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Blum D, Reuter M, Schliebs W, Tomaschewski J, Erdmann R, Wagner R. Membrane binding and pore forming insertion of PEX5 into horizontal lipid bilayer. Biol Chem 2023; 404:157-167. [PMID: 36260915 DOI: 10.1515/hsz-2022-0183] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/16/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022]
Abstract
The assembly of the peroxisomal translocon involves the transition of a soluble form of the peroxisomal targeting receptor PEX5 into a membrane-bound form, which becomes an integral membrane component of the import pore for peroxisomal matrix proteins. How this transition occurs is still a mystery. We addressed this question using a artificial horizontal bilayer in combination with fluorescence time-correlated single photon counting (TCSPC) and electrophysiological channel recording. Purified human isoform PEX5L and truncated PEX5L(1-335) lacking the cargo binding domain were selectively labeled with thiol-reactive Atto-dyes. Diffusion coefficients of labeled protein in solution show that PEX5L is monomeric with a rather compact spherical conformation, while the truncated protein appeared in a more extended conformation. Labeled PEX5L and the truncated PEX5L(1-335) bind stably to horizontal bilayer thereby accumulating around 100-fold. The diffusion coefficients of the membrane-bound PEX5L forms are 3-4 times lower than in solution, indicating the formation of larger complexes. Electrophysiological single channel recording shows that membrane-bound labeled and non-labeled PEX5L, but not the truncated PEX5L(1-335), can form ion conducting membrane channels. The data suggest that PEX5L is the pore-forming component of the oligomeric peroxisomal translocon and that spontaneous PEX5L membrane surface binding might be an important step in its assembly.
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Affiliation(s)
- Daniel Blum
- MOLIFE Research Center, Jacobs, University Bremen, D-28759 Bremen, Germany
| | - Maren Reuter
- Institut für Biochemie und Pathobiochemie, Abt. Systembiochemie, Medizinische Fakultät, Ruhr-Universität Bochum, D-44801 Bochum, Germany
| | - Wolfgang Schliebs
- Institut für Biochemie und Pathobiochemie, Abt. Systembiochemie, Medizinische Fakultät, Ruhr-Universität Bochum, D-44801 Bochum, Germany
| | - Jana Tomaschewski
- Institut für Biochemie und Pathobiochemie, Abt. Systembiochemie, Medizinische Fakultät, Ruhr-Universität Bochum, D-44801 Bochum, Germany
| | - Ralf Erdmann
- Institut für Biochemie und Pathobiochemie, Abt. Systembiochemie, Medizinische Fakultät, Ruhr-Universität Bochum, D-44801 Bochum, Germany
| | - Richard Wagner
- MOLIFE Research Center, Jacobs, University Bremen, D-28759 Bremen, Germany
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2
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Ngo P, Cossa JP, Gueroult S, Blum D, Pélissier E. Some Additional Data That Might Be Useful for Diastasis Recti Assessment. J Abdom Wall Surg 2023; 2:10923. [PMID: 38312411 PMCID: PMC10831680 DOI: 10.3389/jaws.2023.10923] [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] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/24/2023] [Indexed: 02/06/2024]
Abstract
Background: Diastasis recti (DR) is characterized by separation of both rectus muscles and protrusion of the median bulging, but besides median bulging DR can also entail global abdominal bulging. On other note, DR classification is based on the width of divarication, but measurement values are different at rest and at effort due to muscle contraction. Aim of the study is to provide additional features concerning the type of bulging and the width of divarication. Methods: Findings were retrospectively drawn from the data prospectively collected in the records of a continuous cohort of 105 patients (89 females, 16 males) referred for diastasis and concomitant ventral hernia repair. Results: There was a median bulging alone in 45 (42.9%) cases, a global bulging alone in 18 (17.1%) cases, both types combined in 37 (35.2%) cases and no bulging in 5 (4.8%). On 55 patients with a global bulging, 51 were females. Tape measurements values of DR width were closer to the values measured on the CT scan at leg raise than at rest. The differences were significant at rest as well as at leg raise. Though the difference at rest was highly significant (p = 0.000), the difference at effort was not far from being not significant (p = 0.049). Conclusion: Besides median bulging, presence or absence of the global bulging should be included in DR assessment. The difference between width of divarication at rest and on exertion raises the question of which value should be used for DR classification. The question is worth being debated.
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Affiliation(s)
- P. Ngo
- Institut de la Hernie, Paris, France
| | | | | | - D. Blum
- Établissement Français du Sang de Franche Comté, Besançon, France
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3
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Wagner M, Blum D, Raschka SL, Nentwig LM, Gertzen CGW, Chen M, Gatsogiannis C, Harris A, Smits SHJ, Wagner R, Schmitt L. A New Twist in ABC Transporter Mediated Multidrug Resistance - Pdr5 is a Drug/proton Co-transporter. J Mol Biol 2022; 434:167669. [PMID: 35671830 DOI: 10.1016/j.jmb.2022.167669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
The two major efflux pump systems that are involved in multidrug resistance (MDR) are (i) ATP binding cassette (ABC) transporters and (ii) secondary transporters. While the former use binding and hydrolysis of ATP to facilitate export of cytotoxic compounds, the latter utilize electrochemical gradients to expel their substrates. Pdr5 from Saccharomyces cerevisiae is a prominent member of eukaryotic ATP binding cassette (ABC) transporters that are involved in multidrug resistance (MDR) and used as a frequently studied model system. Although investigated for decades, the underlying molecular mechanisms of drug transport and substrate specificity remain elusive. Here, we provide electrophysiological data on the reconstituted Pdr5 demonstrating that this MDR efflux pump does not only actively translocate its substrates across the lipid bilayer, but at the same time generates a proton motif force in the presence of Mg2+-ATP and substrates by acting as a proton/drug co-transporter. Importantly, a strictly substrate dependent co-transport of protons was also observed in in vitro transport studies using Pdr5-enriched plasma membranes. We conclude from these results that the mechanism of MDR conferred by Pdr5 and likely other transporters is more complex than the sole extrusion of cytotoxic compounds and involves secondary coupled processes suitable to increase the effectiveness.
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Affiliation(s)
- Manuel Wagner
- Institute of Biochemistry, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Daniel Blum
- Department of Life Sciences and Chemistry, Jacobs University Bremen, 28719 Bremen, Germany
| | - Stefanie L Raschka
- Institute of Biochemistry, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Lea-Marie Nentwig
- Institute of Biochemistry, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Christoph G W Gertzen
- Center for Structural Studies Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany; Institute of Pharmaceutical and Medicinal Chemistry, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Minghao Chen
- Institute for Medical Physics and Biophysics and Center for Soft Nanoscience, Westfälische Wilhelms Universität Münster, 48149 Münster, Germany; Department of Structural Biochemistry, Max Planck Institute of Molecular Physiology, 44227 Dortmund, Germany
| | - Christos Gatsogiannis
- Institute for Medical Physics and Biophysics and Center for Soft Nanoscience, Westfälische Wilhelms Universität Münster, 48149 Münster, Germany; Department of Structural Biochemistry, Max Planck Institute of Molecular Physiology, 44227 Dortmund, Germany
| | - Andrzej Harris
- Department of Biochemistry, University of Cambridge, Tennis Court Road, Cambridge CB2 1QW, United Kingdom
| | - Sander H J Smits
- Institute of Biochemistry, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany; Center for Structural Studies Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Richard Wagner
- Department of Life Sciences and Chemistry, Jacobs University Bremen, 28719 Bremen, Germany.
| | - Lutz Schmitt
- Institute of Biochemistry, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany.
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Seiler A, Schettle M, Amann M, Gaertner S, Wicki S, Christ SM, Theile G, Feuz M, Hertler C, Blum D. Virtual Reality Therapy in Palliative Care: A Case Series. J Palliat Care 2022:8258597221086767. [PMID: 35293818 DOI: 10.1177/08258597221086767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Virtual reality (VR) opens a variety of therapeutic options to improve symptom burden in patients with advanced disease. Until to date, only few studies have evaluated the use of VR therapy in the context of palliative care. This case series aims to evaluate the feasibility and acceptability of VR therapy in a population of palliative care patients. METHODS In this single-site case series, we report on six palliative care patients undergoing VR therapy. The VR therapy consisted of a one-time session ranging between 20 to 60 minutes depending on the patient's needs and the content chosen for the VR sessions. A semi-structured survey was conducted and the Edmonton Symptom Assessment System (ESAS) and the Distress Thermometer were performed pre- and post-intervention. RESULTS Overall, VR therapy was well accepted by all patients. Five out of six patients reported having appreciated VR therapy. There were individual differences of perceived effects using VR therapy. The semi-structured survey revealed that some patients felt a temporary detachment from their body and that patients were able to experience the VR session as a break from omnipresent worries and the hospital environment ("I completely forgot where I am"). There was a considerable reduction in the total ESAS score post-treatment (T0 ESASTot = 27.2; T1 ESASTot = 18.8) and a slightly reduction in distress (T0 DTTot = 4.4; T1 DTTot = 3.8). However, two patients were more tired after the intervention.Significance of Results: Our preliminary results demonstrate that VR therapy is acceptable, feasible and safe for use within a palliative care population and appears to be a viable treatment option. Clinical trials are both warranted and necessary to confirm any therapeutic effects of VR therapy, as is the need to tailor VR systems better for use in palliative care settings.
