1
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Singanayagam A, Moore C, Froude S, Celma C, Stowe J, Hani E, Ng KF, Muir P, Roderick M, Cottrell S, Bibby DF, Vipond B, Gillett S, Davis PJ, Gibb J, Barry M, Harris P, Rowley F, Song J, Shankar AG, McMichael D, Cohen JM, Manian A, Harvey C, Primrose LS, Wilson S, Bradley DT, Paranthaman K, Beard S, Zambon M, Ramsay M, Saliba V, Ladhani S, Williams C. Increased reports of severe myocarditis associated with enterovirus infection in neonates, United Kingdom, 27 June 2022 to 26 April 2023. Euro Surveill 2023; 28:2300313. [PMID: 37768558 PMCID: PMC10540513 DOI: 10.2807/1560-7917.es.2023.28.39.2300313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Enteroviruses are a common cause of seasonal childhood infections. The vast majority of enterovirus infections are mild and self-limiting, although neonates can sometimes develop severe disease. Myocarditis is a rare complication of enterovirus infection. Between June 2022 and April 2023, twenty cases of severe neonatal enteroviral myocarditis caused by coxsackie B viruses were reported in the United Kingdom. Sixteen required critical care support and two died. Enterovirus PCR on whole blood was the most sensitive diagnostic test. We describe the initial public health investigation into this cluster and aim to raise awareness among paediatricians, laboratories and public health specialists.
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Affiliation(s)
| | | | | | - Cristina Celma
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Julia Stowe
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Erjola Hani
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Khuen Foong Ng
- Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Peter Muir
- UK Health Security Agency South West Regional Laboratory, Bristol, United Kingdom
| | - Marion Roderick
- Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | | | - David F Bibby
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Barry Vipond
- UK Health Security Agency South West Regional Laboratory, Bristol, United Kingdom
| | - Sophie Gillett
- UK Health Security Agency South West Regional Laboratory, Bristol, United Kingdom
| | - Peter J Davis
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, University Hospitals Bristol & Weston Foundation Trust, Bristol, United Kingdom
| | - Jack Gibb
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol & Weston Foundation Trust, Bristol, United Kingdom
| | - Mai Barry
- Public Health Wales, Wales, Cardiff, United Kingdom
| | | | | | - Jiao Song
- Public Health Wales, Wales, Cardiff, United Kingdom
| | | | | | - Jonathan M Cohen
- Evelina London Children's Hospital, Guys & St Thomas National Health Service Foundation Trust, London, United Kingdom
| | - Abirami Manian
- Evelina London Children's Hospital, Guys & St Thomas National Health Service Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Stuart Beard
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Maria Zambon
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Mary Ramsay
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Vanessa Saliba
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Shamez Ladhani
- UK Health Security Agency, Colindale, London, United Kingdom
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2
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Ladhani SN, Aiano F, Edwards DS, Perkins S, Khan WM, Iyanger N, Whittaker E, Cohen JM, Ho D, Hopkins S, Ramsay ME, Chow JY. Very low risk of monkeypox among staff and students after exposure to a confirmed case in educational settings, England, May to July 2022. Euro Surveill 2022; 27:2200734. [PMID: 36205169 PMCID: PMC9540521 DOI: 10.2807/1560-7917.es.2022.27.40.2200734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 11/20/2022] Open
Abstract
We investigated a secondary school (11-16 year-olds), a primary school (5-11 year-olds), reception year (4-5 year-olds) and a nursery (2-5 year-olds) following confirmed monkeypox in an adult in each educational setting during June and July 2022. MVA-BN vaccine was offered up to 14 days post exposure to 186 children < 12 years and 21 were vaccinated. No secondary cases occurred among at least 340 exposed students and more than 100 exposed staff during the 28-day follow-up period.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation Division, UK Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | - Felicity Aiano
- Immunisation Division, UK Health Security Agency, London, United Kingdom
| | - David S Edwards
- UK Health Security Agency East of England Health Protection Team, Mildenhall, United Kingdom
| | - Samantha Perkins
- UK Health Security Agency, South London Health Protection Team and the London Coordination and Response Cell, London, United Kingdom
| | - Wazirzada M Khan
- UK Health Security Agency, South London Health Protection Team and the London Coordination and Response Cell, London, United Kingdom
| | - Nalini Iyanger
- UK Health Security Agency Northwest London Health Protection Team and the London Coordination and Response Cell, London, United Kingdom
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases Department, Imperial College London, London, United Kingdom
| | - Jonathan M Cohen
- Paediatric Immunology and Infectious Diseases, Evelina London Children's Hospital, London, United Kingdom
| | - David Ho
- Paediatric Immunology and Infectious Diseases, Evelina London Children's Hospital, London, United Kingdom
| | - Susan Hopkins
- Clinical and Public Health Group, UK Health Security Agency, London, United Kingdom
| | - Mary E Ramsay
- Immunisation Division, UK Health Security Agency, London, United Kingdom
| | - J Yimmy Chow
- UK Health Security Agency Northwest London Health Protection Team and the London Coordination and Response Cell, London, United Kingdom
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3
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Cohen JM, Bamford A, Eisen S, Emonts M, Ho D, Kadambari S, Kenny J, Lyall H, Owens S, Porter D, Riordan A, Whittaker E, Williams B, Ladhani S. Care of children exposed to monkeypox. Lancet Reg Health Eur 2022; 21:100514. [PMID: 36105884 PMCID: PMC9464873 DOI: 10.1016/j.lanepe.2022.100514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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4
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Duret A, Olgemoeller F, Ferreras-Antolin L, Whittaker E, Cohen JM. Paediatric TB care in the United Kingdom. Int J Tuberc Lung Dis 2022; 26:814-819. [PMID: 35996289 DOI: 10.5588/ijtld.21.0581] [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: 11/10/2022] Open
Abstract
BACKGROUND: Care of patients with paediatric TB is delivered in a variety of settings by different clinicians in the United Kingdom. Paediatric practices vary in size. Guidelines on managing children with TB differ in recommendations. These factors contribute to variations in practice.OBJECTIVE: To describe practice among UK professionals caring for children exposed to or infected with TB, and their investigation and treatment.METHODS: From 81 NHS (National Health Service) clinical services, 114 individuals responded to a web-based questionnaire.RESULTS: We describe variation in several areas of practice, with important differences between smaller and larger centres. Most respondents go beyond National Institute for Health & Care Excellence guidance and screen child contacts of extrapulmonary TB. Most respondents would presume pulmonary TB exposed children aged under 2 years to be infected. They would not rely on immunological investigations to rule out infection. There was wide variety in approaches to microbiological diagnosis, and in the use of laboratory investigations to monitor treatment. Many respondents felt unclear on how to manage newborns exposed to TB, or children exposed to multidrug-resistant TB.CONCLUSION: These findings support the case for further developing regional networks providing evidence and consensus-based care for children with TB.
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Affiliation(s)
- A Duret
- Paediatric Infectious Diseases Department, Imperial Healthcare NHS Trust, London, UK
| | - F Olgemoeller
- Department of Paediatric Immunology & Infectious Diseases, Evelina London Children´s Hospital, London, UK
| | - L Ferreras-Antolin
- Paediatric Infectious Diseases Department, St Georges University Hospitals NHS Foundation Trust, London, UK
| | - E Whittaker
- Paediatric Infectious Diseases Department, Imperial Healthcare NHS Trust, London, UK, Paediatric Infectious Diseases Department, Imperial College London, London, UK
| | - J M Cohen
- Department of Paediatric Immunology & Infectious Diseases, Evelina London Children´s Hospital, London, UK, University College London Great Ormond Street Institute of Child Health, London, UK
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5
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Cohen JM, Carter MJ, Ronny Cheung C, Ladhani S. Lower Risk of Multisystem Inflammatory Syndrome in Children With the Delta and Omicron Variants of Severe Acute Respiratory Syndrome Coronavirus 2. Clin Infect Dis 2022; 76:e518-e521. [PMID: 35788276 PMCID: PMC9278259 DOI: 10.1093/cid/ciac553] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [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: 03/30/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022] Open
Abstract
Little is known about the risk of multisystem inflammatory syndrome in children (MIS-C) with different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. In southeast England, MIS-C rates per confirmed SARS-CoV-2 infections in children aged 0-16 years were 56% lower (rate ratio [RR], 0.34 [95% confidence interval {CI}, .23-.50]) during prevaccine Delta, 66% lower (RR, 0.44 [95% CI, .28-.69]) during postvaccine Delta, and 95% lower (RR, 0.05 [95% CI, .02-.10]) during the Omicron period.
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Affiliation(s)
- Jonathan M Cohen
- Corresponding Author: Paediatric Immunology & Infectious Diseases, Evelina London Children’s Hospital 3rd Floor Becket House, Westminster Bridge Road, London, SE1 7EH, United Kingdom.
| | - Michael J Carter
- School of Life Course and Population Sciences, King’s College London, London, UK,Paediatric Intensive Care Unit, Evelina London Children’s Hospital, London, UK
| | - C Ronny Cheung
- General Paediatrics Department, Evelina London Children’s Hospital, London, UK,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Shamez Ladhani
- Immunisation Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK,Paediatric Infectious Diseases Research Group (PIDRG), St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK
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6
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Wilson BS, Tucci DL, Moses DA, Chang EF, Young NM, Zeng FG, Lesica NA, Bur AM, Kavookjian H, Mussatto C, Penn J, Goodwin S, Kraft S, Wang G, Cohen JM, Ginsburg GS, Dawson G, Francis HW. Harnessing the Power of Artificial Intelligence in Otolaryngology and the Communication Sciences. J Assoc Res Otolaryngol 2022; 23:319-349. [PMID: 35441936 PMCID: PMC9086071 DOI: 10.1007/s10162-022-00846-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/02/2022] [Indexed: 02/01/2023] Open
Abstract
Use of artificial intelligence (AI) is a burgeoning field in otolaryngology and the communication sciences. A virtual symposium on the topic was convened from Duke University on October 26, 2020, and was attended by more than 170 participants worldwide. This review presents summaries of all but one of the talks presented during the symposium; recordings of all the talks, along with the discussions for the talks, are available at https://www.youtube.com/watch?v=ktfewrXvEFg and https://www.youtube.com/watch?v=-gQ5qX2v3rg . Each of the summaries is about 2500 words in length and each summary includes two figures. This level of detail far exceeds the brief summaries presented in traditional reviews and thus provides a more-informed glimpse into the power and diversity of current AI applications in otolaryngology and the communication sciences and how to harness that power for future applications.
