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Radhoe SP, Boersma E, Bertrand M, Remme W, Ferrari R, Fox K, MacMahon S, Chalmers J, Simoons ML, Brugts JJ. The Effects of a Perindopril-Based Regimen in Relation to Statin Use on the Outcomes of Patients with Vascular Disease: a Combined Analysis of the ADVANCE, EUROPA, and PROGRESS Trials. Cardiovasc Drugs Ther 2024; 38:131-139. [PMID: 36194352 PMCID: PMC10876738 DOI: 10.1007/s10557-022-07384-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the effects of a perindopril-based regimen on cardiovascular (CV) outcomes in patients with vascular disease in relation to background statin therapy. METHODS A pooled analysis of the randomized ADVANCE, EUROPA, and PROGRESS trials was performed to evaluate CV outcomes in 29,463 patients with vascular disease treated with perindopril-based regimens versus placebo. The primary endpoint was a composite of CV mortality, nonfatal myocardial infarction, and stroke. Multivariable Cox regression analyses were performed to assess the effects of a perindopril-based regimen versus placebo in relation to statin use. RESULTS At randomization, 39.5% of the overall combined study population used statins. After a mean follow-up of 4.0 years (SD 1.0), the cumulative event-free survival was highest in the statin/perindopril group and lowest in the no statin/placebo group (91.2% vs. 85.6%, respectively, log-rank p < 0.001). In statin users (adjusted hazard ratio [aHR] 0.87, 95% confidence interval [CI] 0.77-0.98) and non-statin users (aHR 0.80, 95% CI 0.74-0.87), a perindopril-based regimen was associated with a significantly lower risk of the primary endpoint when compared to placebo. The additional treatment effect appeared numerically greater in non-statin users, but the observed difference was statistically nonsignificant. CONCLUSION Our data suggest that the treatment benefits of a perindopril-based regimen in patients with vascular disease are independent of statin use.
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Affiliation(s)
- S P Radhoe
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands.
| | - E Boersma
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | | | - W Remme
- STICARES Cardiovascular Research Institute, Rhoon, the Netherlands
| | - R Ferrari
- Department of Cardiology, University of Ferrara, Ferrara, Italy
| | - K Fox
- NHLI, Imperial College and Royal Brompton Hospital, London, UK
| | - S MacMahon
- The George Institute for Global Health, The University of NSW, Sydney, NSW, Australia
| | - J Chalmers
- The George Institute for Global Health, The University of NSW, Sydney, NSW, Australia
| | - M L Simoons
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - J J Brugts
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
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Lancaster JJ, Grijalva A, Fink J, Ref J, Daugherty S, Whitman S, Fox K, Gorman G, Lancaster LD, Avery R, Acharya T, McArthur A, Strom J, Pierce MK, Moukabary T, Borgstrom M, Benson D, Mangiola M, Pandey AC, Zile MR, Bradshaw A, Koevary JW, Goldman S. Biologically derived epicardial patch induces macrophage mediated pathophysiologic repair in chronically infarcted swine hearts. Commun Biol 2023; 6:1203. [PMID: 38007534 PMCID: PMC10676365 DOI: 10.1038/s42003-023-05564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/09/2023] [Indexed: 11/27/2023] Open
Abstract
There are nearly 65 million people with chronic heart failure (CHF) globally, with no treatment directed at the pathologic cause of the disease, the loss of functioning cardiomyocytes. We have an allogeneic cardiac patch comprised of cardiomyocytes and human fibroblasts on a bioresorbable matrix. This patch increases blood flow to the damaged heart and improves left ventricular (LV) function in an immune competent rat model of ischemic CHF. After 6 months of treatment in an immune competent Yucatan mini swine ischemic CHF model, this patch restores LV contractility without constrictive physiology, partially reversing maladaptive LV and right ventricular remodeling, increases exercise tolerance, without inducing any cardiac arrhythmias or a change in myocardial oxygen consumption. Digital spatial profiling in mice with patch placement 3 weeks after a myocardial infarction shows that the patch induces a CD45pos immune cell response that results in an infiltration of dendritic cells and macrophages with high expression of macrophages polarization to the anti-inflammatory reparative M2 phenotype. Leveraging the host native immune system allows for the potential use of immunomodulatory therapies for treatment of chronic inflammatory diseases not limited to ischemic CHF.
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Affiliation(s)
- J J Lancaster
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - A Grijalva
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - J Fink
- Division of Blood & Marrow Transplant & Cellular Therapy, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA
| | - J Ref
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - S Daugherty
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - S Whitman
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - K Fox
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - G Gorman
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - L D Lancaster
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - R Avery
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - T Acharya
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - A McArthur
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - J Strom
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - M K Pierce
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - T Moukabary
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - M Borgstrom
- Research & Discovery Tech, Research Computing Specialist, Principal, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - D Benson
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - M Mangiola
- Department of Pathology, NYU Grossman School of Medicine, New York City, NY, 11016, USA
| | - A C Pandey
- Section of Cardiology, Tulane University Heart and Vascular Institute, John W. Deming Department of Medicine, Section of Cardiology, Department of Medicine, Southeast Louisiana Veterans Healthcare System, Tulane University School of Medicine, New Orleans, LA, 70122, USA
| | - M R Zile
- Ralph H. Johnson VA Medical Center, Division of Cardiology, Medical University of South Carolina, Thurmond/Gazes Building, 30 Courtenay Drive, Charleston, SC, 29425, USA
| | - A Bradshaw
- Ralph H. Johnson VA Medical Center, Division of Cardiology, Medical University of South Carolina, Thurmond/Gazes Building, 30 Courtenay Drive, Charleston, SC, 29425, USA
| | - J W Koevary
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
- Biomedical Engineering, College of Engineering, University of Arizona, 1127 E. James E. Rogers Way, Tucson, AZ, 85721, USA
| | - S Goldman
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA.
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Cowell K, Pang TY, Kwok JS, McCrowe C, Langenberg F, Easton D, Williams C, Davis SM, Donnan GA, De Aizpurua H, Balabanski A, Dos Santos A, Fox K. Can We Miniaturize CT Technology for a Successful Mobile Stroke Unit Roll-Out? Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-5. [PMID: 38083304 DOI: 10.1109/embc40787.2023.10340965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Mortality from stroke remains high in Australia, especially for patients located outside the metropolitan cities. This is because they have limited access to specialized stroke facilities for optimal stroke treatment. Mobile stroke units have the capability to take CT scanners out to the patient however current CT commercial scanner designs are large and heavy. As such, this paper aims to design and develop a lightweight CT scanner for use in a mobile stroke unit (either road-based or air-based ambulance) to bring healthcare solution to patients in the rural and remote areas. We used the engineering design optimization approach to redesign and reduce the weight of the existing CT scanner with without compromised it structural performance. We managed to reduce the weight the CT scanner by three-fold while reducing design costs by allowing numerous simulations to be performed using computer software to achieve our design goals. The results are not only useful to optimize CT scanner structure to retrofit on a mobile stroke unit, but also bring the medical device solution to the market and support scalable solution to the larger community. Such an advance will allow for improved equity in healthcare whereby patients can be treated irrespective of location.
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Fernández Silva B, Jackson M, Fox K, Wynne BP. Tool for automatic macrozone characterization from EBSD data sets of titanium alloys. J Appl Crystallogr 2023; 56:737-749. [PMID: 37284269 PMCID: PMC10241041 DOI: 10.1107/s1600576723003862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
Microtexture heterogeneities are commonly found in titanium forgings because of the thermomechanical processing. Also known as macrozones, these regions can reach millimetres in length, with grains sharing a similar crystallographic orientation leading to less resistance to crack propagation. Since the link between macrozones and the reduction of cold-dwell-fatigue performance on rotative components in gas turbine engines was established, efforts have been put into macrozone definition and characterization. The electron backscatter diffraction (EBSD) technique, widely used for texture analysis, allows for a qualitative macrozone characterization; however, further processing is required to define the boundaries and disorientation spread of each macrozone. Current approaches often use c-axis misorientation criteria, but this can sometimes lead to a large disorientation spread within a macrozone. This article describes the development and application of a computational tool implemented in MATLAB for automatic macrozone identification from EBSD data sets on the basis of a more conservative approach where both the c-axis tilting and rotation are considered. The tool allows for detection of macrozones according to the disorientation angle and density-fraction criteria. The clustering efficiency is validated by pole-figure plots, and the effects of the key parameters defining the macrozone clustering (disorientation and fraction) are discussed. In addition, this tool was successfully applied to both fully equiaxed and bimodal microstructures of titanium forgings.
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Affiliation(s)
- B Fernández Silva
- Department of Material Science and Engineering, University of Sheffield, Sheffield S1 3JD, United Kingdom
| | - M Jackson
- Department of Material Science and Engineering, University of Sheffield, Sheffield S1 3JD, United Kingdom
| | - K Fox
- Rolls-Royce plc, PO Box 31, Derby DE24 8BJ, United Kingdom
| | - B P Wynne
- Department of Material Science and Engineering, University of Sheffield, Sheffield S1 3JD, United Kingdom
- Department of Mechanical and Aerospace Engineering, University of Strathclyde, 75 Montrose Street, Glasgow G1 1XJ, United Kingdom
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Pareek M, Bhatt DL, Zheng L, Lee JJ, Leiter LA, Simon T, Mehta SR, Harrington RA, Fox K, Himmelmann A, Vidal-Petiot E, Steg PG. Blood pressure and clinical outcomes in patients with diabetes and stable coronary artery disease in THEMIS. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Various BP characteristics, e.g., systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), as well as heart rate (HR) may affect the risk of both cardiovascular events and bleeding events. However, the exact way in which these characteristics and outcomes are associated among patients with diabetes and stable coronary artery disease (CAD) remains debated. Moreover, it is unknown whether the risks and benefits of intensified antiplatelet therapy in this patient population are affected by their baseline BP and HR.
Purpose
To assess the relationship between BP components (including HR) and cardiovascular and bleeding events, and to determine if the effects of ticagrelor vs. placebo varied across the BP and HR spectrum, in patients with diabetes and stable CAD.
Methods
THEMIS was a randomized, controlled trial in which 19,220 individuals ≥50 years of age with stable CAD and type 2 diabetes were randomized to receive either ticagrelor plus aspirin or placebo plus aspirin. Patients with a prior myocardial infarction or stroke, or already on dual antiplatelet therapy, were excluded. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety outcome was TIMI major bleeding. We examined prognostic implications of BP components using 1) restricted cubic splines for the overall trends with outcomes; 2) Cox proportional-hazards regression models with predefined BP component intervals adjusted for demographic, clinical, and laboratory variables; and 3) Cox regression models for the effects of ticagrelor vs. placebo on outcomes across the spectrum of BP component values (test for interaction). THEMIS is registered at ClinicalTrials.gov (NCT01991795).
Results
Mean values of baseline BP components were similar between the two study groups. Median follow-up duration was 39.9 months (range 0–57), with 1554 primary efficacy events and 306 primary safety events occurring over the course of the study. All BP components (including HR) displayed various, independent relationships with the tested outcomes. For example, in adjusted spline models, SBP displayed non-linear relationships with the primary outcome, all-cause death, any bleeding, serious adverse events, and intracranial bleeding, and linear relationships with the remaining outcomes. Figure 1 shows the associations of each BP component with the primary efficacy outcome. BP components did not substantially modify the risks and benefits of ticagrelor vs. placebo for the tested outcomes.
Conclusions
BP components were independently associated with efficacy and safety outcomes in patients with stable CAD and type 2 diabetes. However, no important modification of BP components on the effect of ticagrelor vs. placebo was detected.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- M Pareek
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - D L Bhatt
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - L Zheng
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - J J Lee
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - L A Leiter
- St. Michael's Hospital , Toronto , Canada
| | - T Simon
- Sorbonne University , Paris , France
| | - S R Mehta
- McMaster University , Hamilton , Canada
| | - R A Harrington
- Stanford University Medical Center , Stanford , United States of America
| | - K Fox
- Royal Brompton Hospital Imperial College London , London , United Kingdom
| | - A Himmelmann
- AstraZeneca BioPharmaceuticals , Molndal , Sweden
| | - E Vidal-Petiot
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
| | - P G Steg
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
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Barrowcliff A, Khan M, Fox K, Khatib R. Management of statin intolerance in a pharmacy led cardiology innovative medicines optimisation lipid clinic. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Statins are cornerstone in the management of atherosclerotic cardiovascular disease. If a patient has experienced clinically significant adverse drug reactions (ADRs), representing an unacceptable risk or may result in adherence issues, we would consider them intolerant. The prevalence is lower in randomised trials than cohort observational studies, 5% vs. 17%.
Purpose
To assess how many people we reviewed in clinic were able to be re-challenged and successfully continued on a statin, free from side effects.
Methods
Over 6 months we reviewed all patients referred to our innovative clinic for lipid optimisation labelled as “statin intolerant”. Initially, as per our protocol, we adopted a person-centred approach and explored this label (actual vs. potential concerns, any previous issues, symptoms experienced and timings, statins tried (if any), and patient's feelings on re-challenge). A statin re-challenge was offered if not contraindicated. If agreed, based on shared-decision making, we offered patients a once weekly statin (usually rosuvastatin 5mg) with a clear self-management plan to up/down-titrate frequency and dose, until they identify a tolerated regimen. We measured LDL-C at baseline and every 3 months thereafter until satisfactory.
Results
Of 207 patients referred 152 (73%) were labelled as “statin intolerant”. Average age was 62 (±11), 51% females. 78% for secondary prevention and 37% had familial hypercholesterolaemia. The average baseline LDL-C was 4.4mmol/L. 108 (71%) qualified for PCSK9 inhibitors therapy (PCSK9i) as per UK NICE guidance.
