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Parmar S, McRae B, Hines J, Munneke G, Walkden M, Von Stempel C. 806 The Efficacy of Prostatic Arterial Embolisation as Indicated by Clinical Outcomes. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim
PAE (prostatic arterial embolisation) is a non-surgical, minimally invasive procedure used to treat symptoms of benign prostatic hyperplasia (BPH). It is used to treat patients with moderate to severe lower urinary tract symptoms including those requiring long term urinary catheter placement and intermittent self-catheterisation. The incidence of urinary tract infection is greater in this group at baseline and the risk of infection as a complication of PAE is recognised in the literature. This study aimed to compare the clinical outcomes of PAE to those of TURP (transurethral resection of the prostate), the reference standard for BPH treatment.
Method
All patients who underwent PAE between 2019 to 2021 at a single centre were included in this retrospective study. Clinical outcomes of patients were also recorded including international prostate symptom score (IPSS) and urodynamic results. These were compared to TURP results provided in the UK ROPE study.
Results
82% of patients experienced an improved IPSS after PAE, with a median reduction of 15 points, compared with a median reduction of 17 points with TURP. PAE caused a greater reduction in median prostate volume but proved to be less effective in improving urodynamic test results when compared to TURP.
Conclusion
While still clinically effective, PAE is less effective for treatment of lower urinary tract symptoms from BPH when compared to TURP.
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Affiliation(s)
| | - B McRae
- UCLH , London , United Kingdom
| | - J Hines
- UCLH , London , United Kingdom
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2
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Mittal A, Jomaa D, Hassan Z, Hines J, Thavarajah K. Catamenial Pneumothorax in the Setting of a Recent Stroke. Cureus 2022; 14:e23860. [PMID: 35530874 PMCID: PMC9072272 DOI: 10.7759/cureus.23860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Catamenial pneumothorax is a unique condition associated with thoracic endometriosis. It often presents in females of reproductive age as a recurrent pneumothorax aligned with the menstrual cycle. We present a case of a young female diagnosed with catamenial pneumothorax within one year of experiencing a stroke. The clinical presentation related to the stroke allowed for a unique diagnostic process and management considerations. The patient was successfully treated with progesterone-based contraception in the setting of an estrogen contraindication.
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Affiliation(s)
- Aayush Mittal
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Diana Jomaa
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Zakaa Hassan
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Jennifer Hines
- Pulmonary and Critical Care Medicine, Legacy Medical Group, Portland, USA
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3
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Axfors C, Janiaud P, Schmitt AM, Van't Hooft J, Smith ER, Haber NA, Abayomi A, Abduljalil M, Abdulrahman A, Acosta-Ampudia Y, Aguilar-Guisado M, Al-Beidh F, Alejandria MM, Alfonso RN, Ali M, AlQahtani M, AlZamrooni A, Anaya JM, Ang MAC, Aomar IF, Argumanis LE, Averyanov A, Baklaushev VP, Balionis O, Benfield T, Berry S, Birocco N, Bonifacio LB, Bowen AC, Bown A, Cabello-Gutierrez C, Camacho B, Camacho-Ortiz A, Campbell-Lee S, Cao DH, Cardesa A, Carnate JM, Castillo GJJ, Cavallo R, Chowdhury FR, Chowdhury FUH, Ciccone G, Cingolani A, Climacosa FMM, Compernolle V, Cortez CFN, Costa Neto A, D'Antico S, Daly J, Danielle F, Davis JS, De Rosa FG, Denholm JT, Denkinger CM, Desmecht D, Díaz-Coronado JC, Díaz Ponce-Medrano JA, Donneau AF, Dumagay TE, Dunachie S, Dungog CC, Erinoso O, Escasa IMS, Estcourt LJ, Evans A, Evasan ALM, Fareli CJ, Fernandez-Sanchez V, Galassi C, Gallo JE, Garcia PJ, Garcia PL, Garcia JA, Garigliany M, Garza-Gonzalez E, Gauiran DTV, Gaviria García PA, Giron-Gonzalez JA, Gómez-Almaguer D, Gordon AC, Gothot A, Grass Guaqueta JS, Green C, Grimaldi D, Hammond NE, Harvala H, Heralde FM, Herrick J, Higgins AM, Hills TE, Hines J, Holm K, Hoque A, Hoste E, Ignacio JM, Ivanov AV, Janssen M, Jennings JH, Jha V, King RAN, Kjeldsen-Kragh J, Klenerman P, Kotecha A, Krapp F, Labanca L, Laing E, Landin-Olsson M, Laterre PF, Lim LL, Lim J, Ljungquist O, Llaca-Díaz JM, López-Robles C, López-Cárdenas S, Lopez-Plaza I, Lucero JAC, Lundgren M, Macías J, Maganito SC, Malundo AFG, Manrique RD, Manzini PM, Marcos M, Marquez I, Martínez-Marcos FJ, Mata AM, McArthur CJ, McQuilten ZK, McVerry BJ, Menon DK, Meyfroidt G, Mirasol MAL, Misset B, Molton JS, Mondragon AV, Monsalve DM, Moradi Choghakabodi P, Morpeth SC, Mouncey PR, Moutschen M, Müller-Tidow C, Murphy E, Najdovski T, Nichol AD, Nielsen H, Novak RM, O'Sullivan MVN, Olalla J, Osibogun A, Osikomaiya B, Oyonarte S, Pardo-Oviedo JM, Patel MC, Paterson DL, Peña-Perez CA, Perez-Calatayud AA, Pérez-Alba E, Perkina A, Perry N, Pouladzadeh M, Poyato I, Price DJ, Quero AKH, Rahman MM, Rahman MS, Ramesh M, Ramírez-Santana C, Rasmussen M, Rees MA, Rego E, Roberts JA, Roberts DJ, Rodríguez Y, Rodríguez-Baño J, Rogers BA, Rojas M, Romero A, Rowan KM, Saccona F, Safdarian M, Santos MCM, Sasadeusz J, Scozzari G, Shankar-Hari M, Sharma G, Snelling T, Soto A, Tagayuna PY, Tang A, Tatem G, Teofili L, Tong SYC, Turgeon AF, Veloso JD, Venkatesh B, Ventura-Enriquez Y, Webb SA, Wiese L, Wikén C, Wood EM, Yusubalieva GM, Zacharowski K, Zarychanski R, Khanna N, Moher D, Goodman SN, Ioannidis JPA, Hemkens LG. Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials. BMC Infect Dis 2021; 21:1170. [PMID: 34800996 PMCID: PMC8605464 DOI: 10.1186/s12879-021-06829-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.
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Affiliation(s)
- Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Perrine Janiaud
- Department of Clinical Research, University Hospital Basel, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland
| | - Andreas M Schmitt
- Department of Clinical Research, University Hospital Basel, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland
- Department of Medical Oncology, University of Basel, Basel, Switzerland
| | - Janneke Van't Hooft
- Amsterdam University Medical Center, Amsterdam University, Amsterdam, The Netherlands
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, USA
| | - Noah A Haber
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA
| | | | - Manal Abduljalil
- Internal Medicine, Bahrain Defence Force Hospital, Riffa, Bahrain
| | - Abdulkarim Abdulrahman
- Medical Team, National Task Force for Combating the Coronavirus (COVID19), Riffa, Bahrain
- Mohammed Bin Khalifa Cardiac Centre, Awali, Bahrain
| | - Yeny Acosta-Ampudia
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
| | - Manuela Aguilar-Guisado
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Farah Al-Beidh
- Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
| | - Marissa M Alejandria
- Department of Medicine, Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Rachelle N Alfonso
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Mohammad Ali
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Manaf AlQahtani
- Medical Team, National Task Force for Combating the Coronavirus (COVID19), Riffa, Bahrain
- Microbiology, Infectious Diseases, Bahrain Defence Force Hospital, Riffa, Bahrain
- Microbiology, Royal College of Surgeons in Ireland-Medical University in Bahrain, Riffa, Bahrain
| | - Alaa AlZamrooni
- Internal Medicine, Salmaniya Medical Complex, Manama, Bahrain
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
| | - Mark Angelo C Ang
- Department of Laboratories, Division of Blood Bank, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Ismael F Aomar
- Department of Internal Medicine, Hospital Universitario San Cecilio, Granada, Spain
| | - Luis E Argumanis
- Banco de Sangre, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Alexander Averyanov
- Pulmonary Division, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russian Federation
- Fundamental Medicine Department, Pulmonology Scientific and Research Institute under Federal Medical and Biological Agency, Moscow, Russian Federation
| | - Vladimir P Baklaushev
- Fundamental Medicine Department, Pulmonology Scientific and Research Institute under Federal Medical and Biological Agency, Moscow, Russian Federation
- Cell Culture Laboratory, Biomedical Research, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russian Federation
| | - Olga Balionis
- Pulmonary Division, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russian Federation
- Laboratory of Personalized Medicine, Pulmonology Scientific and Research Institute under Federal Medical and Biological Agency, Moscow, Russian Federation
| | - Thomas Benfield
- Center for Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | - Nadia Birocco
- Department of Oncology, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lynn B Bonifacio
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Asha C Bowen
- Menzies School of Health Research, Casuarina, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
| | - Abbie Bown
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
| | - Carlos Cabello-Gutierrez
- Department Research in Virology and Mycology, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Bernardo Camacho
- Instituto Distrital de Ciencia Biotecnología e Investigación en Salud (IDCBIS), Bogotá, Colombia
| | - Adrian Camacho-Ortiz
- Department of Infectious Diseases, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Damon H Cao
- Department of Medicine, Division of Nephrology, Henry Ford Hospital, Detroit, USA
| | - Ana Cardesa
- Clinical Department, Red Andaluza de Diseño y Traslacion de Terapias Avanzadas, Sevilla, Spain
| | - Jose M Carnate
- Department of Laboratories, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - German Jr J Castillo
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Rossana Cavallo
- Department of Laboratory Medicine, Unit of Microbiology and Virology, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fazle R Chowdhury
- Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Giovannino Ciccone
- Department of Quality and Safety in Health Care, Unit of Clinical Epidemiology, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonella Cingolani
- Infectious Disease, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Veerle Compernolle
- Blood Services, Belgian Red Cross-Flanders, Mechelen, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Carlo Francisco N Cortez
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Abel Costa Neto
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil
| | - Sergio D'Antico
- Department of Laboratory Medicine, Unit of Transfusion Medicine, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - James Daly
- Australian Red Cross Lifeblood, Melbourne, Australia
| | - Franca Danielle
- Department of Laboratory Medicine, Blood Bank, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Unit of Infective Diseases, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Justin T Denholm
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Australia
- Doherty Department, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Claudia M Denkinger
- Center of Infectious Diseases, Division of Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | | | | | - Teresita E Dumagay
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Susanna Dunachie
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Cecile C Dungog
- Department of Laboratories, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | | | - Ivy Mae S Escasa
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Lise J Estcourt
- Clinical, Research and Development, NHS Blood and Transplant, Oxford, UK
- Radcliffe Department of Medicine and BRC Haematology Theme, University of Oxford, Oxford, UK
| | - Amy Evans
- Clinical Trials Unit, NHS Blood and Transplant, Cambridge, UK
| | - Agnes L M Evasan
- Department of Medicine, Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Christian J Fareli
- CENETEC (National Center for Health Technology Excellence), Mexico City, Mexico
| | | | - Claudia Galassi
- Department of Quality and Safety in Health Care, Unit of Clinical Epidemiology, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Patricia J Garcia
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia L Garcia
- Servicio de Hemoterapia y Banco de Sangre, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Jesus A Garcia
- Department of Haematology, Centro Transfusional Tejidos y Celulas de Granada, Granada, Spain
| | | | - Elvira Garza-Gonzalez
- Department of Infectious Diseases, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Deonne Thaddeus V Gauiran
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Paula A Gaviria García
- Instituto Distrital de Ciencia Biotecnología e Investigación en Salud (IDCBIS), Bogotá, Colombia
| | | | | | - Anthony C Gordon
- Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
- Intensive Care, Imperial College Healthcare NHS Trust, London, UK
| | - André Gothot
- Immunohematology, Liège University Hospital, Liège, Belgium
| | | | - Cameron Green
- ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Grimaldi
- Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Naomi E Hammond
- The George Institute for Global Health, Sydney and New Delhi, Sydney, Australia
| | - Heli Harvala
- Microbiology Services, NHS Blood and Transplant, London, UK
| | - Francisco M Heralde
- Department of Biochemistry and Molecular Biology, University of the Philippines, Manila, Philippines
| | - Jesica Herrick
- Medicine, Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, USA
| | - Alisa M Higgins
- ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas E Hills
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Jennifer Hines
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | - Karin Holm
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Ashraful Hoque
- Blood Transfusion, Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Eric Hoste
- Intensive Care Medicine, Gand University Hospital, Gent, Belgium
| | - Jose M Ignacio
- Department of Neumology and Pulmonology, Hospital Quiron de Marbella, Málaga, Spain
| | - Alexander V Ivanov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Maike Janssen
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Jeffrey H Jennings
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | - Vivekanand Jha
- The George Institute for Global Health, Sydney and New Delhi, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Ruby Anne N King
- Department of Biochemistry and Molecular Biology, University of the Philippines, Manila, Philippines
| | - Jens Kjeldsen-Kragh
- Clinical Immunology and Transfusion Medicine, University and Regional Laboratories, Region Skåne, Lund, Sweden
| | - Paul Klenerman
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Aditya Kotecha
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | - Fiorella Krapp
- Facultad de Medicina, Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luciana Labanca
- Department of Laboratory Medicine, Blood Bank, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Emma Laing
- Clinical Trials Unit, NHS Blood and Transplant, Cambridge, UK
| | - Mona Landin-Olsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
| | | | | | - Jodor Lim
- Department of Medicine, Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Oskar Ljungquist
- Clinical Sciences, Clinical Infection Medicine, Lund University, Malmo, Sweden
| | - Jorge M Llaca-Díaz
- Department of Clinical Pathology, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Concepción López-Robles
- Department of Infectious Diseases, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Salvador López-Cárdenas
- Department of Infectious Diseases, Hospital Universitario de Jerez de La Frontera, Jerez de la Frontera, Spain
| | - Ileana Lopez-Plaza
- Division of Transfusion Medicine, Department of Pathology, Henry Ford Hospital, Detroit, USA
| | - Josephine Anne C Lucero
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Maria Lundgren
- Clinical Immunology and Transfusion Medicine, University and Regional Laboratories, Region Skåne, Lund, Sweden
| | - Juan Macías
- Department of Infectious Diseases, Hospital Universitario de Valme, Sevilla, Spain
| | - Sandy C Maganito
- Department of Laboratories, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Anna Flor G Malundo
- Department of Medicine, Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Rubén D Manrique
- Epidemiology and Biostatistics Research Group, Universidad CES, Medellín, Colombia
| | - Paola M Manzini
- Department of Laboratory Medicine, Unit of Transfusion Medicine, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Miguel Marcos
- Department of Internal Medicine, Hospital Quiron de Malaga, Málaga, Spain
| | - Ignacio Marquez
- Department of Infectious Diseases, Hospital Regional Universitario de Malaga, Málaga, Spain
| | | | - Ana M Mata
- Department of Internal Medicine, Hospital San Juan de Dios del Aljarafe, Bormujos, Spain
| | - Colin J McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Zoe K McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Haematology, Monash Health, Melbourne, Australia
| | - Bryan J McVerry
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - David K Menon
- University Division of Anaesthesia, Addenbrooke's Hospital Cambridge, University of Cambridge, Cambridge, UK
| | - Geert Meyfroidt
- Intensive Care Medicine, Leuven University Hospital, Leuven, Belgium
| | - Ma Angelina L Mirasol
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Benoît Misset
- Intensive Care Medicine, Liège University Hospital, Liège, Belgium
| | | | - Alric V Mondragon
- Department of Medicine, Division of Allergy and Immunology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
| | - Parastoo Moradi Choghakabodi
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz, Iran
| | | | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Michel Moutschen
- Intensive Care Medicine, Liège University Hospital, Liège, Belgium
| | - Carsten Müller-Tidow
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Erin Murphy
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | | | - Alistair D Nichol
- School of Medicine and Medical Sciences, University College Dublin-Clinical Research Centre, University College Dublin, Dublin, Ireland
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Intensive Care Medicine, Alfred Health, Melbourne, Australia
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Richard M Novak
- Medicine, Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, USA
| | - Matthew V N O'Sullivan
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julian Olalla
- Department of Internal Medicine, Hospital Costa del Sol, Málaga, Spain
| | - Akin Osibogun
- College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Salvador Oyonarte
- Department of Infectious Diseases, Centro Transfusional Tejidos y Celulas de Sevilla, Sevilla, Spain
| | - Juan M Pardo-Oviedo
- Hospital Universitario Mayor Méderi, Universidad del Rosario, Bogotá, Colombia
| | - Mahesh C Patel
- Medicine, Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, USA
| | - David L Paterson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | | | | | - Eduardo Pérez-Alba
- Department of Infectious Diseases, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Anastasia Perkina
- Pulmonary Division, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russian Federation
- Laboratory of Personalized Medicine, Pulmonology Scientific and Research Institute under Federal Medical and Biological Agency, Moscow, Russian Federation
| | - Naomi Perry
- Doherty Department, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Mandana Pouladzadeh
- Emergency Medicine Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Inmaculada Poyato
- Department of Internal Medicine, Hospital Universitario Torrecardenas, Almería, Spain
| | - David J Price
- Doherty Department, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anne Kristine H Quero
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Md M Rahman
- Internal Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Md S Rahman
- Pharmacology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mayur Ramesh
- Department of Internal Medicine, Division of Infectious Diseases, Henry Ford Hospital, Detroit, USA
| | | | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Megan A Rees
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne Health, Melbourne, Australia
| | - Eduardo Rego
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil
| | - Jason A Roberts
- Hospital Universitario Mayor Méderi, Universidad del Rosario, Bogotá, Colombia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - David J Roberts
- Radcliffe Department of Medicine and BRC Haematology Theme, University of Oxford, Oxford, UK
- Clinical and Research and Development, NHS Blood and Transplant, Oxford, UK
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
- Clinica del Occidente, Bogotá, Colombia
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Department of Medicine, University of Sevilla-IBiS, Sevilla, Spain
| | - Benjamin A Rogers
- Monash University, Melbourne, Australia
- Monash Health, Melbourne, Australia
| | - Manuel Rojas
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
| | - Alberto Romero
- Department of Infectious Diseases, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - Fabio Saccona
- Department of Quality and Safety in Health Care, Unit of Clinical Epidemiology, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mehdi Safdarian
- Nanotechnology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maria Clariza M Santos
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Australia
- Doherty Department, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Gitana Scozzari
- Department of Medical Hospital Direction, Unit of Medical Direction, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Manu Shankar-Hari
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Immunology and Microbial Sciences, Kings College London, London, UK
| | - Gorav Sharma
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | - Thomas Snelling
- Menzies School of Health Research, Casuarina, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Sydney School of Public Health, University of Sydney, Camperdown, Australia
- Sydney Children's Hospital Network, Westmead, Australia
| | - Alonso Soto
- Facultad de Medicina Humana, Instituto de Investigación en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma, Lima, Peru
- Department of Internal Medicine, Hospital Nacional Hipolito Unanue, Lima, Peru
| | - Pedrito Y Tagayuna
- Department of Laboratories, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Amy Tang
- Public Health Sciences, Henry Ford Hospital, Detroit, USA
| | - Geneva Tatem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | - Luciana Teofili
- Transfusion Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Januario D Veloso
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, Sydney and New Delhi, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Wesley and Princess Alexandra Hospitals, University of Queensland, Brisbane, Australia
| | | | - Steve A Webb
- School of Medicine and Medical Sciences, University College Dublin-Clinical Research Centre, University College Dublin, Dublin, Ireland
- St John of God Hospital, Subiaco, Subiaco, Australia
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Christian Wikén
- Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Erica M Wood
- Department of Clinical Haematology, Monash Health, Melbourne, Australia
| | - Gaukhar M Yusubalieva
- Cell Culture Laboratory, Biomedical Research, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russian Federation
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Ryan Zarychanski
- Department of Internal Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Canada
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Hygiene and Infection Biology Laboratory, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steven N Goodman
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA
- Stanford University School of Medicine, Stanford, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Lars G Hemkens
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA.
- Department of Clinical Research, University Hospital Basel, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland.
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.
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4
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Fricker M, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Shah N, Hines J, Collins J, Sridhar A, Kelkar A, Briggs T, Kelly J, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. 141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients.
Results
Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p < 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient.
Conclusions
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - N Hanna
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - A Rashid
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - M Fricker
- Newcastle University, Newcastle, United Kingdom
| | - P Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - N Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - S Miah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - N Shah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - J Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - B Lamb
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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5
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Fricker M, Nathan A, Hannah N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Shah N, Hines J, Collins J, Sridhar A, Kelkar A, Briggs T, Kelly J, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. O50 New guidelines to reduce unnecessary blood tests, delayed discharge and costs following robot assisted radical prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Routine postoperative blood tests (POBT) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed, and new guidelines were designed. The guidelines were prospectively validated in a cohort of 300 patients.
Result
Derivation Dataset 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 days due to delayed or incomplete blood tests.
Validation Dataset No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. New guidelines improved sensitivity for complications from 98% to 100% and specificity from 0% to 74%. The number of blood tests requested reduced by 73% (P < 0.001). Discharge delays reduced from 6% to 0% (P = 0.008). Cost savings were £178 per patient.
