Hughes-Davies L, Macpherson IR, Hall PS, Cameron DA, Earl HM, Pinder SE, Poole CJ, Rea DW, McIntosh S, Harmer V, Morgan A, Rooshenas L, Conefrey C, Donovan JL, Hulme C, McCabe C, Stallard N, Campbell A, Higgins H, Bartlett JMS, Marshall A, Dunn JA. OPTIMA: A prospective randomized trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in early breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-06-01.
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Affiliation(s)
- RC Stein
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Makris
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - L Hughes-Davies
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - IR Macpherson
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - PS Hall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - DA Cameron
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - HM Earl
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - SE Pinder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - CJ Poole
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - DW Rea
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - S McIntosh
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - V Harmer
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Morgan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - L Rooshenas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - C Conefrey
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - JL Donovan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - C Hulme
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - C McCabe
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - N Stallard
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Campbell
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - H Higgins
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - JMS Bartlett
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Marshall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - JA Dunn
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
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Ng B, White CC, Klein H, Sieberts SK, McCabe C, Patrick E, Xu J, Yu L, Gaiteri C, Bennett DA, Mostafavi S, De Jager PL. An xQTL map integrates the genetic architecture of the human brain's transcriptome and epigenome. Nat Neurosci 2017; 20:1418-1426. [PMID: 28869584 PMCID: PMC5785926 DOI: 10.1038/nn.4632] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 08/02/2017] [Indexed: 12/15/2022]
Abstract
We report a multi-omic resource generated by applying quantitative trait locus (xQTL) analyses to RNA sequence, DNA methylation and histone acetylation data from the dorsolateral prefrontal cortex of 411 older adults who have all three data types. We identify SNPs significantly associated with gene expression, DNA methylation and histone modification levels. Many of these SNPs influence multiple molecular features, and we demonstrate that SNP effects on RNA expression are fully mediated by epigenetic features in 9% of these loci. Further, we illustrate the utility of our new resource, xQTL Serve, by using it to prioritize the cell type(s) most affected by an xQTL. We also reanalyze published genome wide association studies using an xQTL-weighted analysis approach and identify 18 new schizophrenia and 2 new bipolar susceptibility variants, which is more than double the number of loci that can be discovered with a larger blood-based expression eQTL resource.
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Affiliation(s)
- B Ng
- Department of Statistics and Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Molecular Medicine and Therapeutics, Vancouver, British Columbia, Canada
| | - CC White
- Broad Institute, Cambridge, Massachusetts, USA
| | - H Klein
- Broad Institute, Cambridge, Massachusetts, USA,Center for Translational & Systems Neuroimmunology, Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | | | - C McCabe
- Broad Institute, Cambridge, Massachusetts, USA
| | - E Patrick
- Broad Institute, Cambridge, Massachusetts, USA
| | - J Xu
- Broad Institute, Cambridge, Massachusetts, USA
| | - L Yu
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - C Gaiteri
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - DA Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - S Mostafavi
- Department of Statistics and Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Molecular Medicine and Therapeutics, Vancouver, British Columbia, Canada,Canadian Institute for Advanced Research, CIFAR program in Child and Brain Development, Toronto, Canada,To whom the correspondence should be addressed to: and
| | - PL De Jager
- Broad Institute, Cambridge, Massachusetts, USA,Center for Translational & Systems Neuroimmunology, Department of Neurology, Columbia University Medical Center, New York, New York, USA,To whom the correspondence should be addressed to: and
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Smith AF, Hall PS, Hulme CT, Dunn JA, McConkey CC, Rahman JK, McCabe C, Mehanna H. Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer. Eur J Cancer 2017; 85:6-14. [PMID: 28881249 DOI: 10.1016/j.ejca.2017.07.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/31/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective. METHODS Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results. RESULTS PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective. CONCLUSIONS This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption.
