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Percy C, Turner A, Orr C. Developing a Novel Web-Based Self-Management Support Intervention for Polycystic Ovary Syndrome: Mixed Methods Study With Patients and Health Care Professionals. JMIR Form Res 2024; 8:e52427. [PMID: 38451567 PMCID: PMC10958350 DOI: 10.2196/52427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 01/10/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) represents a significant global health burden requiring urgent attention. This common chronic endocrine and cardiometabolic condition affects around 1 in 10 women and individuals assigned female at birth, with significant adverse effects on well-being, quality of life, and mental health, as well as serious and complex long-term health consequences. International guidelines for best health care practice recommend the provision of comprehensive cognitive behavioral interventions to support self-management and improve health outcomes for those living with PCOS. Web-based health interventions have the potential to meet this need in an accessible and scalable way. OBJECTIVE We aim to identify barriers to self-management and psychological well-being in women with PCOS and adapt a web-based self-management program to provide a prototype digital support intervention for them. METHODS We adapted an existing support program (HOPE) for PCOS using the antecedent target measure approach. We conducted qualitative interviews with 13 adult women living with PCOS, 3 trustees of a patients with PCOS advocacy charity, and 4 endocrinologists to identify "antecedents" (barriers) to self-management and psychological well-being. Framework analysis was used to identify potentially modifiable antecedents to be targeted by the novel intervention. At a national conference, 58 key stakeholders (patients and health professionals) voted for the antecedents they felt were most important to address. We used research evidence and relevant theory to design a prototype for the PCOS intervention. RESULTS Voting identified 32 potentially modifiable antecedents, relating to knowledge, understanding, emotions, motivation, and behaviors, as priorities to be targeted in the new intervention. A modular, web-based prototype HOPE PCOS intervention was developed to address these, covering six broad topic areas (instilling HOPE for PCOS; managing the stress of PCOS; feeding your mind and body well; body image, intimacy, and close relationships; staying healthy with PCOS; and keeping PCOS in its place). CONCLUSIONS We identified barriers to self-management and psychological well-being in women with PCOS and used these to adapt a web-based self-management program, tailoring it for PCOS, which is a comprehensive group intervention combining education, empowerment, lifestyle management, peer support with cognitive behavioral tools, and goal-setting (to be delivered by peers or codelivered with health care professionals). The modular structure offers flexibility to adapt the program further as new clinical recommendations emerge. The intervention has the potential to be delivered, evaluated for feasibility, and, if effective, integrated into health care services. Self-management interventions are not designed to replace clinical care; rather, they serve as an additional source of support. The HOPE PCOS program conveys this message in its content and activities. Future research should evaluate the prototype intervention using primary outcomes such as measures of psychological well-being, self-management self-efficacy, depression, anxiety, and PCOS-related quality of life. They should also assess the intervention's acceptability, scalability, and cost-effectiveness.
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Affiliation(s)
- Carol Percy
- Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Andrew Turner
- Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Charys Orr
- Harris Church of England Academy, Diocese of Coventry Multi Academy Trust, Coventry, United Kingdom
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Garavan H, Chaarani B, Hahn S, Allgaier N, Juliano A, Yuan DK, Orr C, Watts R, Wager TD, Ruiz de Leon O, Hagler DJ, Potter A. The ABCD stop signal data: Response to Bissett et al. Dev Cogn Neurosci 2022; 57:101144. [PMID: 35987133 PMCID: PMC9411576 DOI: 10.1016/j.dcn.2022.101144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/12/2022] [Accepted: 08/04/2022] [Indexed: 11/03/2022] Open
Abstract
This paper responds to a recent critique by Bissett et al. of the fMRI Stop task used in the Adolescent Brain Cognitive Development℠ Study (ABCD Study®). The critique focuses primarily on a task design feature related to race model assumptions (i.e., that the Go and Stop processes are fully independent). In response, we note that the race model is quite robust against violations of its assumptions. Most importantly, while Bissett raises conceptual concerns with the task we focus here on analyzes of the task data and conclude that the concerns appear to have minimal impact on the neuroimaging data (the validity of which do not rely on race model assumptions) and have far less of an impact on the performance data than the critique suggests. We note that Bissett did not apply any performance-based exclusions to the data they analyzed, a number of the trial coding errors they flagged were already identified and corrected in ABCD annual data releases, a number of their secondary concerns reflect sensible design decisions and, indeed, their own computational modeling of the ABCD Stop task suggests the problems they identify have just a modest impact on the rank ordering of individual differences in subject performance.
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Affiliation(s)
- H Garavan
- Department of Psychiatry, University of Vermont, Burlington, VT, USA.