Conclusion
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
Take-home Message
Routine postoperative blood tests following robot assisted radical prostatectomy are often unnecessary. A guideline-based approach can reduce costs and optimise patient care.
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Affiliation(s)
| | - A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- University College London
| | - N Hannah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
- University of Cambridge
| | - A Rashid
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
- University of Cambridge
| | | | | | | | - P Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - N Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - S Miah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - N Shah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - J Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - J Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - A Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- Nuffield Department of Surgical Sciences, University of Oxford
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London
| | - B Lamb
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
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6
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Shriwas P, Roberts D, Li Y, Wang L, Qian Y, Bergmeier S, Hines J, Adhicary S, Nielsen C, Chen X. A small-molecule pan-class I glucose transporter inhibitor reduces cancer cell proliferation in vitro and tumor growth in vivo by targeting glucose-based metabolism. Cancer Metab 2021; 9:14. [PMID: 33771231 PMCID: PMC8004435 DOI: 10.1186/s40170-021-00248-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/03/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cancer cells drastically increase the uptake of glucose and glucose metabolism by overexpressing class I glucose transporters (GLUT1-4) to meet their energy and biomass synthesis needs and are very sensitive and vulnerable to glucose deprivation. Although targeting glucose uptake via GLUTs has been an attractive anticancer strategy, the relative anticancer efficacy of multi-GLUT targeting or single GLUT targeting is unclear. Here, we report DRB18, a synthetic small molecule, is a potent anticancer compound whose pan-class I GLUT inhibition is superior to single GLUT targeting. METHODS Glucose uptake and MTT/resazurin assays were used to measure DRB18's inhibitory activities of glucose transport and cell viability/proliferation in human lung cancer and other cancer cell lines. Four HEK293 cell lines expressing GLUT1-4 individually were used to determine the IC50 values of DRB18's inhibitory activity of glucose transport. Docking studies were performed to investigate the potential direct interaction of DRB18 with GLUT1-4. Metabolomics analysis was performed to identify metabolite changes in A549 lung cancer cells treated with DRB18. DRB18 was used to treat A549 tumor-bearing nude mice. The GLUT1 gene was knocked out to determine how the KO of the gene affected tumor growth. RESULTS DRB18 reduced glucose uptake mediated via each of GLUT1-4 with different IC50s, which match with the docking glidescores with a correlation coefficient of 0.858. Metabolomics analysis revealed that DRB18 altered energy-related metabolism in A549 cells by changing the abundance of metabolites in glucose-related pathways in vitro and in vivo. DRB18 eventually led to G1/S phase arrest and increased oxidative stress and necrotic cell death. IP injection of DRB18 in A549 tumor-bearing nude mice at 10 mg/kg body weight thrice a week led to a significant reduction in the tumor volume compared with mock-treated tumors. In contrast, the knockout of the GLUT1 gene did not reduce tumor volume. CONCLUSIONS DRB18 is a potent pan-class I GLUT inhibitor in vitro and in vivo in cancer cells. Mechanistically, it is likely to bind the outward open conformation of GLUT1-4, reducing tumor growth through inhibiting GLUT1-4-mediated glucose transport and metabolisms. Pan-class I GLUT inhibition is a better strategy than single GLUT targeting for inhibiting tumor growth.
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Affiliation(s)
- Pratik Shriwas
- Department of Biological Sciences, Ohio University, Athens, OH, 45701, USA.,Edison Biotechnology Institute, Ohio University, Athens, OH, 45701, USA.,Molecular and Cellular Biology Program, Ohio University, Athens, OH, 45701, USA.,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA
| | - Dennis Roberts
- Department of Chemistry and Biochemistry, Ohio University, Athens, OH, 45701, USA
| | - Yunsheng Li
- Edison Biotechnology Institute, Ohio University, Athens, OH, 45701, USA
| | - Liyi Wang
- Department of Chemistry and Biochemistry, Ohio University, Athens, OH, 45701, USA
| | - Yanrong Qian
- Edison Biotechnology Institute, Ohio University, Athens, OH, 45701, USA
| | - Stephen Bergmeier
- Molecular and Cellular Biology Program, Ohio University, Athens, OH, 45701, USA.,Department of Chemistry and Biochemistry, Ohio University, Athens, OH, 45701, USA.,Translational Biomedical Sciences Program, Ohio University, Athens, OH, 45701, USA
| | - Jennifer Hines
- Molecular and Cellular Biology Program, Ohio University, Athens, OH, 45701, USA.,Department of Chemistry and Biochemistry, Ohio University, Athens, OH, 45701, USA
| | - Subhodip Adhicary
- Department of Biological Sciences, Ohio University, Athens, OH, 45701, USA.,Translational Biomedical Sciences Program, Ohio University, Athens, OH, 45701, USA
| | - Corinne Nielsen
- Department of Biological Sciences, Ohio University, Athens, OH, 45701, USA.,Molecular and Cellular Biology Program, Ohio University, Athens, OH, 45701, USA.,Translational Biomedical Sciences Program, Ohio University, Athens, OH, 45701, USA
| | - Xiaozhuo Chen
- Department of Biological Sciences, Ohio University, Athens, OH, 45701, USA. .,Edison Biotechnology Institute, Ohio University, Athens, OH, 45701, USA. .,Molecular and Cellular Biology Program, Ohio University, Athens, OH, 45701, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA. .,Department of Chemistry and Biochemistry, Ohio University, Athens, OH, 45701, USA. .,Edison Biotechnology Institute, Ohio University, 172 Water Tower Drive, Athens, OH, 43701, USA.
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7
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Barnes AD, Scherber C, Brose U, Borer ET, Ebeling A, Gauzens B, Giling DP, Hines J, Isbell F, Ristok C, Tilman D, Weisser WW, Eisenhauer N. Biodiversity enhances the multitrophic control of arthropod herbivory. Sci Adv 2020; 6:6/45/eabb6603. [PMID: 33158860 PMCID: PMC7673711 DOI: 10.1126/sciadv.abb6603] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/23/2020] [Indexed: 05/19/2023]
Abstract
Arthropod herbivores cause substantial economic costs that drive an increasing need to develop environmentally sustainable approaches to herbivore control. Increasing plant diversity is expected to limit herbivory by altering plant-herbivore and predator-herbivore interactions, but the simultaneous influence of these interactions on herbivore impacts remains unexplored. We compiled 487 arthropod food webs in two long-running grassland biodiversity experiments in Europe and North America to investigate whether and how increasing plant diversity can reduce the impacts of herbivores on plants. We show that plants lose just under half as much energy to arthropod herbivores when in high-diversity mixtures versus monocultures and reveal that plant diversity decreases effects of herbivores on plants by simultaneously benefiting predators and reducing average herbivore food quality. These findings demonstrate that conserving plant diversity is crucial for maintaining interactions in food webs that provide natural control of herbivore pests.
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Affiliation(s)
- A D Barnes
- School of Science, University of Waikato, Private Bag 3105, Hamilton 3204, New Zealand.
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, 04103 Leipzig, Germany
- Leipzig University, Institute of Biology, Deutscher Platz 5e, 04103 Leipzig, Germany
- Institute of Landscape Ecology, University of Münster, Heisenbergstraße 2, 48149 Münster, Germany
| | - C Scherber
- Institute of Landscape Ecology, University of Münster, Heisenbergstraße 2, 48149 Münster, Germany
- Centre for Biodiversity Monitoring, Zoological Research Museum Alexander Koenig, Adenauerallee 160, 53113 Bonn, Germany
| | - U Brose
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, 04103 Leipzig, Germany
- Institute of Biodiversity, Friedrich Schiller University Jena, Dornburger Str. 159, 07743 Jena, Germany
| | - E T Borer
- Department of Ecology, Evolution and Behavior, University of Minnesota, 1479 Gortner Ave., Saint Paul, MN, USA
| | - A Ebeling
- Institute of Ecology and Evolution, Friedrich Schiller University Jena, Dornburger Str. 159, 07743 Jena, Germany
| | - B Gauzens
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, 04103 Leipzig, Germany
- Institute of Biodiversity, Friedrich Schiller University Jena, Dornburger Str. 159, 07743 Jena, Germany
| | - D P Giling
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, 04103 Leipzig, Germany
- Leipzig University, Institute of Biology, Deutscher Platz 5e, 04103 Leipzig, Germany
- Institute of Biodiversity, Friedrich Schiller University Jena, Dornburger Str. 159, 07743 Jena, Germany
- Centre for Applied Water Science, Institute for Applied Ecology, Faculty of Science and Technology, University of Canberra, 11 Kirinari St., Bruce, ACT 2617, Australia
- CSIRO Land and Water, Commonwealth Scientific and Industrial Research Organisation, Canberra, Building 101, Clunies Ross Street, Black Mountain, ACT 2601, Australia
| | - J Hines
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, 04103 Leipzig, Germany
- Leipzig University, Institute of Biology, Deutscher Platz 5e, 04103 Leipzig, Germany
| | - F Isbell
- Department of Ecology, Evolution and Behavior, University of Minnesota, 1479 Gortner Ave., Saint Paul, MN, USA
| | - C Ristok
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, 04103 Leipzig, Germany
- Institute of Biodiversity, Friedrich Schiller University Jena, Dornburger Str. 159, 07743 Jena, Germany
| | - D Tilman
- Department of Ecology, Evolution and Behavior, University of Minnesota, 1479 Gortner Ave., Saint Paul, MN, USA
- Bren School of Environmental Science and Management, University of California, Santa Barbara, Santa Barbara, CA 93117, USA
| | - W W Weisser
- Terrestrial Ecology Research Group, School of Life Sciences Weihenstephan, Technical University of Munich, Hans-Carl-von-Carlowitz-Platz 2, 85354 Freising, Germany
| | - N Eisenhauer
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, 04103 Leipzig, Germany
- Leipzig University, Institute of Biology, Deutscher Platz 5e, 04103 Leipzig, Germany
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8
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Miah S, Collins J, Sridhar A, Kelkar A, Hines J, Kelly J, Shah N, Briggs T, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. Novel guidelines to avoid routine blood tests after Robot Assisted Radical Prostatectomy (RARP). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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9
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Kenters N, Eikelenboom-Boskamp A, Hines J, McGeer A, Huijskens E, Voss A. Product dose considerations for real-world hand sanitiser efficacy. Am J Infect Control 2020; 48:503-506. [PMID: 31924389 DOI: 10.1016/j.ajic.2019.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol based hand rubs (ABHR) are extremely effective at reducing microbial contamination and have an essential role in best practice hand hygiene described by the World Health Organization. METHODS We determined ABHR drying time when performing hand hygiene in a laboratory setting. Which was followed by identifying the amount of ABHR needed for complete hand coverage. When the aforementioned was analyzed real-time data were gathered to examine the amount used for hand hygiene in a hospital setting. In parallel hands of healthcare workers (HCWs) were monitored for drying time and perception on ABHR use. RESULTS In 86% (24,446,397/28,280,383) of the events a single dose of ABHR was used on clinical wards. Twenty-four HCWs expected hand hygiene to take 7.5 seconds (median; range 3-30 seconds). Forty-three HCWs show that 1.5 mL ABHR dose achieves the desired drying time according to World Health Organization guidelines (av. median 26 seconds), but is consistently perceived to have a longer drying time than expected (av. median 18 seconds). In-vivo results (n = 10) indicate that 2.25 mL ABHR is required for adequate coverage (82%-90%) of both sides of the hand. CONCLUSIONS Results indicate that set standards for the use of ABHR do not match "in-vivo" behaviour of HCWs. Perceived drying times are shorter than actual drying time. The needed drying time to reach acceptable antimicrobial efficacy of ABHRs should be revisited.