The top 3 reported ADRs were musculoskeletal side effects (48%), GI upsets (13%) and deranged LFTs (7%).
25 (58%) of those “intolerant” who did not qualify for PCSK9i attempted a re-challenge with statins vs. 44 (41%) among those who qualified.
Of the 69 patients, who accepted a re-challenge, 43 (62%) were successfully restarted on a statin. At an average of 14 months post re-challenge, LDL-C (available for >80% of the sample) was reduced by an average of 31% in those not on PCSK9i, compared to a 62% reduction (sustained over an average of 40 months) in those on combination therapy with PCSK9i.
The top 3 rosuvastatin regimens established were 5mg OD (29%), 5mg weekly (24%) and 10mg OD (15%). Approximately 80% of patients were on rosuvastatin, and the rest accepted atorvastatin, pravastatin or simvastatin.
There was no attempt to re-challenge in 77 (51%) patients, mostly due to choice (45%) or statins re-challenged prior to referral (44%). We stopped statins in 6 cases due to intolerable ADRs.
Conclusion(s)
By using a person-centred approach, and a variety of strategies to tackle “statin intolerance” we have successfully re-established over 60% of patients with very high CVD risk on statins. While patients who qualified for PCSK9i therapy were less likely to consider re-challenge with statins (41% v 58%), combination lipid-lowering therapies produced better reduction in LDL-C.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - M Khan
- Leeds Teaching Hospitals , Leeds , United Kingdom
| | - K Fox
- Leeds Teaching Hospitals , Leeds , United Kingdom
| | - R Khatib
- Leeds Teaching Hospitals , Leeds , United Kingdom
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Reyburn R, Tuivaga E, Ratu F, Dunne E, Nand D, Kado J, Jenkins K, Tikoduadua L, Jenney A, Howden B, Ballard S, Fox K, Devi R, Satzke C, Rafai E, Kama M, Flasche S, Mulholland E, Russell F. The impact of 10-valent pneumococcal vaccine introduction on invasive disease in Fiji. Lancet Reg Health West Pac 2022; 20:100352. [PMID: 35028629 PMCID: PMC8741523 DOI: 10.1016/j.lanwpc.2021.100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND In 2012, Fiji introduced the 10-valent pneumococcal conjugate vaccine (PCV10). We assessed the impact of PCV10 on invasive pneumococcal disease (IPD), probable bacterial or pneumococcal meningitis (PBPM), meningitis and sepsis 3-5 years post-introduction. METHODS Laboratory-confirmed IPD and PBPM cases were extracted from national laboratory records. ICD-10-AM coded all-cause meningitis and sepsis cases were extracted from national hospitalisation records. Incidence rate ratios were used to compare outcomes pre/post-PCV10, stratified by age groups: 1-23m, 2-4y, 5-9y, 10-19y, 20-54y, ≥55y. To account for different detection and serotyping methods in the pre-and post-PCV10 period, a Bayesian inference model estimated serotype-specific changes in IPD, using pneumococcal carriage and surveillance data. FINDINGS There were 423 IPD, 1,029 PBPM, 1,391 all-cause meningitis and 7,611 all-cause sepsis cases. Five years post-PCV10 introduction, IPD declined by 60% (95%CI: 37%, 76%) in children 1-23m months old, and in age groups 2-4y, 5-9y, 10-19y although confidence intervals spanned zero. PBPM declined by 36% (95%CI: 21%, 48%) among children 1-23 months old, and in all other age groups, although some confidence intervals spanned zero. Among children <5y of age, PCV10-type IPD declined by 83% (95%CI; 70%, 90%) and with no evidence of change in non-PCV10-type IPD (9%, 95%CI; -69, 43%). There was no change in all-cause meningitis or sepsis. Post-PCV10, the most common serotypes in vaccine age-eligible and non-age eligible people were serotypes 8 and 23B, and 3 and 7F, respectively. INTERPRETATIONS Our study demonstrates the effectiveness of PCV10 against IPD in a country in the Asia-Pacific of which there is a paucity of data. FUNDING This study was support by the Department of Foreign Affairs and Trade of the Australian Government and Fiji Health Sector Support Program (FHSSP). FHSSP is implemented by Abt JTA on behalf of the Australian Government.
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Affiliation(s)
- R. Reyburn
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - E.J. Tuivaga
- The Ministry of Health and Medical Services, Suva, Fiji
| | - F.T. Ratu
- The Ministry of Health and Medical Services, Suva, Fiji
| | - E.M. Dunne
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - D. Nand
- The Ministry of Health and Medical Services, Suva, Fiji
| | - J. Kado
- Fiji National University, Suva, Fiji
| | - K. Jenkins
- Australia's support to the Fiji health sector, Suva, Fiji
| | - L. Tikoduadua
- The Ministry of Health and Medical Services, Suva, Fiji
| | - A. Jenney
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Fiji National University, Suva, Fiji
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Victoria, Australia
| | - B.P. Howden
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
- WHO Regional Reference Laboratory for Invasive Bacterial-Vaccine Preventable Diseases (IB-VPD) for Western Pacific Region, Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - S.A. Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
- WHO Regional Reference Laboratory for Invasive Bacterial-Vaccine Preventable Diseases (IB-VPD) for Western Pacific Region, Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - K. Fox
- Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - R. Devi
- The Ministry of Health and Medical Services, Suva, Fiji
| | - C. Satzke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - E. Rafai
- The Ministry of Health and Medical Services, Suva, Fiji
| | - M. Kama
- The Ministry of Health and Medical Services, Suva, Fiji
| | - S. Flasche
- Centre for Mathematical Modelling for Infectious diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - E.K. Mulholland
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Centre for Mathematical Modelling for Infectious diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - F.M. Russell
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Graham C, Tan M, Chew D, Gale C, Fox K, Bagai A, Henderson M, Quraishi A, Dery J, Cheema A, Fisher H, Brieger D, Lutchmedial S, Lavi S, Wong B, Cieza T, Mehta S, Goodman S, Yan A. USE AND OUTCOME OF DUAL ANTIPLATELET THERAPY FOR ACUTE CORONARY SYNDROME IN PATIENTS WITH CHRONIC KIDNEY DISEASE: INSIGHTS FROM THE CANADIAN OBSERVATIONAL ANTIPLATELET STUDY (COAPT), A MULTICENTRE PROSPECTIVE COHORT STUDY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Corroenne R, Yepez M, Pyarali M, Fox K, Mastrobattista JM, Mack LM, Lee W, Whitehead WE, Castillo HA, Castillo J, Mehollin-Ray AR, Espinoza J, Shamshirsaz AA, Nassr AA, Belfort MA, Sanz Cortes M. Longitudinal evaluation of motor function in patients who underwent prenatal or postnatal neural tube defect repair. Ultrasound Obstet Gynecol 2021; 58:221-229. [PMID: 32730648 DOI: 10.1002/uog.22165] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/10/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare the evolution of motor function from mid-gestation to 12 months of age between prenatally and postnatally repaired cases of open neural tube defect (ONTD). METHODS This was a retrospective cohort study of all fetuses that underwent prenatal (fetoscopic or open hysterotomy) or postnatal ONTD repair at a single institution between November 2011 and December 2018. The anatomical level of the lesion was defined as the upper bony spinal defect at initial magnetic resonance imaging assessment. Prenatal motor function of the lower extremities was evaluated by ultrasound according to the metameric level of the neurological lesion, based on the methodology of Carreras et al. Fetal motor function was assessed at referral, at 6 weeks after surgery in prenatally repaired cases or 6 weeks after referral in postnatally repaired cases (6-week follow-up) and at the last scan before delivery. In addition, motor function was assessed by a detailed neurological examination at birth and 12 months of age. First sacral (S1) neurological level of the lesion was considered as intact motor function. For statistical comparisons, we attributed numerical scores to each neurological level and motor function was expressed as median (range) neurological level. Motor function (as numerical score) and the proportion of cases with intact motor function and with motor function two or more levels better than expected based on the anatomical level of the lesion were compared between the prenatal- and postnatal-repair groups. Fetal motor function was compared to the anatomical level of the lesion at referral and a better motor function was defined when it was two or more levels better than the anatomical level of the lesion. To assess the evolution of motor function, we compared motor function at referral with that at each follow-up assessment using paired t-tests. RESULTS We included 127 patients with ONTD, of whom 93 underwent prenatal (51 fetoscopic and 42 open hysterotomy) and 34 postnatal repair. At the time of referral, cases in the prenatal- and postnatal-repair groups presented with a similar anatomical level of lesion (L3 (T9-S1) vs L3 (T7-S1); P = 0.52), similar motor function (S1 (L1-S1) vs S1 (L1-S1); P = 0.52) and a similar proportion of cases with intact motor function (81% vs 79%; P = 0.88) and with motor function two or more levels better than expected based on the anatomical level of the lesion (62% vs 74%; P = 0.24). When compared with prenatally repaired cases, postnatally repaired cases showed worse motor function at birth (S1 (L1-S1) vs L4 (L1-S1); P < 0.01) and at 12 months of age (S1 (L1-S1) vs L4 (L1-S1); P < 0.01). In the prenatal-repair group, motor function remained stable from the time of referral to 12 months of age (P = 0.26). Furthermore, the proportion of patients with intact motor function at referral (81% (75/93)) was similar to that at the 6-week follow-up (74% (64/87)), at the last scan before birth (74% (42/57)), at birth (68% (63/93)) and at 12 months of age (67% (39/58)) in the prenatal-repair group. In the postnatal-repair group, worse motor function, starting from the third trimester to 12 months of age, was observed. The proportion of patients with intact motor function at referral (79% (27/34)) was similar to that at 6-week follow-up (80% (12/15); P = 0.92), but was lower at the last assessment before birth (25% (2/8); P < 0.01), at birth (24% (8/34); P < 0.01) and at 12 months of age (28% (7/25); P < 0.01). Similar findings were noted when assessing the evolution of the proportion of cases with motor function two or more levels better than expected based on the anatomical level of the lesion in each group. CONCLUSIONS Infants with ONTD that underwent postnatal repair had worse motor function at birth and at 12 months of age than at mid-gestation and when compared with infants that underwent prenatal ONTD repair. Prenatal motor function assessment by ultrasound is an adequate tool to identify those infants who should have a good clinical motor function after delivery. Information obtained by fetal motor function assessment can have an important role for patient counseling and case selection for surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Corroenne
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - M Yepez
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - M Pyarali
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - K Fox
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - J M Mastrobattista
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - L M Mack
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - W Lee
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - W E Whitehead
- Department of Neurosurgery, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - H A Castillo
- Department of Developmental Pediatrics, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - J Castillo
- Department of Developmental Pediatrics, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - A R Mehollin-Ray
- E. B. Singleton Department of Pediatric Radiology, Texas Children's Hospital & Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - A A Nassr
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - M Sanz Cortes
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
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10
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Curzen N, Nicholas Z, Stuart B, Wilding S, Hill K, Shambrook J, Eminton Z, Ball D, Barrett C, Johnson L, Nuttall J, Fox K, Connolly D, O'Kane P, Hobson A, Chauhan A, Uren N, Mccann GP, Berry C, Carter J, Roobottom C, Mamas M, Rajani R, Ford I, Douglas P, Hlatky MA. Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J 2021; 42:3844-3852. [PMID: 34269376 PMCID: PMC8648068 DOI: 10.1093/eurheartj/ehab444] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/10/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Aims Fractional flow reserve (FFRCT) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFRCT would improve economic and clinical outcomes compared with standard care. Methods and results Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFRCT (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFRCT. Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from −£112 (−8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). Conclusion A strategy of CTCA with selective FFRCT in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography.
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Affiliation(s)
- N Curzen
- Faculty of Medicine, University of Southampton.,Coronary Research Group, University Hospital Southampton
| | - Z Nicholas
- Coronary Research Group, University Hospital Southampton
| | - B Stuart
- Clinical Trials Unit, University of Southampton
| | - S Wilding
- Clinical Trials Unit, University of Southampton
| | - K Hill
- Clinical Trials Unit, University of Southampton
| | - J Shambrook
- Cardiothoracic Radiology, University Hospital Southampton
| | - Z Eminton
- Clinical Trials Unit, University of Southampton
| | - D Ball
- Clinical Trials Unit, University of Southampton
| | - C Barrett
- Clinical Trials Unit, University of Southampton
| | - L Johnson
- Clinical Trials Unit, University of Southampton
| | - J Nuttall
- Clinical Trials Unit, University of Southampton
| | - K Fox
- Imperial College, London, UK
| | | | - P O'Kane
- Dorset Heart Centre, University Hospitals Dorset, Bournemouth
| | - A Hobson
- Queen Alexandra Hospital, Portsmouth
| | | | - N Uren
- Royal Infirmary, Edinburgh
| | - G P Mccann
- Department of Cardiovascular Sciences, University of Leicester & NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - C Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow
| | - J Carter
- University Hospital of North Tees, Stockton on Tees
| | | | - M Mamas
- Royal Stoke University Hospital, Stoke-on-Trent
| | - R Rajani
- Guy's & St Thomas' Hospital, London
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow
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11
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Fox K, Fox J, Bexfield N, Freeman P. Computerised decision support in veterinary medicine, exemplified in a canine idiopathic epilepsy care pathway. J Small Anim Pract 2021; 62:911-917. [PMID: 34155645 DOI: 10.1111/jsap.13345] [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: 11/11/2020] [Revised: 02/23/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022]
Abstract
Computerised decision support is of emerging and increasing importance in human medicine, but as yet has not been thoroughly applied or evaluated in veterinary medicine. In this essay, the authors report on the first example of a veterinary care pathway, a specific form of computerised decision support, which guides clinicians through a clinical workflow and incorporates individual patient data to inform patient-specific decision recommendations. The veterinary care pathway was designed using consensus statements and specialist neurologist opinion to create a decision support tool concerning canine idiopathic epilepsy. The authors evaluated the care pathway by comparing 35 clinical decisions made by referral clinicians in historical cases of idiopathic epilepsy to decisions recommended by the care pathway when presented with the same clinical case. Their results show that in 77.1% (95% confidence interval [59.9, 89.6]) of cases the care pathway recommended a decision that was the same or similar to a specialist neurologist's decision. Whilst further studies are needed to explore the potential use of such technology in clinical practice, the authors believe this first application provides great promise of a new and alternative method of clinical decision support.