| | - B Chaarani
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - S Hahn
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - N Allgaier
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - A Juliano
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - D K Yuan
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - C Orr
- Department of Psychology, Swinburne University, Melbourne, Australia
| | - R Watts
- School of Medicine, Yale University, New Haven, CT, USA
| | - T D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - O Ruiz de Leon
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - D J Hagler
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - A Potter
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
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Orr C, Fisher H, Elliott I, Yu X, Glennie M, White A, Pearson A, Essex J, Cragg M, Tews I. Conformational regulation in anti-CD40 antibodies. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322096358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Sundanum S, Veale D, Orr C, O’neill L, Young F. AB0965 Serial serology testing in patients with psoriatic arthritis- Should it be done? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe diagnosis of psoriatic arthritis (PsA) is largely based on clinical phenotype due to the heterogeneity of the presenting features, which can include synovio-entheseal disease, dactylitis, skin and nail disease, uveitis and axial involvement. (1)In contrast to rheumatoid arthritis (RA), PsA is a seronegative inflammatory arthropathy. Rheumatoid factor (RF) and Anti-CCP antibodies are usually absent in PsA, and if patients do have positive serological findings for RF or CCP, the titres tend to be low. (2)Seronegativity for RF has a significantly high discriminant value in the Classification Criteria for Psoriatic arthritis (CASPAR), such that a negative RF forms one of the five possible criteria; thus serological testing is often done once at the initial diagnostic appointment. (3)A previous study in the context of RA has shown that there is a tendency for repeated serological testing with as much as 70% of patients having RF tested more than once.(4) Repeated testing amounts to additional expense and is rarely needed in PsA.The literature on the frequency of repeated serology testing in PsA patients is absent.ObjectivesTo determine how often was serology for RF and anti-CCP antibodies repeated in a PsA cohort.MethodsA cohort of consecutive patients attending the rheumatology clinic at our centre with a diagnosis of PsA were included.We reviewed the laboratory results of individual patients to determine how many times each patient had been tested for RF and anti-CCP antibodies.Results118 patients with a diagnosis of PsA were included. 117 patients had RF antibody testing at least once and all 118 patients had a minimum of one anti-CCP antibody test.59/117 (50.4%) patients had RF checked more than once and 28/117 (23.9%) had testing at least 3 times. 3 patients had an initial positive RF which was negative on subsequent testing.Anti-CCP antibody was checked on all 118 patients. 41/118 (34.7%) patients had anti-CCP checked more than once and 13/118 (11.0%) patients had testing at least 2 times. One patient had an initial equivocal anti-CCP antibody titre which was subsequently negative on repeat testing.ConclusionAs opposed to RA, PsA has not been associated with the presence of circulating antibodies. The presence or absence of RF in PsA patients has for long been a subject of debate. (3)In cases of peripheral polyarticular PsA, which may be difficult to distinguish from RA, serological testing can be useful to identify RA. However, studies have found that RF can be present in 5-13% of PsA patients. (5)In the context of RA, serological conversion from negative to positive is infrequent and repeat testing is not recommended. (6)Over half of the patients in our PsA cohort had repeated RF testing. Certainly this is unlikely to be helpful or cost effective and serial serology measurements in PsA patients should be avoided.References[1]Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. The Lancet. 2018;391(10136):2273-84.[2]Merola JF, Espinoza LR, Fleischmann R. Distinguishing rheumatoid arthritis from psoriatic arthritis. RMD Open. 2018;4(2):e000656.[3]Veale DJ, Fearon U. What makes psoriatic and rheumatoid arthritis so different? RMD Open. 2015;1(1):e000025-e.[4]Orr C, Young F, Veale DJ. AB0243 How Often Are Serology Tests Repeated in RA Patients, and What Are the Merits? Annals of the Rheumatic Diseases. 2015;74(Suppl 2):972.[5]Punzi L, Podswiadek M, Oliviero F, Lonigro A, Modesti V, Ramonda R, et al. Laboratory findings in psoriatic arthritis. Reumatismo. 2007;59 Suppl 1:52-5.[6]Reid AB, Wiese M, McWilliams L, Metcalf R, Hall C, Lee A, et al. Repeat serological testing for anti-citrullinated peptide antibody after commencement of therapy is not helpful in patients with seronegative rheumatoid arthritis. Internal Medicine Journal. 2020;50(7):818-22.Disclosure of InterestsNone declared
