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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Cantalupo P, Diacou A, Park S, Soman V, Chen J, Glenn D, Chandran U, Clark D. Single-cell Transcriptional Analysis of the Cellular Immune Response in the Oral Mucosa of Mice. bioRxiv 2023:2023.10.18.562816. [PMID: 37904993 PMCID: PMC10614882 DOI: 10.1101/2023.10.18.562816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Periodontal health is dependent on a symbiotic relationship of the host immune response with the oral microbiota. Pathologic shifts of the microbial plaque elicit an immune response that eventually leads to the recruitment and activation of osteoclasts and matrix metalloproteinases and the eventual tissue destruction that is evident in periodontal disease. Once the microbial stimulus is removed, an active process of inflammatory resolution begins. The goal of this work was to use scRNAseq to demonstrate the unique cellular immune response across three distinct conditions of periodontal health, disease, and resolution using mouse models. Periodontal disease was induced using a ligature model. Resolution was modeled by removing the ligature and allowing the mouse to recover. Immune cells (Cd45+) were isolated from the periodontium and analyzed via scRNAseq. Gene signature shifts across the three conditions were characterized and shown to be largely driven by macrophage and neutrophils during the periodontal disease and resolution conditions. Resolution of periodontal disease was characterized by the differential regulation of unique gene subsets. Clustering analysis characterized multiple cellular subpopulations within B Cells, macrophages, and neutrophils that demonstrated differential expansion and contraction across conditions of periodontal health, disease, and resolution. Interestingly, we identified a transcriptionally distinct macrophage subpopulation that expanded during the resolution condition and demonstrated an immunoregulatory gene signature. We identified a cell surface marker for this resolution-associated macrophage subgroup (Cd74) and validated the expansion of this subgroup during resolution via flow cytometry. This work presents a robust immune cell atlas for study of the immunological changes in the oral mucosa during three distinct conditions of periodontal health, disease, and resolution and it improves our understanding of the cellular and molecular markers that characterize health from disease for the development of future diagnostics and therapies.
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Hamid A, Yimer W, Oshunbade A, Khan MS, Kamimura D, Kipchumba RK, Pandey A, Clark D, Mentz R, Fox ER, Berry J, Stacey B, Shah A, Correa A, Virani SS, Butler J, Hall ME. Trajectory of high sensitivity c-reactive protein and incident heart failure in black adults: the jackson heart study. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Baker KL, MacLaren S, Jones O, Spears BK, Patel PK, Nora R, Divol L, Landen OL, Anderson GJ, Gaffney J, Kruse M, Hurricane OA, Callahan DA, Christopherson AR, Salmonson J, Hartouni EP, Döppner T, Dewald E, Tommasini R, Thomas CA, Weber C, Clark D, Casey DT, Hohenberger M, Khan S, Woods T, Milovich JL, Berger RL, Strozzi D, Kritcher A, Bachmann B, Benedetti R, Bionta R, Celliers PM, Fittinghoff D, Hatarik R, Izumi N, Gatu Johnson M, Kyrala G, Ma T, Meaney K, Millot M, Nagel SR, Pak A, Volegov PL, Yeamans C, Wilde C. Alpha heating of indirect-drive layered implosions on the National Ignition Facility. Phys Rev E 2023; 107:015202. [PMID: 36797905 DOI: 10.1103/physreve.107.015202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Abstract
In order to understand how close current layered implosions in indirect-drive inertial confinement fusion are to ignition, it is necessary to measure the level of alpha heating present. To this end, pairs of experiments were performed that consisted of a low-yield tritium-hydrogen-deuterium (THD) layered implosion and a high-yield deuterium-tritium (DT) layered implosion to validate experimentally current simulation-based methods of determining yield amplification. The THD capsules were designed to reduce simultaneously DT neutron yield (alpha heating) and maintain hydrodynamic similarity with the higher yield DT capsules. The ratio of the yields measured in these experiments then allowed the alpha heating level of the DT layered implosions to be determined. The level of alpha heating inferred is consistent with fits to simulations expressed in terms of experimentally measurable quantities and enables us to infer the level of alpha heating in recent high-performing implosions.
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Affiliation(s)
- K L Baker
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S MacLaren
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - O Jones
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B K Spears
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P K Patel
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Nora
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - L Divol
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - O L Landen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G J Anderson
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Gaffney
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Kruse
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - O A Hurricane
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D A Callahan
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A R Christopherson
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Salmonson
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E P Hartouni
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - T Döppner
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E Dewald
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Tommasini
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C A Thomas
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - C Weber
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Clark
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D T Casey
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Hohenberger
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Khan
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - T Woods
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J L Milovich
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R L Berger
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Strozzi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Kritcher
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B Bachmann
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Benedetti
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Bionta
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P M Celliers
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Fittinghoff
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Hatarik
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Izumi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Gatu Johnson
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - G Kyrala
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T Ma
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Meaney
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Millot
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S R Nagel
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Pak
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P L Volegov
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C Yeamans
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Wilde
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
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Tan M, Dinh D, Gayed D, Liang D, Brennan A, Duffy S, Clark D, Ajani A, Oqueli E, Roberts L, Reid C, Freeman M, Chandrasekhar J. Associations between DAPT score and long-term mortality post PCI. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The dual antiplatelet therapy (DAPT) score was developed to identify patients more likely to derive benefit (score ≥2) or harm (score <2) from DAPT beyond 1-year post PCI. There is no study which looked at the DAPT score and long term outcomes post PCI in Australia.
Purpose
We sought to examine long-term mortality after PCI by the DAPT score in patients treated with DAPT per local guidelines.
Methods
We examined data from the MIG PCI database from 2005 to 2018 in whom the DAPT score could be derived and grouped them as score ≥2 or <2. Long-term mortality was assessed from National Death Index linkage. The primary endpoint was long-term mortality examined using survival analysis. Secondary endpoints included 30-day ischaemic outcomes and in-hospital major bleeding.
Results
Out of 27,740 patients in the study, 9,401 (33.9%) had DAPT score ≥2. They were younger and included more females and higher prevalence of renal impairment. DAPT score ≥2 patients had higher in-hospital major bleeding, 30-day mortality, MI and target vessel revascularisation. DAPT score ≥2 patients had lower long-term survival to 12 years (p<0.001 for all).
Conclusion
A third of all-comer PCI patients had DAPT score ≥2 with greater short-term risk of ischaemic and bleeding outcomes, as well as long-term mortality. Theoretically, those with DAPT score ≥2 would benefit from longer duration of DAPT as ischaemic risk outweighs bleeding risk. However, given our finding of increased short-term bleeding risk and long-term mortality, dynamic bleeding risk assessment should be undertaken to guide pharmacotherapy strategies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Tan
- Eastern Health , Melbourne , Australia
| | - D Dinh
- Monash University , Melbourne , Australia
| | - D Gayed
- Eastern Health , Melbourne , Australia
| | - D Liang
- Eastern Health , Melbourne , Australia
| | - A Brennan
- Monash University , Melbourne , Australia
| | - S Duffy
- Alfred Health , Melbourne , Australia
| | - D Clark
- Austin Hospital , Melbourne , Australia
| | - A Ajani
- Royal Melbourne Hospital , Melbourne , Australia
| | - E Oqueli
- Ballarat Health , Melbourne , Australia
| | - L Roberts
- Eastern Health , Melbourne , Australia
| | - C Reid
- Curtin University , Perth , Australia
| | - M Freeman
- Eastern Health , Melbourne , Australia
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Hamilton E, Meisel J, Alemany C, Virginia B, Lin N, Wesolowski R, Mathauda-Sahota G, Makower D, Lawrence J, Faltaos D, Mitri Z, Sabanathan D, Clark D, Pluard T, Hui R, McCarthy N, Patel M. Phase 1b results from OP-1250-001, a dose escalation and dose expansion study of OP-1250, an oral CERAN, in subjects with advanced and/or metastatic estrogen receptor (ER)-positive, HER2-negative breast cancer (NCT04505826). Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00896-6] [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: 11/28/2022]
