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Qureshi SP, Judson E, Cummins C, Gadoud A, Sanders K, Doherty M. Resisting the (re-)medicalisation of dying and grief in the post-digital age: Natural language processing and qualitative analysis of data from internet support forums. Soc Sci Med 2024; 348:116517. [PMID: 38593612 DOI: 10.1016/j.socscimed.2023.116517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 04/11/2024]
Abstract
In the mid-twentieth century, the social movement of death revivalism sought to resist the medicalisation of dying and grief through promotion of the dying person retaining autonomy, and societal openness toward death and bereavement. Despite this advocacy, present-day dying in high income countries is largely institutionalised, with value placed on control over the body and emotions. These phenomena are at odds with the ambitions of death revivalism, and demonstrate the re-medicalisation of dying and grief. Furthermore, contemporary society is continually advancing into the post-digital age, reflected in digital technologies being a tacit part of human existence. Within this framework, this study aims to investigate how people living with life-limiting illness and their loved ones experience, negotiate, and resist medicalisation of dying and grief through online internet forums. We collected posts through web-scraping and utilised Natural Language Processing techniques to select 7048 forum posts from 2003 to 2020, and initially categorise data, before utilising Inductive Thematic Analysis, which generated two major themes. The theme of 'Comfort' describes online forums facilitating psychosocial support which was often used to compensate for systemic deficiencies, especially during the Covid-19 pandemic. Common sources of comfort included animal companions and spirituality, in stark contrast with the medicalised model. The theme of 'Capability' describes online forums acting as solutions for people facing disempowering care systems, including providing information on legal rights and benefits which may not be otherwise easily available, and facilitating collective advocacy. Our findings indicate that community-led online forums can play an effective and sustainable role in democratising care and retaining agency when facing life-limiting illness and grief. Future palliative and bereavement care research must focus on how online forums can be integrated into existing systems, made transparent and accessible, be adequately funded and structured, and be optimised, including compensating for service disruption encountered during future pandemics.
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Affiliation(s)
- Shaun Peter Qureshi
- Centre for the Art of Dying Well, Faculty of Business and Law, St Mary's University Twickenham, London, TW1 4SX, United Kingdom.
| | - Ellen Judson
- Centre for the Analysis of Social Media, Demos, 15 Whitehall, London, SW1A 2DD, United Kingdom.
| | - Ciaran Cummins
- Centre for the Analysis of Social Media, Demos, 15 Whitehall, London, SW1A 2DD, United Kingdom.
| | - Amy Gadoud
- Lancaster Medical School, Lancaster University, Sir John Fisher Drive, LA1 4AT, United Kingdom; Trinity Hospice, Low Moor Road, Blackpool, FY2 OGB, United Kingdom.
| | - Karen Sanders
- Centre for the Art of Dying Well, Faculty of Business and Law, St Mary's University Twickenham, London, TW1 4SX, United Kingdom.
| | - Margaret Doherty
- Centre for the Art of Dying Well, Faculty of Business and Law, St Mary's University Twickenham, London, TW1 4SX, United Kingdom.
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Sanders K, Peck D, Bentz Pino G, Studinski Jones A, White A, Gavrilov D, Matern D, Oglesbee D, Schultz M, Tortorelli S, Hall PL. SLC6A8 creatine transporter deficiency can be detected by plasma creatine and creatinine concentrations. Mol Genet Metab 2024; 142:108455. [PMID: 38531184 DOI: 10.1016/j.ymgme.2024.108455] [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] [Received: 01/02/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
Creatine transporter deficiency has been described with normal or uninformative levels of creatine and creatinine in plasma, while urine has been the preferred specimen type for biochemical diagnosis. We report a cohort of untreated patients with creatine transporter deficiency and abnormal plasma creatine panel results, characterized mainly by markedly decreased plasma creatinine. We conclude that plasma should be considered a viable specimen type for the biochemical diagnosis of this disorder, and abnormal results should be followed up with further confirmatory testing.
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Affiliation(s)
- Karen Sanders
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Dawn Peck
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Gisele Bentz Pino
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - April Studinski Jones
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Amy White
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Dimitar Gavrilov
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Dietrich Matern
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Devin Oglesbee
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Matthew Schultz
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Silvia Tortorelli
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Patricia L Hall
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America.
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Paton NI, Stöhr W, Arenas-Pinto A, Clarke A, Williams I, Johnson M, Orkin C, Chen F, Lee V, Winston A, Gompels M, Fox J, Sanders K, Dunn DT. Long-term efficacy and safety of a treatment strategy for HIV infection using protease inhibitor monotherapy: 8-year routine clinical care follow-up from a randomised, controlled, open-label pragmatic trial (PIVOT). EClinicalMedicine 2024; 69:102457. [PMID: 38361989 PMCID: PMC10867418 DOI: 10.1016/j.eclinm.2024.102457] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Background Treatment-simplification strategies are important tools for patient-centred management. We evaluated long-term outcomes from a PI monotherapy switch strategy. Methods Eligible participants attending 43 UK treatment centres had a viral load (VL) below 50 copies/ml for at least 24 weeks on combination ART. Participants were randomised to maintain ongoing triple therapy (OT) or switch to a strategy of physician-selected PI monotherapy (PI-mono) with prompt return to combination therapy if VL rebounded. The primary outcome, previously reported, was loss of future drug options after 3 years, defined as new intermediate/high level resistance to at least one drug to which the participant's virus was considered sensitive at trial entry. Here we report resistance and disease outcomes after further extended follow-up in routine care. The study was registered as ISRCTN04857074. Findings We randomised 587 participants to OT (291) or PI-mono (296) between Nov 4, 2008, and July 28, 2010 and followed them for a median of more than 8 years (100 months) until 2018. At the end of this follow-up time, one or more future drug options had been lost in 7 participants in the OT group and 6 in the PI-mono group; estimated cumulative risk by 8 years of 2.7% and 2.1% respectively (difference -0.6%, 95% CI -3.2% to 2.0%). Only one PI-mono participant developed resistance to the protease inhibitor they were taking (atazanavir). Serious clinical events (death, serious AIDS, and serious non-AIDS) were infrequent; reported in a total of 12 (4.1%) participants in the OT group and 23 (7.8%) in the PI-mono group (P = 0.08) over the entire follow-up period. Interpretation A strategy of PI monotherapy, with regular VL monitoring and prompt reintroduction of combination treatment following rebound, preserved future treatment options. Findings confirm the high genetic barrier to resistance of the PI drug class that makes them well suited for creative, patient-centred, treatment-simplification approaches. The possibility of a small excess risk of serious clinical events with the PI monotherapy strategy cannot be excluded. Funding The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Nicholas I. Paton
- MRC Clinical Trials Unit at University College London, London, UK
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wolfgang Stöhr
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Amanda Clarke
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Chloe Orkin
- Barts and the Royal London Hospital NHS Trust, London, UK
| | | | | | | | | | - Julie Fox
- Guys and St. Thomas' Hospital, London, UK
| | - Karen Sanders
- MRC Clinical Trials Unit at University College London, London, UK
| | - David T. Dunn
- MRC Clinical Trials Unit at University College London, London, UK
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Kragh-Furbo M, French M, Dunleavy L, Hancock S, Sanders K, Doherty M, Gadoud A. Deathbed Etiquette - The Guide: A Qualitative Study Exploring the Views of Practitioners on its Introduction into End-of-Life Care Settings. J Palliat Care 2023:8258597231158325. [PMID: 36803230 DOI: 10.1177/08258597231158325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Objectives: It is common for relatives to feel uncertain about what to expect at the bedside of a dying loved one. The Centre for the Art of Dying Well together with clinical, academic and communications experts created a 'Deathbed Etiquette' guide offering information and reassurance to relatives. This study explores the views of practitioners with experience in end-of-life care on the guide and how it might be used. Methods: Three online focus groups and nine individual interviews were conducted with a purposive sample of 21 participants involved in end-of-life care. Participants were recruited through hospices and social media. Data were analysed using thematic analysis. Results: Discussions highlighted the importance of effective communication that normalises experiences of being by the bedside of a dying loved one. Tensions around the use of the words 'death' and 'dying' were identified. Most participants also expressed reservations about the title, with the word 'deathbed' found to be old-fashioned and the word 'etiquette' not capturing the varied experiences of being by the bedside. Overall, however, participants agreed that the guide is useful for 'mythbusting' death and dying. Conclusion: There is a need for communication resources that can support practitioners in having honest and compassionate conversations with relatives in end-of-life care. The 'Deathbed Etiquette' guide is a promising resource to support relatives and healthcare practitioners by providing them with suitable information and helpful phrases. More research is needed on how to implement the guide in healthcare settings.