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Sundanum S, Gorman A, Veale D, Orr C, O’neill L. AB0903 Dual Immunomodulatory Therapies in Psoriatic Disease. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSince the advent of numerous biologic therapies and small molecular drugs targeting specific cytokines and signalling pathways; the management of patients with psoriatic arthritis (PsA) has significantly improved. However, at least 40% of PsA patients exhibit an incomplete or failure to respond to these treatments.While the outcomes of patients with psoriasis (Pso) has dramatically improved with monoclonal antibody therapies targeting IL-23 and IL-17A; achieving a measurable low disease activity state such as minimal disease activity (MDA) for musculoskeletal manifestations of psoriatic disease is infrequent. Given the complex and heterogeneity of signalling pathways, cytokines and cell types resulting in synovio-entheseal disease in PsA; new treatment strategies must be evaluated to induce deep and sustainable clinical responses in all the phenotypic domains of psoriatic disease (cutaneous, synovium, entheseal and axial). (1)In patients who do not achieve remission in all clinical domains on a biologic monotherapy or combination of a biologic therapy with an oral synthetic agent; dual targeted anti-cytokines strategies or combined biologic with a targeted oral small molecule are a possible treatment option.ObjectivesTo describe a series of four patients with recalcitrant psoriatic disease and failure to respond to previous treatment regimens who were successfully treated with dual immunomodulatory therapies.MethodsPatients on dual immunomodulatory therapies attending our department were prospectively followed and clinical response monitored.Results:Table 1.Age/genderDiagnosisprior therapiescombination therapydoseadverse eventsCase 149/ MalePsA + PsOMethotrexate, adalimumab, etanercept, infliximab, golimumab, certolizumab, ustekinumab, secukinumab, ixekizumabBaracitinib + infliximab4mg OD + 5mg/kg Q8WNoneCase 251/ MalePsA + PsOMethotrexate, etanercept, adalimumab, ustekinumab, infliximab, secukinumab, apremilast, ixekizumab, brodalumab, guselkumabAdalimumab + guselkumab40mg QoW +100mg Q8WNoneCase 351/ FemalePsA + PsOMethotrexate, sulphasalazine, etarnercept, certolizumab, leflunomide, infliximab, adalimumab, secukinumab, ustekinumab, tofacitinib, abatacept, baracitinibAdalimumab + tofacinitib40mg QoW + 5mg BDNoneCase 439/ MalePsA +PsOMethotrexate, etanercept, ustekinumab, adalimumab, secukinumab, ixekizumab, sulphasalazineIxekizumab + baracitinib80mg Q4W+ 4mg ODNoneFigure 1.Mini-Arthroscopy of left knee for Case 3 prior to starting dual immunomodulator therapy.(A) Macroscopic aspects of synovitis (B) Synovium vascularizationConclusionMultiple pathways and mediators are responsible for the initiation of and sustained joint inflammation and damage seen in PsA. A phase II trial of ABT-122, a biologic engineered to target both TNF and IL-17A showed statistically significant superior efficacy outcomes at multiple time points based on ACR50, ACR70 and psoriasis outcome measures (PASI75/PASI90) when compared to adalimumab, with similar safety profile.(2)Safety concerns such as infectious risks are important considerations with such strategies; however, the targeted second-generation anti-cytokine biologics and targeted JAK-I have exhibited improved safety profiles.(3) In our small case series, patients have not, to date, experienced adverse events of combination therapy.References[1]Haberman RH, Castillo R, Scher JU. Induction of remission in biologic-naive, severe psoriasis and PsA with dual anti-cytokine combination. Rheumatology. 2021;60(7):e225-e6.[2]Mease PJ, Genovese MC, Weinblatt ME, Peloso PM, Chen K, Othman AA, et al. Phase II Study of ABT-122, a Tumor Necrosis Factor– and Interleukin-17A–Targeted Dual Variable Domain Immunoglobulin, in Patients With Psoriatic Arthritis With an Inadequate Response to Methotrexate. Arthritis & Rheumatology. 2018;70(11):1778-89.[3]Scher JU, Ogdie A, Merola JF, Ritchlin C. Moving the Goalpost Toward Remission: The Case for Combination Immunomodulatory Therapies in Psoriatic Arthritis. Arthritis & Rheumatology. 2021;73(9):1574-8.Disclosure of InterestsNone declared
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Graham C, Orr C, Bricks CS, Hopman WM, Hammad N, Ramjeesingh R. A retrospective analysis of the role of proton pump inhibitors in colorectal cancer disease survival. ACTA ACUST UNITED AC 2016; 23:e583-e588. [PMID: 28050148 DOI: 10.3747/co.23.3204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Proton pump inhibitors (ppis) are a commonly used medication. A limited number of studies have identified a weak-to-moderate association between ppi use and colorectal cancer (crc) risk, but none to date have identified an effect of ppi use on crc survival. We therefore postulated that an association between ppi use and crc survival might potentially exist. METHODS We performed a retrospective chart review of 1304 crc patients diagnosed from January 2005 to December 2011 and treated at the Cancer Centre of Southeastern Ontario. Kaplan-Meier analysis and Cox proportional hazards regression models were used to evaluate overall survival (os). RESULTS We identified 117 patients (9.0%) who were taking ppis at the time of oncology consult. Those taking a ppi were also more often taking asa or statins (or both) and had a statistically significantly increased rate of cardiac disease. No identifiable difference in tumour characteristics was evident in the two groups, including tumour location, differentiation, lymph node status, and stage. Univariate analysis identified a statistically nonsignificant difference in survival, with those taking a ppi experiencing lesser 1-year (82.1% vs. 86.7%, p = 0.161), 2-year (70.1% vs. 76.8%, p = 0.111), and 5-year os (55.2% vs. 62.9%, p = 0.165). When controlling for patient demographics and tumour characteristics, multivariate Cox regression analysis identified a statistically significant effect of ppi in our patient population (hazard ratio: 1.343; 95% confidence interval: 1.011 to 1.785; p = 0.042). CONCLUSIONS Our results suggest a potential adverse effect of ppi use on os in crc patients. These results need further evaluation in prospective analyses.
