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Sirois MJ, Carmichael PH, Daoust R, Eagles D, Griffith L, Lee J, Perry J, Veillette N, Émond M. 53 - Conséquences fonctionnelles des blessures mineures et leurs déterminants chez les aînés - Cohortes CETIe. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Aryal K, Aryal K, Mowbray F, Gruneir A, Griffith L, Howard M, Jabbar A, Jones A, Costa AW. The Association Between Nursing Home Resident Characteristics and Transfers to the Emergency Department: A Population-Level Retrospective Cohort Study. J Am Med Dir Assoc 2021; 22:B23-B24. [PMID: 34287172 DOI: 10.1016/j.jamda.2021.01.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sinhal A, Hooper T, Ng M, Griffith L, Deakin A, Bhindi R, Brieger D, Muller D, Walton A, Camuglia A, Gooley R, Yong G, Wilson W, Stewart J, Whitbourn R, Isaac M, Walters D, Bennetts J. Is STS Score Enough to Predict Appropriate High-risk Surgical Patient for TAVI. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.643] [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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Hooper T, Bennetts J, Ng M, Griffith L, Deakin A, Bhindi R, Brieger D, Muller D, Walton A, Camuglia A, Gooley R, Whitbourn R, Yong G, Wilson W, Stewart J, Isaac M, Walters D, Sinhal A. Establishment of the Australian Transcatheter Aortic Valve Implantation Registry. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.611] [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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Griffith L, Grunier A, Fisher K, Gafni A, Patterson C, Markle-Reid M, Ploeg J. SIMILARITIES IN SERVICE USE AND COMORBIDITY IN OLDER ADULTS WITH DEMENTIA, DIABETES, OR STROKE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.306] [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)
- L. Griffith
- McMaster University, Hamilton, Ontario, Canada,
| | - A. Grunier
- University of Alberta, Edmonton, Alberta, Canada
| | - K. Fisher
- McMaster University, Hamilton, Ontario, Canada,
| | - A. Gafni
- McMaster University, Hamilton, Ontario, Canada,
| | | | | | - J. Ploeg
- McMaster University, Hamilton, Ontario, Canada,
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Griffith L, Gilsing A, van den Heuvel E, Nazmul S, John P, Raina P. MULTIPLE CHRONIC CONDITIONS IN RELATION TO DISABILITY AND SOCIAL PARTICIPATION: DATA FROM THE CLSA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2642] [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)
- L. Griffith
- McMaster University, Hamilton, Ontario, Canada,
| | - A. Gilsing
- McMaster University, Hamilton, Ontario, Canada,
| | | | - S. Nazmul
- McMaster University, Hamilton, Ontario, Canada,
| | - P. John
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - P. Raina
- McMaster University, Hamilton, Ontario, Canada,
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Clark AM, Wheeler SE, Young CL, Stockdale L, Shepard Neiman J, Zhao W, Stolz DB, Venkataramanan R, Lauffenburger D, Griffith L, Wells A. A liver microphysiological system of tumor cell dormancy and inflammatory responsiveness is affected by scaffold properties. Lab Chip 2016; 17:156-168. [PMID: 27910972 PMCID: PMC5242229 DOI: 10.1039/c6lc01171c] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Distant metastasis is the major cause of breast cancer-related mortality, commonly emerging clinically after 5 or more years of seeming 'cure' of the primary tumor, indicating a quiescent dormancy. The lack of relevant accessible model systems for metastasis that recreate this latent stage has hindered our understanding of the molecular basis and the development of therapies against these lethal outgrowths. We previously reported on the development of an all-human 3D ex vivo hepatic microphysiological system that reproduces several features of liver physiology and enables spontaneous dormancy in a subpopulation of breast cancer cells. However, we observed that the dormant cells were localized primarily within the 3D tissue, while the proliferative cells were in contact with the polystyrene scaffold. As matrix stiffness is known to drive inflammatory and malignant behaviors, we explored the occurrence of spontaneous tumor dormancy and inflammatory phenotype. The microphysiological system was retrofitted with PEGDa-SynKRGD hydrogel scaffolding, which is softer and differs in the interface with the tissue. The microphysiological system incorporated donor-matched primary human hepatocytes and non-parenchymal cells (NPCs), with MDA-MB-231 breast cancer cells. Hepatic tissue in hydrogel scaffolds secreted lower levels of pro-inflammatory analytes, and was more responsive to inflammatory stimuli. The proportion of tumor cells entering dormancy was markedly increased in the hydrogel-supported tissue compared to polystyrene. Interestingly, an unexpected differential response of dormant cells to varying chemotherapeutic doses was identified, which if reflective of patient pathophysiology, has important implications for patient dosing regimens. These findings highlight the metastatic microphysiological system fitted with hydrogel scaffolds as a critical tool in the assessment and development of therapeutic strategies to target dormant metastatic breast cancer.
