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Mann J. Dietary fibre and diabetes revisited. Eur J Clin Nutr 2024. [DOI: 10.1038/sj/ejcn/1601258] [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: 11/09/2022]
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Saroya G, Hu J, Hu M, Panaretos C, Mann J, Kim S, Bush J, Kaartinen V. Periderm Fate during Palatogenesis: TGF-β and Periderm Dedifferentiation. J Dent Res 2023; 102:459-466. [PMID: 36751050 PMCID: PMC10041600 DOI: 10.1177/00220345221146454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Failure of palatogenesis results in cleft palate, one of the most common congenital disabilities in humans. During the final phases of palatogenesis, the protective function of the peridermal cell layer must be eliminated for the medial edge epithelia to adhere properly, which is a prerequisite for the successful fusion of the secondary palate. However, a deeper understanding of the role and fate of the periderm in palatal adherence and fusion has been hampered due to a lack of appropriate periderm-specific genetic tools to examine this cell type in vivo. Here we used the cytokeratin-6A (Krt-6a) locus to develop both constitutive (Krt6ai-Cre) and inducible (Krt6ai-CreERT2) periderm-specific Cre driver mouse lines. These novel lines allowed us to achieve both the spatial and temporal control needed to dissect the periderm fate on a cellular resolution during palatogenesis. Our studies suggest that, already before the opposing palatal shelves contact each other, at least some palatal periderm cells start to gradually lose their squamous periderm-like phenotype and dedifferentiate into cuboidal cells, reminiscent of the basal epithelial cells seen in the palatal midline seam. Moreover, we show that transforming growth factor-β (TGF-β) signaling plays a critical periderm-specific role in palatogenesis. Thirty-three percent of embryos lacking a gene encoding the TGF-β type I receptor (Tgfbr1) in the periderm display a complete cleft of the secondary palate. Our subsequent experiments demonstrated that Tgfbr1-deficient periderm fails to undergo appropriate dedifferentiation. These studies define the periderm cell fate during palatogenesis and reveal a novel, critical role for TGF-β signaling in periderm dedifferentiation, which is a prerequisite for appropriate palatal epithelial adhesion and fusion.
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Affiliation(s)
- G. Saroya
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - J. Hu
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - M. Hu
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - C. Panaretos
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - J. Mann
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - S. Kim
- Department of Cell and Tissue Biology and Program in Craniofacial Biology, University of California San Francisco, San Francisco, CA, USA
| | - J.O. Bush
- Department of Cell and Tissue Biology and Program in Craniofacial Biology, University of California San Francisco, San Francisco, CA, USA
| | - V. Kaartinen
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Perkovic V, Baeres F, Bakris G, Bosch-Traberg H, Idorn T, Mahaffey K, Mann J, Mersebach H, Rossing P, Tuttle K, Pratley R. FC 123: Baseline Characteristics of the Flow Trial Population: Kidney Outcomes Trial With Once-Weekly Semaglutide in People With Type 2 Diabetes and Chronic Kidney Disease. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac126.002] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Chronic kidney disease (CKD) in type 2 diabetes (T2D) is the most common cause of kidney failure. Despite treatment advances, there is still a large unmet need to prevent CKD progression, which can increase the risk for cardiovascular (CV) disease and kidney failure. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have beneficial effects on glycaemic control and body weight. Some agents have also shown CV benefit and can be used in people with T2D regardless of CKD status (except in end-stage renal disease). CV outcomes trials have suggested that GLP-1RAs may have kidney-protective effects, reducing albuminuria and preserving estimated glomerular filtration rate (eGFR). FLOW (NCT03819153) is a dedicated kidney outcomes trial designed to evaluate the effect of the once-weekly (OW) GLP-1RA semaglutide on major kidney outcomes in subjects with T2D and CKD; we report the blinded baseline characteristics of the FLOW trial population.
METHOD
FLOW is an ongoing randomized, double-blinded, multinational, phase 3b trial in which 3535 subjects with T2D with an eGFR ≥25–≤75 mL/min/1.73 m², and urine albumin-to-creatinine ratio (UACR) >100 to <5000 mg/g were randomly assigned 1:1 to OW semaglutide 1.0 mg or placebo, as add-on to standard-of-care (including maximum labelled/tolerated renin–angiotensin–aldosterone system inhibitors). The primary endpoint is the time to first occurrence of kidney failure (as measured by persistent eGFR <15 mL/min/1.73 m² or initiation of chronic dialysis or kidney transplantation); ≥50% persistent eGFR reduction compared with baseline; and kidney or CV death.
RESULTS
Baseline characteristics from FLOW are shown in the Table 1. Overall, mean eGFR at baseline was 47.0 mL/min/1.73 m2 with 79.6% of subjects having an eGFR of <60 mL/min/1.73 m2. Median UACR at baseline was 567 mg/g, and 68.5% of subjects had macroalbuminuria (≥300 mg/g). According to Kidney Disease: Improving Global Outcomes categories, 24.8% of subjects were classified as high risk and 68.2% of subjects were classified as very high risk for CKD progression (Figure 1).
CONCLUSION
The FLOW trial will evaluate the efficacy and safety of semaglutide on kidney outcomes in subjects with T2D and high risk of kidney disease progression, a group for which additional therapies are urgently required.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Peter Rossing
- Steno Diabetes Center, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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Hale L, Higgs C, Gray A, Mann J, Mani R, Sullivan T, Terry J, Keen D, Stokes T. The diabetes community exercise programme plus usual care versus usual care in patients with type 2 diabetes: A randomised, two-arm, parallel, open-label trial. EClinicalMedicine 2022; 46:101361. [PMID: 35360148 PMCID: PMC8961191 DOI: 10.1016/j.eclinm.2022.101361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Exercise is important in type 2 diabetes (T2D) management. Focussing on Māori and Pacific people and those from deprived circumstances, the Diabetes Community Exercise Programme (DCEP) was developed to engage people with T2D in exercise. We report the evaluation of whether being offered DCEP (plus usual care) was more effective than usual care in improving glycaemic control at 1-year. METHODS A randomised, two-arm, parallel, open-label trial with blinding of outcome assessor and data analyst. Adults (age ≥35 years) with T2D recruited from two New Zealand (NZ) communities were randomised, using opaque sealed envelopes and stratified by centre with random block lengths, to DCEP or usual care. DCEP comprises twice-weekly, two-hour sessions of exercise and education over 12-weeks, followed by a twice-weekly maintenance exercise class. The primary outcome was between-group differences in mean changes of glycated haemoglobin (HbA1c) from baseline to 1-year follow-up with intention-to treat analysis. This trial is registered with the Australian NZ Clinical Trials Registry (ANZCTR): ACTRN12617001624370p and is closed to new participants. FINDINGS From 2018 - 2019, of 294 people screened, 165 (mean age 63·8, SD16·2 years, 56% female, 78·5% European, 14% Māori, 6% Pacific, 27% most deprived) were baseline evaluated, randomised, and analysed at study end (DCEP = 83, control = 82). Multimorbidity (≥2) and polypharmacy (>5 medications) were high (82%, 69%). We found no statistically significant between-groups differences in HbA1c (mmol/mol) change at 15 months (mean 3% higher in DCEP, 95% CI 2% lower to 8% higher, p = 0·23). Twelve-week intervention adherence was good (41% attended >80% available sessions). No adverse events were reported. INTERPRETATION DCEP was not effective in improving glycaemic control, possibly due to insufficient exercise intensity. Our attendance demonstrated DCEP's cultural accessibility. DCEP might be good to engage in exercise marginalised people with high Hb1Ac levels, multimorbidity, and high polypharmacy. FUNDING Health Research Council of New Zealand.
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Affiliation(s)
- L. Hale
- Centre of Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, PO Box 56, Dunedin 9054, New Zealand
- Corresponding author.
| | - C. Higgs
- Centre of Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, PO Box 56, Dunedin 9054, New Zealand
| | - A.R. Gray
- Biostatistics Centre, University of Otago, Dunedin, Otago, New Zealand
| | - J. Mann
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - R. Mani
- Centre of Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, PO Box 56, Dunedin 9054, New Zealand
| | - T. Sullivan
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - J. Terry
- Centre of Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, PO Box 56, Dunedin 9054, New Zealand
| | - D. Keen
- Centre of Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, PO Box 56, Dunedin 9054, New Zealand
| | - T. Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Strickland K, Levengood A, Foroughirad V, Mann J, Krzyszczyk E, Frère CH. Correction to: A framework for the identification of long-term social avoidance in longitudinal datasets. R Soc Open Sci 2022; 9:220017. [PMID: 35116171 PMCID: PMC8767182 DOI: 10.1098/rsos.220017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
[This corrects the article DOI: 10.1098/rsos.170641.][This corrects the article DOI: 10.1098/rsos.170641.].