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Affiliation(s)
- Blake S. Wilson
- grid.26009.3d0000 0004 1936 7961Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710 USA ,grid.26009.3d0000 0004 1936 7961Duke Hearing Center, Duke University School of Medicine, Durham, NC 27710 USA ,grid.26009.3d0000 0004 1936 7961Department of Electrical & Computer Engineering, Duke University, Durham, NC 27708 USA ,grid.26009.3d0000 0004 1936 7961Department of Biomedical Engineering, Duke University, Durham, NC 27708 USA ,grid.410711.20000 0001 1034 1720Department of Otolaryngology – Head & Neck Surgery, University of North Carolina, Chapel Hill, Chapel Hill, NC 27599 USA
| | - Debara L. Tucci
- grid.26009.3d0000 0004 1936 7961Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710 USA ,grid.214431.10000 0001 2226 8444National Institute On Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892 USA
| | - David A. Moses
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143 USA ,grid.266102.10000 0001 2297 6811UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94117 USA
| | - Edward F. Chang
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143 USA ,grid.266102.10000 0001 2297 6811UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94117 USA
| | - Nancy M. Young
- grid.413808.60000 0004 0388 2248Division of Otolaryngology, Ann and Robert H. Lurie Childrens Hospital of Chicago, Chicago, IL 60611 USA ,grid.16753.360000 0001 2299 3507Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA ,grid.16753.360000 0001 2299 3507Department of Communication, Knowles Hearing Center, Northwestern University, Evanston, IL 60208 USA
| | - Fan-Gang Zeng
- grid.266093.80000 0001 0668 7243Center for Hearing Research, University of California, Irvine, Irvine, CA 92697 USA ,grid.266093.80000 0001 0668 7243Department of Anatomy and Neurobiology, University of California, Irvine, Irvine, CA 92697 USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92697 USA ,grid.266093.80000 0001 0668 7243Department of Cognitive Sciences, University of California, Irvine, Irvine, CA 92697 USA ,grid.266093.80000 0001 0668 7243Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, CA 92697 USA
| | - Nicholas A. Lesica
- grid.83440.3b0000000121901201UCL Ear Institute, University College London, London, WC1X 8EE UK
| | - Andrés M. Bur
- grid.266515.30000 0001 2106 0692Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Hannah Kavookjian
- grid.266515.30000 0001 2106 0692Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Caroline Mussatto
- grid.266515.30000 0001 2106 0692Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Joseph Penn
- grid.266515.30000 0001 2106 0692Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Sara Goodwin
- grid.266515.30000 0001 2106 0692Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Shannon Kraft
- grid.266515.30000 0001 2106 0692Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Guanghui Wang
- grid.68312.3e0000 0004 1936 9422Department of Computer Science, Ryerson University, Toronto, ON M5B 2K3 Canada
| | - Jonathan M. Cohen
- grid.26009.3d0000 0004 1936 7961Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710 USA ,grid.415014.50000 0004 0575 3669ENT Department, Kaplan Medical Center, 7661041 Rehovot, Israel
| | - Geoffrey S. Ginsburg
- grid.26009.3d0000 0004 1936 7961Department of Biomedical Engineering, Duke University, Durham, NC 27708 USA ,grid.26009.3d0000 0004 1936 7961MEDx (Medicine & Engineering at Duke), Duke University, Durham, NC 27708 USA ,grid.26009.3d0000 0004 1936 7961Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27710 USA ,grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University School of Medicine, Durham, NC 27710 USA ,grid.26009.3d0000 0004 1936 7961Department of Pathology, Duke University School of Medicine, Durham, NC 27710 USA ,grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710 USA
| | - Geraldine Dawson
- grid.26009.3d0000 0004 1936 7961Duke Institute for Brain Sciences, Duke University, Durham, NC 27710 USA ,grid.26009.3d0000 0004 1936 7961Duke Center for Autism and Brain Development, Duke University School of Medicine and the Duke Institute for Brain Sciences, NIH Autism Center of Excellence, Durham, NC 27705 USA ,grid.26009.3d0000 0004 1936 7961Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27701 USA
| | - Howard W. Francis
- grid.26009.3d0000 0004 1936 7961Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710 USA
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7
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Yoshida M, Worlock KB, Huang N, Lindeboom RGH, Butler CR, Kumasaka N, Dominguez Conde C, Mamanova L, Bolt L, Richardson L, Polanski K, Madissoon E, Barnes JL, Allen-Hyttinen J, Kilich E, Jones BC, de Wilton A, Wilbrey-Clark A, Sungnak W, Pett JP, Weller J, Prigmore E, Yung H, Mehta P, Saleh A, Saigal A, Chu V, Cohen JM, Cane C, Iordanidou A, Shibuya S, Reuschl AK, Herczeg IT, Argento AC, Wunderink RG, Smith SB, Poor TA, Gao CA, Dematte JE, Reynolds G, Haniffa M, Bowyer GS, Coates M, Clatworthy MR, Calero-Nieto FJ, Göttgens B, O'Callaghan C, Sebire NJ, Jolly C, De Coppi P, Smith CM, Misharin AV, Janes SM, Teichmann SA, Nikolić MZ, Meyer KB. Local and systemic responses to SARS-CoV-2 infection in children and adults. Nature 2022; 602:321-327. [PMID: 34937051 PMCID: PMC8828466 DOI: 10.1038/s41586-021-04345-x] [Citation(s) in RCA: 147] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 12/14/2021] [Indexed: 02/03/2023]
Abstract
It is not fully understood why COVID-19 is typically milder in children1-3. Here, to examine the differences between children and adults in their response to SARS-CoV-2 infection, we analysed paediatric and adult patients with COVID-19 as well as healthy control individuals (total n = 93) using single-cell multi-omic profiling of matched nasal, tracheal, bronchial and blood samples. In the airways of healthy paediatric individuals, we observed cells that were already in an interferon-activated state, which after SARS-CoV-2 infection was further induced especially in airway immune cells. We postulate that higher paediatric innate interferon responses restrict viral replication and disease progression. The systemic response in children was characterized by increases in naive lymphocytes and a depletion of natural killer cells, whereas, in adults, cytotoxic T cells and interferon-stimulated subpopulations were significantly increased. We provide evidence that dendritic cells initiate interferon signalling in early infection, and identify epithelial cell states associated with COVID-19 and age. Our matching nasal and blood data show a strong interferon response in the airways with the induction of systemic interferon-stimulated populations, which were substantially reduced in paediatric patients. Together, we provide several mechanisms that explain the milder clinical syndrome observed in children.
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Affiliation(s)
- Masahiro Yoshida
- UCL Respiratory, Division of Medicine, University College London, London, UK
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kaylee B Worlock
- UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Ni Huang
- Wellcome Sanger Institute, Cambridge, UK
| | | | - Colin R Butler
- NIHR Great Ormond Street BRC and UCL Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | | | - Liam Bolt
- Wellcome Sanger Institute, Cambridge, UK
| | | | | | - Elo Madissoon
- Wellcome Sanger Institute, Cambridge, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute, Cambridge, UK
| | - Josephine L Barnes
- UCL Respiratory, Division of Medicine, University College London, London, UK
| | | | - Eliz Kilich
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Brendan C Jones
- NIHR Great Ormond Street BRC and UCL Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Angus de Wilton
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Henry Yung
- UCL Respiratory, Division of Medicine, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Puja Mehta
- UCL Respiratory, Division of Medicine, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Aarash Saleh
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - Anita Saigal
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - Vivian Chu
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - Jonathan M Cohen
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Cane
- Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Soichi Shibuya
- NIHR Great Ormond Street BRC and UCL Institute of Child Health, London, UK
| | - Ann-Kathrin Reuschl
- UCL Division of Infection and Immunity, University College London, London, UK
| | - Iván T Herczeg
- UCL Respiratory, Division of Medicine, University College London, London, UK
| | - A Christine Argento
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sean B Smith
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Taylor A Poor
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine A Gao
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane E Dematte
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gary Reynolds
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Muzlifah Haniffa
- Wellcome Sanger Institute, Cambridge, UK
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Matthew Coates
- Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Menna R Clatworthy
- Wellcome Sanger Institute, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Berthold Göttgens
- Wellcome, MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Christopher O'Callaghan
- NIHR Great Ormond Street BRC and UCL Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Neil J Sebire
- NIHR Great Ormond Street BRC and UCL Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Clare Jolly
- UCL Division of Infection and Immunity, University College London, London, UK
| | - Paolo De Coppi
- NIHR Great Ormond Street BRC and UCL Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Claire M Smith
- NIHR Great Ormond Street BRC and UCL Institute of Child Health, London, UK
| | - Alexander V Misharin
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sam M Janes
- UCL Respiratory, Division of Medicine, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Sarah A Teichmann
- Wellcome Sanger Institute, Cambridge, UK
- Department of Physics, Cavendish Laboratory, University of Cambridge, Cambridge, UK
| | - Marko Z Nikolić
- UCL Respiratory, Division of Medicine, University College London, London, UK.
- University College London Hospitals NHS Foundation Trust, London, UK.
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8
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Affiliation(s)
- A C Leasure
- Yale University School of Medicine, New Haven, CT, USA
| | - S E Cowper
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - J McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - J M Cohen
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
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9
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Cohen JM, Kridin K, Perez-Chada LM, Merola JF, Cohen AD. Hidradenitis suppurativa and sleep disorders: a population-based study. J Eur Acad Dermatol Venereol 2021; 35:e520-e522. [PMID: 33893667 DOI: 10.1111/jdv.17293] [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] [Accepted: 04/13/2021] [Indexed: 11/27/2022]
Affiliation(s)
- J M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - K Kridin
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - L M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A D Cohen
- Department of Quality Measures and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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10
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Neale FK, Armstrong EJ, Cohen JM, Segal TY, Hargreaves DS. How fair is our service? Evaluating access to specialist paediatric care. Arch Dis Child 2019; 104:1105-1107. [PMID: 31300409 DOI: 10.1136/archdischild-2019-317254] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess equity of access to paediatric outpatient clinics in our hospital. DESIGN/SETTING Retrospective analysis of consecutive accepted referrals to allergy, asthma, epilepsy, general paediatrics, rapid access, chronic fatigue syndrome, diabetes and endocrine outpatient clinics. PATIENTS 32 369 new patients, April 2007 to June 2018. RESULTS Among local patients (58.1%) 0.2%-2.5% of patients referred to each clinic lived in the least deprived quintile, and 43.5%-48.4% in the most deprived quintile-similar to inpatient admissions and the local population. Tertiary clinics showed a much higher proportion of patients from the least deprived quintiles (15.9%-26.2%). CONCLUSIONS Local outpatient referrals broadly reflected the socioeconomic distribution, although not necessarily the distribution of need, of our local population. A relatively high proportion of patients in tertiary clinics were from more affluent postcodes, highlighting the need for referral inequalities to be evaluated across networks or regions.