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Affiliation(s)
- A F Smith
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, UK; National Institute of Health Research (NIHR) Diagnostic Evidence Cooperative (DEC) Leeds, UK.
| | - P S Hall
- National Institute of Health Research (NIHR) Diagnostic Evidence Cooperative (DEC) Leeds, UK; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - C T Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, UK
| | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
| | - C C McConkey
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
| | - J K Rahman
- Institute of Head & Neck Studies and Education, University of Birmingham, UK
| | - C McCabe
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
| | - H Mehanna
- Institute of Head & Neck Studies and Education, University of Birmingham, UK
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Valen S, McCabe C, Maddock E, Bright S, Keeley B. A modified tibial compression test for the detection of meniscal injury in dogs. J Small Anim Pract 2017; 58:109-114. [PMID: 28160306 DOI: 10.1111/jsap.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/26/2016] [Accepted: 10/06/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess diagnostic efficacy of a modified tibial compression test in predicting medial meniscal injury in dogs with cranial cruciate ligament failure. METHODS Dogs admitted for surgical stabilisation of stifles with cranial cruciate ligament failure were examined by five preoperative physical tests to assess medial meniscal injury. Results of each physical test were compared with findings at arthrotomy and used to calculate sensitivities, specificities, positive and negative predictive values. RESULTS None of the physical tests were accurate in reflecting meniscal integrity for dogs with cranial cruciate failure. Out of the five tests, the modified tibial compression test exhibited the highest concordance and sensitivity for the detection of medial meniscal tears. A palpable click during the modified tibial compression test had a sensitivity and specificity up to 63 and 77%, respectively, for the detection of medial meniscal lesions. Concordance values were up to 40% for the modified tibial compression test, followed by the range of motion test (up to 25%), while all other physical tests had concordance values below 10%. CLINICAL SIGNIFICANCE Physical tests are highly available, affordable and can be easily performed, but their efficacy in diagnosing medical meniscal injury is low. Meniscal clicks associated with meniscal tears were more frequently elicited during the modified tibial compression test when compared with other traditional tests.
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Affiliation(s)
- S Valen
- Northwest Surgeons, Sutton Weaver, Cheshire, WA7 3FW
| | - C McCabe
- Northwest Surgeons, Sutton Weaver, Cheshire, WA7 3FW
| | - E Maddock
- Northwest Surgeons, Sutton Weaver, Cheshire, WA7 3FW
| | - S Bright
- Northwest Surgeons, Sutton Weaver, Cheshire, WA7 3FW
| | - B Keeley
- Northwest Surgeons, Sutton Weaver, Cheshire, WA7 3FW
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Martin Garcia A, Arachchillage D, Kempny A, Alonso-Gonzalez R, Martin-Garcia A, Uebing A, Swan L, Wort S, Price L, McCabe C, Sanchez P, Dimopoulos K, Gatzoulis M. P4533Low platelet count and its relation to death in adults with eisenmenger syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Drakopoulou M, Nashat H, Kempny A, Wort S, Price L, Alonso-Gonzalez R, McCabe C, Swan L, Gatzoulis M, Ernst S, Dimopoulos K. P4534Incidence of arrhythmia and relation to mortality in a contemporary cohort of adults with pulmonary arterial hypertension associated with congenital heart disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Martin Garcia A, Arachchillage D, Kempny A, Alonso-Gonzalez R, Martin-Garcia A, Uebing A, Swan L, Wort S, Price L, McCabe C, Sanchez P, Dimopoulos K, Gatzoulis M. P723Abnormalities in platelet volume and count as predictors of thrombosis and bleeding in patients with Eisenmenger syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kempny A, Dimopoulos K, Price L, Gatzoulis M, McCabe C, Wort S. P4244Incidence of pulmonary embolism, associated mortality and bleeding risk in england between 1998-2015. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kasasbeh MAM, McCabe C, Payne S. Cancer-related pain management: A review of knowledge and attitudes of healthcare professionals. Eur J Cancer Care (Engl) 2016; 26. [PMID: 28026070 DOI: 10.1111/ecc.12625] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 11/30/2022]
Abstract
Cancer-related pain (CRP) is common and many patients continue to experience pain in spite of advances in pain management modalities. The lack of knowledge, inadequate assessment of CRP and/or organisational factors, such as lack of time due to heavy workload, can be a barrier to effective pain management of healthcare professionals. The purpose was to examine the evidence with regard to the knowledge and attitudes towards practice of healthcare professionals in relation to CRP management. A search of the literature (1999-2015) was conducted searching databases and journals including CINAHL, MEDLINE, PsycINFO, PubMed, Science Direct and Wiley-Blackwell. The initial search revealed a total of 99 articles and following removal of those that did not meet the inclusion criteria, 19 articles were included in the final review. Recognition of the widespread under treatment of CRP has prompted recent corrective efforts in terms of education from healthcare professionals, however, there is a continuing deficit in healthcare professionals' knowledge with regard to CRP management and indicated that healthcare professionals still have negative attitudes that hinder the delivery of quality care to patients suffering from CRP. Further research on how and where education on this topic should be delivered is required.