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Affiliation(s)
- A Seiler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - M Schettle
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - M Amann
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Sophie Gaertner
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Wicki
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Internal Medicine Centre, Hirslanden Klinik Aarau, Switzerland
| | - S M Christ
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - G Theile
- Clinic Susenberg, Zurich, Switzerland
| | - M Feuz
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - C Hertler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - D Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
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Young A, Imbeault B, Goffi A, Zahirieh A, Kennedy C, Blum D, Wald R, Beaubien-Souligny W. Integrating Point of Care Ultrasound into Nephrology Fellowship Training: Insights from a Pilot Program. POCUS J 2022; 7:5-6. [PMID: 36896107 PMCID: PMC9994291 DOI: 10.24908/pocus.v7ikidney.14987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In nephrology, point-of-care ultrasound (POCUS) has multiple applications including the rapid evaluation of acute kidney injury, enhancing the initial evaluation of chronic kidney disease, direct evaluation of vascular access, and improved fluid balance management in acute and chronic settings [1, 2]. Recently, the role of POCUS has been formally acknowledged by the American College of Physicians and curricula specific to nephrology have been proposed [3, 4]. However, the integration of a novel clinical skill into a field comes with its unique set of challenges. Above all, most nephrologists in leadership roles within fellowship training programs lack POCUS experience, which represent a significant barrier for adequate exposure and teaching. Although educational curriculum centered on nephrology have been proposed, the optimal model to ensure adequate POCUS exposure considering the scarcity of expertise among educators is not known.
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Affiliation(s)
- Ann Young
- Division of Nephrology, St. Michael's Hospital Toronto Canada
| | - Benoit Imbeault
- Division of Nephrology, UHN Toronto General Hospital Toronto Canada
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine, University of Toronto Toronto Canada
| | - Alireza Zahirieh
- Division of Nephrology, Sunnybrook Health Sciences Center Toronto Canada
| | - Claire Kennedy
- Division of Nephrology, UHN Toronto General Hospital Toronto Canada
| | - Daniel Blum
- Division of Nephrology, St. Michael's Hospital Toronto Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital Toronto Canada
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Chen M, Blum D, Engelhard L, Raunser S, Wagner R, Gatsogiannis C. Molecular architecture of black widow spider neurotoxins. Nat Commun 2021; 12:6956. [PMID: 34845192 PMCID: PMC8630228 DOI: 10.1038/s41467-021-26562-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Latrotoxins (LaTXs) are presynaptic pore-forming neurotoxins found in the venom of Latrodectus spiders. The venom contains a toxic cocktail of seven LaTXs, with one of them targeting vertebrates (α-latrotoxin (α-LTX)), five specialized on insects (α, β, γ, δ, ε- latroinsectotoxins (LITs), and one on crustaceans (α-latrocrustatoxin (α-LCT)). LaTXs bind to specific receptors on the surface of neuronal cells, inducing the release of neurotransmitters either by directly stimulating exocytosis or by forming Ca2+-conductive tetrameric pores in the membrane. Despite extensive studies in the past decades, a high-resolution structure of a LaTX is not yet available and the precise mechanism of LaTX action remains unclear. Here, we report cryoEM structures of the α-LCT monomer and the δ-LIT dimer. The structures reveal that LaTXs are organized in four domains. A C-terminal domain of ankyrin-like repeats shields a central membrane insertion domain of six parallel α-helices. Both domains are flexibly linked via an N-terminal α-helical domain and a small β-sheet domain. A comparison between the structures suggests that oligomerization involves major conformational changes in LaTXs with longer C-terminal domains. Based on our data we propose a cyclic mechanism of oligomerization, taking place prior membrane insertion. Both recombinant α-LCT and δ-LIT form channels in artificial membrane bilayers, that are stabilized by Ca2+ ions and allow calcium flux at negative membrane potentials. Our comparative analysis between α-LCT and δ-LIT provides first crucial insights towards understanding the molecular mechanism of the LaTX family. The venom of Latrodectus spiders contains seven Latrotoxins (LaTXs), among them α-latrocrustatoxin (LCT) and δ- latroinsectotoxins δ-LIT. LaTXs bind to specific receptors on the surface of neuronal cells and target the molecular exocytosis machinery. Here, the authors present the cryo-EM structure of the α-LCT monomer and the δ-LIT dimer, which reveal that LaTXs are organized in four domains and they discuss the potential oligomerisation mechanism that takes place before LaTXs membrane insertion. Both recombinant α-LCT and δ-LIT form channels in artificial membrane bilayers, that are stabilized by Ca2+ ions.
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Affiliation(s)
- Minghao Chen
- Institute for Medical Physics and Biophysics and Center for Soft Nanoscience, Westfälische Wilhelms Universität Münster, 48149, Münster, Germany.,Department of Structural Biochemistry, Max Planck Institute of Molecular Physiology, 44227, Dortmund, Germany
| | - Daniel Blum
- MOLIFE Research Center, Jacobs University Bremen, 28759, Bremen, Germany
| | - Lena Engelhard
- Department of Structural Biochemistry, Max Planck Institute of Molecular Physiology, 44227, Dortmund, Germany
| | - Stefan Raunser
- Department of Structural Biochemistry, Max Planck Institute of Molecular Physiology, 44227, Dortmund, Germany
| | - Richard Wagner
- MOLIFE Research Center, Jacobs University Bremen, 28759, Bremen, Germany
| | - Christos Gatsogiannis
- Institute for Medical Physics and Biophysics and Center for Soft Nanoscience, Westfälische Wilhelms Universität Münster, 48149, Münster, Germany. .,Department of Structural Biochemistry, Max Planck Institute of Molecular Physiology, 44227, Dortmund, Germany.
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Harel Z, McArthur E, Jeyakumar N, Sood MM, Garg AX, Silver SA, Dorian P, Blum D, Beaubien-Souligny W, Yan AT, Badve SV, Smyth B, Jun M, Jandoc R, Kitchlu A, Wald R. The Risk of Acute Kidney Injury with Oral Anticoagulants in Elderly Adults with Atrial Fibrillation. Clin J Am Soc Nephrol 2021; 16:1470-1479. [PMID: 34407990 PMCID: PMC8499008 DOI: 10.2215/cjn.05920421] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Anticoagulation with either a vitamin K antagonist or a direct oral anticoagulant may be associated with AKI. Our objective was to assess the risk of AKI among elderly individuals with atrial fibrillation newly prescribed a direct oral anticoagulant (dabigatran, rivaroxaban, or apixaban) versus warfarin. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our population-based cohort study included 20,683 outpatients in Ontario, Canada, ≥66 years with atrial fibrillation who were prescribed warfarin, dabigatran, rivaroxaban, or apixaban between 2009 and 2017. Inverse probability of treatment weighting on the basis of derived propensity scores for the treatment with each direct oral anticoagulant was used to balance baseline characteristics among patients receiving each of the three direct oral anticoagulants compared with warfarin. Cox proportional hazards regression was performed in the weighted population to compare the association between the prescribed anticoagulant and the outcomes of interest. The exposure was an outpatient prescription of warfarin or one of the direct oral anticoagulants. The primary outcome was a hospital encounter with AKI, defined using Kidney Disease Improving Global Outcomes thresholds. Prespecified subgroup analyses were conducted by eGFR category and by the percentage of international normalized ratio measurements in range, a validated marker of anticoagulation control. RESULTS Each direct oral anticoagulant was associated with a significantly lower risk of AKI compared with warfarin (weighted hazard ratio, 0.65; 95% confidence interval, 0.53 to 0.80 for dabigatran; weighted hazard ratio, 0.85; 95% confidence interval, 0.73 to 0.98 for rivaroxaban; and weighted hazard ratio, 0.81; 95% confidence interval, 0.72 to 0.93 for apixaban). In the subgroup analysis, the lower risk of AKI associated with each direct oral anticoagulant was consistent across each eGFR strata. The risk of AKI was significantly lower among users of each of the direct oral anticoagulants compared with warfarin users who had a percentage of international normalized ratio measurements ≤56%. CONCLUSIONS Direct oral anticoagulants were associated with a lower risk of AKI compared with warfarin.
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Affiliation(s)
- Ziv Harel
- Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada,KDT, ICES, London, Ontario, Canada
| | | | | | - Manish M. Sood
- KDT, ICES, London, Ontario, Canada,Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| | - Amit X. Garg
- KDT, ICES, London, Ontario, Canada,Division of Nephrology, Western University, London, Ontario, Canada
| | - Samuel A. Silver
- KDT, ICES, London, Ontario, Canada,Division of Nephrology, Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada
| | - Paul Dorian
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Blum
- Division of Nephrology, McGill University, Montreal, Quebec, Canada
| | | | - Andrew T. Yan
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sunil V. Badve
- Division of Nephrology, The George Institute for Global Health, University of New South Wales, Sydney, Australia,Division of Nephrology, St George Hospital, Sydney, Australia
| | - Brendan Smyth
- Division of Nephrology, The George Institute for Global Health, University of New South Wales, Sydney, Australia,Division of Nephrology, St George Hospital, Sydney, Australia
| | - Min Jun
- Division of Nephrology, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | | | - Ron Wald
- Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada,KDT, ICES, London, Ontario, Canada
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8
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Wang S, Sit HF, Garabiles MR, Blum D, Hannam K, Chérie Armour, Hall BJ. A network analysis investigation of the comorbidity between sleep dysfunction and PTSD symptomatology among Filipino domestic workers in Macao (SAR) China. J Psychiatr Res 2021; 140:337-345. [PMID: 34134057 DOI: 10.1016/j.jpsychires.2021.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/01/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) is highly comorbid with sleep dysfunction. This association was previously explained based on cognitive and emotional dysfunction. The current study extends this literature by investigating the symptom level comorbidity of sleep dysfunction and DSM-5 PTSD utilizing a network approach. Participants were trauma-exposed female Filipino domestic workers (N = 1241). Network analysis was applied to 23 items: 18 items from PCL-5 measuring PTSD (Community 1) and 5 items from PSQI assessing sleep dysfunction (Community 2). The results showed that the symptoms within each community had the strongest correlations. Bridge connections were identified between the sleep dysfunction and PTSD symptom communities. Symptoms with the highest bridge strength were concentration difficulties, recklessness, irritability, and sleep disturbance. This is among the first studies investigating the comorbidity between PTSD and sleep dysfunction from the network approach. Future interventions may be developed that emphasize the bridge symptoms to address comorbidity among trauma exposed migrants.