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Affiliation(s)
- K Fox
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, UK
| | - J Fox
- Department of Engineering, University of Oxford, Oxford, Oxfordshire, OX1 3PJ, UK
| | - N Bexfield
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, UK
| | - P Freeman
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, UK
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12
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Affiliation(s)
- K Fox
- Baylor College of Medicine, Houston, Texas, USA
| | - S L Collins
- The Fetal Medicine Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,The Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
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13
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Gautier A, Ducrocq G, Elbez Y, Fox K, Ferrari R, Ford I, Tardif J, Tendera M, Steg G. Chronic coronary syndrome patients with polyarterial disease are a high risk but heterogenous subset of patients. Insights from the CLARIFY registry. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.002] [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: 11/27/2022]
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14
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Steg P, Bhatt D, James S, Darlington O, Hoskin L, Simon T, Fox K, Leiter L, Mehta S, Harrington R, Himmelmann A, Ridderstrale W, Andersson M, Mellstrom C, Mcewan P. Cost-effectiveness of ticagrelor in patients with type 2 diabetes and coronary artery disease with a history of PCI: an economic evaluation of THEMIS-PCI using a Swedish healthcare perpective. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) evaluated ticagrelor compared to placebo for the prevention of myocardial infarction (MI), stroke and cardiovascular (CV) death in 19 220 patients with type 2 diabetes (T2DM) and stable coronary artery disease (CAD) with no prior myocardial infarction (MI) or stroke. THEMIS-PCI was a pre-specified subgroup of 11 154 patients who had a history of percutaneous coronary intervention (PCI) when entering the study. In THEMIS, ticagrelor reduced CV death, MI or stroke, although with an increase in major bleeding compared to aspirin alone, and there was a significant interaction between a prior history of PCI and the net benefit of ticagrelor. In the THEMIS-PCI population, ticagrelor plus aspirin provided a favourable net clinical benefit with a significant 15% reduction in all-cause death, MI, stroke, fatal bleed, or intracranial haemorrhage.
Objective
The objective of this analysis was to estimate the cost-effectiveness of ticagrelor for the prevention of CV events based on the results of the THEMIS-PCI population using a lifetime horizon from a Swedish healthcare perspective.
Methods
A lifetime Markov state transition model was developed with health states aligned to the THEMIS trial endpoints. Health state transitions were informed by parametric survival equations fitted to patient level data from THEMIS-PCI population. Treatment discontinuation rates were informed by the THEMIS-PCI population, with all patients assumed to discontinue treatment with ticagrelor after four years. The incidence of bleeding and dyspnoea were modelled as adverse events. Costs (2019 Euros) and utility data were derived from the published literature and the THEMIS-PCI population, respectively, and discounted at 3.0% annually. Probabilistic (PSA) and deterministic sensitivity analysis (DSA) were conducted to quantify uncertainty of key input parameters.
Results
Treatment with ticagrelor plus aspirin over four years resulted in estimated Quality Adjusted Life Year (QALY) gains of 0.09 at an incremental cost of €1,891 compared to aspirin alone. The estimated incremental cost-effectiveness ratio (ICER) was €19,959/QALY. PSA indicated that ticagrelor was cost-effective in 93% of simulations using a willingness-to-pay threshold of €47,000/QALY and DSA showed that cost-effectiveness was robust to changes in key input parameters (ICER range: €16,504 to €25,012/QALY).
Conclusion
Based on the results of the THEMIS trial, dual antiplatelet therapy with ticagrelor plus aspirin is likely to be a cost-effective treatment compared with aspirin alone for the prevention of CV events in patients with T2DM and CAD with a history of PCI.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- P Steg
- Hospital Bichat-Claude Bernard, Paris, France
| | - D.L Bhatt
- Brigham and Women's Hospital, Boston, United States of America
| | - S.K James
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - O Darlington
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - L Hoskin
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - T Simon
- Hôpital Saint Antoine, Sorbonne-Université, Paris, France
| | - K Fox
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | | | - S Mehta
- McMaster University, Hamilton, Canada
| | | | | | | | | | | | - P Mcewan
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
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15
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Biscaglia S, Campo G, Fox K, Tardif J, Tendera M, Greenlaw N, Ford I, Stanley B, Ferrari R, Steg P. Prognosis in patients with prior myocardial infarction and PEGASUS-TIMI 54 criteria in the CLARIFY registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The PEGASUS-TIMI 54 trial showed that prolonged treatment with ticagrelor reduces the cumulative occurrence of ischemic adverse events. CLARIFY is the biggest real life registry on chronic coronary syndrome.
Purpose
- To evaluate the percentage of patients eligible for long-term ticagrelor therapy in the CLARIFY registry.
– To compare the outcome of this subgroup of patients with those with PEGASUS exclusion criteria or without PEGASUS inclusion criteria.
Methods
Within the CLARIFY population, we selected post MI patients and we excluded those with missing info (post MI evaluable population). Then, we divided patients into 3 groups: excluded (meeting PEGASUS exclusion criteria, namely use of P2Y12 receptor antagonists or chronic oral anticoagulant, any stroke, coronary-artery bypass grafting in the past 5 years); eligible (meeting PEGASUS high-risk inclusion criteria, namely age≥65 years; diabetes; multivessel disease; creatinine clearance <60 ml/min) and ineligible (not meeting PEGASUS high-risk inclusion criteria).
We therefore compared the ischemic (CV death, MI and stroke) and bleeding (major bleeding) outcome of the 3 groups adjusting for age, sex, smoking and geographical region.
Results
Among the 11811 post-MI evaluable patients, 4706 (39.8%) were included in the eligible group, 5715 (48.4%) in the excluded group, and 1390 in the ineligible group (11.8%). Both the ischemic and bleeding endpoints were significantly different among the 3 groups with the excluded patients with the worst and ineligible patients with the best outcome (see table). The same trend was shown for CV death, while the occurrence of MI was not significantly different among the 3 groups. In the eligible group, the ratio between ischemic and bleeding events was 6:1, whereas between CV death and major bleeding was 3.5:1.
Conclusions
Around 40% of CLARIFY post-MI patients could benefit from prolonged ticagrelor therapy. In this group of patients, ischemic risk seems to be higher than the bleeding one.
Ischemic & bleeding risk in the 3 groups
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): CLARIFY registry was funded by Servier
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Affiliation(s)
- S Biscaglia
- Azienda Ospedaliero Universitaria Sant'Anna, Ferrara, Ferrara, Italy
| | - G Campo
- Azienda Ospedaliero Universitaria Sant'Anna, Ferrara, Ferrara, Italy
| | - K Fox
- Imperial College London, NHLI, London, United Kingdom
| | - J.C Tardif
- Montreal Heart Institute, Montreal, Canada
| | - M Tendera
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - N Greenlaw
- University of Glasgow, Glasgow, United Kingdom
| | - I Ford
- University of Glasgow, Glasgow, United Kingdom
| | - B Stanley
- University of Glasgow, Glasgow, United Kingdom
| | - R Ferrari
- University Hospital of Ferrara, Medical Sciences, Ferrara, Italy
| | - P.G Steg
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
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16
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Yu KH, Palmer N, Fox K, Prock L, Mandl KD, Kohane IS, Prilutsky D. The phenotypical implications of immune dysregulation in fragile X syndrome. Eur J Neurol 2020; 27:590-593. [PMID: 31953887 DOI: 10.1111/ene.14146] [Citation(s) in RCA: 8] [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] [Received: 09/17/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Immune system dysfunction and inflammatory dysregulation have been shown in several animal models of fragile X syndrome (FXS). However, the phenotypical implications of this dysregulation have not been systematically evaluated in a large patient cohort. METHODS Five thousand seven hundred thirty-six FXS patients from a nationwide health insurance database were identified and compared to 573 600 age- and sex-matched controls. The phenome-wide association studies codes of FXS patients and those without FXS were compared and the false discovery rate was controlled at 0.05 using the Benjamini-Hochberg procedure. RESULTS In addition to the commonly reported comorbidities of FXS, an over-representation of infectious diseases, including otitis media, cellulitis and abscess of fingers or toes, viral enteritis, candidiasis and pneumonia, was discovered. In addition, there was an under-representation of autoimmune disorders in FXS patients. CONCLUSIONS Our systematic comorbidity analyses identified immunologically-based phenotypes associated with FXS. Our findings align with previous observations of compromised immunity and phagocytic defects in animal models of FXS. These results suggest the importance of immune-related pathways in FXS patients and their relevance to the FMR1 gene.
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Affiliation(s)
- K-H Yu
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - N Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - K Fox
- Aetna Inc., Hartford, Connecticut, USA
| | - L Prock
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - K D Mandl
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - I S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - D Prilutsky
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
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17
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Sen J, Tonkin A, Varigos J, Fonguh S, Berkowitz S, Yusuf S, Verhamme P, Vanassche T, Anand S, Fox K, Eikelboom J, Amerena J. 023 Risk Stratification Using CHA2DS2-VASc and CHADS2 Scores in Patients With Chronic Atherosclerotic Cardiovascular Disease Receiving Aspirin With or Without Rivaroxaban: An Analysis of the COMPASS Trial. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Chiu ES, Fox K, Wolfe L, Vandewoude S. A novel test for determination of wild felid-domestic cat hybridization. Forensic Sci Int Genet 2019; 44:102160. [PMID: 31683165 DOI: 10.1016/j.fsigen.2019.102160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/23/2019] [Accepted: 09/04/2019] [Indexed: 12/22/2022]
Abstract
In October 2018, Colorado Parks and Wildlife seized an animal believed to be an illegally possessed bobcat. The owner claimed the animal was a bobcat/domestic cat hybrid, exempted from license requirements. Burden of proof lay with CPW to determine the lineage of the animal. Commercial microsatellite arrays and DNA barcoding have not been developed for identification of bobcat/domestic cat hybrids, and limited time and resources prevented development of such tests for this application. Instead, we targeted endogenous feline leukemia virus (enFeLV) to quickly and inexpensively demonstrate the absence of domestic cat DNA in the contested animal. Using this assay, we were able to confirm that the contested animal lacked enFeLV, and therefore was not a domestic cat hybrid.
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Affiliation(s)
- E S Chiu
- Colorado State University, 1619 Campus Delivery, Fort Collins, CO 80523 USA
| | - K Fox
- Colorado Parks and Wildlife, 317 W Prospect Rd, Fort Collins, CO 80526 USA
| | - L Wolfe
- Colorado Parks and Wildlife, 317 W Prospect Rd, Fort Collins, CO 80526 USA
| | - S Vandewoude
- Colorado State University, 1619 Campus Delivery, Fort Collins, CO 80523 USA.
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Fox K, Virdone S, Pieper K. P5708Balancing risk and benefit in patients with atrial fibrillation: the GARFIELD-AF risk score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The GARFIELD-AF risk tool was originally developed to predict future risk of adverse events in patients with atrial fibrillation (AF) using a range of baseline clinical variables. In the present work a new, improved risk tool was developed using data from all five GARFIELD cohorts gathered over 2 years' follow-up.
Purpose
To derive a new integrated risk tool for predicting mortality, stroke/systemic embolism (SE), and major bleeding in AF patients up to 2 years after enrolment and compare the risk tool versus CHA2DS2-VASc and HAS-BLED.
Methods
GARFIELD-AF is an international prospective registry of nonvalvular AF patients diagnosed within 6 weeks prior to enrolment and having at least one risk factor for stroke. In this study only the first occurrence of events was considered. Event rates were estimated using a Poisson model. Potential predictors of events including a large set of demographics, clinical characteristics, choice of treatment, and lifestyle factors were identified, and a Cox proportional hazards model chosen for each outcome by least absolute shrinkage and selection operator (LASSO). Indices were compared versus models of CHA2DS2-VASc and HAS-BLED.
Results
Among a total 52,080 patients enrolled 52,032 (male, 55.8%; median age, 71 years) had available follow-up data. At 2 years, 3702 patients had died (event rate, 3.82 [95% CI, 3.70–3.95] per 100 patient-years) whereas non-haemorrhagic stroke/SE was noted in 957 patients (rate, 1.00 [95% CI, 0.94–1.06] per 100 patient-years) and major bleed/haemorrhagic stroke in 673 patients (rate, 0.70 [95% CI, 0.65–0.75] per 100 patient-years). The GARFIELD risk tool outperformed CHA2DS2-VASc and HAS-BLED at predicting all adverse events in the overall population and pre-selected subpopulations over 2 years. Notably, the new model identified use of OAC therapy, which is not included in CHA2DS2-VASc, as one of the strongest predictors of risk of mortality and stroke, and unlike HAS-BLED, could discriminate a lower risk of bleeding in patients treated with NOACs versus VKAs.
Population All-cause mortality Stroke/SE Major bleeding* GARFIELD CHA2DS2-VASc GARFIELD CHA2DS2-VASc GARFIELD CHA2DS2-VASc Overall 0.76 (0.75–0.76) 0.66 (0.65–0.67) 0.68 (0.67–0.70) 0.64 (0.62–0.66) – – AC treated 0.74 (0.73–0.75) 0.65 (0.64–0.66) 0.68 (0.66–0.70) 0.65 (0.62–0.67) 0.67 (0.64–0.69) 0.63 (0.61–0.65) *Model only considers AC-treated patients.
