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Reynolds G, Maclean M, Cliff ERS, Teh BW, Thursky KA, Slavin MA, Anderson MA, Hawkes EA. Infections in lymphoma patients treated with bispecific antibodies: A systematic review and meta-analysis. Blood Adv 2024:bloodadvances.2024012916. [PMID: 38625983 DOI: 10.1182/bloodadvances.2024012916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/18/2024] Open
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Reynolds G, Lindsay J. Antibacterial prophylaxis for neutropenic and high-risk hematology patients-Do the benefits outweigh the risk? Transpl Infect Dis 2024; 26:e14255. [PMID: 38459753 PMCID: PMC11009044 DOI: 10.1111/tid.14255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases and Immunology, Austin Health, Melbourne, Victoria, Australia
| | - Julian Lindsay
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Mitri E, Reynolds G, Hornung CJ, Trubiano JA. Low-risk penicillin allergy delabeling: a scoping review of direct oral challenge practice, implementation, and multi-disciplinary approaches. Expert Rev Anti Infect Ther 2024; 22:59-69. [PMID: 38098185 DOI: 10.1080/14787210.2023.2296068] [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: 10/12/2023] [Accepted: 12/13/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Penicillin allergy is common, and there is increased clinician interest in direct oral challenge (DOC) as a testing strategy for low-risk penicillin allergy. To aid wider implementation of DOC, consensus definitions of low-risk penicillin allergy phenotypes, and standardized approaches to assessment, DOC procedures, and evaluation, are required. AREAS COVERED This review systematically reviews studies that have utilized penicillin DOC in healthcare settings to identify heterogeneity in implementation approaches and synthesize low-risk definitions, procedures, and evaluation. EXPERT OPINION Opportunity exists to standardize penicillin DOC procedures in patients with a low-risk penicillin allergy to optimize antimicrobial prescribing and reduce the burden of penicillin allergy. Standardizing the definitions of 'low-risk' and 'positive challenge,' and improving the evaluation of patient safety, alongside the development of a unified approach to the structure of undertaking an oral challenge, is likely to increase uptake and confidence among non-allergist clinicians.
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Affiliation(s)
- Elise Mitri
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- National Allergy Centre of Excellence (NACE), Parkville, Victoria, Australia
| | - Gemma Reynolds
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Catherine J Hornung
- National Allergy Centre of Excellence (NACE), Parkville, Victoria, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- National Allergy Centre of Excellence (NACE), Parkville, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
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Perera D, Vogrin S, Khumra S, Motaganahalli S, Batrouney A, Urbancic K, Devchand M, Mitri E, Clements R, Nunn A, Reynolds G, Trubiano JA. Impact of a sustained, collaborative antimicrobial stewardship programme in spinal cord injury patients. JAC Antimicrob Resist 2023; 5:dlad111. [PMID: 38021039 PMCID: PMC10664407 DOI: 10.1093/jacamr/dlad111] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background In patients with spinal cord injuries (SCIs), infections continue to be a leading cause of morbidity, mortality and hospital admission. Objectives This study evaluated the long-term impact of a weekly, multidisciplinary Spinal/Antimicrobial Stewardship (AMS) meeting for acute-care SCI inpatients, on antimicrobial prescribing over 3 years. Methods A retrospective, longitudinal, pre-post comparison of antimicrobial prescribing was conducted at our tertiary hospital in Melbourne. Antimicrobial prescribing was audited in 6 month blocks pre- (25 April 2017 to 24 October 2017), immediately post- (27 March 2018 to 25 September 2018) and 3 years post-implementation (2 March 2021 to 31 August 2021). Antimicrobial orders for patients admitted under the spinal unit at the meeting time were included. Results The number of SCI patients prescribed an antimicrobial at the time of the weekly meeting decreased by 40% at 3 years post-implementation [incidence rate ratio (IRR) 0.63; 95% CI 0.51-0.79; P ≤ 0.001]. The overall number of antimicrobial orders decreased by over 22% at 3 years post-implementation (IRR 0.78; 95% CI 0.61-1.00; P = 0.052). A shorter antimicrobial order duration in the 3 year post-implementation period was observed (-28%; 95% CI -39% to -15%; P ≤ 0.001). This was most noticeable in IV orders at 3 years (-36%; 95% CI -51% to -16%; P = 0.001), and was also observed for oral orders at 3 years (-25%; 95% CI -38% to -10%; P = 0.003). Antimicrobial course duration (days) decreased for multiple indications: skin and soft tissue infections (-43%; 95% CI -67% to -1%; P = 0.045), pulmonary infections (-45%; 95% CI -67% to -9%; P = 0.022) and urinary infections (-31%; 95% CI -47% to -9%; P = 0.009). Ninety-day mortality rates were not impacted. Conclusions This study showed that consistent, collaborative meetings between the Spinal and AMS teams can reduce antimicrobial exposure for acute-care SCI patients without adversely impacting 90 day mortality.
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Affiliation(s)
- D Perera
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - S Vogrin
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Medicine, St Vincent's Health, The University of Melbourne, 29 Regent Street, Fitzroy 3065, Victoria, Australia
| | - S Khumra
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - S Motaganahalli
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - A Batrouney
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - K Urbancic
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - M Devchand
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - E Mitri
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Infectious Diseases, Doherty Institute, University of Melbourne, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
| | - R Clements
- Victorian Spinal Cord Service, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - A Nunn
- Victorian Spinal Cord Service, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
| | - G Reynolds
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3000, Victoria, Australia
| | - J A Trubiano
- Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia
- Department of Infectious Diseases, Doherty Institute, University of Melbourne, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
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Reynolds G, Anderson MA, Thursky K, Teh BW, Slavin MA. Recommendations on prevention of infections in patients with T-cell lymphomas: a narrative review and synthesis. Leuk Lymphoma 2023; 64:2057-2070. [PMID: 37688482 DOI: 10.1080/10428194.2023.2252945] [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: 06/10/2023] [Revised: 08/02/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
T/Natural killer (NK) cell lymphomas (TCL) represent a heterogenous subgroup of non-Hodgkin lymphoma, associated with poorer prognosis and higher treatment toxicity. A cohesive synthesis of infection outcomes among TCL patients is lacking. International guidelines offer no specific recommendations regarding prophylaxis or supportive infection care for TCL patients. This systematic narrative review highlights infection outcomes in TCL patients treated with conventional, and novel therapies. Recommendations for infection screening, antimicrobial prophylaxis and vaccination strategies are outined.
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Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Reynolds G, Hall VG, Teh BW. Vaccine schedule recommendations and updates for patients with hematologic malignancy post-hematopoietic cell transplant or CAR T-cell therapy. Transpl Infect Dis 2023; 25 Suppl 1:e14109. [PMID: 37515788 PMCID: PMC10909447 DOI: 10.1111/tid.14109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023]
Abstract
Revaccination after receipt of a hematopoietic cell transplant (HCT) or cellular therapies is a pillar of patient supportive care, with the potential to reduce morbidity and mortality linked to vaccine-preventable infections. This review synthesizes national, international, and expert consensus vaccination schedules post-HCT and presents evidence regarding the efficacy of newer vaccine formulations for pneumococcus, recombinant zoster vaccine, and coronavirus disease 2019 in patients with hematological malignancy. Revaccination post-cellular therapies are less well defined. This review highlights important considerations around poor vaccine response, seroprevalence preservation after cellular therapies, and the optimal timing of revaccination. Future research should assess the immunogenicity and real-world effectiveness of new vaccine formulations and/or vaccine schedules in patients post-HCT and cellular therapy, including analysis of vaccine response that relates to the target of cellular therapies.
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Affiliation(s)
- Gemma Reynolds
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Infectious DiseasesAustin HealthHeidelbergVictoriaAustralia
| | - Victoria G. Hall
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Benjamin W. Teh
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
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Reynolds G, Urbancic KF, Fong CY, Trubiano JA. Invasive fungal infection following venetoclax and posaconazole co-administration. Br J Haematol 2023; 203:593-598. [PMID: 37731068 DOI: 10.1111/bjh.19116] [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: 07/13/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
The co-administration of venetoclax, a BCL-2 inhibitor, with a mould-active azole, such a posaconazole, has potential to both prevent invasive fungal infection (IFI) and reduce the required treatment dose, and cost, of venetoclax. Posaconazole drug-level monitoring is critical to ensuring adequate mould prophylaxis. A retrospective audit of 99 patients at a tertiary cancer centre, with myeloid malignancies co-prescribed venetoclax and posaconazole between January 2018 and April 2022, was undertaken to evaluate the adequacy of posaconazole prescribing and the rate of breakthrough IFI. Seventy-six patients (77%) had at least one posaconazole level measured in the study period, with 37% requiring a dose adjustment based on steady-state trough levels. Breakthrough IFI occurred in 4% of patients, typically within 1 month of commencing anti-mould prophylaxis. Close monitoring of posaconazole levels in venetoclax-treated patients, particularly in the early, outpatient setting, is critical.
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Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Karen F Urbancic
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Pharmacy, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Chun Y Fong
- Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Reynolds G, Cliff ERS, Mohyuddin GR, Popat R, Midha S, Liet Hing MN, Harrison SJ, Kesselheim AS, Teh BW. Infections following bispecific antibodies in myeloma: a systematic review and meta-analysis. Blood Adv 2023; 7:5898-5903. [PMID: 37467036 PMCID: PMC10558589 DOI: 10.1182/bloodadvances.2023010539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/21/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
Bispecific antibodies, a novel immunotherapy with promising efficacy against multiple myeloma, form immune synapses between T-cell surface marker CD3 and malignant cell markers, including B-cell maturation antigen (BCMA), FcRH5, and G protein-coupled receptor GPRC5D. These bispecific antibodies so effectively deplete plasma cells (and to some extent T-cells) that patients are at increased risk of developing infections. A systematic review and meta-analysis of infections in published studies of patients with myeloma treated with bispecific antibodies was conducted to better characterize the infection risks. A literature search used MEDLINE, EMBASE, and Cochrane to identify relevant studies between inception and February 10, 2023, including major conference presentations. Phase 1b-3 clinical trials and observational studies were included. Sixteen clinical trials comprising 1666 patients were included. Median follow-up was 7.6 months and 38% of the cohort had penta-drug refractory disease. Pooled prevalence of all-grade infections was 56%, whereas the prevalence of grade ≥3 infections was 24%. Patients who were treated with BCMA-targeted bispecifics had significantly higher rates of grade ≥3 infections than non-BCMA bispecifics (25% vs 20%). Similarly, patients treated with bispecifics in combination with other agents had significantly higher rate of all-grade infection than those receiving monotherapy (71% vs 52%). In observational studies (n = 293), excluded from the primary analysis to ensure no overlap with patients in clinical trials, several infections classically associated with T-cell depletion were identified. This systematic review identifies BCMA-targeted bispecifics and bispecific combination therapy as having higher infection risk, requiring vigilant infection screening and prophylaxis strategies.