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, 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N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, 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Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Terkeltaub R, Clark D, Tosone C, Kandinov B, Zhang P, Dahl N, Grujic D, Goldfarb D. POS1157 SAFETY AND EFFICACY OF ALLN-346 ORAL ENZYME THERAPY IN PATIENTS WITH HYPERURICEMIA AND CHRONIC KIDNEY DISEASE (CKD): RESULTS OF THE PHASE 2A STUDY 201. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCurrently available urate lowering therapies (ULTs) are limited in their use for gout patients with advanced CKD based on dosing restrictions, tolerability, safety concerns, and reduced effectiveness, compared to options for the broader gout population. In gout patients with advanced CKD, the intestinal tract becomes the major route of urate elimination, as opposed to in healthy people with normal kidney function where kidneys are the primary route of uric acid excretion.1 Considering some of the limitations of present urate-lowering therapies (ULTs) in gout & CKD and the extra-renal pathway of urate secretion, a new oral therapy, ALLN-346 (engineered urate oxidase), is under development as a non-absorbed, urate specific enzyme, designed to enhance degradation and secretion of urate in the intestinal tract.2ObjectivesTo assess the safety, tolerability, and initial bioactivity data of ALLN-346 in adults with hyperuricemia and CKD.MethodsThis one-week inpatient Phase 2a study (NCT04987242) was conducted at a clinical pharmacology unit. Eleven otherwise healthy adult patients with hyperuricemia (sUA ≥ 6.8 mg/dL) and normal to Stage 2 CKD (eGFR ≥60), not on concurrent ULTs, were randomized (2:1) to receive either 5 capsules of ALLN-346 or matching placebo, three times daily for 7 days. Serum urate was measured daily, and urine uric acid was assessed on days -2, -1, 1, 4, and 7. Safety was monitored throughout the study. To assess possible ALLN-346 systemic absorption, a specific ELISA was used on serum samples collected pre- and post-dose over 7 days.ResultsOf the 11 patients 7 received ALLN-346 and 4 received placebo. Most patients had Stage 2 CKD, including 5 of the 7 subjects treated with ALLN-346. A statistically significant reduction in mean sUA was recorded with ALLN-346 compared to placebo [Figure 1]. The largest mean % reduction in sUA was observed among patients with stage 2 CKD; sUA reduction was correlated with eGFR in the ALLN-346 group (r=0.95; P=0.003), but not the placebo group (r=-0.2; P=0.91). No serious adverse events were reported, and clinical and laboratory parameters revealed no significant safety signals. Lack of systemic absorption of ALLN-346 was confirmed by ELISA assays.Figure 1.Absolute and Percent Change from Baseline in Serum Urate over 7 -days of TreatmentConclusionIn this study, oral therapy with ALLN-346 for 7 days was well tolerated and resulted in a significant reduction in sUA. Consistent with the known pathophysiologic adaptation of increased intestinal elimination of uric acid in patients with impaired kidney function and the intestinal-based mechanism of action of ALLN-346, there was a strong correlation between the effect of ALLN-346 on sUA reduction and the level of kidney function. The generated data support proof of pharmacology for the intestinal mechanism of action of ALLN-346 to degrade urate either formed or secreted in the gut. Future studies in the larger gout population with CKD are underway.References[1]Sorensen BL. Role of the intestinal tract in the elimination of uric acid. Arthritis and Rheumatism, vol 8, part5 1965[2]Pierzynowska K, Deshpande A, Mosiichuk N, et al. Oral Treatment with an Engineered Uricase, ALLN-346, Reduces Hyperuricemia, and Uricosuria in Urate Oxidase-Deficient Mice. Front Med (Lausanne). 2020 Nov 24;7:569215.Disclosure of InterestsRobert Terkeltaub Consultant of: Allena, SOBI, Astra-Zeneca, Fortress, Grant/research support from: Astra-Zeneca, David Clark Shareholder of: Allena, Employee of: Allena, Christine Tosone Shareholder of: Allena, Employee of: Allena, Boris Kandinov Shareholder of: Allena, Employee of: Allena, Ping Zhang Shareholder of: Corbus, Employee of: Previous Corbus, Current Allena, Naomi Dahl Shareholder of: AbbVie shares, Allena options, Employee of: Allena, Danica Grujic Shareholder of: Allena, Employee of: Allena, David Goldfarb Consultant of: Allena, Alnylam, AstraZeneca, Cymabay, Dicerna, Sumitovant, Synlogic, Grant/research support from: Dicerna, Travere
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Clark D, Grujic D, Tosone C, Dahl N, Terkeltaub R. POS1156 PHASE 1 TRIALS OF NOVEL ORAL ENZYME THERAPY (ALLN-346) FOR HYPERURICEMIA & GOUT: SAFETY, PHARMACODYNAMICS, AND LACK OF SYSTEMIC ABSORPTION OF SINGLE AND MULTIPLE ASCENDING DOSES IN HEALTHY VOLUNTEERS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCurrently available therapies for gout in patients with advanced chronic kidney disease (CKD) are either dose-limited or contraindicated due to safety and tolerability concerns. In gout patients with advanced CKD, the intestinal tract becomes the major route of urate elimination, in contrast to healthy people with normal kidney function whose kidneys are the primary route of uric acid excretion.1. Considering some of the limitations of present urate lowering therapies (ULTs) in gout & CKD and the extra-renal pathway of urate secretion, a new oral therapy with ALLN-346 (engineered urate oxidase) is under development as a non-absorbed, urate specific enzyme, designed to enhance degradation and secretion of urate in the intestinal tract. 2ObjectivesTo assess safety and tolerability and evidence for the lack of systemic absorption at various dose levels of ALLN-346 in normal healthy volunteers (NHV) up to 7 days.MethodsTwo randomized, double-blind Phase 1 studies of ALLN-346 or placebo were conducted in adult NHV in a domicile setting; a single-ascending dose (SAD) study of 3 doses on a single day of dosing, and a multiple ascending dose (MAD) study of 2 doses during 7 days (NCT04236219 and NCT04829435, respectively). In the SAD study, subjects received 3 ascending doses of ALLN-346 (3 capsules,6 capsules, and 6 capsules administered twice, or placebo) and were randomized 3:1 (ALLN-346:placebo, n=24). In the MAD study, subjects received 3 (Cohort A) or 5 (Cohort B) of ALLN-346 capsules or placebo (2:1 randomization, n=18) administered orally 3 times daily for 7 days. To assess possible ALLN-346 absorption, a specific ELISA and uricase potency assay were used on PK serum samples collected from all subjects in both studies pre-dose and at intervals post dose.ResultsIn both studies, all randomized subjects completed treatment with 100% compliance. ALLN-346 was well-tolerated, with no serious adverse events (AE) and with no clinically significant safety signals across all cumulative doses. Clinical and laboratory parameters revealed no clinically significant safety signals among all cumulative dosing cohorts across hematology, serum biochemistry, vital signs, or ECGs. The majority of reported AEs were mild with no pattern of differences between ALLN-346 and placebo. No evidence of systemic absorption of ALLN-346 was seen, as confirmed by both ELISA and by uricase potency assay of all PK serum samples from all subjects from SAD (n=240) and MAD (n=324).ConclusionALLN-346, a new oral enzyme therapy in development for the treatment of hyperuricemia and gout in advanced CKD was well tolerated. Consistent with its mechanism of action, no evidence of systemic absorption was demonstrated. Furtherstudies in hyperuricemia patients with gout and CKD are underway.References[1]Sorensen BL. Role of the intestinal tract in the elimination of uric acid. Arthritis and Rheumatism, vol 8, part5 1965[2]Pierzynowska K, Deshpande A, Mosiichuk N, et al. Oral Treatment with an Engineered Uricase, ALLN-346, Reduces Hyperuricemia, and Uricosuria in Urate Oxidase-Deficient Mice. Front Med (Lausanne). 2020 Nov 24;7:569215.Disclosure of InterestsDavid Clark Shareholder of: Allena, Employee of: Allena, Danica Grujic Shareholder of: Allena, Employee of: Allena, Christine Tosone Shareholder of: Allena, Employee of: Allena, Naomi Dahl Shareholder of: AbbVie (shares), Allena (options), Employee of: Allena, Robert Terkeltaub Consultant of: Allena, SOBI, Astra-Zeneca, Fortress, Grant/research support from: Astra-Zeneca
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Smith L, Brewer K, Gearing R, Carr L, Clark D, Robinson A, Roe D. Bipolar Stigma in Jewish Communities in the United States. Eur Psychiatry 2022. [PMCID: PMC9563669 DOI: 10.1192/j.eurpsy.2022.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction This study investigated differences in mood disorder public stigma endorsed by Jewish adults. Specifically, it examined the association between public stigma and the symptomatology and gender of individuals with mood disorders and characteristics of respondents. The symptomatology investigated included major depressive disorder and bipolar disorder presenting with mania or depression. The public stigma factors measured for mood disorders were recovery, relationship disruption, hygiene, anxiety, and treatment/professional efficacy. Objectives
Do symptomatology and gender predict stigma for mood disorders? For Jewish adults, do gender, age, religious characteristics, mental health history, and perceived stigma for mental illness predict their stigma toward individuals with mood disorders? Methods A convenience sample of 243 Jewish adults were randomly administered vignettes using a factorial design. MANCOVA was used for analysis. The Mental Illness Stigma Scale (Day et al., 2007) and the Devaluation of Consumer scale (Struening et al., 2001) were used to measure public and perceived stigma respectively. Results showed that recovery, relationship disruption, and hygiene stigmas were associated with vignette subject symptomatology, an interaction was found between respondent gender and age for treatability/professional efficacy stigma, and perceived stigma was correlated with public stigma factors. Consistent with previous research, the highest levels of stigma were found for individuals with bipolar disorder presenting with mania (Wolkenstein & Meyer, 2008). Conclusions These findings increase our knowledge of mood disorder stigma existing in the Jewish community and supports research showing that bipolar disorder presenting with mania is the most stigmatized type of mood disorder symptomatology (Wolkenstein & Meyer, 2008). Disclosure No significant relationships.