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Affiliation(s)
| | | | - Jonathan M Cohen
- Paediatric Department, University College London Hospitals NHS Foundation Trust, London, UK.,Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Terry Y Segal
- Paediatric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
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11
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Laiacona D, Cohen JM, Coulon K, Lipsky ZW, Maiorana C, Boltyanskiy R, Dufresne ER, German GK. Non-invasive in vivo quantification of human skin tension lines. Acta Biomater 2019; 88:141-148. [PMID: 30735808 DOI: 10.1016/j.actbio.2019.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/23/2019] [Accepted: 02/04/2019] [Indexed: 01/26/2023]
Abstract
Human skin is a composite tissue that exhibits anisotropic mechanical properties. This anisotropy arises primarily from the alignment of collagen and elastin fibers in the dermis, which causes the skin to exhibit greater tension in one direction, making it appear stiffer. A diverse number of skin tension guidelines have been developed to assist surgeons in making incisions that produce the least conspicuous scars. However, skin anisotropy is believed to vary from subject to subject, and no single guideline is universally recognized as the best to implement for surgical applications. To date, no system exists that can rapidly and non-invasively measure lines of skin tension in vivo. In this article, we evaluate the ability of a new aspiration system to measure the anisotropy of human skin. The device painlessly applies a radial stress of 17 kPa to a region of skin, and captures radially asymmetric skin deformations via a dermal camera. These deformations are used to quantify orientations of strain extrema and the direction of greatest skin stiffness. The ratio of these asymmetric strains varies between 1 and -0.75. A simple 2D transverse isotropic model captures this behavior for multiple anatomical sites. Clinical trials reveal that skin tension line orientations are comparable with existing skin tension maps and generally agree across subjects, however orientations statistically differ between individuals. As such, existing guidelines appear to provide only approximate estimates of skin tension orientation. STATEMENT OF SIGNIFICANCE: Skin tension lines (STL) in human skin arise primarily from collagen fiber alignment in the dermis. These lines are used by surgeons to guide incisions that produce the least conspicuous scars. While numerous anatomical STL maps exist, no single guideline is universally recognized as the most reliable. Moreover, manual methods of quantifying STL are imprecise. For the first time, we have developed a device capable of rapidly and non-invasively measuring STL orientations in vivo, using a single test. Our results are used to establish a simple constitutive model of mechanical skin anisotropy. Clinical trials further reveal STL orientations are comparable with existing maps, but statistically differ between individuals. Existing guidelines therefore appear to provide only approximate estimates of STL orientation.
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Affiliation(s)
- D Laiacona
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA
| | - J M Cohen
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA
| | - K Coulon
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA
| | - Z W Lipsky
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA
| | - C Maiorana
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA
| | - R Boltyanskiy
- Department of Physics, Yale University, CT 06520, USA; Department of Radiology & Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, NY 10065, USA
| | - E R Dufresne
- Department of Materials, Swiss Federal Institute of Technology Zürich, 8093 Zürich, Switzerland
| | - G K German
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA.
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12
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Cohen JM, Ziccardi VB. Use of Virtual Surgical Planning as an Adjunct for Enucleation of Multiple Recurrent Odontogenic Keratocysts: Case Report. J Oral Maxillofac Surg 2018; 76:2137.e1-2137.e6. [PMID: 30017842 DOI: 10.1016/j.joms.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
This case report describes an interesting use of virtual surgical planning to fabricate tooth-borne cutting guides to assist in localization and enucleation of multiple recurrent odontogenic keratocysts close to the inferior alveolar nerve. The 3-dimensional models generated and cutting guides increased the accuracy and precision of the procedure and decreased surgical time and potential patient morbidity.
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Affiliation(s)
- Jonathan M Cohen
- Resident, Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, NJ
| | - Vincent B Ziccardi
- Professor, Chair, and Residency Program Director, Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, NJ.
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13
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Mosnier A, Daviaud I, Casalegno JS, Ruetsch M, Burugorri C, Nauleau E, Bui TT, Fleury H, Lina B, van der Werf S, Cohen JM. Influenza B burden during seasonal influenza epidemics in France. Med Mal Infect 2017; 47:11-17. [PMID: 28062245 DOI: 10.1016/j.medmal.2016.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/13/2016] [Accepted: 11/29/2016] [Indexed: 11/15/2022]
Abstract
CONTEXT Seasonal flu outbreaks are linked to the circulation of influenza virus type A or B. Special attention has always been paid to influenza A epidemics; but recently, several studies have investigated the impact of influenza B virus epidemics, particularly as, since the 1980s, two antigenically different influenza B lineages co-circulate, raising the issue of vaccine matching. OBJECTIVES We present the results of influenza B burden during nine influenza seasons (2003-2013) and vaccine matching of the circulating lineages. PATIENTS AND METHODS Clinical and virological influenza surveillance data, collected by the Regional Groups for Influenza Surveillance Network in France, allows for studying the burden of influenza in the practice of the population of ambulatory care physicians. RESULTS AND CONCLUSION Our analysis is based on 37,801 samples, of which 12,036 were virologically confirmed influenza cases (31.8%), including 3576 cases of influenza B (29.7% of influenza cases). Influenza B viruses significantly circulated during six seasons. For each season, the influenza B epidemic peaked later than the influenza A epidemic. Influenza B is very common in children of school age but also affects other age groups. Finally, more than one-third of the analyzed influenza B viruses belonged to a different lineage than the one used in the composition of the trivalent vaccine. Our results are comparable to those described in other countries.
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Affiliation(s)
- A Mosnier
- Open Rome, 67, rue du Poteau, 75018 Paris, France.
| | - I Daviaud
- Open Rome, 67, rue du Poteau, 75018 Paris, France
| | - J S Casalegno
- Centre national de référence des virus influenza, CBPE, hospices civils de Lyon et Virpath, université Claude-Bernard Lyon, 69000 Lyon, France
| | - M Ruetsch
- Réseau des Groupes régionaux d'observation de la grippe (GROG), 75018 Paris, France
| | - C Burugorri
- Réseau des Groupes régionaux d'observation de la grippe (GROG), 75018 Paris, France
| | - E Nauleau
- Open Rome, 67, rue du Poteau, 75018 Paris, France
| | - T T Bui
- Open Rome, 67, rue du Poteau, 75018 Paris, France
| | - H Fleury
- Laboratoire de virologie, hôpital Pellegrin, 33000 Bordeaux, France
| | - B Lina
- Centre national de référence des virus influenza, CBPE, hospices civils de Lyon et Virpath, université Claude-Bernard Lyon, 69000 Lyon, France
| | - S van der Werf
- Centre national de référence des virus influenza, génétique moléculaire des virus respiratoires, Institut Pasteur, CNRS UMR 3569, université Paris Diderot Sorbonne Paris-Cité, 75015 Paris, France
| | - J M Cohen
- Open Rome, 67, rue du Poteau, 75018 Paris, France
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Rabinovich A, Cohen JM, Kahn SR. Predictive value of markers of inflammation in the postthrombotic syndrome: a systematic review: inflammatory biomarkers and PTS. Thromb Res 2015; 136:289-97. [PMID: 26139086 DOI: 10.1016/j.thromres.2015.06.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 05/29/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT). Inflammation may contribute to its pathophysiology. OBJECTIVES We conducted a systematic review of studies that analyzed the association between biomarkers of inflammation and PTS in DVT patients. METHODS The electronic databases PubMed, EMBASE, Medline, Scopus and Web of Science were searched for studies published until March 2015 that measured blood inflammation biomarker levels in adult DVT patients and reported their association with PTS development. Two reviewers independently performed full text assessment and data extraction. RESULTS Ten studies were included. Nine reported on the association between C-reactive protein and PTS; Interleukin (IL)-6 was measured in six studies; IL-8 in four studies; Intracellular adhesion molecule (ICAM)-1 in three studies; IL-10 and vascular cell adhesion molecule-1 in two studies; and monocyte chemotactic protein-1, matrix metalloprotease-9, P-Selectin, tumor necrosis factor α and erythrocyte sedimentation rate were measured in one study. Studies differed in terms of populations included, exclusion criteria, methods used for biomarker measurement and statistical measures of association between biomarkers and PTS. We were able to metaanalyze results only for IL-6 and found no significant association. Descriptively, ICAM-1 was significantly associated with PTS in two out of three studies that measured it. Other biomarkers did not demonstrate a significant association with PTS. CONCLUSIONS Our systematic review found conflicting results regarding the role of inflammatory biomarkers as predictors of PTS. ICAM -1 appears to be a promising marker for further investigation.
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Affiliation(s)
- A Rabinovich
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - J M Cohen
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - S R Kahn
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Canada.
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15
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Wilson R, Cohen JM, Jose RJ, de Vogel C, Baxendale H, Brown JS. Protection against Streptococcus pneumoniae lung infection after nasopharyngeal colonization requires both humoral and cellular immune responses. Mucosal Immunol 2015; 8:627-39. [PMID: 25354319 PMCID: PMC4351900 DOI: 10.1038/mi.2014.95] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [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: 06/30/2014] [Accepted: 09/13/2014] [Indexed: 02/04/2023]
Abstract
Streptococcus pneumoniae is a common cause of pneumonia and infective exacerbations of chronic lung disease, yet there are few data on how adaptive immunity can specifically prevent S. pneumoniae lung infection. We have used a murine model of nasopharyngeal colonization by the serotype 19F S. pneumoniae strain EF3030 followed by lung infection to investigate whether colonization protects against subsequent lung infection and the mechanisms involved. EF3030 colonization induced systemic and local immunoglobulin G against a limited number of S. pneumoniae protein antigens rather than capsular polysaccharide. During lung infection, previously colonized mice had increased early cytokine responses and neutrophil recruitment and reduced bacterial colony-forming units in the lungs and bronchoalveolar lavage fluid compared with control mice. Colonization-induced protection was lost when experiments were repeated in B-cell- or neutrophil-deficient mice. Furthermore, the improved interleukin (IL)-17 response to infection in previously colonized mice was abolished by depletion of CD4+ cells, and prior colonization did not protect against lung infection in mice depleted of CD4+ cells or IL17. Together these data show that naturally acquired protective immunity to S. pneumoniae lung infection requires both humoral and cell-mediated immune responses, providing a template for the design of improved vaccines that can specifically prevent pneumonia or acute bronchitis.
