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Talbot B, Davies S, Burman J, Ritchie A, Snelling P, Lynch S, Park Y, Jones B, Garvey V, Jaure A, Jardine M, Perkovic V, Gallagher M, Brandwood A, Kaur N, Knight J. The Point-of-Care Peritoneal Dialysis System Early Evaluation Study (POC-PDEE): A pilot proof-of-principal study of the Ellen Medical Devices Point-of-Care affordable peritoneal dialysis system. Perit Dial Int 2024:8968608231209850. [PMID: 38179591 DOI: 10.1177/08968608231209850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
The global unmet need for kidney replacement therapy means that millions of people die every year as they cannot afford treatment. Peritoneal dialysis (PD) offers comparable survival to haemodialysis and is often more affordable, but one barrier to increasing access is that conventional manufacturing and distribution of PD fluid is costly. Here we report the results from a pilot proof-of-principal study demonstrating for the first time that the Ellen Medical Devices Point-of-Care system can be used by patients to produce sterile PD fluid at the point-of-care. With further development, this low-cost system could offer a solution to the many millions of people around the world who currently cannot afford treatment for kidney failure.
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Affiliation(s)
- Benjamin Talbot
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Ellen Medical Devices, Sydney, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Simon Davies
- Renal Research Group, School of Medicine, Keele University, UK
- Renal Department, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | | | - Angus Ritchie
- Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Paul Snelling
- Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Youn Park
- Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Brian Jones
- Concord Repatriation General Hospital, Sydney, Australia
- Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Vincent Garvey
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Ellen Medical Devices, Sydney, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Australia
| | - Meg Jardine
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Martin Gallagher
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Arthur Brandwood
- Ellen Medical Devices, Sydney, Australia
- School of Biomedical Engineering, University of Sydney, Australia
| | | | - John Knight
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Ellen Medical Devices, Sydney, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Australia
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TALBOT B, Martin J, Burman J, Kaur N, Garvey V, Knight J. POS-713 PROOF OF CONCEPT FOR A POINT OF CARE AFFORDABLE DIALYSIS SYSTEM. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.747] [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: 11/17/2022] Open
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Kang A, Arnold R, Gallagher M, Snelling P, Green J, Fernando M, Kiernan MC, Hand S, Grimley K, Burman J, Heath A, Rogers K, Bhattacharya A, Smyth B, Bradbury T, Hawley C, Perkovic V, Krishnan AV, Jardine MJ. Effect of Hemodiafiltration on the Progression of Neuropathy with Kidney Failure: A Randomized Controlled Trial. Clin J Am Soc Nephrol 2021; 16:1365-1375. [PMID: 34233923 PMCID: PMC8729572 DOI: 10.2215/cjn.17151120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Neuropathy is a common complication of kidney disease that lacks proven disease-modifying treatments. Hemodiafiltration improves clearance of uremic toxins and is associated with better nerve function than hemodialysis. We aimed to determine whether hemodiafiltration reduces the progression of neuropathy in people receiving hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Filtration in the Neuropathy of End-Stage Kidney Disease Symptom Evolution (FINESSE) study was an open-label, blinded end point assessment, controlled trial that randomized maintenance hemodialysis recipients to hemodiafiltration or high-flux hemodialysis for 48 months or until death or cessation of dialysis at four study centers. The primary outcome was the mean change in the yearly modified total neuropathy score from baseline, with time points weighted equally. RESULTS A total of 124 participants were randomized and followed for a mean of 41 months. At baseline, neuropathy was present in 91 (73%) participants (modified total neuropathy score greater than or equal to two), and 38 (31%) had moderate to severe neuropathy (modified total neuropathy score 9-28). Convection volume in the hemodiafiltration arm was a median of 24.7 (interquartile range, 22.4-26.5) L. The mean modified total neuropathy score (SEM) worsened by 1.7 (0.4)/28 and 1.2 (0.4)/28 in the hemodiafiltration and hemodialysis groups, respectively, with a mean difference of 0.5 (95% confidence interval, -0.7 to 1.7; P=0.37). There was no difference in survival (hazard ratio, 1.24; 95% confidence interval, 0.61 to 2.51; log rank P=0.55) or any of the prespecified adverse events. There was no difference between groups in the number of participants who suffered an adverse event adjusted by follow-up time (relative risk, 1.05; 95% confidence interval, 0.83 to 1.32; P=0.68). CONCLUSIONS Neuropathy is still a common complication of kidney disease without disease-altering therapy. Hemodiafiltration did not affect neuropathy progression compared with hemodialysis. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Filtration in the Neuropathy of End-Stage Kidney Disease Symptom Evolution (FINESSE), ACTRN12609000615280.