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Carruthers H, Clark D, Clarke FC, Faulds K, Graham D. Evaluation of laser direct infrared imaging for rapid analysis of pharmaceutical tablets. Anal Methods 2022; 14:1862-1871. [PMID: 35502820 DOI: 10.1039/d2ay00471b] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vibrational spectroscopic chemical imaging is an important tool in the pharmaceutical industry for characterising the spatial distribution of components within final drug products. The applicability of these techniques is currently limited by the long data acquisition times required to obtain high-definition chemical images of a sample surface. Advancements in quantum cascade laser (QCL) technology have provided an exciting new opportunity for infrared (IR) imaging. Instead of collecting a full IR spectrum at each point, it is possible to focus on distinct spectral bands to reduce imaging data collection time. This study explores a laser direct infrared (LDIR) chemical imaging approach that couples QCL technology with rapid scanning optics to provide high-definition chemical images at an order of magnitude faster than traditional imaging techniques. The capabilities of LDIR chemical imaging were evaluated for pharmaceutical formulations and compared with other established spectroscopic chemical imaging techniques including Raman, near-infrared (NIR) and scanning electron microscopy-energy dispersive X-ray (SEM-EDX) spectroscopy with regards to data acquisition time and image quality. The study showed that LDIR imaging provided high-definition component distribution maps comparable to Raman and SEM-EDX at orders of magnitude faster in terms of time. The ability to obtain high-definition chemical images of the whole tablet surface in relatively fast time frames indicates LDIR imaging could be a promising tool in the pharmaceutical industry to rapidly characterise the size and distribution of components within tablets and could help enhance drug product manufacturing understanding.
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Affiliation(s)
- Hannah Carruthers
- University of Strathclyde, Department of Pure and Applied Chemistry, George Street, Glasgow, G1 1RD, UK.
- Pfizer Ltd., Ramsgate Road, Sandwich, CT19 9NJ, UK
| | - Don Clark
- Pfizer Ltd., Ramsgate Road, Sandwich, CT19 9NJ, UK
| | | | - Karen Faulds
- University of Strathclyde, Department of Pure and Applied Chemistry, George Street, Glasgow, G1 1RD, UK.
| | - Duncan Graham
- University of Strathclyde, Department of Pure and Applied Chemistry, George Street, Glasgow, G1 1RD, UK.
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Pasala M, Anabtawi N, Grimshaw A, Clark D, Ubersax C, Williams G, Giri S. The impact of sarcopenia on survival among adults with hematologic malignancies: A systematic review and meta-analysis. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Rangarajan S, Clark D, Ubersax C, Ye S, Bal S, Godby K, Ravi G, Costa L, Williams G, Bhatia S, Giri S. Discordance between simplified Frailty Score and the IMWG frailty score among newly diagnosed older adults with Multiple Myeloma: Findings from the CARE-HEME registry. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cohen NS, Dinh D, Ajani A, Clark D, Brennan A, Nan Tie E, Dagan M, Hamilton G, Sebastian M, Shaw J, Oqueli E, Freeman M, Reid C, Stub D, Duffy SJ. Outcomes after percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (cabg). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with prior CABG requiring subsequent PCI there is uncertainty whether bypass grafts or native coronary arteries should be targeted.
Methods
We analysed data from 2,764 patients with prior CABG in the Melbourne Interventional Group registry (2005–2018), divided into two groups: those undergoing PCI to a native vessel (n=1,928) and those with PCI to a graft vessel (n=836).
Results
Patients with a graft vessel PCI were older, had more high-risk clinical characteristics (prior MI, heart failure, ejection fraction <50%, renal impairment, peripheral and cerebrovascular disease), and high-risk procedural features (ACC/AHA types B2/C lesions). However, patients in the native vessel group were more likely to have PCI to a chronic total occlusion. The majority of graft PCI were to saphenous vein grafts (84%), with 10% to radial and 6% to LIMA/RIMA grafts. Distal embolic protection devices were used in 30% of graft PCI. Patients with graft PCI had higher rates of no reflow (6.3% vs. 1.5%; p<0.001), coronary perforation (p=0.016) and inpatient stent thrombosis (p=0.028). However, 30-day mortality and major adverse cardiovascular and cerebrovascular events (MACCE) were similar. Unadjusted long-term mortality (median follow up 4.8 years) was higher in patients who had undergone a graft PCI (44% vs. 32%, p<0.001), but following Cox proportional hazards modelling, PCI vessel type was not a predictor of long-term mortality (HR 1.13; 95% CI 0.96–1.33, p=0.14).
Conclusions
Early clinical outcomes and risk-adjusted long-term mortality are similar for patients with prior CABG undergoing PCI to a native vessel or a bypass graft.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The Alfred Hospital
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Affiliation(s)
- N S Cohen
- The Alfred Hospital, Melbourne, Australia
| | - D Dinh
- Monash University, Melbourne, Australia
| | - A Ajani
- Royal Melbourne Hospital, Melbourne, Australia
| | - D Clark
- Austin Hospital, Melbourne, Australia
| | - A Brennan
- Monash University, Melbourne, Australia
| | - E Nan Tie
- The Alfred Hospital, Melbourne, Australia
| | - M Dagan
- The Alfred Hospital, Melbourne, Australia
| | | | | | - J Shaw
- The Alfred Hospital, Melbourne, Australia
| | - E Oqueli
- Ballarat Health Services, Ballarat, Australia
| | - M Freeman
- Eastern Health, Melbourne, Australia
| | - C Reid
- Monash University, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Melbourne, Australia
| | - S J Duffy
- The Alfred Hospital, Melbourne, Australia
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Saad S, Ahmed J, Drutel R, Clark D, Danrad R, Lelorier P. Correlation of signal averaged electrocardiography findings with fibrosis on cardiac magnetic resonance imaging. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Signal averaged electrocardiogram (SAECG) is a non invasive test to record delayed depolarization of myocardium with slow conduction that can potentially be the substrate for monomorphic ventricular tachycardia in high risk patients. Cardiac magnetic resonance imaging (cMRI) techniques for fibrosis imaging using late gadolinium enhancement (LGE) and T1 mapping remain the gold standard for characterization of myocardial tissue and triaging patients for risk of ventricular arrhythmias. However, cMRI remains unavailable in some areas, is time consuming, expensive and impossible for some patients to obtain due to claustrophobia, renal impairment or implanted hardware. To date, data is lacking with regards to correlation of findings between these two modalities.
Purpose
To investigate whether late potentials identified by SAECG correlate with the presence of fibrosis seen with cMRI. If correlation is established, SAECG could potentially be used as a non-invasive, cheaper, more convenient and readily available tool for risk stratification in patients at high risk for ventricular arrhythmias.
Methods
SAECGs were obtained in 25 consecutive patients undergoing cMRI. Patients with wide QRS (>120 ms) on ECG were excluded. Positive SAECG was defined as at least 1/3 abnormal criteria. Standard criteria were used. Results of the 2 modalities were compared. Sensitivity and specificity of SAECG for diagnosing fibrosis on cMRI were calculated.
Results
The mean age of the patients was 50.3±5.8 years and the mean ejection fraction was 48.9±5.8% as determined by cMRI. Forty-eight percent of the patients had fibrosis on cMRI by either LGE, T1 mapping or both. The sensitivity and specificity of SAECG were 75% and 100%, respectively. Seven patients had history of ventricular tachycardia and 6 patients had dilated cardiomyopathy.
Conclusion
SAECG is extremely specific in identifying patients with myocardial fibrosis on cMRI. A positive test may confer a lesser indication to pursue cMRI solely for purposes of risk stratification, and may correlate with risk of ventricular arrhythmia.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Saad
- LSU Health Science Center, Cardiology, New Orleans, United States of America
| | - J Ahmed
- LSU Health Science Center, Cardiology, New Orleans, United States of America
| | - R Drutel
- LSU Health Science Center, Cardiology, New Orleans, United States of America
| | - D Clark
- LSU Health Science Center, Cardiology, New Orleans, United States of America
| | - R Danrad
- LSU Health Science Center, Cardiology, New Orleans, United States of America
| | - P Lelorier
- LSU Health Science Center, Cardiology, New Orleans, United States of America
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Nan Tie E, Dinh D, Clark D, Ajani AE, Brennan A, Cohen N, Dagan M, Shaw J, Sebastian M, Freeman M, Oqueli E, Reid C, Kaye D, Stub D, Duffy SJ. Trends in intra-aortic balloon pump use in cardiogenic shock in the post-SHOCK II trial era. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial infarction complicated by cardiogenic shock (MI-CS) has a poor prognosis, even with early revascularisation. Previously, intra-aortic balloon pump (IABP) use was thought to improve outcomes, but the SHOCK-II trial in 2012 found no survival benefit.
Purpose
This study aimed to determine the trends in IABP use in patients with MI-CS undergoing percutaneous intervention (PCI) over time and characteristics associated with use.
Methods
Between 2005–2018, patients presenting with MI-CS that underwent percutaneous coronary intervention (PCI) at a hospital participating in the Melbourne Interventional Group Registry were included. The primary outcome was the trend in IABP use over time. Secondary outcomes included mortality, 30-day MACCE (major adverse cardiovascular and cerebrovascular events) and predictors of outcome, determined via logistic regression.