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Affiliation(s)
- C Graham
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
| | - C Orr
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
| | - C S Bricks
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
| | - W M Hopman
- Clinical Research Centre, Kingston General Hospital, and Department of Public Health Sciences, Queen's University, Kingston, ON
| | - N Hammad
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
| | - R Ramjeesingh
- Department of Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS
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Kirouac D, Schaefer G, Chan J, Merchant M, Orr C, Liu L, Huang A, Moffat J, Gadkar K, Ramanujan S. Clinical responses to ERK inhibitor (GDC-0994) treatment combinations predicted using a Quantitative Systems Pharmacology model of MAPK signaling in BRAF(V600E)-mutant colorectal cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32639-9] [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: 11/30/2022]
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Luff J, Rowland P, Mader M, Orr C, Yuan H. Two Canine Papillomaviruses Associated With Metastatic Squamous Cell Carcinoma in Two Related Basenji Dogs. Vet Pathol 2016; 53:1160-1163. [DOI: 10.1177/0300985816630795] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Papillomaviruses (PV) are associated with benign mucosal and cutaneous epithelial proliferations. In dogs, PV-associated pigmented plaques and papillomas can undergo malignant transformation, but this is rare, and most cases of canine squamous cell carcinoma do not arise from PV-induced precursor lesions. We describe herein the progression of pigmented plaques to invasive and metastatic squamous cell carcinoma associated with 2 canine papillomaviruses (CPV) in 2 related Basenji dogs. Immunohistochemistry for PV antigen revealed strong nuclear immunoreactivity within keratinocytes from pigmented plaques from both dogs, consistent with a productive viral infection. Polymerase chain reaction (PCR) using degenerate primers for the L1 gene revealed PV DNA sequences from 2 different CPVs. In situ hybridization for CPV revealed strong hybridization signals within the pigmented plaques and neoplastic squamous epithelial cells from both dogs. We report here progression of PV-associated pigmented plaques to metastatic squamous cell carcinoma within 2 Basenji dogs associated with 2 different CPVs.
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Affiliation(s)
- J. Luff
- North Carolina State University, Raleigh, NC, USA
| | - P. Rowland
- Histopath Consulting, Worcester, MA, USA
| | - M. Mader
- North Carolina State University, Raleigh, NC, USA
| | - C. Orr
- Animal Clinic of East Avenue, Rochester, NY, USA
| | - H. Yuan
- Georgetown University Medical School, Washington, DC, USA
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Najm A, Orr C, Fearon U, Veale D. SAT0533 Knee Synovitis: Ultrasonographic Findings Strongly Correlate with Synovial Membrane Histology. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wade S, Connelly M, Cregan S, Orr C, Veale D, Fearon U. OP0083 Mir-125a Decreased in Psa Synovium and Peripheral Blood CD14+ Monocytes and Correlates To Joint Angiogenesis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5821] [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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Ramjeesingh R, Orr C, Bricks CS, Hopman WM, Hammad N. A retrospective study on the role of diabetes and metformin in colorectal cancer disease survival. ACTA ACUST UNITED AC 2016; 23:e116-22. [PMID: 27122979 DOI: 10.3747/co.23.2809] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent studies have suggested an effect of metformin on mortality for patients with both diabetes and colorectal cancer (crc). However, the literature is contradictory, with both positive and negative effects being identified. We set out to determine the effect of metformin with respect to prognosis in crc patients. METHODS After a retrospective chart review of crc patients treated at the Cancer Centre of Southeastern Ontario, Kaplan-Meier analyses and Cox proportional hazards regression models were used to compare overall survival (os) in patients with and without diabetes. RESULTS We identified 1304 crc patients treated at the centre. No significant differences between the diabetic and nondiabetic groups were observed with respect to tumour pathology, extent of metastatic disease, time or toxicity of chemotherapy, and the os rate (1-year os: 85.6% vs. 86.4%, p = 0.695; 2-year os: 73.6% vs. 77.0%, p = 0.265). In subgroup analysis, diabetic patients taking metformin survived significantly longer than their counterparts taking other diabetes treatments (os for the metformin group: 91% at 1 year; 80.5% at 2 years; os for the group taking other treatments, including diet control: 80.6% at 1 year, 67.4% at 2 years). Multivariate analysis suggests that patients with diabetes taking treatments other than metformin experience worse survival (p = 0.025). CONCLUSIONS Our results suggest that crc patients with diabetes, excluding those taking metformin, might have a worse crc prognosis. Taking metformin appears to have a positive association with prognosis. The protective nature of metformin needs further evaluation in prospective analyses.
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Affiliation(s)
- R Ramjeesingh
- Department of Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS
| | - C Orr
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
| | - C S Bricks
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
| | - W M Hopman
- Clinical Research Centre, Kingston General Hospital, and Department of Public Health Sciences, Queen's University, Kingston, ON
| | - N Hammad
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
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Wade S, Trenkmann M, McGarry T, Orr C, Veale DJ, Fearon U. A8.13 TLR regulated MIR-23A down-regulated in psoriatic arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cregan S, Creevey K, McGarry T, Orr C, Veale DJ, Fearon U, Wilson AG. A8.08 The role of epigenetics in determining the clinical response to methotrexate for the treatment of rheumatoid arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.161] [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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Canavan M, O’Rourke M, Orr C, Basdeo S, Fletcher J, Veale DJ, Fearon U. A1.08 CD141 +CLEC9A +dendritic cells are enriched in an active state in the inflamedsynovium and contribute to synovial inflammation in rheumatoid arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wade S, Connolly M, Orr C, Veale DJ, Fearon U. A8.12 Decreased expression of MIR-125A in psoriatic arthritis. Implications for joint pathogenesis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.165] [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: 11/04/2022]