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Buerke M, Galfalvy H, Keilp J, Sheftall A, Burke A, Bridge J, Mann J, Szanto K. Age effects on clinical and neurocognitive risk factors for suicide attempt in depression - Findings from the AFSP lifespan study. J Affect Disord 2021; 295:123-130. [PMID: 34425314 PMCID: PMC8551053 DOI: 10.1016/j.jad.2021.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies of risk factors for suicidal behavior are typically restricted to narrow age ranges, making it difficult to determine if they have the same relevance or potency across the full adult lifespan. METHODS This study examined selected clinical and neurocognitive risk factors for suicidal behavior - borderline personality traits, aggression, depressive rumination, memory performance, and language fluency- in a multi-site sample (N = 309, ages 16-80) of depressed patients with a recent (last 5 years) suicide attempt or no history of attempt, and demographically similar non-psychiatric controls. We examined cross-sectional age and attempter/non-attempter differences on these risk factors, and whether certain risk factors were more prominent discriminators of past suicide attempt earlier or later in the lifespan. Correlations with age were computed, and logistic regression was used to classify attempter status based on each risk factor and its interaction with age. RESULTS Nearly all risk factors were negatively correlated with age. Borderline traits, aggression, memory, and category fluency each predicted attempter status (p < 0.05), but these effects were not different across ages. In contrast, the association between rumination and suicide attempt status differed across the lifespan, becoming a stronger discriminator of past suicidal behavior at older ages. LIMITATIONS The cross-sectional design limits our developmental findings. CONCLUSIONS Despite age-related changes in symptom severity or neurocognitive performance, key risk factors for suicidal behavior previously identified in studies with more restricted age-ranges are salient throughout the adult lifespan. In contrast, depressive rumination may be particularly salient in later life.
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Affiliation(s)
- M. Buerke
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - H. Galfalvy
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - J. Keilp
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - A. Sheftall
- Ohio State University College of Medicine, Departments of Pediatrics and Psychiatry & Behavioral Health, Columbus, OH, USA
| | - A. Burke
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - J. Bridge
- Ohio State University College of Medicine, Departments of Pediatrics and Psychiatry & Behavioral Health, Columbus, OH, USA
| | - J. Mann
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - K. Szanto
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
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Cheung A, Chang TI, Cushman W, Furth S, Hou FF, Ix JH, Knoll G, Muntner P, Pecoits-Filho R, Sarnak MJ, Tobe SW, Tomson C, Mann J. Abstract 52: KDIGO (Kidney Disease: Improving Global Outcomes) Guideline Update On The Management Of Blood Pressure In Chronic Kidney Disease: What’s New And What’s Different From Other Guidelines. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.52] [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: 11/16/2022]
Abstract
Introduction:
In 2012, KDIGO released a guideline on BP management in CKD not receiving dialysis. The emergence of new trials and meta-analyses coupled with wider recognition of the importance of standardized BP measurement protocols have prompted a call to update the 2012 guideline. This summary will outline the changes to the prior recommendations and highlight similarities to guidelines from ACC/AHA and ESC/ESH.
Methods:
A systematic review was undertaken to formally assess the following issues: 1) BP measurement; 2) lifestyle interventions; BP management in 3) patients with CKD, with and without diabetes, 4) kidney transplant recipients, and 5) children with CKD.
Results:
A total of 6863 citations were screened. Of these, 290 RCTs, 14 observational studies, and 35 systematic reviews were included in the evidence review. A major addition to the KDIGO 2021 guideline is a chapter devoted to BP measurement. KDIGO recommends the use of standardized office BP over routine BP. Out-of-office measurements (ABPM, HBPM) can be used to complement standardized readings. This emphasis on standardized office BP measurement is similar to recommendations from ACC/AHA and ESC/ESH. A systolic BP target of <120 mm Hg is suggested; however, the guidance emphasizes that the target is only applicable when BP is measured using standardized office protocols. RASi are the preferred agents for adults with CKD with increased albuminuria. For lifestyle interventions, dietary sodium intake should be limited to <2 g/day, and ≥150 minutes/week of physical activity is recommended. A BP target of <130/80 mm Hg and use of CCB or ARB are preferred in kidney transplant recipients. BP in children with CKD should be guided by 24-hour MAP using ambulatory monitoring, targeting ≤50th percentile for age, sex, and height. Similar to ACC/AHA and ESC/ESH guidelines, KDIGO also encourages shared-decision making between patients and clinicians in the individualization of BP therapy.
Conclusions:
KDIGO has revised its guideline for BP management in CKD based on a rigorous development process and emerging new evidence underscoring the importance of standardized office BP measurement and a lower systolic BP target of <120 mm Hg for achieving potential cardiovascular, kidney, and mortality benefits.
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Affiliation(s)
| | | | | | | | | | - Joachim H Ix
- UNIVERSITY OF CALIFORNIA SAN DIEGO, San Diego, CA
| | - Gregory Knoll
- The Ottawa Hosp, Ottawa Hosp Rsch Institute, Ottawa, Canada
| | | | | | | | | | - Charles Tomson
- Freeman Hosp, Newcastle upon Tyne Hosps NHS Trust, Newcastle upon Tyne, United Kingdom
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Mann J, Li L, Kulakov E, Bassett P, Birnie A. Home viewing of educational video improves patient understanding of Mohs Surgery. Clin Exp Dermatol 2021; 47:93-97. [PMID: 34260092 DOI: 10.1111/ced.14845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/27/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Educational videos improve patient knowledge of wound care and skin cancer. However, the effect of viewing an educational video at home prior to Mohs surgery has not been demonstrated. OBJECTIVE To evaluate the use of an educational video to improve patient understanding of MMS MATERIALS AND METHODS: Patients scheduled to undergo MMS were randomized to receive standard patient education, or standard patient education with an additional video developed by the authors. The educational material was mailed to patients along with the details of their MMS appointment. Both groups answered questionnaires to assess their knowledge of MMS, as well as their anxiety and satisfaction. RESULTS Patients that watched the educational video scored higher on the knowledge questionnaire than patients in the control group (0.8, 95% CI 0.3 to 1.4, p = 0.003), but were not statistically less anxious (-0.7, 95% CI -2.6 to 1.3, p = 0.50). Overall, patients undergoing MMS were satisfied. CONCLUSION Home viewing of an educational video prior to MMS can improve patient understanding.
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Affiliation(s)
- J Mann
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, United Kingdom
| | - L Li
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - E Kulakov
- Dermatology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Bassett
- Statsconsultancy Ltd, Amersham, United Kingdom
| | - A Birnie
- Department of Dermatology, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
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Schwaab B, Bjarnason-Wehrens B, Meng K, Albus C, Salzwedel A, Schmid JP, Benzer W, Metz M, Jensen K, Rauch B, Bönner G, Brzoska P, Buhr-Schinner H, Charrier A, Cordes C, Dörr G, Eichler S, Exner AK, Fromm B, Gielen S, Glatz J, Gohlke H, Grilli M, Gysan D, Härtel U, Hahmann H, Herrmann-Lingen C, Karger G, Karoff M, Kiwus U, Knoglinger E, Krusch CW, Langheim E, Mann J, Max R, Metzendorf MI, Nebel R, Niebauer J, Predel HG, Preßler A, Razum O, Reiss N, Saure D, von Schacky C, Schütt M, Schultz K, Skoda EM, Steube D, Streibelt M, Stüttgen M, Stüttgen M, Teufel M, Tschanz H, Völler H, Vogel H, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2. J Clin Med 2021; 10:jcm10143071. [PMID: 34300237 PMCID: PMC8306118 DOI: 10.3390/jcm10143071] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients’ groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
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Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, D-23669 Timmendorfer Strand, Germany
- Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany
- Correspondence:
| | - Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Karin Meng
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | | | | | - Matthes Metz
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany;
- Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Gerd Bönner
- Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany;
| | - Patrick Brzoska
- Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany;
| | | | | | - Carsten Cordes
- Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany;
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | - Anne-Kathrin Exner
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Bernd Fromm
- REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany;
| | - Stephan Gielen
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | - Helmut Gohlke
- Private Practice, D-79282 Ballrechten-Dottingen, Germany;
| | - Maurizio Grilli
- Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany;
| | - Detlef Gysan
- Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany;
| | - Ursula Härtel
- LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany;
| | | | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, D-37075 Göttingen, Germany;
| | | | | | | | | | | | - Eike Langheim
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | | | - Regina Max
- Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Hans-Georg Predel
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Axel Preßler
- Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany;
| | - Oliver Razum
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | | | - Morten Schütt
- Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany;
| | - Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany;
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Marco Streibelt
- Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany;
| | | | | | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Heiner Vogel
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany;
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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10
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Alani A, Wernham AGH, Mann J, Veitch D, Affleck A, Ghura V. UK National Mohs Surgeon Survey 2020. Clin Exp Dermatol 2021; 46:1609-1610. [PMID: 34170560 DOI: 10.1111/ced.14817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022]
Affiliation(s)
- A Alani
- Dermatological Surgery Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - A G H Wernham
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK
| | - J Mann
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Veitch
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Affleck
- Department of Dermatology, Leicester Royal Infirmary, Leicester, UK.,Dermatological Surgery Unit, Ninewells Hospital, Tayside, Dundee, UK
| | - V Ghura
- Dermatological Surgery Unit, Salford Royal Foundation Trust, Manchester, UK
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11
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Braunisch MC, Gundel P, Werfel S, Mayer CC, Bauer A, Haller B, Günthner R, Lorenz G, Angermann S, Matschkal J, Schaller C, Holzmann-Littig C, Kemmner S, Mann J, Krieter A, Renders L, Wassertheurer S, Schmidt G, Heemann U, Malik M, Schmaderer C. Electrocardiographic parameters of left ventricular hypertrophy and prediction of mortality in hemodialysis patients. J Nephrol 2021; 35:233-244. [PMID: 34014512 PMCID: PMC8803820 DOI: 10.1007/s40620-021-01068-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/09/2021] [Indexed: 11/09/2022]
Abstract
Background In hemodialysis patients, left ventricular hypertrophy (LVH) contributes to high cardiovascular mortality. We examined cardiovascular mortality prediction by the recently proposed Peguero-Lo Presti voltage since it identifies more patients with electrocardiographic (ECG) LVH than Cornell or Sokolow-Lyon voltages. Methods A total of 308 patients on hemodialysis underwent 24 h ECG recordings. LVH parameters were measured before and after dialysis. The primary endpoint of cardiovascular mortality was recorded during a median 3-year follow up. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score. Results The Peguero-Lo Presti voltage identified with 21% the most patients with positive LVH criteria. All voltages significantly increased during dialysis. Factors such as ultrafiltration rate, Kt/V, body mass index, sex, and phosphate were the most relevant for these changes. During follow-up, 26 cardiovascular deaths occurred. Post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages were independently associated with cardiovascular mortality in unadjusted and adjusted analysis. The Sokolow-Lyon voltage was not significantly associated with mortality. An optimal cut-off for the prediction of cardiovascular mortality was estimated at 1.38 mV for the Peguero-Lo Presti. Conclusions The post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages allowed independent risk prediction of cardiovascular mortality in hemodialysis patients. Measuring the ECG LVH parameters after dialysis might allow a standardized interpretation as dialysis-specific factors influence the voltages. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01068-0.