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Affiliation(s)
- Siyuan Wang
- New York University (Shanghai), People's Republic of China
| | - Hao Fong Sit
- New York University (Shanghai), People's Republic of China
| | | | - Daniel Blum
- New York University (Shanghai), People's Republic of China
| | - Kevin Hannam
- University of St. Joseph, Macao (SAR), People's Republic of China
| | - Chérie Armour
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK; New York University (Shanghai), Shanghai, China
| | - Brian J Hall
- New York University (Shanghai), People's Republic of China; School of Global Public Health, New York University, New York, NY, USA.
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9
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Blum D, Seiler A, Schmidt E, Pavic M, Strasser F. Patterns of integrating palliative care into standard oncology in an early ESMO designated center: a 10-year experience. ESMO Open 2021; 6:100147. [PMID: 33984671 PMCID: PMC8134655 DOI: 10.1016/j.esmoop.2021.100147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Integration of specialist palliative care (PC) into standard oncology care is recommended. This study investigated how integration at the Cantonal Hospital St. Gallen (KSSG) was manifested 10 years after initial accreditation as a European Society for Medical Oncology (ESMO) Designated Center (ESMO-DC) of Integrated Oncology and Palliative Care. METHODS A chart review covering the years 2006-2009 and 2016 was carried out in patients with an incurable malignancy receiving PC. Visual graphic analysis was utilized to identify patterns of integration of PC into oncology based on the number and nature of medical consultations recorded for both specialties. A follow-up cohort collected 10 years later was analyzed and changes in patterns of integrating specialist PC into oncology were compared. RESULTS Three hundred and forty-five patients from 2006 to 2009 and 64 patients from 2016 were included into analyses. Four distinct patterns were identified using visual graphic analysis. The 'specialist PC-led pattern' (44.9%) and the 'oncology-led pattern' (20.3%) represent disciplines that took primary responsibility for managing patients, with occasional and limited involvement from other disciplines. Patients in the 'concurrent integrated care pattern' (18.3%) had medical consultations that frequently bounced between specialist PC and oncology. In the 'segmented integrated care pattern' (16.5%), patients had sequences of continuous consultations provided by one discipline before alternating to a stretch of consultations provided by the other specialty. In the 2016 follow-up, while the 'oncology-led pattern' occurred significantly less frequently relative to the 'specialist PC-led pattern' and the 'segmented integrated care pattern', the 'concurrent integrated care pattern' emerged more frequently when compared with the 2006-2009 follow-up. CONCLUSION The 'specialist PC-led pattern' was the most prominent pattern in this data. The 2016 follow-up showed that a growing number of patients received a collaborative pattern of care, indicating that integration of specialist PC into standard oncology can manifest as either segmented or concurrent care pathways. Our data suggest a closer, more dynamic and flexible collaboration between oncology and specialist PC early in the disease course of patients with advanced cancer and concurrent with active treatment.
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Affiliation(s)
- D. Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland,Correspondence to: Dr David Blum, Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, CH-8091 Zürich, Switzerland. Tel: +044-255-37-42; Mob: +079-154-87-47
| | - A. Seiler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - E. Schmidt
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland,Oncological Palliative Medicine, Clinic Oncology/Hematology, Cantonal Hospital St. Gallen, Switzerland
| | - M. Pavic
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - F. Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Cantonal Hospital St. Gallen, Switzerland
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10
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Silver SA, Beaubien-Souligny W, Shah PS, Harel S, Blum D, Kishibe T, Meraz-Munoz A, Wald R, Harel Z. The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis. Kidney Med 2021; 3:83-98.e1. [PMID: 33319190 PMCID: PMC7723763 DOI: 10.1016/j.xkme.2020.11.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE & OBJECTIVE Coronavirus disease 2019 (COVID-19) may be associated with high rates of acute kidney injury (AKI) and kidney replacement therapy (KRT), potentially overwhelming health care resources. Our objective was to determine the pooled prevalence of AKI and KRT among hospitalized patients with COVID-19. STUDY DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, the Cochrane Library, and a registry of preprinted studies, published up to October 14, 2020. STUDY SELECTION Eligible studies reported the prevalence of AKI in hospitalized patients with COVID-19 according to the Kidney Disease: Improving Global Outcomes (KDIGO) definition. DATA EXTRACTION & SYNTHESIS We extracted data on patient characteristics, the proportion of patients developing AKI and commencing KRT, important clinical outcomes (discharge from hospital, ongoing hospitalization, and death), and risk of bias. OUTCOMES & MEASURES We calculated the pooled prevalence of AKI and receipt of KRT along with 95% CIs using a random-effects model. We performed subgroup analysis based on admission to an intensive care unit (ICU). RESULTS Of 2,711 records reviewed, we included 53 published and 1 preprint study in the analysis, which comprised 30,657 hospitalized patients with COVID-19. Data for AKI were available for 30,639 patients (n = 54 studies), and receipt of KRT, for 27,525 patients (n = 48 studies). The pooled prevalence of AKI was 28% (95% CI, 22%-34%; I 2 = 99%), and the pooled prevalence of KRT was 9% (95% CI, 7%-11%; I 2 = 97%). The pooled prevalence of AKI among patients admitted to the ICU was 46% (95% CI, 35%-57%; I 2 = 99%), and 19% of all ICU patients with COVID-19 (95% CI, 15%-22%; I 2 = 88%) commenced KRT. LIMITATIONS There was significant heterogeneity among the included studies, which remained unaccounted for in subgroup analysis. CONCLUSIONS AKI complicated the course of nearly 1 in 3 patients hospitalized with COVID-19. The risk for AKI was higher in critically ill patients, with a substantial number receiving KRT at rates higher than the general ICU population. Because COVID-19 will be a public health threat for the foreseeable future, these estimates should help guide KRT resource planning.
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Affiliation(s)
- Samuel A. Silver
- Division of Nephrology, Kingston Health Sciences Centre, Queen’s University, Kingston, Ontario, Canada
| | | | - Prakesh S. Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shai Harel
- Division of Nephrology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Daniel Blum
- Division of Nephrology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Teruko Kishibe
- Health Sciences Library, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Alejandro Meraz-Munoz
- Division of Nephrology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Ron Wald
- Division of Nephrology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Ziv Harel
- Division of Nephrology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
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11
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Blum D, Thomas A, Harris C, Hingwala J, Beaubien-Souligny W, Silver SA. An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis. Can J Kidney Health Dis 2020; 7:2054358120975314. [PMID: 33343910 PMCID: PMC7727051 DOI: 10.1177/2054358120975314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/24/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Quality metrics or indicators help guide quality improvement work by reporting on measurable aspects of health care upon which improvement efforts can focus. For recipients of in-center hemodialysis (ICHD) in Canada, it is unclear what ICHD quality indicators exist and whether they adequately cover different domains of health care quality. Objectives: To identify and evaluate current Canadian ICHD quality metrics to document a starting point for future collaborations and standardization of quality improvement in Canada. Design: Environmental scan of quality metrics in ICHD, and subsequent indicator evaluation using a modified Delphi approach. Setting: Canadian ICHD units. Participants: Sixteen-member pan-Canadian working group with expertise in ICHD and quality improvement. Measurements: We classified the existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods: Each metric was rated by a 5-person subcommittee using a modified Delphi approach based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for additional comments. Results: We identified 27 metrics that are tracked across 8 provinces, with only 9 (33%) tracked by multiple provinces (ie, more than 1 province). We rated 9 metrics (33%) as “necessary” to distinguish high-quality from low-quality care, of which only 2 were tracked by multiple provinces (proportion of patients by primary access and rate of vascular access-related bloodstream infections). Most (16/27, 59%) indicators assessed the IOM domains of safe or effective care, and none of the “necessary” indicators measured the IOM domains of timely, patient-centered, or equitable care. Limitations: The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals, with more representation from academic sites. Conclusions: Quality indicators in Canada mainly focus on safe and effective care, with little provincial overlap. These results highlight current gaps in quality of care measurement for ICHD, and this initial work should provide programs with a starting point to combine highly rated indicators with newly developed indicators into a concise balanced scorecard that supports quality improvement initiatives across all aspects of ICHD care. Trial Registration: not applicable.