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Gao W, McGarry T, Orr C, McCormick J, Veale DJ, Fearon U. Tofacitinib regulates synovial inflammation in psoriatic arthritis, inhibiting STAT activation and induction of negative feedback inhibitors. Ann Rheum Dis 2015; 75:311-5. [PMID: 26353790 PMCID: PMC4717390 DOI: 10.1136/annrheumdis-2014-207201] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/13/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a chronic inflammatory disease, characterised by synovitis and destruction of articular cartilage/bone. Janus-kinase and signal transducer and activator of transcription (JAK-STAT) signalling pathway is implicated in the pathogenesis of PsA. OBJECTIVES To examine the effect of tofacitinib (JAK inhibitor) on proinflammatory mechanisms in PsA. METHODS Primary PsA synovial fibroblasts (PsAFLS) and ex vivo PsA synovial explants were cultured with tofacitinib (1 µM). PhosphoSTAT3 (pSTAT3), phosphoSTAT1 (pSTAT1), suppressor of cytokine signaling-3 (SOCS3), protein inhibitor of activated Stat3 (PIAS3) and nuclear factor kappa B cells (NFκBp65) were quantified by western blot. The effect of tofacitinib on PsAFLS migration, invasion, Matrigel network formation and matrix metallopeptidase (MMP)2/9 was quantified by invasion/migration assays and zymography. Interleukin (IL)-6, IL-8, IFN-gamma-inducible protein 10 (IP-10) monocyte chemoattractant protein (MCP)-1, IL-17, IL-10, MMP3 and tissue inhibitor of metalloproteinases 3 (TIMP3) were assessed by ELISA. RESULTS Tofacitinib significantly decreased pSTAT3, pSTAT1, NFκBp65 and induced SOCS3 and PIAS3 expression in PsAFLS and synovial explant cultures (p<0.05). Functionally, PsAFLS invasion, network formation and migration were inhibited by tofacitinib (all p<0.05). In PsA explant, tofacitinib significantly decreased spontaneous secretion of IL-6, IL-8, MCP-1, MMP9/MMP2, MMP3 (all p<0.05) and decreased the MMP3/TIMP3 ratio (p<0.05), with no effect observed for IP-10 or IL-10. CONCLUSIONS This study further supports JAK-STAT inhibition as a therapeutic target for the treatment of PsA.
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Affiliation(s)
- W Gao
- Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, St Vincent's University Hospital, Dublin, Ireland
| | - T McGarry
- Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, St Vincent's University Hospital, Dublin, Ireland
| | - C Orr
- Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, St Vincent's University Hospital, Dublin, Ireland
| | - J McCormick
- Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, St Vincent's University Hospital, Dublin, Ireland
| | - D J Veale
- Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, St Vincent's University Hospital, Dublin, Ireland
| | - U Fearon
- Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, St Vincent's University Hospital, Dublin, Ireland
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McGarry T, Robertson A, Orr C, Coll R, Cooper M, O'Neill L, Veale D, Fearon U. THU0027 The Effect of Novel Compound Mcc950 on the Nlrp3 Inflammasome in the RA Joint. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gao W, McGarry T, Orr C, Veale D, Fearon U. SAT0031 Tofacitinib Regulates Synovial Inflammation in Psoriatic Arthritis, Inhibiting Stat Activation and Induction of Negative Feedback Inhibitors. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Canavan M, O'Rourke M, Orr C, Veale D, Fearon U. AB0047 Characterisation and Activation of Dendritic Cell Within the Inflammed Synovium of Rheumatoid Arthritis Patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4792] [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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Orr C, McGarry T, Young F, Linehan E, Fearon U, Veale D. SAT0040 Macroscopic Scores of Synovitis at Knee Arthroscopy Correlate well with CRP, Inflammatory Histology Findings, And can Predict Later Erosive Disease on Hands and Feet Plain Film Radiographs. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Orr C, Young F, MacMullan P, O'Dwyer E, Veale D. AB0337 Improving the Quality and Efficiency of Clinic Visits for IA Patients by Preparing for their Visit. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2869] [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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Cregan S, Creevey K, McGarry T, Orr C, Veale D, Fearon U, Wilson A. AB0020 The Role of Epigenetics in Determining the Clinical Response To Methotrexate for the Treatment of Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Orr C, Young F, Veale D. AB0243 How Often Are Serology Tests Repeated in RA Patients, and What Are the Merits? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Orr C, Linehan E, Gao W, Creevey K, McGarry T, Fearon U, Veale D. SAT0013 Molecular and Cellular Repsonses to Inhibition of JAK-STAT Signalling in RA Synovial Fibroblasts and Whole Tissue Explants. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5332] [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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Orr C, McCarthy C, Bergin D, Carroll T, Creevey K, Reeves E, McElvaney N, Fearon U, Veale D. AB0115 Phenotypic Variations of Alpha-One Anti-Trypsin Are Associated with Higher Titres of Ana. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5318] [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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Behan LA, Sherlock M, Moyles P, Renshaw O, Thompson CJT, Orr C, Holte K, Salehmohamed MR, Glynn N, Tormey W, Thompson CJ. Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study. Eur J Endocrinol 2015; 172:243-50. [PMID: 25430399 DOI: 10.1530/eje-14-0719] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT AND OBJECTIVE Patients with cranial diabetes insipidus (CDI) are at risk of developing both hypernatraemia and hyponatraemia, due to the condition itself or secondary to treatment with vasopressin-analogues or during administration of i.v. fluids. We aimed to assess the frequency and impact of dysnatraemias in the inpatient (INPT) and outpatient (OPT) setting in desmopressin-treated CDI, comparing those with normal thirst with those with abnormal thirst. DESIGN The study included 192 patients with cranial diabetes, who were identified from the Beaumont Pituitary Database, a tertiary referral centre. Retrospective case note audit was performed and the clinical and biochemical information of 147 patients with CDI were available for analysis. RESULTS A total of 4142 plasma sodium measurements for 137 patients with normal thirst, and 385 plasma sodium measurements for ten patients with abnormal thirst were analysed. In those with normal thirst, the most common OPT abnormality was mild hyponatraemia (pNa(+) 131-134 mmol/l) in 27%, while 14.6% had more significant hyponatraemia (pNa(+) ≤130 mmol/l). Of those patients with normal thirst, 5.8% were admitted due to complications directly related to hyponatraemia. Compared with patients with normal thirst, those with abnormal thirst were more likely to develop significant OPT hypernatraemia (20% vs 1.4%, P=0.02) and significant INPT hyponatraemia (50% vs 11.1%, P 0.02). CONCLUSION OPT management of CDI is complicated by a significant incidence of hyponatraemia. In contrast, OPT hypernatraemia is almost exclusively a complication seen in adipsic CDI, who also had more frequent INPT hyponatraemia. CDI associated with thirst disorder requires increased physician attention and patient awareness of potential complications.