Conclusions
The GARFIELD-AF risk tool demonstrated good calibration and discrimination, outperforming CHA2DS2-VASc at predicting risk of death and non-haemorrhagic stroke and HAS-BLED for major bleed in AF patients over 2 years.
Acknowledgement/Funding
The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.
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Affiliation(s)
- K Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Virdone
- Thrombosis Research Institute, London, United Kingdom
| | - K Pieper
- Thrombosis Research Institute, London, United Kingdom
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Triolo TM, Fouts A, Pyle L, Yu L, Gottlieb PA, Steck AK, Greenbaum CJ, Atkinson M, Baidal D, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Clements M, Colman P, DiMeglio L, Gitelman S, Goland R, Gottlieb P, Herold K, Knip M, Krischer J, Lernmark A, Moore W, Moran A, Muir A, Palmer J, Peakman M, Philipson L, Raskin P, Redondo M, Rodriguez H, Russell W, Spain L, Schatz D, Sosenko J, Wentworth J, Wherrett D, Wilson D, Winter W, Ziegler A, Anderson M, Antinozzi P, Benoist C, Blum J, Bourcier K, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Insel R, Kaufman F, Kay T, Leschek E, Mahon J, Marks J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Pugliese A, Roep B, Roncarolo M, Savage P, Simell O, Sherwin R, Siegelman M, Skyler J, Steck A, Thomas J, Trucco M, Wagner J, Krischer JP, Leschek E, Rafkin L, Bourcier K, Cowie C, Foulkes M, Insel R, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Rafkin L, Sosenko JM, Kenyon NS, Santiago I, Krischer JP, Bundy B, Abbondondolo M, Dixit S, Pasha M, King K, Adcock H, Atterberry L, Fox K, Englert N, Mauras J, Permuy K, Sikes T, Adams T, Berhe B, Guendling L, McLennan L, Paganessi C, Murphy M, Draznin M, Kamboj S, Sheppard V, Lewis L, Coates W, Amado D, Moore G, Babar J, Bedard D, Brenson-Hughes J, Cernich M, Clements R, Duprau S, Goodman L, Hester L, Huerta-Saenz A, Asif I, Karmazin T, Letjen S, Raman D, Morin W, Bestermann E, Morawski J, White A, Brockmyer R, Bays S, Campbell A, Boonstra M, Stapleton N, Stone A, Donoho H, Everett H, Hensley M, Johnson C, Marshall N, Skirvin P, Taylor R, Williams L, Burroughs C, Ray C, Wolverton D, Nickels C, Dothard P, Speiser M, Pellizzari L, Bokor K, Izuora S, Abdelnour P, Cummings S, Cuthbertson D, Paynor M, Leahy M, Riedl S, Shockley R, Saad T, Briones S, Casella C, Herz K, Walsh J, Greening F, Deemer M, Hay S, Hunt N, Sikotra L, Simons D, Karounos R, Oremus L, Dye L, Myers D, Ballard W, Miers R, Eberhard C, Sparks K, Thraikill K, Edwards J, Fowlkes S, Kemp A, Morales L, Holland L, Johnson P, Paul A, Ghatak K, Fiske S, Phelen H, Leyland T, Henderson D, Brenner E, Oppenheimer I, Mamkin C, Moniz C, Clarson M, Lovell A, Peters V, Ford J, Ruelas D, Borut D, Burt M, Jordan S, Castilla P, Flores M, Ruiz L, Hanson J, Green-Blair R, Sheridan K, Garmeson J, Wintergerst G, Pierce A, Omoruyi M, Foster S, Kingery A, Lunsford I, Cervantes T, Parker P, Price J, Urben I, Guillette H, Doughty H, Haydock V, Parker P, Bergman S, Duncum C, Rodda A, Perelman R, Calendo C, Barrera E, Arce-Nunez Y, Geyer S, Martinez M, De la Portilla I, Cardenas L, Garrido M, Villar R, Lorini E, Calandra G, D’Annuzio K, Perri N, Minuto C, Hays B, Rebora R, Callegari O, Ali J, Kramer B, Auble S, Cabrera P, Donohoue R, Fiallo-Scharer M, Hessner P, Wolfgram A, Henderson C, Kansra N, Bettin R, McCuller A, Miller S, Accacha J, Corrigan E, Fiore R, Levine T, Mahoney C, Polychronakos V, Henry M, Gagne H, Starkman M, Fox D, Chin F, Melchionne L, Silverman I, Marshall L, Cerracchio J, Cruz A, Viswanathan J, Heyman K, Wilson S, Chalew S, Valley S, Layburn A, Lala P, Clesi M, Genet G, Uwaifo A, Charron T, Allerton W, Hsiao B, Cefalu L, Melendez-Ramirez R, Richards C, Alleyn E, Gustafson M, Lizanna J, Wahlen S, Aleiwe M, Hansen H, Wahlen C, Karges C, Levy A, Bonaccorso R, Rapaport Y, Tomer D, Chia M, Goldis L, Iazzetti M, Klein C, Levister L, Waldman E, Keaton N, Wallach M, Regelmann Z, Antal M, Aranda C, Reynholds A, Vinik P, Barlow M, Bourcier M, Nevoret J, Couper S, Kinderman A, Beresford N, Thalagne H, Roper J, Gibbons J, Hill S, Balleaut C, Brennan J, Ellis-Gage L, Fear T, Gray L, Law P, Jones C, McNerney L, Pointer N, Price K, Few D, Tomlinson N, Leech D, Wake C, Owens M, Burns J, Leinbach A, Wotherspoon A, Murray K, Short G, Curry S, Kelsey J, Lawson J, Porter S, Stevens E, Thomson S, Winship L, Liu S, Wynn E, Wiltshire J, Krebs P, Cresswell H, Faherty C, Ross L, Denvir J, Drew T, Randell P, Mansell S, Lloyd J, Bell S, Butler Y, Hooton H, Navarra A, Roper G, Babington L, Crate H, Cripps A, Ledlie C, Moulds R, Malloy J, Norton B, Petrova O, Silkstone C, Smith K, Ghai M, Murray V, Viswanathan M, Henegan O, Kawadry J, Olson L, Maddox K, Patterson T, Ahmad B, Flores D, Domek S, Domek K, Copeland M, George J, Less T, Davis M, Short A, Martin J, Dwarakanathan P, O’Donnell B, Boerner L, Larson M, Phillips M, Rendell K, Larson C, Smith K, Zebrowski L, Kuechenmeister M, Miller J, Thevarayapillai M, Daniels H, Speer N, Forghani R, Quintana C, Reh A, Bhangoo P, Desrosiers L, Ireland T, Misla C, Milliot E, Torres S, Wells J, Villar M, Yu D, Berry D, Cook J, Soder A, Powell M, Ng M, Morrison Z, Moore M, Haslam M, Lawson B, Bradley J, Courtney C, Richardson C, Watson E, Keely D, DeCurtis M, Vaccarcello-Cruz Z, Torres K, Muller S, Sandberg H, Hsiang B, Joy D, McCormick A, Powell H, Jones J, Bell S, Hargadon S, Hudson M, Kummer S, Nguyen T, Sauder E, Sutton K, Gensel R, Aguirre-Castaneda V, Benavides, Lopez D, Hemp S, Allen J, Stear E, Davis T, O’Donnell R, Jones A, Roberts J, Dart N, Paramalingam L, Levitt Katz N, Chaudhary K, Murphy S, Willi B, Schwartzman C, Kapadia D, Roberts A, Larson D, McClellan G, Shaibai L, Kelley G, Villa C, Kelley R, Diamond M, Kabbani T, Dajani F, Hoekstra M, Sadler K, Magorno J, Holst V, Chauhan N, Wilson P, Bononi M, Sperl A, Millward M, Eaton L, Dean J, Olshan H, Stavros T, Renna C, Milliard, Brodksy L, Bacon J, Quintos L, Topor S, Bialo B, Bancroft A, Soto W, Lagarde H, Tamura R, Lockemer T, Vanderploeg M, Ibrahim M, Huie V, Sanchez R, Edelen R, Marchiando J, Palmer T, Repas M, Wasson P, Wood K, Auker J, Culbertson T, Kieffer D, Voorhees T, Borgwardt L, DeRaad K, Eckert E, Isaacson H, Kuhn A, Carroll M, Xu P, Schubert G, Francis S, Hagan T, Le M, Penn E, Wickham C, Leyva K, Rivera J, Padilla I, Rodriguez N, Young K, Jospe J, Czyzyk B, Johnson U, Nadgir N, Marlen G, Prakasam C, Rieger N, Glaser E, Heiser B, Harris C, Alies P, Foster H, Slater K, Wheeler D, Donaldson M, Murray D, Hale R, Tragus D, Word J, Lynch L, Pankratz W, Badias F, Rogers R, Newfield S, Holland M, Hashiguchi M, Gottschalk A, Philis-Tsimikas R, Rosal S, Franklin S, Guardado N, Bohannon M, Baker A, Garcia T, Aguinaldo J, Phan V, Barraza D, Cohen J, Pinsker U, Khan J, Wiley L, Jovanovic P, Misra M, Bassi M, Wright D, Cohen K, Huang M, Skiles S, Maxcy C, Pihoker K, Cochrane J, Fosse S, Kearns M, Klingsheim N, Beam C, Wright L, Viles H, Smith S, Heller M, Cunningham A, Daniels L, Zeiden J, Field R, Walker K, Griffin L, Boulware D, Bartholow C, Erickson J, Howard B, Krabbenhoft C, Sandman A, Vanveldhuizen J, Wurlger A, Zimmerman K, Hanisch L, Davis-Keppen A, Bounmananh L, Cotterill J, Kirby M, Harris A, Schmidt C, Kishiyama C, Flores J, Milton W, Martin C, Whysham A, Yerka T, Bream S, Freels J, Hassing J, Webster R, Green P, Carter J, Galloway D, Hoelzer S, Roberts S, Said P, Sullivan H, Freeman D, Allen E, Reiter E, Feinberg C, Johnson L, Newhook D, Hagerty N, White L, Levandoski J, Kyllo M, Johnson C, Gough J, Benoit P, Iyer F, Diamond H, Hosono S, Jackman L, Barette P, Jones I, Sills S, Bzdick J, Bulger R, Ginem J, Weinstock I, Douek R, Andrews G, Modgill G, Gyorffy L, Robin N, Vaidya S, Crouch K, O’Brien C, Thompson N, Granger M, Thorne J, Blumer J, Kalic L, Klepek J, Paulett B, Rosolowski J, Horner M, Watkins J, Casey K, Carpenter C, Michelle Kieffer MH, Burns J, Horton C, Pritchard D, Soetaert A, Wynne C, Chin O, Molina C, Patel R, Senguttuvan M, Wheeler O, Lane P, Furet C, Steuhm D, Jelley S, Goudeau L, Chalmers D, Greer C, Panagiotopoulos D, Metzger D, Nguyen M, Horowitz M, Linton C, Christiansen E, Glades C, Morimoto M, Macarewich R, Norman K, Patin C, Vargas A, Barbanica A, Yu P, Vaidyanathan W, Nallamshetty L, Osborne R, Mehra S, Kaster S, Neace J, Horner G, Reeves C, Cordrey L, Marrs T, Miller S, Dowshen D, Oduah V, Doyle S, Walker D, Catte H, Dean M, Drury-Brown B, Hackman M, Lee S, Malkani K, Cullen K, Johnson P, Parrimon Y, Hampton M, McCarrell C, Curtis E, Paul, Zambrano Y, Paulus K, Pilger J, Ramiro J, Luvon Ritzie AQ, Sharma A, Shor A, Song X, Terry A, Weinberger J, Wootten M, Lachin JM, Foulkes M, Harding P, Krause-Steinrauf H, McDonough S, McGee PF, Owens Hess K, Phoebus D, Quinlan S, Raiden E, Batts E, Buddy C, Kirpatrick K, Ramey M, Shultz A, Webb C, Romesco M, Fradkin J, Leschek E, Spain L, Savage P, Aas S, Blumberg E, Beck G, Brillon D, Gubitosi-Klug R, Laffel L, Vigersky R, Wallace D, Braun J, Lernmark A, Lo B, Mitchell H, Naji A, Nerup J, Orchard T, Steffes M, Tsiatis A, Veatch R, Zinman B, Loechelt B, Baden L, Green M, Weinberg A, Marcovina S, Palmer JP, Weinberg A, Yu L, Babu S, Winter W, Eisenbarth GS, Bingley P, Clynes R, DiMeglio L, Eisenbarth G, Hays B, Leschek E, Marks J, Matheson D, Rafkin L, Rodriguez H, Spain L, Wilson D, Redondo M, Gomez D, McDonald A, Pena S, Pietropaolo M, Shippy K, Batts E, Brown T, Buckner J, Dove A, Hammond M, Hefty D, Klein J, Kuhns K, Letlau M, Lord S, McCulloch-Olson M, Miller L, Nepom G, Odegard J, Ramey M, Sachter E, St. Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Pat Gallagher M, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Pugliese A, Sanders-Branca N, Ray Arce LA, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Peterson Eck S, Finney L, Albright Fischer T, Martin A, Jacqueline Muzamhindo C, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Jo Ricci M, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Teresa Muscato M, Viscardi M, Bingley P, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del A, Rio A, Logan H, Collier C, Rishton G, Whalley A, Ali S, Ramtoola T, Quattrin L, Mastrandea A, House M, Ecker C, Huang C, Gougeon J, Ho D, Pacuad D, Dunger J, May C, O’Brien C, Acerini B, Salgin A, Thankamony R, Williams J, Buse G, Fuller M, Duclos J, Tricome H, Brown D, Pittard D, Bowlby A, Blue T, Headley S, Bendre K, Lewis K, Sutphin C, Soloranzo J, Puskaric H, Madison M, Rincon M, Carlucci R, Shridharani B, Rusk E, Tessman D, Huffman H, Abrams B, Biederman M, Jones V, Leathers W, Brickman P, Petrie D, Zimmerman J, Howard L, Miller R, Alemzadeh D, Mihailescu R, Melgozza-Walker N, Abdulla C, Boucher-Berry D, Ize-Ludlow R, Levy C, Swenson, Brousell N, Crimmins D, Edler T, Weis C, Schultz D, Rogers D, Latham C, Mawhorter C, Switzer W, Spencer P, Konstantnopoulus S, Broder J, Klein L, Knight L, Szadek G, Welnick B, Thompson R, Hoffman A, Revell J, Cherko K, Carter E, Gilson J, Haines G, Arthur B, Bowen W, Zipf P, Graves R, Lozano D, Seiple K, Spicer A, Chang J, Fregosi J, Harbinson C, Paulson S, Stalters P, Wright D, Zlock A, Freeth J, Victory H, Maheshwari A, Maheshwari T, Holmstrom J, Bueno R, Arguello J, Ahern L, Noreika V, Watson S, Hourse P, Breyer C, Kissel Y, Nicholson M, Pfeifer S, Almazan J, Bajaj M, Quinn K, Funk J, McCance E, Moreno R, Veintimilla A, Wells J, Cook S, Trunnel J, Henske S, Desai K, Frizelis F, Khan R, Sjoberg K, Allen P, Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care 2019; 42:192-199. [PMID: 30061316 PMCID: PMC6341285 DOI: 10.2337/dc18-0288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.