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Affiliation(s)
- R Wilson
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College Medical School, Rayne Institute, London, UK
| | - J M Cohen
- Infectious Diseases and Microbiology Unit, UCL Institute of Child Health, London, UK
| | - R J Jose
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College Medical School, Rayne Institute, London, UK
| | - C de Vogel
- Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - H Baxendale
- Clinical Immunology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - J S Brown
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College Medical School, Rayne Institute, London, UK,()
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16
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Rabinovich A, Cohen JM, Cushman M, Wells PS, Rodger MA, Kovacs MJ, Anderson DR, Tagalakis V, Lazo-Langner A, Solymoss S, Miron MJ, Yeo E, Smith R, Schulman S, Kassis J, Kearon C, Chagnon I, Wong T, Demers C, Hanmiah R, Kaatz S, Selby R, Rathbun S, Desmarais S, Opatrny L, Ortel TL, Ginsberg JS, Kahn SR. Inflammation markers and their trajectories after deep vein thrombosis in relation to risk of post-thrombotic syndrome. J Thromb Haemost 2015; 13:398-408. [PMID: 25495610 DOI: 10.1111/jth.12814] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/09/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT). OBJECTIVE In the BioSOX study, we investigated whether inflammation markers predict the risk of PTS after DVT. METHODS We measured C-reactive protein (CRP), ICAM-1, interleukin (IL)-6, and IL-10, at baseline, and 1 month and 6 months after a first proximal DVT, among 803 participants in the SOX trial. Participants were prospectively followed for 24 months for development of PTS. RESULTS Median CRP levels at 1 month, ICAM-1 levels at baseline, 1 month and 6 months, IL-6 levels at 1 month and 6 months and IL-10 levels at 6 months were higher in patients who developed PTS than in those who did not. Multivariable regression with the median as a cutoff showed risk ratios (RRs) for PTS of 1.23 (95% confidence interval [CI] 1.05-1.45) and 1.25 (95% CI 1.05-1.48) for ICAM-1 at 1 month and 6 months, respectively, and 1.27 (95% CI 1.07-1.51) for IL-10 at 6 months. Quartile-based analysis demonstrated a dose-response association between ICAM-1 and PTS. ICAM-1 and IL-10 were also associated with PTS severity. Analysis of biomarker trajectories after DVT demonstrated an association between the highest-trajectory group of ICAM-1 and PTS. CONCLUSIONS In this prospective study, ICAM-1 over time was most consistently associated with the risk of PTS. Further study is required to confirm these findings and assess their potential clinical relevance.
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Affiliation(s)
- A Rabinovich
- Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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17
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Cohen JM, Kahn SR, Platt RW, Basso O, Evans RW, Kramer MS. Small-for-gestational-age birth and maternal plasma antioxidant levels in mid-gestation: a nested case-control study. BJOG 2015; 122:1313-21. [PMID: 25677044 DOI: 10.1111/1471-0528.13303] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Accepted: 12/13/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess whether maternal plasma antioxidant levels in mid-pregnancy are associated with small-for-gestational-age (SGA) birth. DESIGN Case-control study nested within a population-based cohort study. SETTING Four hospitals in Montreal, Canada. POPULATION Pregnant women recruited before 24 weeks of gestation, whose pregnancies were not complicated by pre-eclampsia or preterm delivery. METHODS Blood samples were obtained at 24-26 weeks and assayed for nutritionally derived antioxidant levels in SGA cases (n = 324) and randomly selected controls with birthweights between the 25th and 75th centiles (n = 672). We performed logistic regression analyses using the standardised z-score of each antioxidant as the main independent variable, after summing highly correlated antioxidants or combining via principle component analysis. We adjusted for risk factors for SGA that were associated with antioxidant levels. MAIN OUTCOME MEASURES SGA, birthweight <10th centile for gestational age and sex. RESULTS Retinol was positively associated with risk of SGA (adjusted odds ratio [OR] 1.41; 95% confidence interval [95% CI] 1.22-1.63, per SD increase). Carotenoids (log of the sum of β-carotene, lutein/zeaxanthin, α- and β-cryptoxanthin) were negatively associated with SGA (adjusted OR 0.64; 95% CI 0.54-0.78, per SD increase). We found no significant associations between SGA and lycopene or any of the forms of vitamin E assessed, including α-tocopherol, corrected α-tocopherol (per nmol/l of low-density lipoprotein articles), or γ-tocopherol. CONCLUSIONS Elevated retinol may be associated with an increased risk of SGA, whereas elevated carotenoid levels may reduce the risk. A better understanding of the nature of these associations is required, however, before recommending specific nutritional interventions in an attempt to prevent SGA birth.
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Affiliation(s)
- J M Cohen
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - S R Kahn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - R W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - O Basso
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - R W Evans
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - M S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada
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Cohen JM, Nambudiri VE, Kulke MH, Todd DJ, Murphy GF, LeBoeuf NR. Cutaneous paraneoplastic granulomatous eruptions secondary to metastatic carcinoid tumour. Br J Dermatol 2014; 172:1451-4. [PMID: 25388104 DOI: 10.1111/bjd.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J M Cohen
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, U.S.A
| | - V E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, U.S.A
| | - M H Kulke
- Program in Neuroendocrine and Carcinoid Tumors, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, U.S.A
| | - D J Todd
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, U.S.A
| | - G F Murphy
- Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, U.S.A
| | - N R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, U.S.A.,The Center for Cutaneous Oncology, Department of Dermatology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, 02115, U.S.A
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Affiliation(s)
- M Lamure
- University Claude Bernard Lyon 1, Paris, France
| | - J M Cohen
- Regional Group for the Surveillance of Influenza - GROG, Open Rome, Paris, France
| | | | | | - J Auray
- Cyklad Group, Rilleux la Pape, France
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Silva ML, Perrier L, Paget J, Mosnier A, Buthion V, Cohen JM, Späth HM. Information Used in the Decision-Making Process Regarding Influenza Vaccination Policy: Perceptions of Stakeholders in France and the Netherlands. Value Health 2014; 17:A329. [PMID: 27200564 DOI: 10.1016/j.jval.2014.08.603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M L Silva
- Research Group in Health Economics (GATE, UMR 5824, CNRS); University Lyon 2, Ecully, France
| | - L Perrier
- Cancer Centre Léon Bérard, Lyon, France
| | - J Paget
- Netherlands Institute For Health Services Research (NIVEL), Utrecht, The Netherlands
| | - A Mosnier
- Regional Group for the Surveillance of Influenza - GROG, Open Rome, Paris, France
| | - V Buthion
- COACTIS EA 4161, University of Lyon, Lyon, France
| | - J M Cohen
- Regional Group for the Surveillance of Influenza - GROG, Open Rome, Paris, France
| | - H M Späth
- University Claude Bernard, Lyon 1 EAM 4128, Lyon, France
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Kissling E, Valenciano M, Buchholz U, Larrauri A, Cohen JM, Nunes B, Rogalska J, Pitigoi D, Paradowska-Stankiewicz I, Reuss A, Jiménez-Jorge S, Daviaud I, Guiomar R, O'Donnell J, Necula G, Głuchowska M, Moren A. Influenza vaccine effectiveness estimates in Europe in a season with three influenza type/subtypes circulating: the I-MOVE multicentre case-control study, influenza season 2012/13. ACTA ACUST UNITED AC 2014; 19. [PMID: 24556348 DOI: 10.2807/1560-7917.es2014.19.6.20701] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the fifth season of Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE), we undertook a multicentre case-control study (MCCS) in seven European Union (EU) Member States to measure 2012/13 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory confirmed as influenza. The season was characterised by substantial co-circulation of influenza B, A(H1N1)pdm09 and A(H3N2) viruses. Practitioners systematically selected ILI patients to swab ≤7 days of symptom onset. We compared influenza-positive by type/subtype to influenza-negative patients among those who met the EU ILI case definition. We conducted a complete case analysis using logistic regression with study as fixed effect and calculated adjusted vaccine effectiveness (AVE), controlling for potential confounders (age, sex, symptom onset week and presence of chronic conditions). We calculated AVE by type/subtype. Study sites sent 7,954 ILI/acute respiratory infection records for analysis. After applying exclusion criteria, we included 4,627 ILI patients in the analysis of VE against influenza B (1,937 cases), 3,516 for A(H1N1)pdm09 (1,068 cases) and 3,340 for influenza A(H3N2) (730 cases). AVE was 49.3% (95% confidence interval (CI): 32.4 to 62.0) against influenza B, 50.4% (95% CI: 28.4 to 65.6) against A(H1N1)pdm09 and 42.2% (95% CI: 14.9 to 60.7) against A(H3N2). Our results suggest an overall low to moderate AVE against influenza B, A(H1N1)pdm09 and A(H3N2), between 42 and 50%. In this season with many co-circulating viruses, the high sample size enabled stratified AVE by type/subtype. The low estimates indicate seasonal influenza vaccines should be improved to achieve acceptable protection levels.
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22
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Rabinovich A, Cohen JM, Prandoni P, Kahn SR. Association between thrombophilia and the post-thrombotic syndrome: a systematic review and meta-analysis. J Thromb Haemost 2014; 12:14-23. [PMID: 24406063 DOI: 10.1111/jth.12447] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The postthrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT), occurring in 20-40% of patients. Identifying risk factors for PTS may be useful to provide patients with prognostic information and target prevention strategies. OBJECTIVE To conduct a systematic review to assess whether, among patients with DVT, inherited and acquired thrombophilias are associated with a risk of PTS. METHODS We searched the electronic databases PubMed, EMBASE, Scopus, and Web of Science for studies published from 1990 to 2013 that assessed any thrombophilia in adult DVT patients and its association with the development of PTS. We calculated odds ratios and 95% confidence intervals for PTS according to the presence of thrombophilia. Meta-analysis was performed using the random-effects model. RESULTS Sixteen studies were included: 13 assessed factor V Leiden (FVL), 10 assessed prothrombin mutation, five assessed protein S and C deficiencies, three assessed antithrombin deficiency, four assessed elevated FVIII levels, and six assessed antiphospholipid antibodies. None of the meta-analyses identified any thrombophilia to be predictive of PTS. Both FVL and prothrombin mutation appeared protective among studies including patients with both first and recurrent DVT and studies in which more than 50% of patients had an unprovoked DVT. CONCLUSIONS Our meta-analysis did not demonstrate a significant association between any of the thrombophilias assessed and the risk of PTS in DVT patients. Other biomarkers in the pathophysiological pathway may be more predictive of PTS.