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Affiliation(s)
- L A Behan
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - M Sherlock
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - P Moyles
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - O Renshaw
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - C J T Thompson
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - C Orr
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - K Holte
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - M R Salehmohamed
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - N Glynn
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - W Tormey
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - C J Thompson
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
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Orr C, Linehan E, Gao W, McCreevy K, McGarry T, Fearon U, Veale DJ. A2.26 JAK-STAT signalling regulates pro-inflammatory mediators and fibroblast invasion in RA. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.61] [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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Canavan M, O’Rourke M, Orr C, Veale DJ, Fearon U. A1.14 Characterisation and activation of dendritic cell subsets within the inflammed synovium of rheumatoid arthritis patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Merchant M, Chan J, Orr C, Cheng J, Wang X, Hunsaker T, Wagle M, Huang S, Tremayne J, Ngu H, Solon M, Eastham-Anderson J, Koeppen H, Friedman L, Belvin M, Moffat J, Junttila M. 387 Combination of the ERK inhibitor GDC-0994 with the MEK inhibitor cobimetinib significantly enhances anti-tumor activity in KRAS and BRAF mutant tumor models. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70513-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Haddad R, O'Brien B, Evans J, Orr C. Novel finding of carbamazepine induced gall bladder granulomatous vasculitis. Intern Med J 2014; 44:700-3. [DOI: 10.1111/imj.12466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- R. Haddad
- Department of Neurology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - B. O'Brien
- Department of Neurology; Gosford Hospital; Gosford New South Wales Australia
| | - J. Evans
- Department of Neurology; Gosford Hospital; Gosford New South Wales Australia
| | - C. Orr
- Macquarie Neurology; Macquarie University; Sydney New South Wales Australia
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Orr C, McCarthy C, Gunaratnam C, Kearns G. Life threatening sepsis while on high dose steroids requiring extra-corporeal membrane oxygenation. Ir Med J 2013; 106:213-214. [PMID: 24218750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present a case of life-threatening streptococcal sepsis in a young man with a history of Behçet's disease within two weeks of commencing high dose corticosteroid therapy for an exacerbation of Behçet's disease.
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Affiliation(s)
- C Orr
- Beaumont Hospital, Beaumont, Dublin 9.
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Orr C, O’Connor C, McGrogan K. AB0810-PC Even short term treatment with nsaids may be unsafe: the feasibility of replacing the nsaid prescription with regular paracetemol. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Orr C, O’Connor C, Kavanagh J. OP0203-PC New Data, New Problem; Assessing the Prevalence of Nsaid Prescribing in Primary Care in Those with a Background of Ischaemic Heart Disease (IHD) or Risk Factors for IHD. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.408] [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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Mohty D, Ettaif H, Magne J, Damy T, Echahidi N, Lavergne D, Virot P, Cogne M, Jaccard A, La Manna A, Sanfilippo A, Capodanno D, Salemi A, Cadoni A, Cascone I, Figuera M, Pittala R, Privitera C, Tamburino C, Jimenez Rubio C, Isasti Aizpurua G, Miralles Ibarra J, Taldir G, Redheuil A, Perdrix L, Chaudeurge A, Mousseaux E, Diebold B, Pastormerlo LE, Maffei S, Chubuchny V, Mazzone A, Susini C, Passino C, Chiappino D, Emdin M, Clerico A, Mckavanagh P, Lusk L, Ball P, Trinick T, Duly E, Walls G, Orr C, Harbinson M, Donnelly P, Qureshi W, Blaha M, Nasir K, Nour K, Al-Mallah M, Park HE, Heo N, Kim M, Choi S, Igual Munoz B, Bel Minguez A, Donate Bertolin L, La Huerta AA, Dominguez PA, Ferrer JM, Gonzalez AM, Erill JE, Menadas JM, Argudo AM, Dores H, Goncalves P, Sousa P, Carvalho M, Marques H, Machado F, Gaspar A, Aleixo A, Carmo M, Roquette J. Multimodality Imaging - MRI - CT and Nuclear Cardiology: Magnetic Resonance Imaging. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes263] [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: 11/12/2022] Open
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Choo E, Belvin M, Merchant M, Chan E, Hollingshead P, Orr C, Boggs J, Plise E, Robarge K, Zak M. 502 Preclinical Pharmacokinetics and Efficacy Assessment of a Potent and Selective MEK Inhibitor, GDC-0623. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72299-2] [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: 11/25/2022]