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Affiliation(s)
- Matthias C Braunisch
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Peter Gundel
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Klinik für Innere Medizin 4, Schwerpunkt Nephrologie und Hypertensiologie, Klinikum Nürnberg, Nuremberg, Germany
| | - Stanislas Werfel
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christopher C Mayer
- Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Axel Bauer
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria.,Department of Cardiology, Munich University Clinic, DZHK (German Centre for Cardiovascular Research), Ludwig-Maximilians University, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology (IMedIS), School of Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Roman Günthner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georg Lorenz
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Susanne Angermann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Matschkal
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carolin Schaller
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christopher Holzmann-Littig
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,TUM Medical Education Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Transplant Center, University Hospital Munich, Ludwig-Maximillians University (LMU), Munich, Germany
| | - Johannes Mann
- Department of Nephrology, University of Erlangen-Nürnberg, Erlangen, Germany.,KfH Kidney Center Munich, Isoldenstraße 15, Munich, Germany
| | - Axel Krieter
- Nephrocare München-Ost, Rosenkavalierplatz 5, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Siegfried Wassertheurer
- Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Georg Schmidt
- School of Medicine, Klinik für Innere Medizin I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
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12
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Mann J, Doshi M, Quentin L, Eaton K, Morton-Holtham L. Cost Benefit Analysis of Two Oral health Improvement Programmes. Community Dent Health 2021; 38:26-32. [PMID: 33079498 DOI: 10.1922/cdh_001012020mann07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Oral health is frequently given a low priority when healthcare funds are allocated to new initiatives. One method to highlight the health and social benefits of new oral health initiatives is to use cost benefit analysis to show their value. AIM To demonstrate how Cost Benefit Analysis (CBA) has been applied to two recent oral health initiatives to evaluate their ability to reduce costs and improve the quality of life. METHODS CBA was applied to the Mouth Care Matters project in Kent, Surrey and Sussex, and the Senior Smiles project - improving oral health in residential homes in Australia. RESULTS Over a five-year period, the Mouth Care Matters project would generate £2.66 in cost savings, within the healthcare system, for every £1 spent. Over a three year period the Senior Smiles project would generate a cost saving for the healthcare system of $3.14 for every $1 spent. These evaluations were instrumental to enable a national rollout for Mouth Care Matters and a public endorsement of the programme for Senior Smiles. CONCLUSIONS Health economics can be a useful tool in aiding care organisations to assess the implications of decisions to spend limited resources in particular areas of healthcare over others.
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Affiliation(s)
- J Mann
- Special Care Dentistry, University Hospitals Bristol and West Trust, Bristol Dental Hospital
| | - M Doshi
- Surrey and Sussex Healthcare Trust
| | - L Quentin
- Kent Surrey Sussex Academic Health Science Network
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13
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Roberts EJ, Mann J, Ravenscroft JC. What is the demand for out-of-hours dermatology? A UK-based region-wide survey of dermatology demand and provision during the evenings and at weekends. Clin Exp Dermatol 2021; 46:861-866. [PMID: 33438243 DOI: 10.1111/ced.14555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/07/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the demand for out-of-hours (OOH) dermatology in the UK, and this can make commissioning of acute services difficult. The East Midlands region has a population of 4.5 million people, with variable access to OOH dermatology services. AIM We sought to investigate the provision of, and demand for, OOH dermatology services across the region with a view to informing commissioning decisions for the future. METHODS We contacted all dermatology departments in the East Midlands region to establish what level of service was commissioned at evenings and weekends. At the sites providing any form of OOH service, we recorded all requests for advice received after 17.00 h on weekdays, or at any time during weekends and bank holidays over a 3-month period from October to December 2019. RESULTS The OOH services provided ranged from 24 h/day cover 7 days/week at one site, to no formal provision across much of the rest of the region. In total, 125 calls were received during the study period, averaging 1 call per day on weekday evenings, and 2 calls per day at weekends and on bank holidays. Of these 125 calls, 11 patients (9%) were prioritized and seen by the on-call dermatologist on the day of referral, and 9 of these had potentially life-threatening skin conditions. A further 39 (31%) were deemed to need review within 24 h and 22 (18%) within 48 h. The remaining 42% were given appointments within 7 days or dealt with by telephone advice. CONCLUSION The demand for OOH dermatology across the East Midlands is low, but access to timely dermatology advice is essential in some situations. Commissioning of a regional dermatology OOH service incorporating digital technology may help to improve the equity of access for all patients across the region.
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Affiliation(s)
- E J Roberts
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Mann
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Dermatology, University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
| | - J C Ravenscroft
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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14
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Martir J, Flanagan T, Mann J, Fotaki N. Impact of Food and Drink Administration Vehicles on Paediatric Formulation Performance Part 2: Dissolution of Montelukast Sodium and Mesalazine Formulations. AAPS PharmSciTech 2020; 21:287. [PMID: 33063245 PMCID: PMC7561592 DOI: 10.1208/s12249-020-01815-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
Paediatric medicines are not always age-appropriate, causing problems with dosing, acceptability and adherence. The use of food and drinks as vehicles for medicine co-administration is common practice, yet the impact on drug bioavailability, safety and efficacy remains unaddressed. The aim of this study was to use in vitro dissolution testing, under infant simulating conditions, to evaluate the effect of co-administration with vehicles on the dissolution performance of two poorly soluble paediatric drugs. Dissolution studies of mesalazine and montelukast formulations were conducted with mini-paddle apparatus on a two-stage approach: simulated gastric fluid followed by addition of simulated intestinal fluid. The testing scenarios were designed to reflect daily administration practices: direct administration of formulation; formulation co-administered with food and drinks, both immediately after mixing and 4 h after mixing. Drug dissolution was significantly affected by medicine co-administration with vehicles, compared to the direct administration of formulation. Furthermore, differences were observed on drug dissolution when the formulations were mixed with different vehicles of the same subtype. The time between preparation and testing of the drug-vehicle mixture also impacted dissolution behaviour. Drug dissolution was shown to be significantly affected by the physicochemical properties and composition of the vehicles, drug solubility in each vehicle and drug/formulation characteristics. Ultimately, in this study, we show the potential of age-appropriate in vitro dissolution testing as a useful biopharmaceutical tool for estimating drug dissolution in conditions relevant to the paediatric population. The setup developed has potential to evaluate the impact of medicine co-administration with vehicles on paediatric formulation performance.
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15
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Martir J, Flanagan T, Mann J, Fotaki N. In Vivo Predictive Dissolution Testing of Montelukast Sodium Formulations Administered with Drinks and Soft Foods to Infants. AAPS PharmSciTech 2020; 21:282. [PMID: 33051713 PMCID: PMC7554011 DOI: 10.1208/s12249-020-01825-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022] Open
Abstract
In vitro dissolution testing conditions that reflect and predict in vivo drug product performance are advantageous, especially for the development of paediatric medicines, as clinical testing in this population is hindered by ethical and technical considerations. The aim of this study was to develop an in vivo predictive dissolution test in order to investigate the impact of medicine co-administration with soft food and drinks on the dissolution performance of a poorly soluble compound. Relevant in vitro dissolution conditions simulating the in vivo gastrointestinal environment of infants were used to establish in vitro-in vivo relationships with corresponding in vivo data. Dissolution studies of montelukast formulations were conducted with mini-paddle apparatus on a two-stage approach: infant fasted-state simulated gastric fluid (Pi-FaSSGF; for 1 h) followed by either infant fasted-state or infant fed-state simulated intestinal fluid (FaSSIF-V2 or Pi-FeSSIF, respectively; for 3 h). The dosing scenarios tested reflected in vivo paediatric administration practices: (i.) direct administration of formulation; (ii.) formulation co-administered with vehicles (formula, milk or applesauce). Drug dissolution was significantly affected by co-administration of the formulation with vehicles compared with after direct administration of the formulation. Montelukast dissolution from the granules was significantly higher under fed-state simulated intestinal conditions in comparison with the fasted state and was predictive of the in vivo performance when the granules are co-administered with milk. This study supports the potential utility of the in vitro biorelevant dissolution approach proposed to predict in vivo formulation performance after co-administration with vehicles, in the paediatric population.