Results
Of the 1,110 patients identified, IABP was used in 478 (43%). IABP was used more in patients with left main and left anterior descending culprit lesions (62% vs. 46%), lower ejection fraction (<35%; 18% vs. 11%), and pre-procedural inotrope use (81% vs. 73%), all p<0.05. IABP use was associated with higher inpatient bleeding (18% vs. 13%) and 30-day MACCE (58% vs. 51%), both p<0.05. The rate of MI-CS increased over time, but after 2012 there was a decline in IABP use (Figure 1). IABP use was a predictor of 30-day MACCE (OR 1.6, 95% CI 1.18–2.29, p=0.003). However, IABP was not associated with in-hospital, 30-day or long-term mortality (45% vs. 47%, p=0.44; 46% vs. 50%, p=0.25; 60% vs. 62%, p=0.39).
Conclusions
Consistent with the SHOCK II trial, IABP use is not associated with reduced short- or long-term mortality, but in this study was associated with increased short-term adverse events. IABP use is declining, but is still used in sicker patients with greater myocardium at risk, given limited alternatives.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Melbourne interventional group
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Affiliation(s)
- E Nan Tie
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - D Dinh
- Monash University, Melbourne, Australia
| | - D Clark
- Austin Hospital, Melbourne, Australia
| | - A E Ajani
- Royal Melbourne Hospital, Melbourne, Australia
| | - A Brennan
- Monash University, Melbourne, Australia
| | - N Cohen
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - M Dagan
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - J Shaw
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | | | - M Freeman
- Eastern Health, Melbourne, Australia
| | - E Oqueli
- Ballarat Health Services, Ballarat, Australia
| | - C Reid
- Monash University, Melbourne, Australia
| | - D Kaye
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - S J Duffy
- The Alfred Hospital, Cardiology, Melbourne, Australia
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Biddle K, Koushesh S, Blundell A, Clark D, Krishna S, Sofat N. POS1195 ASSESSING ANTIBODY STATUS FOR SARS-CoV-2 IN PEOPLE WITH CORONAVIRUS INFECTION: A TIME COURSE STUDY IN PEOPLE WITH AUTOIMMUNE CONDITIONS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:With the emergence of the global coronavirus pandemic, increasing concerns have been raised about the course of SARS-CoV-2 infection in people with immune-mediated disorders.Objectives:In this study we aimed to assess the time course of proven SARS-CoV-2 infection, development of humoral immunity with detectable antibodies to the virus and evaluate any changes in antibody titres over time.Methods:We recruited 114 participants in total who had potential symptoms of Covid-19 infection. Participants were recruited from rheumatology or inflammatory bowel disease (IBD) clinics from their records who attended a London Teaching hospital for care. Ethical Approval was in place for the study. Age- and gender- matched control participants without any underlying rheumatological condition/IBD were recruited as a comparator group. Clinical symptoms for Covid-19 infection were assessed using the Covid-19 Rheumatology Global Alliance assessment criteria (https://rheum-covid.org/). Information about Disease Modifying Anti-Rheumatic Drug (DMARD) drug use was also recorded. Participants’ serum samples were collected for quantitative serological assessment of antibodies to SARS-CoV-2 using the Mologic Enzyme-Linked ImmunoSorbent Assay (ELISA) IgG kit. The optical density values were plotted aganist time using a normalisation as previously described (1). A cut-off above 0 indicated positive serology.Results:A total of 114 subjects were recruited into the study. Subjects were recruited if they had suspected Covid symptoms. Of the population recruited, the total number subsequently testing positive for SARS-CoV-2 was n=59 (either on serology or PCR). The number of subjects with autoimmune conditions diagnosed with Covid-19 was 32, with 30 subjects being symptomatic (the asymptomatic 2 subjects were excluded from further analyses). Of the 30 symptomatic subjects, the average age was 56, with a female to male ratio of 19:11. The most prevalent diagnoses were RA (30%), Psoriatic Arthritis (16.7%), SLE (10%), sarcoidosis 10%), Ulcerative Colitis (10%), Crohn’s disease (10%), seronegative inflammatory arthritis (6.7%), Sjogren’s (3.3%) and Juvenile Idiopathic Arthritis (3.3%). The majority were on csDMARDs (60%), biologic DMARDs (20%), tacrolimus (3.3%) and the remaining 16.7% were not on DMARDs. Most subjects required treatment in hospital (56.7%), a smaller number required high dependency care (6.7%) and the rest were treated at home (36.6%). The majority required no oxygen (63.3%), with a further 30% requiring oxygen and 6.7% needed more supportive care i.e. CPAP/ventilation. We also had a matched control group (n=29) of subjects who developed SARS-CoV-2 but had no underlying autoimmune conditions. These subjects had a mean age of 55, female: male ratio 18: 11. Of these 31% had home management, 55.2% had ward level treatments and 13.8% had intensive care treatment. Of the controls, 48.3% did not require oxygen, 37.9% needed simple oxygen and 13.8% were on CPAP. A total of 35 subjects from the original study have attended for follow-up visits. Antibody titres for IgG using the Mologic ELISA detection assay were compared at two visits for the control and autoimmune group. Results showed that subjects with autoimmune conditions and those without who developed SARS-CoV-2 showed very similar antibody titres by optical density (OD) (Figure 1) and maintained antibody responses beyond 6 months in most cases.Conclusion:Serological assays can assist in the understanding of disease severity of SAR-CoV-2 infection. They can be a useful tool for patient surveillance, especially in people who are on immunomodulatory drugs and are being seen in Rheumatology services. Future work is needed to assess the duration and potential protective nature of humoral antibody responses to SARS-CoV-2.References:[1]Staines HM, Kirwan D, Clark DJ et al. Dynamics of IgG seroconversion and pathophysiology of COVID:19 infections. medRxiv preprint doi: https://doi.org/10.1101/2020.06.07.20124636.Disclosure of Interests:Kathryn Biddle: None declared, Soraya Koushesh: None declared, Anna Blundell: None declared, David Clark: None declared, Sanjeev Krishna: None declared, Nidhi Sofat Consultant of: Advisory work for Pfizer and Eli Lilly, Grant/research support from: Received grants from Bristol Myers Squibb and Pfizer for Investigator Initiated Studies.
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Lau S, Kong J, Bell S, Heriot A, Stevenson A, Moloney J, Hayes J, Merrie A, Eglinton T, Guest G, Clark D, Warrier S. Transanal mesorectal excision: early outcomes in Australia and New Zealand. Br J Surg 2021; 108:214-219. [PMID: 33711138 DOI: 10.1093/bjs/znaa098] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transanal total mesorectal excision (taTME) aims to overcome some of the technical challenges faced when operating on mid and low rectal cancers. Specimen quality has been confirmed previously, but recent concerns have been raised about oncological safety. This multicentre prospective study aimed to evaluate the safety of taTME among early adopters in Australia and New Zealand. METHODS Data from all consecutive patients who had taTME for rectal cancer from July 2014 to February 2020 at six tertiary referral centres in Australasia were recorded and analysed. RESULTS A total of 308 patients of median age of 64 years underwent taTME. Some 75.6 per cent of patients were men, and the median BMI was 26.8 kg/m2. The median distance of tumour from anal verge was 7 cm. Neoadjuvant chemoradiotherapy was administered to 57.8 per cent of patients. The anastomotic leak rate was 8.1 per cent and there was no mortality within 30 days of surgery. Pathological examination found a complete mesorectum in 295 patients (95.8 per cent), a near-complete mesorectum in seven patients (2.3 per cent), and an incomplete mesorectum in six patients (1.9 per cent). The circumferential resection margin and distal resection margin was involved in nine patients (2.9 per cent), and two patients (0.6 per cent) respectively. Over a median follow-up of 22 months, the local recurrence rate was 1.9 per cent and median time to local recurrence was 30.5 months. CONCLUSION This study showed that, with appropriate training and supervision, skilled minimally invasive rectal cancer surgeons can perform taTME with similar pathological and oncological results to open and laparoscopic surgery.
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Affiliation(s)
- S Lau
- Department of Surgery, University Hospital Geelong, Geelong, Victoria, Australia
| | - J Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - S Bell
- Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - A Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A Stevenson
- Department of Surgery, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - J Moloney
- Department of Surgery, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - J Hayes
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - A Merrie
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - T Eglinton
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - G Guest
- Department of Surgery, University Hospital Geelong, Geelong, Victoria, Australia
| | - D Clark
- Department of Surgery, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - S Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia
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Abstract
The prevalence of periodontal disease increases with age. Systemic inflammatory dysregulation also increases with age and has been reported to contribute to the myriad of diseases and conditions that become more prevalent with advanced age. As periodontal disease involves a dysregulated host inflammatory response, the age-related inflammatory dysregulation may contribute to the pathogenesis of periodontal disease in aging populations. However, our understanding of what drives the age-related inflammatory dysregulation is limited. Here, we investigate the macrophage and its contribution to periodontal disease in old and young mice using a ligature-induced periodontal disease model. We demonstrate that control old mice present with an aged periodontal phenotype, characterized by increased alveolar bone loss and increased local inflammatory cytokine expression compared to young mice. Macrophages were demonstrated to be present in the periodontium of old and young mice in equal numbers in controls, during disease induction, and during disease recovery. However, it appears age may have a detrimental effect on macrophage activity during disease recovery. Depletion of macrophages during disease recovery in old mice resulted in decreased inflammatory cytokines within the gingiva and decreased bone loss as measured by micro-computed tomography. In young mice, macrophage depletion during disease recovery had no beneficial or detrimental effect. Macrophage depletion during disease induction resulted in decreased disease severity similarly in young and old mice. Findings from this work support the diverse roles of macrophages in disease induction as well as the active roles of disease recovery, including the resolution of inflammation. Here, we conclude that age-related changes to the macrophage appear to be detrimental to the recovery from disease and may explain, in part, the age-related increase in prevalence of periodontal disease. Future studies examining the specific intrinsic age-related changes to the macrophage will help identify therapeutic targets.