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Hannon MJ, Orr C, Moran C, Behan LA, Agha A, Ball SG, Thompson CJ. Anterior hypopituitarism is rare and autoimmune disease is common in adults with idiopathic central diabetes insipidus. Clin Endocrinol (Oxf) 2012; 76:725-8. [PMID: 22026638 DOI: 10.1111/j.1365-2265.2011.04270.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Central diabetes insipidus is a rare clinical condition with a heterogenous aetiology. Up to 40% of cases are classified as idiopathic, although many of these are thought to have an autoimmune basis. Published data have suggested that anterior hypopituitarism is common in childhood-onset idiopathic diabetes insipidus. We aimed to assess the incidence of anterior hypopituitarism in a cohort of adult patients with idiopathic diabetes insipidus. DESIGN AND PATIENTS We performed a retrospective review of the databases of two pituitary investigation units. This identified 39 patients with idiopathic diabetes insipidus. All had undergone magnetic resonance imaging scanning and dynamic pituitary testing (either insulin tolerance testing or GHRH/arginine and short synacthen testing) to assess anterior pituitary function. RESULTS One patient had partial growth hormone deficiency; no other anterior pituitary hormonal deficits were found. Thirty-three percent had at least one autoimmune disease in addition to central diabetes insipidus. CONCLUSIONS Our data suggest that anterior hypopituitarism is rare in adult idiopathic diabetes insipidus. Routine screening of these patients for anterior hypopituitarism may not, therefore, be indicated. The significant prevalence of autoimmune disease in this cohort supports the hypothesis that idiopathic diabetes insipidus may have an autoimmune aetiology.
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Affiliation(s)
- M J Hannon
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
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Boot B, Orr C, Ferman T, Roberts R, Pankratz V, Dickson D, Ahlskog J, Knopman D, Petersen R, Boeve B. Risk Factors for Dementia with Lewy Bodies (S24.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s24.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Geisler JP, Orr C, Manahan KJ. Robotically-assisted laparoscopic radical parametrectomy and radical vaginectomy. EUR J GYNAECOL ONCOL 2011; 32:674-676. [PMID: 22335034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Radical parametrectomy is a technically challenging operation used for women found to have occult cervix cancer after a hysterectomy for benign reasons. A similar operation, radical vaginectomy, is rarely performed because of the its technical difficulty in getting adequate margins without an attached uterus. CASE REPORTS A 41-year-old woman was found to have a presumed surgical Stage IB1 squamous cell carcinoma of the cervix at time of surgery for uterine prolapse. The patient was offered multiple options of surgery and chemoradiation. A second case, a 55-year-old woman, was found to have 1 cm vaginal cancer nine years after a total vaginal hysterectomy for carcinoma in situ of the cervix. She was also offered chemoradiation versus surgery. For the robotically-assisted laparoscopic radical parametrectomy operating time was 186 minutes with an estimated blood loss of 250 ml. For the robotically-assisted laparoscopic radical vaginectomy operating time was 154 minutes with an estimated blood loss of 150 ml. Neither patient had a hospitalization over 24 hours. There were no intraoperative or postoperative complications. CONCLUSIONS Robotically-assisted laparoscopic radical paremetrectomy and vaginectomy are both technically feasible procedures.
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Affiliation(s)
- J P Geisler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toledo, OH 43614, USA.
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Belvin M, Berry L, Chan J, den Otter D, Friedman L, Hoeflich K, Koeppen H, Merchant M, Orr C, Rice K. 132 Intermittent dosing of the MEK inhibitor, GDC-0973, and the PI3K inhibitor, GDC-0941, results in prolonged accumulation of Bim and causes strong tumor growth inhibition in vivo. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71837-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Dickson D, Fujishiro H, Orr C, DelleDonne A, Josephs K, Frigerio R, Burnett M, Parisi J, Klos K, Ahlskog J. O.014 Neuropathology of non-motor features of Parkinson disease. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70029-x] [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: 11/25/2022]
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Higman MA, Schwartz CL, Chen L, Chen AR, Friedman D, Hutchison R, Kawash SB, Orr C, Ambinder RF. Epstein Barr viral DNA in the serum of children and adolescents with Hodgkin disease and early response to chemotherapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Omori K, Valiente L, Orr C, Rawson J, Ferreri K, Todorov I, Al-Abdullah IH, Medicherla S, Potter AA, Schreiner GF, Kandeel F, Mullen Y. Improvement of human islet cryopreservation by a p38 MAPK inhibitor. Am J Transplant 2007; 7:1224-32. [PMID: 17331110 DOI: 10.1111/j.1600-6143.2007.01741.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The activation of p38 mitogen-activated protein kinase (MAPK) has been shown to cause ischemia/reperfusion injury of several organs used for transplantation and also to play a significant role in primary islet graft nonfunction. Activation of p38 MAPK may also occur during islet cryopreservation and thawing. In this study, a p38 MAPK inhibitor (p38IH) was applied to human islet cryopreservation to improve islet yield and quality after thawing. Under serum-free conditions, human islets were cryopreserved, thawed and cultured using our standard procedures. Three types of solutions were tested: conventional RPMI1640 medium (RPMI), a newly developed islet cryopreservation solution (ICS), and ICS supplemented with a p38IH, SD-282 (ICS-p38IH). Activation or inhibition of p38 MAPK was demonstrated by the diminished phosphorylation of HSP27 substrate. Islet recovery on day 2 after thawing was highest with ICS-p38IH and islet viability was not significantly different in the three groups. beta Cell numbers and function were the highest in islets cryopreserved with ICS-p38IH. Glucose-stimulated human C-peptide levels were 86% of that of the nonfrozen islets when measured 4 weeks after transplantation into NODscid mice. This improvement may provide an opportunity to establish islet banks and allow the use of cryopreserved islets for clinical transplantation.