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Warner R, Bastianpillai C, Allchorne P, Chowdhury S, Graham S, Li CY, Pal P, Peters J, Hines J, Green J. 10,000 urology emergencies: A single centre series – The changing shape of acute urology. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Vallejo-Torres L, Melnychuk M, Vindrola-Padros C, Aitchison M, Clarke CS, Fulop NJ, Hines J, Levermore C, Maddineni SB, Perry C, Pritchard-Jones K, Ramsay AIG, Shackley DC, Morris S. Discrete-choice experiment to analyse preferences for centralizing specialist cancer surgery services. Br J Surg 2018; 105:587-596. [PMID: 29512137 PMCID: PMC5900867 DOI: 10.1002/bjs.10761] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 05/18/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 12/21/2022]
Abstract
Background Centralizing specialist cancer surgery services aims to reduce variations in quality of care and improve patient outcomes, but increases travel demands on patients and families. This study aimed to evaluate preferences of patients, health professionals and members of the public for the characteristics associated with centralization. Methods A discrete‐choice experiment was conducted, using paper and electronic surveys. Participants comprised: former and current patients (at any stage of treatment) with prostate, bladder, kidney or oesophagogastric cancer who previously participated in the National Cancer Patient Experience Survey; health professionals with experience of cancer care (11 types including surgeons, nurses and oncologists); and members of the public. Choice scenarios were based on the following attributes: travel time to hospital, risk of serious complications, risk of death, annual number of operations at the centre, access to a specialist multidisciplinary team (MDT) and specialist surgeon cover after surgery. Results Responses were obtained from 444 individuals (206 patients, 111 health professionals and 127 members of the public). The response rate was 52·8 per cent for the patient sample; it was unknown for the other groups as the survey was distributed via multiple overlapping methods. Preferences were particularly influenced by risk of complications, risk of death and access to a specialist MDT. Participants were willing to travel, on average, 75 min longer in order to reduce their risk of complications by 1 per cent, and over 5 h longer to reduce risk of death by 1 per cent. Findings were similar across groups. Conclusion Respondents' preferences in this selected sample were consistent with centralization. Most favour it
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Affiliation(s)
- L Vallejo-Torres
- Department of Applied Health Research, University College London, London, UK.,Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - M Melnychuk
- Department of Applied Health Research, University College London, London, UK
| | - C Vindrola-Padros
- Department of Applied Health Research, University College London, London, UK
| | - M Aitchison
- Department of Renal and Nephrology Services, Royal Free London NHS Foundation Trust, London, UK
| | - C S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - N J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - J Hines
- Urology Department, University College London Hospital, London, UK
| | - C Levermore
- University College London Hospitals Cancer Collaborative, University College London Hospitals NHS Foundation Trust, London, UK
| | - S B Maddineni
- Department of Urology, Salford Royal NHS Foundation Trust, Salford, UK
| | - C Perry
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - K Pritchard-Jones
- University College London Hospitals Cancer Collaborative, University College London Hospitals NHS Foundation Trust, London, UK.,Academic Health Science Network Cancer Programme, University College London Partners, London, UK
| | - A I G Ramsay
- Department of Applied Health Research, University College London, London, UK
| | - D C Shackley
- Greater Manchester Cancer, hosted by Christie NHS Foundation Trust, Christie Hospital, Manchester, UK
| | - S Morris
- Department of Applied Health Research, University College London, London, UK
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12
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Wilkinson MAC, Ormandy K, Bradley CR, Fraise AP, Hines J. Dose considerations for alcohol-based hand rubs. J Hosp Infect 2017; 95:175-182. [PMID: 28153555 DOI: 10.1016/j.jhin.2016.12.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 12/20/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Manufacturers' recommended dosages for alcohol-based hand rubs are typically determined by measuring product efficacy using a model protocol such as EN 1500; however, anecdotal reports and informal observation suggests that in many cases users self-titrate to much lower doses in real-world application. AIM To examine the interdependence of alcohol-based hand-rub volume on in-vivo efficacy using the EN 1500 standard test method, on drying time on users' hands, and on their perceptions of acceptability. METHODS Three formulations were studied using EN 1500 and a modification of this method. The modification used volumes ranging from 0.5 to 3.0 mL and 30 s application. Drying times were recorded and user acceptability was established using a three-point scale (too long, OK, or too short). Dying times were analysed in relation to hand surface area. FINDINGS The drying time for all three products increased as a function of volume. The drying time displayed a positive association with volume and a negative association with hand surface area. The optimum volume for user acceptability was between 1.5 and 2 mL, yielding a drying time of between 20 and 30 s. CONCLUSION Whereas EN 1500 is appropriate for establishing the efficacy of a hygienic hand-rub formulation compared to a benchmark, it does not reflect actual in-use conditions or the likely clinical effectiveness of the product. In particular, it fails to address the need to optimize the volume of application and user acceptability of the product.
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Affiliation(s)
- M A C Wilkinson
- Hospital Infection Research Laboratory, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - K Ormandy
- Deb Group Ltd, Denby, Derbyshire, UK
| | - C R Bradley
- Hospital Infection Research Laboratory, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
| | - A P Fraise
- Hospital Infection Research Laboratory, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - J Hines
- Deb Group Ltd, Denby, Derbyshire, UK
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Hines J, Wilkinson SM, John SM, Diepgen TL, English J, Rustemeyer T, Wassilew S, Kezic S, Maibach HI. Response to letter to the editor re. Hines J, Wilkinson SM, John SM, et al. The three moments of skin cream application: an evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace. J Eur Acad Dermatol Venereol 2016; 31:e308. [PMID: 27878862 DOI: 10.1111/jdv.14039] [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: 11/28/2022]
Affiliation(s)
- J Hines
- Deb Group Ltd., Research & Development, Denby, Derbyshire, DE5 8JZ, UK
| | - S M Wilkinson
- Leeds Teaching Hospitals NHS Trust, Leeds, LS7 4SA, UK
| | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Am Finkenhügel 7a, 49076, Osnabrueck, Germany
| | - T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Grabengasse 1, 69117, Heidelberg, Germany
| | - J English
- Nottingham NHS Treatment Center, Nottingham, NG7 2FT, UK
| | - T Rustemeyer
- Department of Dermatology and Allergology, VU University Medical Center Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - S Wassilew
- Hautarztzentrum Krefeld, Moerser Landstraβe 352, 47802, Krefeld, Germany
| | - S Kezic
- Coronel Institute of Occupational Health, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands
| | - H I Maibach
- Dermatology Department, University of California San Francisco, 94115, San Francisco, CA, USA
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Halliday L, Walker A, Vig S, Hines J, Brecknell J. The relationship between grit and burnout: How do surgical trainees compare to other doctors? Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hines J, Wilkinson SM, John SM, Diepgen TL, English J, Rustemeyer T, Wassilew S, Kezic S, Maibach HI. The three moments of skin cream application: an evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace. J Eur Acad Dermatol Venereol 2016; 31:53-64. [PMID: 27545662 PMCID: PMC5434821 DOI: 10.1111/jdv.13851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 03/10/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Abstract
Contact dermatitis is one of the most common occupational diseases, with serious impact on quality of life, lost days at work and a condition that may be chronically relapsing. Regular prophylactic skin cream application is widely acknowledged to be an effective prevention strategy against occupational contact dermatitis; however, compliance rates remain low. To present a simple programme for skin cream application in the workplace with focus on implementation to drive down the rate of occupational irritant contact dermatitis, an expert panel of eight international dermatologists combined personal experience with extensive literature review. The recommendations are based on clinical experience as supported by evidence-based data from interventional studies. The authors identified three moments for skin cream application in the work place: (i) before starting a work period; (ii) after washing hands; and (iii) after work. Affecting behaviour change requires systematic communications, monitoring and reporting, which is proposed through Kotter's principles of organizational change management. Measurement tools are provided in the appendix. Interventional data based on application of this proposal is required to demonstrate its effectiveness.
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Affiliation(s)
- J Hines
- Deb Group Ltd., Research & Development, Denby, Derbyshire, UK
| | | | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Osnabrueck, Germany
| | - T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J English
- Nottingham NHS Treatment Center, Nottingham, UK
| | - T Rustemeyer
- Department of Dermatology and Allergology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - S Wassilew
- Hautarztzentrum Krefeld, Krefeld, Germany
| | - S Kezic
- Coronel Institute of Occupational Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - H I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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Leang B, Lynen L, Schrooten W, Hines J. Comparison of albendazole regimen for prophylaxis of strongyloides hyperinfection in nephrotic syndrome patients on long-term steroids in Cambodia. Trop Doct 2016; 35:212-3. [PMID: 16354470 DOI: 10.1258/004947505774938558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nephrotic syndrome patients on long-term steroids face the risk of having heavy uncomplicated strongyloidiasis or death from its extreme form, the strongyloides hyperinfection. The risk can be minimized if we eradicate the parasite first. We compare a once daily and twice daily albendazole regimen in preventing this potentially fatal complication in 122 patients with nephrotic syndrome.
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Affiliation(s)
- Bunse Leang
- Medical Department, Sihanouk Hospital Center of Hope (SHCH), Phnom Penh, Cambodia.
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Spanyer J, Hines J, Beaumont CM, Yerasimides J. Catastrophic Femoral Neck Failure after THA with the Accolade(®) I Stem in Three Patients. Clin Orthop Relat Res 2016; 474:1333-8. [PMID: 26152781 PMCID: PMC4814423 DOI: 10.1007/s11999-015-4438-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Received: 02/08/2015] [Accepted: 06/25/2015] [Indexed: 01/31/2023]
Abstract
CASE DESCRIPTION We report a series of three femoral stem failures, each occurring at the head-neck junction, with all patients experiencing limited and painful ambulation, leading to subsequent revision arthroplasty. All patients were male with high-offset femoral stems and increased head lengths, and each had undergone primary THA at a minimum of 7 years before presentation (average, 94 months). There were no associated deep infections or cases of aseptic loosening in the cohort. LITERATURE REVIEW There is a paucity of similar reports in the literature regarding femoral stem failure at the head-neck junction. When failures of titanium stems have been reported, failure has been attributed to material design and geometry, laser etching, overload, implant alignment, and patient characteristics. PURPOSE AND CLINICAL RELEVANCE Catastrophic failures of femoral stems at the head-neck junction are a rare cause for revision after THA. Component material and design, surgical technique, and patient factors may contribute.