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Affiliation(s)
- Gemma Reynolds
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
| | - Edward R. Scheffer Cliff
- Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Rakesh Popat
- NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Shonali Midha
- Division of Myeloma, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Melissa Ng Liet Hing
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Simon J. Harrison
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Aaron S. Kesselheim
- Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Benjamin W. Teh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
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Reynolds G, Sim B, Anderson MA, Spelman T, Teh BW, Slavin MA, Thursky KA. Predicting infections in patients with haematological malignancies treated with chimeric antigen receptor T-cell therapies: A systematic scoping review and narrative synthesis. Clin Microbiol Infect 2023; 29:1280-1288. [PMID: 37201866 DOI: 10.1016/j.cmi.2023.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/04/2023] [Revised: 03/14/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Chimeric antigen receptor T cells (CAR-T cells) are increasingly used to treat haematological malignancies. Strategies for preventing infections in CAR-T-treated patients rely on expert opinions and consensus guidelines. OBJECTIVES This scoping review aimed to identify risk factors for infections in CAR-T-treated patients with haematological malignancies. DATA SOURCES A literature search utilized MEDLINE, EMBASE and Cochrane to identify relevant studies from conception until 30 September 2022. STUDY ELIGIBILITY CRITERIA Trials and observational studies were eligible. PARTICIPANTS Studies required ≥10 patients treated for haematological malignancy to report infection events (as defined by the study), and either (a) a descriptive, univariate or multivariate analysis of the relationship between infections event and a risk factors for infections, or (b) diagnostic performance of a biochemical/immunological marker in CAR-T-treated patients with infection. METHODS A scoping review was conducted in accordance with PRISMA guidelines. DATA SOURCES A literature search utilised MEDLINE, EMBASE and Cochrane to identify relevant studies from conception until September 30, 2022. Eligibility/Participants/Intervention: Trials and observational studies were eligible. Studies required ≥ 10 patients treated for haematological malignancy, to report infection events (as defined by the study), and either A) a descriptive, univariate or multivariate analysis of the relationship between infections event and a risk-factors for infections, or B) diagnostic performance of a biochemical/immunological marker in CAR-T treated patients with infection. ASSESSMENT OF RISK OF BIAS Bias assessment was undertaken according to Joanna Brigg's Institute criteria for observational studies. METHODS OF DATA SYNTHESIS Data were synthesized descriptively because of the heterogeneity of reporting. RESULTS A total of 1522 patients across 15 studies were identified. All-cause infections across haematological malignancies were associated with lines of prior therapy, steroid administration, immune-effector cell-associated neurotoxicity and treatment-emergent neutropenia. Procalcitonin, C-reactive protein and cytokine profiles did not reliably predict infections. Predictors of viral, bacterial and fungal infections were poorly canvassed. DISCUSSION Meta-analysis of the current literature is not possible because of significant heterogeneity in definitions of infections and risk factors, and small, underpowered cohort studies. Radical revision of how we approach reporting infections for novel therapies is required to promptly identify infection signals and associated risks in patients receiving novel therapies. Prior therapies, neutropenia, steroid administration and immune-effector cell-associated neurotoxicity remain the most associated with infections in CAR-T-treated patients.
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Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.
| | - Beatrice Sim
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tim Spelman
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Karin A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Teh BW, Reynolds G, Slavin MA, Cooley L, Roberts M, Liu E, Thursky K, Talaulikar D, Mollee P, Szabo F, Ward C, Chan H, Prince HM, Harrison SJ. Executive summary of consensus clinical practice guidelines for the prevention of infection in patients with multiple myeloma. Intern Med J 2023; 53:1469-1477. [PMID: 37093163 DOI: 10.1111/imj.16100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
Infection remains a significant contributor to morbidity and mortality in patients with myeloma. This guideline was developed by a multidisciplinary group of clinicians who specialise in the management of patients with myeloma and infection from the medical and scientific advisory group from Myeloma Australia and the National Centre for Infections in Cancer. In addition to summarising the current epidemiology and risk factors for infection in patients with myeloma, this guideline provides recommendations that address three key areas in the prevention of infection: screening for latent infection, use of antimicrobial prophylaxis and immunoglobulin replacement and vaccination against leading respiratory infections (severe acute respiratory syndrome coronavirus 2, influenza and Streptococcus pneumoniae) and other preventable infections. This guideline provides a practical approach to the prevention of infection in patients with myeloma and harmonises the clinical approach to screening for infection, use of prophylaxis and vaccination to prevent infectious complications.
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Affiliation(s)
- Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Louise Cooley
- Department of Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Matthew Roberts
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Eunice Liu
- Department of Infectious Diseases, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Dipti Talaulikar
- Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Peter Mollee
- Queensland Haematology Department, Princess Alexandra Hospital, Sydney, Queensland, Australia
- School of Medicine, University of Queensland, Sydney, Queensland, Australia
| | - Ferenc Szabo
- Haematology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Flinders University, Adelaide, South Australia, Australia
| | - Chris Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Henry Chan
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - H Miles Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Epworth Healthcare, Melbourne, Victoria, Australia
| | - Simon J Harrison
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Collis B, Vogrin S, Trubiano JA, Reynolds G. Validation Study of a Clinical Predictive Model for Fluconazole Resistance in Patients With Candida Bloodstream Infection. Open Forum Infect Dis 2023; 10:ofad323. [PMID: 37496611 PMCID: PMC10368446 DOI: 10.1093/ofid/ofad323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/09/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
- Brennan Collis
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Gemma Reynolds
- Correspondence: Gemma Reynolds, BArts (Hons), MBBS (Hons), MIDI (Dist), FRACP, Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia ()
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12
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Hall VG, Sim BZ, Lim C, Hocking C, Teo T, Runnegar N, Boan P, Heath CH, Rainey N, Lyle M, Steer C, Liu E, Doig C, Drummond K, Charles PG, See K, Lim LL, Shum O, Bak N, Mclachlan SA, Singh KP, Laundy N, Gallagher J, Stewart M, Saunders NR, Klimevski E, Demajo J, Reynolds G, Thursky KA, Worth LJ, Spelman T, Yong MK, Slavin MA, Teh BW. COVID-19 infection among patients with cancer in Australia from 2020 to 2022: a national multicentre cohort study. Lancet Reg Health West Pac 2023; 38:100824. [PMID: 37360862 PMCID: PMC10278158 DOI: 10.1016/j.lanwpc.2023.100824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
Background The global COVID-19 pandemic disproportionately affected certain populations and its management differed between countries. This national study describes characteristics and outcomes of COVID-19 in patients with cancer in Australia. Methods We performed a multicentre cohort study of patients with cancer and COVID-19 from March 2020 to April 2022. Data were analysed to determine varying characteristics between cancer types and changes in outcomes over time. Multivariable analysis was performed to determine risk factors associated with oxygen requirement. Findings 620 patients with cancer from 15 hospitals had confirmed COVID-19. There were 314/620 (50.6%) male patients, median age 63.5 years (IQR 50-72) and majority had solid organ tumours (392/620, 63.2%). The rate of COVID-19 vaccination (≥1 dose) was 73.4% (455/620). Time from symptom onset to diagnosis was median 1 day (IQR 0-3), patients with haematological malignancy had a longer duration of test positivity. Over the study period, there was a significant decline in COVID-19 severity. Risk factors associated with oxygen requirement included male sex (OR 2.34, 95% CI 1.30-4.20, p = 0.004), age (OR 1.03, 95% CI 1.01-1.06, p = 0.005); not receiving early outpatient therapy (OR 2.78, 95% CI 1.41-5.50, p = 0.003). Diagnosis during the omicron wave was associated with lower odds of oxygen requirement (OR 0.24, 95% CI 0.13-0.43, p < 0.0001). Interpretation Outcomes from COVID-19 in patients with cancer in Australia over the pandemic have improved, potentially related to changing viral strain and outpatient therapies. Funding This study was supported by research funding from MSD.
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Affiliation(s)
- Victoria G. Hall
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Beatrice Z. Sim
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Chhay Lim
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Christopher Hocking
- Department of Oncology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Teddy Teo
- Department of Infectious Diseases, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Naomi Runnegar
- Department of Infectious Diseases, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Christopher H. Heath
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Natalie Rainey
- Department of Cancer Services, Cairns Hospital, Cairns, Queensland, Australia
| | - Megan Lyle
- Department of Cancer Services, Cairns Hospital, Cairns, Queensland, Australia
| | - Christopher Steer
- Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia
| | - Eunice Liu
- Department of Infectious Diseases, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Cassandra Doig
- Department of Infectious Diseases, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Kate Drummond
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
| | | | - Katharine See
- Department of Respiratory, Northern Hospital, Epping, VIC, Australia
| | - Lyn-Li Lim
- Monash University, Eastern Health Clinical School, Box Hill, VIC, Australia
| | - Omar Shum
- Department of Infectious Diseases, Wollongong Hospital, Wollongong, NSW, Australia
| | - Narin Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sue-Anne Mclachlan
- Department of Oncology, St Vincent's Hospital, Fitzroy, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Kasha P. Singh
- Department of Infectious Diseases, Peninsula Health, Frankston, VIC, Australia
| | - Nicholas Laundy
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jenny Gallagher
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Marcelle Stewart
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Natalie R. Saunders
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Emily Klimevski
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jessica Demajo
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Gemma Reynolds
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Karin A. Thursky
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Leon J. Worth
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Timothy Spelman
- Department of Biostatistics and Epidemiology, Peter MacCallum Cancer Centre, VIC, Australia
- Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia
| | - Michelle K. Yong
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Monica A. Slavin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Benjamin W. Teh
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
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13
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Cliff ERS, Reynolds G, Popat R, Teh BW, Kesselheim AS, Mohyuddin GR. Acknowledging Infection Risk in Bispecific Antibody Trials in the Treatment of Multiple Myeloma. J Clin Oncol 2023; 41:1949-1951. [PMID: 36716411 DOI: 10.1200/jco.22.02197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/08/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Edward R Scheffer Cliff
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Gemma Reynolds
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Rakesh Popat
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Benjamin W Teh
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Aaron S Kesselheim
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Ghulam Rehman Mohyuddin
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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14
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Cliff ERS, Reynolds G, Grigg A. Disseminated Invasive Mucormycosis Infection Following Autologous Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma. Clin Hematol Int 2023:10.1007/s44228-023-00031-z. [PMID: 36750525 PMCID: PMC9905013 DOI: 10.1007/s44228-023-00031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023] Open
Abstract
Invasive fungal infections (IFI) are challenging to predict, diagnose and treat, and are associated with a particularly high mortality among patients with hematological malignancies. They are relatively uncommon in patients with lymphoma, compared with those with acute leukemia or undergoing allogeneic transplantation. We present a patient, autografted for recurrent lymphoma, with fever and refractory diarrhea persisting post engraftment, eventually attributable to disseminated mucor infection. This case illustrates the challenge of timely diagnosis and initiation of treatment for IFI in lymphoma patients, who do not routinely receive antifungal prophylaxis, and the importance of aggressive investigation and symptom-directed tissue sampling for evidence of IFI in febrile immunocompromised hosts not responding to broad-spectrum antibiotics.