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Affiliation(s)
- M A M Kasasbeh
- Medical Ward, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - C McCabe
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - S Payne
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
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Davies B, Cramp F, Gauntlett-Gilbert J, McCabe C. Should pain management programme strategies be part of managing painful diabetic neuropathy (PDN)? Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND We have previously shown that the selective serotonergic reuptake inhibitor, citalopram, reduces the neural response to reward and aversion in healthy volunteers. We suggest that this inhibitory effect might underlie the emotional blunting reported by patients on these medications. Bupropion is a dopaminergic and noradrenergic reuptake inhibitor and has been suggested to have more therapeutic effects on reward-related deficits. However, how bupropion affects the neural responses to reward and aversion is unclear. METHOD Seventeen healthy volunteers (9 female, 8 male) received 7 days bupropion (150 mg/day) and 7 days placebo treatment, in a double-blind crossover design. Our functional magnetic resonance imaging task consisted of three phases; an anticipatory phase (pleasant or unpleasant cue), an effort phase (button presses to achieve a pleasant taste or to avoid an unpleasant taste) and a consummatory phase (pleasant or unpleasant tastes). Volunteers also rated wanting, pleasantness and intensity of the tastes. RESULTS Relative to placebo, bupropion increased activity during the anticipation phase in the ventral medial prefrontal cortex (vmPFC) and caudate. During the effort phase, bupropion increased activity in the vmPFC, striatum, dorsal anterior cingulate cortex and primary motor cortex. Bupropion also increased medial orbitofrontal cortex, amygdala and ventral striatum activity during the consummatory phase. CONCLUSIONS Our results are the first to show that bupropion can increase neural responses during the anticipation, effort and consummation of rewarding and aversive stimuli. This supports the notion that bupropion might be beneficial for depressed patients with reward-related deficits and blunted affect.
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Affiliation(s)
- Z Dean
- School of Psychology and Clinical Language Sciences, University of Reading,Reading,UK
| | - S Horndasch
- School of Psychology and Clinical Language Sciences, University of Reading,Reading,UK
| | - P Giannopoulos
- School of Psychology and Clinical Language Sciences, University of Reading,Reading,UK
| | - C McCabe
- School of Psychology and Clinical Language Sciences, University of Reading,Reading,UK
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Read M, Fong J, Imruetaicharoenchoke W, Modasia B, Nieto H, Watkinson J, Boelaert K, Smith V, Turnell A, McCabe C. Comparative analysis of human and mouse expression data identifies distinct proto-oncogene PTTG- and PBF-associated genes in thyroid cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61115-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Read M, Smith J, Smith V, Morgan N, Wake N, Watkinson J, Wallis Y, Maher E, McCabe C, Woodward E. A novel ESR2 frameshift mutation predisposes to medullary thyroid carcinoma and causes inappropriate RET expression. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stein RC, Marshall A, Hall PS, Bartlett JMS, Rooshenas L, Campbell A, Cameron DA, Rea D, Macpherson I, Earl HM, Poole CJ, Francis A, Morgan A, Harmer V, Pinder SE, Stallard N, Donovan J, Hulme C, McCabe C, Hughes-Davies L, Makris A, Dunn JA. Abstract OT3-02-12: OPTIMA (optimal personalised treatment of early breast cancer usIng multi-parameter analysis), a prospective trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-02-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Multi-parameter gene expression assays (MPAs) are widely used to estimate individual patient residual risk and to guide chemotherapy use in hormone-sensitive HER2-negative node-negative early breast cancer. These uses of MPAs have not yet been prospectively validated. OPTIMA aims to validate the use of MPA testing to predict chemotherapy sensitivity in a largely node-positive breast cancer population.