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16
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Mathews K, Perlman S, Conway K, Ciafaloni E, Thomas S, Mann J, Romitti P. DMD & BMD – CLINICAL. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.053] [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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17
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Ciafaloni E, Fapo O, Conway K, Street N, Romitti P, Westfield C, Fox D, Matthews K, Mann J, Thomas S, Soim A, STARnet MD. DMD & BMD – CLINICAL. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Martir J, Flanagan T, Mann J, Fotaki N. BCS-based biowaivers: Extension to paediatrics. Eur J Pharm Sci 2020; 155:105549. [PMID: 32941998 DOI: 10.1016/j.ejps.2020.105549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/25/2020] [Accepted: 09/11/2020] [Indexed: 12/25/2022]
Abstract
A BCS-based biowaiver allows extrapolation of drug product bioequivalence (when applicable) based on the BCS class of the drug and in vitro dissolution testing. Drug permeability and solubility considerations for adult BCS might not apply directly to paediatric subpopulations and bridging of adult and paediatric formulations should be undertaken with caution. The aims of this study were to: (i.) identify compounds which would change drug solubility classification in the paediatric population, and (ii.) to assess the risk of extending BCS-based biowaiver criteria into paediatric products of these compounds. Amoxicillin, prednisolone, and amlodipine were selected as the model compounds. Dissolution studies of IR formulations of these compounds were conducted with USP II (paddle) and mini-paddle apparatus, in media of three pHs (pH 1.2, 4.5 and 6.8). Three dissolution setups were tested: (1) 'typical' BCS-based biowaiver conditions, (2) "BE" setup derived from BE study protocols (volume: 250 mL), and (3) "paediatric" setup based on representative volume for the paediatric population (50 mL). Results revealed that extension of regulated BCS-based biowaiver criteria for paediatric application is not as simple as scaling down volumes. It was further shown that BCS-based biowaiver criteria should not be applied when there is the risk of change of the drug solubility class, from the adult to paediatric populations. A deeper knowledge of the paediatric gastrointestinal environment is still lacking and would assist in refining the biopharmaceutical tools needed to appropriately evaluate formulation performance across age groups. This would potentially reduce the number of clinical studies required and speed up formulation development.
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Affiliation(s)
- J Martir
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - T Flanagan
- Oral Product Development, Pharmaceutical Technology & Development, Operations, AstraZeneca, Macclesfield, UK; Currently at UCB Pharma, Chemin du Foriest, B - 1420 Braine-l'Alleud, Belgium
| | - J Mann
- Oral Product Development, Pharmaceutical Technology & Development, Operations, AstraZeneca, Macclesfield, UK
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
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Haag G, Stocker G, Lorenzen S, Ettrich T, Longo F, Kiani A, Venerito M, Trojan J, Mahlberg R, Moosmann N, Chibaudel B, Kubicka S, Greil R, Daum S, Geissler M, Mann J, Lordick F. 1447P S-1 maintenance therapy in non-Asian patients with advanced, Her-2 negative esophagogastric adenocarcinoma – First results of the international MATEO trial initiated by the AIO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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20
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Zarmpi P, Flanagan T, Meehan E, Mann J, Østergaard J, Fotaki N. Biopharmaceutical implications of excipient variability on drug dissolution from immediate release products. Eur J Pharm Biopharm 2020; 154:195-209. [PMID: 32681966 DOI: 10.1016/j.ejpb.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Elucidating the impact of excipient variability on oral product performance in a biopharmaceutical perspective would be beneficial and allow excipient implementation on Quality by Design (QbD) approaches. The current study investigated the impact of varying viscosity of binders (hypromellose (HPMC)) and superdisintegrants (sodium starch glycolate (SSG)) and particle size distribution of lubricants (magnesium stearate (MgSt)) on the in vitro dissolution of a highly and a poorly soluble drug from immediate release formulations. Compendial (pharmacopoeia buffers) and biorelevant (media simulating the gastrointestinal fluids) media and the USP 2 and USP 4 apparatuses were used to assess the exerted excipient effects on drug dissolution. Real-time dissolution UV imaging provided mechanistic insights into disintegration and dissolution of the immediate release formulations. Varying the viscosity type of HPMC or SSG did not significantly affect drug dissolution irrespective of the compound used. Faster drug dissolution was observed when decreasing the particle size of MgSt for the highly soluble drug. The use of real-time dissolution UV Imaging revealed the influential role of excipient variability on tablet disintegration, as for the highly soluble drug, tablets containing high viscosity HPMC or low particle size MgSt disintegrated faster as compared to the control tablets while for the poorly soluble drug, slower tablet disintegration was observed when increasing the viscosity of the HPMC as compared to the control tablets. Changes in drug dissolution when varying excipients may be anticipated if the excipient change has previously affected drug solubility. The use of multivariate data analysis revealed the influential biopharmaceutical factors such as critical excipient types/properties, drug aqueous solubility, medium/hydrodynamic characteristics affecting the impact of excipient variability on in vitro drug dissolution.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom; Currently at UCB Pharma, Chemin du Foriest, B - 1420 Braine-l'Alleud, Belgium
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - J Østergaard
- Department of Pharmacy, Faculty of Health and Medicinal Sciences, University of Copenhagen, Denmark
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
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21
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Martir J, Flanagan T, Mann J, Fotaki N. Impact of Food and Drink Administration Vehicles on Paediatric Formulation Performance: Part 1-Effects on Solubility of Poorly Soluble Drugs. AAPS PharmSciTech 2020; 21:177. [PMID: 32592045 PMCID: PMC7373161 DOI: 10.1208/s12249-020-01722-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Abstract
Food and drinks are commonly used to facilitate administration of
paediatric medicines to improve palatability and enhance patient compliance.
However, the impact of this practice on drug solubility and on oral drug
bioavailability is not usually studied. Based on recommended strategies for oral
administration of paediatric medicines with food and drink vehicles, the aims of
this study were (i) to measure the physicochemical properties of (soft) food and
drink vehicles, commonly mixed with paediatric medicines prior to administration,
and (ii) to assess the impact of the co-administered vehicles on the solubility of
two poorly soluble paediatric drugs. Montelukast (sodium) and mesalazine were
selected as the model compounds. Distinct differences were observed between the
physicochemical properties (i.e. pH, surface
tension, osmolality, viscosity and buffer capacity) and macronutrient composition
(i.e. fat, sugar and protein content) of the
different soft foods and drinks, not only among vehicle type but also within
vehicles of the same subtype. Solubility studies of the two model compounds in
selected drinks and soft foods resulted in considerably different drug solubility
values in each vehicle. The solubility of the drugs was significantly affected by
the vehicle physicochemical properties and macronutrient composition, with the
solubility of montelukast being driven by the pH, fat and protein content of the
vehicles and the solubility of mesalazine by vehicle osmolality, viscosity and sugar
content. This vehicle-dependent impact on drug solubility could compromise its
bioavailability, and ultimately affect the safety and/or efficacy of the drug and
should be taken into consideration during paediatric product development.
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Mann J, Wernham A, Kulkarni K, Varma S. An unexpected lesion on the scalp. Clin Exp Dermatol 2020; 45:922-924. [PMID: 32449175 DOI: 10.1111/ced.14268] [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] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- J Mann
- Departments of Dermatology, Nottingham Treatment Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Wernham
- Departments of Dermatology, Nottingham Treatment Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Kulkarni
- Department of Histopathology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Varma
- Departments of Dermatology, Nottingham Treatment Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Impact of Magnesium Stearate Presence and Variability on Drug Apparent Solubility Based on Drug Physicochemical Properties. AAPS J 2020; 22:75. [PMID: 32440810 PMCID: PMC7242257 DOI: 10.1208/s12248-020-00449-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/20/2020] [Indexed: 11/30/2022]
Abstract
Excipients are major components of oral solid dosage forms, and changes in their critical material attributes (excipient variability) and/or amount (excipient variation) in pharmaceutical formulations may present a challenge for product performance. Understanding the biopharmaceutical factors affecting excipient performance is recommended for the successful implementation of excipient variability on Quality by Design (QbD) approaches. The current study investigated the impact of magnesium stearate (MgSt) variability on the apparent solubility of drugs with a wide range of physicochemical properties (drug ionization, drug lipophilicity, drug aqueous solubility). Compendial and biorelevant media were used to assess the role of gastrointestinal (GI) conditions on the excipient effects on drug apparent solubility. The lipophilic nature of MgSt decreased the apparent solubility of most compounds. The reduction in drug apparent solubility was more pronounced for highly soluble and/or highly ionized drugs and in presence of more highly crystalline or smaller particle size MgSt. The use of multivariate data analysis revealed the critical physicochemical and biopharmaceutical factors and the complex nature of excipient variability on the reduction in drug apparent solubility. The construction of a roadmap combining drug, excipient and medium characteristics allowed the identification of the cases where the presence of excipient or excipient variability may present risks for oral drug performance.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK.,UCB Pharma, Chemin du Foriest, B-1420, Braine-l'Alleud, Belgium
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - Nikoletta Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK.