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Affiliation(s)
- Edward R. Scheffer Cliff
- grid.410678.c0000 0000 9374 3516Department of Clinical Haematology, Austin Health, Heidelberg, VIC Australia
| | - Gemma Reynolds
- grid.410678.c0000 0000 9374 3516Department of Infectious Diseases, Austin Health, Heidelberg, VIC Australia ,grid.1055.10000000403978434Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, University of Melbourne, Parkville, VIC Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, VIC, Australia. .,Department of Medicine, University of Melbourne, Parkville, VIC, Australia. .,Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, VIC, Australia.
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15
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Tarkin J, Corovic A, Wall C, Nus M, Gopalan D, Huang Y, Imaz M, Zulcinski M, Reynolds G, Morgan AW, Jorgensen HF, Mallat Z, Peters JE, Rudd JHF, Mason JC. Somatostatin receptor PET/MR imaging of large vessel inflammation in active compared with inactive vasculitis and atherosclerosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.320] [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
Use of 18F-FDG PET in large vessel vasculitis (LVV) is limited by non-specific uptake due to arterial remodelling and/or atherosclerosis leading to diagnostic uncertainty.
Purpose
To investigate somatostatin receptor 2 (SST2) as a novel inflammation-specific PET imaging target in LVV.
Methods
In a prospective observational cohort study, we tested the ability of PET/MRI using two somatostatin receptor tracers (68Ga-DOTATATE and 18F-FET-βAG-TOCA) to differentiate active from inactive LVV, and aortic atherosclerosis in patients with recent myocardial infarction. Ex vivo mapping of the imaging target was performed using immunofluorescence microscopy, imaging mass cytometry, and bulk, single-cell and single-nuclei RNA sequencing of temporal artery biopsies from LVV patients.
Results
Sixty-one participants were included (LVV, n=27; myocardial infarction ≤2 weeks, n=25; control subjects with an oncological indication for imaging, n=9). LVV patients (mean age 58 [SD 16] years; 78% female; 63% active or grumbling disease) had giant cell arteritis (n=13), Takayasu arteritis (n=13), or unspecified LVV (n=1). Baseline index vessel SST2 PET maximum tissue-to-blood ratio (TBRmax) was 61.8% (95% CI 31.5–99.0%, p<0.0001) higher in patients with active/grumbling LVV than inactive LVV, and 34.6% (95% CI 15.1–57.6%, p=0.0002) higher than recent myocardial infarction (Fig. 1a–c; arrow: PET signal; arrowhead: aortic thickening; asterisk: aortic atherosclerosis), with good diagnostic accuracy (AUC ≥0.86, p<0.001 for both). None of the control subjects without LVV or MI had increased arterial SST2 PET signal (Fig. 1d).
Mean aortic TBRmax was strongly correlated with Indian Takayasu Clinical Activity Score (r=0.82 [95% CI 0.46–0.95], p=0.001) and maximum wall thickness on MRI (r=0.68 [95% CI 0.31–0.87], p=0.002). SST2 PET/MRI was generally consistent with 18F-FDG PET/CT in LVV patients with contemporaneous scans (Fig. 1a, b), but with very low background signal in the brain and heart allowing for unimpeded assessment of nearby coronary, myocardial, and intracranial artery involvement. On follow-up imaging after a mean 9.3 (SD 3.2) months, clinically effective treatment for LVV was associated with a 0.49 ±SEM 0.24 (p=0.04; 22.3%) reduction in SST2 PET TBRmax, with good scan-scan repeatability in inactive LVV patients with no change in treatment (ICC 0.86, 95% CI 0.04–0.99).
SST2 localised to macrophages, pericytes, and perivascular adipocytes in inflamed arterial specimens (Fig. 2; a: H&E; b: imaging mass cytometry; arrow: SST2/CD68 co-staining). SSTR2-expressing macrophages co-expressed pro-inflammatory markers (S100A8, S100A9). Specific SST2 radioligand binding was confirmed by autoradiography in LVV specimens.
Conclusion
This is the first study to examine SST2 PET/MRI in LVV and to provide histological and gene expression data for validation. Here we show this novel approach holds major promise for diagnosis and therapeutic monitoring in LVV.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wellcome Trust; Imperial NIHR Biomedical Research Centre
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Affiliation(s)
- J Tarkin
- University of Cambridge , Cambridge , United Kingdom
| | - A Corovic
- University of Cambridge , Cambridge , United Kingdom
| | - C Wall
- University of Cambridge , Cambridge , United Kingdom
| | - M Nus
- University of Cambridge , Cambridge , United Kingdom
| | - D Gopalan
- Imperial College Healthcare NHS Trust , London , United Kingdom
| | - Y Huang
- University of Cambridge , Cambridge , United Kingdom
| | - M Imaz
- University of Cambridge , Cambridge , United Kingdom
| | - M Zulcinski
- University of Leeds , Leeds , United Kingdom
| | - G Reynolds
- Newcastle University , Newcastle-Upon-Tyne , United Kingdom
| | - A W Morgan
- University of Leeds , Leeds , United Kingdom
| | - H F Jorgensen
- University of Cambridge , Cambridge , United Kingdom
| | - Z Mallat
- University of Cambridge , Cambridge , United Kingdom
| | - J E Peters
- Imperial College London , London , United Kingdom
| | - J H F Rudd
- University of Cambridge , Cambridge , United Kingdom
| | - J C Mason
- Imperial College London , London , United Kingdom
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16
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Gilmour N, Reynolds J, Przybylak K, Aleksic M, Aptula N, Baltazar MT, Cubberley R, Rajagopal R, Reynolds G, Spriggs S, Thorpe C, Windebank S, Maxwell G. Next generation risk assessment for skin allergy: Decision making using new approach methodologies. Regul Toxicol Pharmacol 2022; 131:105159. [PMID: 35311660 DOI: 10.1016/j.yrtph.2022.105159] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/11/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Our aim is to develop and apply next generation approaches to skin allergy risk assessment (SARA) that do not require new animal test data and better quantify uncertainties. Significant progress has been made in the development of New Approach Methodologies (NAMs), non-animal test methods, for assessment of skin sensitisation and there is now focus on their application to derive potency information for use in Next Generation Risk Assessment (NGRA). The SARA model utilises a Bayesian statistical approach to infer a human-relevant metric of sensitiser potency and a measure of risk associated with a given consumer exposure based upon any combination of human repeat insult patch test, local lymph node, direct peptide reactivity assay, KeratinoSens™, h-CLAT or U-SENS™ data. Here we have applied the SARA model within our weight of evidence NGRA framework for skin allergy to three case study materials in four consumer products. Highlighting how to structure the risk assessment, apply NAMs to derive a point of departure and conclude on consumer safety risk. NGRA based upon NAMs were, for these exposures, at least as protective as the historical risk assessment approaches. Through such case studies we are building our confidence in using NAMs for skin allergy risk assessment.
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Affiliation(s)
- N Gilmour
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK.
| | - J Reynolds
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - K Przybylak
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - M Aleksic
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - N Aptula
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - M T Baltazar
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - R Cubberley
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - R Rajagopal
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - G Reynolds
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - S Spriggs
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - C Thorpe
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - S Windebank
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - G Maxwell
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
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Abstract
Understanding how the public views harm reduction strategies may help inform researchers on how to reduce related stigma and barriers to help-seeking. The current study explored whether stigma towards those who use opioids was affected by gender and type of harm reduction strategy used. Undergraduate students (N = 328) were randomly assigned to read one of six vignettes varying by gender and the type of harm reduction strategy: no harm reduction, opioid agonist therapy (OAT), or safe consumption sites (SCSs). Results demonstrated that participants were less stigmatizing towards the character who engaged in OAT compared to the character with no harm reduction. There was also a pattern demonstrating that SCSs may be perceived more negatively than OAT, although these differences only met conventional significance, not adjusted/corrected alphas. There were no significant effects for gender. Qualitative results revealed that participants held misconceptions about harm reduction. Implications and future directions are discussed.
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Affiliation(s)
- Gemma Reynolds
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4 Canada
| | - Brittany L Lindsay
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4 Canada
| | - Stephanie Knaak
- Department of Psychiatry and Faculty of Nursing, University of Calgary, Calgary, Canada
| | - Andrew C H Szeto
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4 Canada
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18
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Pearce D, Gould RL, Roughley M, Reynolds G, Ward EV, Bhome R, Reeves S. Paranoid and misidentification subtypes of psychosis in dementia. Neurosci Biobehav Rev 2022; 134:104529. [PMID: 35032536 DOI: 10.1016/j.neubiorev.2022.104529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/22/2021] [Accepted: 01/09/2022] [Indexed: 11/24/2022]
Abstract
This study aimed to review the neurobiological and neuropsychological correlates of paranoid (persecutory delusions) and misidentification (misidentification delusions and/or hallucinations) subtypes of psychosis in dementia, to establish if they represent distinct subphenotypes. Nine studies were eligible, all included patients with Alzheimer's disease. Greater global cognitive deficits and an accelerated global cognitive decline were observed in the misidentification subtype. Neuroimaging studies showed more marked volume loss in multiple regions in patients with the misidentification subtype, including those involved in object recognition and the processing of information on spatial and temporal context. A single study found greater impairment in visual sustained attention and object recognition in the misidentification subtype. The small number of studies and methodological heterogeneity limit interpretation of the findings. Nevertheless, these findings would tentatively suggest that there may be additional or accelerated pathological change in functional networks involved in visuoperceptual processing in the misidentification subtype. This should be further explored in prospective studies and the investigation extended to other forms of dementia, to gain a transdiagnostic perspective.