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Affiliation(s)
- Taylor M. Triolo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alexandra Fouts
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Peter A. Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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Ronco C, Heifetz A, Fox K, Curtin C, Brendolan A, Gastaldon F, Crepaldi C, Fortunato A, Pietribasi G, Caberlotto A, Brunello A, Manani SM, Zanella M, La Greca G. Beta 2-microglobulin Removal by Synthetic Dialysis Membranes. Mechanisms and Kinetics of the Molecule. Int J Artif Organs 2018. [DOI: 10.1177/039139889702000303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Beta 2-microglobulin (ß2-m) accumulation represents a possible complication of long term dialysis. It is therefore important to evaluate the capacity of removal of this molecule from the patient by different dialysis membranes. The present study is aimed at evaluating the mechanisms involved in ß2-m removal by three different synthetic membranes: a) highly asymmetric hydrophobic polysulfone (Biosulfane, NMC), b) moderately asymmetric and hydrophobic polysulfone (PS600, Fresenius), c) Polyacylonitrile (AN69HF, Hospal). The adsorption capacity and sieving coefficients of the three membranes for native and labeled ß2-m were studied in vitro utilizing human blood. The amount adsorbed by the membrane was measured by the elution of the molecule obtained with a detergent solution. Clearances, total removal and membrane adsorption were studied in six patients treated in a randomized sequence with the three membranes. For this purpose, plasma and dialysate measurements as well as total collection of spent dialysate and ß2-m elution from the used dialyzers were carried out. Ex novo generation of ß2-m did not take place during in vitro circulation. The molecule was removed by the studied membranes both by filtration and adsorption. The Biosulfane membrane removed ß2-m mostly by adsorption while the PS600 membrane removed ß2-m almost entirely by filtration. Intermediate behaviour was shown by AN69 membrane. Similar quantities of ß2-m were removed from the patients with the three membranes. Total removal could only be precisely measured by adding the quantity of ß2-m eluted from the membrane to the amount recovered in the spent dialysate. Out of total removal, adsorption was more than 90% with Biosulfane, while only 5% with the PS600. These findings contribute to the understanding of the discrepancy found between the clearance measured from the plasma side and that measured from the dialysate side. In conclusion, clearance and sieving measurements for ß2-m cannot be correctly performed unless the capacity of adsorption of the membrane is taken into account.
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Affiliation(s)
- C. Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Heifetz
- Washington Research Center, Washington, DC
| | - K. Fox
- National Medical Care, Rockleigh, New Jersey - USA
| | - C. Curtin
- National Medical Care, Rockleigh, New Jersey - USA
| | - A. Brendolan
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - F. Gastaldon
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - C. Crepaldi
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Fortunato
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - G. Pietribasi
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Caberlotto
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Brunello
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - S. Milan Manani
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - M. Zanella
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - G. La Greca
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
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McKernon SL, Fox K, Balmer M. A randomised control trial evaluating non-technical skills acquisition using simulated situational training in oral surgery. Br Dent J 2018; 225:sj.bdj.2018.808. [PMID: 30287966 DOI: 10.1038/sj.bdj.2018.808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
- S L McKernon
- University of Liverpool, School of Dentistry, Pembroke Place, Liverpool, Merseyside L3 5PS
| | - K Fox
- University of Liverpool, School of Dentistry, Pembroke Place, Liverpool, Merseyside L3 5PS
| | - M Balmer
- University of Liverpool, School of Dentistry, Pembroke Place, Liverpool, Merseyside L3 5PS
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Boivin-Proulx L, Deneault-Marchand A, Matteau A, Mansour S, Camm J, Fox K, Potter B. UPTAKE OF THE 2016 CCS AF GUIDELINES FOR PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Brugts JJ, Bertrand M, Remme W, Ferrari R, Fox K, MacMahon S, Chalmers J, Simoons ML, Boersma E. The Treatment Effect of an ACE-Inhibitor Based Regimen with Perindopril in Relation to Beta-Blocker use in 29,463 Patients with Vascular Disease: a Combined Analysis of Individual Data of ADVANCE, EUROPA and PROGRESS Trials. Cardiovasc Drugs Ther 2018; 31:391-400. [PMID: 28856537 PMCID: PMC5607906 DOI: 10.1007/s10557-017-6747-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In everyday practice, angiotensin converting enzyme inhibitors and beta-blockers are cornerstone treatments in patients with (cardio-)vascular disease. Clear data that evaluate the effects of the combination of these agents on morbidity and mortality are lacking. METHODS In this retrospective pooled analysis of three large perindopril outcome trials (ADVANCE, EUROPA, PROGRESS), clinical outcomes were evaluated in 29,463 patients with vascular disease. Multivariate Cox regression analyses were performed in patients randomized to a perindopril-based regimen or placebo (treatment effect), and data were stratified according to background beta-blocker treatment. The primary endpoint was a composite of cardiovascular mortality, non-fatal myocardial infarction, and stroke. RESULTS The cumulative incidence of the primary endpoint over mean follow-up of 4.0 years (Sd 1.0) was significantly lower in the beta-blocker/perindopril group (9.6%; 545/5700 patients) as compared to beta-blocker/placebo (11.8%; 676/5718 patients) (p < 0.01). Adding perindopril to existing beta-blocker treatment reduced the relative risk of the primary endpoint by 20% (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.71-0.90), non-fatal myocardial infarction by 23% (HR 0.77; 95% CI 0.65-0.91), and all-cause mortality by 22% (HR 0.78; 95% CI 0.68-0.88) as compared to placebo. Significant treatment benefit was not observed for stroke (HR 0.93; 95% CI 0.75-1.15). Significance was maintained for the primary endpoint and cardiovascular endpoints when data were further stratified by baseline hypertension. However, the mortality benefit was only observed in patients with hypertension with background beta-blocker use. CONCLUSIONS These data suggest that the beneficial cardioprotective effects of perindopril treatment are additive to the background beta-blockers use.
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Affiliation(s)
- J J Brugts
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | | | - W Remme
- STICARES Cardiovascular Research Institute, Rhoon, The Netherlands
| | - R Ferrari
- Centro Cardiologico Universitario University of Ferrara, Italy and Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Ravenna, Italy
| | - K Fox
- NHLI, Imperial College and ICMS, Royal Brompton Hospital, London, UK
| | - S MacMahon
- The George Institute for Global Health, The Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - J Chalmers
- The George Institute for Global Health, The Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - M L Simoons
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - E Boersma
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Murray S, Carrera C, Lazure P, Vardas P, Zamorano JL, Kearney P, Goncalves L, Fox K, Vahanian A. Identifying the needs for competency-based education in Europe: a needs assessment of cardiologists across 52 countries. J Eur CME 2018; 6:1337478. [PMID: 29644134 PMCID: PMC5843045 DOI: 10.1080/21614083.2017.1337478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/16/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: This international needs assessment was mandated by the European Society of Cardiology (ESC) to obtain an in-depth understanding of the current gaps and challenges of European cardiology professionals, with the aim to provide evidence for the development of needs-driven educational and professional development activities. Methods: This ethics-approved needs assessment was conducted among cardiologists from all sub-specialties across 56 countries of Europe and the Mediterranean basin. A mixed-methods research approach was used, combining qualitative in-depth interviews and focus groups with a quantitative survey. Results: Seventy-four (74) cardiologists participated in the qualitative phase and 866 completed the survey. Respondents represented 52 of the 56 targeted countries. Three themes were identified: 1) Challenges in the clinical decision-making process, 2) Challenges in establishing the patient-physician relationship, and 3) Sub-optimal team communication and collaboration. Specific gaps and causalities related to each challenge were found. Although most of the gaps were common across countries and sub-specialties, some significant differences were noted. Conclusion: The findings of this needs assessment indicate gaps and challenges in clinical practice across countries and across sub-specialities. Taking cardiology as an example, this study identifies clear areas of focus, especially around issues of collaboration and communication, for targeted competency-based education in Europe.
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Affiliation(s)
- S Murray
- AXDEV Group Inc., Brossard, Canada
| | - C Carrera
- Education Department, European Society of Cardiology, Sophia Antipolis, France
| | - P Lazure
- Performance Improvement Research Division, AXDEV Group Inc., Brossard, Canada
| | - P Vardas
- Cardiology Department, Heraklion University Hospital, Heraklion (Crete), Greece
| | - J L Zamorano
- Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain
| | - P Kearney
- Cardiovascular Division, Cork University Hospital, Cork, Ireland
| | - L Goncalves
- Cardiology Department, University Hospitals of Coimbra, Coimbra, Portugal
| | - K Fox
- Cardiovascular Medicine, Imperial College, London, UK
| | - A Vahanian
- Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France
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DeMichele A, Soucier-Ernst DJ, Clark C, Shih N, Stavropoulos W, Maxwell KN, Feldman M, Lierbamen D, Morrissette JJD, Paul MR, Pan TC, Wang J, Belka GK, Chen Y, Yee S, Carpenter E, Fox K, Matro J, Clark A, Shah P, Domchek S, Bradbury A, Chodosh L. Abstract OT2-06-03: METAMORPH: METAstatic markers of recurrent tumor PHenotype for breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-06-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Up to 30% of patients diagnosed with breast cancer will develop recurrent disease within their lifetime, and currently this form of the disease is incurable. There are unmet needs to better understand underlying metastatic biology, identify new therapeutic targets and develop better methods for monitoring changes in disease, both to monitor response and elucidate resistance mechanisms. To address these needs, the METAMORPH Study encompasses a comprehensive approach that combines serial molecular tissue profiling at the RNA and DNA level with circulating markers (DTCs, CTCs, plasma tumor DNA), and ongoing assessment of therapeutic response.
METAMORPH is a prospective cohort study of women with suspected or confirmed recurrent breast cancer and accessible tumor by standard clinical biopsy, who are enrolled at the University of Pennsylvania prior to starting a new therapy for recurrent metastatic disease. The aims of this trial are to (1) evaluate the mechanisms through which recurrent breast cancer are genetically distinct from the primary tumor, (2) evaluate the circulating tumor biomarker trajectory of recurrent disease, (3) elucidate “escape pathways” of progressing tumors that emerge during the selective pressure of therapy, and (4) explore clinical utility of tumor and blood testing. The study protocol integrates research aims into clinical care, including a standardized approach to disease assessment and biopsy, pathologic confirmation of histology and receptor subtype, panel-based CLIA-approved genomic profiling, collection of research specimens, and standardized reporting of results, which are returned to patients and physicians. Patients are followed for treatment and outcome, and serial samples are collected at progression. A companion protocol, COMET, provides education about genomic testing and assesses patient understanding and impact of results. To date, 155 patients have enrolled, 142 (92%) have been biopsied, 120 (77%) have had sufficient DNA for molecular profiling and 109 (70%) have had genomic panel testing. Accrual is ongoing, with an initial target of 300 patients. Multiple sites within the UPHS Health System are enrolling. Contact information: angela.demichele@uphs.upenn.edu.
Key words: Metastatic disease, tumor profiling.
Citation Format: DeMichele A, Soucier-Ernst DJ, Clark C, Shih N, Stavropoulos W, Maxwell KN, Feldman M, Lierbamen D, Morrissette JJD, Paul MR, Pan T-C, Wang J, Belka GK, Chen Y, Yee S, Carpenter E, Fox K, Matro J, Clark A, Shah P, Domchek S, Bradbury A, Chodosh L. METAMORPH: METAstatic markers of recurrent tumor PHenotype for breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-06-03.