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Affiliation(s)
- D Clark
- Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - B Halpern
- Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - T Miclau
- Orthopaedic Trauma Institute, University of California San Francisco, San Francisco, CA, USA
| | - M Nakamura
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.,Arthritis/Immunology Section, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Y Kapila
- Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - R Marcucio
- Orthopaedic Trauma Institute, University of California San Francisco, San Francisco, CA, USA
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Singla DR, Meltzer-Brody SE, Silver RK, Vigod SN, Kim JJ, La Porte LM, Ravitz P, Schiller CE, Schoueri-Mychasiw N, Hollon SD, Kiss A, Clark D, Dalfen AK, Dimidjian S, Gaynes BN, Katz SR, Lawson A, Leszcz M, Maunder RG, Mulsant BH, Murphy KE, Naslund JA, Reyes-Rodríguez ML, Stuebe AM, Dennis CL, Patel V. Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) through non-specialist providers and telemedicine: a study protocol for a non-inferiority randomized controlled trial. Trials 2021; 22:186. [PMID: 33673867 PMCID: PMC7933917 DOI: 10.1186/s13063-021-05075-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/28/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Depression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to non-specialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven. METHODS This study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist, telemedicine non-specialist, in-person specialist, in-person non-specialist), stratified by pregnancy status (antenatal/postnatal) and study site. The primary outcome is participant-reported depressive symptoms (EPDS) at 3 months post-randomization. Secondary outcomes are maternal symptoms of anxiety and trauma symptoms, perceived social support, activation levels and quality of life at 3-, 6-, and 12-month post-randomization, and depressive symptoms at 6- and 12-month post-randomization. Primary analyses are per-protocol and intent-to-treat. The study has successfully continued despite the COVID-19 pandemic, with needed adaptations, including temporary suspension of the in-person arms and ongoing randomization to telemedicine arms. DISCUSSION The SUMMIT trial is expected to generate evidence on the non-inferiority of BA delivered by a non-specialist provider compared to specialist and telemedicine compared to in-person. If confirmed, results could pave the way to a dramatic increase in access to treatment for perinatal depression and anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT04153864 . Registered on November 6, 2019.
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Affiliation(s)
- D R Singla
- Department of Psychiatry, Sinai Health and Lunenfeld Tanenbaum Research Institute, Toronto, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - S E Meltzer-Brody
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - R K Silver
- Department of Obstetrics & Gynecology, NorthShore University HealthSystem, Chicago, IL, USA
| | - S N Vigod
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital and Research Institute, Toronto, Canada
| | - J J Kim
- Department of Obstetrics & Gynecology, NorthShore University HealthSystem, Chicago, IL, USA
- Department of Obstetrics & Gynecology, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - L M La Porte
- Department of Obstetrics & Gynecology, NorthShore University HealthSystem, Chicago, IL, USA
| | - P Ravitz
- Department of Psychiatry, Sinai Health and Lunenfeld Tanenbaum Research Institute, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - C E Schiller
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - N Schoueri-Mychasiw
- Department of Psychiatry, Sinai Health and Lunenfeld Tanenbaum Research Institute, Toronto, Canada
| | - S D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - A Kiss
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - D Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - A K Dalfen
- Department of Psychiatry, Sinai Health and Lunenfeld Tanenbaum Research Institute, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - S Dimidjian
- Renee Crown Wellness Institute and Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA
| | - B N Gaynes
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - S R Katz
- Department of Psychiatry, Sinai Health and Lunenfeld Tanenbaum Research Institute, Toronto, Canada
| | - A Lawson
- Department of Obstetrics & Gynecology, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - M Leszcz
- Department of Psychiatry, Sinai Health and Lunenfeld Tanenbaum Research Institute, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - R G Maunder
- Department of Psychiatry, Sinai Health and Lunenfeld Tanenbaum Research Institute, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - B H Mulsant
- Department of Obstetrics and Gynecology, Sinai Health and University of Toronto, Toronto, Canada
| | - K E Murphy
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - J A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - M L Reyes-Rodríguez
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - A M Stuebe
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, USA
| | - C-L Dennis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - V Patel
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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21
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Carruthers H, Clark D, Clarke F, Faulds K, Graham D. Comparison of Raman and Near-Infrared Chemical Mapping for the Analysis of Pharmaceutical Tablets. Appl Spectrosc 2021; 75:178-188. [PMID: 32757763 DOI: 10.1177/0003702820952440] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Raman and near-infrared (NIR) chemical mapping are widely used methods in the pharmaceutical industry to understand the distribution of components within a drug product. Recent advancements in instrumentation have enabled the rapid acquisition of high-resolution images. The comparison of these techniques for the analysis of pharmaceutical tablets has not recently been explored and thus the relative performance of each technique is not currently well defined. Here, the differences in the chemical images obtained by each method are assessed and compared with scanning electron microscopy with energy dispersive X-ray microanalysis (SEM-EDX), as an alternative surface imaging technique to understand the ability of each technique to acquire a chemical image representative of the sample surface. It was found that the Raman data showed the best agreement with the spatial distribution of components observed in the SEM-EDX images. Quantitative and qualitative comparison of the Raman and NIR images revealed a very different spatial distribution of components with regards to domain size and shape. The Raman image exhibited sharper and better discriminated domains of each component, whereas the NIR image was heavily dominated by large pixelated domains. This study demonstrated the superiority of using Raman chemical mapping compared with NIR chemical mapping to produce a chemical image representative of the sample surface using routinely available instrumentation to obtain a better approximation of domain size and shape. This is fundamental for understanding knowledge gaps in current manufacturing processes; particularly relating the relationship between components in the formulation, processing condition, and final characteristics. By providing a means to more accurately visualize the components within a tablet matrix, these areas can all be further understood.
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Affiliation(s)
- Hannah Carruthers
- Department of Pure and Applied Chemistry, University of Strathclyde, Glasgow, UK
- Pfizer Ltd, Sandwich, UK
| | | | | | - Karen Faulds
- Department of Pure and Applied Chemistry, University of Strathclyde, Glasgow, UK
| | - Duncan Graham
- Department of Pure and Applied Chemistry, University of Strathclyde, Glasgow, UK
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22
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Zylstra AB, Kritcher AL, Hurricane OA, Callahan DA, Baker K, Braun T, Casey DT, Clark D, Clark K, Döppner T, Divol L, Hinkel DE, Hohenberger M, Kong C, Landen OL, Nikroo A, Pak A, Patel P, Ralph JE, Rice N, Tommasini R, Schoff M, Stadermann M, Strozzi D, Weber C, Young C, Wild C, Town RPJ, Edwards MJ. Record Energetics for an Inertial Fusion Implosion at NIF. Phys Rev Lett 2021; 126:025001. [PMID: 33512226 DOI: 10.1103/physrevlett.126.025001] [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] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/27/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
Inertial confinement fusion seeks to create burning plasma conditions in a spherical capsule implosion, which requires efficiently absorbing the driver energy in the capsule, transferring that energy into kinetic energy of the imploding DT fuel and then into internal energy of the fuel at stagnation. We report new implosions conducted on the National Ignition Facility (NIF) with several improvements on recent work [Phys. Rev. Lett. 120, 245003 (2018)PRLTAO0031-900710.1103/PhysRevLett.120.245003; Phys. Rev. E 102, 023210 (2020)PRESCM2470-004510.1103/PhysRevE.102.023210]: larger capsules, thicker fuel layers to mitigate fuel-ablator mix, and new symmetry control via cross-beam energy transfer; at modest velocities, these experiments achieve record values for the implosion energetics figures of merit as well as fusion yield for a NIF experiment.