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Biopharmaceutical Understanding of Excipient Variability on Drug Apparent Solubility Based on Drug Physicochemical Properties: Case Study-Hypromellose (HPMC). AAPS J 2020; 22:49. [PMID: 32072317 PMCID: PMC7028811 DOI: 10.1208/s12248-019-0411-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/21/2019] [Indexed: 02/07/2023]
Abstract
Identification of the biopharmaceutical risks of excipients and excipient variability on oral drug performance can be beneficial for the development of robust oral drug formulations. The current study investigated the impact of Hypromellose (HPMC) presence and varying viscosity type, when used as a binder in immediate release formulations, on the apparent solubility of drugs with wide range of physicochemical properties (drug ionization, drug lipophilicity, drug aqueous solubility). The role of physiological conditions on the impact of excipients on drug apparent solubility was assessed with the use of pharmacopoeia (compendial) and biorelevant media. Presence of HPMC affected drug solubility according to the physicochemical properties of studied compounds. The possible combined effects of polymer adsorption (drug shielding effect) or the formation of a polymeric viscous layer around drug particles may have retarded drug dissolution leading to reduced apparent solubility of highly soluble and/or highly ionized compounds and were pronounced mainly at early time points. Increase in the apparent solubility of poorly soluble low ionized drugs containing a neutral amine group was observed which may relate to enhanced drug solubilization or reduced drug precipitation. The use of multivariate data analysis confirmed the importance of drug physicochemical properties on the impact of excipients on drug apparent solubility and revealed that changes in HPMC material properties or amount may not be critical for oral drug performance when HPMC is used as a binder. The construction of a roadmap combining drug, excipient, and medium characteristics allowed the identification of the cases where HPMC presence may present risks in oral drug performance and bioavailability.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK.,UCB Pharma, Chemin du Foriest, 1420, Braine-l'Alleud, Belgium
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Surface dissolution UV imaging for characterization of superdisintegrants and their impact on drug dissolution. Int J Pharm 2020; 577:119080. [PMID: 31988030 DOI: 10.1016/j.ijpharm.2020.119080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/15/2022]
Abstract
Superdisintegrants are a key excipient used in immediate release formulations to promote fast tablet disintegration, therefore understanding the impact of superdisintegrant variability on product performance is important. The current study examined the impact of superdisintegrant critical material attributes (viscosity for sodium starch glycolate (SSG), particle size distribution (PSD) for croscarmellose sodium (CCS)) on their performance (swelling) and on drug dissolution using surface dissolution UV imaging. Acidic and basic pharmacopoeia (compendial) media were used to assess the role of varying pH on superdisintegrant performance and its effect on drug dissolution. A highly soluble (paracetamol) and a poorly soluble (carbamazepine) drug were used as model compounds and drug compacts and drug-excipient compacts were prepared for the dissolution experiments. The presence of a swelled SSG or CCS layer on the compact surface, due to the fast excipient hydration capacity, upon contact with dissolution medium was visualized. The swelling behaviour of superdisintegrants depended on excipient critical material attributes and the pH of the medium. Drug dissolution was faster in presence compared to superdisintegrant absence due to improved compact wetting or compact disintegration. The improvement in drug dissolution was less pronounced with increasing SSG viscosity or CCS particle size. Drug dissolution was slightly more complete in basic compared to acidic conditions in presence of the studied superdisintegrants for the highly soluble drug attributed to the increased excipient hydration capacity and the fast drug release through the swelled excipient structure. The opposite was observed for the poorly soluble drug as potentially the improvement in drug dissolution was compromised by drug release from the highly swelled structure. The use of multivariate data analysis revealed the influential role of excipient and drug properties on the impact of excipient variability on drug dissolution.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
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Salchow J, Mann J, Koch B, von Grundherr J, Jensen W, Elmers S, Straub LA, Vettorazzi E, Escherich G, Rutkowski S, Dwinger S, Bergelt C, Sokalska-Duhme M, Bielack S, Calaminus G, Baust K, Classen CF, Rössig C, Faber J, Faller H, Hilgendorf I, Gebauer J, Langer T, Metzler M, Schuster S, Niemeyer C, Puzik A, Reinhardt D, Dirksen U, Sander A, Köhler M, Habermann JK, Bokemeyer C, Stein A. Comprehensive assessments and related interventions to enhance the long-term outcomes of child, adolescent and young adult cancer survivors - presentation of the CARE for CAYA-Program study protocol and associated literature review. BMC Cancer 2020; 20:16. [PMID: 31906955 PMCID: PMC6945396 DOI: 10.1186/s12885-019-6492-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/23/2019] [Indexed: 12/21/2022] Open
Abstract
Background Improved, multimodal treatment strategies have been shown to increase cure rates in cancer patients. Those who survive cancer as a child, adolescent or young adult (CAYA), are at a higher risk for therapy-, or disease-related, late or long-term effects. The CARE for CAYA-Program has been developed to comprehensively assess any potential future problems, to offer need-based preventative interventions and thus to improve long-term outcomes in this particularly vulnerable population. Methods The trial is designed as an adaptive trial with an annual comprehensive assessment followed by needs stratified, modular interventions, currently including physical activity, nutrition and psycho-oncology, all aimed at improving the lifestyle and/or the psychosocial situation of the patients. Patients, aged 15–39 years old, with a prior cancer diagnosis, who have completed tumour therapy and are in follow-up care, and who are tumour free, will be included. At baseline (and subsequently on an annual basis) the current medical and psychosocial situation and lifestyle of the participants will be assessed using a survey compiled of various validated questionnaires (e.g. EORTC QLQ C30, NCCN distress thermometer, PHQ-4, BSA, nutrition protocol) and objective parameters (e.g. BMI, WHR, co-morbidities like hyperlipidaemia, hypertension, diabetes), followed by basic care (psychological and lifestyle consultation). Depending on their needs, CAYAs will be allocated to preventative interventions in the above-mentioned modules over a 12-month period. After 1 year, the assessment will be repeated, and further interventions may be applied as needed. During the initial trial phase, the efficacy of this approach will be compared to standard care (waiting list with intervention in the following year) in a randomized study. During this phase, 530 CAYAs will be included and 320 eligible CAYAs who are willing to participate in the interventions will be randomly allocated to an intervention. Overall, 1500 CAYAs will be included and assessed. The programme is financed by the innovation fund of the German Federal Joint Committee and will be conducted at 14 German sites. Recruitment began in January 2018. Discussion CAYAs are at high risk for long-term sequelae. Providing structured interventions to improve lifestyle and psychological situation may counteract against these risk factors. The programme serves to establish uniform regular comprehensive assessments and need-based interventions to improve long-term outcome in CAYA survivors. Trial registration Registered at the German Clinical Trial Register (ID: DRKS00012504, registration date: 19th January 2018).
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Affiliation(s)
- J Salchow
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - J Mann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Koch
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J von Grundherr
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Jensen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Elmers
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L A Straub
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Vettorazzi
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Escherich
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Rutkowski
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Dwinger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Bergelt
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - S Bielack
- Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | | | - K Baust
- University Hospital Bonn, Bonn, Germany
| | - C F Classen
- University Hospital Rostock, Rostock, Germany
| | - C Rössig
- University Children's Hospital Münster, Münster, Germany
| | - J Faber
- Mainz University Medical Center, Mainz, Germany
| | - H Faller
- University Hospital Würzburg, Würzburg, Germany
| | | | - J Gebauer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - T Langer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - M Metzler
- University Hospital Erlangen, Erlangen, Germany
| | - S Schuster
- University Hospital Erlangen, Erlangen, Germany
| | - C Niemeyer
- Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Puzik
- Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Reinhardt
- University Hospital Essen, Essen, Germany.,German Cancer Consortium, Essen, Germany
| | - U Dirksen
- University Hospital Essen, Essen, Germany.,German Cancer Consortium, Essen, Germany
| | - A Sander
- Hannover Medical School, Hannover, Germany
| | - M Köhler
- Medical Faculty University Hospital Magdeburg, Magdeburg, Germany
| | | | - C Bokemeyer
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stein
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Verma S, Bain S, Honoré J, Mann J, Nauck M, Pratley R, Rasmussen S, Sejersten Ripa M, Zinman B, Buse J. IMPACT OF MICROVASCULAR DISEASE ON CARDIORENAL OUTCOMES IN TYPE 2 DIABETES: AN ANALYSIS FROM THE LEADER AND SUSTAIN 6 CLINICAL TRIALS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Baiyegunhi O, Mann J, Nkosi T, Pansegrou J, Dong K, Ndungu T, Walker B, Ndhlovu Z. High HIV viral burden persists in CXCR3+TFH despite very early cART initiation. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)31059-1] [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] Open
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Perkovic V, Bain S, Bakris G, Buse J, Idorn T, Mahaffey K, Marso S, Nauck M, Pratley R, Rasmussen S, Rossing P, Tornoe K, Zinman B, Mann J. SaO010EFFECTS OF THE GLUCAGON-LIKE PEPTIDE-1 (GLP-1) ANALOGUES SEMAGLUTIDE AND LIRAGLUTIDE ON RENAL OUTCOMES – A POOLED ANALYSIS OF THE SUSTAIN 6 AND LEADER TRIALS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz101.sao010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vlado Perkovic
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Stephen Bain
- Swansea University Medical School, Swansea, United Kingdom
| | - George Bakris
- University of Chicago Medicine, Chicago, United States of America
| | - John Buse
- University of North Carolina School of Medicine, Chapel Hill, United States of America
| | | | - Kenneth Mahaffey
- Stanford Center for Clinical Research, Stanford School of Medicine, Stanford, United States of America
| | - Steven Marso
- Research Medical Center, Kansas City, United States of America
| | - Michael Nauck
- Diabetes Center Bochum-Hattingen, St Josef Hospital (Ruhr-Universität Bochum), Bochum, Germany
| | - Richard Pratley
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, United States of America
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte; University of Copenhagen, Copenhagen, Denmark
| | | | - Bernard Zinman
- Lunenfeld–Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto, Canada
| | - Johannes Mann
- Friedrich Alexander University of Erlangen, Erlagen, Germany
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Perkovic V, Bain S, Bakris G, Buse J, Idorn T, Mahaffey K, Marso S, Nauck M, Pratley R, Rasmussen S, Rossing P, Tornoe K, Zinman B, Mann J. FP483EFFECTS OF SEMAGLUTIDE AND LIRAGLUTIDE ON URINARY ALBUMIN-TO-CREATININE RATIO (UACR) – A POOLED ANALYSIS OF SUSTAIN 6 AND LEADER. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vlado Perkovic
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Stephen Bain
- Swansea University Medical School, Swansea, United Kingdom
| | - George Bakris
- University of Chicago Medicine, Chicago, United States of America
| | - John Buse
- University of North Carolina School of Medicine, Chapel Hill, United States of America
| | | | - Kenneth Mahaffey
- Stanford Center for Clinical Research, Stanford School of Medicine, Stanford, United States of America
| | - Steven Marso
- Research Medical Center, Kansas City, United States of America
| | - Michael Nauck
- Diabetes Center Bochum-Hattingen, St Josef Hospital (Ruhr-Universität Bochum), Bochum, Germany
| | - Richard Pratley
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, United States of America
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte; University of Copenhagen, Copenhagen, Denmark
| | | | - Bernard Zinman
- Lunenfeld–Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto, Canada
| | - Johannes Mann
- Friedrich Alexander University of Erlangen, Erlagen, Germany
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Combe C, Mann J, Goldsmith D, Dellanna F, Zaoui P, London G, Denhaerynck K, Krendyukov A, Abraham I, MacDonald K. Potential life-years gained over a 5-year period by correcting DOPPS-identified modifiable practices in haemodialysis: results from the European MONITOR-CKD5 study. BMC Nephrol 2019; 20:81. [PMID: 30836953 PMCID: PMC6402099 DOI: 10.1186/s12882-019-1251-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/08/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND DOPPS reported that thousands of life-years could be gained in the US and Europe over 5 years by correcting six modifiable haemodialysis practices. We estimated potential life-years gained across 10 European countries using MONITOR-CKD5 study data. METHODS The DOPPS-based target ranges were used, except for haemoglobin due to label changes, as well as DOPPS-derived relative mortality risks. Percentages of MONITOR-CKD5 patients outside targets were calculated. Consistent with the DOPPS-based analyses, we extrapolated life-years gained for the MONITOR-CKD5 population over 5 years if all patients were within targets. RESULTS Bringing the 10 MONITOR-CKD5 countries' dialysis populations into compliance on the six practices results in a 5-year gain of 97,428 patient-years. In descending order, survival impact was the highest for albumin levels, followed by phosphate levels, vascular access, haemoglobin, dialysis adequacy, and interdialytic weight gain. CONCLUSIONS Optimal management of the six modifiable haemodialysis practices may achieve 6.2% increase in 5-year survival. TRIAL REGISTRATION NCT01121237 . Clinicaltrials.gov registration May 12, 2010 (retrospectively registered).