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Affiliation(s)
- Amy Kang
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Ria Arnold
- Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Martin Gallagher
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Paul Snelling
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Julianne Green
- Department of Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Mangalee Fernando
- Department of Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Samantha Hand
- Department of Renal Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Kim Grimley
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jenny Burman
- Department of Renal Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Anne Heath
- Department of Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Kris Rogers
- Statistics Division, The George Institute The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Statistics, University of Technology, Sydney, New South Wales, Australia
| | - Amritendu Bhattacharya
- Statistics Division, The George Institute The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Brendan Smyth
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Kidney Health Division, National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, St. George Hospital, Sydney, New South Wales, Australia
| | - Thomas Bradbury
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Carmel Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Arun V Krishnan
- Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Prince of Wales Hospital, Sydney, New South Wales, Australia
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Das J, Snowden JA, Burman J, Freedman MS, Atkins H, Bowman M, Burt RK, Saccardi R, Innocenti C, Mistry S, Laud PJ, Jessop H, Sharrack B. Autologous haematopoietic stem cell transplantation as a first-line disease-modifying therapy in patients with 'aggressive' multiple sclerosis. Mult Scler 2021; 27:1198-1204. [PMID: 33565902 PMCID: PMC8226372 DOI: 10.1177/1352458520985238] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Autologous haematopoietic stem cell transplantation (AHSCT) is an effective treatment for patients with multiple sclerosis (MS) who have highly active disease, despite the use of standard disease-modifying therapies (DMTs). However, the optimal time for offering AHSCT to patients with 'aggressive' MS is yet to be established. OBJECTIVES The objective was to explore the safety and efficacy of AHSCT as a first-line DMT in patients with 'aggressive' MS. METHODS All patients with 'aggressive' MS who received AHSCT as a first-line DMT in five European and North American centres were retrospectively evaluated. RESULTS Twenty patients were identified. The median interval between diagnosis and AHSCT was 5 (1-20) months. All had multiple poor prognostic markers with a median pre-transplant Expanded Disability Status Scale (EDSS) score of 5.0 (1.5-9.5). After a median follow-up of 30 (12-118) months, the median EDSS score improved to 2.0 (0-6.5, p < 0.0001). No patient had further relapses. Three had residual magnetic resonance imaging (MRI) disease activities in the first 6 months post-transplant, but no further new or enhancing lesions were observed in subsequent scans. CONCLUSION AHSCT is safe and effective as a first-line DMT in inducing rapid and sustained remission in patients with 'aggressive' MS.