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Affiliation(s)
- Jonathon Spanyer
- />Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Jennifer Hines
- />Department of Internal Medicine, St. Joseph Mercy Health System, 5301 E. Huron River Drive, Ypsilanti, MI 48197 USA
| | | | - Jonathan Yerasimides
- />Department of Orthopaedic Surgery, University of Louisville, Louisville, KY USA , />Norton Healthcare, Louisville, KY USA
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Limbert DP, Nabuurs-Franssen M, Besselink-Quint P, van den Wildenberg F, Schaafstra J, Hines J, Voss A. Impact of hand hygiene product accessibility on 5 moment compliance within an acute care facility ward. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475175 DOI: 10.1186/2047-2994-4-s1-p298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Wilkinson MAC, Bradley C, Hines J, Ormandy K, Fraise A. Do international standards for hygienic handrubs reflect realistic usage? Antimicrob Resist Infect Control 2015. [PMCID: PMC4475216 DOI: 10.1186/2047-2994-4-s1-p305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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McLaws ML, Hines J, Kilpatrick C, Storr J, Voss A, Leroy C, Limbert D. Comparison of hand hygiene opportunities (HHOS) between a us study and in acute care facilities in three other countries. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475186 DOI: 10.1186/2047-2994-4-s1-p299] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Boghosian M, Cassel K, Hammes M, Funaki B, Kim S, Qian X, Wang X, Dhar P, Hines J. Hemodynamics in the cephalic arch of a brachiocephalic fistula. Med Eng Phys 2014; 36:822-30. [PMID: 24695337 DOI: 10.1016/j.medengphy.2014.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 08/15/2013] [Revised: 01/22/2014] [Accepted: 03/08/2014] [Indexed: 12/01/2022]
Abstract
The care and outcome of patients with end stage renal disease (ESRD) on chronic hemodialysis is directly dependent on their hemodialysis access. A brachiocephalic fistula (BCF) is commonly placed in the elderly and in patients with a failed lower-arm, or radiocephalic, fistula. However, there are numerous complications such that the BCF has an average patency of only 3.6 years. A leading cause of BCF dysfunction and failure is stenosis in the arch of the cephalic vein near its junction with the axillary vein, which is called cephalic arch stenosis (CAS). Using a combined clinical and computational investigation, we seek to improve our understanding of the cause of CAS, and to develop a means of predicting CAS risk in patients with a planned BCF access. This paper details the methodology used to determine the hemodynamic consequences of the post-fistula environment and illustrates detailed results for a representative sample of patient-specific anatomies, including a single, bifurcated, and trifurcated arch. It is found that the high flows present due to fistula creation lead to secondary flows in the arch owing to its curvature with corresponding low wall shear stresses. The abnormally low wall shear stress locations correlate with the development of stenosis in the singular case that is tracked in time for a period of one year.
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Affiliation(s)
- M Boghosian
- Mechanical, Materials, and Aerospace Engineering Department, Illinois Institute of Technology, Chicago, IL, United States.
| | - K Cassel
- Mechanical, Materials, and Aerospace Engineering Department, Illinois Institute of Technology, Chicago, IL, United States
| | - M Hammes
- Nephrology, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - B Funaki
- Vascular and Interventional Radiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States
| | - S Kim
- Vascular and Interventional Radiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States
| | - X Qian
- Mechanical, Materials, and Aerospace Engineering Department, Illinois Institute of Technology, Chicago, IL, United States
| | - X Wang
- Mechanical, Materials, and Aerospace Engineering Department, Illinois Institute of Technology, Chicago, IL, United States
| | - P Dhar
- Biomedical Engineering Department, Illinois Institute of Technology, Chicago, IL, United States
| | - J Hines
- Nephrology, Department of Medicine, University of Chicago, Chicago, IL, United States
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Liu Y, Cao Y, Zhang W, Bergmeier S, Qian Y, Akbar H, Colvin R, Ding J, Tong L, Wu S, Hines J, Chen X. A small-molecule inhibitor of glucose transporter 1 downregulates glycolysis, induces cell-cycle arrest, and inhibits cancer cell growth in vitro and in vivo. Mol Cancer Ther 2012; 11:1672-82. [PMID: 22689530 DOI: 10.1158/1535-7163.mct-12-0131] [Citation(s) in RCA: 387] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The functional and therapeutic importance of the Warburg effect is increasingly recognized, and glycolysis has become a target of anticancer strategies. We recently reported the identification of a group of novel small compounds that inhibit basal glucose transport and reduce cancer cell growth by a glucose deprivation-like mechanism. We hypothesized that the compounds target Glut1 and are efficacious in vivo as anticancer agents. Here, we report that a novel representative compound WZB117 not only inhibited cell growth in cancer cell lines but also inhibited cancer growth in a nude mouse model. Daily intraperitoneal injection of WZB117 at 10 mg/kg resulted in a more than 70% reduction in the size of human lung cancer of A549 cell origin. Mechanism studies showed that WZB117 inhibited glucose transport in human red blood cells (RBC), which express Glut1 as their sole glucose transporter. Cancer cell treatment with WZB117 led to decreases in levels of Glut1 protein, intracellular ATP, and glycolytic enzymes. All these changes were followed by increase in ATP-sensing enzyme AMP-activated protein kinase (AMPK) and declines in cyclin E2 as well as phosphorylated retinoblastoma, resulting in cell-cycle arrest, senescence, and necrosis. Addition of extracellular ATP rescued compound-treated cancer cells, suggesting that the reduction of intracellular ATP plays an important role in the anticancer mechanism of the molecule. Senescence induction and the essential role of ATP were reported for the first time in Glut1 inhibitor-treated cancer cells. Thus, WZB117 is a prototype for further development of anticancer therapeutics targeting Glut1-mediated glucose transport and glucose metabolism.
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Affiliation(s)
- Yi Liu
- Department of Biological Science, Ohio University, Athens, OH, USA
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Liu Y, Cao Y, Zhang W, Bergmeier S, Qian Y, Akbar H, Colvin R, Ding J, Tong L, Wu S, Hines J, Chen X. Abstract 3231: A small molecule inhibitor of glucose transporter 1 (Glut1) down-regulates glycolysis, induces cell cycle arrest, and inhibits cancer cell growth in vitro and in vivo. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-3231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Increased dependence on glycolysis and glucose metabolism, known as the Warburg effect, is a near-universal hallmark of cancer. The functional and therapeutic importance of the effect has been increasingly recognized and glycolysis has become a new target of anticancer strategies. We recently reported the identification of a group of novel small compounds that inhibit basal glucose transport and reduce cancer cell growth by using a glucose deprivation-like mechanism. Based on these and other results, we hypothesized that the compounds inhibit cancer growth by targeting Glut1 and they are efficacious in vivo as anticancer agents. Here we report that the representative and novel compound WZB117 not only inhibited cancer cell growth in multiple cancer cell lines but also inhibited cancer growth in a nude mouse model. Daily intraperitoneal (ip) injection of WZB117 at a dose of 10 mg/kg resulted in an over 70% reduction in the average size of xenografted tumor of human lung cancer A549 cell origin. Compound target study showed that WZB117 inhibited glucose transport in human red blood cells (RBC) and RBC-derived vesicles, both of which express Glut1 as their sole glucose transporter. Docking studies of WZB117-Glut1 interaction also demonstrate and support the binding of WZB117 to Glut1. Mechanism studies using multiple cancer cell lines revealed that treatment of WZB117 led to an induction of glycolytic enzymes, such as hexokinase, PKM2 and PGAM1; and then a decline of glycolysis as indicated by reduced lactate production with changes in Akt, AMPK and mTOR, protein factors in energy sensitive signaling pathways. These resulted in ER stress, followed by cell cycle arrest mediated through downregulation of cyclin E and Rb. Taken together, cell cycle arrest at G1/S phase plays major roles in the WZB117-induced inhibition of cancer cell growth while apoptosis is secondary. WZB117 can serve as a prototypic compound for further development of Glut1 inhibitors into novel anticancer therapeutics targeting glucose transport and glucose metabolism.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3231. doi:1538-7445.AM2012-3231
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Affiliation(s)
- Yi Liu
- 1Ohio University, Athens, OH
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Bergmeier S, Maciagiewicz I, Fang F, Roberts D, Zhou S, Hines J. A Synthesis of 1,4-Disubstituted Imidazolidin-2-ones from Fused-Ring Aziridines. SYNTHESIS-STUTTGART 2012. [DOI: 10.1055/s-0031-1289684] [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: 10/14/2022]
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Yaghoubian A, Kaji A, Galante J, Collins C, Dolich M, Easter D, Hines J, Salim A, De Virgilio C. Is Gender Predictive of Fellowship Choice at West Coast Programs? West Coast Surgery Program Director Study Group. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sakhel K, Kirakosyan A, Lukban J, Hines J. Comparison between Robot-Assisted Laparoscopic Hysterectomy and Total Laparoscopic Hysterectomy – A Cohort Study. J Minim Invasive Gynecol 2009. [DOI: 10.1016/j.jmig.2009.08.077] [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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Reisine T, Woulfe D, Raynor K, Kong H, Heerding J, Hines J, Tallent M, Law S. Interaction of somatostatin receptors with G proteins and cellular effector systems. Ciba Found Symp 2007; 190:160-7; discussion 167-70. [PMID: 7587645 DOI: 10.1002/9780470514733.ch10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Somatostatin induces its multiple biological actions by interacting with a family of receptors, referred to as sstr1-sstr5. To determine the molecular mechanisms of action of somatostatin, we have investigated the interaction of the different cloned receptors with G proteins and cellular effector systems. sstr2, sstr3 and sstr5 associate with pertussis toxin-sensitive G proteins and are able to mediate the inhibition of adenylyl cyclase activity by somatostatin. Two forms of sstr2, sstr2A and sstr2B, are generated by alternative splicing and differ in their C-terminal amino acid sequence. sstr2B couples to adenylyl cyclase whereas sstr2A does not. To investigate the basis for the differential coupling to adenylyl cyclase, we truncated sstr2B to the point of amino acid sequence divergence from sstr2A. The truncated sstr2B mediated the inhibition of cAMP formation by somatostatin, indicating that the C-terminus is not needed for coupling sstr2 to adenylyl cyclase. It is likely that the C-terminus of sstr2A hinders coupling to adenylyl cyclase. sstr2A associates with Gi alpha 3 and G(o) alpha but does not effectively interact with Gi alpha 1, a G protein that is necessary for coupling somatostatin receptors to adenylyl cyclase. The differential association of the splice variants with Gi alpha 1 may explain their contrasting effects on adenylyl cyclase activity. sstr3 also couples to adenylyl cyclase. Gi alpha 1 links sstr3 to adenylyl cyclase and mutagenesis studies have shown that the C-terminus of Gi alpha 1 is necessary for this coupling. The C-terminus of the Gi alpha proteins differ by only a few amino acid residues and only Gi alpha 1 couples sstr3 to adenylyl cyclase.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T Reisine
- Department of Pharmacology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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Montgomery K, Mundt C, Thonier G, Tellier A, Udoh U, Barker V, Ricks R, Giovangrandi L, Davies P, Cagle Y, Swain J, Hines J, Kovacs G. Lifeguard--a personal physiological monitor for extreme environments. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:2192-5. [PMID: 17272160 DOI: 10.1109/iembs.2004.1403640] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Monitoring vital signs in applications that require the subject to be mobile requires small, lightweight, and robust sensors and electronics. A body-worn system should be unobtrusive, noninvasive, and easy-to-use. It must be able to log vital signs data for several hours as well as transmit it on demand in real-time using secure wireless technologies. The NASA Ames Research Center (Astrobionics) and Stanford University (National Center for Space Biological Technologies) are currently developing a wearable physiological monitoring system for astronauts, called LifeGuard, that meets all of the above requirements and is also applicable to clinical, home-health monitoring, first responder and military applications.