Methods: OPTIMA is a partially blinded multi-center, phase 3 randomized controlled trial with an adaptive two-stage design. The preliminary phase (OPTIMA prelim) evaluated the performance of MPAs to identify a suitable test(s) to be used in the main efficacy trial and assessed the feasibility and acceptability of a large UK trial. Eligible patients are men or women aged 40 years or older who have surgically resected early stage breast cancer, which is ER-positive and HER2-negative and who have either 1-9 involved axillary lymph nodes or tumors of at least 30mm diameter. Randomization is to standard management (chemotherapy followed by endocrine therapy) or to MPA-directed treatment. Those with a tumor categorized as "high-risk" by the test will be assigned to standard management whilst those at "low-risk" will be treated with endocrine therapy alone. OPTIMA prelim used Oncotype DX as the primary discriminator; the main trial will use Prosigna (PAM50). The co-primary outcomes are (1) Invasive Disease Free Survival (IDFS) and (2) cost-effectiveness of test-directed therapy compared to standard practice. Secondary outcomes include IDFS in "low-risk" patients, distant disease free survival, breast cancer specific survival, overall survival and quality of life. An integrated qualitative recruitment study will identify and address challenges to recruitment and informed consent. Tumor blocks from all consenting participants will be banked allowing the performance of alternative MPA technologies to be evaluated. Recruitment of 4500 patients over 4 years will permit demonstration of 3% non-inferiority of test-directed treatment, with 5% significance and 85% power, assuming 3 years follow-up and a control arm 5-year IDFS of at least 85%. The addition of patients from OPTIMA prelim will allow non-inferiority to be assessed with 2.5% significance.
Results: OPTIMA-prelim recruited 412 patients in 23 months from 35 sites. It confirmed the acceptability of randomization to patients with a 47% acceptance rate, and to clinicians and hence the feasibility of a large prospective trial of test-directed treatment running in 100-plus UK sites. It showed that investment into research on test-directed therapy, especially with Prosigna, should be of substantial value to the NHS.
Conclusion: OPTIMA, as one of two large scale prospective trials validating the use of test-guided chemotherapy in node-positive hormone-sensitive early breast cancer will have a global impact on patient treatment. Recruitment into the main efficacy trial will commence in October 2015.
Funding: Project funded by the UK NIHR HTA Programme (10/34/501). Views expressed are those of the authors and not those of the HTA Programme, NIHR, NHS or the DoH.
Citation Format: Stein RC, Marshall A, Hall PS, Bartlett JMS, Rooshenas L, Campbell A, Cameron DA, Rea D, Macpherson I, Earl HM, Poole CJ, Francis A, Morgan A, Harmer V, Pinder SE, Stallard N, Donovan J, Hulme C, McCabe C, Hughes-Davies L, Makris A, Dunn JA. OPTIMA (optimal personalised treatment of early breast cancer usIng multi-parameter analysis), a prospective trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-02-12.
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Affiliation(s)
- RC Stein
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Marshall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - PS Hall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - JMS Bartlett
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - L Rooshenas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Campbell
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - DA Cameron
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - D Rea
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - I Macpherson
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - HM Earl
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - CJ Poole
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Francis
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Morgan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - V Harmer
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - SE Pinder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - N Stallard
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - J Donovan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - C Hulme
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - C McCabe
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - L Hughes-Davies
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Makris
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - JA Dunn