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Affiliation(s)
- Mette Kragh-Furbo
- The Centre for the Art of Dying Well, 62693St Mary's University, Twickenham, UK
| | - Maddy French
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
| | - Sophie Hancock
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
| | - Karen Sanders
- Institute of Business, Law and Society, 62693St Mary's University, Twickenham, UK
| | - Margaret Doherty
- The Centre for the Art of Dying Well, 62693St Mary's University, Twickenham, UK
| | - Amy Gadoud
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
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Patel LN, Gurumurthy M, Bronson G, Sanders K, Rusen ID. Implementation challenges and lessons learned from the STREAM clinical trial-a survey of trial sites. Trials 2023; 24:51. [PMID: 36691098 PMCID: PMC9869607 DOI: 10.1186/s13063-023-07068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Design and implementation of multi-country clinical trials for multidrug-resistant tuberculosis (MDR-TB) are complex for several reasons, including trial duration, varying levels of experience and infrastructure across settings, and different regulatory requirements. STREAM was an MDR-TB clinical trial that recruited over 1000 participants. We documented challenges and best practices/lessons learned from the site perspective to improve implementation of future trials. METHODS We conducted a voluntary survey of trial staff at all sites to obtain information on challenges encountered and best practices/lessons learned from implementation of the STREAM trial. Respondents were asked to identify substantive aspects of trial implementation from a list that included: trial administration, laboratory strengthening/infrastructure, pharmacy and supply chain management, community engagement, regulatory and ethics requirements, health economics, and other (respondent designated) about which a practical guide would be useful to improve future trial implementation. For each aspect of trial implementation selected, respondents were asked to report challenges and best practices/lessons learned during STREAM. Lastly, respondents were asked to list up to three things they would do differently when implementing future trials. Summary statistics were generated for quantitative data and thematic analysis was undertaken for qualitative data. RESULTS Of 67 responses received from 13 of 15 sites, 47 (70%) were included in the analyses, after excluding duplicate or incomplete responses. Approximately half the respondents were investigators or trial coordinators. The top three aspects of trial implementation identified for a best practices/lessons learned practical guide to improve future trial implementation were: trial administration, community engagement, and laboratory strengthening/infrastructure. For both challenges and best practices/lessons learned, three common themes were identified across different aspects of trial implementation. Investment in capacity building and ongoing monitoring; investment in infrastructure and well-designed trial processes; and communication and coordination between staff and meaningful engagement of stakeholders were all thought to be critical to successful trial implementation. CONCLUSIONS Existing practices for clinical trial implementation should be reevaluated. Sponsors should consider the local context and the need to increase upfront investment in the cross-cutting thematic areas identified to improve trial implementation.
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Affiliation(s)
- Leena N. Patel
- grid.475681.9Vital Strategies, 100 Broadway, 4th Floor, New York, NY 10005 USA
| | - Meera Gurumurthy
- Vital Strategies Health Systems, Asia Pacific, Singapore, Singapore
| | - Gay Bronson
- grid.475681.9Vital Strategies, 100 Broadway, 4th Floor, New York, NY 10005 USA
| | - Karen Sanders
- grid.415052.70000 0004 0606 323XMedical Research Council Clinical Trials Unit at UCL, London, England
| | - I. D. Rusen
- grid.475681.9Vital Strategies, 100 Broadway, 4th Floor, New York, NY 10005 USA
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6
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Goodall RL, Meredith SK, Nunn AJ, Bayissa A, Bhatnagar AK, Bronson G, Chiang CY, Conradie F, Gurumurthy M, Kirenga B, Kiria N, Meressa D, Moodliar R, Narendran G, Ngubane N, Rassool M, Sanders K, Solanki R, Squire SB, Torrea G, Tsogt B, Tudor E, Van Deun A, Rusen ID. Evaluation of two short standardised regimens for the treatment of rifampicin-resistant tuberculosis (STREAM stage 2): an open-label, multicentre, randomised, non-inferiority trial. Lancet 2022; 400:1858-1868. [PMID: 36368336 PMCID: PMC7614824 DOI: 10.1016/s0140-6736(22)02078-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [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: 08/26/2022] [Revised: 10/05/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The STREAM stage 1 trial showed that a 9-month regimen for the treatment of rifampicin-resistant tuberculosis was non-inferior to the 20-month 2011 WHO-recommended regimen. In STREAM stage 2, we aimed to compare two bedaquiline-containing regimens with the 9-month STREAM stage 1 regimen. METHODS We did a randomised, phase 3, non-inferiority trial in 13 hospital clinics in seven countries, in individuals aged 15 years or older with rifampicin-resistant tuberculosis without fluoroquinolone or aminoglycoside resistance. Participants were randomly assigned 1:2:2:2 to the 2011 WHO regimen (terminated early), a 9-month control regimen, a 9-month oral regimen with bedaquiline (primary comparison), or a 6-month regimen with bedaquiline and 8 weeks of second-line injectable. Randomisations were stratified by site, HIV status, and CD4 count. Participants and clinicians were aware of treatment-group assignments, but laboratory staff were masked. The primary outcome was favourable status (negative cultures for Mycobacterium tuberculosis without a preceding unfavourable outcome) at 76 weeks; any death, bacteriological failure or recurrence, and major treatment change were considered unfavourable outcomes. All comparisons used groups of participants randomly assigned concurrently. For non-inferiority to be shown, the upper boundary of the 95% CI should be less than 10% in both modified intention-to-treat (mITT) and per-protocol analyses, with prespecified tests for superiority done if non-inferiority was shown. This trial is registered with ISRCTN, ISRCTN18148631. FINDINGS Between March 28, 2016, and Jan 28, 2020, 1436 participants were screened and 588 were randomly assigned. Of 517 participants in the mITT population, 133 (71%) of 187 on the control regimen and 162 (83%) of 196 on the oral regimen had a favourable outcome: a difference of 11·0% (95% CI 2·9-19·0), adjusted for HIV status and randomisation protocol (p<0·0001 for non-inferiority). By 76 weeks, 108 (53%) of 202 participants on the control regimen and 106 (50%) of 211 allocated to the oral regimen had an adverse event of grade 3 or 4; five (2%) participants on the control regimen and seven (3%) on the oral regimen had died. Hearing loss (Brock grade 3 or 4) was more frequent in participants on the control regimen than in those on the oral regimen (18 [9%] vs four [2%], p=0·0015). Of 134 participants in the mITT population who were allocated to the 6-month regimen, 122 (91%) had a favourable outcome compared with 87 (69%) of 127 participants randomly assigned concurrently to the control regimen (adjusted difference 22·2%, 95% CI 13·1-31·2); six (4%) of 143 participants on the 6-month regimen had grade 3 or 4 hearing loss. INTERPRETATION Both bedaquiline-containing regimens, a 9-month oral regimen and a 6-month regimen with 8 weeks of second-line injectable, had superior efficacy compared with a 9-month injectable-containing regimen, with fewer cases of hearing loss. FUNDING USAID and Janssen Research & Development.
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Affiliation(s)
- Ruth L Goodall
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK.
| | - Sarah K Meredith
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
| | - Andrew J Nunn
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
| | - Adamu Bayissa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Anuj K Bhatnagar
- Rajan Babu Institute for Pulmonary Medicine & Tuberculosis, Delhi, India
| | | | - Chen-Yuan Chiang
- Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; International Union against Tuberculosis and Lung Disease, Paris, France
| | | | | | - Bruce Kirenga
- Makerere University Lung Institute, Mulago Hospital, Kampala, Uganda
| | - Nana Kiria
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Daniel Meressa
- St Peter's Tuberculosis Specialized Hospital and Global Health Committee, Addis Ababa, Ethiopia
| | - Ronelle Moodliar
- Tuberculosis & HIV Investigative, Doris Goodwin Hospital, Pietermaritzburg, South Africa
| | | | | | - Mohammed Rassool
- Clinical HIV Research Unit, Helen Joseph Hospital, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Sanders
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
| | | | - S Bertel Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Elena Tudor
- Institute of Phthisiopneumology Chiril Draganiuc, Chisinau, Moldova
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Lynch C, Sanders K, Gordon T, Griffin D. Investigation of the feasibility and efficacy of rebiopsy following "no result" in PGT-A. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.073] [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]
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Rangaka MX, Hamada Y, Duong T, Bern H, Calvert J, Francis M, Clarke AL, Ghanouni A, Layton C, Hack V, Owen-Powell E, Surey J, Sanders K, Booth HL, Crook A, Griffiths C, Horne R, Kunst H, Lipman M, Mandelbaum M, White PJ, Zenner D, Abubakar I. Evaluating the effect of short-course rifapentine-based regimens with or without enhanced behaviour-targeted treatment support on adherence and completion of treatment for latent tuberculosis infection among adults in the UK (RID-TB: Treat): protocol for an open-label, multicentre, randomised controlled trial. BMJ Open 2022; 12:e057717. [PMID: 36691120 PMCID: PMC9454004 DOI: 10.1136/bmjopen-2021-057717] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The successful scale-up of a latent tuberculosis (TB) infection testing and treatment programme is essential to achieve TB elimination. However, poor adherence compromises its therapeutic effectiveness. Novel rifapentine-based regimens and treatment support based on behavioural science theory may improve treatment adherence and completion. METHODS AND ANALYSIS A pragmatic multicentre, open-label, randomised controlled trial assessing the effect of novel short-course rifapentine-based regimens for TB prevention and additional theory-based treatment support on treatment adherence against standard-of-care. Participants aged between 16 and 65 who are eligible to start TB preventive therapy will be recruited in England. 920 participants will be randomised to one of six arms with allocation ratio of 5:5:6:6:6:6: daily isoniazid +rifampicin for 3 months (3HR), routine treatment support (control); 3HR, additional treatment support; weekly isoniazid +rifapentine for 3 months (3HP), routine treatment support; weekly 3HP, additional treatment support ; daily isoniazid +rifapentine for 1 month (1HP), routine treatment support; daily 1HP, additional treatment support. Additional treatment support comprises reminders using an electronic pillbox, a short animation, and leaflets based on the perceptions and practicalities approach. The primary outcome is adequate treatment adherence, defined as taking ≥90% of allocated doses within the pre-specified treatment period, measured by electronic pillboxes. Secondary outcomes include safety and TB incidence within 12 months. We will conduct process evaluation of the trial interventions and assess intervention acceptability and fidelity and mechanisms for effect and estimate the cost-effectiveness of novel regimens. The protocol was developed with patient and public involvement, which will continue throughout the trial. ETHICS AND DISSEMINATION Ethics approval has been obtained from The National Health Service Health Research Authority (20/LO/1097). All participants will be required to provide written informed consent. We will share the results in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT 2020-004444-29.