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Affiliation(s)
- J Das
- Sheffield Institute for Translational Neuroscience, University of Sheffield, UK/Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Burman
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - M S Freedman
- Department of Medicine (Neurology), The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - H Atkins
- Department of Medicine (Neurology), The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Bowman
- Department of Medicine (Neurology), The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - R K Burt
- Division of Immunotherapy, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R Saccardi
- Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| | - C Innocenti
- Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| | - S Mistry
- Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - P J Laud
- Statistical Services Unit, University of Sheffield, Sheffield, UK
| | - H Jessop
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - B Sharrack
- Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Sheffield Institute for Translational Neuroscience, University of Sheffield, UK
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Tappenden P, Wang Y, Sharrack B, Burman J, Kazmi M, Saccardi R, Bermejo I, Harvey R, Badoglio M, Farge D, Snowden JA. Evaluating the clinical effectiveness of autologous haematopoietic stem cell transplantation versus disease-modifying therapy in multiple sclerosis using a matching-adjusted indirect comparison: an exploratory study from the Autoimmune Diseases Working Party (ADWP) of the European Society of Bone and Marrow Transplantation (EBMT). Bone Marrow Transplant 2019; 55:1473-1475. [PMID: 31745252 DOI: 10.1038/s41409-019-0747-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 12/29/2022]
Affiliation(s)
- P Tappenden
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Y Wang
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - B Sharrack
- Academic Department of Neuroscience, Sheffield INHR BRC, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Burman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - M Kazmi
- Kings Health Partners, Department of Haematology, Guys Hospital, London, UK
| | - R Saccardi
- Haematology Department, Careggi University Hospital, Florence, Italy
| | - I Bermejo
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Harvey
- Cabourn Statistics Ltd, Manchester, UK
| | - M Badoglio
- EBMT Paris study office / CEREST-TC-Department of Haematology, Saint Antoine Hospital-INSERM UMR 938-Université Pierre et Marie Curie, Paris, France
| | - D Farge
- Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Autoimmune and Vascular Disease Unit, Internal Medicine (UF04), Center of Reference for Rare Systemic Autoimmune Diseases (FAI2R), Université de Paris, EA 3518, Paris, France.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Smyth B, Krishnan AV, Gallagher M, Kiernan M, Snelling P, Hawley C, Fernando M, Hand S, Grimley K, Burman J, Heath A, Kang A, Perkovic V, Jardine MJ. Randomised controlled trial of the impact of haemodiafiltration on uraemic neuropathy: FINESSE study protocol. BMJ Open 2019; 9:e023736. [PMID: 30782714 PMCID: PMC6340424 DOI: 10.1136/bmjopen-2018-023736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The majority of patients undergoing haemodialysis (HD) show evidence of uraemic neuropathy, a condition with no known disease-modifying treatments. The pathogenesis of uraemic neuropathy is poorly understood, but may be related to cumulative exposure to middle molecules or other solutes such as potassium. It is not known whether haemodiafiltration (HDF) reduces the progression of uraemic neuropathy. METHODS AND ANALYSIS Filtration In the Neuropathy of End-Stage kidney disease Symptom Evolution (FINESSE) is a multicentre, randomised, open-label, blinded endpoint assessment, controlled trial designed to assess the impact of HDF versus HD on uraemic neuropathy. Maintenance HD patients will be randomised in a 1:1 ratio to receive HDF or HD with high-flux membranes for 4 years. The primary endpoint is the difference in the mean change in Total Neuropathy Score (TNS)-a measure of peripheral neuropathy combining symptoms, signs and nerve conduction velocity-over the study period. Secondary outcomes include change at annual timepoints in the TNS and the Neuropathy Symptom Score; and in morbidity, mortality and safety events. ETHICS AND DISSEMINATION The FINESSE trial has been approved by the Ethics Review Committee of the Sydney South West Area Health Service (HREC/09/RPAH/268) and of Adventist HealthCare Limited (2012-027). When published in a peer-reviewed journal, it will be the largest and longest reported randomised trial aimed at reducing the incidence and severity of uraemic neuropathy. It will advance the understanding of the natural history of uraemic neuropathy and the influence of convective therapies on both neurophysiological and clinical outcomes. It will also allow refinement of current hypotheses surrounding the pathogenesis of uraemic neuropathy and, most importantly, may lead to improvements in the lives of the many patients affected by this debilitating condition. TRIAL REGISTRATION NUMBER ACTRN12609000615280.