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
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Grieve S, Jones L, Walsh N, McCabe C. What outcome measures are commonly used for Complex Regional Pain Syndrome clinical trials? A systematic review of the literature. Eur J Pain 2015; 20:331-40. [PMID: 26075938 DOI: 10.1002/ejp.733] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/10/2022]
Affiliation(s)
- S. Grieve
- Royal National Hospital for Rheumatic Diseases; Bath UK
- Faculty of Health and Applied Sciences; University of the West of England; Bristol UK
| | - L. Jones
- Faculty of Health and Applied Sciences; University of the West of England; Bristol UK
| | - N. Walsh
- Faculty of Health and Applied Sciences; University of the West of England; Bristol UK
| | - C. McCabe
- Royal National Hospital for Rheumatic Diseases; Bath UK
- Faculty of Health and Applied Sciences; University of the West of England; Bristol UK
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Czoski MCJ, Meads DM, McCabe C, Edlin R, Rutherford C, Hulme CT, Nixon J. A Utility Algorithm forthe Pressure Ulcer Quality of Life - Utility Instrument (Puqol-Ui). Value Health 2014; 17:A513. [PMID: 27201583 DOI: 10.1016/j.jval.2014.08.1582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - C McCabe
- University of Alberta, Edmonton, AB, Canada
| | - R Edlin
- University of Auckland, Auckland, New Zealand
| | | | | | - J Nixon
- University of Leeds, Leeds, UK
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Meads DM, Czoski-Murray C, Rutherford C, Dealey C, McGinnis E, Stubbs N, Wilson L, Nixon J, Hulme CT, McCabe C. Health State Utilities for Pressure Ulcers - A Comparison of Condition-Specific and Generic Measures and Time-Trade-Off (Tto). Value Health 2014; 17:A610. [PMID: 27202124 DOI: 10.1016/j.jval.2014.08.2137] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | - C Dealey
- Birmingham Hospitals NHS Trust and University of Birmingham, Birmingham, UK
| | - E McGinnis
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Stubbs
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | | | - J Nixon
- University of Leeds, Leeds, UK
| | | | - C McCabe
- University of Alberta, Edmonton, AB, Canada
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Meads DM, McCabe C, Hulme CT, Edlin R, Kharroubi SA, Browne C, Ford H, Dunn J, Marshall A. Cost-Utility of Cancer Therapies - the 'Cost' of Different Utility Generation Strategies. Value Health 2014; 17:A327. [PMID: 27200549 DOI: 10.1016/j.jval.2014.08.591] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - C McCabe
- University of Alberta, Edmonton, AB, Canada
| | | | - R Edlin
- University of Auckland, Auckland, New Zealand
| | | | | | - H Ford
- Addenbrooke's Hospital, Cambridge, UK
| | - J Dunn
- University of Warwick, Coventry, UK
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Paulden M, O'Mahony JF, Culyer AJ, McCabe C. Nice's Proposed Value-Based Assessment of Health Technologies: Concerns of Inconsistent Consideration of Social Values. Value Health 2014; 17:A330. [PMID: 27200565 DOI: 10.1016/j.jval.2014.08.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M Paulden
- University of Alberta, Edmonton, AB, Canada
| | | | - A J Culyer
- University of Toronto, Toronto, ON, Canada
| | - C McCabe
- University of Alberta, Edmonton, AB, Canada
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Gates S, Perkins GD, Lamb SE, Kelly C, Thickett DR, Young JD, McAuley DF, Snaith C, McCabe C, Hulme CT, Gao Smith F. Beta-Agonist Lung injury TrIal-2 (BALTI-2): a multicentre, randomised, double-blind, placebo-controlled trial and economic evaluation of intravenous infusion of salbutamol versus placebo in patients with acute respiratory distress syndrome. Health Technol Assess 2014; 17:v-vi, 1-87. [PMID: 24028755 DOI: 10.3310/hta17380] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is a major cause of mortality in intensive care patients and lacks effective treatments. A previous randomised controlled Phase II trial suggested that an intravenous (i.v.) infusion of salbutamol may be beneficial, as it reduced extravascular lung water and plateau airway pressure. The Beta-Agonist Lung injury TrIal-2 (BALTI-2) was initiated to evaluate the effects of this intervention on mortality in patients with ARDS. OBJECTIVES To evaluate whether or not, in patients with ARDS, an i.v. infusion of salbutamol given at 15 μg/kg ideal body weight (IBW)/hour for up to 7 days, compared with a placebo (0.9% sodium chloride) infusion, reduces 28-day all-cause mortality and other clinical outcomes. To evaluate salbutamol's