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Affiliation(s)
- Daniel Blum
- Division of Nephrology, Jewish General Hospital, Montreal, QC, Canada
- Daniel Blum, Division of Nephrology, Jewish General Hospital, 3755 Cote Sainte Catherine, D-070, Montreal, QC, Canada H3T 1E2.
| | - Alison Thomas
- Division of Nephrology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Claire Harris
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Jay Hingwala
- Division of Nephrology, University of Manitoba, Winnipeg, Canada
| | | | - Samuel A. Silver
- Division of Nephrology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
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Hauser R, Mehta S, Maulis M, Bhargava P, Navia B, Blum D, Pappert E. Patient-reported motor responses to apomorphine sublingual film based on home dosing and response diaries. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.272] [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: 11/29/2022]
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13
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Affiliation(s)
- Daniel Blum
- Division of Nephrology (Blum), Jewish General Hospital, Montréal, Que.; Division of Nephrology (Meraz-Munoz, Harel) St. Michael's Hospital, Toronto, Ont
| | - Alejandro Meraz-Munoz
- Division of Nephrology (Blum), Jewish General Hospital, Montréal, Que.; Division of Nephrology (Meraz-Munoz, Harel) St. Michael's Hospital, Toronto, Ont
| | - Ziv Harel
- Division of Nephrology (Blum), Jewish General Hospital, Montréal, Que.; Division of Nephrology (Meraz-Munoz, Harel) St. Michael's Hospital, Toronto, Ont.
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14
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Li DH, Wald R, Blum D, McArthur E, James MT, Burns KEA, Friedrich JO, Adhikari NKJ, Nash DM, Lebovic G, Harvey AK, Dixon SN, Silver SA, Bagshaw SM, Beaubien-Souligny W. Predicting mortality among critically ill patients with acute kidney injury treated with renal replacement therapy: Development and validation of new prediction models. J Crit Care 2019; 56:113-119. [PMID: 31896444 DOI: 10.1016/j.jcrc.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/30/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Severe acute kidney injury (AKI) is associated with a significant risk of mortality and persistent renal replacement therapy (RRT) dependence. The objective of this study was to develop prediction models for mortality at 90-day and 1-year following RRT initiation in critically ill patients with AKI. METHODS All patients who commenced RRT in the intensive care unit for AKI at a tertiary care hospital between 2007 and 2014 constituted the development cohort. We evaluated the external validity of our mortality models using data from the multicentre OPTIMAL-AKI study. RESULTS The development cohort consisted of 594 patients, of whom 320(54%) died and 40 (15% of surviving patients) remained RRT-dependent at 90-day Eleven variables were included in the model to predict 90-day mortality (AUC:0.79, 95%CI:0.76-0.82). The performance of the 90-day mortality model declined upon validation in the OPTIMAL-AKI cohort (AUC:0.61, 95%CI:0.54-0.69) and showed modest calibration. Similar results were obtained for mortality model at 1-year. CONCLUSIONS Routinely collected variables at the time of RRT initiation have limited ability to predict mortality in critically ill patients with AKI who commence RRT.
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Affiliation(s)
- Daniel H Li
- Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada; ICES, Ontario, Canada
| | - Daniel Blum
- Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | | | - Matthew T James
- Division of Nephrology, Foothills Medical Center, Calgary, Canada
| | - Karen E A Burns
- Critical Care and Medicine Departments, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Jan O Friedrich
- Critical Care and Medicine Departments, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Neill K J Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | | | - Gerald Lebovic
- Applied Health Research Centre, University of Toronto, Toronto, Canada
| | - Andrea K Harvey
- Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Stephanie N Dixon
- ICES, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Canada; Department of Mathematics and Statistics, University of Guelph, Guelph, Canada
| | - Samuel A Silver
- ICES, Ontario, Canada; Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, School of Public Health, University of Alberta, Edmonton, Canada
| | - William Beaubien-Souligny
- Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada; Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
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15
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Thomas A, Silver SA, Perl J, Freeman M, Slater JJ, Nash DM, Vinegar M, McArthur E, Garg AX, Harel Z, Chanchlani R, Zappitelli M, Iliescu E, Kitchlu A, Blum D, Beaubien-Souligny W, Wald R. The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients. Am J Kidney Dis 2019; 75:471-479. [PMID: 31732233 DOI: 10.1053/j.ajkd.2019.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 06/03/2019] [Accepted: 08/20/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Surveillance blood work is routinely performed in maintenance hemodialysis (HD) recipients. Although more frequent blood testing may confer better outcomes, there is little evidence to support any particular monitoring interval. STUDY DESIGN Retrospective population-based cohort study. SETTING & PARTICIPANTS All prevalent HD recipients in Ontario, Canada, as of April 1, 2011, and a cohort of incident patients commencing maintenance HD in Ontario, Canada, between April 1, 2011, and March 31, 2016. EXPOSURE Frequency of surveillance blood work, monthly versus every 6 weeks. OUTCOMES The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiovascular events, all-cause hospitalization, and episodes of hyperkalemia. ANALYTICAL APPROACH Cox proportional hazards with adjustment for demographic and clinical characteristics was used to evaluate the association between blood testing frequency and all-cause mortality. Secondary outcomes were evaluated using the Andersen-Gill extension of the Cox model to allow for potential recurrent events. RESULTS 7,454 prevalent patients received care at 17 HD programs with monthly blood sampling protocols (n=5,335 patients) and at 8 programs with blood sampling every 6 weeks (n=2,119 patients). More frequent monitoring was not associated with a lower risk for all-cause mortality compared to blood sampling every 6 weeks (adjusted HR, 1.16; 95% CI, 0.99-1.38). Monthly monitoring was not associated with a lower risk for any of the secondary outcomes. Results were consistent among incident HD recipients. LIMITATIONS Unmeasured confounding; limited data for center practices unrelated to blood sampling frequency; no information on frequency of unscheduled blood work performed outside the prescribed sampling interval. CONCLUSIONS Monthly routine blood testing in HD recipients was not associated with a lower risk for death, cardiovascular events, or hospitalizations as compared with testing every 6 weeks. Given the health resource implications, the frequency of routine blood sampling in HD recipients deserves careful reassessment.
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Affiliation(s)
- Alison Thomas
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada; ICES, London, Ontario, Canada
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Megan Freeman
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | | | - Amit X Garg
- ICES, London, Ontario, Canada; Division of Nephrology, Western University, London, Ontario, Canada
| | - Ziv Harel
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; ICES, London, Ontario, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, McMaster University, Hamilton, Ontario, Canada
| | - Michael Zappitelli
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eduard Iliescu
- Division of Nephrology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Abhijat Kitchlu
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Daniel Blum
- Division of Nephrology, Sir Mortimer B Davis Jewish General Hospital, Quebec, Canada
| | | | - Ron Wald
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; ICES, London, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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16
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Sapir-Pichhadze R, Zhang X, Ferradji A, Madbouly A, Tinckam KJ, Gebel HM, Blum D, Marrari M, Kim SJ, Fingerson S, Bashyal P, Cardinal H, Foster BJ. Epitopes as characterized by antibody-verified eplet mismatches determine risk of kidney transplant loss. Kidney Int 2019; 97:778-785. [PMID: 32059998 DOI: 10.1016/j.kint.2019.10.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/26/2019] [Accepted: 10/17/2019] [Indexed: 01/01/2023]
Abstract
To optimize strategies that mitigate the risk of graft loss associated with HLA incompatibility, we evaluated whether sequence defined HLA targets (eplets) that result in donor-specific antibodies are associated with transplant outcomes. To define this, we fit multivariable Cox proportional hazard models in a cohort of 118 382 United States first kidney transplant recipients to assess risk of death-censored graft failure by increments of ten antibody-verified eplet mismatches. To verify robustness of our findings, we conducted sensitivity analysis in this United States cohort and assessed the role of antibody-verified eplet mismatches as autonomous predictors of transplant glomerulopathy in an independent Canadian cohort. Antibody-verified eplet mismatches were found to be independent predictors of death-censored graft failure with hazard ratios of 1.231 [95% confidence interval 1.195, 1. 268], 1.268 [1.231, 1.305] and 1.411 [1.331, 1.495] for Class I (HLA-A, B, and C), -DRB1 and -DQB1 loci, respectively. To address linkage disequilibrium between HLA-DRB1 and -DQB1, we fit models in a subcohort without HLA-DQB1 eplet mismatches and found hazard ratios for death-censored graft failure of 1.384 [1.293, 1.480] for each additional antibody-verified HLA-DRB1 eplet mismatch. In a subcohort without HLA-DRB1 mismatches, the hazard ratio was 1.384 [1.072, 1.791] for each additional HLA-DQB1 mismatch. In the Canadian cohort, antibody-verified eplet mismatches were independent predictors of transplant glomerulopathy with hazard ratios of 5.511 [1.442, 21.080] for HLA-DRB1 and 3.640 [1.574, 8.416] for -DRB1/3/4/5. Thus, donor-recipient matching for specific HLA eplets appears to be a feasible and clinically justifiable strategy to mitigate risk of graft loss.