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Affiliation(s)
- Brendan Smyth
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
| | - Arun V Krishnan
- Neurology, Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Martin Gallagher
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Matthew Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Snelling
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Carmel Hawley
- Renal Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mangalee Fernando
- Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Samantha Hand
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Kim Grimley
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jenny Burman
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Anne Heath
- Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Amy Kang
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
| | - Vlado Perkovic
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
| | - Meg J Jardine
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
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Burman J, Kukkonen AK, Pelkonen AS, Mäkelä MJ. High arachis hypogaea allergen 2 immunoglobulin E levels predict responses to exposure to a small amount of peanut protein. Acta Paediatr 2018; 107:2216. [PMID: 30043419 DOI: 10.1111/apa.14511] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J Burman
- Helsinki University Skin and Allergy Hospital; Helsinki Finland
| | - A K Kukkonen
- Helsinki University Skin and Allergy Hospital; Helsinki Finland
| | - A S Pelkonen
- Helsinki University Skin and Allergy Hospital; Helsinki Finland
| | - M J Mäkelä
- Helsinki University Skin and Allergy Hospital; Helsinki Finland
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Berntsson SG, Kristoffersson A, Boström I, Feresiadou A, Burman J, Landtblom AM. Rapidly increasing off-label use of rituximab in multiple sclerosis in Sweden - Outlier or predecessor? Acta Neurol Scand 2018; 138:327-331. [PMID: 29797711 DOI: 10.1111/ane.12963] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Off-label use of rituximab to treat MS patients in Sweden is high, and the need for long-term safety data may not be met. Our objectives were to assess the rate of rituximab prescription in patients with multiple sclerosis in Sweden and, in addition, to evaluate the safety of rituximab in a single centre for patients with multiple sclerosis. MATERIAL AND METHODS Review of the Swedish MS register was performed to study the number of MS patients treated with rituximab during the last 6 years. Investigation also included a retrospective review of medical files in search for possible side effects/adverse events in all adult patients with MS treated with rituximab at Uppsala University Hospital. RESULTS Presently, in Sweden the rate of rituximab prescriptions in relation to other annually started of disease- modifying drugs in MS is 53.5%. CONCLUSIONS The share of MS patients in Sweden who are treated with rituximab is very high, and also rapidly increasing. Taken into account the off-label use, cases with adverse medical conditions that could possibly be related to rituximab use should be reported thoroughly.
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Affiliation(s)
- S. G. Berntsson
- Department of Neuroscience, Neurology; Uppsala University; University Hospital; Uppsala Sweden
| | - A. Kristoffersson
- Department of Neuroscience, Neurology; Uppsala University; University Hospital; Uppsala Sweden
- Neurology Policlinic; Department of Medical Specialist; Motala General Hospital; Motala Sweden
| | - I. Boström
- Department of Clinical and Experimental Medicine, Neurology; Medical Faculty; University of Linköping; Linköping Sweden
| | - A. Feresiadou
- Department of Neuroscience, Neurology; Uppsala University; University Hospital; Uppsala Sweden
| | - J. Burman
- Department of Neuroscience, Neurology; Uppsala University; University Hospital; Uppsala Sweden
| | - A. M. Landtblom
- Department of Neuroscience, Neurology; Uppsala University; University Hospital; Uppsala Sweden
- Department of Clinical and Experimental Medicine, Neurology; Medical Faculty; University of Linköping; Linköping Sweden
- Neurology Policlinic; Department of Medical Specialist; Motala General Hospital; Motala Sweden