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Affiliation(s)
- Molebogeng X Rangaka
- Institute for Global Health, University College London, London, UK
- School of Public Health, and Clinical Infectious Disease Research Institute-AFRICA, University of Cape Town, Cape Town, South Africa
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, UK
| | - Trinh Duong
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Henry Bern
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Joanna Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Marie Francis
- Institute for Global Health, University College London, London, UK
| | | | - Alex Ghanouni
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Charlotte Layton
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Vanessa Hack
- Institute for Global Health, University College London, London, UK
| | - Ellen Owen-Powell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Julian Surey
- Institute for Global Health, University College London, London, UK
| | - Karen Sanders
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Helen L Booth
- North Central London Tuberculosis Service, Whittington Health NHS Trust and University College London Hospitals NHS Foundation Trust, London, UK
| | - Angela Crook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Chris Griffiths
- Wolfson Institute for Population Health Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Marc Lipman
- UCL Respiratory, Division of Medicine, University College, London, UK
- Royal Free London Hospital NHS Foundation Trust, London, UK
| | | | - Peter J White
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College, London, UK
| | - Dominik Zenner
- Institute for Global Health, University College London, London, UK
- Wolfson Institute for Population Health Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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Crispi V, Sanders K, Kenning L, Spink G. 1041 Impact of Spectral Contamination and Anatomical Location on Diagnostic Accuracy of Single-Voxel Spectroscopy in Pre-Operative Glioma Characterisation. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.281] [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: 11/06/2022]
Abstract
Abstract
Aim
Single-voxel spectroscopy (SVS) discriminates amongst brain tumours by measuring metabolite variations reflective of malignant transformation. However, spectral contamination may affect diagnostic accuracy, impacting radiological opinion of regions of interest (ROI) required to determine extent of surgical resection.
Method
A single-centre, retrospective, observational study, including 93 SVS meaningfully interpretable examinations between 2012 and 2018. Accuracy of lesion classification was assessed by comparison of histological diagnosis as reference standards against discrimination between entities and tumour grades by SVS, with consideration for voxel location, volume, and proximity to the calvaria or ventricular system. Quantification of metabolites was recorded as ratios, and visual inspection, qualitative and descriptive analysis were undertaken.
Results
SVS demonstrated high entity accuracy (100%) but lower grade accuracy (87%), ranging from periventricular (73%) vs non-periventricular (90%), and subcalvarial (86%) vs subcortical (88%) voxels. CSF contamination caused metabolite dilution and/or enhanced lactate signals from sub-arachnoid or ventricular CSF, especially in areas of increased brain-skull distance; lipid contamination from peri-calvarial fat and subcutaneous tissue resulted in enhanced lipid signals neighbouring areas of increased brain-scalp distance. Misclassified lesions were located regions of increased cranial concavity, reduced cerebral cortical thickness and inappropriate outer volume suppression (OVS). Voxel volume variation had no impact across cerebral coordinates (p=0.605), calvaria proximity (p=0.127) or ventricular proximity (p=0.367).
Conclusion
Spectral contamination significantly impacted grade accuracy, with metabolite dilution and enhance lactate and lipids signals leading to radiological under- and overestimation of glioma grade, respectively, thus indicating that avoidance of contaminating tissues and OVS are pivotal to adequate spectral quality for diagnostic accuracy.
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Affiliation(s)
- V Crispi
- Bradford Royal Infirmary , Bradford , United Kingdom
- Hull York Medical School , Hull , United Kingdom
| | - K Sanders
- Hull York Medical School , Hull , United Kingdom
| | - L Kenning
- Hull University Teaching Hospitals , Hull , United Kingdom
| | - G Spink
- Hull University Teaching Hospitals , Hull , United Kingdom
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Crispi V, Sanders K, Kenning L, Spink G. 1040 Metabolite Quantification and Entity and Grade Characterisation of Gliomas via Single-Voxel Spectroscopy for Pre-Operative Radiological Diagnosis. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.280] [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: 11/05/2022]
Abstract
Abstract
Aim
Brain tumours pose a diagnostic challenge, but single-voxel spectroscopy (SVS) provides a non-invasive tool to quantify brain metabolite variations reflective of neoplasia, such as NAA, choline (Cho), creatinine (Cr), lipids (Lip) and lactate (Lac). Inconsistency in spectroscopic research and time-patient pressures emphasises the need for reviewing SVS characterisation of gliomas for peri-operative decision-making.
Method
A single-centre, retrospective, observational study, including 93 SVS meaningfully interpretable examinations between 2012 and 2018 (PRESS, TE=35ms, 144ms). Spectroscopic diagnoses were compared to histopathologic reports for overall, entity and grade accuracy analysis. Metabolite ratios to Cr were recorded or obtained from peak area integrals.
Results
High accuracy of lesions discrimination was observed (83–98%). Significant metabolite variation for Cho/Cr (p=0.021) and Cho/NAA (p=0.013) was observed across grades (WHO Grade I-IV). Spectra of astrocytomas and oligodendrogliomas (grade II) were similarly characterised by high Cho, decreased NAA and Cr, and small-to-moderate Lac-Lip and mIns. In contrast, grade III anaplastic oligodendrogliomas (AO) were distinguished from anaplastic astrocytomas (AA) thanks to smaller Lac-Lip and mIns/Cr. Finally, glioblastoma multiforme (GBM, grade IV) displayed high Cho, decreased Cr, the lowest or virtually absent NAA, and the highest Lac-Lip. High-grade spectroscopy, such as enhanced Lac or Lac-Lip, may be an early indicator of grade transformation prior to reflection in histopathology in tumours, which were follow up prospectively.
Conclusion
This study enhanced spectral characterisation of gliomas and discrimination amongst low- and high-grade gliomas. Whilst these aid pre-operative radiological diagnoses, further research is required to investigate spectroscopy predictive of tumour genetics, now necessary for diagnosis.
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Affiliation(s)
- V Crispi
- Bradford Royal Infirmary , Bradford , United Kingdom
- Hull York Medical School , Hull , United Kingdom
| | - K Sanders
- Hull York Medical School , Hull , United Kingdom
| | - L Kenning
- Hull University Teaching Hospitals , Hull , United Kingdom
| | - G Spink
- Hull University Teaching Hospitals , Hull , United Kingdom
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11
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Goodall RL, Sanders K, Bronson G, Gurumurthy M, Torrea G, Meredith S, Nunn A, Rusen ID. Keeping up with the guidelines: design changes to the STREAM stage 2 randomised controlled non-inferiority trial for rifampicin-resistant tuberculosis. Trials 2022; 23:474. [PMID: 35672833 PMCID: PMC9171092 DOI: 10.1186/s13063-022-06397-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Results from the STREAM stage 1 trial showed that a 9-month regimen for patients with rifampicin-resistant tuberculosis was non-inferior to the 20-month regimen recommended by the 2011 WHO treatment guidelines. Similar levels of severe adverse events were reported on both regimens suggesting the need for further research to optimise treatment. Stage 2 of STREAM evaluates two additional short-course regimens, both of which include bedaquiline. Throughout stage 2 of STREAM, new drug choices and a rapidly changing treatment landscape have necessitated changes to the trial's design to ensure it remains ethical and relevant. This paper describes changes to the trial design to ensure that stage 2 continues to answer important questions. These changes include the early closure to recruitment of two trial arms and an adjustment to the definition of the primary endpoint. If the STREAM experimental regimens are shown to be non-inferior or superior to the stage 1 study regimen, this would represent an important contribution to evidence about potentially more tolerable and more efficacious MDR-TB regimens, and a welcome advance for patients with rifampicin-resistant tuberculosis and tuberculosis control programmes globally.Trial registration: ISRCTN ISRCTN18148631 . Registered 10 February 2016.
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Affiliation(s)
- Ruth L Goodall
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn 2nd Floor, London, WC1V 6LJ, UK.
| | - Karen Sanders
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn 2nd Floor, London, WC1V 6LJ, UK
| | - Gay Bronson
- Research Division, Vital Strategies, New York, USA
| | | | | | - Sarah Meredith
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn 2nd Floor, London, WC1V 6LJ, UK
| | - Andrew Nunn
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn 2nd Floor, London, WC1V 6LJ, UK
| | - I D Rusen
- Research Division, Vital Strategies, New York, USA
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12
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Lee K, Eto M, Sanders K, Koh S. A novel bladder fibrosis pathway through PDGFRα+ cells associated with estrogen deficiency and replacement. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Chousou P, Chattopadhyay R, Sanders K, Carpenter V, Hayes J, Vassiliou V, Pugh P. Optimal left ventricular lead positioning during cardiac resynchronisation therapy; a comparison of 2 methods. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0707] [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/Introduction
Superior response to CRT and improved clinical outcomes can be achieved when placing the left ventricular (LV) lead at the site of latest mechanical activation and avoiding regions of scar during cardiac resynchronisation therapy (CRT). The site of latest mechanical activation can be identified using speckle-tracking echocardiography, whilst the area of latest electrical activation can be assessed by measuring QLV, the time from the initial deflection of the surface QRS complex to sensing at the LV lead electrode. It remains unclear if the two techniques are interchangeable and whether the site of latest mechanical activation is related to the site of latest electrical activation, or sensed electrical signals correspond to sites of scar.
Purpose
To determine whether electrical targeting of LV lead position corresponds to echo-guided mechanical targeting and whether myocardial electrogram signals can predict areas of myocardial scar
Methods
This was a pilot study of patients receiving CRT, in sinus rhythm with severe LV impairment (ejection fraction ≤35%) and left bundle branch block (LBBB) with QRS ≥130ms. Ethics approval was obtained, and written consent was sought. Participants underwent echocardiographic speckle-tracking 2-dimensional radial strain imaging to identify amplitude and time to peak contraction of posterior, posterolateral, lateral, anterolateral and anterior segments. During CRT implant, the sensed R wave and QLV were measured at the respective branch of the coronary sinus, where the anatomy permitted. The site of latest mechanical was compared to the site of latest electrical activation and classified as concordant (same site), adjacent (within 1 segment), or remote (2 segments away). The strain amplitude was compared to the sensed R wave and time to mechanical activation with QLV.