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Affiliation(s)
- A Rabinovich
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Wilson RJ, Jose RJ, Barabas M, Marshall H, Cohen JM, Sapey E, Baxendale H, Brown JS. P238 Role of naturally-acquired IgG in protection from S. pneumoniae lung infection. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cohen JM, Wilson R, Shah P, Baxendale HE, Brown JS. Lack of cross-protection against invasive pneumonia caused by heterologous strains following murine Streptococcus pneumoniae nasopharyngeal colonisation despite whole cell ELISAs showing significant cross-reactive IgG. Vaccine 2013; 31:2328-32. [DOI: 10.1016/j.vaccine.2013.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 02/27/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
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Chiyaka C, Tatem AJ, Cohen JM, Gething PW, Johnston G, Gosling R, Laxminarayan R, Hay SI, Smith DL. Infectious disease. The stability of malaria elimination. Science 2013; 339:909-10. [PMID: 23430640 DOI: 10.1126/science.1229509] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Eradication may not be necessary before countries can eliminate, scale back control, and rely on health systems.
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Affiliation(s)
- C Chiyaka
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
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Kissling E, Valenciano M, Larrauri A, Oroszi B, Cohen JM, Nunes B, Pitigoi D, Rizzo C, Rebolledo J, Paradowska-Stankiewicz I, Jiménez-Jorge S, Horváth JK, Daviaud I, Guiomar R, Necula G, Bella A, O'Donnell J, Głuchowska M, Ciancio BC, Nicoll A, Moren A. Low and decreasing vaccine effectiveness against influenza A(H3) in 2011/12 among vaccination target groups in Europe: results from the I-MOVE multicentre case-control study. ACTA ACUST UNITED AC 2013; 18. [PMID: 23399425 DOI: 10.2807/ese.18.05.20390-en] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE) project we conducted a multicentre case–control study in eight European Union (EU) Member States to estimate the 2011/12 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory-confirmed as influenza A(H3) among the vaccination target groups. Practitioners systematically selected ILI / acute respiratory infection patients to swab within seven days of symptom onset. We restricted the study population to those meeting the EU ILI case definition and compared influenza A(H3) positive to influenza laboratory-negative patients. We used logistic regression with study site as fixed effect and calculated adjusted influenza vaccine effectiveness (IVE), controlling for potential confounders (age group, sex, month of symptom onset, chronic diseases and related hospitalisations, number of practitioner visits in the previous year). Adjusted IVE was 25% (95% confidence intervals (CI): -6 to 47) among all ages (n=1,014), 63% (95% CI: 26 to 82) in adults aged between 15 and 59 years and 15% (95% CI: -33 to 46) among those aged 60 years and above. Adjusted IVE was 38% (95%CI: -8 to 65) in the early influenza season (up to week 6 of 2012) and -1% (95% CI: -60 to 37) in the late phase. The results suggested a low adjusted IVE in 2011/12. The lower IVE in the late season could be due to virus changes through the season or waning immunity. Virological surveillance should be enhanced to quantify change over time and understand its relation with duration of immunological protection. Seasonal influenza vaccines should be improved to achieve acceptable levels of protection.
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Chimalapati S, Cohen JM, Camberlein E, MacDonald N, Durmort C, Vernet T, Hermans PWM, Mitchell T, Brown JS. Effects of deletion of the Streptococcus pneumoniae lipoprotein diacylglyceryl transferase gene lgt on ABC transporter function and on growth in vivo. PLoS One 2012; 7:e41393. [PMID: 22911788 PMCID: PMC3404074 DOI: 10.1371/journal.pone.0041393] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/21/2012] [Indexed: 12/14/2022] Open
Abstract
Lipoproteins are an important class of surface associated proteins that have diverse roles and frequently are involved in the virulence of bacterial pathogens. As prolipoproteins are attached to the cell membrane by a single enzyme, prolipoprotein diacylglyceryl transferase (Lgt), deletion of the corresponding gene potentially allows the characterisation of the overall importance of lipoproteins for specific bacterial functions. We have used a Δlgt mutant strain of Streptococcus pneumoniae to investigate the effects of loss of lipoprotein attachment on cation acquisition, growth in media containing specific carbon sources, and virulence in different infection models. Immunoblots of triton X-114 extracts, flow cytometry and immuno-fluorescence microscopy confirmed the Δlgt mutant had markedly reduced lipoprotein expression on the cell surface. The Δlgt mutant had reduced growth in cation depleted medium, increased sensitivity to oxidative stress, reduced zinc uptake, and reduced intracellular levels of several cations. Doubling time of the Δlgt mutant was also increased slightly when grown in medium with glucose, raffinose and maltotriose as sole carbon sources. These multiple defects in cation and sugar ABC transporter function for the Δlgt mutant were associated with only slightly delayed growth in complete medium. However the Δlgt mutant had significantly reduced growth in blood or bronchoalveolar lavage fluid and a marked impairment in virulence in mouse models of nasopharyngeal colonisation, sepsis and pneumonia. These data suggest that for S. pneumoniae loss of surface localisation of lipoproteins has widespread effects on ABC transporter functions that collectively prevent the Δlgt mutant from establishing invasive infection.
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Affiliation(s)
- Suneeta Chimalapati
- Centre for Respiratory Research, Department of Medicine, Royal Free and University College Medical School, Rayne Institute, London, United Kingdom
| | - Jonathan M. Cohen
- Centre for Respiratory Research, Department of Medicine, Royal Free and University College Medical School, Rayne Institute, London, United Kingdom
- Infectious Diseases & Microbiology Unit, UCL Institute of Child Health, London, United Kingdom
| | - Emilie Camberlein
- Centre for Respiratory Research, Department of Medicine, Royal Free and University College Medical School, Rayne Institute, London, United Kingdom
| | - Nathanael MacDonald
- Centre for Respiratory Research, Department of Medicine, Royal Free and University College Medical School, Rayne Institute, London, United Kingdom
| | - Claire Durmort
- CEA, Institut de Biologie Structurale Jean-Pierre Ebel, Grenoble, France
- CNRS, Institut de Biologie Structurale Jean-Pierre Ebel, Grenoble, France
- Université Joseph Fourier – Grenoble 1, Institut de Biologie Structurale Jean-Pierre Ebel, Grenoble, France
| | - Thierry Vernet
- CEA, Institut de Biologie Structurale Jean-Pierre Ebel, Grenoble, France
- CNRS, Institut de Biologie Structurale Jean-Pierre Ebel, Grenoble, France
- Université Joseph Fourier – Grenoble 1, Institut de Biologie Structurale Jean-Pierre Ebel, Grenoble, France
| | - Peter W. M. Hermans
- Laboratory of Pediatric Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Timothy Mitchell
- Division of Infection and Immunity, IBLS, University of Glasgow, Glasgow, United Kingdom
| | - Jeremy S. Brown
- Centre for Respiratory Research, Department of Medicine, Royal Free and University College Medical School, Rayne Institute, London, United Kingdom
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Cohen EP, Cohen JM. New clinical trial of DNA-based vaccines for patients with non-small cell lung cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13034] [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: 11/20/2022] Open
Abstract
e13034 Background: We report a new immunotherapeutic trial for patients with non-small cell lung cancer (NSCLC). The trial to be conducted at the University of Pittsburgh Cancer Institute is a two-stage uncontrolled non-randomized Phase IB study designed to evaluate the safety, immunogenicity and feasibility of a new vaccine, consisting of human allogeneic fibroblasts transfected with DNA derived from the patient’s own tumor. The vaccine is prepared by transfer of genomic DNA-fragments (25 kb) from the patient’s tumor into MRC-5 cells, a human embryonic fibroblast cell line. The rationale is that numerous mutant and dysregulated genes in the tumor specifying an array of patient-specific tumor antigens are expressed in a highly immunogenic form by the DNA-transfected cells. A large body of preclinical studies in tumor-bearing mice supports this approach. An IND has been issued. Cohort 1 is underway without DLT. Methods: We plan to use a two-stage trial design. Initially, 15 early-stage patients with NSCLC will be enrolled. If there is no evidence of toxicity, and >3 of the initial patients show an immunologic response, the second stage of the study will be opened for the accrual of 22 additional patients. A portion of the primary tumor removed at surgery will be obtained to serve as a source of tumor-DNA. Each vaccine will contain 1 X 10E7 DNA-transfected fibroblasts. The vaccine will be lethally irradiated before it is administered. It will be injected intradermally in the Outpatient Clinic. Immunologic responses to the vaccine and to the autologous tumor will be evaluated by IFN-g secretion in ELISPOT assays prior to and after vaccination for the frequency of T-cells responsive to the autologous tumor. Additional assays will include lymphocyte proliferation determinations in response anti CD3 and anti CD28 monoclonal antibodies and the effect of the immunizations on the proportion of myeloid-derived suppressor T cells in the patient’s peripheral blood. The patients will also be evaluated before and after immunization for the capacity of their T cells to respond to activating signals delivered via the T cell receptor (TcR). Results: Vaccines have been prepared. First patient has been enrolled. Conclusions: No data to report in this early trial.