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Berntsson SG, Kristoffersson A, Boström I, Feresiadou A, Burman J, Landtblom AM. Outside Back Cover. Acta Neurol Scand 2018. [DOI: 10.1111/ane.13021] [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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Affiliation(s)
- Z. Mahamud
- Department of Clinical Neuroscience; Sahlgrenska Academy; University of Gothenburg and Sahlgrenska University Hospital; Gothenburg Sweden
| | - J. Burman
- Department of Neuroscience; Uppsala University; Uppsala Sweden
| | - J. Zelano
- Department of Clinical Neuroscience; Sahlgrenska Academy; University of Gothenburg and Sahlgrenska University Hospital; Gothenburg Sweden
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Burman J, Kirgizov K, Carlson K, Badoglio M, Mancardi GL, De Luca G, Casanova B, Ouyang J, Bembeeva R, Haas J, Bader P, Snowden J, Farge D. Autologous hematopoietic stem cell transplantation for pediatric multiple sclerosis: a registry-based study of the Autoimmune Diseases Working Party (ADWP) and Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2017; 52:1133-1137. [DOI: 10.1038/bmt.2017.40] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/14/2016] [Accepted: 01/27/2017] [Indexed: 11/09/2022]
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Vågberg M, Axelsson M, Birgander R, Burman J, Cananau C, Forslin Y, Granberg T, Gunnarsson M, von Heijne A, Jönsson L, Karrenbauer VD, Larsson EM, Lindqvist T, Lycke J, Lönn L, Mentesidou E, Müller S, Nilsson P, Piehl F, Svenningsson A, Vrethem M, Wikström J. Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society. Acta Neurol Scand 2017; 135:17-24. [PMID: 27558404 PMCID: PMC5157754 DOI: 10.1111/ane.12667] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 01/28/2023]
Abstract
Multiple sclerosis (MS) is associated with inflammatory lesions in the brain and spinal cord. The detection of such inflammatory lesions using magnetic resonance imaging (MRI) is important in the consideration of the diagnosis and differential diagnoses of MS, as well as in the monitoring of disease activity and predicting treatment efficacy. Although there is strong evidence supporting the use of MRI for both the diagnosis and monitoring of disease activity, there is a lack of evidence regarding which MRI protocols to use, the frequency of examinations, and in what clinical situations to consider MRI examination. A national workshop to discuss these issues was held in Stockholm, Sweden, in August 2015, which resulted in a Swedish consensus statement regarding the use of MRI in the care of individuals with MS. The aim of this consensus statement is to provide practical advice for the use of MRI in this setting. The recommendations are based on a review of relevant literature and the clinical experience of workshop attendees. It is our hope that these recommendations will benefit individuals with MS and guide healthcare professionals responsible for their care.
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Affiliation(s)
- M. Vågberg
- Department of Pharmacology and Clinical Neuroscience, Section of Neuroscience; Umeå University; Umeå Sweden
| | - M. Axelsson
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - R. Birgander
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - J. Burman
- Department of Neuroscience; Uppsala University; Uppsala Sweden
| | - C. Cananau
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Y. Forslin
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - T. Granberg
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - M. Gunnarsson
- Department of Neurology; School of Medical Sciences; Örebro University; Örebro Sweden
| | - A. von Heijne
- Department of Clinical Sciences; Karolinska Institutet; Danderyd Hospital; Stockholm Sweden
| | - L. Jönsson
- Department of Neuroradiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - V. D. Karrenbauer
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - E.-M. Larsson
- Department of Surgical Sciences, Radiology; Uppsala University; Uppsala Sweden
| | - T. Lindqvist
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - J. Lycke
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - L. Lönn
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - E. Mentesidou