Results
Seventeen patients (13 male) were studied, mean age 74.2 (SD 8.7). Mean QRS was 161 ms (SD 18), mean PR 186 ms (SD 37). A modest and significant positive correlation was found between the site of latest mechanical and latest electrical activation (Pearson r=0.66, p 0.004). The site of latest electrical activation was concordant with latest mechanical activation in 13 patients (76.5%), adjacent in 4 patients (23.5%) and remote in none. There was no apparent association between sensed R wave and strain amplitude (Pearson r=0.2, p=0.12) or between QLV and time to mechanical activation (Pearson r=0.1, p=0.5).
Conclusion
A significant positive correlation was found between the site of latest mechanical and latest electrical activation in patients undergoing CRT implant. Electrical targeting might be a suitable alternative to mechanical targeting particularly when imaging is not available, however, does not appear to discriminate scar. Future larger studies are needed to confirm our findings and determine whether QLV can be used as an alternative method for targeting LV lead placement.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Chousou
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - R Chattopadhyay
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - K Sanders
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - V Carpenter
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - J Hayes
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - V Vassiliou
- University of East Anglia, Norwich Medical School, Norwich, United Kingdom
| | - P Pugh
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
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14
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Lynch C, Sanders K, Gordon T, Griffin D. P–574 Examination of inter centre variation in PGT-A “no result rate” and efficacy of rebiopsy - Analysis of 22,833 samples 2015–2019. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Are there significant differences in PGT-A “no result” rates and clinical outcomes following rebiopsy between ART clinics, and do rebiopsied embryos perform better than transferring with no result?
Summary answer
There is significant differences between clinics in terms of “no result rate” in PGT-A and utilisation of rebiopsy. What is known already: With any testing platform used in PGT-A, there is always a chance that a sample will not yield a result and rebiopsy may be considered to ascertain an embryos cytogenetic status. Studies have demonstrated rebiopsy yields results and adds to embryos genetically suitable for transfer. Clinical outcome data, however, remains scarce, leading to difficulty for clinics in benchmarking their performance when rebiopsied embryos are transferred.
Study design, size, duration
A retrospective analysis was performed of trophectoderm samples submitted for PGT-A via NGS over a 5yr period, 2015–2019. The no result (NR) rate was calculated per year and per clinic. Clinics were contacted for follow up data on NR embryos in terms of usage and clinical outcomes. Clinical outcomes from rebiopsied embryos were compared with those transferred as NR without rebiopsy.
Participants/materials, setting, methods
Data was collected on 22833 trophectoderm samples, submitted by 30 IVF laboratories. NR rate was analysed by year and by clinic. Clinics were asked if NR embryos had undergone rebiopsy, and if so if they had survived warming and rebiopsy. Clinics were asked if embryos selected for transfer had survived (re)warming, and to provide clinical follow-up including hCG test, clinical pregnancies, miscarriage and livebirth. The two tailed Fishers exact test was used for statistical analysis.
Main results and the role of chance
There was a wide range in sample numbers submitted by clinics over the time period, ranging from 9 samples through to 2633. In tclinics submitting over 500 samples the NR rate ranged from 0.6% to 7.4%, and in the those submitting 100–499 samples it ranged from 1.1% to 5.8%. Both these differences proved to be statistically significant (p < 0.05) between the best and worst performing clinics, and shows that a gap in performance exists between clinics. Less than 50% of NR embryos underwent rebiopsy. While the majority of embryos undergoing rebiopsy yielded a result (92.3%) and 31.4% of these were euploid or mosaic, almost half still remain in storage. The rate of livebirth/ongoing implantation in the rebiopsy group is 35.5% and 17.1% in the non rebiopsy group, illustrating a non significant trend towards a higher chance of implantation and livebirth in the rebiopsy group. Of 58 patients undergoing rebiopsy without any euploids in their initial cycle, 18 had a euploid embryo identified for future use. The additional manipulations involved in rebiopsy do not impact on survival at warming for transfer, but clinical outcomes in rebiopsied embryos appear poorer than those where a result was generated at first biopsy.
Limitations, reasons for caution
Despite starting with 22833 samples, 1115 of which were classified as NR, there were only 31 rebiopsied and 42 NR embryos transferred. It was therefore not possible to analyse transfer data by clinic or by embryo quality.
Wider implications of the findings: Rebiopsy yields genetic results and embryos suitable for patient use, including for patients who produced no other euploid/mosaic embryos in their cycle. However, it is not offered/performed in many cases. Clinical outcome data must continue to be compiled and analysed to confirm performance exceeds transfer of NR embryos.
Trial registration number
Not applicable
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Affiliation(s)
- C Lynch
- CooperSurgical Fertility and Genomics Solutions, Medical Affairs, Nottingham, United Kingdom
| | - K Sanders
- University of Kent, School of Biosciences, Canterbury, United Kingdom
| | - T Gordon
- CooperSurgical Fertility and Genomics Solutions, CooperGenomics, London, United Kingdom
| | - D Griffin
- University of Kent, School of Biosciences, Canterbury, United Kingdom
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15
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Abstract
Pituitary tumours are common in dogs and are being increasingly recognized in cats. Pituitary tumours are usually classified as adenomas and should only be classified as carcinomas when there is evidence of metastatic spread of the tumour, which is rare. Despite the benign nature of most pituitary tumours, they can still compress or invade neighbouring tissues. Pituitary tumours can be functional (hormonally active) or non-functional (hormonally silent). The aim of this review was to provide an overview of the different pituitary tumour types in dogs and cats that have been reported in the literature. In dogs, the most common pituitary tumour type is the corticotroph adenoma, which can cause pituitary-dependent hypercortisolism. In cats, the most common pituitary tumour is the somatotroph adenoma, which can cause hypersomatotropism, and the second-most common is the corticotroph adenoma. A lactotroph adenoma has been described in one dog, while gonadotroph, thyrotroph and null cell adenomas have not been described in dogs or cats. Hormonally silent adenomas are likely underdiagnosed because they do not result in an endocrine syndrome. Tools used to classify pituitary tumours in humans, particularly immunohistochemistry for lineage-specific transcription factors, are likely to be useful to classify canine and feline pituitary tumours of unknown origin. Future studies are required to better understand the full range of pituitary adenoma pathology in dogs and cats and to determine whether certain adenoma subtypes behave more aggressively than others. Currently, the mechanisms that underlie pituitary tumorigenesis in dogs and cats are still largely unknown. A better understanding of the molecular background of these tumours could help to identify improved pituitary-targeted therapeutics.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
| | - S Galac
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - B P Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
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16
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Tambone V, Boudreau D, Ciccozzi M, Sanders K, Campanozzi LL, Wathuta J, Violante L, Cauda R, Petrini C, Abbate A, Alloni R, Argemi J, Argemí Renom J, De Benedictis A, Galerneau F, García-Sánchez E, Ghilardi G, Hafler JP, Linden M, Marcos A, Onetti Muda A, Pandolfi M, Pelaccia T, Picozzi M, Revello RO, Ricci G, Rohrbaugh R, Rossi P, Sirignano A, Spagnolo AG, Stammers T, Velázquez L, Agazzi E, Mercurio M. Ethical Criteria for the Admission and Management of Patients in the ICU Under Conditions of Limited Medical Resources: A Shared International Proposal in View of the COVID-19 Pandemic. Front Public Health 2020; 8:284. [PMID: 32612972 PMCID: PMC7308475 DOI: 10.3389/fpubh.2020.00284] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vittoradolfo Tambone
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Donald Boudreau
- Department of Medicine, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Massimo Ciccozzi
- Research Unit of Medical Statistic and Molecular Epidemiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Karen Sanders
- Department of Business, Law and Society, St Mary's University, London, United Kingdom
| | - Laura Leondina Campanozzi
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Jane Wathuta
- Institute for Family Studies & Ethics, Strathmore University, Nairobi, Kenya
| | | | - Roberto Cauda
- Section of Infection Diseases, Department of Healthcare Surveillance and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Petrini
- Bioethics Unit, Italian National Institute of Health, Rome, Italy
| | - Antonio Abbate
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Rossana Alloni
- Hospital Clinical Direction, Campus Bio-Medico University of Rome, Rome, Italy
| | - Josepmaria Argemi
- Division of Medicine, Gastroenterology and Hepatology Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Josep Argemí Renom
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna De Benedictis
- Hospital Clinical Direction, Campus Bio-Medico University of Rome, Rome, Italy
| | - France Galerneau
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Emilio García-Sánchez
- Department of Political Sciences, Ethics and Sociology, University CEU Cardenal Herrera, Valencia, Spain
| | - Giampaolo Ghilardi
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Janet Palmer Hafler
- Teaching and Learning Center, Yale University School of Medicine, New Haven, CT, United States
| | - Magdalena Linden
- Department of Medicine, Solna, Karolinska Institutet, Center for Molecular Medicine, Stockholm, Sweden
| | - Alfredo Marcos
- Department of Philosophy, Universidad de Valladolid, Valladolid, Spain
| | - Andrea Onetti Muda
- Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Pandolfi
- Fondazione Leonardo, Civiltà delle Macchine, Rome, Italy
| | - Thierry Pelaccia
- Prehospital Emergency Medical Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
| | - Mario Picozzi
- Center for Clinical Ethics, Insubria University, Varese, Italy
| | - Ruben Oscar Revello
- Instituto de Bioética de la Facultad de Ciencias Médica, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | | | - Robert Rohrbaugh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Patrizio Rossi
- Central Medical Department, National Institute for Insurance against Accidents at Work (INAIL), Rome, Italy
| | | | | | - Trevor Stammers
- Centre for Bioethics and Emerging Technologies, Institute of Theology, St Mary's University, London, United Kingdom
| | - Lourdes Velázquez
- Interdisciplinary Bioethics Center, Universidad Panamericana, Mexico City, Mexico
| | - Evandro Agazzi
- Interdisciplinary Bioethics Center, Universidad Panamericana, Mexico City, Mexico
| | - Mark Mercurio
- Program for Biomedical Ethics, Yale University School of Medicine, New Haven, CT, United States
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17
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Abstract
Abstract