clinical effectiveness and its cost-effectiveness in subgroups of patients. DESIGN A multicentre, randomised, placebo-controlled trial. SETTING Forty-six intensive care units (ICUs) in the UK. PARTICIPANTS Patients were eligible if they (1) were intubated and mechanically ventilated patients in participating ICUs; (2) were within 72 hours of onset of ARDS; (3) fulfilled American-European Consensus Conference definition for ARDS {acute-onset, severe hypoxaemic respiratory failure [partial pressure of oxygen in arterial blood/fraction of inspired oxygen ≤ 26.7 kPa (200 mmHg)] and bilateral infiltrates on the chest radiograph in the absence of clinical evidence of left atrial hypertension}; and (4) were aged ≥ 16 years. INTERVENTIONS Intravenous infusion of salbutamol (15 μg/kg IBW/hour) or placebo (0.9% saline) for up to 7 days. MAIN OUTCOME MEASURES All-cause mortality 28 days after randomisation, mortality at (first) discharge from ICU, mortality at (first) discharge from hospital, number of ventilator-free days, number of organ failure-free days, mortality at 12 months post randomisation, side effects (tachycardia/new arrhythmia/lactic acidosis) sufficient to stop treatment with trial drug, health-related quality of life (European Quality of Life-5 Dimensions and Short Form questionnaire-12 items at 6 and 12 months after randomisation), length of stay in critical care unit and length of stay in hospital. RESULTS Forty-six ICUs recruited patients to the trial. A total of 326 patients were randomised; 162 were allocated to salbutamol and 164 to placebo. One patient in each group withdrew consent. Recruitment was stopped after the second interim analysis because of safety concerns. Salbutamol increased 28-day mortality: 55 (34%) of 161 patients died in the salbutamol group compared with 38 (23%) of 163 in the placebo group (risk ratio 1.47, 95% confidence interval 1.03 to 2.08). CONCLUSIONS Treatment with i.v. salbutamol early in the course of ARDS was poorly tolerated, is unlikely to be beneficial and could worsen outcomes. Further trials of β-agonists in patients with ARDS are unlikely to be conducted. Some questions remain, such as whether or not there may be benefit at a different dose or in specific populations, but any studies investigating these would require a very strong rationale. TRIAL REGISTRATION Current Controlled Trials ISRCTN38366450. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- S Gates
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK
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Hlushak SP, Cummings PT, McCabe C. Comparison of several classical density functional theories for the adsorption of flexible chain molecules into cylindrical nanopores. J Chem Phys 2013; 139:234902. [DOI: 10.1063/1.4843655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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McCabe C, Hoole, White P, Axell R, Shapiro L, Pepke-Zaba J. S48 Inefficient ventriculo-arterial coupling contributes to reduced exercise capacity in pulmonary hypertension: Abstract S48 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The ability to match individual patients to tailored treatments has the potential to greatly improve outcomes for individuals suffering from major depression. In particular, while the vast majority of antidepressant treatments affect either serotonin or noradrenaline or a combination of these two neurotransmitters, it is not known whether there are particular patients or symptom profiles which respond preferentially to the potentiation of serotonin over noradrenaline or vice versa. Experimental medicine models suggest that the primary mode of action of these treatments may be to remediate negative biases in emotional processing. Such models may provide a useful framework for interrogating the specific actions of antidepressants. Here, we therefore review evidence from studies examining the effects of drugs which potentiate serotonin, noradrenaline or a combination of both neurotransmitters on emotional processing. These results suggest that antidepressants targeting serotonin and noradrenaline may have some specific actions on emotion and reward processing which could be used to improve tailoring of treatment or to understand the effects of dual-reuptake inhibition. Specifically, serotonin may be particularly important in alleviating distress symptoms, while noradrenaline may be especially relevant to anhedonia. The data reviewed here also suggest that noradrenergic-based treatments may have earlier effects on emotional memory that those which affect serotonin.