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Affiliation(s)
- Christian Combe
- Centre Hospitalier Universitaire de Bordeaux and Unité INSERM 1026, University of Bordeaux, Bordeaux, France
| | - Johannes Mann
- Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | | - Gérard London
- Centre Hospitalier F.H. Manhés, Fleury-Mérogis, France
| | - Kris Denhaerynck
- Matrix45, Tucson, AZ USA
- Department of Public Health, University of Basel, Basel, Switzerland
| | | | - Ivo Abraham
- Matrix45, Tucson, AZ USA
- University of Arizona College of Pharmacy and College of Medicine, Tucson, AZ USA
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Mann J. Dental equipment: Hands-free heaven. Br Dent J 2018; 225:994. [DOI: 10.1038/sj.bdj.2018.1089] [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: 11/09/2022]
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Biegalski S, Kane N, Mann J, Tipping T, Dayman K. Neutron activation of NIST surrogate post-detonation urban debris (SPUD) candidate SRMs. J Radioanal Nucl Chem 2018. [DOI: 10.1007/s10967-018-6023-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: 11/29/2022]
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Wan Muhammad Hatta SF, Kandaswamy L, Gherman-Ciolac C, Mann J, Buch HN. An unusual case of shortness of breath. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180074. [PMID: 30087779 PMCID: PMC6063989 DOI: 10.1530/edm-18-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 11/08/2022] Open
Abstract
Myopathy is a well-known complication of hypercortisolism and commonly involves proximal lower-limb girdle. We report a rare case of Cushing’s syndrome in a 60-year-old female presenting with significant respiratory muscle weakness and respiratory failure. She had history of rheumatoid arthritis, primary biliary cirrhosis and primary hypothyroidism and presented with weight gain and increasing shortness of breath. Investigations confirmed a restrictive defect with impaired gas transfer but with no significant parenchymatous pulmonary disease. Respiratory muscle test confirmed weakness of respiratory muscles and diaphragm. Biochemical and radiological investigations confirmed hypercortisolaemia secondary to a left adrenal tumour. Following adrenalectomy her respiratory symptoms improved along with an objective improvement in the respiratory muscle strength, diaphragmatic movement and pulmonary function test.
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Affiliation(s)
- S F Wan Muhammad Hatta
- 1New Cross Hospital, Wolverhampton, UK
- 2Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia
| | | | | | - J Mann
- 1New Cross Hospital, Wolverhampton, UK
| | - H N Buch
- 1New Cross Hospital, Wolverhampton, UK
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Renault O, Martinez E, Zborowski C, Mann J, Inoue R, Newman J, Watanabe K. Analysis of buried interfaces in multilayer device structures with hard XPS (HAXPES) using a CrKα source. SURF INTERFACE ANAL 2018. [DOI: 10.1002/sia.6451] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- O. Renault
- Université Grenoble Alpes; CEA, LETI; 38000 Grenoble France
| | - E. Martinez
- Université Grenoble Alpes; CEA, LETI; 38000 Grenoble France
| | - C. Zborowski
- Université Grenoble Alpes; CEA, LETI; 38000 Grenoble France
- Department of Physics, Chemistry and Pharmacy; University of Southern Denmark; Odense M Denmark
| | - J. Mann
- Physical Electronics; 18725 Lake Drive Chanhassen MN 55317 USA
| | - R. Inoue
- ULVAC-PHI, Inc; 2500 Hagisono Chigasaki Kanagawa 253-8522 Japan
| | - J. Newman
- Physical Electronics; 18725 Lake Drive Chanhassen MN 55317 USA
| | - K. Watanabe
- ULVAC-PHI, Inc; 2500 Hagisono Chigasaki Kanagawa 253-8522 Japan
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Floege J, Covic AC, Ketteler M, Mann J, Rastogi A, Spinowitz B, Rakov V, Lisk LJ, Sprague SM. One-year efficacy and safety of the iron-based phosphate binder sucroferric oxyhydroxide in patients on peritoneal dialysis. Nephrol Dial Transplant 2018; 32:1918-1926. [PMID: 28339993 DOI: 10.1093/ndt/gfw460] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/09/2016] [Indexed: 01/24/2023] Open
Abstract
Background Sucroferric oxyhydroxide is a noncalcium, iron-based phosphate binder that demonstrated sustained serum phosphorus control, good tolerability and lower pill burden compared with sevelamer carbonate (sevelamer) in a Phase 3 study conducted in dialysis patients. This subanalysis examines the efficacy and tolerability of sucroferric oxyhydroxide and sevelamer in the peritoneal dialysis (PD) patient population. Methods The initial study (NCT01324128) and its extension (NCT01464190) were multicenter, Phase 3, open-label, randomized (2:1), active-controlled trials comparing sucroferric oxyhydroxide (1.0-3.0 g/day) with sevelamer (2.4-14.4 g/day) in dialysis patients over 52 weeks in total. Results In the overall study, 84/1055 (8.1%) patients received PD and were eligible for efficacy analysis (sucroferric oxyhydroxide, n = 56; sevelamer, n = 28). The two groups were broadly comparable to each other and to the overall study population. Serum phosphorus concentrations decreased comparably with both phosphate binders by week 12 (mean change from baseline - 0.6 mmol/L). Over 52 weeks, sucroferric oxyhydroxide effectively reduced serum phosphorus concentrations to a similar extent as sevelamer; 62.5% and 64.3% of patients, respectively, were below the Kidney Disease Outcomes Quality Initiative target range (≤1.78 mmol/L). This was achieved with a lower pill burden (3.4 ± 1.3 versus 8.1 ± 3.7 tablets/day) with sucroferric oxyhydroxide compared with sevelamer. Treatment adherence rates were 91.2% with sucroferric oxyhydroxide and 79.3% with sevelamer. The proportion of patients reporting at least one treatment-emergent adverse event was 86.0% with sucroferric oxyhydroxide and 93.1% with sevelamer. The most common adverse events with both treatments were gastrointestinal: diarrhea and discolored feces with sucroferric oxyhydroxide and nausea, vomiting and constipation with sevelamer. Conclusions Sucroferric oxyhydroxide is noninferior to sevelamer for controlling serum phosphorus in patients undergoing PD, while providing a relatively low pill burden and a high rate of adherence.