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Affiliation(s)
- A B Zylstra
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A L Kritcher
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - O A Hurricane
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D A Callahan
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Baker
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - T Braun
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D T Casey
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Clark
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Clark
- General Atomics, San Diego, California 92121, USA
| | - T Döppner
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - L Divol
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D E Hinkel
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Hohenberger
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Kong
- General Atomics, San Diego, California 92121, USA
| | - O L Landen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Nikroo
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Pak
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P Patel
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J E Ralph
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Rice
- General Atomics, San Diego, California 92121, USA
| | - R Tommasini
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Schoff
- General Atomics, San Diego, California 92121, USA
| | - M Stadermann
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Strozzi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Weber
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Young
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Wild
- Diamond Materials Gmbh, 79108 Freiburg, Germany
| | - R P J Town
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M J Edwards
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
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23
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Nezafati P, Dinh D, Duffy S, Reid C, Ajani A, Clark D, Brennan A, Hiew C, Freeman M, Roberts L, Sharma A, Oqueli E. Percutaneous Coronary Intervention Outcomes Based on American College of Cardiology/American Heart Association Coronary Lesion Classification Over 14 Years – Melbourne Interventional Group (MIG) Registry. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Sampaio RT, Koshy A, Gow P, Clark D, Horrigan M, Farouque O. Feasibility and Safety of Drug-Eluting Stent Implantation in Patients with End-Stage Liver Disease Prior to Liver Transplantation. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Liang D, Dinh D, Gayed D, Tan M, Clark D, Duffy S, Brennan A, Ajani A, Oquiel E, Roberts L, Cooke J, Reid C, Chandrasekhar J, Freeman M. Are Public Holidays, Sporting Events and Significant Historical Events Triggers of ST-elevation Myocardial Infarction (STEMI) Presentations in Victoria? A Melbourne Interventional Group (MIG) Observational Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Toner L, Sampaio Rodrigues T, Undrill S, Ajani A, Yeoh J, Clark D. Takotsubo Cardiomyopathy Complicated by Cardiogenic Shock Secondary to Left Ventricular Outflow Tract Obstruction and Severe Mitral Regurgitation. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Liew S, Dinh D, Brennan A, Reid C, Duffy S, Oqueli E, Ajani A, Clark D, Freeman M, Hiew C, Jaworski C, Hutchison A, Mok M, Sebastian M. Ultrathin Strut, Biodegradable-Polymer, Sirolimus-Eluting Stents versus Thin-Strut, Durable-Polymer, Drug-Eluting Stents for Percutaneous Coronary Revascularisation in the ST-Elevation Myocardial Infarction (STEMI) Population. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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28
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Gayed D, Dinh D, Liang D, Tan M, Oquiel E, Duffy S, Ajani A, Brennan A, Clark D, Roberts L, Reid C, Freeman M. Is There a Mortality Benefit of Statin Use for Secondary Prevention of Coronary Artery Disease (CAD) in an Older Population? Insights from the Melbourne Interventional Group (MIG) Registry. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.302] [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: 11/24/2022]
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29
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Tan M, Dinh D, Gayed D, Liang D, Brennan A, Duffy S, Clark D, Ajani A, Oqueli E, Roberts L, Reid C, Freeman M, Chandrasekhar J. Associations Between DAPT Score and Long-term Mortality Post PCI. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.260] [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: 11/29/2022]
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Dawson L, Dinh D, Duffy S, Brennan A, Guymer E, Clark D, Oqueli E, Freeman M, Hiew C, Reid C, Ajani A. Long-term outcomes following percutaneous coronary intervention for patients with rheumatoid arthritis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Rheumatoid arthritis (RA) is the most common inflammatory arthritis and is associated with increased risk of cardiovascular events and mortality. Despite this, data regarding long-term outcomes following percutaneous coronary intervention (PCI) are limited.
Methods
We identified 756 patients with RA from the Melbourne Interventional Group PCI registry (2005–2018) and compared outcomes to the remaining cohort (N=38,579). Cox regression analysis was performed to assess risk of adverse cardiac events including long-term mortality (derived from linkage with the National Death Index [NDI]).
Results
Patients with RA were older (68.9±10.0 vs. 64.6±12.0 years) and more often female (40% vs. 23%), with higher rates of hypertension (70% vs 67%), previous stroke (9% vs 6%), peripheral vascular disease (9% vs 6%), obstructive sleep apnoea (10% vs 5%), chronic lung disease (22% vs 12%), prior myocardial infarction (32% vs 27%), and impaired renal function (eGFR<60 ml/min/1.73m2 in 31% vs 24%), while rates of current smoking were lower (20% vs. 25%), all p<0.05. Lesions were more frequently complex (ACC/AHA type B2/C in 61% vs 57%), required longer stents (>20mm in 39% vs 35%), and rates of no reflow were higher (5% vs 3%), all p<0.05. 30-day mortality was higher (4.4% vs. 3.3%, p=0.04) mainly owing to higher non-cardiac mortality (1.6% vs. 0.8%, p=0.01). National Death Index-linked long-term mortality was 28% vs. 19% (p<0.01) with mean follow-up 4.6 vs. 5.4 years. Risk of 30-day and long-term mortality (including by indication subgroup) are presented in the Table.
Conclusions
Patients with RA undergoing PCI have more comorbidities and longer, more complex coronary lesions. After adjustment, risk of short-term adverse outcomes are similar, while risk of long-term mortality is higher, particularly among patients with acute coronary syndromes.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Dawson
- Royal Melbourne Hospital, Melbourne, Australia
| | - D Dinh
- Monash University, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia
| | - S.J Duffy
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - A Brennan
- Monash University, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia
| | - E Guymer
- Monash Health, Rheumatology, Melbourne, Australia
| | - D Clark
- Austin Hospital, Cardiology, Melbourne, Australia
| | - E Oqueli
- Deakin University, Melbourne, Australia
| | - M Freeman
- Box Hill Hospital, Cardiology, Melbourne, Australia
| | - C Hiew
- Geelong Hospital, Cardiology, Geelong, Australia
| | - C Reid
- Monash University, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia
| | - A.E Ajani
- Royal Melbourne Hospital, Melbourne, Australia
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Clark D, Goodwin PC. Rehabilitation of Watson-Jones proximal tibial avulsion injury in elite academy level football: A report of two separate cases in one season. Phys Ther Sport 2020; 46:23-29. [PMID: 32871361 DOI: 10.1016/j.ptsp.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Watson-Jones proximal tibial avulsion injuries occur more frequently in athletic and muscular adolescent males. However, they are rare and therefore infrequently described in the medical literature. Two of these injuries occurred in a Category 1 football academy in the same season within a six-month period. We have described the cases with the hope of better informing other clinicians should they encounter this injury. METHODS This case report describes the injury mechanism, surgical management and rehabilitation for the two cases [Players A and B]. Outcomes measures including player speed, agility and power were compared with scores from players of the same age group at the time of injury in the Premier League academies. Risk factors are also discussed. RESULTS Both players were managed surgically, initially. Player B had the surgical fixation removed during rehabilitation. Player A still has the fixation in situ. Post-surgery, player A returned to full play at thirty-two weeks and thirty-eight weeks for player B. No critical incidents occurred during rehabilitation. CONCLUSION Watson-Jones avulsion fractures, although rare, can be managed successfully. Athletes can achieve a successful return to play at their previous level.
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Affiliation(s)
- D Clark
- Manchester City Football Club, 400 Ashton New Road, Manchester, M11 4TQ, UK.
| | - P C Goodwin
- Department of Health Professions, Manchester Metropolitan University, 53 Bonsall St Manchester, M15 6GX, UK.
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32
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Baker KL, Thomas CA, Casey DT, Hohenberger M, Khan S, Spears BK, Landen OL, Nora R, Woods DT, Milovich JL, Berger RL, Strozzi D, Weber C, Clark D, Hurricane OA, Callahan DA, Kritcher AL, Bachmann B, Benedetti LR, Bionta R, Celliers PM, Fittinghoff D, Goyon C, Hatarik R, Izumi N, Gatu Johnson M, Kyrala G, Ma T, Meaney K, Millot M, Nagel SR, Patel PK, Turnbull D, Volegov PL, Yeamans C, Wilde C. Hotspot parameter scaling with velocity and yield for high-adiabat layered implosions at the National Ignition Facility. Phys Rev E 2020; 102:023210. [PMID: 32942378 DOI: 10.1103/physreve.102.023210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
This paper presents a study on hotspot parameters in indirect-drive, inertially confined fusion implosions as they proceed through the self-heating regime. The implosions with increasing nuclear yield reach the burning-plasma regime, hotspot ignition, and finally propagating burn and ignition. These implosions span a wide range of alpha heating from a yield amplification of 1.7-2.5. We show that the hotspot parameters are explicitly dependent on both yield and velocity and that by fitting to both of these quantities the hotspot parameters can be fit with a single power law in velocity. The yield scaling also enables the hotspot parameters extrapolation to higher yields. This is important as various degradation mechanisms can occur on a given implosion at fixed implosion velocity which can have a large impact on both yield and the hotspot parameters. The yield scaling also enables the experimental dependence of the hotspot parameters on yield amplification to be determined. The implosions reported have resulted in the highest yield (1.73×10^{16}±2.6%), yield amplification, pressure, and implosion velocity yet reported at the National Ignition Facility.