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - S. Müller
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - P. Nilsson
- Department of Clinical Sciences Lund, Neurology; Faculty of Medicine; Lund University; Lund Sweden
| | - F. Piehl
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - A. Svenningsson
- Department of Clinical Sciences; Karolinska Institutet; Danderyd Hospital; Stockholm Sweden
| | - M. Vrethem
- Department of Neurology and Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - J. Wikström
- Department of Surgical Sciences, Radiology; Uppsala University; Uppsala Sweden
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Burman J, Zetterberg H, Fransson M, Loskog ASI, Raininko R, Fagius J. Assessing tissue damage in multiple sclerosis: a biomarker approach. Acta Neurol Scand 2014; 130:81-9. [PMID: 24571714 DOI: 10.1111/ane.12239] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) of the brain and spinal cord is the gold standard for assessing disease activity in multiple sclerosis (MS). MRI is an excellent instrument for determination of accumulated damage to the brain and spinal cord, but tells us little about ongoing tissue damage. In this study, biomarkers of oligodendrocyte, axonal and astrocyte injury were related to MRI and clinical findings and used to assess tissue damage in MS. MATERIALS AND METHODS Cerebrospinal fluid from 44 patients with relapsing-remitting MS, 20 with secondary progressive MS and 15 controls were investigated with ELISA to determine levels of myelin basic protein (MBP), neurofilament light (NFL) and glial fibrillary acidic protein (GFAp). Patients underwent MRI of the brain and spinal cord, and gadolinium enhancing lesions, T1 lesions and T2 lesions were counted. RESULTS Patients in clinical relapse and patients with nonsymptomatic gadolinium enhancing lesions had high levels of MBP and NFL, indicating ongoing damage to oligodendrocytes and axons. The level of MBP dropped quickly within a week from the onset of a relapse, whereas NFL remained elevated for several weeks and GFAp slowly rose during the course of a relapse. Relapsing-remitting MS patients without gadolinium enhancing lesions had values of MBP, NFL and GFAp similar to controls, while patients with secondary progressive disease had moderately increased values of all biomarkers. CONCLUSIONS Analysis of MBP, NFL and GFAp provides direct means to measure tissue damage and is a useful addition to our methods for evaluation of MS.
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Affiliation(s)
- J. Burman
- Department of Neuroscience; Uppsala University; Uppsala Sweden
- Department of Neurology; Uppsala University Hospital; Uppsala Sweden
- Department of Immunology; Genetics and Pathology; Uppsala University; Uppsala Sweden
| | - H. Zetterberg
- Department of Psychiatry and Neurochemistry; the Sahlgrenska Academy at the University of Gothenburg; Mölndal Sweden
- UCL Institute of Neurology; London UK
| | - M. Fransson
- Department of Immunology; Genetics and Pathology; Uppsala University; Uppsala Sweden
| | - A. SI. Loskog
- Department of Immunology; Genetics and Pathology; Uppsala University; Uppsala Sweden
| | - R. Raininko
- Department of Radiology; Uppsala University; Uppsala Sweden
| | - J. Fagius
- Department of Neuroscience; Uppsala University; Uppsala Sweden
- Department of Neurology; Uppsala University Hospital; Uppsala Sweden
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Abstract
BACKGROUND Treatment of multiple sclerosis (MS) with natalizumab during pregnancy is not recommended due to potential risks for the foetus. Despite strong advice accidental pregnancies occur. CASE A 32-year old woman with MS since the age of 26 was treated with natalizumab since January 2008. Treatment was stopped April 2011 due to pregnancy plans, but was restarted following an MS relapse. The patient was thoroughly informed about potential foetal risks, but nevertheless she one year later disclosed that she was pregnant in gestational week 15. Treatment was continued, since the first trimester had passed. The pregnancy course was normal and a healthy daughter was born at full gestational term. CONCLUSIONS This is the second known case where natalizumab treatment continued throughout the whole gestational period.