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Cohen JM, Chimalapati S, de Vogel C, van Belkum A, Baxendale HE, Brown JS. Contributions of capsule, lipoproteins and duration of colonisation towards the protective immunity of prior Streptococcus pneumoniae nasopharyngeal colonisation. Vaccine 2012; 30:4453-9. [PMID: 22561489 PMCID: PMC3657162 DOI: 10.1016/j.vaccine.2012.04.080] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 04/17/2012] [Accepted: 04/23/2012] [Indexed: 12/12/2022]
Abstract
Live attenuated vaccines have been proposed as a strategy to induce protective immunity against infectious diseases. Recent data have demonstrated that nasopharyngeal colonisation with Streptococcus pneumoniae induces protective immunity against subsequent invasive infection, suggesting nasal vaccination with live attenuated bacteria could be a preventative strategy. However the bacterial factors affecting the strength of this adaptive immune response remain unclear. In a direct comparison with the parent wild-type strain, we found that colonisation with bacteria lacking either capsule or surface lipoproteins led to significantly diminished protection. Immunity after colonisation was not dependent on serum IgG to capsular antigens. Colonisation density and duration was reduced for all the non-protective strains, suggesting that protective immunity maybe related to the extent of nasopharyngeal bacterial exposure. To investigate this hypothesis, we utilised an auxotrophic bacterial Δpab strain where duration of colonisation could be controlled by supply and removal of para-amino-benzoic acid (PABA) to mouse drinking water. Supporting colonisation with the Δpab strain for 5 days with PABA led to a faster serum antibody response compared to colonisation for less than 48 h. This enhanced immunogenicity was associated with a trend towards protection. The data presented here aid our understanding of why only certain live attenuated strains are able to function as effective vaccines, and may be valuable in informing the constituents of future live attenuated vaccines.
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Affiliation(s)
- Jonathan M Cohen
- Centre for Respiratory Research, Department of Medicine, UCL, London, United Kingdom.
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Cohen JM, Khandavilli S, Camberlein E, Hyams C, Baxendale HE, Brown JS. Protective contributions against invasive Streptococcus pneumoniae pneumonia of antibody and Th17-cell responses to nasopharyngeal colonisation. PLoS One 2011; 6:e25558. [PMID: 22003400 PMCID: PMC3189185 DOI: 10.1371/journal.pone.0025558] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 09/07/2011] [Indexed: 11/18/2022] Open
Abstract
The nasopharyngeal commensal bacteria Streptococcus pneumoniae is also a frequent cause of serious infections. Nasopharyngeal colonisation with S. pneumoniae inhibits subsequent re-colonisation by inducing Th17-cell adaptive responses, whereas vaccination prevents invasive infections by inducing antibodies to S. pneumoniae capsular polysaccharides. In contrast, protection against invasive infection after nasopharyngeal colonisation with mutant S. pneumoniae strains was associated with antibody responses to protein antigens. The role of colonisation-induced Th17-cell responses during subsequent invasive infections is unknown. Using mouse models, we show that previous colonisation with S. pneumoniae protects against subsequent lethal pneumonia mainly by preventing bacteraemia with a more modest effect on local control of infection within the lung. Previous colonisation resulted in CD4-dependent increased levels of Th17-cell cytokines during subsequent infectious challenge. However, mice depleted of CD4 cells prior to challenge remained protected against bacteraemia, whereas no protection was seen in antibody deficient mice and similar protection could be achieved through passive transfer of serum. Serum from colonised mice but not antibody deficient mice promoted phagocytosis of S. pneumoniae, and previously colonised mice were able to rapidly clear S. pneumoniae from the blood after intravenous inoculation. Thus, despite priming for a Th17-cell response during subsequent infection, the protective effects of prior colonisation in this model was not dependent on CD4 cells but on rapid clearance of bacteria from the blood by antibody-mediated phagocytosis. These data suggest that whilst nasopharyngeal colonisation induces a range of immune responses, the effective protective responses depend upon the site of subsequent infection.
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Affiliation(s)
- Jonathan M. Cohen
- Centre for Respiratory Research, Department of Medicine, University College London, London, United Kingdom
- Infectious Diseases and Microbiology Unit, Child Health Institute, University College London, London, United Kingdom
| | - Suneeta Khandavilli
- Centre for Respiratory Research, Department of Medicine, University College London, London, United Kingdom
| | - Emilie Camberlein
- Centre for Respiratory Research, Department of Medicine, University College London, London, United Kingdom
| | - Catherine Hyams
- Centre for Respiratory Research, Department of Medicine, University College London, London, United Kingdom
| | - Helen E. Baxendale
- Infectious Diseases and Microbiology Unit, Child Health Institute, University College London, London, United Kingdom
- Department of Immunology, Royal Free Hospital Medical School Campus, University College London, London, United Kingdom
| | - Jeremy S. Brown
- Centre for Respiratory Research, Department of Medicine, University College London, London, United Kingdom
- * E-mail:
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Cohen JM, Hutcheon JA, Kramer MS, Joseph KS, Abenhaim H, Platt RW. Influence of ultrasound-to-delivery interval and maternal-fetal characteristics on validity of estimated fetal weight. Ultrasound Obstet Gynecol 2010; 35:434-441. [PMID: 20069655 DOI: 10.1002/uog.7506] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To explore the effects of ultrasound-to-delivery interval and maternal-fetal characteristics on the distribution of measurement error in estimated fetal weights (EFWs), and to determine the predictive ability of EFW for diagnosis of small-for-gestational age (SGA) and large-for-gestational age (LGA) among infants delivered within 1 day of an ultrasound examination. METHODS Percentage differences between EFW and birth weights were calculated in 3697 pregnancies. Linear regression was used to compare the accuracy of EFW for births on each of the 6 days after an ultrasound scan with the accuracy observed among births on the same day. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value for diagnosis of SGA and LGA according to EFW was assessed. RESULTS The mean +/- SD percentage difference among deliveries within 1 day of the last ultrasound scan was 0.2 +/- 9.0%. Mean percentage differences were not significantly different from day 0 on days 1, 2 and 3; however, combining the data from these 4 days obscured a slight bias towards an overestimation of weight evident on day 0 and day 1. Among deliveries within 1 day of an ultrasound scan, the PPV was 61% for SGA diagnosis and 54% for LGA diagnosis. CONCLUSION Combining data from births > 1 day after the last ultrasound examination may lead to a false conclusion that there is systematic underestimation of weight. EFW tended to underestimate the weight of macrosomic fetuses and overestimate that of small fetuses which limited sensitivity and PPV. Maternal-fetal characteristics are weak predictors of individual errors in EFW.
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Affiliation(s)
- J M Cohen
- Department of Biostatistics, The Montreal Children's Hospital Research Institute, Montreal, QC, Canada
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Abstract
Radiosurgery is increasingly employed in the treatment of acoustic neuroma, but the optimal dose in terms of long-term tumour control and minimal adverse effects has not been established. We performed a systematic review of the published literature of radiosurgery of acoustic neuroma to assess whether the use of low dose radiosurgery is as effective as high dose treatment. Reports of radiosurgery for acoustic neuroma were identified through a Medline search. Studies with at least 15 patients and a median follow-up longer than 12 months were included. The relationship between actuarial 5-year progression-free survival (PFS), and tumour and treatment parameters was examined. Forty-two studies were included. Tumour control following lower radiosurgery doses was similar to that reported following high doses. Only 12 studies reported actuarial outcomes at 5 years. There was no relationship between PFS at 5 years and dose to the tumour margin. Radiosurgery of larger tumours was associated with lower 5 year PFS (p < 0.05). Although on initial inspection radiosurgery of acoustic neuroma with doses of 12 - 13 Gy seems to be as effective as higher dose treatment, the available reports are subject to a number of confounding factors, are not sufficiently statistically powered and there is only limited long-term actuarial outcome data. Currently, available studies do not provide sufficient confidence to support the claim that low dose radiosurgery is equally effective as higher doses in the long-term control of acoustic neuroma.
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Affiliation(s)
- R S Weil
- Neuro-Oncology Unit, Royal Marsden NHS Foundation Trust, London, UK
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Abstract
UNLABELLED We report two cases of life-threatening haemorrhage from bladder telangiectasia in children with ataxia-telangiectasia (A-T) who had been treated for lymphoma earlier in life. Whilst oculocutaneous telangiectasiae are an almost universal finding in this syndrome, bladder wall telangiectasis has not been reported previously. Both teenagers presented with recurrent severe haematuria due to extensive bladder telangiectasis. Recurrent haemorrhage was controlled with cystoscopic diathermy treatment. As A-T is a DNA repair disorder, it is possible that chemotherapy-mediated damage to the bladder mucosa prompted the development of clinically significant telangiectasis in these patients. CONCLUSION We advocate early cystoscopy for A-T patients who develop haematuria to investigate the cause, and cystodiathermy to pre-emptively treat developing lesions prior to haemodynamically significant haemorrhage.
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Affiliation(s)
- Jonathan M Cohen
- Department of Immunology, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
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Cohen JM, Whittaker E, Walters S, Lyall H, Tudor-Williams G, Kampmann B. Presentation, diagnosis and management of tuberculosis in HIV-infected children in the UK. HIV Med 2008; 9:277-84. [PMID: 18331563 DOI: 10.1111/j.1468-1293.2008.00559.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Management of HIV-infected children with tuberculosis (TB) is challenging. The objective of this study was to assess current treatment and outcomes in a resource-rich setting in the era of highly active antiretroviral therapy (HAART). METHODS A retrospective case-note review of coinfected children was carried out in a large UK-based HIV family clinic. RESULTS Of 328 HIV-infected children, 18 were diagnosed and treated for active TB. TB presentation led to HIV diagnosis in eight of these 18 children. TB was confirmed microbiologically in 33% of children. Fifteen of the 18 children presented with pulmonary TB, and three with extrapulmonary TB (EPTB). Immunological status at TB diagnosis did not predict EPTB. The mean CD4 T-cell count at TB presentation was 402 cells/microL (mean CD4 percentage 16%), with a range of 0-790 cells/microL (0-34%). In seven children concurrently treated with HAART and anti-tuberculous therapy (ATT), therapeutic drug monitoring (TDM) guided management. No immune reconstitution disease occurred. There was one death, unrelated to TB, 2 years after completion of ATT. CONCLUSIONS An HIV test should be considered in all children diagnosed with TB, especially if there are epidemiological risk factors. Our experience shows that, even with deferral of HAART in concurrently infected children, good therapeutic responses to ATT can be achieved. Where necessary, TDM guiding concurrent HAART and ATT can facilitate good clinical and virological responses.