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Affiliation(s)
| | - Adrian C Covic
- Gr.T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | | | | | | | | | | | | | - Stuart M Sprague
- NorthShore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, IL, USA
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Mann J, Fonseca V, Mosenzon O, Raz I, Frimer-Larsen H, Scholten BJ, Idorn T, Poulter N, Lüdemann J. Sicherheit von Liraglutid vs. Placebo bei Patienten mit T2D und CKD in der LEADER Studie. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J Mann
- KfH Nierenzentrum, München, Germany
| | - V Fonseca
- Tulane University Health Sciences Center, New Orleans, United States
| | - O Mosenzon
- Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - I Raz
- Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | | | - T Idorn
- Novo Nordisk A/S, Søborg, Denmark
| | - N Poulter
- Imperial College London, London, United Kingdom
| | - J Lüdemann
- Schwerpunktpraxis für Diabetes, Gefäß- & Ernährungsmedizin, Falkensee, Germany
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Poulter N, Mann J, Fonseca V, Mosenzon O, Raz I, Frimer-Larsen H, Scholten BJ, Idorn T, Nauck M. Liraglutid reduzierte MACE (Major Cardiovascular Events, schwere unerwünschte kardiovaskuläre Ereignisse) bei Patienten mit chronischer Nierenerkrankung: Ergebnisse aus der LEADER Studie. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- N Poulter
- Imperial College London, London, United Kingdom
| | - J Mann
- KfH Nierenzentrum, München, Germany
| | - V Fonseca
- Tulane University Health Sciences Center, New Orleans, United States
| | - O Mosenzon
- Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - I Raz
- Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | | | - T Idorn
- Novo Nordisk A/S, Søborg, Denmark
| | - M Nauck
- Universitätsklinikum St. Josef-Hospital, Bochum, Germany
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Miketa M, Patterson E, Krzyszczyk E, Foroughirad V, Mann J. Calf age and sex affect maternal diving behaviour in Shark Bay bottlenose dolphins. Anim Behav 2018. [DOI: 10.1016/j.anbehav.2017.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abreu LN, Oquendo MA, Galfavy H, Burke A, Grunebaum MF, Sher L, Sullivan GM, Sublette ME, Mann J, Lafer B. Are comorbid anxiety disorders a risk factor for suicide attempts in patients with mood disorders? A two-year prospective study. Eur Psychiatry 2017; 47:19-24. [PMID: 29096128 DOI: 10.1016/j.eurpsy.2017.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/05/2017] [Accepted: 09/10/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Comorbid anxiety disorders have been considered a risk factor for suicidal behavior in patients with mood disorders, although results are controversial. The aim of this two-year prospective study was to determine if lifetime and current comorbid anxiety disorders at baseline were risk factors for suicide attempts during the two-year follow-up. METHODS We evaluated 667 patients with mood disorders (504 with major depression and 167 with bipolar disorder) divided in two groups: those with lifetime comorbid anxiety disorders (n=229) and those without (n=438). Assessments were performed at baseline and at 3, 12, and 24 months. Kaplan-Meier survival analysis and log-rank test were used to evaluate the relationship between anxiety disorders and suicide attempts. Cox proportional hazard regression was performed to investigate clinical and demographic variables that were associated with suicide attempts during follow-up. RESULTS Of the initial sample of 667 patients, 480 had all three follow-up interviews. During the follow-up, 63 patients (13.1%) attempted suicide at least once. There was no significant difference in survival curves for patients with and without comorbid anxiety disorders (log-rank test=0.269; P=0.604). Female gender (HR=3.66, P=0.001), previous suicide attempts (HR=3.27, P=0.001) and higher scores in the Buss-Durkee Hostility Inventory (HR=1.05, P≤0.001) were associated with future suicide attempts. CONCLUSIONS Our results suggest that comorbid anxiety disorders were not risk factors for suicide attempts. Further studies were needed to determine the role of anxiety disorders as risk factors for suicide attempts.
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Affiliation(s)
- L N Abreu
- Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - M A Oquendo
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - H Galfavy
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - A Burke
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - M F Grunebaum
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - L Sher
- James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, New York, USA
| | - G M Sullivan
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - M E Sublette
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - J Mann
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - B Lafer
- Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Bak N, Mann J, Fagerlund B, Glenthøj BY, Jepsen JRM, Oranje B. Testing a decades' old assumption: Are individuals with lower sensory gating indeed more easily distracted? Psychiatry Res 2017; 255:387-393. [PMID: 28666245 DOI: 10.1016/j.psychres.2017.05.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/05/2017] [Accepted: 05/30/2017] [Indexed: 12/16/2022]
Abstract
The sensory gating deficits in schizophrenia have been theorized to associate with increased distractibility. We explore the potential associations between sensory and sensorimotor gating and subjective and objective indices of distraction in healthy subjects. Forty healthy males were assessed with the P50 suppression and pre-pulse inhibition of the startle reflex (PPI) paradigms. Additionally, a neurocognitive test battery was administered in a cross-over design: with/without auditory distraction. Significant effects of distraction were found in response inhibition, and verbal working memory and attention. Parameters from the PPI and P50 suppression paradigms were significantly associated with the distractor effects on strategy formation, cognitive inhibition and flexibility, visual short-term memory, and the level of subjective distraction. Subjectively reported distraction was significantly associated with verbal working memory and attention as well as executive and supervisory processes. Sensory and sensorimotor gating efficiency do not reflect the effect of distraction across executive and attention functions i.e. we did not observe a generalized distractor effect. Gating only related to the effect of distraction on strategy formation, cognitive inhibition and flexibility, as well as visual short term memory. Future studies should investigate if gating deficits affect the distractibility of the same specific cognitive functions in patients with schizophrenia.
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Affiliation(s)
- N Bak
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, The Capital Region, Copenhagen, Denmark.
| | - J Mann
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark
| | - B Fagerlund
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, The Capital Region, Copenhagen, Denmark
| | - B Y Glenthøj
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, The Capital Region, Copenhagen, Denmark
| | - J R M Jepsen
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, The Capital Region, Copenhagen, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - B Oranje
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, The Capital Region, Copenhagen, Denmark; Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
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Abstract
Background The loss of dentures for inpatients can have a detrimental effect on their well-being. Self-respect and dignity become compromised along with their ability to eat meals and communicate clearly, and long-term recovery.Aim This investigation aimed to identify the reported number of dentures lost in hospitals and the financial reimbursements given by trusts to replace them.Method Information on reported denture loss and reimbursement was collected in 12 trusts throughout Kent, Surrey and Sussex.Results Eleven out of 12 trusts returned data about how many dentures were lost in their hospitals, between them 695 dentures were reported lost over five years (2011-16). Seven trusts reported financial reimbursements for dentures losses; results showed £357,672 was reimbursed over six years (2010-16), the highest amount reimbursed for a single denture was £2,200.Conclusion The results indicate that denture loss is a problem in hospitals that contributes to the financial burden for the NHS. Consideration needs to be given by hospitals to find ways to reduce the number of dentures lost every year.
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Affiliation(s)
- J Mann
- Special Care and Dental Public Health Trainee, East Surrey Hospital Canada Avenue, Redhill, RH1 5RH
| | - M Doshi
- Consultant in Special Care Dentistry, East Surrey Hospital Canada Avenue, Redhill, RH1 5RH
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Mann J, Doshi M. 19MOUTH CARE MATTERS (MCM) IS A HEALTH EDUCATION ENGLAND TRAINING INITIATIVE FOCUSSED ON IMPROVING THE ORAL HEALTH OF OLDER PEOPLE. THE HOSPITAL ARM OF THE PROGRAMME WAS DEVELOPED AND PILOTED AT EAST SURREY HOSPITAL AND IS CURRENTLY BEING ROLLED OUT ACROSS ALL ACUTE TRUSTS IN KENT, SURREY AND SUSSEX. Age Ageing 2017. [DOI: 10.1093/ageing/afx115.19] [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: 11/13/2022] Open
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Mann J, Angelou N, Arnqvist J, Callies D, Cantero E, Arroyo RC, Courtney M, Cuxart J, Dellwik E, Gottschall J, Ivanell S, Kühn P, Lea G, Matos JC, Palma JMLM, Pauscher L, Peña A, Rodrigo JS, Söderberg S, Vasiljevic N, Rodrigues CV. Complex terrain experiments in the New European Wind Atlas. Philos Trans A Math Phys Eng Sci 2017; 375:rsta.2016.0101. [PMID: 28265025 PMCID: PMC5346220 DOI: 10.1098/rsta.2016.0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 05/31/2023]
Abstract
The New European Wind Atlas project will create a freely accessible wind atlas covering Europe and Turkey, develop the model chain to create the atlas and perform a series of experiments on flow in many different kinds of complex terrain to validate the models. This paper describes the experiments of which some are nearly completed while others are in the planning stage. All experiments focus on the flow properties that are relevant for wind turbines, so the main focus is the mean flow and the turbulence at heights between 40 and 300 m. Also extreme winds, wind shear and veer, and diurnal and seasonal variations of the wind are of interest. Common to all the experiments is the use of Doppler lidar systems to supplement and in some cases replace completely meteorological towers. Many of the lidars will be equipped with scan heads that will allow for arbitrary scan patterns by several synchronized systems. Two pilot experiments, one in Portugal and one in Germany, show the value of using multiple synchronized, scanning lidar, both in terms of the accuracy of the measurements and the atmospheric physical processes that can be studied. The experimental data will be used for validation of atmospheric flow models and will by the end of the project be freely available.This article is part of the themed issue 'Wind energy in complex terrains'.