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Affiliation(s)
- J. Fagius
- Department of Neuroscience/Neurology; Uppsala University; Uppsala Sweden
- Department of Neurology; University Hospital; Uppsala Sweden
| | - J. Burman
- Department of Neuroscience/Neurology; Uppsala University; Uppsala Sweden
- Department of Neurology; University Hospital; Uppsala Sweden
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15
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Abstract
OBJECTIVE To assess the frequency of bilateral and recurrent optic neuritis (ON) in multiple sclerosis (MS) and to compare these results with epidemiological data of ON in neuromyelitis optica (NMO) and recurrent ON without other signs of disease. METHODS We identified 472 patients with diagnosis of MS from the Swedish Multiple Sclerosis Register. These patients were evaluated for the presence of ON and whether the ON was the presenting symptom of MS; unilateral or bilateral; monophasic or recurrent. RESULTS Twenty-one percent presented with ON as their first manifestation of MS. The proportion of patients developing a second attack of ON before demonstration of other manifestations of MS was 5.5% and the frequency of recurrent bilateral ON as the presenting symptom was 3.8%. Only two patients presented with simultaneously appearing bilateral ON corresponding to 0.42%. CONCLUSION Recurrent ON, whether unilateral or bilateral, is a common presentation of MS. As MS is a much more common disease than NMO, care must be taken when evaluating the work-up of patients with recurrent ON. In some cases repeated MRI and lumbar punctures are warranted to improve diagnostic accuracy, even in the presence of the serological marker NMO-IgG.
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Affiliation(s)
- J Burman
- Department of Neuroscience/Neurology, Uppsala University, Sweden.
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17
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Zeibecoglou K, Ying S, Yamada T, North J, Burman J, Bungre J, Meng Q, Kay AB, Robinson DS. Increased mature and immature CCR3 messenger RNA+ eosinophils in bone marrow from patients with atopic asthma compared with atopic and nonatopic control subjects. J Allergy Clin Immunol 1999; 103:99-106. [PMID: 9893192 DOI: 10.1016/s0091-6749(99)70532-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Eosinophil infiltration of the bronchial mucosa is characteristic of asthma. Eosinophils differentiate from CD34(+) progenitors. Animal models suggest cooperation between IL-5 and eotaxin to allow rapid mobilization of a pool of bone marrow eosinophils followed by recruitment to the airway mucosa. OBJECTIVE The purpose of this study was to enumerate CD34(+) cell numbers in blood and bone marrow from atopic asthmatics and control subjects and to test the hypothesis that there is an increased bone marrow pool of CCR3(+) eosinophils in patients with atopic asthma, as compared with control subjects. METHODS Bone marrow aspirates and peripheral blood were obtained from volunteers with asthma and control volunteers. CD34(+) cell numbers were evaluated by flow cytometry, and eosinophil colony-forming activity was evaluated by methylcellulose cultures. Mature eosinophils, eosinophil myelocytes, metamyelocytes, and band forms (immature eosinophils) were enumerated by morphologic findings and immunocytochemistry for eosinophil cationic protein. CCR3 and eotaxin mRNA expression was examined by in situ hybridization, and protein expression was examined by immunocytochemistry. CCR3(+) cells were further identified with Chromotrope 2R staining. RESULTS CD34(+) cell numbers in bone marrow were increased in atopic subjects. Numbers of eosinophil colony-forming units in blood and bone marrow did not differ between groups. Percentages of both mature and immature eosinophils were increased in bone marrow from patients with atopic asthma, but not atopic patients with no asthma or normal control subjects. CCR3 was expressed by immature and mature bone marrow eosinophils. Eotaxin was expressed by bone marrow cells from all 3 groups, but there was no increase in subjects with asthma. CONCLUSION These findings suggest that in humans there is an increased bone marrow pool of CCR3(+) mature and immature eosinophils available for rapid mobilization in subjects with asthma but not in atopic subjects with no asthma.