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Affiliation(s)
- Danielle Pearce
- Division of Psychiatry, University College London, W1T 7NF, UK
| | - Rebecca L Gould
- Division of Psychiatry, University College London, W1T 7NF, UK
| | | | - Gemma Reynolds
- Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Emma V Ward
- Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Rohan Bhome
- Division of Psychiatry, University College London, W1T 7NF, UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, W1T 7NF, UK.
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Bupha-Intr O, Butters C, Reynolds G, Kennedy K, Meyer W, Patil S, Bryant P, Morrissey CO. Consensus guidelines for the diagnosis and management of invasive fungal disease due to moulds other than Aspergillus in the haematology/oncology setting, 2021. Intern Med J 2021; 51 Suppl 7:177-219. [PMID: 34937139 DOI: 10.1111/imj.15592] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Invasive fungal disease (IFD) due to moulds other than Aspergillus is a significant cause of mortality in patients with malignancies or post haemopoietic stem cell transplantation. The current guidelines focus on the diagnosis and management of the common non-Aspergillus moulds (NAM), such as Mucorales, Scedosporium species (spp.), Lomentospora prolificans and Fusarium spp. Rare but emerging NAM including Paecilomyces variotii, Purpureocillium lilacinum and Scopulariopsis spp. are also reviewed. Culture and histological examination of tissue biopsy specimens remain the mainstay of diagnosis, but molecular methods are increasingly being used. As NAM frequently disseminate, blood cultures and skin examination with biopsy of any suspicious lesions are critically important. Treatment requires a multidisciplinary approach with surgical debridement as a central component. Other management strategies include control of the underlying disease/predisposing factors, augmentation of the host response and the reduction of immunosuppression. Carefully selected antifungal therapy, guided by susceptibility testing, is critical to cure. We also outline novel antifungal agents still in clinical trial which offer substantial potential for improved outcomes in the future. Paediatric recommendations follow those of adults. Ongoing epidemiological research, improvement in diagnostics and the development of new antifungal agents will continue to improve the poor outcomes that have been traditionally associated with IFD due to NAM.
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Affiliation(s)
- Olivia Bupha-Intr
- Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand
| | - Coen Butters
- Department of General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gemma Reynolds
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia.,ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Clinical School and Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - Sushrut Patil
- Malignant Haematology and Stem Cell Transplantation Service, Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Penelope Bryant
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Catherine O Morrissey
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Baltazar M, Cable S, Carmichael P, Cubberley R, Cull T, Dent M, Houghton J, Kukic P, Hatherell S, Middleton A, Malcomber S, Pendlington R, Reynolds G, Reynolds J, Moxon T, Nicol B, White A, Westmoreland C, Sparham C, Scott S, Rigarlsford A. An industry perspective on strategies for integrating new approach methodologies for next generation risk assessment. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(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: 11/29/2022]
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21
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Reynolds G, Crawford S, Cuenca J, Ghosh N, Newton P. Penicillin versus anti-staphylococcal beta-lactams for penicillin-susceptible Staphylococcus aureus blood stream infections: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2021; 41:147-151. [PMID: 34432165 DOI: 10.1007/s10096-021-04330-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022]
Abstract
The objective of the study is to assess the efficacy and tolerability of penicillins compared to anti-staphylococcal beta-lactams for treatment of penicillin-susceptible Staphylococcus aureus bloodstream infections (PSSA BSI). A retrospective cohort study was conducted of 140 sequential PSSA BSI presenting to a local health district (90 cases included). Penicillin susceptibility was confirmed by disc diffusion, Vitek® and Nitrocefin beta-lactamase methods. Clinical information regarding comorbidities and infection complexity was recorded. Antibiotic choice, dosage and duration were reviewed. Outcomes were compared according to the definitive treatment with either penicillin or ASBLs. The primary outcome was 30-day mortality. Secondary outcomes included renal injury, microbiological relapse and treatment tolerability. Ninety patients met inclusion criteria and were included in subsequent analysis. Of PSSA BSI, 69% were community acquired. Eighty-two percent had complex PSSA infections. The average duration of bacteraemia was 2.8 days (SD = 1.8 days). Sixty-six patients received definitive penicillin treatment, with a mean of 3.5 days of empiric antibiotics prior to penicillin. Twenty-four patients received definitive ASBL treatment (11 cefazolin, 13 flucloxacillin). There was no difference in 30-day mortality between groups (p = 1). There was no difference in renal injury (p > 0.5), hospital length of stay (p = 0.59) or microbiological relapse within 1 year (p = 0.17). Penicillin treatment was well tolerated. Our data supports penicillin as a suitable and well-tolerated alternative to ASBL in managing complex PSSA BSI.
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Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Austin Hospital, 145 Studley Road, Heidelberg, VIC, Australia.
| | - Simeon Crawford
- Department of Infectious Diseases and Microbiology, Wollongong Hospital, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Jose Cuenca
- Research Central, Illawarra Shoalhaven Local Health District, NSW, Wollongong, Australia
| | - Niladri Ghosh
- Department of Infectious Diseases and Microbiology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Peter Newton
- Department of Infectious Diseases and Microbiology, Wollongong Hospital, Wollongong, NSW, Australia.,Microbiology, NSW Health Pathology, Wollongong Hospital, Wollongong, Australia
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22
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Chifa M, Hadar T, Politimou N, Reynolds G, Franco F. The Soundscape of Neonatal Intensive Care: A Mixed-Methods Study of the Parents' Experience. Children (Basel) 2021; 8:children8080644. [PMID: 34438535 PMCID: PMC8391440 DOI: 10.3390/children8080644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/03/2022]
Abstract
Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a comprehensive instrument to investigate the relationship between sounds in NICUs and parental stress. To address this gap, this report presents the “Soundscape of NICU Questionnaire” (SON-Q), which was developed specifically to capture parents’ perceptions and beliefs about the impact that sound had on them and their infants, from pre-birth throughout the NICU stay and in the first postdischarge period. Parents of children born preterm (n = 386) completed the SON-Q and the Perinatal PTSD Questionnaire (PPQ). Principal Component Analysis identifying underlying dimensions comprising the parental experience of the NICU soundscape was followed by an exploration of the relationships between subscales of the SON-Q and the PPQ. Moderation analysis was carried out to further elucidate relationships between variables. Finally, thematic analysis was employed to analyse one memory of sounds in NICU open question. The results highlight systematic associations between aspects of the NICU soundscape and parental stress/trauma. The findings underscore the importance of developing specific studies in this area and devising interventions to best support parents’ mental health, which could in turn support infants’ developmental outcomes.
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Affiliation(s)
- Maria Chifa
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK; (M.C.); (G.R.)
| | - Tamar Hadar
- Division of Expressive Therapies, Graduate School of Arts & Social Sciences, Lesley University, Cambridge, MA 02138, USA;
| | - Nina Politimou
- Institute of Education, University College London, London WC1H 0AA, UK;
| | - Gemma Reynolds
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK; (M.C.); (G.R.)
| | - Fabia Franco
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK; (M.C.); (G.R.)
- Correspondence:
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23
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Lee M, Reynolds G, Yates M, Galloway J. POS1448 EVIDENCE BASED PRACTICE: WHAT IS THE EVIDENCE THAT BRITISH SOCIETY FOR RHEUMATOLOGY GUIDELINES ARE EVIDENCE BASED? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Clinical practice guidelines are designed to ensure that patients are treated according to best evidence, with the goal of optimizing clinical outcomes and reducing unwarranted variation in care. They compile, rate and translate the data available into recommendations that form the basis of evidence-based practice for most clinicians. Despite their importance, the evidence base informing different guidelines varies in quality. A recent study of American College of Rheumatology (ACR) Practice Guidelines demonstrated only 17 of 35 class I (strong benefit to harm ratio) recommendations were supported by level A evidence (high quality randomized controlled trails or meta-analyses)1.Objectives:To review the evidence supporting the British Society for Rheumatology (BSR) guidelines.Methods:Thirteen sets of guidelines that were available on the BSR website as of October 16th 2019 were reviewed (https://www.rheumatology.org.uk/practice-quality/guidelines). A range of methodologies (including Grading of Recommendations Assessment, Development and Evaluation (GRADE), Scottish Intercollegiate Guidelines Network (SIGN), EULAR and Royal College of Physicians (RCP) recommendations) were used to assess the quality of evidence and strength of recommendation. For comparability between guidelines the level of evidence was converted to a score between I (highest quality) and IV (lowest quality) and the strength of recommendation was converted to a rating between A and D. The polymyalgia rheumatica guideline was not assessed due to unclear methodology and lack of level of evidence for all recommendations.Results:Of the 12 BSR guidelines assessed, there were 554 recommendations in total. The number of recommendations per guideline ranged between 13 and 80. Across all assessed guidelines, 94 recommendations (17.0%) were classified as level I, 161 (29.1%) as level 2 and 299 (54.0%) as level 3 or 4. These figures are similar to those reported in the ACR guidelines (23%, 19% and 58% respectively)1. The proportion of level I evidence varied from 46.2% (Axial Spondyloarthropathy guideline) to 0% (Hot Swollen Joint guideline).Conclusion:Over half of all BSR guideline recommendations have level of supporting evidence of III/IV. A wide range of methodologies are used to generate BSR guidelines (GRADE, SIGN, RCP / EULAR). This makes it challenging for readers unfamiliar with these approaches to interpret evidence and hinders comparisons between guidelines. A standardized methodology for future guideline development would overcome these barriers.References:[1]Duarte-Garcia A, Zamore R & Wong JB. The Evidence Basis for the American College of Rheumatology Practice Guidelines. JAMA Intern Med, 2018 Jan 1;178(1):146-148.Disclosure of Interests:None declared
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24
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Reynolds G, Ewing D. Children's sleepiness facilitates the effect of vicarious learning on the development of fear. J Exp Child Psychol 2021; 208:105129. [PMID: 33784542 DOI: 10.1016/j.jecp.2021.105129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/18/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022]
Abstract
A substantial body of research demonstrates the importance of sleep for emotional processing and learning as well as the association between sleep problems and heightened anxiety. However, there is currently no research exploring the impact of sleepiness on vicariously learned fear responses. Experiment 1 (N = 38) first demonstrated no effect of trait or state sleepiness on children's (7-11 years of age) subjective ratings of fear. Experiment 2 (N = 42) and Experiment 3 (N = 46) used an established vicarious learning paradigm to demonstrate that trait sleepiness facilitated vicariously acquired avoidance preferences for animals paired with fearful faces (fear-paired animals), whereas state sleepiness facilitated children's fear cognitions and attentional bias toward fear-paired animals. This study is the first to demonstrate the role of state and trait sleepiness in moderating vicarious fear learning in children.