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Affiliation(s)
- K Montgomery
- National Center for Space Biological Technologies, Stanford University, CA, USA
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31
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Salek J, Hines J. Education and imaging. Gastrointestinal: cecal ileus. J Gastroenterol Hepatol 2007; 22:132. [PMID: 17201893 DOI: 10.1111/j.1440-1746.2006.04812.x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- J Salek
- Department of Internal Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, NY, USA
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32
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Seibert R, Ramsey C, Hines J. SU-FF-J-97: Modeling of Lung Tumor Response to Image-Guided Radiation Therapy. Med Phys 2006. [DOI: 10.1118/1.2240873] [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: 11/07/2022] Open
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33
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Lane TM, Ansell W, Farrugia D, Wilson P, Williams G, Chinegwundoh F, Philp T, Hines J, Oliver RTD. Long-Term Outcomes in Patients with Prostate Cancer Managed with Intermittent Androgen Suppression. Urol Int 2004; 73:117-22. [PMID: 15331894 DOI: 10.1159/000079690] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2003] [Accepted: 01/28/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the long-term outcomes of patients with prostate cancer managed with intermittent androgen suppression (IAS) following their enrollment in an open, non-randomised feasibility study initiated 10 years ago. PATIENTS AND METHODS Patients with prostate cancer who developed marked side effects following androgen deprivation were considered for entry into the study. All patients were required to have been managed with androgen deprivation for a minimum of 9 months and to have achieved PSA remissions to levels <4 ng/ml or falls to greater than 90% of pre-treatment levels. Patients remained off treatment until PSA values rose to >20 ng/ml or individuals became symptomatic--at which stage a 9-month cycle of androgen suppression was repeated. Such on-off cycling continued until hormone-resistant disease developed and patients proceeded (off trial) to second-line therapies. RESULTS 75 patients were recruited to the study following an initial referral with treatment-related side effects specifically associated with androgen deprivation. 86% of these remain alive at a median of 134 months (11 years) since initial histological diagnosis. Survival times and times to hormone resistance (from first cycle hormone deprivation) have also been calculated. Overall there is a median survival time of 95 months (8 years) from initial (first-cycle) androgen deprivation in those presenting with localised or locally advanced disease and a median survival time of 87 months (7 years) for those presenting with metastatic disease. There exists a median of 83 months to hormone resistance in the localised and locally advanced group and a median of 50 months in those presenting with metastatic disease. We have calculated a 100% 5-year actuarial survival rate for those presenting with localised or locally advanced disease (from time of first cycle hormone ablation) and a 70% 5-year actuarial survival rate for those presenting with metastatic. CONCLUSIONS Long-term outcome figures and actuarial survival rates presented here provide further support for a pulsed or intermittent approach to androgen ablation in patients with prostate cancer. In addition, they serve as valuable extended outcome data for patients managed in this way. Likewise, data presented here suggests that apparent survival advantages appear related, at least in part, to a delay in the onset of androgen resistance and that such a management approach is both safe and effective in those presenting with both metastatic disease as well as those with more localised pathology.
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Affiliation(s)
- T M Lane
- Departments of Medical Oncology and Urology, St Bartholomew's Hospital, London, UK.
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34
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Buller DB, Woodall WG, Zimmerman DE, Heimendinger J, Rogers EM, Slater MD, Hau BA, Pepper JI, Bartlett-Horch K, Burris-Woodall PA, Dignan MB, Hines J, Le Blanc ML. Formative research activities to provide Web-based nutrition education to adults in the Upper Rio Grande Valley. Fam Community Health 2001; 24:1-12. [PMID: 11563940 DOI: 10.1097/00003727-200110000-00003] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The Internet is a promising new tool for disseminating cancer prevention information. Barriers to full implementation include disparities in access and skill and availability of information relevant at the local level. A nutrition education Web site to promote fruit and vegetable intake is being produced for a tri-ethnic adult population in Colorado and New Mexico. Development is guided by findings from formative research including focus groups with local residents, a survey on computer and Internet use with 200 adults in 1998, an assessment of public access computer sites, and in-depth discussion with local community computer skills trainers.
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Affiliation(s)
- D B Buller
- Center for Health Communication, AMC Cancer Research Center, Denver, Colorado, USA
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35
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Hines J, Fluharty SJ, Yee DK. Chimeric AT1/AT2 receptors reveal functional similarities despite key amino acid dissimilarities in the domains mediating agonist-dependent activation. Biochemistry 2001; 40:11251-60. [PMID: 11551225 DOI: 10.1021/bi002780u] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chimeric AT1/AT2 angiotensin II (AngII) receptors in which the sixth and/or seventh transmembrane-spanning domains of the AT2 receptor were substituted into the AT1 receptor were used to investigate the activation mechanisms of the two receptor subtypes. Numerous reports have identified amino acid residues in the sixth and seventh transmembrane-spanning domains of the AT1 receptor involved in the intrareceptor activation mechanism following agonist binding. Many of these residues are not conserved in the AT2 receptor; the corresponding AT2 receptor residues are, in fact, disruptive of AngII-dependent activation when substituted into the AT1 receptor. Surprisingly, the chimeric AT1/AT2 receptors--which also lack these crucial AT1 residues--exhibited AngII-induced activation of phosphoinositide hydrolysis with efficacies and potencies similar to the wild-type AT1 receptor. Consistent with earlier reports, a AT1[Y292F] point mutant demonstrated greatly decreased agonist-induced activation of phosphoinositide hydrolysis. However, a AT1[Y292F/N295S] double-point mutant allowed for normal agonist-induced activation with a pharmacodynamic profile indistinguishable from the wild-type receptor. Despite amino acid dissimilarities, the same corresponding domains and even the same residue loci in both of the AngII receptor subtypes are equally able to mediate agonist-induced receptor activation. This suggests that these corresponding domains in the AT1 and the AT2 receptors are crucial to the activation mechanism, demonstrating greater structural flexibility than previously believed regarding AT1 receptor activation and supporting the possibility of a common activation mechanism for the two receptor subtypes.
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Affiliation(s)
- J Hines
- Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6046, USA
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36
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Zhao Y, Xue Y, Oberley TD, Kiningham KK, Lin SM, Yen HC, Majima H, Hines J, St Clair D. Overexpression of manganese superoxide dismutase suppresses tumor formation by modulation of activator protein-1 signaling in a multistage skin carcinogenesis model. Cancer Res 2001; 61:6082-8. [PMID: 11507057] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Manganese superoxide dismutase (MnSOD) is a nuclear encoded primary antioxidant enzyme localized in mitochondria. Because expression of MnSOD plays a major role in maintaining cellular redox status and reactive oxygen species are known to play a role in signal transduction and carcinogenesis, we investigated the role of MnSOD in the development of cancer using a two-stage [7,12-dimethylbenz(a)-anthracene plus 12-O-tetradecanoylphorbol-13-acetate (TPA)] skin carcinogenesis model. Female transgenic mice expressing the human MnSOD gene in the skin and their nontransgenic counterparts were used in this study. Pathological examination demonstrated significant reduction of papilloma formation in transgenic mice. Quantitative analysis of 4-hydroxy-2-nonenal-modified proteins showed greater accumulation of oxidative damage products in nontransgenic compared with transgenic mice, and this oxidative damage was demonstrated to be present in both mitochondria and nucleus. TPA increased activator protein-1 (AP-1) binding activity within 6 h in nontransgenic mice, but increased AP-1 binding activity was delayed in the transgenic mice. Electrophoretic mobility shift assay, transcription of the target genes, and Western analysis studies indicated that the increased AP-1 binding activity was attributable to induction of the Jun but not the Fos protein families. Overexpression of MnSOD selectively inhibited the TPA-induced activation of protein kinase Cepsilon and prevented subsequent activation of c-Jun NH(2)-terminal kinase in response to TPA. Overall, these results indicate that MnSOD regulates both cellular redox status and selectively modulates PKCepsilon signaling, thereby delaying AP-1 activation and inhibiting tumor promotion, resulting in reduction of tumors in MnSOD transgenic mice.
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Affiliation(s)
- Y Zhao
- Graduate Center for Toxicology, University of Kentucky, Lexington, Kentucky 40536, USA
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37
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Hines J, Heerding JN, Fluharty SJ, Yee DK. Identification of angiotensin II type 2 (AT2) receptor domains mediating high-affinity CGP 42112A binding and receptor activation. J Pharmacol Exp Ther 2001; 298:665-73. [PMID: 11454929] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
Chimeric angiotensin II (AngII) receptors constructed of portions of the AT2 receptor substituted into the AT1 receptor revealed the AT2 third extracellular loop and seventh transmembrane-spanning domain as major determinants for the ability to bind and activate in response to the AT2 receptor-selective agonist CGP 42112A. Radioligand binding experiments showed that chimeric AngII receptors possessing the AT2 third extracellular loop and seventh transmembrane-spanning domain bound CGP 42112A with high affinity approaching that of the wild-type AT2 receptor. The presence of the AT2 third extracellular loop appeared sufficient for high-affinity CGP 42112A binding, which was further enhanced by the additional presence of the AT2 seventh transmembrane-spanning domain. Experiments with PD 123319, losartan, and [Sar1,Ile8]-AngII showed that increases in binding affinity associated with these domains were specific for CGP 42112A. Use of phosphoinositide hydrolysis as a functional index to measure activation of these chimeric AngII receptors further demonstrated that the AT2 seventh transmembrane-spanning domain was especially critical for CGP 42112A to act as an agonist. The absence of the AT2 seventh transmembrane-spanning domain prohibited CGP 42112A-induced activation of these receptors, even in the presence of high concentrations of CGP 42112A sufficient to saturate the binding sites. This study is the first to identify binding determinants of the AT2 receptor that are selective for CGP 42112A, and indicates that these determinants are at least partially distinct from those for the AT2-selective antagonist PD 123319. These differences may be a factor in the pharmacodynamic difference between these two ligands.