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Affiliation(s)
- K Omori
- Southern California Islet Cell Resources Center, Department of Diabetes, Endocrinology and Metabolism, City of Hope National Medical Center/Beckman Research Institute, Duarte, CA, USA.
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Todorov I, Nair I, Ferreri K, Rawson J, Kuroda A, Pascual M, Omori K, Valiente L, Orr C, Al-Abdullah I, Riggs A, Kandeel F, Mullen Y. Multipotent progenitor cells isolated from adult human pancreatic tissue. Transplant Proc 2006; 37:3420-1. [PMID: 16298614 DOI: 10.1016/j.transproceed.2005.09.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The supply of islet cells is a limiting factor for the widespread application of islet transplantation of type-1 diabetes. Islets constitute 1% to 2% of pancreatic tissue, leaving approximately 98% as discard after islet isolation and purification. In this report we present our data on the isolation of multipotent progenitor cells from discarded adult human pancreatic tissue. The collected cells from discarded nonislet fractions, after enzymatic digestion and gradient purification of islets, were dissociated for suspension culture in a serum-free medium. The cell clusters grown to a size of 100 to 150 mum contained cells staining for stage-specific embryonic antigens, but not insulin or C-peptide. To direct cell differentiation toward islets, clusters were recultured in a pancreatic differentiation medium. Insulin and C-peptide-positive cells by immunocytochemistry appeared within a week, reaching over 10% of the cell population. Glucagon and somatostatin-positive cells were also detected. The cell clusters were found to secrete insulin in response to glucose stimulation. Cells from the same clusters also had the capacity for differentiation into neural cells, as documented by staining for neural and glial cell markers when cultured as monolayers in media containing neurotrophic factors. These data suggest that multipotent pancreatic progenitor cells exist within the human pancreatic tissue that is typically discarded during islet isolation procedures. These adult progenitor cells can be successfully differentiated into insulin-producing cells, and thus they have the potential for treatment of type-1 diabetes mellitus.
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Affiliation(s)
- I Todorov
- Southern California Islet Cell Resource Center, Department of Diabetes, Endocrinology and Metabolism, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Omori K, Valiente L, Orr C, Rawson J, Ferreri K, Todorov I, Medicherla S, Protter AA, Schreiner GF, Riggs AD, Kandeel F, Mullen Y. Inhibition of p38 Mitogen-Activated Protein Kinase Protects Human Islets From Cryoinjury and Improves the Yield, Viability, and Quality of Frozen-Thawed Islets. Transplant Proc 2005; 37:3422-3. [PMID: 16298615 DOI: 10.1016/j.transproceed.2005.09.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The development of an optimal islet cryopreservation method will permit transplantation of islets from multiple donors in a single procedure and contribute to alleviation of the islet shortage. In this study, we have improved human islet cryopreservation methods under serum-free conditions using an intracellular-based islet cryopreservation solution (ICS), especially supplemented with a p38 pathway inhibitor (p38IH) to suppress p38 mitogen-activated protein kinase (MAPK) activation. Three different solutions were compared for freezing and thawing of human islets (1) conventional RPMI1640 medium, (2) ICS, and (3) ICS supplemented with a p38IH, SD-282 (ICS-p38IH). Islet cryopreservation with ICS-p38IH significantly improved islet recovery, viability, and quality after thawing of cryopreserved islets. This improvement may allow the use of cryopreserved islets in clinical islet transplantation.
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Affiliation(s)
- K Omori
- Department of Diabetes, Endocrinology and Metabolism, City of Hope National Medical Center/Beckman Research Institute, 1500 East Duarte Road, Duarte, CA 91010, USA
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Abstract
OBJECTIVE Whether the environment is stressed in function-dysfunction decisions appears to depend on where in the hierarchy of components of complex tasks and of role skills the evaluating therapist is focused. This study examined the intervention planning decisions of occupational therapists who used the Model of Student Role Adaptation, which emphasizes the complex tasks involved in the student role. The purpose of the study was to determine whether these therapists were responding to environmental demands in planning their interventions. METHOD Special education teachers selected tasks that they believed were the most essential for student functioning within their classroom environments. These selections were compared with the goals and objectives developed by occupational therapists who serve children in these settings. RESULTS Chi square analysis indicated a significant relationship between tasks designated by the teacher participants as environmental demands and those included in occupational therapy intervention planning. CONCLUSION The results suggest that the occupational therapist participants were responding to the environmental demands of the classroom when constructing their intervention plans.
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Affiliation(s)
- C Orr
- Texas Woman's University, Dallas 75231, USA
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Orr C. Crown indemnity--the final solution? Med Leg J 1989; 57 ( Pt 3):145-6. [PMID: 2811739 DOI: 10.1177/002581728905700301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Boodhoo N, Orr C. Keeping clear of the law. W INDIAN MED J 1988; 37:129-30. [PMID: 3247722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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