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Affiliation(s)
- Ruth Sapir-Pichhadze
- Division of Nephrology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada; The Multi Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montreal, Quebec, Canada
| | - Abdelhakim Ferradji
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Abeer Madbouly
- Bioinformatics Research, Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
| | - Kathryn J Tinckam
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; The Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Howard M Gebel
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Daniel Blum
- Division of Nephrology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marilyn Marrari
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - S Joseph Kim
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; The Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Fingerson
- Bioinformatics Research, Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
| | - Pradeep Bashyal
- Bioinformatics Research, Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
| | | | - Bethany J Foster
- Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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17
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Blum D, Beaubien-Souligny W, Battistella M, Tseng E, Harel Z, Nijjar J, Nazvitch E, Silver SA, Wald R. Quality Improvement Program Improves Time in Therapeutic Range for Hemodialysis Recipients Taking Warfarin. Kidney Int Rep 2019; 5:159-164. [PMID: 32043029 PMCID: PMC7000800 DOI: 10.1016/j.ekir.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/04/2019] [Accepted: 10/28/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Studies have shown that achieving a time in therapeutic range (TTR) for warfarin of greater than 60% is associated with a lower risk of bleeding. However, many patients on hemodialysis (HD) do not achieve this target. Methods We audited TTR achievement at the in-center HD unit of our hospital in 2017 and found that only 40% of patients had achieved a TTR >60%. We aimed to improve the percentage of HD patients achieving target TTR within 2 years. We reported each patient's individualized trend in quarterly TTR to their primary warfarin prescriber as an audit-feedback report. These reports were generated, disseminated, and subsequently improved following a series of plan-do-study-act cycles. We then used statistical process control to assess for changes in the percentage of HD patients achieving target TTR over time. Results In the primary analysis, 28 patients were included in the baseline period, and 46 were included in the intervention period. At baseline, the percentage of patients achieving a TTR >60% varied between 33% and 45% (mean ± SD, 40% ± 5%); post-intervention, this metric improved and varied between 52% and 71% (mean ± SD, 61% ± 8%). In time-series analysis, there was evidence of statistically significant variation between the 2 periods and evidence of sustained improvement. Conclusions A quality improvement program consisting of an audit-feedback report that raises awareness of the quality gap in TTR achievement can result in substantial improvement in the safe and efficacious administration of warfarin to patients receiving maintenance hemodialysis.
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Affiliation(s)
- Daniel Blum
- Division of Nephrology, Jewish General Hospital, Montreal, Quebec, Canada
| | | | | | - Eric Tseng
- Division of Hematology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ziv Harel
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jaspreet Nijjar
- Department of Pharmacy, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Elena Nazvitch
- Department of Pharmacy, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
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18
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Blum D, Beaubien-Souligny W, Silver SA, Wald R. Thinking Volume First: Developing a Multifaceted Systematic Approach to Volume Management in Hemodialysis. Can J Kidney Health Dis 2019; 6:2054358119879776. [PMID: 31598215 PMCID: PMC6764043 DOI: 10.1177/2054358119879776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/03/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose of review: Volume overload and hypovolemia-induced symptoms are common in the
hemodialysis (HD) population and frequently result in emergency department
visits and hospitalization. A structured strategy for the reporting,
evaluation, and management of disordered volume status may improve clinical
outcomes and the patient experience. We developed a new strategy that
systematically addresses volume issues by leveraging the electronic medical
record, technological adjuncts, and multidisciplinary expertise to institute
new processes of care in our HD unit. Sources of information: This initiative was implemented in a unit located in an urban academic
hospital where 250 patients receive maintenance HD. This initiative involved
a multidisciplinary team of health professionals including physicians, nurse
practitioners, social workers, and dieticians. Methods: We generated volume metrics for HD recipients based on routinely collected
data from the unit’s electronic medical record. We then engaged stakeholders
in a root cause analysis to identify the major causes of abnormal volume
metrics locally. We subsequently developed interventions that were designed
to address each of the major causes in a pragmatic and sustainable
program. Key findings: The final product was a local volume management program with 3 components.
First, we integrated volume metric reporting into the routine surveillance
bloodwork reports across our unit. This enabled the clinical teams to more
easily target patients at risk for volume-related adverse events and provide
them with closer surveillance. Those identified with abnormal volume metrics
were then evaluated with the use of technologic adjuncts such as lung
ultrasound and bioimpedance spectroscopy to complement traditional
assessments of volume status. Finally, those with abnormal volume metrics
underwent rigorous interdisciplinary review for potential nutritional/social
interventions. Limitations: While we report the successful initial implementation of the program within a
single center, it remains unclear whether this initiative will lead to
meaningful benefits for HD recipients, be readily applicable in other
centers, or be sustainable in the long term. Implications: This volume management program will need further evaluation linked to outcome
assessment and feasibility in other centers before wider adoption is
advocated.
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Affiliation(s)
- Daniel Blum
- Jewish General Hospital, Montreal, QC, Canada
| | | | | | - Ron Wald
- St. Michael's Hospital, Toronto, ON, Canada
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Beaubien-Souligny W, Kontar L, Blum D, Bouchard J, Denault AY, Wald R. Meta-Analysis of Randomized Controlled Trials Using Tool-Assisted Target Weight Adjustments in Chronic Dialysis Patients. Kidney Int Rep 2019; 4:1426-1434. [PMID: 31701052 PMCID: PMC6829199 DOI: 10.1016/j.ekir.2019.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/22/2019] [Accepted: 07/01/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Technological adjuncts have been developed to improve the accuracy of fluid removal goals in maintenance dialysis recipients. We aimed to determine whether the introduction of these tools has been shown to impact clinical outcomes. METHODS We performed a systematic review and meta-analysis of randomized controlled trials that compared fluid management guided by technological adjuncts to standard care in hemodialysis and peritoneal dialysis. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular events, hospitalizations, intradialytic hypotension, blood pressure, symptoms, antihypertensive medications. and left ventricular mass index. RESULTS Of the 2940 citations retrieved, we identified a total of 12 eligible trials comprising 2406 participants. In the 10 studies (n = 2111) with data on mortality, the use of adjunct technologies was not associated with a reduction of mortality (rate ratio [RR]: 0.92; confidence interval [CI]: 0.57-1.51; I2 = 36%). The intervention conferred a reduction in systolic arterial pressure (mean difference: -3.14; CI: -5.89 to -0.38; I2 = 39%) but did not affect other outcomes. In a subgroup analysis, bioimpedance was associated with a reduced risk of hospitalization (RR: 0.68; CI: 0.46-0.99; I2 = 55%). The risk of bias was high or unclear in most studies and the quality of evidence was judged to be low. CONCLUSIONS Among maintenance dialysis recipients, technological adjuncts for fluid management did not improve survival. Trials mostly investigated the use of bioimpedance, whereas the evidence for use of other technologies remain very scarce. Future adequately powered trials should assess a broader array of promising technologies using meaningful clinical outcomes over a prolonged follow-up duration.
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Affiliation(s)
- William Beaubien-Souligny
- Department of Anesthesiology and Intensive Care, Montréal Heart Institute, Montréal, Canada
- Division of Nephrology, St. Michael’s Hospital and the University of Toronto, Toronto, Canada
- Division of Nephrology, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Loay Kontar
- Department of Anesthesiology and Intensive Care, Montréal Heart Institute, Montréal, Canada
| | - Daniel Blum
- Division of Nephrology, St. Michael’s Hospital and the University of Toronto, Toronto, Canada
| | - Josée Bouchard
- Department of Nephrology, Hôpital Sacré-Coeur de Montréal, Montréal, Canada
| | - André Y. Denault
- Department of Anesthesiology and Intensive Care, Montréal Heart Institute, Montréal, Canada
- Division of Intensive Care, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael’s Hospital and the University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
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Blum D, Chan CT. Iatrogenesis Imperfecta Medicamentosa: Adverse Drug Events in Dialysis Patients are Associated with Higher Resource Utilization and Mortality. Am J Nephrol 2019; 47:438-440. [PMID: 29895031 DOI: 10.1159/000489704] [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] [Received: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 11/19/2022]
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Gidal BE, Jacobson MP, Ben-Menachem E, Carreño M, Blum D, Soares-da-Silva P, Falcão A, Rocha F, Moreira J, Grinnell T, Ludwig E, Fiedler-Kelly J, Passarell J, Sunkaraneni S. Exposure-safety and efficacy response relationships and population pharmacokinetics of eslicarbazepine acetate. Acta Neurol Scand 2018; 138:203-211. [PMID: 29732549 PMCID: PMC6099471 DOI: 10.1111/ane.12950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 11/27/2022]
Abstract
Objectives Eslicarbazepine acetate (ESL) is a once‐daily (QD) oral antiepileptic drug (AED) for focal‐onset seizures (FOS). Pharmacokinetic (PK) and pharmacodynamic (PD) models were developed to assess dose selection, identify significant AED drug interactions, and quantitate relationships between exposure and safety and efficacy outcomes from Phase 3 trials of adjunctive ESL. Methods Eslicarbazepine (the primary active metabolite of ESL) population PK was evaluated using data from 1351 subjects enrolled in 14 studies (11 Phase 1 and three Phase 3 studies) after multiple oral doses ranging from 400 to 1200 mg. Population PK and PD models related individual eslicarbazepine exposures to safety outcomes and efficacy responses. Results Eslicarbazepine PK was described by a one‐compartment model with linear absorption and elimination. The probability of a treatment‐emergent adverse event (TEAE; dizziness, headache, or somnolence) was higher with an initial dose of ESL 800 mg than with an initial dose of ESL 400 mg QD. Body weight, sex, region, and baseline use of carbamazepine (CBZ) or lamotrigine were also found to influence the probability of TEAEs. Eslicarbazepine exposure influenced serum sodium concentration, standardized seizure frequency, and probability of response; better efficacy outcomes were predicted in patients not from Western Europe (WE; vs WE patients) and those not taking CBZ (vs taking CBZ) at baseline. Conclusions Pharmacokinetic and PK/PD modeling were implemented during the development of ESL for adjunctive treatment of FOS in adults. This quantitative approach supported decision‐making during the development of ESL, and contributed to dosing recommendations and labeling information related to drug interactions.