A method is described for the quantitative analysis of patulin in apple juice involving ethyl acetate extraction followed by derivatization of the patulin and subsequent GLC analysis of the derivative. Preparation of 3 derivatives, the silyl ether, acetate, and chloroacetate, is described. Using the acetate derivative and the hydrogen flame detector, recoveries of patulin in spiked apple juice are 90% or better and the detection limit is about 0.7 μg/ml
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Affiliation(s)
- A E Pohland
- Division of Food Chemistry and Technology, Food and Drug Administration, Washington, D.C. 20204
| | - K Sanders
- Division of Food Chemistry and Technology, Food and Drug Administration, Washington, D.C. 20204
| | - C W Thorpe
- Division of Food Chemistry and Technology, Food and Drug Administration, Washington, D.C. 20204
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18
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Enayati A, Sanders K, Thomas D, Naismith C, Papadopoulos S, Seevanayagam S, Horrigan M. 482 ECG Monitoring in the Cardiac Acute Care Area: Utilization Patterns in Contemporary Practice. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Nunn AJ, Phillips PPJ, Meredith SK, Chiang CY, Conradie F, Dalai D, van Deun A, Dat PT, Lan N, Master I, Mebrahtu T, Meressa D, Moodliar R, Ngubane N, Sanders K, Squire SB, Torrea G, Tsogt B, Rusen ID. A Trial of a Shorter Regimen for Rifampin-Resistant Tuberculosis. N Engl J Med 2019; 380:1201-1213. [PMID: 30865791 DOI: 10.1056/nejmoa1811867] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cohort studies in Bangladesh showed promising cure rates among patients with multidrug-resistant tuberculosis who received existing drugs in regimens shorter than that recommended by the World Health Organization (WHO) in 2011. METHODS We conducted a phase 3 noninferiority trial in participants with rifampin-resistant tuberculosis that was susceptible to fluoroquinolones and aminoglycosides. Participants were randomly assigned, in a 2:1 ratio, to receive a short regimen (9 to 11 months) that included high-dose moxifloxacin or a long regimen (20 months) that followed the 2011 WHO guidelines. The primary efficacy outcome was a favorable status at 132 weeks, defined by cultures negative for Mycobacterium tuberculosis at 132 weeks and at a previous occasion, with no intervening positive culture or previous unfavorable outcome. An upper 95% confidence limit for the between-group difference in favorable status that was 10 percentage points or less was used to determine noninferiority. RESULTS Of 424 participants who underwent randomization, 383 were included in the modified intention-to-treat population. Favorable status was reported in 79.8% of participants in the long-regimen group and in 78.8% of those in the short-regimen group - a difference, with adjustment for human immunodeficiency virus status, of 1.0 percentage point (95% confidence interval [CI], -7.5 to 9.5) (P = 0.02 for noninferiority). The results with respect to noninferiority were consistent among the 321 participants in the per-protocol population (adjusted difference, -0.7 percentage points; 95% CI, -10.5 to 9.1). An adverse event of grade 3 or higher occurred in 45.4% of participants in the long-regimen group and in 48.2% in the short-regimen group. Prolongation of either the QT interval or the corrected QT interval (calculated with Fridericia's formula) to 500 msec occurred in 11.0% of participants in the short-regimen group, as compared with 6.4% in the long-regimen group (P = 0.14); because of the greater incidence in the short-regimen group, participants were closely monitored and some received medication adjustments. Death occurred in 8.5% of participants in the short-regimen group and in 6.4% in the long-regimen group, and acquired resistance to fluoroquinolones or aminoglycosides occurred in 3.3% and 2.3%, respectively. CONCLUSIONS In persons with rifampin-resistant tuberculosis that was susceptible to fluoroquinolones and aminoglycosides, a short regimen was noninferior to a long regimen with respect to the primary efficacy outcome and was similar to the long regimen in terms of safety. (Funded by the U.S. Agency for International Development and others; Current Controlled Trials number, ISRCTN78372190; ClinicalTrials.gov number, NCT02409290.).
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Affiliation(s)
- Andrew J Nunn
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Patrick P J Phillips
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Sarah K Meredith
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Chen-Yuan Chiang
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Francesca Conradie
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Doljinsuren Dalai
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Armand van Deun
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Phan-Thuong Dat
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Ngoc Lan
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Iqbal Master
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Tesfamarium Mebrahtu
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Daniel Meressa
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Ronelle Moodliar
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Nosipho Ngubane
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Karen Sanders
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Stephen Bertel Squire
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Gabriela Torrea
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - Bazarragchaa Tsogt
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
| | - I D Rusen
- From the Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London (A.J.N, P.P.J.P., S.K.M., K.S.), and the Liverpool School of Tropical Medicine, Liverpool (S.B.S.) - both in the United Kingdom; International Union against Tuberculosis and Lung Disease (the Union), Paris (C.-Y.C., A.D., I.D.R.); the Department of Internal Medicine, Wanfang Hospital, and School of Medicine, Taipei Medical University (C.-Y.C.) - both in Taipei, Taiwan; the University of Witwatersrand, Faculty of Health Sciences, Johannesburg (F.C.), King Dinizulu Hospital Complex, Kwazulu Natal (I.M., N.N.), and Think TB and HIV Investigative Network, Durban (R.M.) - all in South Africa; National Center for Communicable Diseases (D.D.) and the Mongolian Tuberculosis Coalition (B.T.) - both in Ulaanbaatar, Mongolia; the Institute of Tropical Medicine, Antwerp, Belgium (A.D., G.T.); Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam (P.-T.D., N.L.); Armauer Hansen Research Institute (T.M.), and St. Peter's Tuberculosis Specialized Hospital and Global Health Committee (D.M.) - all in Addis Ababa, Ethiopia; the Division of Research and Development, Vital Strategies, New York (I.D.R.); and the Dalla Lana School of Public Health, University of Toronto, Toronto (I.D.R.)
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Hameleers M, Bos L, Fawzi N, Reinemann C, Andreadis I, Corbu N, Schemer C, Schulz A, Shaefer T, Aalberg T, Axelsson S, Berganza R, Cremonesi C, Dahlberg S, de Vreese CH, Hess A, Kartsounidou E, Kasprowicz D, Matthes J, Negrea-Busuioc E, Ringdal S, Salgado S, Sanders K, Schmuck D, Stromback J, Suiter J, Boomgaarden H, Tenenboim-Weinblatt K, Weiss-Yaniv N. Start Spreading the News: A Comparative Experiment on the Effects of Populist Communication on Political Engagement in Sixteen European Countries. Int J Press Polit 2018; 23:517-538. [PMID: 30443283 PMCID: PMC6196348 DOI: 10.1177/1940161218786786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although populist communication has become pervasive throughout Europe, many important questions on its political consequences remain unanswered. First, previous research has neglected the differential effects of populist communication on the Left and Right. Second, internationally comparative studies are missing. Finally, previous research mostly studied attitudinal outcomes, neglecting behavioral effects. To address these key issues, this paper draws on a unique, extensive, and comparative experiment in sixteen European countries (N = 15,412) to test the effects of populist communication on political engagement. The findings show that anti-elitist populism has the strongest mobilizing effects, and anti-immigrant messages have the strongest demobilizing effects. Moreover, national conditions such as the level of unemployment and the electoral success of the populist Left and Right condition the impact of populist communication. These findings provide important insights into the persuasiveness of populist messages spread throughout the European continent.
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Affiliation(s)
| | - Linda Bos
- University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Nicoleta Corbu
- National University of Political Studies and Public Administration, Bucharest, Romania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elena Negrea-Busuioc
- National University of Political Studies and Public Administration, Bucharest, Romania
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Sanders K, Kooistra HS, Galac S. Treating canine Cushing's syndrome: Current options and future prospects. Vet J 2018; 241:42-51. [PMID: 30340659 DOI: 10.1016/j.tvjl.2018.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 12/17/2022]
Abstract
Naturally occurring hypercortisolism, also known as Cushing's syndrome, is a common endocrine disorder in dogs that can be caused by an adenocorticotrophic hormone (ACTH)-producing pituitary adenoma (pituitary-dependent hypercortisolism, PDH; 80-85% of cases), or by an adrenocortical tumor (ACT; 15-20% of cases). To determine the optimal treatment strategy, differentiating between these two main causes is essential. Good treatment options are surgical removal of the causal tumor, i.e. hypophysectomy for PDH and adrenalectomy for an ACT, or radiotherapy in cases with PDH. Because these options are not without risks, not widely available and not suitable for every patient, pharmacotherapy is often used. In cases with PDH, the steroidogenesis inhibitor trilostane is most often used. In cases with an ACT, either trilostane or the adrenocorticolytic drug mitotane can be used. Although mostly effective, both treatments have disadvantages. This review discusses the current treatment options for canine hypercortisolism, and considers their mechanism of action, efficacy, adverse effects, and effect on survival. In addition, developments in both adrenal-targeting and pituitary-targeting drugs that have the potential to become future treatment options are discussed, as a more selective and preferably also tumor-targeted approach could have many advantages for both PDH and ACTs.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - H S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
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Erne P, Wardle J, Sanders K, Lewis SM, Maseri A. Mean Platelet Volume and Size Distribution and Their Sensitivity to Agonists in Patients with Coronary Artery Disease and Congestive Heart Failure. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642766] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
SummaryMean platelet volume was related to platelet count in patients with myocardial infarction (n = 55) and patients with congestive heart failure (n = 9). 18 patients with acute myocardial infarction were tested at admission and 4-7 days later, together with 13 patients with chronic stable angina and 10 patients with chest pain which was not related to coronary artery disease. In citrated blood a relative reduced frequency of large platelets (>13 fl) occured in patients with acute myocardial infarction at admission but was not seen during recovery or in patients with chronic stable angina. This suggests consumption of large platelets at time of thrombus formation. No relation was found between plasma catecholamine levels and mean platelet volumes. Effects of serotonine, adrenaline and CGP 28392, a calcium agonist, on platelet volume distributions were determined. Sensitivity of platelets to adrenaline was increased in patients with acute myocardial infarction on admission and reduced 4-7 days later, while in patients with congestive heart failure reactivity to both serotonine and adrenaline were reduced. This indicates a fast down-regulation during the early recovery phase of myocardial infarction and chronically in congestive heart failure.