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Affiliation(s)
- Gemma Reynolds
- Department of Psychology, Middlesex University, The Burroughs, Hendon, London NW4 4BT, UK.
| | - Donna Ewing
- School of Applied Social Science, University of Brighton, Brighton BN2 4AT, UK
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25
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Reynolds G, Haeusler G, Slavin MA, Teh B, Thursky K. Latent infection screening and prevalence in cancer patients born outside of Australia: a universal versus risk-based approach? Support Care Cancer 2021; 29:6193-6200. [PMID: 33763725 DOI: 10.1007/s00520-021-06116-w] [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: 12/01/2020] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Contention surrounds how best to screen patients for latent and undiagnosed infection prior to cancer treatment. Early treatment and prophylaxis against reactivation may improve infection-associated morbidity. This study sought to examine rates of screening and prevalence of latent infection in overseas-born patients receiving cancer therapies. METHODS A single-centre retrospective audit of 952 overseas-born patients receiving chemotherapy, targeted agents and immunotherapy between January 1 and December 31 2019 was undertaken at Peter MacCallum Cancer Centre. Pre-treatment screening for hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV), latent tuberculosis (LTBI), toxoplasmosis and strongyloidiasis was audited. RESULTS Approximately half of our overseas-born patients were screened for HBV (58.9%) and HCV (50.7%). Fewer patients were screened for HIV (30.5%), LTBI (18.3%), strongyloidiasis (8.6%) or toxoplasmosis (8.1%). Although 59.7% of our patients were born in countries with high epidemiological risk for latent infection, according to World Health Organization data, 35% were not screened for any infection prior to commencement of therapy. CONCLUSION The prevalence of latent infections amongst overseas-born patients with cancer, and complexities associated with risk-based screening, likely supports universal latent infection screening amongst this higher-risk cohort.
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Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.
| | - Gabrielle Haeusler
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
- Department of Infectious Diseases, Royal Children's Hospital, Melbourne, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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26
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Reynolds G, Stewart T, Harrison SJ, Spencer A, Teh BW. Hepatitis B reverse seroconversion despite entecavir prophylaxis in a myeloma patient on multiple novel agents: a case report and review of the literature. Leuk Lymphoma 2020; 62:1271-1274. [PMID: 33275059 DOI: 10.1080/10428194.2020.1855343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tamasine Stewart
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Simon J Harrison
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Andrew Spencer
- Department of Malignant Haematology and Stem Cell Transplantation, Alfred Health, Melbourne, Australia
| | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.,National Centre for Infections in Cancer, Melbourne, Australia
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27
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Scott-Charlton A, Reynolds G. A case of systemic lupus erythematosus associated auto-splenectomy presenting as invasive pneumococcal sepsis. Mod Rheumatol Case Rep 2020; 4:233-236. [PMID: 33087009 DOI: 10.1080/24725625.2020.1751407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 21-year-old female with a history of systemic lupus erythematosus (SLE) presented to the emergency department with septic shock. She had been maintained on 5 mg prednisolone daily and hydroxychloroquine 400 mg once daily and been investigated three years prior for recurrent left upper quadrant chest pain. Her previous SLE complications included pericardial effusion and high-risk pregnancy. Intensive care support was required due to septic shock, and a diagnosis of primary invasive Streptococcus pneumoniae bacteraemia was made following positive blood cultures. Computer tomography imaging of the abdomen demonstrated asplenia, with a diagnosis of auto-splenectomy thought most likely. Retrospective analysis of blood films from the two years prior was consistent with hyposplenism, including Howell-Jolly Bodies. The patient recovered from her sepsis and is maintained on amoxicillin prophylaxis. She was vaccinated according to post splenectomy guidelines and registered to the spleen registry. We report a case of auto-splenectomy and subsequent invasive pneumococcal disease in a SLE patient.
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Affiliation(s)
- Adam Scott-Charlton
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.,Department of Rheumatology, St George Hospital, Kogarah, NSW, Australia
| | - Gemma Reynolds
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
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28
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Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
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29
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Reynolds G, Holland C, Petrides G, Lorenzi A, Thompson B, Heaney J, Ali T. SAT0272 THE VALUE OF CLINICAL AND LABORATORY FEATURES TO PREDICT EXTENT OF LARGE VESSEL VASCULITIS ON PET CT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2452] [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:Giant cell arteritis (GCA) is an idiopathic vasculitis affecting large and medium-sized vessels. The pattern of arterial involvement is heterogeneous with two overlapping categories recognised: classical cranial GCA and extra-cranial GCA (or large vessel vasculitis – LVV) that predominantly affects the aorta and its proximal branches. Although LVV is present in around 80% of patients with cranial GCA, and around one third will develop large vessel complications, there are no guidelines for which patients should be screened for it (1). We sought to investigate whether clinical and laboratory features were a useful guide to the severity of LVV on FDG PET-CT.Objectives:To retrospectively analyse whether baseline patient characteristics are able to predict the extent of large vessel vasculitis on PET-CT.Methods:Clinical data for 65 patients referred for a PET-CT scan by Rheumatology at the Freeman Hospital, Newcastle between January 2015 and May 2018 were retrospectively analysed. The most recent full blood count and inflammatory markers prior to the scan were used. Scans were reviewed by a consultant radiologist and trainee. The arterial network was split in to ten potentially involved territories (aortic arch, thoracic aorta, abdominal aorta, iliac vessels, axillary, brachiocephalic, subclavian, carotid, vertebral and femoral arteries. Both the value of highest standardised uptake value (SUV max) and the territory affected was recorded for each positive scan.Results:In the period analysed 65 PET-CT scans were requested, mostly (77%) as baseline investigations for symptoms with LVV in the differential diagnosis. Of these 22 (34%) were positive for LVV and in that group the majority of patients (64%) were female. In those with a negative scan, 47.5% were on concurrent steroid treatment compared to 9% with a positive scan. Regression analysis suggested that the number of systemic features (weight loss, pyrexia, polymyalgia) was weakly correlated with the number of affected territories (p=0.04). In contrast there was no correlation between laboratory tests ((CRP (p=0.91), ESR (p=0.46), Hb (p=0.44), platelets (p=0.74)) and the number of territories affected. The aortic arch (47%) was most commonly the territory with the highest degree of FDG uptake (SUV max) followed by the abdominal aorta (21%) and thoracic (10%) and femoral arteries (10%). There was no correlation between SUV max and laboratory tests ((CRP (p=0.55), ESR (p=0.89), Hb (p=0.82), platelets (p=0.17)) or the number of systemic features (p=0.7). There was no significant difference in the number of territories affected between those on steroid treatment at the time of the scan and steroid-naïve patients, albeit the number of positive scans in those on steroid treatment was low (n=5).Conclusion:These results suggest that clinical and laboratory features are a poor guide to predicting the maximal severity and extent of disease on FDG PET-CT.References:[1]Koster MJ, Matteson EL, Warrington KJ. Large-vessel giant cell arteritis: diagnosis, monitoring and management. Rheumatology (Oxford). 2018;57(suppl_2):ii32-ii42.Disclosure of Interests:None declared
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30
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Stoops WW, Johnson MF, Strickland JC, Knudsen HK, Gilbert GH, Massingale SD, Ray MN, Studts CR, Atchley L, Reynolds G, Slade E, Studts JL. Feasibility of Collecting Saliva for Biological Verification of Tobacco Use Status in Dental Practices and Patients' Homes: Results from the National Dental PBRN. Community Dent Health 2019; 36:187-189. [PMID: 31436924 DOI: 10.1922/cdh_4474stoops03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the feasibility of collecting and analyzing saliva samples from dental practices and patients' homes for biochemical verification of tobacco use status. BASIC RESEARCH DESIGN Sub-study within single-arm, multi-center, longitudinal clinical study. CLINICAL SETTING Dental practices in the South Central region of the United States National Dental Practice-Based Research Network and patients' homes. PARTICIPANTS Fifty-five patients recruited from 30 dental practices. INTERVENTIONS Participants in the sub-study were instructed on saliva collection for cotinine analysis in dental practices where they enrolled in the primary study. Saliva was collected at the practices and then from patients' homes. MAIN OUTCOME MEASURES Feasibility for dental practice collection was define as 80% of enrolled participants having analyzable samples. For patients' home collection, feasibility was defined as 70%. RESULTS Forty-seven samples (i.e., 86% of those enrolled) collected in dental practices were analyzable. Twenty-one samples (i.e. 38% of those enrolled) collected in patients' homes were analyzable. CONCLUSIONS Collecting saliva samples for cotinine analysis from dental practices, but not from patients' homes, was feasible. Dental practices may provide an advantageous setting for biochemically verifying tobacco use status as part of clinical trials for tobacco cessation.
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Affiliation(s)
- W W Stoops
- Department of Behavioral Science, College of Medicine, University of Kentucky, KY USA.,Department of Psychiatry, College of Medicine, University of Kentucky, KY USA.,Department of Psychology, College of Arts and Sciences, University of Kentucky, KY USA
| | - M F Johnson
- Behavioral and Community-Based Research Shared Resource Facility, University of Kentucky Markey Cancer Center, KY USA
| | - J C Strickland
- Department of Psychology, College of Arts and Sciences, University of Kentucky, KY USA
| | - H K Knudsen
- Department of Behavioral Science, College of Medicine, University of Kentucky, KY USA
| | - G H Gilbert
- Department of Clinical & Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL USA
| | - S D Massingale
- Department of Clinical & Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL USA
| | - M N Ray
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL USA
| | - C R Studts
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY US
| | - L Atchley
- General Dentist, Phenix City, AL USA
| | - G Reynolds
- Health Decision Technologies LLC, Oakland, CA USA
| | - E Slade
- Department of Biostatistics, College of Public Health, University of Kentucky, KY USA
| | - J L Studts
- Department of Behavioral Science, College of Medicine, University of Kentucky, KY USA.,Behavioral and Community-Based Research Shared Resource Facility, University of Kentucky Markey Cancer Center, KY USA.,Cancer Prevention and Control Program, University of Kentucky Markey Cancer Center, KY USA
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31
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Trad MA, Materne M, Reynolds G, Yao J, Miyakis S, Skyring T, Newton P. Carbapenem sparing in the management of post-transrectal prostate biopsy bacteraemia. ANZ J Surg 2019; 89:935-939. [PMID: 31272128 DOI: 10.1111/ans.15322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/30/2019] [Accepted: 05/11/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sepsis following transrectal ultrasound (TRUS)-guided prostate biopsy is a major complication. With the emergence of multidrug-resistant organisms, empirical use of carbapenem antibiotics has been increasing. This study, conducted in the Illawarra Shoalhaven Local Health District (ISLHD), Australia, quantifies how much we can spare carbapenem use. METHODS A retrospective audit of patients who underwent TRUS prostate biopsy and were admitted post-operatively with proven bacteraemia between January 2007 and April 2016. RESULTS Of 2719 TRUS procedures, 50 (1.84%) cases had bacteraemia. The most common isolate was Escherichia coli in 44 of 50 (88%) of which six of 50 (12%) were extended-spectrum beta-lactamase (ESBL)-producing. Sixteen different empirical antimicrobial regimens were used, to which 42 of 50 (84%) of isolates were susceptible. Eight (16%) isolates were resistant to the chosen empiric combination, with five switched over to appropriate treatment once antimicrobial sensitivity results became available. Empirical carbapenem was utilized in 12 of 50 (24%) patients with only two of the ESBL isolates covered. A further 10 of 50 patients received carbapenems during their admission. Carbapenems could have been avoided in 18 of 22 (82%). A total of 86% of organisms (n = 43) were susceptible to the combination of amoxicillin-clavulanate and gentamicin. CONCLUSION Although the rates of bacteraemia with ESBL-producing organisms post-TRUS biopsy are increasing, use of carbapenem-free combination antimicrobials as empirical therapy appears to be safe and effective in our setting. Clinicians can utilize local resistance patterns to inform targeted and appropriate therapy for septic patients.