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Affiliation(s)
- J Hines
- Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6046, USA
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38
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Heerding JN, Hines J, Fluharty SJ, Yee DK. Identification and function of disulfide bridges in the extracellular domains of the angiotensin II type 2 receptor. Biochemistry 2001; 40:8369-77. [PMID: 11444984 DOI: 10.1021/bi002805p] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The angiotensin II (AngII) receptor family is comprised of two subtypes, type 1 (AT(1)) and type 2 (AT(2)). Although sharing low homology (only 34%), mutagenesis has identified some key residues that are conserved between both subtypes, including four extracellular cysteines. Previous AT(1) mutagenesis demonstrated that the cysteines form two disulfide bonds, one linking the first and second extracellular loops and another connecting the amino terminus to the third extracellular loop. The importance of these AT(1) disulfides in ligand binding is supported by the effect of dithiothreitol (DTT). DTT breaks disulfide bonds, thereby strongly inhibiting ligand binding in AT(1) receptors. Despite retaining the same cysteines, AT(2) receptor ligand binding is paradoxically enhanced by DTT. Thus, we constructed a series of AT(2) cysteine mutations, either individually or paired, to establish the role of the cysteines and the source of DTT's effects. The AT(2) cysteine mutants surprisingly confirmed that the cysteines form disulfide bonds in the same manner as in the AT(1) subtype. However, breaking the AT(2) disulfide bridges yielded two responses. As in AT(1) receptors, mutations disrupting the disulfide bond between the first and second extracellular loops reduced AT(2) binding by 4-fold. In contrast, mutations breaking the disulfide bridge between the amino terminus and the third extracellular loop increased AT(2) binding, mimicking DTT's effect on this subtype. Further analysis of AT(1)/AT(2) chimeric exchange mutants of these domains suggested that the AT(2) amino terminus and third extracellular loop may possess latent binding epitopes that are only uncovered after DTT exposure.
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Affiliation(s)
- J N Heerding
- Department of Animal Biology, University of Pennsylvania, Philadelphia, PA 19104-6046, USA
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39
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Hines J, Skrzypek E, Kajava AV, Straley SC. Structure-function analysis of Yersinia pestis YopM's interaction with alpha-thrombin to rule on its significance in systemic plague and to model YopM's mechanism of binding host proteins. Microb Pathog 2001; 30:193-209. [PMID: 11312613 DOI: 10.1006/mpat.2000.0424] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The plague virulence protein YopM of Yersinia pestis KIM5 belongs to the large family of leucine-rich repeat (LRR) proteins. The only activity demonstrated so far for YopM is thrombin-binding, which could be a function of the small amount of YopM that is released into surrounding tissues by the bacteria. This study combined deletional and mutational analysis, chemical crosslinking assays, and in vitro functional tests with molecular modelling to identify key features of YopM necessary for interacting with thrombin. Two Y. pestis strains expressing YopM variants that differed in thrombin binding were used to assess the importance of thrombin-binding for lethality of plague. Both strains suffered a similar decrease in virulence by three orders of magnitude, indicating that thrombin-binding per se was not the major deficiency for lethality in the systemic disease model employed. It remains possible that extracellular YopM could contribute to plague pathology and to early events in peripheral tissues. The structural studies provided a model for how YopM may interact with thrombin and an insight into how YopM's LRR structure may assemble distinct regions for binding different targets.
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Affiliation(s)
- J Hines
- Department of Microbiology and Immunology, University of Kentucky, Lexington, KY 40536-0298, USA
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40
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Peng H, Moffett J, Myers J, Fang X, Stachowiak EK, Maher P, Kratz E, Hines J, Fluharty SJ, Mizukoshi E, Bloom DC, Stachowiak MK. Novel nuclear signaling pathway mediates activation of fibroblast growth factor-2 gene by type 1 and type 2 angiotensin II receptors. Mol Biol Cell 2001; 12:449-62. [PMID: 11179427 PMCID: PMC30955 DOI: 10.1091/mbc.12.2.449] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In bovine adrenal medullary cells synergistically acting type 1 and type 2 angiotensin II (AII) receptors activate the fibroblast growth factor-2 (FGF-2) gene through a unique AII-responsive promoter element. Both the type 1 and type 2 AII receptors and the downstream cyclic adenosine 1',3'-monophosphate- and protein kinase C-dependent signaling pathways activate the FGF-2 promoter through a novel signal-transducing mechanism. This mechanism, which we have named integrative nuclear FGF receptor-1 signaling, involves the nuclear translocation of FGF receptor-1 and its subsequent transactivation of the AII-responsive element in the FGF-2 promoter.
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Affiliation(s)
- H Peng
- Molecular and Structural Neurobiology and Gene Therapy Program, State University of New York, Buffalo, New York 14214, USA
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41
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Lumerman J, Gershbaum MD, Hines J, Nardi P, Beuchert P, Katz DS. Unenhanced helical computed tomography for the evaluation of suspected renal colic in the adolescent population: a pilot study. Urology 2001; 57:342-6. [PMID: 11182351 DOI: 10.1016/s0090-4295(00)00872-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Unenhanced helical computed tomography (UHCT) is rapidly becoming the preferred imaging modality for the evaluation of suspected renal colic in the adult population; however, a series addressing its use in the adolescent population has not been previously published. We assessed the utility of UHCT in the evaluation of suspected renal colic in this age group. METHODS Seventeen patients between the ages of 8 and 18 years (mean 14.7) presented to the emergency departments of four hospitals for evaluation of suspected renal colic. All patients were studied with UHCT immediately after initial evaluation. A single helical acquisition was performed from the midpoint of T-12 vertebra to a point below the bladder base, using a slice thickness of 5 mm. Films were reviewed by the institutional radiologist, and results were quantified. RESULTS Of the 17 patients who underwent evaluation, no abnormality was detected in 8 patients. A stone was localized in 7 patients who were then appropriately treated. One patient had no stone visualized, but secondary signs suggested a recently passed stone. The final patient had no stone; however, marked bilateral hydroureteronephrosis was noted that led to further evaluation. A single phlebolith was seen in only 1 patient, and no study was nondiagnostic. CONCLUSIONS UHCT is a safe, rapidly performed test for the evaluation of suspected renal colic in adolescents. It is highly sensitive and specific for renal and ureteral calculi and, more importantly, allows visualization of alternate pathology. In addition, secondary signs are seen that aid in determining obstruction and are helpful if no stone is visualized. Phleboliths, which can simulate a stone, are rarely seen in adolescence. We believe UHCT allows for rapid triage and localization of stones and should be recommended as the primary diagnostic modality for the evaluation of adolescents with suspected renal colic.
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Affiliation(s)
- J Lumerman
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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42
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Rai KR, Peterson BL, Appelbaum FR, Kolitz J, Elias L, Shepherd L, Hines J, Threatte GA, Larson RA, Cheson BD, Schiffer CA. Fludarabine compared with chlorambucil as primary therapy for chronic lymphocytic leukemia. N Engl J Med 2000; 343:1750-7. [PMID: 11114313 DOI: 10.1056/nejm200012143432402] [Citation(s) in RCA: 783] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fludarabine is an effective treatment for chronic lymphocytic leukemia that does not respond to initial treatment with chlorambucil. We compared the efficacy of fludarabine with that of chlorambucil in the primary treatment of chronic lymphocytic leukemia. METHODS Between 1990 and 1994, we randomly assigned 509 previously untreated patients with chronic lymphocytic leukemia to one of the following treatments: fludarabine (25 mg per square meter of body-surface area, administered intravenously daily for 5 days every 28 days), chlorambucil (40 mg per square meter, given orally every 28 days), or fludarabine (20 mg per square meter per day for 5 days every 28 days) plus chlorambucil (20 mg per square meter every 28 days). Patients with an additional response at each monthly evaluation continued to receive the assigned treatment for a maximum of 12 cycles. RESULTS Assignment of patients to the fludarabine-plus-chlorambucil group was stopped when a planned interim analysis revealed excessive toxicity and a response rate that was not better than the rate with fludarabine alone. Among the other two groups, the response rate was significantly higher for fludarabine alone than for chlorambucil alone. Among 170 patients treated with fludarabine, 20 percent had a complete remission, and 43 percent had a partial remission. The corresponding values for 181 patients treated with chlorambucil were 4 percent and 33 percent (P< 0.001 for both comparisons). The median duration of remission and the median progression-free survival in the fludarabine group were 25 months and 20 months, respectively, whereas both values were 14 months in the chlorambucil group (P<0.001 for both comparisons). The median overall survival among patients treated with fludarabine was 66 months, which was not significantly different from the overall survival in the other two groups (56 months with chlorambucil and 55 months with combined treatment). Severe infections and neutropenia were more frequent with fludarabine than with chlorambucil (P=0.08), although, overall, toxic effects were tolerable with the two single-drug regimens. CONCLUSIONS When used as the initial treatment for chronic lymphocytic leukemia, fludarabine yields higher response rates and a longer duration of remission and progression-free survival than chlorambucil.
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MESH Headings
- Administration, Oral
- Adult
- Aged
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chlorambucil/adverse effects
- Chlorambucil/therapeutic use
- Cross-Over Studies
- Disease-Free Survival
- Female
- Humans
- Infusions, Intravenous
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Prospective Studies
- Remission Induction
- Survival Analysis
- Vidarabine/adverse effects
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- K R Rai
- Cancer and Leukemia Group B, Chicago, USA.
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43
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Abstract
AIM The main objective of this national survey was to check the findings of an earlier pilot survey. This had found that patients who had a hearing-impairment and were in hospital were often seriously disadvantaged by their disability. METHOD The survey was conducted by questionnaire and the sampling frame confined to hearing-impaired patients who had been in hospital during the previous three years. A total of 359 completed and valid questionnaires were returned. RESULTS The responses confirmed the finding of the pilot survey. They indicated that there were serious shortcomings in the ability of many hospital staff to cope with the problems of hearing-impaired patients. CONCLUSION Common causes of the problems were identified. The major factor was inadequate training of both nurses and doctors in deaf awareness and the associated communication skills. Other significant factors included patients concealing their disability, pressure of work and poor communication between staff. Appropriate training at all staff levels should eliminate a high proportion of these problems.