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Affiliation(s)
- P Erne
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - J Wardle
- Department of Haematology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - K Sanders
- Department of Haematology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - S M Lewis
- Department of Haematology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - A Maseri
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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Nattkemper L, Rosen J, Sanders K, Andersent H, Hsiang J, Bernigaud C, Guillot J, Chosidow O, Yosipovitch G. 460 Non-histaminergic itch mediators elevated in the skin of human scabies patients and a porcine model of scabies. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.467] [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: 11/25/2022]
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Sanders K, Mol JA, Slob A, Kooistra HS, Galac S. Steroidogenic factor-1 inverse agonists as a treatment option for canine hypercortisolism: in vitro study. Domest Anim Endocrinol 2018; 63:23-30. [PMID: 29223003 DOI: 10.1016/j.domaniend.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Received: 09/21/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 01/14/2023]
Abstract
Hypercortisolism is one of the most commonly diagnosed endocrinopathies in dogs, and new targeted medical treatment options are desirable. Steroidogenic factor-1 (SF-1), an orphan nuclear hormone receptor, is a key regulator of adrenal steroidogenesis, development, and growth. In pituitary-dependent hypercortisolism (PDH), high plasma ACTH concentrations increase the transcriptional activity of SF-1. In adrenal-dependent hypercortisolism, SF-1 expression is significantly greater in dogs with recurrence after adrenalectomy than in those without recurrence. Inhibition of SF-1 could therefore be an interesting treatment option in canine spontaneous hypercortisolism. We determined the effects of 3 SF-1 inverse agonists, compounds IsoQ A, #31, and #32, on cortisol production, on the messenger RNA (mRNA) expression of steroidogenic enzymes and SFs, and on cell viability, in primary adrenocortical cell cultures of 8 normal adrenal glands and of 3 cortisol-secreting adrenocortical tumors (ATs). To mimic PDH, the normal adrenocortical cell cultures were stimulated with ACTH. The results show that only compound #31 inhibited cortisol production and SF-1 target gene expression in non-ACTH-stimulated and ACTH-stimulated normal adrenocortical cells but did not affect cell viability. In the AT cell cultures, the effects of #31 on cortisol production and target gene expression were variable, possibly caused by a difference in the SF-1 mRNA expressions of the primary tumors. In conclusion, inhibition of SF-1 activity shows much promise as a future treatment for canine hypercortisolism.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - J A Mol
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - A Slob
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - H S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
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Chousou PA, Bellanti R, Sanders K, Papadimitraki EA, Houghton S, Belham MRD, Pugh PJ. 673Incidence of atrial arrhythmia and uptake of anticoagulation in stroke and non-stroke populations according to arrhythmia burden; a 7-year experience. Europace 2018. [DOI: 10.1093/europace/euy015.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P A Chousou
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - R Bellanti
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - K Sanders
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - E A Papadimitraki
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - S Houghton
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - MRD Belham
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - P J Pugh
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
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26
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Chousou PA, Bellanti R, Hayes J, Marinakis A, Sanders K, Carpenter V, Hewitt H, Domingos A, Virdee MS, Pugh PJ. P318Day-case implant of complex pacing devices is safe and preferred by patients; a 2 year experience. Europace 2018. [DOI: 10.1093/europace/euy015.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P A Chousou
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - R Bellanti
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - J Hayes
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - A Marinakis
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - K Sanders
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - V Carpenter
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - H Hewitt
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - A Domingos
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - M S Virdee
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - P J Pugh
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
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Albanese AP, Ayvazian J, Bope E, Van Gilder A, Pelic C, Sanders K, Lypson M, Clary C, Klink K. A Year 3 Progress Report on Graduate Medical Education Expansion in the Veterans Access, Choice, and Accountability Act. Fed Pract 2018; 35:22-27. [PMID: 30766339 PMCID: PMC6248221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The VA has made progress in implementing mandates to expand medical residency programs to more rural and underserved locations and to increase access to family care providers, but some specialties, like geriatrics, remain underrepresented.
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Affiliation(s)
- Anthony P Albanese
- is an Affiliations Officer, is the Clinical Director for Nursing Education, is the Lead Graduate Medical Education Affiliations Officer, is a Management Analyst, is Clinical Director of Medical Dental Education, is Director of Medical Dental Education, is the Deputy Chief, is a Health System Specialist, and is the Acting Chief; all for the VA Office of Academic Affiliations
| | - Jemma Ayvazian
- is an Affiliations Officer, is the Clinical Director for Nursing Education, is the Lead Graduate Medical Education Affiliations Officer, is a Management Analyst, is Clinical Director of Medical Dental Education, is Director of Medical Dental Education, is the Deputy Chief, is a Health System Specialist, and is the Acting Chief; all for the VA Office of Academic Affiliations
| | - Edward Bope
- is an Affiliations Officer, is the Clinical Director for Nursing Education, is the Lead Graduate Medical Education Affiliations Officer, is a Management Analyst, is Clinical Director of Medical Dental Education, is Director of Medical Dental Education, is the Deputy Chief, is a Health System Specialist, and is the Acting Chief; all for the VA Office of Academic Affiliations
| | - Amanda Van Gilder
- is an Affiliations Officer, is the Clinical Director for Nursing Education, is the Lead Graduate Medical Education Affiliations Officer, is a Management Analyst, is Clinical Director of Medical Dental Education, is Director of Medical Dental Education, is the Deputy Chief, is a Health System Specialist, and is the Acting Chief; all for the VA Office of Academic Affiliations
| | - Christopher Pelic
- is an Affiliations Officer, is the Clinical Director for Nursing Education, is the Lead Graduate Medical Education Affiliations Officer, is a Management Analyst, is Clinical Director of Medical Dental Education, is Director of Medical Dental Education, is the Deputy Chief, is a Health System Specialist, and is the Acting Chief; all for the VA Office of Academic Affiliations
| | - Karen Sanders
- is an Affiliations Officer, is the Clinical Director for Nursing Education, is the Lead Graduate Medical Education Affiliations Officer, is a Management Analyst, is Clinical Director of Medical Dental Education, is Director of Medical Dental Education, is the Deputy Chief, is a Health System Specialist, and is the Acting Chief; all for the VA Office of Academic Affiliations
| | - Monica Lypson
- is an Affiliations Officer, is the Clinical Director for Nursing Education, is the Lead Graduate Medical Education Affiliations Officer, is a Management Analyst, is Clinical Director of Medical Dental Education, is Director of Medical Dental Education, is the Deputy Chief, is a Health System Specialist, and is the Acting Chief; all for the VA Office of Academic Affiliations
| | - Christyann Clary
- is an Affiliations Officer, is the Clinical Director for Nursing Education, is the Lead Graduate Medical Education Affiliations Officer, is a Management Analyst, is Clinical Director of Medical Dental Education, is Director of Medical Dental Education, is the Deputy Chief, is a Health System Specialist, and is the Acting Chief; all for the VA Office of Academic Affiliations
| | - Kathleen Klink
- is an Affiliations Officer, is the Clinical Director for Nursing Education, is the Lead Graduate Medical Education Affiliations Officer, is a Management Analyst, is Clinical Director of Medical Dental Education, is Director of Medical Dental Education, is the Deputy Chief, is a Health System Specialist, and is the Acting Chief; all for the VA Office of Academic Affiliations
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Chousou PA, Bellanti R, Hayes J, Marinakis A, Sanders K, Carpenter V, Hewitt H, Domingos A, Virdee MS, Pugh PJ. 57Day- case implant of complex pacing devices is safe and preferred by patients. Europace 2017. [DOI: 10.1093/europace/eux283.014] [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: 11/12/2022] Open
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29
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Chousou PA, Bellanti R, Sanders K, Papadimitraki EA, Houghton S, Belham MRD, Pugh PJ. 17Atrial arrhythmia detection by implantable loop recorder in patients with and without previous stroke; implications for investigating patients with unexplained ischaemic stroke. Europace 2017. [DOI: 10.1093/europace/eux283.026] [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: 11/12/2022] Open
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30
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Sakai K, Sanders K, Yosipovitch G, Akiyama T. LB1006 Mouse model of post-burn itch. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.090] [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: 11/15/2022]
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31
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Bodd M, Lee J, Mackeyev Y, Aliru M, Aziz K, Sanders K, Khoo A, Tailor R, Krishnan S. Radiosensitization of triple negative breast cancer with gold nanosphere conjugates targeting the folate receptor. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1995] [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: 11/15/2022]
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Aliru M, Aziz K, Bodd M, Sanders K, Mahadevan L, Sahoo N, Tailor R, Krishnan S. Targeted Gold Nanoparticles Enhance Radiation Effects in Pancreatic Tumor Models. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1983] [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: 10/18/2022]
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Chousou P, Bellanti R, Papadimitraki E, Sanders K, Belham M, Pugh P. P4599Atrial arrhythmia detection by Implantable Loop Recorder in patients with and without previous stroke; impact of arrhythmia duration and time to diagnosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4599] [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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34
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Sanders K, Watts J, Abimanyi-Ochom J, Barker A. REDUCED FRACTURE RISK IN OLDER ADULTS TAKING LOW DOSE ASPIRIN: MODELING COSTS AND QUALITY OF LIFE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K. Sanders
- Australian Catholic University, Melbourne, Victoria, Australia,
- The University of Melbourne, Melbourne, Victoria, Australia,
| | - J. Watts
- Deakin University, Melbourne, Victoria, Australia,
| | | | - A. Barker
- Monash University, Melbourne, Victoria, Australia
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Ashraf Kharaz Y, Zamboulis D, Sanders K, Comerford E, Clegg P, Peffers M. Comparison between chaotropic and detergent-based sample preparation workflow in tendon for mass spectrometry analysis. Proteomics 2017; 17:1700018. [PMID: 28547889 PMCID: PMC5575552 DOI: 10.1002/pmic.201700018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 01/12/2023]
Abstract
Exploring the tendon proteome is a challenging but important task for understanding the mechanisms of physiological/pathological processes during ageing and disease and for the development of new treatments. Several extraction methods have been utilised for tendon mass spectrometry, however different extraction methods have not been simultaneously compared. In the present study we compared protein extraction in tendon with two chaotropic agents, guanidine hydrochloride (GnHCl) and urea, a detergent, RapiGest™, and their combinations for shotgun mass spectrometry. An initial proteomic analysis was performed following urea, GnHCl, and RapiGest™ extraction of equine superficial digital flexor tendon (SDFT) tissue. Subsequently, another proteomic analysis was performed following extraction with GnHCl, Rapigest™, and their combinations. Between the two chaotropic agents, GnHCl extracted more proteins, whilst a greater number of proteins were solely identified after Rapigest™ extraction. Protein extraction with a combination of GnHCl followed by RapiGest™ on the insoluble pellet demonstrated, after label-free quantification, increased abundance of identified collagen proteins and low sample to sample variability. In contrast, GnHCl extraction on its own showed increased abundance of identified proteoglycans and cellular proteins. Therefore, the selection of protein extraction method for tendon tissue for mass spectrometry analysis should reflect the focus of the study.