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Affiliation(s)
- B. E. Gidal
- School of Pharmacy; University of Wisconsin-Madison; Madison WI USA
| | - M. P. Jacobson
- Department of Neurology; Lewis Katz School of Medicine; Temple University; Philadelphia PA USA
| | | | - M. Carreño
- Epilepsy Unit, Hospital Clínic; Barcelona Spain
| | - D. Blum
- Sunovion Pharmaceuticals Inc.; Marlborough MA USA
| | - P. Soares-da-Silva
- BIAL - Portela & C , S.A.; S. Mamede do Coronado Portugal
- Faculty of Medicine; Department of Pharmacology & Therapeutics; University of Porto; Porto Portugal
| | - A. Falcão
- Faculty of Pharmacy; Laboratory of Pharmacology; University of Coimbra; Coimbra Portugal
| | - F. Rocha
- BIAL - Portela & C , S.A.; S. Mamede do Coronado Portugal
| | - J. Moreira
- BIAL - Portela & C , S.A.; S. Mamede do Coronado Portugal
| | - T. Grinnell
- Sunovion Pharmaceuticals Inc.; Marlborough MA USA
| | - E. Ludwig
- Cognigen Corporation; a Simulations Plus company; Buffalo NY USA
| | - J. Fiedler-Kelly
- Cognigen Corporation; a Simulations Plus company; Buffalo NY USA
| | - J. Passarell
- Cognigen Corporation; a Simulations Plus company; Buffalo NY USA
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Nguyen TD, Schwarzer M, Schrepper A, Amorim PA, Blum D, Hain C, Faerber G, Haendeler J, Altschmied J, Doenst T. Increased Protein Tyrosine Phosphatase 1B (PTP1B) Activity and Cardiac Insulin Resistance Precede Mitochondrial and Contractile Dysfunction in Pressure-Overloaded Hearts. J Am Heart Assoc 2018; 7:JAHA.118.008865. [PMID: 29929988 PMCID: PMC6064925 DOI: 10.1161/jaha.118.008865] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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] [Indexed: 01/13/2023]
Abstract
BACKGROUND Insulin resistance in diabetes mellitus has been associated with mitochondrial dysfunction. Defects at the level of mitochondria are also characteristic of heart failure. We assessed changes in cardiac insulin response and mitochondrial function in a model of pressure overload-induced heart failure. METHODS AND RESULTS Rats underwent aortic banding to induce pressure overload. At 10 weeks, rats showed cardiac hypertrophy and pulmonary congestion, but left ventricular dilatation and systolic dysfunction were only evident after 20 weeks. This contractile impairment was accompanied by mitochondrial dysfunction as shown by markedly reduced state 3 respiration of isolated mitochondria. Aortic banding did not affect systemic insulin response. However, insulin-stimulated cardiac glucose uptake and glucose oxidation were significantly diminished at 10 and 20 weeks, which indicates cardiac insulin resistance starting before the onset of mitochondrial and contractile dysfunction. The impaired cardiac insulin action was related to a decrease in insulin-stimulated phosphorylation of insulin receptor β. Consistently, we found elevated activity of protein tyrosine phosphatase 1B (PTP1B) at 10 and 20 weeks, which may blunt insulin action by dephosphorylating insulin receptor β. PTP1B activity was also significantly increased in left ventricular samples of patients with systolic dysfunction undergoing aortic valve replacement because of aortic stenosis. CONCLUSIONS Pressure overload causes cardiac insulin resistance that precedes and accompanies mitochondrial and systolic dysfunction. Activation of PTP1B in the heart is associated with heart failure in both rats and humans and may account for cardiac insulin resistance. PTP1B may be a potential target to modulate insulin sensitivity and contractile function in the failing heart.
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Affiliation(s)
- T Dung Nguyen
- Department of Cardiothoracic Surgery, Jena University Hospital Friedrich Schiller University Jena, Jena, Germany
| | - Michael Schwarzer
- Department of Cardiothoracic Surgery, Jena University Hospital Friedrich Schiller University Jena, Jena, Germany
| | - Andrea Schrepper
- Department of Cardiothoracic Surgery, Jena University Hospital Friedrich Schiller University Jena, Jena, Germany
| | - Paulo A Amorim
- Department of Cardiothoracic Surgery, Jena University Hospital Friedrich Schiller University Jena, Jena, Germany
| | - Daniel Blum
- Department of Cardiothoracic Surgery, Jena University Hospital Friedrich Schiller University Jena, Jena, Germany
| | - Claudia Hain
- Department of General and Visceral Surgery, Klinikum Burgenlandkreis, Zeitz, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital Friedrich Schiller University Jena, Jena, Germany
| | - Judith Haendeler
- IUF-Leibniz Research Institute for Environmental Medicine, Duesseldorf, Germany.,Central Institute of Clinical Chemistry and Laboratory Medicine, University of Duesseldorf, Germany
| | - Joachim Altschmied
- IUF-Leibniz Research Institute for Environmental Medicine, Duesseldorf, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital Friedrich Schiller University Jena, Jena, Germany
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Puy A, García Avilés JM, Balbo AL, Keller M, Riedesel S, Blum D, Bubenzer O. Drip irrigation uptake in traditional irrigated fields: The edaphological impact. J Environ Manage 2017; 202:550-561. [PMID: 27424883 DOI: 10.1016/j.jenvman.2016.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
Historical and traditional flood-irrigated (FI) schemes are progressively being upgraded by means of drip irrigation (DI) to tackle current water and demographic challenges. This modernization process is likely to foster several changes of environmental relevance at the system level. In this paper we assess the effects derived from DI uptake on soil health and structure in ancient FI systems through the case study of Ricote, SE Spain, first established in the 10-13th centuries CE. We approach the topic by means of physico-chemical analyses (pH, electrical conductivity, available P, carbon analyses, bulk density, soil water content and particle size distribution), Electrical Resistivity Measurements (ERT) and robust statistics. We reach a power of 1-ß = 77 aiming at detecting a large effect size (f ≥ 0.4). Results indicate that, compared to FI, DI soils present significantly higher water content, a higher proportion of coarse particles relative to fines due to clay translocation, and less dispersion in salt contents. The soils away from the emitters, which were formerly FI and comparatively account for larger extensions, appear significantly depleted in organic matter, available P and N. These results are not affected by departures from statistical model assumptions and suggest that DI uptake in formerly FI systems might have relevant implications in terms of soil degradation and emission of greenhouse gases. A proper assessment of the edaphological trade-offs derived from this modernization process is mandatory in order to tackle undesired environmental consequences.
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Affiliation(s)
- Arnald Puy
- Maritime Civilizations Department, Recanati Institute for Maritime Studies, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel; Institute of Geography, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany.
| | - José M García Avilés
- University Library, University of Alicante, Campus de San Vicente del Raspeig, Carretera de San Vicente del Raspeig s/n, 03690, San Vicente del Raspeig, Alicante, Spain
| | - Andrea L Balbo
- Research Group Climate Change and Security (CLISEC), KlimaCampus, Center for Earth System Research and Sustainability (CEN), University of Hamburg, Grindelberg 5/7, 20144, Hamburg, Germany
| | - Michèle Keller
- Institute of Geography, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany
| | - Svenja Riedesel
- Institute of Geography, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany
| | - Daniel Blum
- Institute of Geography, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany
| | - Olaf Bubenzer
- Institute of Geography, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany
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Strasser F, Kalbermatten Magaya N, Hehli D, Früh M, Blum D. Chemotherapy in advanced cancer patients with poor performance status (PS) initiated in an integrated oncology and palliative care (PC) setting: an observational comparative study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx382.008] [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: 11/14/2022] Open
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Laurent C, Burnouf S, Ferry B, Batalha VL, Coelho JE, Baqi Y, Malik E, Marciniak E, Parrot S, Van der Jeugd A, Faivre E, Flaten V, Ledent C, D'Hooge R, Sergeant N, Hamdane M, Humez S, Müller CE, Lopes LV, Buée L, Blum D, Blum D. A2A adenosine receptor deletion is protective in a mouse model of Tauopathy. Mol Psychiatry 2016. [PMID: 26216297 DOI: 10.1038/mp.2015.115] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Strasser F, Blum D, von Moos R, Cathomas R, Ribi K, Aebi S, Betticher D, Hayoz S, Klingbiel D, Brauchli P, Haefner M, Mauri S, Kaasa S, Koeberle D. The effect of real-time electronic monitoring of patient-reported symptoms and clinical syndromes in outpatient workflow of medical oncologists: E-MOSAIC, a multicenter cluster-randomized phase III study (SAKK 95/06). Ann Oncol 2015; 27:324-32. [PMID: 26646758 DOI: 10.1093/annonc/mdv576] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [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: 10/06/2015] [Accepted: 11/16/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with advanced, incurable cancer receiving anticancer treatment often experience multidimensional symptoms. We hypothesize that real-time monitoring of both symptoms and clinical syndromes will improve symptom management by oncologists and patient outcomes. PATIENTS AND METHODS In this prospective multicenter cluster-randomized phase-III trial, patients with incurable, symptomatic, solid tumors, who received new outpatient chemotherapy with palliative intention, were eligible. Immediately before the weekly oncologists' visit, patients completed the palm-based E-MOSAIC assessment (Edmonton-Symptom-Assessment-Scale, ≤3 additional symptoms, estimated nutritional intake, body weight change, Karnofsky Performance Status, medications for pain, fatigue, nutrition). A cumulative, longitudinal monitoring sheet (LoMoS) was printed immediately. Eligible experienced oncologists were defined as one cluster each and randomized to receive the immediate print-out LoMoS (intervention) or not (control). Primary analysis limited to patients having uninterrupted (>4/6 visits with same oncologist) patient-oncologist sequences was a mixed model for the difference in patients global quality of life (G-QoL; items 29/30 of EORTC-QlQ-c30) between baseline (BL) and week 6. Intention-to-treat (ITT) analysis included all eligible patients. RESULTS In 8 centers, 82 oncologists treated 264 patients (median 66 years; overall survival intervention 6.3, control 5.4 months) with various tumors. The between-arm difference in G-QoL of 102 uninterrupted patients (intervention: 55; control: 47) was 6.8 (P = 0.11) in favor of the intervention; in a sensitivity analysis (oncologists treating ≥2 patients; 50, 39), it was 9.0 (P = 0.07). ITT analysis revealed improvement in symptoms (difference last study visit-BL: intervention -5.4 versus control 2.1, P = 0.003) and favored the intervention for communication and coping. More patients with high symptom load received immediate symptom management (chart review, nurse-patient interview) by oncologists getting the LoMoS. CONCLUSION Monitoring of patient symptoms, clinical syndromes and their management clearly reduced patients' symptoms, but not QoL. Our results encourage the implementation of real-time monitoring in the routine workflow of oncologist with a computer solution.