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Affiliation(s)
- Mohamad-Ali Trad
- Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Mishael Materne
- Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Gemma Reynolds
- Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jinna Yao
- Department of Urology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Spiros Miyakis
- Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Tim Skyring
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Department of Urology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Peter Newton
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,NSW Health Pathology, Microbiology, Wollongong Hospital, Wollongong, New South Wales, Australia
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Abstract
Fear and disgust are defensive emotions that have evolved to protect us from harm. Whereas fear is thought to elicit an instinctive response to deal with immediate threat, disgust elicits immediate sensory rejection to avoid contamination. One mechanism through which disgust and fear may be linked is via attentional bias toward threat. Attentional bias is a well-established feature of anxiety disorders and is known to increase following vicarious fear learning. However, the contribution of vicarious learning to the development of disgust-related attentional biases is currently unknown. Furthermore, the influence of individual differences in disgust propensity and disgust sensitivity on fear and disgust responses has not been investigated in the context of vicarious learning. Therefore, 53 children aged 7-9 years were randomly assigned to receive either fear vicarious learning or disgust vicarious learning. Children's fear beliefs, disgust beliefs, avoidance preferences, and attentional bias were measured at baseline and postlearning. Findings demonstrated increased fear and disgust responding to stimuli following disgust and fear vicarious learning. Crucially, the study provided the first evidence that disgust vicarious learning can create an attentional bias for threat in children similar to that created via fear vicarious learning. However, there was no relationship between disgust propensity and sensitivity and vicariously acquired increases in fear, disgust, and attention. In conclusion, both fear and disgust vicarious learning can create attentional bias, allowing rapid detection of potentially harmful stimuli. This effect could contribute to fear development and is found even in children who are not particularly high in disgust proneness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Reynolds G, Campbell L, Heslop O. Microbiological profile of high vaginal swabs collected over two years at a tertiary level hospital in Jamaica. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3886] [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: 11/30/2022] Open
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Reynolds G, Reed P. The effect of stimulus duration on over-selectivity: Evidence for the role of within-compound associations. J Exp Psychol Anim Learn Cogn 2018; 44:293-308. [PMID: 29847985 DOI: 10.1037/xan0000175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The phenomenon whereby behavior becomes controlled by one aspect of the environment at the expense of other aspects of the environment (stimulus overselectivity) is widespread across many intellectual and developmental disabilities. However, the theoretical mechanisms underpinning overselectivity are not understood. Given similarities between overselectivity and overshadowing, exploring overselectivity using associative learning paradigms might allow better theoretical understanding of the phenomenon. Three experiments explored overselectivity using a simultaneous discrimination task with typically developing participants undergoing a cognitively demanding task. Experiment 1 investigated whether stimulus duration effects found within the overshadowing literature also occurred in an overselectivity paradigm, and demonstrated that greater overselectivity was observed when stimuli were presented for short durations (2s and 5s) compared with longer durations (10s). Experiment 2 demonstrated that a posttraining revaluation procedure resulted in retrospective revaluation for stimuli presented at shorter durations (2s) and mediated extinction for stimuli presented at longer durations (10s). Such results replicate findings from the overshadowing literature that have been interpreted in terms of within-compound associations while also supporting assumptions made by an extended comparator hypothesis. Experiment 3 uses an additional control condition to further demonstrate that the retrospective revaluation is a genuine revaluation effect. Additionally, the experiment provides further evidence for the within-compound association explanation of the results through manipulating the consistency with which elements of a compound were paired during training. Taken together, the findings highlight the necessity to consider the role of within-compound associations in overselectivity, allowing for a better understanding of overselectivity effects. (PsycINFO Database Record
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Affiliation(s)
| | - Phil Reed
- Department of Psychology, Swansea University
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35
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Abstract
OBJECTIVES The objective of this study was to evaluate the effect of tumour necrosis factor-alpha inhibitors (TNF-αI) on Alzheimer's disease-associated pathology. DESIGN A literature search of PubMed, Embase, PsychINFO, Web of Science, Scopus, and the Cochrane Library databases for human and animal studies that evaluated the use of TNF-αI was performed on 26 October 2016. RESULTS The main outcomes assessed were cognition and behaviour, reduction in brain tissue mass, presence of plaques and tangles, and synaptic function. Risk of bias was assessed regarding blinding, statistical model, outcome reporting, and other biases. Sixteen studies were included, 13 of which were animal studies and 3 of which were human. All animal studies found that treatment with TNF-αI leads to an improvement in cognition and behaviour. None of the studies measured change in brain tissue mass. The majority of studies documented a beneficial effect in other areas, including the presence of plaques and tangles and synaptic function. The amount of data from human studies was limited. Two out of 3 studies concluded that TNF-αI are beneficial in Alzheimer's disease patients, with one being an observational study and the latter being a small pilot study, with a high risk of bias. CONCLUSION It was concluded that a large-scale randomized controlled trial assessing the effectiveness of TNF-αI on humans is warranted.
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Affiliation(s)
- Justyna O Ekert
- Division of Psychiatry, University College London, London, UK
| | - Rebecca L Gould
- Division of Psychiatry, University College London, London, UK
| | - Gemma Reynolds
- Department of Psychology, Middlesex University, London, UK
| | - Robert J Howard
- Division of Psychiatry, University College London, London, UK
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36
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Powell PA, Wills O, Reynolds G, Puustinen-Hopper K, Roberts J. The effects of exposure to images of others' suffering and vulnerability on altruistic, trust-based, and reciprocated economic decision-making. PLoS One 2018; 13:e0194569. [PMID: 29561883 PMCID: PMC5862494 DOI: 10.1371/journal.pone.0194569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 03/06/2018] [Indexed: 11/18/2022] Open
Abstract
In this paper we explored the effects of exposure to images of the suffering and vulnerability of others on altruistic, trust-based, and reciprocated incentivized economic decisions, accounting for differences in participants' dispositional empathy and reported in-group trust for their recipient(s). This was done using a pictorial priming task, framed as a memory test, and a triadic economic game design. Using the largest experimental sample to date to explore this issue, our integrated analysis of two online experiments (total N = 519), found statistically consistent evidence that exposure to images of suffering and vulnerability (vs. neutral images) increased altruistic in-group giving as measured by the "triple dictator game", and that the manipulation was significantly more effective in those who reported lower trust for their recipients. The experimental manipulation also significantly increased altruistic giving in the standard "dictator game" and trust-based giving in the "investment game", but only in those who were lower in in-group trust and also high in affective or cognitive empathy. Complementary qualitative evidence revealed the strongest motivations associated with increased giving in the experimental condition were greater assumed reciprocation and a lower aversion to risk. However, no consistent effects of the experimental manipulation on participants' reciprocated decisions were observed. These findings suggest that, as well as altruistic decision-making in the "triple dictator game", collaboratively witnessing the suffering of others may heighten trust-based in-group giving in the "investment game" for some people, but the effects are heterogeneous and sensitive to context.
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Affiliation(s)
- Philip A. Powell
- Department of Economics, University of Sheffield, Sheffield, United Kingdom
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- * E-mail:
| | - Olivia Wills
- Department of Economics, University of Sheffield, Sheffield, United Kingdom
| | - Gemma Reynolds
- Department of Psychology, Middlesex University, London, United Kingdom
| | - Kaisa Puustinen-Hopper
- Centre for Advanced Spatial Analysis, University College London, London, United Kingdom
- Impossible Labs, London, United Kingdom
| | - Jennifer Roberts
- Department of Economics, University of Sheffield, Sheffield, United Kingdom
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Vrzalikova K, Ibrahim M, Vockerodt M, Perry T, Margielewska S, Lupino L, Nagy E, Soilleux E, Liebelt D, Hollows R, Last A, Reynolds G, Abdullah M, Curley H, Care M, Krappmann D, Tooze R, Allegood J, Spiegel S, Wei W, Woodman CBJ, Murray PG. S1PR1 drives a feedforward signalling loop to regulate BATF3 and the transcriptional programme of Hodgkin lymphoma cells. Leukemia 2018; 32:214-223. [PMID: 28878352 PMCID: PMC5737877 DOI: 10.1038/leu.2017.275] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/15/2022]
Abstract
The Hodgkin/Reed-Sternberg cells of classical Hodgkin lymphoma (HL) are characterised by the aberrant activation of multiple signalling pathways. Here we show that a subset of HL displays altered expression of sphingosine-1-phosphate (S1P) receptors (S1PR)s. S1P activates phosphatidylinositide 3-kinase (PI3-K) in these cells that is mediated by the increased expression of S1PR1 and the decreased expression of S1PR2. We also showed that genes regulated by the PI3-K signalling pathway in HL cell lines significantly overlap with the transcriptional programme of primary HRS cells. Genes upregulated by the PI3-K pathway included the basic leucine zipper transcription factor, ATF-like 3 (BATF3), which is normally associated with the development of dendritic cells. Immunohistochemistry confirmed that BATF3 was expressed in HRS cells of most HL cases. In contrast, in normal lymphoid tissues, BATF3 expression was confined to a small fraction of CD30-positive immunoblasts. Knockdown of BATF3 in HL cell lines revealed that BATF3 contributed to the transcriptional programme of primary HRS cells, including the upregulation of S1PR1. Our data suggest that disruption of this potentially oncogenic feedforward S1P signalling loop could provide novel therapeutic opportunities for patients with HL.