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Affiliation(s)
- J Mann
- Technical University of Denmark, Roskilde, Denmark
| | - N Angelou
- Technical University of Denmark, Roskilde, Denmark
| | | | - D Callies
- Fraunhofer Institute for Wind Energy and Energy System Technology IWES, Germany
| | - E Cantero
- National Renewable Energy Centre (CENER), Sarriguren, Spain
| | | | - M Courtney
- Technical University of Denmark, Roskilde, Denmark
| | - J Cuxart
- Universitat de les Illes Balears, Mallorca, Spain
| | - E Dellwik
- Technical University of Denmark, Roskilde, Denmark
| | - J Gottschall
- Fraunhofer Institute for Wind Energy and Energy System Technology IWES, Germany
| | | | - P Kühn
- Fraunhofer Institute for Wind Energy and Energy System Technology IWES, Germany
| | - G Lea
- Technical University of Denmark, Roskilde, Denmark
| | - J C Matos
- Instituto de Ciência e Inovação em Engenharia Mecânica e Gestão Industrial (INEGI), Porto, Portugal
| | - J M L M Palma
- Faculdade de Engenharia da Universidade do Porto (FEUP), Porto, Portugal
| | - L Pauscher
- Fraunhofer Institute for Wind Energy and Energy System Technology IWES, Germany
| | - A Peña
- Technical University of Denmark, Roskilde, Denmark
| | - J Sanz Rodrigo
- National Renewable Energy Centre (CENER), Sarriguren, Spain
| | | | - N Vasiljevic
- Technical University of Denmark, Roskilde, Denmark
| | - C Veiga Rodrigues
- Faculdade de Engenharia da Universidade do Porto (FEUP), Porto, Portugal
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Biopharmaceutical aspects and implications of excipient variability in drug product performance. Eur J Pharm Biopharm 2017; 111:1-15. [DOI: 10.1016/j.ejpb.2016.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 12/29/2022]
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Mersel A, Baruch N, Tayeb I, Mann J, Zini A. [Dentist's satisfaction of continuing education: survey among dentists in Jerusalem]. Refuat Hapeh Vehashinayim (1993) 2017; 34:53-75. [PMID: 30699496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Continuing professional development (CpD or Continuing education is defined as a career-long process required by dentist to maintain, update and broaden their attitudes, knowledge and skills in a way that will bring the greatest benefit to their patients and improve patient care. This research is a survey among 295 dentists, members of the IDA in Jerusalem. The study was conducted, in order to examine their satisfaction of CPD programs offered by IDA Jerusalem. Results indicate that in most variables )lecturer, knowledge and comfort)the satisfaction degree was at a high level. Differences in the level of satisfaction were found between general dental practitioners and dental specialists, and between dentist who graduated in Israel as compared to dentists who graduated abroad. There is a great need to further investigate this issue, in order to develop, promote and improve CE studies and arrive at practical conclusions to support the development of high-quality continuing dental education programs designed to upgrade high-quality dental care, similar to other countries that have CE programs.
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Schmaderer C, Tholen S, Hasenau AL, Hauser C, Suttmann Y, Wassertheurer S, Mayer CC, Bauer A, Rizas KD, Kemmner S, Kotliar K, Haller B, Mann J, Renders L, Heemann U, Baumann M. Rationale and study design of the prospective, longitudinal, observational cohort study "rISk strAtification in end-stage renal disease" (ISAR) study. BMC Nephrol 2016; 17:161. [PMID: 27784272 PMCID: PMC5080708 DOI: 10.1186/s12882-016-0374-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/15/2016] [Indexed: 01/14/2023] Open
Abstract
Background The ISAR study is a prospective, longitudinal, observational cohort study to improve the cardiovascular risk stratification in endstage renal disease (ESRD). The major goal is to characterize the cardiovascular phenotype of the study subjects, namely alterations in micro- and macrocirculation and to determine autonomic function. Methods/design We intend to recruit 500 prevalent dialysis patients in 17 centers in Munich and the surrounding area. Baseline examinations include: (1) biochemistry, (2) 24-h Holter Electrocardiography (ECG) recordings, (3) 24-h ambulatory blood pressure measurement (ABPM), (4) 24 h pulse wave analysis (PWA) and pulse wave velocity (PWV), (5) retinal vessel analysis (RVA) and (6) neurocognitive testing. After 24 months biochemistry and determination of single PWA, single PWV and neurocognitive testing are repeated. Patients will be followed up to 6 years for (1) hospitalizations, (2) cardiovascular and (3) non-cardiovascular events and (4) cardiovascular and (5) all-cause mortality. Discussion/conclusion We aim to create a complex dataset to answer questions about the insufficiently understood pathophysiology leading to excessively high cardiovascular and non-cardiovascular mortality in dialysis patients. Finally we hope to improve cardiovascular risk stratification in comparison to the use of classical and non-classical (dialysis-associated) risk factors and other models of risk stratification in ESRD patients by building a multivariable Cox-Regression model using a combination of the parameters measured in the study. Clinical trials identifier ClinicalTrials.gov NCT01152892 (June 28, 2010)
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Affiliation(s)
- Christoph Schmaderer
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Susanne Tholen
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Anna-Lena Hasenau
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Christine Hauser
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Yana Suttmann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Siegfried Wassertheurer
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Biomedical Systems, Donau-City-Str. 1, 1220, Vienna, Austria
| | - Christopher C Mayer
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Biomedical Systems, Donau-City-Str. 1, 1220, Vienna, Austria
| | - Axel Bauer
- Medizinische Klinik und Poliklinik I, Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Kostantinos D Rizas
- Medizinische Klinik und Poliklinik I, Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Konstantin Kotliar
- FH Aachen, University of applied sciences, Heinrich-Mussmann-Str. 1, 52428, Jülich, Germany
| | - Bernhard Haller
- Institute of medical statistics and epidemiology (IMSE), Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Johannes Mann
- Städtisches Klinikum Schwabing, KFH Dialysezentrum Schwabing, Kölner Platz 1, 80804, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Marcus Baumann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
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Rodrigues CV, Palma JMLM, Vasiljević N, Courtney M, Mann J. Coupled simulations and comparison with multi-lidar measurements of the wind flow over a double-ridge. ACTA ACUST UNITED AC 2016. [DOI: 10.1088/1742-6596/753/3/032025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Robinson SM, Mann DA, Manas DM, Oakley F, Mann J, White SA. Response to 'Comment on 'The potential contribution of tumour-related factors to the development of FOLFOX-induced sinusoidal obstruction syndrome'’. Br J Cancer 2016; 115:e8. [PMID: 27632370 PMCID: PMC5061903 DOI: 10.1038/bjc.2016.268] [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: 11/09/2022] Open
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Borthwick LA, Suwara MI, Carnell SC, Green NJ, Mahida R, Dixon D, Gillespie CS, Cartwright TN, Horabin J, Walker A, Olin E, Rangar M, Gardner A, Mann J, Corris PA, Mann DA, Fisher AJ. Pseudomonas aeruginosa Induced Airway Epithelial Injury Drives Fibroblast Activation: A Mechanism in Chronic Lung Allograft Dysfunction. Am J Transplant 2016; 16:1751-65. [PMID: 26714197 PMCID: PMC4879508 DOI: 10.1111/ajt.13690] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 12/03/2015] [Accepted: 12/06/2015] [Indexed: 01/25/2023]
Abstract
Bacterial infections after lung transplantation cause airway epithelial injury and are associated with an increased risk of developing bronchiolitis obliterans syndrome. The damaged epithelium is a source of alarmins that activate the innate immune system, yet their ability to activate fibroblasts in the development of bronchiolitis obliterans syndrome has not been evaluated. Two epithelial alarmins were measured longitudinally in bronchoalveolar lavages from lung transplant recipients who developed bronchiolitis obliterans syndrome and were compared to stable controls. In addition, conditioned media from human airway epithelial cells infected with Pseudomonas aeruginosa was applied to lung fibroblasts and inflammatory responses were determined. Interleukin-1 alpha (IL-1α) was increased in bronchoalveolar lavage of lung transplant recipients growing P. aeruginosa (11.5 [5.4-21.8] vs. 2.8 [0.9-9.4] pg/mL, p < 0.01) and was significantly elevated within 3 months of developing bronchiolitis obliterans syndrome (8.3 [1.4-25.1] vs. 3.6 [0.6-17.1] pg/mL, p < 0.01), whereas high mobility group protein B1 remained unchanged. IL-1α positively correlated with elevated bronchoalveolar lavage IL-8 levels (r(2) = 0.6095, p < 0.0001) and neutrophil percentage (r(2) = 0.25, p = 0.01). Conditioned media from P. aeruginosa infected epithelial cells induced a potent pro-inflammatory phenotype in fibroblasts via an IL-1α/IL-1R-dependent signaling pathway. In conclusion, we propose that IL-1α may be a novel therapeutic target to limit Pseudomonas associated allograft injury after lung transplantation.
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Affiliation(s)
- L. A. Borthwick
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - M. I. Suwara
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - S. C. Carnell
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - N. J. Green
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - R. Mahida
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - D. Dixon
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - C. S. Gillespie
- School of Mathematics and StatisticsNewcastle UniversityNewcastle upon TyneUK
| | - T. N. Cartwright
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - J. Horabin
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - A. Walker
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - E. Olin
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - M. Rangar
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK,Institute of TransplantationNewcastle Upon Tyne Hospitals NHS Foundation TrustFreeman HospitalNewcastle upon TyneUK
| | - A. Gardner
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - J. Mann
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - P. A. Corris
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK,Institute of TransplantationNewcastle Upon Tyne Hospitals NHS Foundation TrustFreeman HospitalNewcastle upon TyneUK
| | - D. A. Mann
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - A. J. Fisher
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK,Institute of TransplantationNewcastle Upon Tyne Hospitals NHS Foundation TrustFreeman HospitalNewcastle upon TyneUK
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