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Affiliation(s)
- F Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine and Palliative Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - D Blum
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine and Palliative Center, Cantonal Hospital St Gallen, St Gallen, Switzerland European Palliative Research Centre, NTNU, and St Olavs University Hospital Trondheim, Trondheim, Norway
| | - R von Moos
- Department of Oncology, Cantonal Hospital Chur, Chur
| | - R Cathomas
- Department of Oncology, Cantonal Hospital Chur, Chur
| | | | - S Aebi
- Department of Oncology, University Hospital Bern, Bern
| | - D Betticher
- Department of Oncology, Cantonal Hospital Fribourg, Fribourg
| | - S Hayoz
- SAKK Coordinating Center, Bern
| | | | | | | | - S Mauri
- Department of Oncology, Cantonal Hospital Lugano, Lugano
| | - S Kaasa
- European Palliative Research Centre, NTNU, and St Olavs University Hospital Trondheim, Trondheim, Norway
| | - D Koeberle
- Clinic Oncology/Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Blum D, Blake G. Lupus-associated thrombotic thrombocytopenic purpura-like microangiopathy. World J Nephrol 2015; 4:528-531. [PMID: 26558190 PMCID: PMC4635373 DOI: 10.5527/wjn.v4.i5.528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/03/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Recently reported cases of lupus complicated by a thrombotic thrombocytopenic purpura (TTP)-like syndrome suggest a survival benefit to early treatment with plasma exchange. The following is a report of the eighth such case in the last ten years. A 44-year-old lady known for lupus presented with the nephrotic syndrome and a renal biopsy was consistent with class 4G lupus nephritis. She was given high-dose steroids and cytotoxic therapy, but her induction therapy was complicated by the classic pentad of TTP. She was subsequently treated with another course of high-dose steroids, a different cytotoxic agent, and plasma exchange, with clinical resolution shortly thereafter. Similar to seven recently reported cases of microangiopathy in lupus, this lady’s TTP-like syndrome improved dramatically after initiation of plasma exchange, despite not having a severely deficient ADAMTS13. This has implications on both current clinical practice and on the pathogenesis of TTP-like syndromes in lupus.
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Schmid S, Omlin A, Blum D, Strasser F, Gillessen S, Rothermundt C. Assessment of anticancer-treatment outcome in patients with metastatic castration-resistant prostate cancer-going beyond PSA and imaging, a systematic literature review. Ann Oncol 2015. [PMID: 26216388 DOI: 10.1093/annonc/mdv326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In the past years, there has been significant progress in anticancer drug development for patients with metastatic castration-resistant prostate cancer (CRPC). However, the current instruments to assess clinical treatment response have limitations and may not sufficiently reflect patient benefit. Our objective was to systematically identify tools to evaluate both patient benefit and clinical anticancer-treatment response as basis for an international consensus process and development of a specific pragmatic instrument for men with CRPC. METHODS PubMed, Embase and CINAHL were searched to identify currently available tools to assess anticancer-treatment benefit, other than standard imaging procedures and prostate-specific antigen measurements, namely quality of life (QoL), detailed pain assessment, physical function and objective measures of other complex cancer-related syndromes in patients with CRPC. Additionally, all CRPC phase III trials published in the last 5 years were reviewed as well as studies using physical function tools in a general cancer population. The PRIMSA statement was followed for the systematic review process. RESULTS The search generated 1096 hits, 185 full-text papers were screened and finally 73 publications were included. Additional 89 publications were included by hand-search. We identified a total of 98 tools used in CRPC trials and grouped these into three categories: 22 tools assessing QoL domains and subgroups, 47 tools for pain assessment and 29 tools for objective measures, mainly physical function and assessment of skeletal disease burden. CONCLUSION A wide variety of assessment tools and also efforts to standardize and harmonize patient-reported outcomes and pain assessment were identified. However, the specific needs of the increasing CRPC population living longer with their incurable cancer are insufficiently captured and objective physical outcome measures are under-represented. In the age of new anticancer drug targets and principles, new methods to monitor patient relevant outcomes of antineoplastic therapy are of utmost importance.
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Affiliation(s)
- S Schmid
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - A Omlin
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - D Blum
- Division of Oncological Palliative Medicine, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - F Strasser
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland Division of Oncological Palliative Medicine, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - S Gillessen
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - C Rothermundt
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
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Blum D, Koeberle D, Omlin A, Walker J, Von Moos R, Mingrone W, deWolf-Linder S, Hayoz S, Kaasa S, Strasser F, Ribi K. Feasibility and acceptance of electronic monitoring of symptoms and syndromes using a handheld computer in patients with advanced cancer in daily oncology practice. Support Care Cancer 2014; 22:2425-34. [DOI: 10.1007/s00520-014-2201-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
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Blum D, Stene GB, Solheim TS, Fayers P, Hjermstad MJ, Baracos VE, Fearon K, Strasser F, Kaasa S. Validation of the Consensus-Definition for Cancer Cachexia and evaluation of a classification model--a study based on data from an international multicentre project (EPCRC-CSA). Ann Oncol 2014; 25:1635-42. [PMID: 24562443 DOI: 10.1093/annonc/mdu086] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Weight loss limits cancer therapy, quality of life and survival. Common diagnostic criteria and a framework for a classification system for cancer cachexia were recently agreed upon by international consensus. Specific assessment domains (stores, intake, catabolism and function) were proposed. The aim of this study is to validate this diagnostic criteria (two groups: model 1) and examine a four-group (model 2) classification system regarding these domains as well as survival. PATIENTS AND METHODS Data from an international patient sample with advanced cancer (N = 1070) were analysed. In model 1, the diagnostic criteria for cancer cachexia [weight loss/body mass index (BMI)] were used. Model 2 classified patients into four groups 0-III, according to weight loss/BMI as a framework for cachexia stages. The cachexia domains, survival and sociodemographic/medical variables were compared across models. RESULTS Eight hundred and sixty-one patients were included. Model 1 consisted of 399 cachectic and 462 non-cachectic patients. Cachectic patients had significantly higher levels of inflammation, lower nutritional intake and performance status and shorter survival. In model 2, differences were not consistent; appetite loss did not differ between group III and IV, and performance status not between group 0 and I. Survival was shorter in group II and III compared with other groups. By adding other cachexia domains to the model, survival differences were demonstrated. CONCLUSION The diagnostic criteria based on weight loss and BMI distinguish between cachectic and non-cachectic patients concerning all domains (intake, catabolism and function) and is associated with survival. In order to guide cachexia treatment a four-group classification model needs additional domains to discriminate between cachexia stages.