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Affiliation(s)
- A DeMichele
- University of Pennsylvania, Philadelphia, PA
| | | | - C Clark
- University of Pennsylvania, Philadelphia, PA
| | - N Shih
- University of Pennsylvania, Philadelphia, PA
| | | | - KN Maxwell
- University of Pennsylvania, Philadelphia, PA
| | - M Feldman
- University of Pennsylvania, Philadelphia, PA
| | - D Lierbamen
- University of Pennsylvania, Philadelphia, PA
| | | | - MR Paul
- University of Pennsylvania, Philadelphia, PA
| | - T-C Pan
- University of Pennsylvania, Philadelphia, PA
| | - J Wang
- University of Pennsylvania, Philadelphia, PA
| | - GK Belka
- University of Pennsylvania, Philadelphia, PA
| | - Y Chen
- University of Pennsylvania, Philadelphia, PA
| | - S Yee
- University of Pennsylvania, Philadelphia, PA
| | - E Carpenter
- University of Pennsylvania, Philadelphia, PA
| | - K Fox
- University of Pennsylvania, Philadelphia, PA
| | - J Matro
- University of Pennsylvania, Philadelphia, PA
| | - A Clark
- University of Pennsylvania, Philadelphia, PA
| | - P Shah
- University of Pennsylvania, Philadelphia, PA
| | - S Domchek
- University of Pennsylvania, Philadelphia, PA
| | - A Bradbury
- University of Pennsylvania, Philadelphia, PA
| | - L Chodosh
- University of Pennsylvania, Philadelphia, PA
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Lamy A, Eikelboom J, Bosch J, Fox K, Yusuf S, Tonkin A. Impact of Rivaroxaban Alone or in Combination With Aspirin Versus Aspirin in Preventing Graft Occlusion in Patients With CABG Surgery: The COMPASS CABG Analysis. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lee MH, Fox K, Goldwasser S, Lau DWM, Aliahmad B, Sarossy M. Green lasers are beyond power limits mandated by safety standards. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:5144-5147. [PMID: 28269425 DOI: 10.1109/embc.2016.7591885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There has been an increasing number of reports of people losing vision from laser exposure from pocket laser pointers despite the safety limit of 1 milliwatt (1mW) imposed by the Australian government. We hypothesize that this is because commercially available red and green laser pointers are exceeding their labeled power outputs. We tested the power outputs of 4 red and 4 green lasers which were purchased for less than AUD$30 each. The average of 10 measurements was recorded for each laser. We found that 3 out of 4 red lasers conformed to the 1mW safety standard; in contrast, all of the green lasers exceeded this limit, with one of the lasers recording an output of 127.9 mW. This contrast in compliance is explained by the construction of these lasers - green lasers are typically Diode Pumped Solid State (DPSS) lasers that can emit excessive infrared (IR) radiation with poor workmanship or inconsistent adherence to practices of safe design and quality control; red lasers are diode lasers which have limited power outputs due to `Catastrophic Optical Damage' (COD). Relevant professional bodies ought to advocate more strongly for stringent testing, quality control and licensing of DPSS lasers with a view towards government intervention to banning green laser pointer use.
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DeMichele AM, Clark AS, Holmes R, Volpe M, Medrano C, Troxel A, Fox K, Domchek S, Matro J, Bradbury A, Shih N, Feldman M, Hexner E, Bromberg J. Abstract P2-08-03: Targeting inflammatory pathways: A phase 2 trial of the JAK-inhibitor ruxolitinib in combination with exemestane for aromatase inhibitor-resistant, estrogen receptor-positive breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-08-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In vitro mechanisms link IL-6 to poor outcome in breast cancer via inflammatory pathways, activated JAK/STAT tumor signaling and upregulation of aromatase, leading to an aggressive tumor phenotype. Epidemiological data from our group and others support these mechanisms in women with ER-positive (+) disease. We therefore hypothesized that the JAK inhibitor, ruxolitinib (RUX, INCB018424; Incyte), would enhance activity of exemestane (EXE) in women with ER+ breast cancer who relapsed after non-steroidal aromatase inhibitor therapy, particularly among carriers of a germ-line polymorphism in IL-6, conferring elevated levels of IL-6 in the tumor microenvironment.
Methods: The “JAKEE trial” is a phase II trial to determine the safety and efficacy of RUX + EXE in postmenopausal women with relapsed, ER+ advanced breast cancer. Eligible patients were required to have progressed on a non-steroidal AI and either measureable or bone-only disease. CRP, a putative biomarker of tumor microenvironment inflammation, was measured at baseline and serially during treatment. Using a Simon 2-stage design, we treated 15 patients with RUX at 25 mg BID and EXE at 25mg daily on a continuous 28-day schedule. First stage results were previously presented (AACR, 2014). Accrual proceeded to second stage after no patient met the pre-defined stopping rule of grade (G) 3/4 toxicity requiring discontinuation from the study within the first treatment cycle. Due to the substantial rate of anemia requiring dose reductions, however, RUX dose was reduced to 15 mg BID in second stage.
Results: A total of 25 patients were enrolled; 24/25 had progressed on AI in metastatic setting; 1 relapsed on adjuvant AI. RUX+EXE was well-tolerated overall, with only 2 G4 events (creatinine elevation, hepatic failure); both were due to disease progression. 16% had G3 fatigue, anemia or hypertension; 12% had G3 neutropenia or depression. Other lower grade toxicities in >20% included musculoskeletal pain, increased ALT, and headache. Overall, patients stayed on therapy for a median of 3 cycles (range 2 – 21). There were no CR or PR, but 6/25 (24%) had prolonged disease control (SD> 6 months). Median CRP at study entry was 6.4 (range 0.3-38.9), with 8/25 (32%) having CRP>10. Achieving SD>6 months was not associated with baseline CRP (CRP>10 in 32% with vs. 33% without SD>6 months, p(exact)=1.0). A novel pharmacodynamic assay to assess STAT3 phosphorylation in peripheral blood mononuclear cells after RUX exposure demonstrated differential effects in patients with response.
Conclusions: Targeting JAK/STAT signaling in AI-resistant breast cancer with RUX+EXE was safe and well-tolerated. 24% of patients had prolonged SD, but baseline CRP level did not predict response. Correlative studies to determine whether host and/or tumor biomarkers predict response to therapy, including germline IL-6 genotype, immune profiles, p-STAT3 and estradiol levels, are currently underway.
Citation Format: DeMichele AM, Clark AS, Holmes R, Volpe M, Medrano C, Troxel A, Fox K, Domchek S, Matro J, Bradbury A, Shih N, Feldman M, Hexner E, Bromberg J. Targeting inflammatory pathways: A phase 2 trial of the JAK-inhibitor ruxolitinib in combination with exemestane for aromatase inhibitor-resistant, estrogen receptor-positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-08-03.
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Affiliation(s)
- AM DeMichele
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - AS Clark
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Holmes
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Volpe
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Medrano
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Troxel
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - K Fox
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Domchek
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Matro
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Bradbury
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Shih
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Feldman
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - E Hexner
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Bromberg
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
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Lawson KD, Lewsey JD, Ford I, Fox K, Ritchie LD, Tunstall-Pedoe H, Watt GCM, Woodward M, Kent S, Neilson M, Briggs AH. A cardiovascular disease policy model: part 2-preparing for economic evaluation and to assess health inequalities. Open Heart 2016; 3:e000140. [PMID: 27335653 PMCID: PMC4908904 DOI: 10.1136/openhrt-2014-000140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 02/17/2016] [Accepted: 04/13/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives This is the second of the two papers introducing a cardiovascular disease (CVD) policy model. The first paper described the structure and statistical underpinning of the state-transition model, demonstrating how life expectancy estimates are generated for individuals defined by ASSIGN risk factors. This second paper describes how the model is prepared to undertake economic evaluation. Design To generate quality-adjusted life expectancy (QALE), the Scottish Health Survey was used to estimate background morbidity (health utilities) and the impact of CVD events (utility decrements). The SF-6D algorithm generated utilities and decrements were modelled using ordinary least squares (OLS). To generate lifetime hospital costs, the Scottish Heart Health Extended Cohort (SHHEC) was linked to the Scottish morbidity and death records (SMR) to cost each continuous inpatient stay (CIS). OLS and restricted cubic splines estimated annual costs before and after each of the first four events. A Kaplan-Meier sample average (KMSA) estimator was then used to weight expected health-related quality of life and costs by the probability of survival. Results The policy model predicts the change in QALE and lifetime hospital costs as a result of an intervention(s) modifying risk factors. Cost-effectiveness analysis and a full uncertainty analysis can be undertaken, including probabilistic sensitivity analysis. Notably, the impacts according to socioeconomic deprivation status can be made. Conclusions The policy model can conduct cost-effectiveness analysis and decision analysis to inform approaches to primary prevention, including individually targeted and population interventions, and to assess impacts on health inequalities.
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Affiliation(s)
- K D Lawson
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK; Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - J D Lewsey
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - I Ford
- Robertson Centre for Biostatistics, Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - K Fox
- BHF Centre for Research Excellence, University of Edinburgh , Edinburgh , UK
| | - L D Ritchie
- Centre of Academic Primary Care, University of Aberdeen , Aberdeen , UK
| | - H Tunstall-Pedoe
- Institute of Cardiovascular Research, Ninewells Hospital, University of Dundee , Dundee , UK
| | - G C M Watt
- General Practice & Primary Care , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - M Woodward
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia; Oxford Martin School, University of Oxford, Oxford, UK
| | - S Kent
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - M Neilson
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - A H Briggs
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
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Timpka J, Fox T, Fox K, Honig H, Odin P, Martinez-Martin P, Antonini A, Ray Chaudhuri K. Improvement of dyskinesias with L-dopa infusion in advanced Parkinson's disease. Acta Neurol Scand 2016; 133:451-8. [PMID: 26358227 DOI: 10.1111/ane.12483] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We wanted to investigate whether continuous intrajejunal levodopa-carbidopa intestinal gel (LCIG) therapy has an antidyskinetic effect in patients with Parkinson's disease (PD) and troublesome dyskinesias. We also sought to examine the effect of LCIG therapy on motor function and health-related quality of life (HRQoL). MATERIALS AND METHODS This open-label pilot study used a single group pre-post design with follow-up at 6 months. Nine patients with PD who reported to spend at least 3 h per day in on with troublesome dyskinesia were included. The patients were examined at baseline using clinical and self-assessment measures and then switched from peroral/transdermal pharmacotherapy to LCIG therapy. Data collection was repeated 6 months after the pharmaceutical intervention. Nonparametric statistical methods were used for data analyses. RESULTS The mean time spent in on with troublesome dyskinesia per day after 6 months of LCIG therapy decreased by 47% (P < 0.05). This observation was paralleled by a 112% increase in mean time spent in on without troublesome dyskinesia (P < 0.01). Patient self-assessment of dyskinesia intensity on the visual analog scale displayed a 90% reduction of mean dyskinesia intensity (P < 0.01) and patients also exhibited less dyskinesia during standardized levodopa tests. Furthermore, we noted improvements in motor function and HRQoL. CONCLUSIONS In this pilot study, we found indications that LCIG therapy has a substantial antidyskinetic effect and could be an alternative also for PD patients with dyskinesias as a major symptom. However, further studies with blinded evaluation and larger numbers of patients are warranted to confirm the findings.
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Affiliation(s)
- J. Timpka
- Department of Clinical Sciences, Neurology; Lund University; Lund Sweden
| | - T. Fox
- Department of Neurology; Central Hospital; Bremerhaven Germany
| | - K. Fox
- Department of Neurology; Central Hospital; Bremerhaven Germany
| | - H. Honig
- Department of Neurology; Central Hospital; Bremerhaven Germany
| | - P. Odin
- Department of Clinical Sciences, Neurology; Lund University; Lund Sweden
- Department of Neurology; Central Hospital; Bremerhaven Germany
| | - P. Martinez-Martin
- National Center of Epidemiology and CIBERNED; Carlos III Institute of Health; Madrid Spain
| | - A. Antonini
- Parkinson's Disease and Movement Disorders Unit; IRCCS Hospital San Camillo; Venice Italy
| | - K. Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence; King's College Hospital; King's College; London UK
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Clark AS, O'Dwyer P, Troxel A, Lal P, Feldman M, Gallagher M, Driscoll A, Colameco C, Lewis D, Rosen M, Matro J, Bradbury A, Domchek S, Fox K, DeMichele A. Abstract P6-13-08: Palbociclib and paclitaxel on an alternating schedule for advanced breast cancer: Results of a phase Ib trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-13-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Palbociclib (P) is an oral CDK 4/6 inhibitor (CDKi) that was recently FDA approved in combination with endocrine therapy for metastatic breast cancer. We have performed a Phase I trial of P in combination with paclitaxel (T) based on preclinical studies suggesting that P synergizes with T when given on an alternating schedule, enabling cell cycle synchronization in tumor cells. We now present the dose expansion cohort.
Methods: Patients (Pts) enrolled on the trial had Rb-expressing tumors of any estrogen/progesterone/HER2 receptor type, adequate organ function, and ≤3 prior chemotherapy regimens for metastatic breast cancer (mBC). Prior adjuvant or metastatic taxane was allowed. Dose escalation led to expansion at P100mg or 75mg, starting with 3 days of P (run-in) and reduction of P dosing from 5-day to 3-day intervals (days 2-4, 9-11, 16-18 of each 28 day cycle). T at 80mg/m2 was given weekly for 3 cycles; thereafter, T was administered days 1, 8 and 15 of 28 day cycle. Weekly toxicity assessments were performed; RECIST 1.0 response was assessed every 2 cycles as partial response (PR), stable disease (SD) or progressive disease (PD). Pts had the option to discontinue T and continue on P alone (3 on/1 off schedule) if they attained SD after cycle 6.
Results: 27 pts enrolled on study (15- dose escalation, 12- dose expansion). Results are shown in the Table. 21 pts had received prior taxane; pts had received a median of 2 chemotherapy regimens for mBC. DLTs were grade 3 AST/ALT (n=1, at 125 mg) and febrile neutropenia (FN) (n=1, at 100 mg). Uncomplicated grade 3/4 NTP was common and frequently led to dose reduction or dose interruption during the first cycle of therapy. Frequency of NTP did not change with reducing the days of P. Among 24 evaluable patients, 14 (58%), had PR or SD ≥ 6 months across all dose levels. Of 14 pts who responded, 10 (71%) had received prior taxane. 20 pts are off study; 19 for PD, and 2 for toxicity (NTP in cycle 17 and FN in cycle 1); 7 pts remain on study. Prolonged tumor responses were seen.