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Affiliation(s)
- A Pringle
- Department of Psychiatry, University of Oxford, Oxford, UK
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46
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Czoski-Murray C, Lloyd Jones M, McCabe C, Claxton K, Oluboyede Y, Roberts J, Nicholl JP, Rees A, Reilly CS, Young D, Fleming T. What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature. Health Technol Assess 2013; 16:i-xvi, 1-159. [PMID: 23302507 DOI: 10.3310/hta16500] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The evidence base which supported the National Institute for Health and Clinical Excellence (NICE) published Clinical Guideline 3 was limited and 50% was graded as amber. However, the use of tests as part of pre-operative work-up remains a low-cost but high-volume activity within the NHS, with substantial resource implications. The objective of this study was to identify, evaluate and synthesise the published evidence on the clinical effectiveness and cost-effectiveness of the routine use of three tests, full blood counts (FBCs), urea and electrolytes tests (U&Es) and pulmonary function tests, in the pre-operative work-up of otherwise healthy patients undergoing minor or intermediate surgery in the NHS. OBJECTIVE The aims of this study were to estimate the clinical effectiveness and cost-effectiveness of routine pre-operative testing of FBC, electrolytes and renal function and pulmonary function in adult patients classified as American Society of Anaesthesiologists (ASA) grades 1 and 2 undergoing elective minor (grade 1) or intermediate (grade 2) surgical procedures; to compare NICE recommendations with current practice; to evaluate the cost-effectiveness of mandating or withdrawing each of these tests in this patient group; and to identify the expected value of information and whether or not it has value to the NHS in commissioning further primary research into the use of these tests in this group of patients. DATA SOURCES The following electronic bibliographic databases were searched: (1) BIOSIS; (2) Cumulative Index to Nursing and Allied Health Literature; (3) Cochrane Database of Systematic Reviews; (4) Cochrane Central Register of Controlled Trials; (5) EMBASE; (6) MEDLINE; (7) MEDLINE In-Process & Other Non-Indexed Citations; (8) NHS Database of Abstracts of Reviews of Effects; (9) NBS Health Technology Assessment Database; and (10) Science Citation Index. To identify grey and unpublished literature, the Cochrane Register of Controlled Trials, National Research Register Archive, National Institute for Health Research Clinical Research Network Portfolio database and the Copernic Meta-search Engine were searched. A large routine data set which recorded the results of tests was obtained from Leeds Teaching Hospitals Trust. REVIEW METHODS A systematic review of the literature was carried out. The searches were undertaken in March to April 2008 and June 2009. Searches were designed to retrieve studies that evaluated the clinical effectiveness and cost-effectiveness of routine pre-operative testing of FBC, electrolytes and renal function and pulmonary function in the above group of patients. A postal survey of current practice in testing patients in this group pre-operatively was undertaken in 2008. An exemplar cost-effectiveness model was constructed to demonstrate what form this would have taken had there been sufficient data. A large routine data set that recorded the results of tests was obtained from Leeds Teaching Hospitals Trust. This was linked to individual patient data with surgical outcomes, and regression models were estimated. RESULTS A comprehensive and systematic search of both the clinical effectiveness and cost-effectiveness literature identified a large number of potentially relevant studies. However, when these studies were subjected to detailed review and quality assessment, it became clear that the literature provides no evidence on the clinical effectiveness and cost-effectiveness of these specific tests in the specific patient groups. The postal survey had a 17% response rate. Results reported that in ASA grade 1, patients aged < 40 years with no comorbidities undergoing minor surgery did not have routine tests for FBC, electrolytes and renal function and pulmonary function. The results from the regression model showed that the frequency of test use was not consistent with the hypothesis of their routine use. FBC tests were performed in only 58% of patients in the data set and U&E testing was carried out in only 57%. LIMITATIONS Systematic searches of the clinical effectiveness and cost-effectiveness literature found that there is no evidence on the clinical effectiveness or cost-effectiveness of these tests in this specific clinical context for the NHS. A survey of NHS hospitals found that respondent trusts were implementing current NICE guidance in relation to pre-operative testing generally, and a de novo analysis of routine data on test utilisation and post-operative outcome found that the tests were not be used in routine practice; rather, use was related to an expectation of a more complex clinical case. The paucity of published evidence is a limitation of this study. The studies included relied on non-UK health-care systems data, which may not be transferable. The inclusion of non-randomised studies is associated with an increased risk of bias and confounding. Scoping work to establish the likely mechanism of action by which tests would impact upon outcomes and resource utilisation established that the cause of an abnormal test result is likely to be a pivotal determinant of the cost-effectiveness of a pre-operative test and therefore evaluations would need to consider tests in the context of the underlying risk of specific clinical problems (i.e. risk guided rather