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Affiliation(s)
- D Blum
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim
| | - G B Stene
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - T S Solheim
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim
| | - P Fayers
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - M J Hjermstad
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Oslo, Norway
| | - V E Baracos
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Alberta, Canada
| | - K Fearon
- Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary, Edinburgh, UK
| | - F Strasser
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Department of Internal Medicine and Palliative Center Cantonal Hospital, Oncological Palliative Medicine, Oncology, St Gallen, Switzerland
| | - S Kaasa
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim
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Grion C, Tanita MT, Dantas de Maio Carrilho CM, Garcia JP, Festti J, Cardoso LTQ, Chiquetti F, Kanehissa MM, Branco Lopes CC, Blum D, Anami V, Ruiz AR, Rossatto PA. Parenteral colistin for the treatment of severe infections by multidrug-resistant Gram-negative bacteria. Crit Care 2013. [PMCID: PMC3890970 DOI: 10.1186/cc12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Blum D, Koeberle D, von Moos R, Ribi K, Aebi S, Betticher D, Hayoz S, Nadig J, Mauri S, Strasser F. Real-Time Electronic Monitoring of Patient-Reported Symptoms and Syndromes (PRS): E-Mosaic, a Multicenter Phase iii Study (Sakk 95/06). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33977-6] [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: 10/25/2022] Open
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Graser JC, Blum D, Brancato K, Burks JJ, Chan EW, Nicosia N, Neumann MJ, Ritschard HV, Mundell BF. The Economics of Air Force Medical Service Readiness. Rand Health Q 2012; 2:1. [PMID: 28083242 PMCID: PMC4945265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The prime mission of the Air Force Medical Service (AFMS), like those of the medical departments of its sister services, is to provide medical care during wartime. AFMS currently runs three successful in-theater hospitals that treat severely injured or wounded U.S. personnel from all four services. But this wartime mission depends on capabilities built at home, as critical-care specialists maintain their technical proficiency, as much as peacetime opportunities allow, by meeting health-care needs of Department of Defense beneficiaries at home. These patients have ranged from young, healthy active-duty personnel to aging retirees, historically presenting a broad range of injuries and illnesses for treatment. However, between the demands of deployments creating gaps in staff at home and changes in care plans, some beneficiaries now seek care in the civilian sector. In addition, several AFMS hospitals stateside have been closed, converted to clinics, or combined with those of other services for various reasons. All is problematic for two reasons: First, inpatient workloads in particular represent the best opportunities for critical care providers to prepare for their wartime missions. AFMS will need to increase these opportunities, perhaps working with other services, the Department of Veterans Affairs, or civilian hospitals. Second, AFMS's funding depends, in part, on the workload performed, but current measurement methods do not necessarily do a good job of accounting for the work AFMS practitioners accomplish outside their home stations. Some imminent changes may help resolve this situation, but AFMS should pursue opportunities to create additional workload for its medical personnel and to increase its budgets.
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Buee L, Blum D. 10 Innovative therapeutic strategies for tau pathology: from cholesterol metabolism to immunotherapy. Neurobiol Aging 2012. [DOI: 10.1016/j.neurobiolaging.2012.01.028] [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: 10/28/2022]
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Cheng H, Zummo J, Sousa R, Versavel M, Blum D. An Exploratory Analysis of Predictors of Minimum Sodium Level Related to Treatment with Adjunct Eslicarbazepine Acetate (P06.124). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.124] [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: 11/15/2022] Open
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Versavel M, Meador K, Blum D, Zummo J, Tripp K, Soares-da-Silva P. The Incidence of Cognitive Adverse Events Related to Eslicarbazepine Acetate: An Integrated Analysis (P06.116). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.116] [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: 11/15/2022] Open
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Blum D, Grinnell T, Versavel M, Zummo J, Nunes T, Soares-da-Silva P. Safety of Eslicarbazepine Acetate by Type of Concomitantly Used AEDs: An Exploratory Integrated Analysis of Two Phase III Studies (P06.095). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.095] [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: 11/15/2022] Open
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Versavel M, Cheng H, Blum D, Zummo J, Nunes T, Soares-da-Silva P. Efficacy of Eslicarbazepine Acetate by Type of Concomitantly Used AEDs: An Exploratory Integrated Analysis of Two Phase III Studies (P06.105). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.105] [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: 11/15/2022] Open
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Sperling M, Grinnell T, Versavel M, Zummo J, Blum D, Soares-da-Silva P. An Investigation of the Incidence and Time to Onset of Adverse Events Associated with Eslicarbazepine Acetate Adjunct Treatment: An Integrated Analysis of Two Double-Blind Placebo-Controlled Trials (P06.104). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.104] [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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Lim S, Chesser A, Grima J, Rappold P, Blum D, Przedborski S, Tieu K. 3.260 D-β-HYDROXYBUTYRATE IS NEUROPROTECTIVE IN MOUSE MODELS OF HUNTINGTON'S DISEASE. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70931-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Belarbi K, Burnouf S, Fernandez-Gomez FJ, Desmercieres J, Troquier L, Brouillette J, Tsambou L, Grosjean ME, Caillierez R, Demeyer D, Hamdane M, Schindowski K, Blum D, Buee L. Loss of Medial Septum Cholinergic Neurons in THY-Tau22 Mouse Model: What Links with tau Pathology? Curr Alzheimer Res 2011; 8:633-8. [DOI: 10.2174/156720511796717230] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/02/2010] [Accepted: 06/03/2010] [Indexed: 11/22/2022]
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Blum D. Anonymat du patient dans le Programme de médicalisation des systèmes d’information : quel leurre est-il ? Rev Epidemiol Sante Publique 2011. [DOI: 10.1016/j.respe.2011.03.035] [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: 10/18/2022] Open
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Strasser F, deWolf-Linder S, Blum D, Widmer C, Omlin AG, Koeberle D. Early palliative cancer care. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19547] [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: 11/20/2022] Open
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Strasser F, Blum D, Oberholzer R, deWolf-Linder S, Driessen C, Cerny T. The use of subcutaneous natural ghrelin to treat cachexia (CC)-related symptom distress, nutritional intake (NI), and physical functioning: A two-step phase I/II study with an intrapatient dose escalation followed by maintenance treatment. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps234] [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: 11/20/2022] Open
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Strasser F, Oberholzer R, Blum D, Joerger M, Driessen C, deWolf-Linder S, Haile SR, von Moos R, Zerkiebel N, Jatoi A, Woelky R, Fearon K, Cerny T. Lenalidomide in solid tumor patients with inflammatory cancer cachexia: A multicenter, randomized, double-blind, proof-of-concept study of fixed dose or CRP-response-guided dose or placebo. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps239] [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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Richter HG, Benson G, Bleicher K, Blum D, Chaput E, Clemann N, Feng S, Gardes C, Grether U, Hartman P, Kuhn B, Martin R, Plancher JM, Rudolph M, Schuler F, Taylor S. Optimization of a novel class of benzimidazole-based farnesoid X receptor (FXR) agonists to improve physicochemical and ADME properties. Bioorg Med Chem Lett 2011; 21:1134-40. [DOI: 10.1016/j.bmcl.2010.12.123] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/22/2010] [Accepted: 12/23/2010] [Indexed: 01/09/2023]
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Duru C, Simonin C, Richard F, Hincker P, Génin M, Charles P, Youssov K, Burnouf S, Azulay JP, Verny C, Tranchant C, Goizet C, Defebvre L, Sablonnière B, Rousseau M, Buée L, Amouyel P, Godefroy O, Dürr A, Bachoud-Lévi AC, Blum D, Krystkowiak P. C08 Caffeine is a modifier of age at onset in Huntington's disease. J Neurol Neurosurg Psychiatry 2010. [DOI: 10.1136/jnnp.2010.222588.8] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Stroes ESG, Kastelein JJP, Bénardeau A, Kuhlmann O, Blum D, Campos LA, Clerc RG, Niesor EJ. Dalcetrapib: no off-target toxicity on blood pressure or on genes related to the renin-angiotensin-aldosterone system in rats. Br J Pharmacol 2010; 158:1763-70. [PMID: 19917065 DOI: 10.1111/j.1476-5381.2009.00460.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The association between torcetrapib and its off-target effects on blood pressure suggested a possible class-specific effect. The effects of dalcetrapib (RO4607381/JTT-705) and torcetrapib on haemodynamics and the renin-angiotensin-aldosterone system (RAAS) were therefore assessed in a rat model. EXPERIMENTAL APPROACH Arterial pressure (AP) and heart rate were measured by telemetry in normotensive and spontaneously hypertensive rats (SHR) receiving torcetrapib 10, 40 or 80 mg kg(-1) day(-1); dalcetrapib 100, 300 or 500 mg(-1) kg day(-1); or vehicle (placebo) for 5 days. Expression of RAAS genes in adrenal gland, kidney, aorta and lung from normotensive rats following 5 days' treatment with torcetrapib 40 mg kg(-1) day(-1), dalcetrapib 500 mg kg(-1) day(-1) or vehicle was measured by quantitative polymerase chain reaction. KEY RESULTS Torcetrapib transiently increased mean AP in normotensive rats (+3.7 +/- 0.1 mmHg), whereas treatment in SHR resulted in a dose-dependent and sustained increase [+6.5 +/- 0.6 mmHg with 40 mg kg(-1) day(-1) at day 1 (P < 0.05 versus placebo)], which lasted over the treatment period. No changes in AP or heart rate were observed with dalcetrapib. Torcetrapib, but not dalcetrapib, increased RAAS-related mRNAs in adrenal glands and aortas. CONCLUSIONS AND IMPLICATIONS In contrast to torcetrapib, dalcetrapib did not increase blood pressure or RAAS-related gene expression in rats, suggesting that the off-target effects of torcetrapib are not a common feature of all compounds acting on cholesteryl ester transfer protein.
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Affiliation(s)
- E S G Stroes
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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El-Ekiaby M, Sayed MA, Caron C, Burnouf S, El-Sharkawy N, Goubran H, Radosevich M, Goudemand J, Blum D, de Melo L, Soulié V, Adam J, Burnouf T. Solvent-detergent filtered (S/D-F) fresh frozen plasma and cryoprecipitate minipools prepared in a newly designed integral disposable processing bag system. Transfus Med 2010; 20:48-61. [DOI: 10.1111/j.1365-3148.2009.00963.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hamdane M, Desmercières J, Burnouf S, Bouafia H, Belarbi K, Troquier L, Becque S, Demeyer D, Grosjean ME, Caillierez R, Barbot B, Brion I, Fernandez Gomez F, Humez S, Sergeant N, Blum D, Buée L. C10 Modèles expérimentaux de la pathologie Tau. Rev Neurol (Paris) 2009. [DOI: 10.1016/s0035-3787(09)72563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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