Conclusions: P and T can be safely combined on an alternating dosing schedule; the optimal combination dose is 75 mg of P and 80mg/m2 of weekly T. The high response rate warrants a randomized trial to determine the incremental benefit over T alone. Additional mechanistic studies are in progress to understand the in vivo effects of the alternating dosing schedule on cell cycle activity and tumor proliferation.
Starting Dose Level P (mg)Number (Total 27)DLTGrade 3/4 NTP (n)Final Dose P mg (n)Dose Interruption (n)Best Response (n)5030050 (1) 50 (1) 50 (1)No (2) Yes (1)PR (1) SD (1) PD (1)7530275 (1) 50 (1) 25 (1)No (1) Yes (2)PR (2) SD (1)100605100 (2) 75 (3) 25 (1)No (1) Yes (5)PR (2) SD (1) PD (3)12531- LFT375 (1) 50 (2)No (0) Yes (3)PR (1) SD (2)75 (Run-In)60175 (5) 50 (1)No (4) Yes (2)PR (1) SD (2) PD (1) N/A (2)*100 (Run-In)61- FN5100 (1) 75 (4) 25(1)No (1) Yes (5)PR (4) SD (1) N/A (1)^*2 pts not yet evaluable. ^1 pt went off study due to FN after cycle 1.
Citation Format: Clark AS, O'Dwyer P, Troxel A, Lal P, Feldman M, Gallagher M, Driscoll A, Colameco C, Lewis D, Rosen M, Matro J, Bradbury A, Domchek S, Fox K, DeMichele A. Palbociclib and paclitaxel on an alternating schedule for advanced breast cancer: Results of a phase Ib trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-13-08.
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Affiliation(s)
- AS Clark
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - P O'Dwyer
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Troxel
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - P Lal
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Feldman
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Gallagher
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Driscoll
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - C Colameco
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - D Lewis
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Rosen
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - J Matro
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Bradbury
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - S Domchek
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - K Fox
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A DeMichele
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Soucier-Ernst D, Colameco C, Troxel AB, Clark C, Shih N, Maxwell KN, Morrissette J, Lieberman D, Feldman M, Goodman N, Bradbury A, Clark A, Domchek S, Fox K, Glick J, Matro J, Nathanson K, Chodosh L, DeMichele A. Abstract P6-07-05: Mutational spectrum and tumor response in metastatic breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-07-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: While several comprehensive genomic sequencing tests are clinically available for breast cancer(BC), little is known about the spectrum of findings reported in the general population and clinical utility of findings for patients(pts). Here we report tumor sequencing from the METAMORPH study, a comprehensive genomic testing approach in pts with metastatic(met) BC.
Methods: Pts with either known or suspected BC mets consented to and clinically underwent concurrent diagnostic and research tumor biopsies(bx). FFPE specimens were profiled via Illumina TruSeq Cancer Panel next generation sequencing platform covering 212 amplicons in 47 cancer genes. Pathology, treatment and outcome data were prospectively collected and tracked. Aside from Her2-directed treatment, therapy was not mutation (mut)-matched.
Results: 64 pts enrolled between 11/2013 – 05/2015. Of these, 48 had bx successfully sequenced (75%). Of those without sequencing, 5 had negative/insufficient tissue, 2 had insufficient DNA, remainder no bx/pending. Median age of those sequenced was 56 (range 31-78); 81% Caucasian, 17% African American. 25% (12 pts) presented with de novo stage IV disease. Of those with recurrence (n=36), 83% had prior adjuvant chemotherapy; 81% hormone receptor positive(HR+) had prior endocrine therapy. Median # prior lines of therapy for met disease was 2 (IQR 0 – 8). Tumor characteristics, including mut analyses, are shown in Table 1. # muts did not differ significantly by subtype(p=0.22). Frequency of TP53 and PIK3CA hotspot muts was nearly identical to TCGA. Median # muts was 1 for pts with both de novo mets and recurrence(p=0.79). # of muts was not associated with time to recurrence(p=0.80). Excluding pts found to have TP53 mut only or ERBB2 alterations in known Her2+ disease, 42% of pts were identified as having at least one potentially actionable alteration (PIK3CA mut, AKT1 mut or EGFR amplification). Median time to treatment failure(TTF) on subsequent therapy was 4.1 months for overall group, and 4.1, 6.2, and 1.6 months for HR+/Her2-, any Her2+ and TN, respectively, adjusted for line of therapy(p=0.03). After adjustment for # lines of prior met therapy, TTF was 4.7 vs. 4.1 months for pts with any mut vs. none(p=0.89); 5.7 vs 4.1 months for PIK3CA+ vs. not (p=0.94); 3.3 vs. 6.5 months for TP53+ vs. not (p=0.03).
Conclusion: Pts with met BC have frequent and potentially actionable muts.While overall # of muts did not affect response, tumors with TP53 muts had shorter response to subsequent therapy in this cohort. Additional data are needed to determine the clinical utility of mut testing in met BC, for both standard and mut-matched therapy.
Total (n=48)HR+/Her2- (n=28)Any HER2+ (n=7)TN (n=13)Receptor concordant with primary 100%78%77%# Mutations Median (Range)1 (0-4)1 (0-3)1 (1-2)1 (0-4)014 (29%)10 (36 %)04 (31%)118 (38%)11 (39%)4 (57%)3 (23%)213 (27%)5 (18%)3 (43%)5 (38%)3+3 (6%)2 (7%)01 (8%)Prevalent Mutations (>20%)TP53 (38%), PIK3CA (35%)PIK3CA (50%), TP53 (25%)TP53 (60%), ERBB2amp (86%)TP53 (62%),PIK3CA (23%)Other Alterations (#)ATM (1), KIT (1), PDGFRA (1), PTEN(1), RB1 (1), SMAD4 (1), SMO (1), STK11 (1)AKT1 (1), ATM VUS (1), ERBB2 (1), PTEN (1), SMAD4 VUS (1), SMO VUS (1)ERBB2 (1), STK11(1)EGFR amp (2), KIT amp (1),PDGFRA amp (1), RB1 VUS (1)
Citation Format: Soucier-Ernst D, Colameco C, Troxel AB, Clark C, Shih N, Maxwell KN, Morrissette J, Lieberman D, Feldman M, Goodman N, Bradbury A, Clark A, Domchek S, Fox K, Glick J, Matro J, Nathanson K, Chodosh L, DeMichele A. Mutational spectrum and tumor response in metastatic breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-07-05.
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Affiliation(s)
| | - C Colameco
- University of Pennsylvania, Philadelphia, PA
| | - AB Troxel
- University of Pennsylvania, Philadelphia, PA
| | - C Clark
- University of Pennsylvania, Philadelphia, PA
| | - N Shih
- University of Pennsylvania, Philadelphia, PA
| | - KN Maxwell
- University of Pennsylvania, Philadelphia, PA
| | | | - D Lieberman
- University of Pennsylvania, Philadelphia, PA
| | - M Feldman
- University of Pennsylvania, Philadelphia, PA
| | - N Goodman
- University of Pennsylvania, Philadelphia, PA
| | - A Bradbury
- University of Pennsylvania, Philadelphia, PA
| | - A Clark
- University of Pennsylvania, Philadelphia, PA
| | - S Domchek
- University of Pennsylvania, Philadelphia, PA
| | - K Fox
- University of Pennsylvania, Philadelphia, PA
| | - J Glick
- University of Pennsylvania, Philadelphia, PA
| | - J Matro
- University of Pennsylvania, Philadelphia, PA
| | - K Nathanson
- University of Pennsylvania, Philadelphia, PA
| | - L Chodosh
- University of Pennsylvania, Philadelphia, PA
| | - A DeMichele
- University of Pennsylvania, Philadelphia, PA
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Abstract
BACKGROUND Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major risk factor for stroke. Rivaroxaban, an oral factor Xa inhibitor, is approved for the prevention of stroke in patients with non-valvular AF. In the pivotal phase III trial ROCKET AF, rivaroxaban demonstrated non-inferiority compared with warfarin for reducing the risk of stroke or systemic embolism (SE) in patients with AF (intention-to-treat analysis), without an increased risk of major bleeding. Superior efficacy vs. warfarin was achieved while patients were on study medication. Other direct oral factor Xa inhibitors have completed phase III clinical trials in this indication. Compared with warfarin, apixaban (in the ARISTOTLE trial) and edoxaban (in the ENGAGE-AF trial) were shown to be superior or non-inferior, respectively, for reduction in stroke or SE risk in patients with AF. Baseline stroke risk, as indicated by CHADS2 scores, was lower in patients in the ARISTOTLE and ENGAGE-AF trials than in ROCKET AF. OBJECTIVES This review discusses the main findings from ROCKET AF, specifically examining recent subgroup analyses investigating rivaroxaban use across various patient types at high risk for adverse outcomes, including those with prior stroke or transient ischaemic attack, reduced renal function, prior myocardial infarction, peripheral artery disease, heart failure or patients aged ≥ 75 years and those resident in East Asia. CONCLUSIONS These subgroup analyses demonstrate that the treatment effect for rivaroxaban vs. warfarin is broadly consistent across a wide range of patient groups, with respect to both efficacy and safety.
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Affiliation(s)
- H-C Diener
- Department of Neurology, University of Essen, Essen, Germany
| | - J L Halperin
- Cardiology Clinical Services, Mount Sinai School of Medicine, New York, NY, USA
| | - K Fox
- Department of Cardiology, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - G J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia
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Steplewski Z, Fox K, Glick J, Koprowski H. Human antimouse antibody response in patients treated with multiple infusions of monoclonal antibody CO17-1A. Front Radiat Ther Oncol 2015; 24:69-72; discussion 121-2. [PMID: 2341051 DOI: 10.1159/000417770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Aramesh M, Shimoni O, Fox K, Karle TJ, Lohrmann A, Ostrikov K, Prawer S, Cervenka J. Ultra-high-density 3D DNA arrays within nanoporous biocompatible membranes for single-molecule-level detection and purification of circulating nucleic acids. Nanoscale 2015; 7:5998-6006. [PMID: 25744416 DOI: 10.1039/c4nr07351g] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Extracellular nucleic acids freely circulating in blood and other physiologic fluids are important biomarkers for non-invasive diagnostics and early detection of cancer and other diseases, yet difficult to detect because they exist in very low concentrations and large volumes. Here we demonstrate a new broad-range sensor platform for ultrasensitive and selective detection of circulating DNA down to the single-molecule level. The biosensor is based on a chemically functionalized nanoporous diamond-like carbon (DLC) coated alumina membrane. The few nanometer-thick, yet perfect and continuous DLC-coating confers the chemical stability and biocompatibility of the sensor, allowing its direct application in biological conditions. The selective detection is based on complementary hybridization of a fluorescently-tagged circulating cancer oncomarker (a 21-mer nucleic acid) with covalently immobilized DNA on the surface of the membrane. The captured DNAs are detected in the nanoporous structure of the sensor using confocal scanning laser microscopy. The flow-through membrane sensor demonstrates broad-range sensitivity, spanning from 10(15) molecules per cm(2) down to single molecules, which is several orders of magnitude improvement compared to the flat DNA microarrays. Our study suggests that these flow-through type nanoporous sensors represent a new powerful platform for large volume sampling and ultrasensitive detection of different chemical biomarkers.
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Affiliation(s)
- M Aramesh
- School of Physics, The University of Melbourne, Melbourne, Victoria 3010, Australia.
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Fox K, Borth C, Fife J, Golbeck A, Molgaard C. Rural health in a global context: case study of human trafficking. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Reid C, Shiel L, Jelinek M, Freedman B, Hockings B, Alwyard P, Hamilton-Craig I, Steg P, Ford I, Fox K. Clinical outcomes for patients with stable coronary disease in Australia - findings from the CLARIFY registry. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sounderajah V, Moore HM, Thapar A, Lane TRA, Fox K, Franklin IJ, Davies AH. Acoustic reflectors are visible in the right heart during radiofrequency ablation of varicose veins. Phlebology 2014; 30:557-63. [DOI: 10.1177/0268355514542680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Cerebrovascular events have been noted after foam sclerotherapy for varicose veins. One hypothesis is migration of microemboli to the brain through a cardiac septal defect. The aim of this study was to identify whether acoustic reflectors are found in the right side of the heart during radiofrequency ablation of varicose veins, as neurological events are not reported during these procedures. Methods Transthoracic echocardiography was performed during local anaesthetic radiofrequency ablation (VNUS ClosureFast) of the great saphenous vein in 14 patients. An apical view was captured at the start of the procedure, during each cycle of heating and at 1 min post-treatment. Patients were monitored for 1 h. Video loops were read by an independent cardiologist. The presence of acoustic reflectors was classified as: 0 = absent, 1 = occasional, 2 = stream, 3 = complete opacification. Results Loops were of diagnostic quality in 11/14 (79%) patients. After the second cycle of heating, acoustic reflectors moving through the right heart were seen in 5/11 (45%) patients. These were classified as grade 1 in four patients and grade 2 in one patient. No acoustic reflectors were seen in the left heart. No neurological symptoms were reported. Conclusion Acoustic reflectors in the right heart are a common finding during radiofrequency ablation of varicose veins. Considering the prevalence of cardiac septal defects (17%), more neurological events would be expected if these particles were indeed responsible for these events. Further work is required to elicit the mechanisms underlying neurological complications following sclerotherapy.