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Affiliation(s)
- Yalda Ashraf Kharaz
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic DiseaseUniversity of LiverpoolLiverpoolUK
| | - Danae Zamboulis
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic DiseaseUniversity of LiverpoolLiverpoolUK
| | - Karen Sanders
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic DiseaseUniversity of LiverpoolLiverpoolUK
| | - Eithne Comerford
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic DiseaseUniversity of LiverpoolLiverpoolUK
| | - Peter Clegg
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic DiseaseUniversity of LiverpoolLiverpoolUK
- The MRC‐Arthritis Research UK Centre for Integrated research into Musculoskeletal Ageing (CIMA)LiverpoolUK
| | - Mandy Peffers
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic DiseaseUniversity of LiverpoolLiverpoolUK
- The MRC‐Arthritis Research UK Centre for Integrated research into Musculoskeletal Ageing (CIMA)LiverpoolUK
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36
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Chousou PA, Bellanti R, Sanders K, Houghton S, Belham MRD, Pugh PJ. P1381Incidence of atrial fibrillation detection in patients with an implantable loop recorder; implications for investigating patients with unexplained ischaemic stroke. Europace 2017. [DOI: 10.1093/ehjci/eux158.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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37
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Stöhr W, Dunn DT, Arenas-Pinto A, Orkin C, Clarke A, Williams I, Johnson M, Beeching NJ, Wilkins E, Sanders K, Paton NI. Factors associated with virological rebound in HIV-infected patients receiving protease inhibitor monotherapy. AIDS 2016; 30:2617-2624. [PMID: 27456983 DOI: 10.1097/qad.0000000000001206] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The Protease Inhibitor Monotherapy Versus Ongoing Triple Therapy (PIVOT) trial found that protease inhibitor monotherapy as a simplification strategy is well tolerated in terms of drug resistance but less effective than combination therapy in suppressing HIV viral load. We sought to identify factors associated with the risk of viral load rebound in this trial. METHODS PIVOT was a randomized controlled trial in HIV-positive adults with suppressed viral load for at least 24 weeks on combination therapy comparing a strategy of physician-selected ritonavir-boosted protease inhibitor monotherapy versus ongoing triple therapy. In participants receiving monotherapy, we analysed time to confirmed viral load rebound and its predictors using flexible parametric survival models. RESULTS Of 290 participants initiating protease inhibitor monotherapy (80% darunavir, 14% lopinavir, and 6% other), 93 developed viral load rebound on monotherapy. The risk of viral load rebound peaked at 9 months after starting monotherapy and then declined to approximately 5 per 100 person-years from 18 months onwards. Independent predictors of viral load rebound were duration of viral load suppression before starting monotherapy (hazard ratio 0.81 per additional year <50 copies/ml; P < 0.001), CD4 cell count (hazard ratio 0.73 per additional 100 cells/μl for CD4 nadir; P = 0.008); ethnicity (hazard ratio 1.87 for nonwhite versus white, P = 0.025) but not the protease inhibitor agent used (P = 0.27). Patients whose viral load was analysed with the Roche TaqMan-2 assay had a 1.87-fold risk for viral load rebound compared with Abbott RealTime assay (P = 0.012). CONCLUSION A number of factors can identify patients at low risk of rebound with protease inhibitor monotherapy, and this may help to better target those who may benefit from this management strategy.
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Affiliation(s)
- Wolfgang Stöhr
- aMRC Clinical Trials Unit at University College London bBarts and The Royal London Hospital NHS Trust, London cBrighton and Sussex University Hospitals NHS Trust, Brighton dUniversity College London eRoyal Free Hospital, London fRoyal Liverpool University Hospital, Liverpool gNorth Manchester General Hospital, Manchester, UK hYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. *Members of the PIVOT Trial Team are listed in the acknowledgements
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Abstract
The study reports the results of the most extensive survey of its kind conducted in British journalism education, examining attitudes towards journalism ethics and news media roles held by 653 first-year undergraduates as they began British university journalism courses in 2002 and 2003. Findings are compared with similar data for British journalists. Influences such as social background, gender, and time spent in newsrooms are examined. The findings provide some evidence for a distinct British journalistic “culture” already embedded in students' attitudes when they begin formal journalism education, as well as for a gender difference in views of journalism ethics
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Affiliation(s)
| | - Mark Hanna
- Department of Journalism Studies at the University of Sheffield
| | - Karen Sanders
- Department of Journalism Studies, University of Sheffield
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Sanders K, Mol JA, Kooistra HS, Slob A, Galac S. New Insights in the Functional Zonation of the Canine Adrenal Cortex. J Vet Intern Med 2016; 30:741-50. [PMID: 27108660 PMCID: PMC4913559 DOI: 10.1111/jvim.13946] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/29/2016] [Accepted: 03/14/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Current understanding of adrenal steroidogenesis is that the production of aldosterone or cortisol depends on the expression of aldosterone synthase (CYP11B2) and 11β-hydroxylase cytochrome P450 (CYP11B1), respectively. However, this has never been studied in dogs, and in some species, a single CYP11B catalyzes both cortisol and aldosterone formation. Analysis of the canine genome provides data of a single CYP11B gene which is called CYP11B2, and a large sequence gap exists near the so-called CYP11B2 gene. OBJECTIVES To investigate the zonal expression of steroidogenic enzymes in the canine adrenal cortex and to determine whether dogs have 1 or multiple CYP11B genes. ANIMALS Normal adrenal glands from 10 healthy dogs. METHODS Zona fasciculata (zF) and zona glomerulosa (zG) tissue was isolated by laser microdissection. The mRNA expression of steroidogenic enzymes and their major regulators was studied with RT-qPCR. Southern blot was performed to determine whether the sequence gap contains a CYP11B gene copy. Immunohistochemistry (IHC) was performed for 17α-hydroxylase/17,20-lyase (CYP17). RESULTS Equal expression (P = .62) of the so-called CYP11B2 gene was found in the zG and zF. Southern blot revealed a single gene. CYP17 expression (P = .05) was significantly higher in the zF compared with the zG, which was confirmed with IHC. CONCLUSIONS AND CLINICAL IMPORTANCE We conclude that there is only 1 CYP11B gene in canine adrenals. The zone-specific production of aldosterone and cortisol is probably due to zone-specific CYP17 expression, which makes it an attractive target for selective inhibition of cortisol synthesis without affecting mineralocorticoid production in the zG.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - J A Mol
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - H S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - A Slob
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Bourgeois A, Egbert R, Gilbert P, Sanders K, Yamada R, Anderson M, Guimaraes M. Patent hemostasis modified technique in transradial interventional procedures. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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41
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Pryor W, Bourgeois A, Sanders K, Gilbert P, Egbert, Yamada R, Guimaraes M. Radial access for liver-directed therapy: a single center prospective study. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.506] [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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42
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Brundage M, Sydes MR, Parulekar WR, Warde P, Cowan R, Bezjak A, Kirkbride P, Parliament M, Moynihan C, Bahary JP, Parmar MKB, Sanders K, Chen BE, Mason MD. Impact of Radiotherapy When Added to Androgen-Deprivation Therapy for Locally Advanced Prostate Cancer: Long-Term Quality-of-Life Outcomes From the NCIC CTG PR3/MRC PR07 Randomized Trial. J Clin Oncol 2015; 33:2151-7. [PMID: 26014295 DOI: 10.1200/jco.2014.57.8724] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The NCIC CTG PR3/MRC PR07 randomized phase III trial compared androgen-deprivation therapy (ADT) alone versus ADT with radiotherapy (RT) for patients with locally advanced prostate cancer. This article reports the health-related quality-of-life (HRQOL) outcomes of this trial. PATIENTS AND METHODS A total of 1,205 patients were randomly allocated to either ADT alone or ADT with RT. HRQOL was assessed at baseline and every 6 months thereafter using the European Organisation for Research and Treatment of Cancer Core Questionnaire and a prostate cancer-specific checklist or the Functional Assessment of Cancer Therapy-Prostate questionnaire. Mean changes from baseline scores for five function domains and nine symptom domains were analyzed as those most relevant to ADT and RT. The proportions of patients with improved, stable, or worsened HRQOL scores according to instrument-specific minimal important differences were calculated. RESULTS Baseline questionnaires were completed by 1,028 patients (88%). At 6 months, RT had a statistically significant impact on mean score for bowel symptoms (P = .02), diarrhea (P < .001), urinary function (P = .003), and erectile dysfunction (P = .008); by 3 years, however, there were no significant between-group differences in any domain. Generalized linear mixed modeling revealed no significant between-arm differences in any of the function scales but showed significant deterioration in both arms over time for Functional Assessment of Cancer Therapy-Prostate total score, treatment outcome index, and physical and functional well-being. CONCLUSION The addition of RT to ADT for patients with locally advanced prostate cancer significantly improved overall survival and had only modest and transient negative impact on relevant domains of HRQOL.