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Affiliation(s)
- J M Cohen
- Department of Paediatric Infectious Diseases, Imperial College London, Norfolk Place, London, UK
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Cohen JM, Sebire NJ, Harvey J, Gaspar HB, Cathy C, Jones A, Rao K, Cubitt D, Amrolia PJ, Davies EG, Veys P. Successful treatment of lymphoproliferative disease complicating primary immunodeficiency/immunodysregulatory disorders with reduced-intensity allogeneic stem-cell transplantation. Blood 2007; 110:2209-14. [PMID: 17502458 DOI: 10.1182/blood-2006-12-062174] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lymphoproliferative disease (LPD) is a recognized complication of primary immunodeficiency (PID) and immunodysregulatory syndromes. Historically, it has a very poor outcome. For patients surviving LPD, myeloablative hematopoietic stem cell transplantation (SCT) was the only cure for the underlying PID, with a high risk of developing posttransplantation complications, including recurrent lymphoproliferative disease. We describe 8 patients with a range of PID and immunodysregulatory syndromes complicated by LPD. After initial treatment of the LPD (including the use of anti-CD20 monoclonal antibody, rituximab, in 6 of the patients), all patients underwent reduced-intensity conditioning (RIC) SCT with prospective monitoring for Epstein-Barr virus (EBV) viremia. After transplantation, 3 patients received rituximab, and 3 patients received prophylactic EBV-specific cytotoxic T-lymphocytes. Only 1 patient developed recurrent LPD posttransplantation, which responded to rituximab. All patients who underwent transplantation survive free of LPD and are cured of their PID at a median follow-up of 4 years (range, 1-7 years). With careful monitoring and pre-emptive therapy, we advocate this RIC SCT approach to patients with PID who have pre-existing EBV-LPD.
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Affiliation(s)
- Jonathan M Cohen
- Department of Clinical Immunology, Great Ormond Street Hospital, London, United Kingdom
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Cohen JM, Cooper N, Chakrabarti S, Thomson K, Samarasinghe S, Cubitt D, Lloyd C, Woolfrey A, Veys P, Amrolia PJ. EBV-related disease following haematopoietic stem cell transplantation with reduced intensity conditioning. Leuk Lymphoma 2007; 48:256-69. [PMID: 17325885 DOI: 10.1080/10428190601059837] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The use of reduced intensity regimens has decreased early mortality following stem cell transplantation. However, the increased immunosuppression following these protocols results in profound and often prolonged lymphopenia, resulting in an increased incidence of viral reactivation. We and others have observed a high incidence of EBV viraemia and post-transplant lymphoproliferative disease (PTLD) following reduced-intensity conditioning regimens, reflecting the delayed recovery of EBV-specific immunity after such transplants. The clinical and histological features at presentation are similar to that seen after conventional intensity conditioning. Given the increasing use of reduced intensity conditioning (RIC) transplants, we review the risk factors for EBV related disease following transplantation with RIC, the potential for pre-emptive therapy of PTLD based on monitoring EBV viraemia and management options in such patients.
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Affiliation(s)
- Jonathan M Cohen
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital, NHS Trust, London, UK
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Cohen JM, Rogers V, Gaspar HB, Jones A, Davies EG, Rao K, McCloskey DJ, Gilmour K, Wynn R, Amrolia PJ, Veys P. Serial transplantation of mismatched donor hematopoietic cells between HLA-identical sibling pairs with congenital immunodeficiency: in vivo tolerance permits rapid immune reconstitution following T-replete transplantation without GVHD in the secondary recipient. Blood 2006; 108:2124-6. [PMID: 16728699 DOI: 10.1182/blood-2006-03-009712] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
We report serial transplantation procedures in 2 sets of brothers with X-linked primary immunodeficiency. The first boy in each family received a T-cell–depleted transplant from a mismatched donor. The recipients then acted as donors for T-replete transplantation of the “tolerized” graft into their HLA-identical brothers with the same disorder. Immune reconstitution was noted to occur at a significantly faster rate in the secondary recipients, and without the occurrence of graft-versus-host disease (GVHD), despite the presence of donor cells mismatched for 1 to 3 HLA antigens. This serial transplantation technique allows the primary recipient of HLA-mismatched donor cells to act as a functionally “HLA-matched” donor for subsequent affected siblings, and should be considered as a therapeutic option in families with congenital disorders.
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Affiliation(s)
- Jonathan M Cohen
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, United Kingdom
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Cohen JM, Mosnier A, Valette M, Bensoussan JL, Van Der Werf S. [General practice and surveillance: the example of influenza in France]. Med Mal Infect 2005; 35:252-6. [PMID: 15878816 DOI: 10.1016/j.medmal.2005.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Accepted: 02/18/2005] [Indexed: 11/15/2022]
Abstract
UNLABELLED Data registration by the GROG national network (Regional Group for the Surveillance of Influenza) since 1984 has helped to identify methodological problems. The choice of sentinels and the selection of indicators depend on the analysis of actual influenza consequences. Various sentinels may be concerned: health insurance companies, private companies, schools, physicians, pharmacists. Health care organization modifies the validity of indicators. In France, for instance, home visits were an excellent indicator for early warning before 1995 but this indicator is no longer as efficient as before. The virological detection of Influenza depends on the organization of transportation (samples, results). The predictive value of cases definitions depends on the incidence of infection. The level of choice between specificity and sensibility modifies the perception of outbreaks. Sentinel participation rate influences the sample representativity. The farther this rate is from 100%, the more result validity decreases (in the same way that patients lost to follow-up compromise the validity of results in clinical trials). The publication of results can modify health expenses and behaviors. CONCLUSION The GROG network stresses the important role that general practitioners play in health surveillance; it also raises questions in the field of mathematics, statistics, professional organization, training, education, and politics.
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Affiliation(s)
- J M Cohen
- Coordination nationale des GROG, open Rome, 67 rue du Poteau, 75018 Paris, France.
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Abstract
For influenza monitoring, the use of laboratory data usually in combination with morbidity data from primary care facilities is common. The estimated excess morbidity, or resulting rates and consultation incidences are the basic parameter for the estimation of influenza activity in conjunction with antigen assays of influenza in a selected sub-sample of the recorded patients. The interpretation of such data is complicated by several selection processes, confounding influences and bias. The case definition (CD) given for the selection of cases is important for the sensitivity and specificity of the registrations. For the clinical morbidity data, the lower specificity found when more general (acute respiratory tract infections) criteria are used seems to be compensated by a higher statistical sensitivity due to the larger number of cases. The relative stability of the background morbidity against the expected values is critical for the interpretation. The sub-sample of patients tested by antigen assays is usually small due to cost constraints. Testing all patients with the defined symptoms in a sub-sample of practices is rarely possible because of the workload in the GPs offices during an influenza epidemic but does allow the number of positives to be used as an indicator. Usually, a sub-sample of GPs is asked to test a limited number of patients suffering with the symptoms given as selection criteria. In this case, the rate of positives is the better indicator for the influenza activity. However, the low number of tests particularly when flu is circulating at a low level limits the statistical sensitivity of this parameter. The specificity of the criteria given for the selection of patients being swabbed and the sensitivity of the test largely determine the function between the rate of positives and the influenza activity. The virological results are mostly interpreted in a more qualitative way, to see if influenza is circulating significantly. For this interpretation, more specific selection criteria (CD) seem useful and a high sensitivity for an increasing circulation can be expected.
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Affiliation(s)
- H Uphoff
- Deutsches Grünes Kreuz, Schuhmarkt 4, 35039 Marburg, Germany.
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Bricaire F, Cohen JM, Jacquet M, Boucot I, Nicolas M. Patient perspective on zanamivir in the treatment of influenza. Int J Clin Pract 2002; 56:7-10. [PMID: 11831842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Placebo-controlled clinical studies have shown zanamivir to be an effective treatment of influenza A and influenza B illness. This survey, conducted in France, was done to evaluate patients' perception of zanamivir in clinical practice. Between January and mid-April 2000, 271 retail pharmacists gave questionnaires to patients with a prescription for zanamivir to be completed on a voluntary basis. A total of 514 patients returned completed questionnaires, of whom 97 (19%) were considered at high risk of developing influenza complications. Fifty-one (10%) patients, mainly those over 65 years, were vaccinated against influenza. Fever or feverishness was reported by 93% of patients, and cough, myalgia and headache by 72%. Most (58%) patients consulted their doctor within 24 hours of the onset of symptoms, and 96% within 48 hours. Eighty-five per cent of patients overall and 82% of high-risk individuals (82/97) reported being satisfied with their zanamivir treatment. Treatment compliance was high with 75% of patients completing the whole course of treatment. Symptom relief was reported by 45% of patients within 24 hours and by 74% of patients within 48 hours; 66% of patients resumed normal activities within 72 hours. These results suggest that patient satisfaction is high and compliance with zanamivir is highly satisfactory. In addition, the use of zanamivir was reported to be associated with rapidsymptom relief and return to normal activity
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Affiliation(s)
- F Bricaire
- Infectious and Tropical Diseases Department, Pitié Salpétrière Hospital, Paris, France
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Chhieng DC, Elgert P, Cohen JM, Cangiarella JF. Clinical implications of atypical glandular cells of undetermined significance, favor endometrial origin. Cancer 2001; 93:351-6. [PMID: 11748574 DOI: 10.1002/cncr.10139] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Bethesda System recommends qualifying atypical glandular cells with regard to their possible origin: endocervical versus endometrial. This study was undertaken to determine the clinical significance of atypical glandular cells of undetermined significance that favor an endometrial origin (AGUS-EM). METHODS A computer search identified 62 cervicovaginal smears (5.25% of all smears classified as AGUS) with a diagnosis of AGUS-EM in the files of Shared Cytopathology Laboratory of New York University Medical Center/Bellevue Hospital Medical Center between January 1995 and December 1999. The patients ranged in age from 29 years to 88 years (mean age, 53 years). Thirty-four patients were postmenopausal (55%), and 5 patients were on hormonal replacement therapy. Follow-up was available for 56 patients (90%); 45 patients (73%) underwent biopsy, and 11 patients (17%) had repeat cervicovaginal smears. Six patients were lost to follow-up. RESULTS Among patients who underwent biopsy, 14 patients (31%) had a clinically significant uterine lesions, including 6 (13%) endometrial adenocarcinomas, 5 (11%) endometrial hyperplasias, and 3 (7%) squamous lesions (2 high-grade squamous intraepithelial lesions and 1 squamous cell carcinoma). Ten of 11 patients with significant endometrial pathology findings were postmenopausal. The remaining 31 patients had benign pathology results, which included chronic cervicitis, endometritis, endometrial polyps, microglandular hyperplasia, and tubal metaplasia. Among the patients with repeat cervicovaginal smears, one patient had atypical squamous cells of undetermined significance; the remaining patients were within normal limits. CONCLUSIONS Approximately one-third of women with a diagnosis of AGUS-EM had a significant uterine lesion on subsequent biopsy; the majority of these lesions were endometrial in origin. Patients with a diagnosis of AGUS-EM on cervicovaginal smears should be followed closely, and endometrial curettage or biopsy should be included in their initial work-up.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, University of Alabama at Birmingham, 35249-6823, USA.