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Affiliation(s)
- K Vrzalikova
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - M Ibrahim
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - M Vockerodt
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Institute of Anatomy and Cell Biology, Georg-August University of Göttingen, Göttingen, Germany
| | - T Perry
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - S Margielewska
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - L Lupino
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - E Nagy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - E Soilleux
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK
| | - D Liebelt
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - R Hollows
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - A Last
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - G Reynolds
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - M Abdullah
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Pathology, Universiti Putra Malaysia, Selangor, Malaysia
| | - H Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - M Care
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - D Krappmann
- Research Unit Cellular Signal Integration, Helmholtz Zentrum München, Neuherberg, Germany
| | - R Tooze
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - J Allegood
- Department of Biochemistry and Molecular Biology and Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - S Spiegel
- Department of Biochemistry and Molecular Biology and Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - W Wei
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - C B J Woodman
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - P G Murray
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Clinical and Molecular Pathology, Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
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38
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Abstract
Research with children has demonstrated that both positive vicarious learning (modelling) and positive verbal information can reduce children's acquired fear responses for a particular stimulus. However, this fear reduction appears to be more effective when the intervention pathway matches the initial fear learning pathway. That is, positive verbal information is a more effective intervention than positive modelling when fear is originally acquired via negative verbal information. Research has yet to explore whether fear reduction pathways are also important for fears acquired via vicarious learning. To test this, an experiment compared the effectiveness of positive verbal information and positive vicarious learning interventions for reducing vicariously acquired fears in children (7-9 years). Both vicarious and informational fear reduction interventions were found to be equally effective at reducing vicariously acquired fears, suggesting that acquisition and intervention pathways do not need to match for successful fear reduction. This has significant implications for parents and those working with children because it suggests that providing children with positive information or positive vicarious learning immediately after a negative modelling event may prevent more serious fears developing.
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Affiliation(s)
- Gemma Reynolds
- a Department of Psychology , Middlesex University , London , UK
| | - David Wasely
- a Department of Psychology , Middlesex University , London , UK
| | - Güler Dunne
- b Department of Psychology , Kingston University , London , UK
| | - Chris Askew
- c School of Psychology , University of Surrey , Guildford , UK
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39
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Lynch C, Reynolds G, Lee A. Pre-test Risk and Risk Factors as a Predictor of CTCA Severity and Calcium Score. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.521] [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: 11/30/2022]
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40
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Lynch C, Reynolds G, Lee A. Demographics and Risk Profiles of CTCA Patients and Characteristics of CTCA Severity. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.488] [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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41
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Anderson AE, Swan DJ, Wong OY, Buck M, Eltherington O, Harry RA, Patterson AM, Pratt AG, Reynolds G, Doran JP, Kirby JA, Isaacs JD, Hilkens CMU. Tolerogenic dendritic cells generated with dexamethasone and vitamin D3 regulate rheumatoid arthritis CD4 + T cells partly via transforming growth factor-β1. Clin Exp Immunol 2016; 187:113-123. [PMID: 27667787 DOI: 10.1111/cei.12870] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/09/2016] [Accepted: 09/21/2016] [Indexed: 12/28/2022] Open
Abstract
Tolerogenic dendritic cells (tolDC) are a new immunotherapeutic tool for the treatment of rheumatoid arthritis (RA) and other autoimmune disorders. We have established a method to generate stable tolDC by pharmacological modulation of human monocyte-derived DC. These tolDC exert potent pro-tolerogenic actions on CD4+ T cells. Lack of interleukin (IL)-12p70 production is a key immunoregulatory attribute of tolDC but does not explain their action fully. Here we show that tolDC express transforming growth factor (TGF)-β1 at both mRNA and protein levels, and that expression of this immunoregulatory cytokine is significantly higher in tolDC than in mature monocyte-derived DC. By inhibiting TGF-β1 signalling we demonstrate that tolDC regulate CD4+ T cell responses in a manner that is at least partly dependent upon this cytokine. Crucially, we also show that while there is no significant difference in expression of TGF-βRII on CD4+ T cells from RA patients and healthy controls, RA patient CD4+ T cells are measurably less responsive to TGF-β1 than healthy control CD4+ T cells [reduced TGF-β-induced mothers against decapentaplegic homologue (Smad)2/3 phosphorylation, forkhead box protein 3 (FoxP3) expression and suppression of (IFN)-γ secretion]. However, CD4+ T cells from RA patients can, nonetheless, be regulated efficiently by tolDC in a TGF-β1-dependent manner. This work is important for the design and development of future studies investigating the potential use of tolDC as a novel immunotherapy for the treatment of RA.
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Affiliation(s)
- A E Anderson
- Musculoskeletal Research Group.,Arthritis Research UK Rheumatoid Arthritis Centre of Excellence (RACE)
| | | | | | - M Buck
- Musculoskeletal Research Group
| | - O Eltherington
- Musculoskeletal Research Group.,Arthritis Research UK Rheumatoid Arthritis Centre of Excellence (RACE)
| | - R A Harry
- Musculoskeletal Research Group.,Arthritis Research UK Rheumatoid Arthritis Centre of Excellence (RACE)
| | | | - A G Pratt
- Musculoskeletal Research Group.,Arthritis Research UK Rheumatoid Arthritis Centre of Excellence (RACE)
| | - G Reynolds
- Musculoskeletal Research Group.,Arthritis Research UK Rheumatoid Arthritis Centre of Excellence (RACE)
| | | | - J A Kirby
- Applied Immunobiology and Transplantation Research Group, Institute of Cellular Medicine at the Newcastle NIHR Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Trust, Newcastle upon Tyne, UK
| | - J D Isaacs
- Musculoskeletal Research Group.,Arthritis Research UK Rheumatoid Arthritis Centre of Excellence (RACE)
| | - C M U Hilkens
- Musculoskeletal Research Group.,Arthritis Research UK Rheumatoid Arthritis Centre of Excellence (RACE)
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42
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Abstract
Vicarious learning has become an established indirect pathway to fear acquisition. It is generally accepted that associative learning processes underlie vicarious learning; however, whether this association is a form of conditioned stimulus-unconditioned stimulus (CS-US) learning or stimulus–response (CS-CR) learning remains unclear. Traditionally, these types of learning can be dissociated in a US revaluation procedure. The current study explored the effects of post-vicarious learning US revaluation on acquired fear responses. Ninety-four children (46 males and 48 females) aged 6 to 10 years first viewed either a fear vicarious learning video or a neutral vicarious learning video followed by random allocation to one of three US revaluation conditions: inflation; deflation; or control. Inflation group children were presented with still images of the adults in the video and told that the accompanying sound and image of a very fast heart rate monitor belonged to the adult. The deflation group were shown the same images but with the sound and image of a normal heart rate. The control group received no US revaluation. Results indicated that inflating how scared the models appeared to be did not result in significant increases in children’s fear beliefs, avoidance preferences, avoidance behavior or heart rate for animals above increases caused by vicarious learning. In contrast, US devaluation resulted in significant decreases in fear beliefs and avoidance preferences. Thus, the findings provide evidence that CS-US associations underpin vicarious learning and suggest that US devaluation may be a successful method for preventing children from developing fear beliefs following a traumatic vicarious learning episode with a stimulus.
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Affiliation(s)
- Gemma Reynolds
- Department of Psychology, Kingston University, Penrhyn Road, Kingston-upon-Thames, Surrey, KT1 2EE UK
- Present Address: Department of Psychology, Middlesex University, The Burroughs, Hendon, London, NW4 4BT UK
| | - Andy P. Field
- School of Psychology, University of Sussex, Brighton, BN1 9RH UK
| | - Chris Askew
- Department of Psychology, Kingston University, Penrhyn Road, Kingston-upon-Thames, Surrey, KT1 2EE UK
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43
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Lentle RG, Sequeira IR, Hardacre AK, Reynolds G. A method for assessing real time rates of dissolution and absorption of carbohydrate and other food matrices in human subjects. Food Funct 2016; 7:2820-32. [PMID: 27228950 DOI: 10.1039/c6fo00406g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We prepared pasta of differing physical dimensions but identical chemical composition that contained two monosaccharide probes (lactulose and mannitol) that are absorbed passively and promptly excreted in urine. We showed that the rates of their liberation from the pasta under simulated gastric and small intestinal conditions largely depended upon the rate of digestion of the starchy matrix. We showed, in 20 female subjects, that excretion of mannitol was slower from the pasta with the larger particle size. Hence, after consumption of either the powdered pasta or the simple solution of probe sugars, the mass of mannitol excreted between 1 and 2½ hours was greater than that excreted between 2½ and 4 hours. However these masses did not differ significantly after consumption of the pasta pellets. These differences were not reflected in the concurrent patterns of variation in either serum glucose or insulin taken over 120 minutes, their levels being similar for pasta pellets and powder with their peak values occurring synchronously during the first hour. Hence feeding test foods impregnated with lactulose and mannitol probes provided a reproducible and practical means of assessing the timing of digestion of the carbohydrate matrix and showed that this was more protracted than suggested by post prandial glucose levels. Further, the transit times calculated on a basis of the ratios of the two marker sugars could identify that the prolongation of digestion of larger particles was not accompanied by retention of digesta in particular segments of the gut.