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Affiliation(s)
- V Sounderajah
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College School of Medicine, London, UK
| | - HM Moore
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College School of Medicine, London, UK
| | - A Thapar
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College School of Medicine, London, UK
| | - TRA Lane
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College School of Medicine, London, UK
| | - K Fox
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - IJ Franklin
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College School of Medicine, London, UK
| | - AH Davies
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College School of Medicine, London, UK
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Prine L, Fox K, Olenzek E, Shah S, Nayot A. LEVONORGESTREL IUD AS POSSIBLE EMERGENCY CONTRACEPTION. Contraception 2014. [DOI: 10.1016/j.contraception.2014.06.014] [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: 11/27/2022]
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Bhattacharyya S, James R, Rimington H, Allen J, Lee L, Fox K, Masani ND, Lloyd G. Development of a National Echocardiography Quality Improvement Programme: insights into feasibility, uptake, and clinical utility. Eur Heart J Cardiovasc Imaging 2014; 15:747-52. [DOI: 10.1093/ehjci/jet280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Decelis A, Fox K, Jago R. Prevalence of obesity among 10-11-year-old Maltese children using four established standards. Pediatr Obes 2013; 8:e54-8. [PMID: 23894110 DOI: 10.1111/j.2047-6310.2013.00191.x] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to establish, through measured height and weight, the prevalence of overweight and obesity in a representative sample of Maltese children aged 10-11 years. METHODS Height and weight were measured in a sample, stratified by sex, region and type of school, of 874 year 6 children and their body mass index classified as normal weight, overweight, and obese using International Obesity Task Force (IOTF), World Health Organization (WHO), US Centre for Disease Control and U.K. Department of Health standards. RESULTS IOTF standards indicated 20.4% overweight and 14.2% obese, while WHO standards indicated 23.1% overweight and 20.9% obese. All four standards reported significant sex differences, classifying more boys in the overweight and obesity categories. CONCLUSIONS The prevalence of overweight and obesity among 10-11-year-old Maltese children are higher than previously estimated through self-reported height and weight and all other countries in the world except Greece. These high rates confirm the urgent need to identify causes and tackle childhood obesity in Malta.
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Affiliation(s)
- A Decelis
- Institute for PE and Sport, University of Malta, Msida, Malta; Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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White HD, Roe M, Alexander K, Westerhout C, Winters K, Fox K, Prabhakaran D, Hochman J, Armstrong P, Ohman EM. Frailty is associated with worse outcomes in acute coronary syndromes: outcomes in TRILOGY. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.4534] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fauchier L, Greenlaw N, Ferrari R, Ford I, Fox K, Tardif JC, Tendera M, Steg PG. Use of anticoagulants and antiplatelet agents in stable outpatients with coronary artery disease and atrial fibrillation. Data from the international CLARIFY registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p530] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ferrari R, Ford I, Greenlaw N, Tardif JC, Tendera M, Abergel H, Fox K, Hu D, Shalnova S, Steg PG. Geographic variations in prevalence and management of cardiovascular risk factors in 33 283 outpatients with CAD: data from the contemporary CLARIFY registry from 45 countries. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.2777] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Winnik S, Raptis DA, Komajda M, Bax JJ, Tendera M, Fox K, Van De Werf F, Luescher TF, Nallamothu BK, Matter CM. The wealth of nations and the dissemination of cardiovascular research. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p245] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Roy A, Roe M, Cyr D, Zamoryakhin D, Fox K, White H, Armstrong P, Ohman EM, Prabhakaran D. Differences in the profile and risk of acute coronary syndrome patients stratified by country-level human development index: results from the global TRILOGY ACS trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2505] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kalra PR, Zachariah D, Greenlaw N, Ford I, Fox K. 127 CHARACTERISTICS AND TREATMENT OF 2346 PATIENTS WITH STABLE CORONARY ARTERY DISEASE IN UK PRIMARY CARE. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Iliuta L, Uno K, Ebihara A, Hayashi N, Chigira M, Yoshikawa T, Kimura K, Yamagata H, Yatomi Y, Takenaka K, Neves A, Mathias L, Leshko J, Linask K, Henriques-Coelho T, Areias J, Huhta J, Barbier P, Castiglioni L, Colazzo F, Fontana L, Nobili E, Franzosi M, Li Causi T, Sironi L, Tremoli E, Guerrini U, Stankovic I, Claus P, Jasaityte R, Putnikovic B, Neskovic A, Voigt J, Kutty S, Attebery J, Yeager E, Truemper E, Li L, Hammel J, Danford D, Tumasyan L, Adamyan K, Chilingaryan A, Mjolstad O, Andersen G, Dalen H, Graven T, Kleinau J, Skjetne K, Haugen B, Sucu M, Uku O, Sari I, Ercan S, Davutoglu V, Ozer O, Kim S, Na JO, Im S, Choi C, Lim H, Kim J, Han S, Seo H, Park C, Oh D, Hammoudi N, Duprey M, Regnier P, Vignalou J, Boubrit L, Pousset F, Jobard O, Isnard R, Shin SH, Woo S, Kim D, Park K, Kwan J, Andersen G, Mjolstad O, Graven T, Kleinau J, Skjetne K, Haugen B, Dalen H, Grigoryan S, Tunyan L, Hazarapetyan L, Shkolnik E, Vasyuk Y, Nesvetov V, Ruddox V, Edvardsen T, Otterstad J, Patrianakos A, Zacharaki A, Kalogerakis A, Nyktari E, Psathakis E, Parthenakis F, Vardas P, Yodwut C, Weinert L, Lang R, Mor-Avi V, Bandera F, Arena R, Labate V, Castelvecchio S, Menicanti L, Guazzi M, Nedeljkovic I, Ostojic M, Stepanovic J, Giga V, Beleslin B, Popovic D, Djordjevic-Dikic A, Petrovic M, Nedeljkovic M, Seferovic P, Popovic D, Ostojic M, Popovic B, Petrovic M, Vujisic-Tesic B, Nedeljkovic I, Arandjelovic A, Banovic M, Seferovic P, Damjanovic S, Horovitz A, Iriart X, De Guillebon D, Reant P, Lafitte S, Thambo J, Venkatesh A, Shahgaldi K, Johnson J, Brodin L, Winter R, Sahlen A, Manouras A, Szulik M, Streb W, Kalarus Z, Kukulski T, Lesniak-Sobelga AM, Kostkiewicz M, Tomkiewicz-Pajak L, Olszowska M, Hlawaty M, Rubis P, Podolec P, Spinelli L, Di Panzillo EA, Morisco C, Crispo S, Trimarco B, Lutay Y, Parkhomenko A, Stepura A, Zamfir D, Tautu O, Nestoruc A, Onut R, Comanescu I, Scafa Udriste A, Dorobantu M, Guseva O, Zhuravskaya N, Bartosh-Zelenaya S, Zagatina A, Kekovic P, Isailovic-Kekovic M, Squeri A, Macri' G, Anglano F, Censi S, Conti R, Pizzarelli M, Trecroci U, Bosi S, Le Tourneau T, Probst V, Kyndt F, Duval D, Trochu J, Bernstein J, Hagege A, Levine R, Le Marec H, Schott J, Enache R, Muraru D, Popescu B, Mateescu A, Purcarea F, Calin A, Beladan C, Rosca M, Ginghina C, Urdaniz MM, Rodriguez Palomares JF, Rius JB, Acosta Velez JG, Garcia-Moreno LG, Tura GT, Alujas MTG, Mas PT, Masip AE, Dorado DG, Zito C, Cusma-Piccione M, Miceli M, Di Bella G, Mohammed M, Oreto L, Di Matteo I, Crea P, Alongi G, Carerj S, Mizariene V, Zaliaduonyte-Peksiene D, Vaskelyte J, Jonkaitiene R, Jurkevicius R, D'auria F, Stinziani V, Grego S, Polisca P, Chiariello L, Cardoso M, Almeida A, David C, Marques J, Jorge C, Silva D, Magalhaes A, Goncalves S, Diogo A, Shiran A, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, Gaspar T, Necas J, Kovalova S, Bombardini T, Sicari R, Ciampi Q, Gherardi S, Costantino M, Picano E, Casartelli M, Bombardini T, Simion D, Gaspari M, Procaccio F, Tsatsopoulou A, Prappa E, Kalantzi M, Patrianakos A, Anastasakis A, Protonotarios N, Monteforte N, Bloise R, Napolitano C, Priori S, Davos C, Varela A, Tsilafakis C, Kostavassili I, Mavroidis M, Di Molfetta A, Musca F, Fresiello L, Santini L, Forleo G, Lunati M, Ferrari G, Romeo F, Moreo A, Lourenco M, Azevedo O, Machado I, Nogueira I, Fernandes M, Pereira V, Quelhas I, Lourenco A, Estensen M, Langesaeter E, Gullestad L, Aakhus S, Skulstad H, Gronlund C, Gustavsson S, Morner S, Suhr O, Lindqvist P, Sunbul M, Kepez A, Durmus E, Ozben B, Mutlu B, Esposito R, Santoro A, Ippolito R, Schiano Lomoriello V, De Palma D, Santoro C, Muscariello R, Ierano P, Galderisi M, Mohammed M, Zito C, Cusma-Piccione M, Di Bella G, Antonini-Canterin F, Taha N, Di Bello V, Vriz O, Pugliatti P, Carerj S, Beladan C, Popescu B, Calin A, Rosca M, Matei F, Enache E, Gurzun M, Ginghina C, Stanescu C, Manoliu V, Branidou K, Daha I, Baicus C, Adam C, Ene I, Dan G, Von Bibra H, Wulf G, Schuster T, Pfuetzner A, Heilmeyer P, Dobson G, Smith B, Grapsa J, Nihoyannopoulos P, Montoro Lopez M, Alonso Ladreda A, Florez Gomez R, Itziar Soto C, Rios Blanco J, Gemma D, Iniesta Manjavacas A, Moreno Yanguela M, Lopez Sendon J, Guzman Martinez G, O'driscoll J, Marciniak A, Perez-Lopez M, Sharma R, Bombardini T, Cini D, Gherardi S, Del Bene R, Serra W, Moreo A, Sicari R, Picano E, Fernandez Cimadevilla O, De La Hera Galarza J, Pasanisi E, Alvarez Pichel I, Diaz Molina B, Martin Fernandez M, Corros C, Lambert Rodriguez J, Sicari R, Jedrzychowska-Baraniak J, Jarosz K, Jozwa R, Kasprzak J, Mohty D, Petitalot V, El Hamel C, Damy T, Lavergne D, Echahidi N, Virot P, Cogne M, Jaccard A, Weng KP, Hsieh KS, Yang YY, Wutthachusin T, Kaier T, Grapsa J, Morgan D, Hakky S, Purkayastha S, Connolly S, Fox K, Ahmed A, Cousins J, Nihoyannopoulos P, Sveric K, Richter U, Wunderlich C, Strasser R, Spethmann S, Dreger H, Baldenhofer G, Mueller E, Stuuer K, Stangl V, Laule M, Baumann G, Stangl K, Knebel F, Ruiz Ortiz M, Mesa D, Delgado M, Romo E, Castillo F, Morenate M, Baeza F, Toledano F, Leon C, De Lezo JS, Ishizu T, Seo Y, Kameda Y, Enomoto M, Atsumi A, Yamamoto M, Nogami Y, Aonuma K, Theodosis-Georgilas A, Tountas H, Fousteris E, Tsaoussis G, Margetis P, Deligiorgis A, Katidis Z, Melidonis A, Beldekos D, Foussas S, Butz T, Faber L, Piper C, Reckefuss N, Wirdeier S, Van Bracht M, Prull M, Plehn G, Horstkotte D, Trappe HJ, Winter S, Martinek M, Ebner C, Nesser H, Kilickiran Avci B, Yurdakul S, Sahin S, Tanrikulu A, Ermis E, Aytekin S, Cefalu C, Barbier P, Santoro A, Ippolito R, Esposito R, Schiano Lomoriello V, De Palma D, Muscariello R, Galderisi M, Karamanou A, Hamodraka E, Vrakas S, Paraskevaides I, Lekakis I, Kremastinos D, Enache R, Piazza R, Muraru D, Mateescu A, Popescu B, Calin A, Beladan C, Rosca M, Nicolosi G, Ginghina C, Erdogan E, Bacaksiz A, Akkaya M, Tasal A, Vatankulu M, Turfan M, Sonmez O, Ertas G, Uyarel H, Goktekin O, Singelton J, Petraco R, Shaikh R, Cole G, Francis D, Manisty C, Almeida A, Cortez-Dias N, Sousa J, Carpinteiro L, Marques J, Silva D, Jorge C, Carrilho-Ferreira P, Pinto F, Diogo A, Kleczynski P, Legutko J, Rakowski T, Dziewierz A, Siudak Z, Zdzienicka J, Brzozowska-Czarnek A, Dubiel J, Dudek D, Carvalho MS, De Araujo Goncalves P, Dores H, Sousa P, Marques H, Pereira Machado F, Gaspar A, Aleixo A, Mota Carmo M, Roquette J, Obase K, Sakakura T, Matsushita S, Takeuchi M, Tamai S, Komeda M, Yoshida K, Jimenez Rubio C, Isasti Aizpurua G, Miralles Ibarra J, Gianstefani S, Catibog N, Whittaker A, Wathen P, Kogoj P, Reiken J, Monaghan M, Salvetti M, Muiesan M, Paini A, Agabiti Rosei C, Aggiusti C, Bertacchini F, Stassaldi D, Rubagotti G, Comaglio A, Agabiti Rosei E, Soldati E, Corciu A, Zucchelli G, Di Cori A, Segreti L, De Lucia R, Paperini L, Viani S, Vannozzi A, Bongiorni M, Kablak-Ziembicka A, Przewlocki T, Stepien E, Wrotniak L, Karch I, Podolec P, Kleczynski P, Rakowski T, Dziewierz A, Jakala J, Legutko J, Dubiel J, Dudek D. Poster session Friday 7 December - PM: Effect of systemic illnesses on the heart. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes266] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fox K. Intervention design using self-determination theory to promote activity in depressed patients, older adults, and slimmers. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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