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Affiliation(s)
- K Zeibecoglou
- Department of Allergy and Clinical Immunology, Imperial College School of Medicine at the National Heart and Lung Institute, London, United Kingdom
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18
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Stamps AC, Davies SC, Burman J, O'Hare MJ. Analysis of proviral integration in human mammary epithelial cell lines immortalized by retroviral infection with a temperature-sensitive SV40 T-antigen construct. Int J Cancer 1994; 57:865-74. [PMID: 8206680 DOI: 10.1002/ijc.2910570616] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.5] [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: 01/29/2023]
Abstract
A panel of eight conditionally immortal lines derived by infection of human breast epithelial cells with an amphotropic retrovirus transducing a ts mutant of SV40 large T-antigen was analyzed with respect to individual retroviral integration patterns. Each line contained multiple integration sites which were clonal and stable over extended passage. Similar integration patterns were observed between individual lines arising separately from the same stock of pre-immortal cells, suggesting a common progenitor. Retroviral integration analysis of pre-immortal cells at different stages of pre-crisis growth showed changes indicative of a progressive transition from polyclonality to clonality as the cells approached crisis. Each of the immortal lines contained a sub-set of the integration sites of their pre-immortal progenitors, with individual combinations and copy numbers of sites. Since all the cell lines appeared to originate from single foci in separate flasks, it is likely that each set arose from a common clone of pre-immortal cells as the result of separate genetic events. There was no evidence from this analysis to suggest that specific integration sites played any part either in the selection of pre-crisis clones or in the subsequent establishment of immortal lines.
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Affiliation(s)
- A C Stamps
- Haddow Laboratories, Institute of Cancer Research, Sutton, Surrey, UK
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19
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Abstract
BACKGROUND The endothelium can regulate vascular tone by releasing both endothelium-derived relaxing factor (EDRF or nitric oxide) and contracting factors. To date, there has only been circumstantial evidence to indicate EDRF activity in vivo in human coronary arteries. Using human hemoglobin as a specific inhibitor, the hypothesis that acetylcholine-induced coronary vasodilation is due to EDRF release was tested. METHODS AND RESULTS We studied the response of normal coronary arteries to acetylcholine (an endothelium-dependent vasodilator) and isosorbide dinitrate (an endothelium-independent vasodilator) in seven patients. The specificity of any vasodilator response was assessed by the infusion of reduced free human hemoglobin. Hemoglobin 10(-5) M infusion alone had no effect on coronary artery diameter. Drugs were infused into the coronary artery, and the diameter changes were assessed by quantitative angiography. Acetylcholine 10(-7) M increased left anterior descending coronary artery diameter from control: 2.30 +/- 0.12 mm to 2.79 +/- 0.20 mm (mean +/- SEM, n = 7, p < 0.01). Hemoglobin both in a concentration of 10(-6) M and 10(-5) M reversed this vasodilator effect, causing constriction to 2.11 +/- 0.18 mm (p < 0.001 compared with acetylcholine 10(-7) M) and 2.29 +/- 0.14 mm (p < 0.05 compared with acetylcholine 10(-7) M). Isosorbide dinitrate in the presence of hemoglobin caused dilatation of the coronary artery in all cases to 3.04 +/- 0.24 mm (p < 0.001 compared with acetylcholine 10(-7) M and hemoglobin 10(-6) M). CONCLUSIONS Using a specific inhibitor of nitric oxide, reduced free hemoglobin, we have demonstrated that basal EDRF release does not appear to play an important role in the maintenance of human epicardial coronary artery diameter in vivo but is responsible for the acetylcholine-induced dilatation.
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Affiliation(s)
- P Collins
- Department of Cardiac Medicine, National Heart and Lung Institute, London, UK
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Turner P, Burman J, Hicks DC, Cherrington NK, MacKinnon J, Wallet T, Woolnough M. A comparison of the effects of propranolol and practolol on forced expiratory volume and resting heart rate in normal subjects. Arch Int Pharmacodyn Ther 1971; 191:104-10. [PMID: 4397623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Thompson H, Burman J, Williams JA, Cooke WT. Further observations on the pathology of Crohn's disease. J Pathol 1970; 100:Piv. [PMID: 5420769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Burman J. Case of Ununited Fracture, Treated by Galvanism. West J Med 1847. [DOI: 10.1136/bmj.s1-11.24.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Burman J. Doncaster Union Medical Officers. West J Med 1844; 7:458. [DOI: 10.1136/bmj.s1-7.180.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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