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Affiliation(s)
- R G Lentle
- Massey Institute of Food Science and Technology, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand
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44
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Reynolds G, Campbell L, Monroe-Williams TD, Heslop O. Microbiological profile of mycotic eye infections at a tertiary care institution in the Caribbean: A retrospective analysis. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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45
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Reynolds G, Field AP, Askew C. Reductions in Children’s Vicariously Learnt Avoidance and Heart Rate Responses Using Positive Modeling. Journal of Clinical Child & Adolescent Psychology 2016; 47:555-568. [DOI: 10.1080/15374416.2016.1138410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Chris Askew
- Department of Psychology, Kingston University
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46
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Askew C, Reynolds G, Fielding-Smith S, Field AP. Inhibition of vicariously learned fear in children using positive modeling and prior exposure. J Abnorm Psychol 2015; 125:279-291. [PMID: 26653136 PMCID: PMC4745387 DOI: 10.1037/abn0000131] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One of the challenges to conditioning models of fear acquisition is to explain how different individuals can experience similar learning events and only some of them subsequently develop fear. Understanding factors moderating the impact of learning events on fear acquisition is key to understanding the etiology and prevention of fear in childhood. This study investigates these moderators in the context of vicarious (observational) learning. Two experiments tested predictions that the acquisition or inhibition of fear via vicarious learning is driven by associative learning mechanisms similar to direct conditioning. In Experiment 1, 3 groups of children aged 7 to 9 years received 1 of 3 inhibitive information interventions—psychoeducation, factual information, or no information (control)—prior to taking part in a vicarious fear learning procedure. In Experiment 2, 3 groups of children aged 7 to 10 years received 1 of 3 observational learning interventions—positive modeling (immunization), observational familiarity (latent inhibition), or no prevention (control)—before vicarious fear learning. Results indicated that observationally delivered manipulations inhibited vicarious fear learning, while preventions presented via written information did not. These findings confirm that vicarious learning shares some of the characteristics of direct conditioning and can explain why not all individuals will develop fear following a vicarious learning event. They also suggest that the modality of inhibitive learning is important and should match the fear learning pathway for increased chances of inhibition. Finally, the results demonstrate that positive modeling is likely to be a particularly effective method for preventing fear-related observational learning in children. The studies demonstrate that positive modeling and prior exposure to a stimulus are effective methods to prevent vicarious fear learning in 7 to 10-year-olds. This confirms that positive modeling is a useful part of prevention programs and that associative learning mechanisms underpin its effectiveness. The findings also explain why not everyone develops fear following a negative vicarious learning event.
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Affiliation(s)
- Chris Askew
- Department of Psychology, Kingston University
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47
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Affiliation(s)
- Gemma Reynolds
- Department of Psychology, Kingston University, Kingston-upon-Thames, Surrey, UK
| | - Andy P. Field
- School of Psychology, University of Sussex, Brighton, UK
| | - Chris Askew
- Department of Psychology, Kingston University, Kingston-upon-Thames, Surrey, UK
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48
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Reynolds G, Gibbon JR, Pratt AG, Wood MJ, Coady D, Raftery G, Lorenzi AR, Gray A, Filer A, Buckley CD, Haniffa MA, Isaacs JD, Hilkens CMU. Synovial CD4+ T-cell-derived GM-CSF supports the differentiation of an inflammatory dendritic cell population in rheumatoid arthritis. Ann Rheum Dis 2015; 75:899-907. [PMID: 25923217 PMCID: PMC4853576 DOI: 10.1136/annrheumdis-2014-206578] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 04/05/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE A population of synovial inflammatory dendritic cells (infDCs) has recently been identified in rheumatoid arthritis (RA) and is thought to be monocyte-derived. Here, we investigated the role and source of granulocyte macrophage-colony-stimulating factor (GM-CSF) in the differentiation of synovial infDC in RA. METHODS Production of GM-CSF by peripheral blood (PB) and synovial fluid (SF) CD4+ T cells was assessed by ELISA and flow cytometry. In vitro CD4+ T-cell polarisation experiments were performed with T-cell activating CD2/CD3/CD28-coated beads in the absence or presence of pro-Th1 or pro-Th17 cytokines. CD1c+ DC and CD16+ macrophage subsets were flow-sorted and analysed morphologically and functionally (T-cell stimulatory/polarising capacity). RESULTS RA-SF CD4+ T cells produced abundant GM-CSF upon stimulation and significantly more than RA-SF mononuclear cells depleted of CD4+ T cells. GM-CSF-producing T cells were significantly increased in RA-SF compared with non-RA inflammatory arthritis SF, active RA PB and healthy donor PB. GM-CSF-producing CD4+ T cells were expanded by Th1-promoting but not Th17-promoting conditions. Following coculture with RA-SF CD4+ T cells, but not healthy donor PB CD4+ T cells, a subpopulation of monocytes differentiated into CD1c+ infDC; a process dependent on GM-CSF. These infDC displayed potent alloproliferative capacity and enhanced GM-CSF, interleukin-17 and interferon-γ production by CD4+ T cells. InfDC with an identical phenotype to in vitro generated cells were significantly enriched in RA-SF compared with non-RA-SF/tissue/PB. CONCLUSIONS We demonstrate a therapeutically tractable feedback loop of GM-CSF secreted by RA synovial CD4+ T cells promoting the differentiation of infDC with potent capacity to induce GM-CSF-producing CD4+ T cells.
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Affiliation(s)
- G Reynolds
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence Musculoskeletal Research Group, Newcastle University, Newcastle-Upon-Tyne, UK
| | - J R Gibbon
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence Musculoskeletal Research Group, Newcastle University, Newcastle-Upon-Tyne, UK
| | - A G Pratt
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence Musculoskeletal Research Group, Newcastle University, Newcastle-Upon-Tyne, UK
| | - M J Wood
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence Musculoskeletal Research Group, Newcastle University, Newcastle-Upon-Tyne, UK
| | - D Coady
- Sunderland Royal Hospital, Sunderland, UK
| | - G Raftery
- Sunderland Royal Hospital, Sunderland, UK
| | - A R Lorenzi
- Department of Rheumatology, Freeman Hospital, Newcastle-Upon-Tyne, UK
| | - A Gray
- Department of Rheumatology, Freeman Hospital, Newcastle-Upon-Tyne, UK
| | - A Filer
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence Rheumatology Research Group, MRC Centre for Immune Regulation, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - C D Buckley
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence Rheumatology Research Group, MRC Centre for Immune Regulation, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M A Haniffa
- Haematological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK
| | - J D Isaacs
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence Musculoskeletal Research Group, Newcastle University, Newcastle-Upon-Tyne, UK
| | - C M U Hilkens
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence Musculoskeletal Research Group, Newcastle University, Newcastle-Upon-Tyne, UK
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Bull CT, Ortiz-Lytle MC, Ibarra AG, du Toit LJ, Reynolds G. First Report of Bacterial Blight of Crucifers Caused by Pseudomonas cannabina pv. alisalensis in Minnesota on Arugula (Eruca vesicaria subsp. sativa). Plant Dis 2015; 99:415. [PMID: 30699715 DOI: 10.1094/pdis-10-14-1020-pdn] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In 2011, bacterial blight of arugula (Eruca vesicaria subsp. sativa; cv. Roquette) was observed in organically grown plants under overhead irrigation in a field near Delano, MN. Approximately 80 to 100% of each planting was affected, with greater rates of infection occurring after periods of high humidity. Small, water-soaked, angular spots apparent on both sides of the leaves comprised the initial symptoms, which sometimes expanded and coalesced. Lesions maintained a dark water-soaked appearance or dried and turned a brown/tan color. Additionally, some lesions were outlined by a purple margin. Blue-green fluorescent pseudomonads were isolated consistently on King's Medium B agar (KMB) from symptomatic leaf tissue surface-disinfested with sodium hypochlorite (0.525%). The isolates nucleated ice and produced levan. Isolates were oxidase and arginine dihydrolase negative. They did not rot potato slices but did induce a hypersensitive reaction in tobacco (Nicotiana tabacum cv. Samsun). These data indicated that the bacteria belonged to Lelliott's LOPAT group 1 (2). DNA fragment banding patterns generated by amplifying DNA of the arugula isolates using repetitive extragenic palindromic sequence-polymerase chain reaction (rep-PCR) and the BOX A1R primer were identical and nearly identical to the banding patterns of the Pseudomonas cannabina pv. alisalensis (formerly P. syringae pv. alisalensis) (1) strain (CFBP1637) and the pathotype strain (CFBP 6866PT), respectively. Pathogenicity was confirmed on the arugula cv. My Way in two independent experiments, each with three replicate plants per treatment. Four isolates were grown on KMB for 48 h at 27°C, suspended in 0.01M potassium phosphate buffer (pH 7.0), and adjusted to 0.6 optical density at 600 nm (approximately 1 × 108 CFU/ml). Five- to six-week old plants were spray-inoculated until run-off, incubated in a humidity chamber for 48 h, and then placed in a greenhouse at 20 to 25°C for symptom development. For negative and positive control treatments, a similar number of plants each were sprayed with sterile buffer or P. cannabina pv. alisalensis strains CFBP1637 and CFBP 6866PT, respectively. Water-soaked and brown/tan lesions similar to the original symptoms appeared on plants inoculated with the arugula isolates and P. cannabina pv. alisalensis strains 7 to 14 days postinoculation. No symptoms developed on plants treated with sterile buffer. The bacterial strains re-isolated from surface-disinfested symptomatic tissue were identical by rep-PCR to the isolates used to inoculate the plants, thus, confirming Koch's postulates. Identical replicated experiments conducted on broccoli raab indicated that the arugula isolates were also pathogens of broccoli raab (Brassica rapa subsp. rapa, the original host from which P. cannabina pv. alisalensis was isolated). To our knowledge, this is the first report of bacterial blight of crucifers caused by P. cannabina pv. alisalensis in Minnesota. Arugula germplasm is being evaluated for resistance to this pathogen as an acceptable management method for organic cropping systems. References: (1) C. T. Bull et al. Syst. Appl. Microbiol. 33:105, 2010. (2) R. A. Lelliott. J. Appl. Bacteriol. 29:470, 1966.
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Affiliation(s)
- C T Bull
- USDA-ARS Agricultural Research Station, Salinas, CA 93905
| | - M C Ortiz-Lytle
- California State University, Monterey Bay, Undergraduate Research Opportunities Center, Seaside, CA 93955
| | - A G Ibarra
- Science and Math Institute, Hartnell College, Salinas, CA 93901
| | - L J du Toit
- Washington State University Mount Vernon NWREC, Mount Vernon, WA 98273
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Reynolds G, Field AP, Askew C. Effect of vicarious fear learning on children's heart rate responses and attentional bias for novel animals. ACTA ACUST UNITED AC 2014; 14:995-1006. [PMID: 25151521 PMCID: PMC4170822 DOI: 10.1037/a0037225] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research with children has shown that vicarious learning can result in changes to 2 of Lang’s (1968) 3 anxiety response systems: subjective report and behavioral avoidance. The current study extended this research by exploring the effect of vicarious learning on physiological responses (Lang’s final response system) and attentional bias. The study used Askew and Field’s (2007) vicarious learning procedure and demonstrated fear-related increases in children’s cognitive, behavioral, and physiological responses. Cognitive and behavioral changes were retested 1 week and 1 month later, and remained elevated. In addition, a visual search task demonstrated that fear-related vicarious learning creates an attentional bias for novel animals, which is moderated by increases in fear beliefs during learning. The findings demonstrate that vicarious learning leads to lasting changes in all 3 of Lang’s anxiety response systems and is sufficient to create attentional bias to threat in children.
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Affiliation(s)
| | | | - Chris Askew
- Department of Psychology, Kingston University
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