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Affiliation(s)
- K L Baker
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C A Thomas
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - D T Casey
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Hohenberger
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Khan
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B K Spears
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - O L Landen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Nora
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D T Woods
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J L Milovich
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R L Berger
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Strozzi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Weber
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Clark
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - O A Hurricane
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D A Callahan
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A L Kritcher
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B Bachmann
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - L R Benedetti
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Bionta
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P M Celliers
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Fittinghoff
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Goyon
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Hatarik
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Izumi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Gatu Johnson
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - G Kyrala
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T Ma
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Meaney
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Millot
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S R Nagel
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P K Patel
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Turnbull
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - P L Volegov
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C Yeamans
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Wilde
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
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Warrier SK, Bell S, Guest G, Heriot A, Kong JC, Eglinton TW, Hayes J, Merrie A, Clark D, Stevenson A. Locoregional recurrences after transanal total mesorectal excision of rectal cancer during the exploration phase. Br J Surg 2020; 107:e353. [DOI: 10.1002/bjs.11753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/07/2022]
Affiliation(s)
- S K Warrier
- Division of Cancer Surgery, Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Surgery, Alfred Hospital, Melbourne, Australia
| | - S Bell
- Department of Surgery, Alfred Hospital, Melbourne, Australia
| | - G Guest
- Department of Surgery, Geelong University Hospital, Geelong, Victoria, Australia
| | - A Heriot
- Division of Cancer Surgery, Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J C Kong
- Division of Cancer Surgery, Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T W Eglinton
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - J Hayes
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - A Merrie
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - D Clark
- Department of Surgery, University of Queensland, Brisbane, Queensland, Australia
| | - A Stevenson
- Department of Surgery, University of Queensland, Brisbane, Queensland, Australia
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Lo STH, Yong AS, Sinhal A, Shetty S, McCann A, Clark D, Galligan L, El-Jack S, Sader M, Tan R, Hallani H, Barlis P, Sechi R, Dictado E, Walton A, Starmer G, Bhagwandeen R, Leung DY, Juergens CP, Bhindi R, Muller DWM, Rajaratnum R, French JK, Kritharides L. Consensus guidelines for interventional cardiology services delivery during covid-19 pandemic in Australia and new Zealand. Heart Lung Circ 2020; 29:e69-e77. [PMID: 32471696 PMCID: PMC7202321 DOI: 10.1016/j.hlc.2020.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The global coronavirus disease (COVID-19) pandemic poses an unprecedented stress on healthcare systems internationally. These Health system-wide demands call for efficient utilisation of resources at this time in a fair, consistent, ethical and efficient manner would improve our ability to treat patients. Excellent co-operation between hospital units (especially intensive care unit [ICU], emergency department [ED] and cardiology) is critical in ensuring optimal patient outcomes. The purpose of this document is to provide practical guidelines for the effective use of interventional cardiology services in Australia and New Zealand. The document will be updated regularly as new evidence and knowledge is gained with time. Goals Considerations.
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Affiliation(s)
- S T H Lo
- Department of Cardiology, Liverpool Hospital, NSW, Australia.
| | - A S Yong
- Department of Cardiology, Concord Repatriation General Hospital, NSW, Australia; University of Sydney, Australia
| | - A Sinhal
- Flinders Medical Centre, SA, Australia
| | - S Shetty
- Department of Cardiology, Fiona Stanley Hospital, WA, Australia
| | - A McCann
- Department of Cardiology, Princess Alexandra Hospital, QLD, Australia; University of Queensland, Australia
| | - D Clark
- Department of Cardiology, Austin Hospital, VIC, Australia
| | - L Galligan
- Department of Cardiology, Royal Hobart Hospital, TAS, Australia
| | - S El-Jack
- Department of Cardiology, North Shore Hospital, New Zealand
| | - M Sader
- University of Sydney, Australia; Department of Cardiology, St George Hospital, NSW, Australia
| | - R Tan
- Department of Cardiology, The Canberra Hospital, ACT, Australia
| | - H Hallani
- Department of Cardiology, The Canberra Hospital, ACT, Australia
| | - P Barlis
- Department of Cardiology, Nepean Hospital, NSW, Australia; Department of Cardiology, The Northern Hospital, VIC, Australia; Department of Cardiology, St Vincents' Hospital, VIC, Australia; University of Melbourne, VIC, Australia
| | - R Sechi
- Department of Nursing, Liverpool Hospital, NSW, Australia
| | - E Dictado
- Department of Nursing, Liverpool Hospital, NSW, Australia
| | - A Walton
- Department of Cardiology, Alfred Hospital, VIC, Australia; Monash University, VIC, Australia
| | - G Starmer
- Department of Cardiology, Cairns Hospital, QLD, Australia
| | - R Bhagwandeen
- Department of Cardiology, John Hunter Hospital, NSW, Australia; Lake Macquarie Private Hospital, NSW, Australia
| | - D Y Leung
- Department of Cardiology, Liverpool Hospital, NSW, Australia; University of New South Wales, NSW, Australia
| | - C P Juergens
- Department of Cardiology, Liverpool Hospital, NSW, Australia; University of New South Wales, NSW, Australia
| | - R Bhindi
- University of Sydney, Australia; Department of Cardiology, Royal North Shore Hospital, NSW, Australia
| | - D W M Muller
- University of New South Wales, NSW, Australia; St Vincent's Hospital, NSW, Australia
| | - R Rajaratnum
- Department of Cardiology, Liverpool Hospital, NSW, Australia; University of New South Wales, NSW, Australia; Western Sydney University, NSW, Australia
| | - J K French
- Department of Cardiology, Liverpool Hospital, NSW, Australia; University of New South Wales, NSW, Australia; Western Sydney University, NSW, Australia
| | - L Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, NSW, Australia; University of Sydney, Australia; ANZAC Medical Research Institute, Australia
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Hisler G, Pedersen S, Clark D, Rothenberger S, Hasler B. 0216 Is There a Daily Rhythm in Alcohol Craving and Does It Vary by Circadian Timing? Sleep 2020. [DOI: 10.1093/sleep/zsaa056.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
People with later circadian timing tend to consume more alcohol, potentially due to altered rhythms in when and how much they crave alcohol throughout the day. However, whether circadian factors play a role in alcohol craving has received scant attention. Here, we investigated if the daily rhythm of alcohol craving varied by circadian timing in two independent studies of late adolescent and young adult drinkers.
Methods
In Study 1, 32 participants (18–22 years of age; 61% female; 69% White) completed momentary reports of alcohol craving five times a day for 14 days. Participants wore wrist actigraphs and completed two in-lab assessments of dim light melatonin onset (DLMO). Average actigraphically-assessed midpoint of sleep on weekends and average DLMO were used as indicators of circadian timing. In Study 2, 231 participants (21–35 years of age; 28% female; 71% White) completed momentary reports of alcohol craving six times a day for 10 days. Average midpoint of self-reported time-in-bed on weekends was used to estimate circadian timing.
Results
Multilevel cosinor analysis revealed a 24-hour daily rhythm in alcohol craving which was moderated by circadian timing in both studies (p’s<0.05). In both Study 1 and 2, people with later circadian timing had a later timed peak of craving. In Study 1, but not Study 2, later circadian timing predicted a blunted amplitude in craving.
Conclusion
Findings support a daily rhythm in craving that varies by individual differences in circadian timing. Because craving is an important predictor of future alcohol use, the findings implicate circadian factors as a useful area to advance alcohol research and potentially improve interventions.
Support
R21AA023209; R01DA044143; K01AA021135; ABMRF/The Foundation for Alcohol Research.
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Affiliation(s)
- G Hisler
- University of Pittsburgh, Pittsburgh, PA
| | - S Pedersen
- University of Pittsburgh, Pittsburgh, PA
| | - D Clark
- University of Pittsburgh, Pittsburgh, PA
| | | | - B Hasler
- University of Pittsburgh, Pittsburgh, PA
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Borton Z, Shivji F, Simeen S, Williams R, Tambe A, Espag M, Cresswell T, Clark D. Diabetic patients are almost twice as likely to experience complications from arthroscopic rotator cuff repair. Shoulder Elbow 2020; 12:109-113. [PMID: 32313560 PMCID: PMC7153207 DOI: 10.1177/1758573219831691] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 10/24/2018] [Accepted: 01/25/2019] [Indexed: 11/15/2022]
Abstract
AIMS Large population-based studies have demonstrated increased prevalence of rotator cuff disease amongst diabetics. Recent studies have suggested comparable clinical outcomes from rotator cuff repair despite suggestions of increased complication rates amongst diabetics. However, there is a relative paucity of studies considering the effect of diabetes upon complication rate. We aim to report and quantify the effect of diabetes on complication rates following arthroscopic rotator cuff repair. MATERIALS AND METHODS A retrospective review of a consecutive series of patients undergoing arthroscopic rotator cuff repair between January 2011 and December 2014 was performed. Diabetic status and complication data defined as infection, frozen shoulder, re-tear or re-operation were collected and interrogated. RESULTS A total of 462 patients were included at median follow-up of 5.6 years. Diabetics were significantly more likely to experience frozen shoulder (15.8% vs. 4.4%, p = 0.001), re-tear (26.3% vs. 15.6%, p = 0.042) or at least one complication following surgery (35.1% vs. 22.7%, p = 0.041) compared to non-diabetics. These equated to odds ratios of 4.03, 1.94 and 1.84, respectively. CONCLUSIONS Diabetic patients are almost twice as likely to experience complications following arthroscopic rotator cuff repair, including double the risk of repair failure and more than four times the risk of frozen shoulder.
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Affiliation(s)
- Z Borton
- Z Borton, C/o Mr D Clark, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
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Abstract
At present six million people are suffering from clinical depression or anxiety disorders, but only a quarter of them are in treatment. NICE Guidelines prescribe the offer of evidence-based psychological therapy, but they are not implemented, due to lack of therapists within the NHS. We therefore estimate the economic costs and benefits of providing psychological therapy to people not now in treatment. The cost to the governement would be fully covered by the savings in incapacity benefits and extra taxes that result from more people being able to work. On our estimates, the cost could be recovered within two years - and certainly within five. And the benefits to the whole economy are greater still. This is not because we expect the extra therapy to be targeted especially at people with problems about work. It is because the cost of the therapy is so small (£750 in total), the recovery rates are so high (50 per cent) and the cost of a person on IB is so large (£750 per month). These findings strongly reinforce the humanitatian case for implementing the NICE Guidelines. Current proposals for doing this would require some 8,000 extra psychological therapists withing the NHS over the six years.