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Chhieng DC, Cangiarella JF, Zakowski MF, Goswami S, Cohen JM, Yee HT. Use of thyroid transcription factor 1, PE-10, and cytokeratins 7 and 20 in discriminating between primary lung carcinomas and metastatic lesions in fine-needle aspiration biopsy specimens. Cancer 2001; 93:330-6. [PMID: 11668468 DOI: 10.1002/cncr.9048] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The distinction of a primary lung carcinoma from a metastatic lesion is important, because the treatment and prognosis differ for patients with these malignancies. Such a distinction can be difficult because of overlapping cytologic features. It has been shown that antibodies to thyroid transcription factor 1 (TTF-1) and PE-10 are fairly specific markers for primary lung tumors in histologic specimens. TTF-1 regulates the expression of surfactant protein production, and PE-10 is a monoclonal antibody against components of human surfactant proteins. The combination of cytokeratin 7 (CK7) and cytokeratin 20 (CK20) immunoprofiling has been helpful in the identification of the primary site of origin of lung tumors. METHODS In the current study, the authors evaluated the utility of TTF-1 and PE-10 immunostaining and also compared the staining with expression of CK7 and CK20 in the discrimination between primary lung tumors and metastatic lesions in 55 specimens from fine-needle aspiration (FNA) biopsies of the lung. Formalin fixed, paraffin embedded cell blocks from 35 primary lung tumors (16 adenocarcinomas, 8 squamous cell carcinomas, 6 large cell undifferentiated carcinomas, and 5 small cell carcinomas) and 20 metastatic carcinomas (6 breast lesions, 6 colon lesions, 3 urinary bladder lesions, 2 kidney lesions, 1 biliary tract lesion, 1 endometrial lesion, and 1 thyroid lesion) were immunostained with monoclonal antibodies to TTF-1, PE-10, CK7, and CK 20. Positive immunostaining for CK7, CK20, and PE-10 was based on cytoplasmic staining, whereas TTF-1 positive staining was based on nuclear staining of the neoplastic cells. RESULTS Positive immunostaining with TTF-1 and PE-10 was noted in six primary lung tumors (17%). One metastatic lesion (5%) and two metastatic lesions (10%) were positive for TTF-1 and PE-10, respectively. The CK7 positive/CK20 negative immunophenotype was noted in 30 primary lung tumors (86%) and in 11 metastatic lesions (55%). The CK7 negative/CK20 negative immunophenotype was seen in four metastatic lesions and in the remaining five primary lung tumors. The CK7 negative/CK20 positive and CK7 positive/CK20 positive immunophenotypes were seen in two and three metastatic lesions, respectively, but in none of the primary lung tumors. When a CK7 positive/CK20 negative adenocarcinoma also demonstrated either TTF-1 positive or PE-10 positive staining, it was likely that the adenocarcinoma was of pulmonary origin (P < 0.035; Fisher exact test). The specificity of such a combination for discriminating between primary and metastatic adenocarcinomas was 94%. CONCLUSIONS The results suggest that TTF-1, PE-10, or CK7/CK20 alone did not distinguish reliably between primary pulmonary tumors carcinomas and metastatic neoplasms of the lung in FNA biopsy specimens because of low sensitivity and specificity. The use of a panel of antibodies that includes CK7/CK20, TTF-1, and PE-10 may be helpful in discriminating between primary and metastatic adenocarcinomas of the lung. An adenocarcinoma is likely a primary lung tumor when it is of the CK7 positive/CK20 negative phenotype and demonstrates either TTF-1 positive or PE-10 positive staining.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, University of Alabama at Birmingham, 35249-6823, USA.
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Hummel P, Cangiarella JF, Cohen JM, Yang G, Waisman J, Chhieng DC. Transthoracic fine-needle aspiration biopsy of pulmonary spindle cell and mesenchymal lesions: a study of 61 cases. Cancer 2001; 93:187-98. [PMID: 11391606 DOI: 10.1002/cncr.9028] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Spindle cell and mesenchymal lesions of the lung encompass a wide variety of benign and malignant conditions. However, to the authors' knowledge, because of their rarity, few reports concerning their cytologic findings are available in the literature. The current review emphasizes the cytomorphologic features, differential diagnosis, and potential pitfalls associated with these lesions. METHODS Seven hundred seventy-nine percutaneous lung fine-needle aspiration (FNA) specimens were retrieved from the authors' cytopathology files over a period of 5 years. Sixty-one cases (7.8%) in which a spindle cell component was the dominant or key feature were identified. The authors reviewed the cytologic smears, immunocytochemical studies, and corresponding surgical material and clinical information. RESULTS Of these 61 aspirates, 33 (54%) were reactive processes (31 granulomas, 1 organizing pneumonia, and 1 inflammatory pseudotumor). Five cases (0.8%) were benign neoplasms (2 hamartomas, 2 solitary fibrous tumors, and 1 schwannoma). Twenty-three cases (38%) were malignant neoplasms (8 cases were primary tumors [including 5 carcinomas with spindle cell or sarcomatoid features, 1 spindle cell carcinoid tumor, 1 leiomyosarcoma, and 1 synovial sarcoma] and 15 cases were secondary tumors [including 9 melanomas, 2 leiomyosarcomas, 1 malignant fibrous histiocytoma, 1 meningioma, 1 sarcomatoid renal cell carcinoma, and 1 uterine malignant mixed müllerian tumor]). A specific diagnosis was rendered in 52 cases (85%). No false-positive cases were encountered but there was one false-negative case. One patient who was diagnosed with granulomatous inflammation on FNA was found to have nonsmall cell lung carcinoma on subsequent transbronchial biopsy. No malignant cells were identified in the smears on review. The FNA from the organizing pneumonia was interpreted as a solitary fibrous tumor whereas the inflammatory pseudotumor was diagnosed as granulomatous inflammation. The FNA from one pulmonary hamartoma initially was considered to be nondiagnostic. One solitary fibrous tumor and the schwannoma were diagnosed as smooth muscle tumor and spindle cell tumor, not otherwise specified, respectively. Among the malignant tumors, the primary synovial sarcoma and one of the metastatic malignant melanomas initially were interpreted as primitive neuroectodermal tumor/Ewing sarcoma and poorly differentiated carcinoma, respectively. CONCLUSIONS Spindle cell lesions of the lung rarely are encountered on transthoracic lung FNA and are comprised of a wide variety of benign and malignant entities. By correlating clinical and radiologic data, cytologic findings, and ancillary studies, a high diagnostic accuracy rate can be achieved with FNA.
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Affiliation(s)
- P Hummel
- Department of Pathology, New York University Medical Center, New York, New York, USA
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Cangiarella J, Waisman J, Cohen JM, Chhieng D, Symmans WF, Axelrod D, Gross J. Radial sclerosing lesion: correlation between mammotome core biopsy and surgical excision. Breast J 2001; 7:66-7. [PMID: 11348419 DOI: 10.1046/j.1524-4741.2001.007001066.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Cangiarella
- Department of Pathology, New York University Medical Center, New York, New York, USA
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Abstract
OBJECTIVE To determine the frequency of atypical glandular cells of undetermined significance (AGUS) for three consecutive calendar years from three different referral sources. STUDY DESIGN Cervicovaginal smears with a diagnosis of AGUS were identified from January 1995 through December 1997. The smears were submitted from three different sources: two were city government hospital clinics, one with predominantly African American and Hispanic patients and the other with predominantly Asian and Hispanic patients. The third referral source was private practitioners' offices with predominantly Caucasian patients. RESULTS A diagnosis of AGUS was made in 707 cases, accounting for 0.56% of all smears examined. This was in contrast to 6,872 smears reported as atypical squamous cells of undetermined significance (ASCUS) (5.4%) and 3,347 reported as squamous intraepithelial lesions (SIL) or above (2.7%). The incidence of AGUS ranged from 0.16% to 1.00% among different patient populations. This difference was also noted in the rate of ASCUS and SIL in the same patient population. There was a steady increase in the rate of AGUS for each referral source during the study period. The overall rate of patients who underwent histologic evaluation and the incidence of biopsy-proven preinvasive and invasive lesions were 62.4% and 23%, respectively. There was no significant difference in the rate of significant lesions after a diagnosis of AGUS during the study period or between the three referral sources. CONCLUSION The AGUS rate in our laboratory was low and within the range (0.17-1.83%) reported in the literature. The AGUS rate varies with different patient populations, particularly with the incidence of SIL and age distribution.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, New York University Medical Center, New York, New York, USA
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Diver CS, Cohen JM. Genophobia: what is wrong with genetic discrimination? Univ PA Law Rev 2001; 149:1439-1482. [PMID: 12741378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Abstract
OBJECTIVE To study the clinical significance of atypical glandular cells of undertermined significance (AGUS) in pregnant and postpartum women. STUDY DESIGN We evaluated 35 women who were pregnant (30) or within three months postpartum (5) and had a cytologic diagnosis of AGUS. Twenty-seven (77%) patients had follow-up: 17 (63%) patients underwent colposcopic examination and biopsy, and 10 (37%) had repeat Pap smears. Eight patients were lost to follow-up. RESULTS Five (29.4%) patients had a squamous intraepithelial lesion (SIL), including three high grade and two low grade, on subsequent biopsy. The remaining (70.6%) patients had benign pathology, which included 5 chronic cervicitis, 4 endocervical and/or endometrial polyps, 2 Arias-Stella reaction and 1 microglandular hyperplasia. Among the patients with repeat Pap smears, two had persistent AGUS/atypical squamous cells of undetermined significance, the remaining cases were within normal limits. CONCLUSION Pregnancy-related changes may present with glandular atypia. In addition, about one-third of pregnant and postpartum women with a diagnosis of AGUS had SIL on subsequent biopsy; that rate is similar to that in nonpregnant women. Therefore, pregnant women with a cytologic diagnosis of AGUS should be followed closely.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, New York University Medical Center, New York, New York, USA.
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