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44
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Abstract
The angiotensin II type 1 (AT(1)) receptor plays a pivotal role in the regulation of blood pressure and electrolyte balance, and is involved in the control of specific ingestive behaviours. Irbesartan (SR 47436/BMS 186295) is a recently developed angiotensin AT(1) receptor antagonist, chemically described as 2-butyl-3-([2'-¿1H-tetrazol-5-yl¿biphenyl-4-yl]methyl)-1, 3-diazaspiro (4,4)non-1-en-4-one. Irbesartan displays higher affinity for its target receptor than other similar antagonists. In radioligand binding assays performed on membranes from WB-Fischer 344 (WB) rat liver epithelial cells, irbesartan was able to displace [125I]angiotensin II with a K(i) of 4.05 nM as compared to losartan (DuP 753) and tasosartan (WAY 126756), which had K(i) values of 25.2 nM and 46.6 nM, respectively. Similarly, in functional assays, irbesartan exhibited the highest functional potency to block angiotensin II-induced inositol trisphosphate (IP(3)) turnover. The improved affinity of irbesartan for the angiotensin AT(1) receptor does not coincide with a concomitant increase in affinity for the angiotensin AT(2) receptor, as irbesartan and losartan exhibited the same low potency to displace [125I]angiotensin II in radioligand binding assays performed on membranes from PC-12w cells. In binding assays performed on peripheral tissues in rat, irbesartan bound to the angiotensin AT(1) receptor expressed in liver, adrenal, kidney and pituitary with an overall affinity closely approaching that of the high affinity peptidic antagonist [Sar(1), Ile(8)]angiotensin II. Due to the higher affinity of irbesartan over other similar antagonists for the angiotensin AT(1) receptor in many tissues and its greater potency to block receptor activation, irbesartan may be quite useful in the study of the angiotensin AT(1) receptor and its role in controlling ingestive behaviours and, furthermore, shows great potential to improve the treatment of hypertension and other cardiovascular disease states.
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MESH Headings
- Adrenal Glands/metabolism
- Angiotensin II/metabolism
- Angiotensin Receptor Antagonists
- Animals
- Binding, Competitive/drug effects
- Biphenyl Compounds/metabolism
- Biphenyl Compounds/pharmacology
- Cells, Cultured
- Dose-Response Relationship, Drug
- Iodine Radioisotopes
- Irbesartan
- Kidney/metabolism
- Liver/metabolism
- Losartan/pharmacology
- Male
- PC12 Cells
- Pituitary Gland/metabolism
- Pyrimidines/pharmacology
- Radioligand Assay
- Rats
- Rats, Inbred F344
- Rats, Sprague-Dawley
- Receptor, Angiotensin, Type 1
- Receptor, Angiotensin, Type 2
- Receptors, Angiotensin/metabolism
- Receptors, Angiotensin/physiology
- Signal Transduction/drug effects
- Tetrazoles/metabolism
- Tetrazoles/pharmacology
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Affiliation(s)
- J Hines
- Department of Pharmacology, University of Pennsylvania, Philadelphia, PA 19104-6046, USA.
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45
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Katz DS, Hines J, Rausch DR, Perlmutter S, Sommer FG, Lumerman JH, Friedman RM, Lane MJ. Unenhanced helical CT for suspected renal colic. AJR Am J Roentgenol 1999; 173:425-30. [PMID: 10430148 DOI: 10.2214/ajr.173.2.10430148] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- D S Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY 11501, USA
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46
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Penfold J, Staples E, Thompson L, Tucker I, Hines J, Thomas RK, Lu JR, Warren N. Structure and Composition of Mixed Surfactant Micelles of Sodium Dodecyl Sulfate and Hexaethylene Glycol Monododecyl Ether and of Hexadecyltrimethylammonium Bromide and Hexaethylene Glycol Monododecyl Ether. J Phys Chem B 1999. [DOI: 10.1021/jp990582a] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Penfold
- ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, Oxon 0X11 0QX, U.K., Unilever Research, Port Sunlight Laboratory, Quarry Road East, Bebington, Wirral L63 3JW, U.K., Physical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford 0X1 3QZ, U.K., and Chemistry Department, University of Surrey, Guildford, Surrey 9U2 5XH, U.K
| | - E. Staples
- ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, Oxon 0X11 0QX, U.K., Unilever Research, Port Sunlight Laboratory, Quarry Road East, Bebington, Wirral L63 3JW, U.K., Physical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford 0X1 3QZ, U.K., and Chemistry Department, University of Surrey, Guildford, Surrey 9U2 5XH, U.K
| | - L. Thompson
- ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, Oxon 0X11 0QX, U.K., Unilever Research, Port Sunlight Laboratory, Quarry Road East, Bebington, Wirral L63 3JW, U.K., Physical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford 0X1 3QZ, U.K., and Chemistry Department, University of Surrey, Guildford, Surrey 9U2 5XH, U.K
| | - I. Tucker
- ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, Oxon 0X11 0QX, U.K., Unilever Research, Port Sunlight Laboratory, Quarry Road East, Bebington, Wirral L63 3JW, U.K., Physical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford 0X1 3QZ, U.K., and Chemistry Department, University of Surrey, Guildford, Surrey 9U2 5XH, U.K
| | - J. Hines
- ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, Oxon 0X11 0QX, U.K., Unilever Research, Port Sunlight Laboratory, Quarry Road East, Bebington, Wirral L63 3JW, U.K., Physical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford 0X1 3QZ, U.K., and Chemistry Department, University of Surrey, Guildford, Surrey 9U2 5XH, U.K
| | - R. K. Thomas
- ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, Oxon 0X11 0QX, U.K., Unilever Research, Port Sunlight Laboratory, Quarry Road East, Bebington, Wirral L63 3JW, U.K., Physical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford 0X1 3QZ, U.K., and Chemistry Department, University of Surrey, Guildford, Surrey 9U2 5XH, U.K
| | - J. R. Lu
- ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, Oxon 0X11 0QX, U.K., Unilever Research, Port Sunlight Laboratory, Quarry Road East, Bebington, Wirral L63 3JW, U.K., Physical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford 0X1 3QZ, U.K., and Chemistry Department, University of Surrey, Guildford, Surrey 9U2 5XH, U.K
| | - N. Warren
- ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, Oxon 0X11 0QX, U.K., Unilever Research, Port Sunlight Laboratory, Quarry Road East, Bebington, Wirral L63 3JW, U.K., Physical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford 0X1 3QZ, U.K., and Chemistry Department, University of Surrey, Guildford, Surrey 9U2 5XH, U.K
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Abstract
OBJECTIVE The purpose of our study is to describe the CT findings of fat collections related to the intrahepatic inferior vena cava and to review the literature about this benign incidental finding. CONCLUSION Focal collections of fat related to the inferior vena cava are benign incidental findings located exclusively at the level of the liver. The fat collections are always adjacent to the medial wall of the inferior vena cava; appear to be extraluminal in origin and may, in fact, be entirely extraluminal; and are uncommon findings that are usually of no clinical significance.
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Affiliation(s)
- J Hines
- Department of Radiology, Winthrop University Hospital, Mineola, NY 11501, USA
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Affiliation(s)
- D S Katz
- Department of Radiology, Winthrop University Hospital, Mineola, NY 11501, USA
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49
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Abstract
OBJECTIVE The purpose of this study was to describe the CT findings of pancreatic lipomas in four patients. CONCLUSION In all four cases, the lipoma was revealed incidentally on CT scans obtained for other reasons. CT scans were diagnostic, showing well-circumscribed masses within the pancreas composed almost entirely of fat, with a few scattered vessels or septa or both, which ranged in size from 1.4 x 2.0 cm to 4.5 x 5.3 cm in the axial plane. Pancreatic lipomas are rare, usually incidental tumors and, as with lipomas found elsewhere in the body, conservative management is often indicated.
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Affiliation(s)
- D S Katz
- Department of Radiology, Winthrop University Hospital, Mineola, NY 11501, USA
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Kitada S, Andersen J, Akar S, Zapata JM, Takayama S, Krajewski S, Wang HG, Zhang X, Bullrich F, Croce CM, Rai K, Hines J, Reed JC. Expression of apoptosis-regulating proteins in chronic lymphocytic leukemia: correlations with In vitro and In vivo chemoresponses. Blood 1998; 91:3379-89. [PMID: 9558396] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
B-cell chronic lymphocytic leukemia (B-CLL) represents a neoplastic disorder caused primarily by defective programmed cell death (PCD), as opposed to increased cell proliferation. Defects in the PCD pathway also contribute to chemoresistance. The expression of several apoptosis-regulating proteins, including the Bcl-2 family proteins Bcl-2, Bcl-XL, Mcl-1, Bax, Bak, and BAD; the Bcl-2-binding protein BAG-1; and the cell death protease Caspase-3 (CPP32), was evaluated by immunoblotting using 58 peripheral blood B-CLL specimens from previously untreated patients. Expression of Bcl-2, Mcl-1, BAG-1, Bax, Bak, and Caspase-3 was commonly found in circulating B-CLL cells, whereas the Bcl-XL and BAD proteins were not present. Higher levels of the anti-apoptotic protein Mcl-1 were strongly correlated with failure to achieve complete remission (CR) after single-agent therapy (fludarabine or chlorambucil) (P = .001), but the presence of only seven CRs among the 42 patients for whom follow-up data were available necessitates cautious interpretation of these observations. Higher levels of the anti-apoptotic protein BAG-1 were also marginally associated with failure to achieve CR (P = .04). Apoptosis-regulating proteins were not associated with patient age, sex, Rai stage, platelet count, hemoglobin (Hb) concentration, or lymph node involvement, although higher levels of Bcl-2 and a high Bcl-2:Bax ratio were correlated with high numbers (>10(5)/microL) of white blood cells (WBC) (P = .01; .007) and higher levels of Bak were weakly associated with loss of allelic heterozygosity at 13q14 (P = .04). On the basis of measurements of apoptosis induction by fludarabine using cultured B-CLL specimens, in vitro chemosensitivity data failed to correlate with in vivo clinical response rates (n = 42) and expression of the various apoptosis-regulating proteins. Although larger prospective studies are required before firm conclusions can be reached, these studies show the expression in B-CLLs of multiple apoptosis-regulating proteins and suggest that the relative levels of some of these, such as Mcl-1, may provide information about in vivo responses to chemotherapy. In vitro chemosensitivity data, however, do not appear to be particularly useful in predicting responses in B-CLL.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Apoptosis
- Blotting, Western
- Carrier Proteins/metabolism
- Caspase 3
- Caspases
- Chromosomes, Human, Pair 13
- Cysteine Endopeptidases/metabolism
- DNA Fragmentation
- DNA-Binding Proteins
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Loss of Heterozygosity
- Male
- Membrane Proteins/metabolism
- Middle Aged
- Myeloid Cell Leukemia Sequence 1 Protein
- Neoplasm Proteins/metabolism
- Proto-Oncogene Proteins/metabolism
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Transcription Factors
- bcl-2 Homologous Antagonist-Killer Protein
- bcl-2-Associated X Protein
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Affiliation(s)
- S Kitada
- Burnham Institute, Cancer Research Center, La Jolla, CA, USA
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