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Koshy A, Dinh D, Brennan A, Fulcher J, Murphy A, Duffy S, Ajani A, Oqueli E, Hiew C, Yudi M, Farouque O, Clark D. 809 Comparison of Ischaemia-Guided Versus Angiography-Guided Revascularization in Stable Ischaemic Heart Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Warren J, Dinh D, Tan C, Clark D, Dagan M, Ajani A, Brennan A, Stehli J, Sebastian M, Freeman M, Oqueli E, Kaye D, Duffy S. 501 Impact of Pre-Procedural Diastolic Blood Pressure on Outcomes in Patients Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Batchelor R, Dinh D, Brennan A, Noaman S, Clark D, Ajani A, Freeman M, Stub D, Reid C, Oqueli E, Yip T, Duffy S, Chan W. 784 Adverse Long-Term Clinical Outcomes Among Patients With Pre-procedural Atrial Fibrillation Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Scully T, Toner L, Yeoh J, Clark D. 836 Identification of Risk Factors for Failure of a Deferred Revascularisation Strategy in Patients With Fractional Flow Reserve >0.8. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.843] [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: 12/01/2022]
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Tan C, Dinh D, Clark D, Ajani A, Brennan A, Warren J, Stub D, Freeman M, O'Brien J, Hiew C, Reid C, Oqueli E, Chan W, Duffy S. 909 Trends in Prescribing Patterns of Ticagrelor, Prasugrel and Clopidogrel Following Percutaneous Coronary Intervention for Acute Coronary Syndromes. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Prosser H, Dinh D, Roberts L, Chandrasekhar J, Brennan A, Duffy S, Clark D, Ajani A, Oqueli E, Sebastian M, Reid C, Freeman M, Teh A. 571 Use of Renin-Angiotensin System Antagonists Post-PCI is Associated With Lower Mortality in Patients With Reduced and Preserved Left Ventricular (LV) Function. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.578] [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: 12/01/2022]
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Dagan M, Dinh D, Stehli J, Tan C, Brennan A, Ajani A, Freeman M, Reid C, Hiew C, Oqueli E, Kaye D, Clark D, Duffy S. 165 Sex Differences in Pharmacotherapy and Long-Term Outcomes in Patients With Ischaemic Heart Disease and Left Ventricular Dysfunction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.172] [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: 11/29/2022]
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Dagan M, Dinh D, Stehli J, Tan C, Brennan A, Ajani A, Freeman M, Reid C, Hiew C, Oqueli E, Kaye D, Clark D, Duffy S. 123 Impact of Sex on Heart Failure Pharmacotherapy and Outcomes in Patients With Ischaemic Heart Disease and Comorbid Heart Failure With Reduced Ejection Fraction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dawson L, Dinh D, Duffy S, Brennan A, Guymer E, Clark D, Oqueli E, Freeman M, Hiew C, Reid C, Ajani A. 861 Outcomes of Percutaneous Coronary Intervention Among Patients With Rheumatoid Arthritis. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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O'Brien J, Dinh D, Roberts L, Teh A, Brennan A, Duffy S, Clark D, Ajani A, Oqueli E, Sebastian M, Reid C, Freeman M, Chandrasekhar J. 564 The Impact of the Metabolic Syndrome on Cardiovascular Outcomes in Patients Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vinson AJ, Bartolacci J, Goldstein J, Swain J, Clark D, Tennankore KK. Predictors of Need for First and Recurrent Emergency Medical Service Transport to Emergency Department after Dialysis Initiation. PREHOSP EMERG CARE 2019; 24:822-830. [PMID: 31800335 DOI: 10.1080/10903127.2019.1701157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Dialysis patients are frequently transported to the emergency department (ED) by Emergency Medical Services (EMS) due to acute and severe illness. However, little is known about predictors of first and recurrent transport to the ED (EMS-ED), based on characteristics at the time of dialysis initiation.Methods: We analyzed a cohort of adult (≥18 years) patients affiliated with a large quaternary care center who initiated chronic dialysis from 2009 to 2013 (last follow-up: 2015). Data on patient characteristics at the time of dialysis initiation were linked to regional EMS data. Candidate predictors of first and recurrent EMS-ED transport included comorbid conditions, dialysis characteristics and frailty severity (using the first version of the clinical frailty scale score; CFS). Time to first EMS-ED was analyzed using a multivariable sub-hazards regression model accounting for competing events (transplantation or death). Time to recurrent EMS-ED was analyzed using the Anderson-Gill counting approach, accounting for competing risks.Results: A total of 455 patients were included in the study, 243 (53%) had 1+ EMS-ED events, 90 (20%) never required an EMS-ED at last follow-up, and 69 (15%) and 53 (12%) experienced transplant or death as their first event, respectively. The mean age of the cohort was 62 ± 15 years, 89% were Caucasian, and 35% were female sex. Patients were highly comorbid and 97/381 (25.5%) with available data on frailty severity had a CFS score of ≥5, inclusive of CFS scores ranging from mildly to severely frail. After adjustment, a CFS score of ≥5 (relative to 1-2) was associated with a > 2-fold increase in the risk of first EMS-ED (subdistribution relative hazard; SHR 2.28, 95% confidence interval; CI 1.30-3.98). A history of peripheral vascular disease (SHR 1.43, 95% CI 1.00-2.03) and rheumatologic disease (SHR 1.84, 95% CI 1.00-3.38) was also associated with first EMS-ED. Frailty severity was the only factor associated with recurrent EMS-ED.Conclusion: Patients are at a high risk of EMS-ED after dialysis initiation. Frailty severity (at the time of dialysis initiation) is a strong predictor of first and recurrent EMS-ED and this may be important to guide informed decision making and resource planning for dialysis patients who require EMS.
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Thiex NJ, Erem TV, Amundson D, Boucher J, Clark A, Clark D, Coco P, Dow D, Fahey P, Hoffmann H, Mertens D, Morris H, Rittenhouse T, Wohla M. Determination of Water (Moisture) and Dry Matter in Animal Feed, Grain, and Forage (Plant Tissue) by Karl Fischer Titration: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/85.2.318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A Karl Fischer method for determining water (dry matter) in animal feed and forages was collaboratively studied. Water was extracted from animal feed or forage material into methanol–formamide (1 + 1) directly in the Karl Fischer titration vessel by high-speed homogenization. The water was titrated at 50°C with one-component Karl Fischer reagent based on imidazole. Ten blind samples were sent to 9 collaborators in the United States, Canada, and Germany. The within-laboratory relative standard deviation (repeatability) ranged from 1.14 to 6.99% for water or from 0.09 to 0.56% for dry matter. Among-laboratory (including within-) relative standard deviation (reproducibility) ranged from 5.35 to 10.73%, or from 0.44 to 0.77% for dry matter. The authors recommend that the method be adopted as Official First Action by AOAC INTERNATIONAL. A comparable alternative extraction procedure using boiling methanol is also recommended for Official First Action.
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Affiliation(s)
- Nancy J Thiex
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
| | - Terri van Erem
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
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Alferness PL, Wiebe LA, Anderson L, Bennett O, Bosch M, Clark D, Claussen F, Colin T, Cook C, Davis H, Ely V, Graham D, Grazzini R, Hickes H, Holland P, Hom W, Ingram R, Ling Y, Markley B, Peoples G, Pitz G, Robert G, Robinson C, Sen L, Sensue A, South N, Steginsky C, Summer S, Trower T, Wieczorek P, Zheng S. Determination of Glyphosate and Aminomethylphosphonic Acid in Crops by Capillary Gas Chromatography with Mass-Selective Detection: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.3.823] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A collaborative study was conducted to validate a method for the determination of glyphosate and aminomethylphosphonic acid (AMPA) in crops. The analytes are extracted from crops with water, and the crude extracts are then subjected to a cation exchange cleanup. The analytes are derivatized by the direct addition of the aqueous extract into a mixture of heptafluorobutanol and trifluoroacetic anhydride. The derivatized analytes are quantitated by capillary gas chromatography with mass-selective detection (MSD). The collaborative study involved 13 laboratories located in 5 countries 12 laboratories returned valid data sets. The crops tested were field corn grain, soya forage, and walnut nutmeat at concentrations of 0.050, 0.40, and 2.0 mg/kg. The study used a split-level pair replication scheme with blindly coded laboratory samples. Twelve materials were analyzed, including 1 control and 3 split-level pairs for each matrix, 1 pair at each nominal concentration. For glyphosate, the mean recovery was 91%, the average intralaboratory variance, the repeatability relative standard deviation (RSDr), was 11%, and the interlaboratory variance, the reproducibility relative standard deviation (RSDR), was 16%. For AMPA, the mean recovery was 87%, the RSDr was 16%, and the RSDR was 25% at mg/kg levels.
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Affiliation(s)
- Philip L Alferness
- Zeneca Ag Products 1 , Western Research Center, 1200 S 47th St, Richmond, CA
| | - Lawrence A Wiebe
- Zeneca Ag Products 1 , Western Research Center, 1200 S 47th St, Richmond, CA
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