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Affiliation(s)
- Michael Brundage
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom.
| | - Matthew R Sydes
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Wendy R Parulekar
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Padraig Warde
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Richard Cowan
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Andrea Bezjak
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Peter Kirkbride
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Matthew Parliament
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Clare Moynihan
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Jean-Paul Bahary
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Mahesh K B Parmar
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Karen Sanders
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Bingshu E Chen
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
| | - Malcolm D Mason
- Michael Brundage, Queen's Cancer Research Institute and Cancer Centre of Southeastern Ontario; Wendy R. Parulekar and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University, Kingston; Padraig Warde and Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario; Matthew Parliament, Cross Cancer Institute, Edmonton, Alberta; Jean-Paul Bahary, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada; Matthew R. Sydes, Mahesh K.B. Parmar, and Karen Sanders, Medical Research Council Clinical Trials Unit, University College London, London; Richard Cowan, Christie Hospital and University of Manchester, Manchester; Peter Kirkbride, Clatterbridge Cancer Centre, National Health Service Foundation Trust, Wirral; Clare Moynihan, Institute of Cancer Research, Sutton; and Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital, Cardiff, United Kingdom
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Link T, Arpornsukant P, Chareddy A, Alluri A, Chyong D, Eshleman C, Hu M, Jain S, Kahn J, Kemelmakher H, Kepner A, Krishnaswamy A, Raman V, Sanders K, Stock G. CFTR: Structural Mishap by Mutation. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.lb64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- T Link
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - P Arpornsukant
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - A Chareddy
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - A Alluri
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - D Chyong
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - C Eshleman
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - M Hu
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - S Jain
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - J Kahn
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - H Kemelmakher
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - A Kepner
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - A Krishnaswamy
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - V Raman
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - K Sanders
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
| | - G Stock
- ChemistryGeorgia Institute of TechnologyAtlantaGeorgiaUnited States
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Han H, Djukiadmodjo F, Al-Fiadh A, Sanders K, Scott P, Teh A, Lim H, O’Donnell D, Jones E, Farouque O. Resuscitated out-of-hospital cardiac arrest: predictors of in-hospital survival. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hoff E, Namara KM, Gellatly R, Elliott R, Karunajeewa H, Sanders K, Lay D, Welsh M, Poole S, Janus E. PW094 Variation in measured quality of discharge prescribing for acute coronary syndrome using common indicators. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.2228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Gard J, Taylor D, Wilhite D, Rodning S, Woodall C, Schnuelle M, Sanders K, Denny T. A bovine model for equine digital cushion development. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2013.08.071] [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: 10/26/2022]
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Sanders K. Phoenix nurses: a path to renewal. Beginnings 2013; 33:10-12. [PMID: 24575517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Sometimes being on the front lines involves caring for our colleagues. "Assisting nurses to nurture and heal themselves" is a defined role of holistic nursing practice (AHNA & ANA, 2013, p. 8). Nothing can be more catastrophic for a nurse's career than the loss of her/his license to practice. In this dark hour a nurse will often need extra support and someone to walk alongside her/him in the healing process. This article describes a holistic nurse in North Carolina who is helping nurses in her region find the courage to rise up from the ashes and start anew.
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Affiliation(s)
- Karen Sanders
- Transylavania Regional Hospital, Mission Health, Brevard, North Carolina, USA
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New G, Jangwal H, Parker H, Roberts L, Barger B, Smith K, Toogood G, Soon K, Cox N, Malaiapan Y, van Gaal W, Wilson J, Whitbourn R, Maclsaac A, Grigg L, Black A, Broughton A, Farouque HMO, Sanders K, Dick R, Briganti E, Lefkovits J, Harper R. PRE-HOSPITAL NOTIFICATION OF STEMI (PNS): COLLABORATION BETWEEN THE VICTORIAN CARDIAC CLINICAL NETWORK, AMBULANCE VICTORIA AND PARTICIPATING HOSPITALS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60121-7] [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: 10/27/2022]
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Ise W, Heuser M, Sanders K, Beck J, Gekeler V. P-glycoprotein-associated resistance to taxol and taxotere and its reversal by dexniguldipine-HCl, dexverapamil-HCl, or cyclosporin A. Int J Oncol 2012; 8:951-6. [PMID: 21544450 DOI: 10.3892/ijo.8.5.951] [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: 11/06/2022] Open
Abstract
A series of different human MDR (multidrug-resistant) cell lines including a HeLa-MDR1 transfectant which exhibit high overexpression of the MDR1/P-glycoprotein gene, but no enhanced expression of the MRP (multidrug resistance associated protein) gene, showed different ratios of relative resistances to the taxanes taxol and taxotere. Using these cell lines the chemosensitizing efficacies of several structurally different chemosensitizers, i.e. the dihydropyridine dexniguldipine-HC1 (B8509-035), its main pyridine metabolite M1 (B8909-008), the cyclic peptide cyclosporin A, or the phenylalkylamine dexverapamil-HCl, were examined applying a 72 h tetrazolium based colorimetric MTT-assay, or a 96 h sulforhodamine B assay. Remarkably, we observed in some instances that the modulating efficacy of a particular chemosensitizer was strongly dependent on the cell line used for experimentation. Thus, dexniguldipine-HCl efficiently modulated taxane resistances of the ovarian carcinoma MDR cell line 2780AD in the submicromolar concentration range, whereas cyclosporin A and the other chemosensitizers were rather ineffective. Dexniguldipine-HCl or cyclosporin A, however, both showed a similarly strong modulating activity on the HeLa-MDR1 transfectant in clear contrast to the effects observed using the pyridine B8909-008, or dexverapamil-HCl, respectively, at the same final concentrations. Our results point to additional, as yet unidentified factors beyond the expression levels of P-glycoprotein which could contribute to the susceptibility of MDR cells to a combined treatment using taxanes and different chemosensitizing compounds. This result appears to be important considering the clinical application of chemosensitizers for combination therapy of tumors of different origin.
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Affiliation(s)
- W Ise
- BYK GULDEN GMBH,D-78403 CONSTANCE,GERMANY. UNIV TUBINGEN,KINDERKLIN,D-72070 TUBINGEN,GERMANY
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Sydes MR, Parmar MKB, Mason MD, Clarke NW, Amos C, Anderson J, de Bono J, Dearnaley DP, Dwyer J, Green C, Jovic G, Ritchie AWS, Russell JM, Sanders K, Thalmann G, James ND. Flexible trial design in practice - stopping arms for lack-of-benefit and adding research arms mid-trial in STAMPEDE: a multi-arm multi-stage randomized controlled trial. Trials 2012; 13:168. [PMID: 22978443 PMCID: PMC3466132 DOI: 10.1186/1745-6215-13-168] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 08/16/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Systemic Therapy for Advanced or Metastatic Prostate cancer: Evaluation of Drug Efficacy (STAMPEDE) is a randomized controlled trial that follows a novel multi-arm, multi-stage (MAMS) design. We describe methodological and practical issues arising with (1) stopping recruitment to research arms following a pre-planned intermediate analysis and (2) adding a new research arm during the trial. METHODS STAMPEDE recruits men who have locally advanced or metastatic prostate cancer who are starting standard long-term hormone therapy. Originally there were five research and one control arms, each undergoing a pilot stage (focus: safety, feasibility), three intermediate 'activity' stages (focus: failure-free survival), and a final 'efficacy' stage (focus: overall survival). Lack-of-sufficient-activity guidelines support the pairwise interim comparisons of each research arm against the control arm; these pre-defined activity cut-off becomes increasingly stringent over the stages. Accrual of further patients continues to the control arm and to those research arms showing activity and an acceptable safety profile. The design facilitates adding new research arms should sufficiently interesting agents emerge. These new arms are compared only to contemporaneously recruited control arm patients using the same intermediate guidelines in a time-delayed manner. The addition of new research arms is subject to adequate recruitment rates to support the overall trial aims. RESULTS (1) Stopping Existing Therapy: After the second intermediate activity analysis, recruitment was discontinued to two research arms for lack-of-sufficient activity. Detailed preparations meant that changes were implemented swiftly at 100 international centers and recruitment continued seamlessly into Activity Stage III with 3 remaining research arms and the control arm. Further regulatory and ethical approvals were not required because this was already included in the initial trial design.(2) Adding New Therapy: An application to add a new research arm was approved by the funder, (who also organized peer review), industrial partner and regulatory and ethical bodies. This was all done in advance of any decision to stop current therapies. CONCLUSIONS The STAMPEDE experience shows that recruitment to a MAMS trial and mid-flow changes its design are achievable with good planning. This benefits patients and the scientific community as research treatments are evaluated in a more efficient and cost-effective manner. TRIAL REGISTRATION ISRCTN78818544, NCT00268476. First patient into trial: 17 October 2005. First patient into abiraterone comparison: 15 November 2011.
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Affiliation(s)
| | | | | | - Noel W Clarke
- The Christie and Salford Royal Hospitals Foundations Trusts, Manchester, UK
| | | | | | - Johann de Bono
- Institute of Cancer Research and Royal Marsden Hospitals Foundation Trust, Sutton, UK
| | - David P Dearnaley
- Institute of Cancer Research and Royal Marsden Hospitals Foundation Trust, Sutton, UK
| | - John Dwyer
- Prostate Cancer Support Federation, Stockport, UK
| | | | | | | | | | | | | | - Nicholas D James
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
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