than routine use). CONCLUSIONS The time of universal utilisation of pre-operative tests for all surgical patients is likely to have passed. The evidence we have identified, though weak, indicates that tests are increasingly utilised in patients in whom there is a reason to consider an underlying raised risk of a clinical abnormality that should be taken into account in their clinical management. It is likely that this strategy has led to substantial resource savings for the NHS, although there is not a published evidence base to establish that this is the case. The total expenditure on pre-operative tests across the NHS remains significant. Evidence on current practice indicates that clinical practice has changed to such a degree that the original research question is no longer relevant to UK practice. Future research on the value of these tests in pre-operative work-up should be couched in terms of the clinical effectiveness and cost-effectiveness in the identification of specific clinical abnormalities in patients with a known underlying risk. We suggest that undertaking a multicentre study making use of linked, routinely collected data sets would identify the extent and nature of pre-operative testing in this group of patients. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Czoski-Murray
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Bartlett J, Canney P, Campbell A, Cameron D, Donovan J, Dunn J, Earl H, Francis A, Hall P, Harmer V, Higgins H, Hillier L, Hulme C, Hughes-Davies L, Makris A, Morgan A, McCabe C, Pinder S, Poole C, Rea D, Stallard N, Stein R. Selecting breast cancer patients for chemotherapy: the opening of the UK OPTIMA trial. Clin Oncol (R Coll Radiol) 2012; 25:109-16. [PMID: 23267818 DOI: 10.1016/j.clon.2012.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/19/2012] [Accepted: 10/19/2012] [Indexed: 11/26/2022]
Abstract
The mortality from breast cancer has improved steadily over the past two decades, in part because of the increased use of more effective adjuvant therapies. Thousands of women are routinely treated with intensive chemotherapy, which can be unpleasant, is expensive and is occasionally hazardous. Oncologists have long known that some of these women may not need treatment, either because they have a low risk of relapse or because they have tumour biology that makes them less sensitive to chemotherapy and more suitable for early adjuvant endocrine therapy. There is an urgent need to improve patient selection so that chemotherapy is restricted to those patients who will benefit from it. Here we review the emerging technologies that are available for improving patient selection for chemotherapy. We describe the OPTIMA trial, which has just opened to recruitment in the UK, is the latest addition to trials in this area, and is the first to focus on the relative cost-effectiveness of alternate predictive assays.
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Affiliation(s)
- J Bartlett
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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McCabe C, Taboada D, Mackenzie-Ross R, Harvey I, Sheares K, White P, Axell R, Hoole S, Shapiro L, Pepke-Zaba J. S41 Conductance-Derived Right Ventricular Stroke Work Measured by Pressure Volume Loops in Chronic Thromboembolic Pulmonary Vascular Disease. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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49
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McCabe C, Sheares K, Graf S, Pepke-Zaba J, Morrell N. S39 Whole Exome Sequencing in Chronic Thromboembolic Pulmonary Hypertension Reveals Biologically Plausible Novel Genetic Variation. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Cohen H, McCabe C, Harris N, Hall J, Lewis J, Blake DR. Clinical evidence of parietal cortex dysfunction and correlation with extent of allodynia in CRPS type 1. Eur J Pain 2012; 17:527-38. [PMID: 23132624 DOI: 10.1002/j.1532-2149.2012.00213.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unusual symptoms such as digit misidentification and neglect-like phenomena have been reported in complex regional pain syndrome (CRPS), which we hypothesized could be explained by parietal lobe dysfunction. METHODS Twenty-two patients with chronic CRPS attending an in-patient rehabilitation programme underwent standard neurological examination followed by clinical assessment of parietal lobe function and detailed sensory testing. RESULTS Fifteen (68%) patients had evidence of parietal lobe dysfunction. Six (27%) subjects failed six or more test categories and demonstrated new clinical signs consistent with their parietal testing impairments, which were impacting significantly on activities of daily living. A higher incidence was noted in subjects with >1 limb involvement, CRPS affecting the dominant side and in left-handed subjects. Eighteen patients (82%) had mechanical allodynia covering 3-57.5% of the body surface area. Allochiria (unilateral tactile stimulation perceived only in the analogous location on the opposite limb), sensory extinction (concurrent bilateral tactile stimulation perceived only in one limb), referred sensations (unilateral tactile stimulation perceived concurrently in another discrete body area) and dysynchiria (unilateral non-noxious tactile stimulation perceived bilaterally as noxious) were present in some patients. Greater extent of body surface allodynia was correlated with worse parietal function (Spearman's rho = -0.674, p = 0.001). CONCLUSION In patients with chronic CRPS, detailed clinical examination may reveal parietal dysfunction, with severity relating to the extent of allodynia.
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Affiliation(s)
- H Cohen
- Royal National Orthopaedic Hospital, Stanmore, UK.
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