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Affiliation(s)
- A M Clark
- Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA.
| | - S E Wheeler
- Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA.
| | - C L Young
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - L Stockdale
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - J Shepard Neiman
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - W Zhao
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - D B Stolz
- Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA. and Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA and McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA and University of Pittsburgh Cancer Center, Pittsburgh, PA, USA
| | - R Venkataramanan
- Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA. and Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - D Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - L Griffith
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - A Wells
- Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA. and Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA and Pittsburgh VA Medical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA and McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Sarkar U, Tannenbaum S, Carrier R, Chen K, Cirit M, Griffith L, Hughes D, Large E, Wishnok J, Yu J. Assessment of Drug Clearance, Metabolite Profile, and Drug Induced Toxicity in a Coculture of Human 3D Liver and Gut Microphysiological Systems: : Toward developing a perfused human liver‐gut interactome. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.779.4] [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)
- U. Sarkar
- Biological EngineeringMITCambridgeMAUnited States
| | - S. Tannenbaum
- Biological EngineeringMITCambridgeMAUnited States
- ChemistryMITCambridgeMAUnited States
| | - R. Carrier
- BioengineeringNortheastern UniversityBostonMAUnited States
| | - K Chen
- Biological EngineeringMITCambridgeMAUnited States
| | - M Cirit
- Biological EngineeringMITCambridgeMAUnited States
| | - L. Griffith
- Biological EngineeringMITCambridgeMAUnited States
| | - D. Hughes
- DIscovery CN Bio Innovations LimitedOxfordshireUnited Kingdom
| | - E Large
- DIscovery CN Bio Innovations LimitedOxfordshireUnited Kingdom
| | - J. Wishnok
- Biological EngineeringMITCambridgeMAUnited States
| | - J Yu
- Biological EngineeringMITCambridgeMAUnited States
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Wheeler SE, Clark AM, Taylor DP, Young CL, Pillai VC, Stolz DB, Venkataramanan R, Lauffenburger D, Griffith L, Wells A. Spontaneous dormancy of metastatic breast cancer cells in an all human liver microphysiologic system. Br J Cancer 2014; 111:2342-50. [PMID: 25314052 PMCID: PMC4264444 DOI: 10.1038/bjc.2014.533] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/08/2014] [Accepted: 09/11/2014] [Indexed: 12/25/2022] Open
Abstract
Background: Metastatic outgrowth in breast cancer can occur years after a seeming cure. Existing model systems of dormancy are limited as they do not recapitulate human metastatic dormancy without exogenous manipulations and are unable to query early events of micrometastases. Methods: Here, we describe a human ex vivo hepatic microphysiologic system. The system is established with fresh human hepatocytes and non-parenchymal cells (NPCs) creating a microenvironment into which breast cancer cells (MCF7 and MDA-MB-231) are added. Results: The hepatic tissue maintains function through 15 days as verified by liver-specific protein production and drug metabolism assays. The NPCs form an integral part of the hepatic niche, demonstrated within the system through their participation in differential signalling cascades and cancer cell outcomes. Breast cancer cells intercalate into the hepatic niche without interfering with hepatocyte function. Examination of cancer cells demonstrated that a significant subset enter a quiescent state of dormancy as shown by lack of cell cycling (EdU− or Ki67−). The presence of NPCs altered the cancer cell fraction entering quiescence, and lead to differential cytokine profiles in the microenvironment effluent. Conclusions: These findings establish the liver microphysiologic system as a relevant model for the study of breast cancer metastases and entry into dormancy.
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Affiliation(s)
- S E Wheeler
- Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, USA
| | - A M Clark
- Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, USA
| | - D P Taylor
- 1] Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, USA [2] Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - C L Young
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - V C Pillai
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - D B Stolz
- 1] Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, USA [2] Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA [3] McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA [4] University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - R Venkataramanan
- 1] Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, USA [2] Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - D Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - L Griffith
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - A Wells
- 1] Department of Pathology, University of Pittsburgh, S711 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, USA [2] Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA [3] McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA [4] University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA [5] Pittsburgh VA Medical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Wheeler SE, Taylor DP, Clark AM, Borenstein JT, Ebrahimkhani MR, Inman W, Nguyen T, Pillai VC, Prantil-Baun R, Ulrich TA, Venkataramanan R, Lauffenburger DA, Griffith L, Stolz DB, Wells A. Abstract P5-04-08: Modeling breast cancer dormancy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-04-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Most cancer mortality results from distant metastases. The metastatic microenvironment protects ectopic tumors, these nodules are often resistant to agents that eradicate the primary mass. Although significant interventional progress has been made on primary tumors, the lack of relevant accessible model in vitro systems in which to study metastases has plagued metastatic therapeutic development – particularly among micrometastases. One third of women diagnosed with breast cancer (BC) will have metastatic disease which often presents years after a seeming cure from the primary malignancy. An in silico model of micrometastases strongly suggests that these disseminated cells are quiescent, or ‘dormant’, for long periods of time. Current models fail to recapitulate metastatic dormancy, in vivo due to issues of spontaneous metastases and rodent lifespan and in vitro due to the nascent state of organotypic organs or microphysiological systems (MPS). We hypothesize that even the most developed MPS do not allow tumors to attain dormancy due to continued stress signaling from stiff matrices and an artificial microenvironment. We use an innovative all human three dimensional liver MPS to faithfully reproduce human physiology and pathology. In the initial iteration, the liver cells are isolated from therapeutic partial hepatectomies, but as this source may be limiting, we are examining induced pluripotent stem cells (iPSC). Currently these iPSC-derived hepatocyte-like cells demonstrate cyp p450 activity and production of fibrinogen and urea through 15 days in our MPS, albeit at levels below fresh human hepatocytes; optimization protocols are underway.
In the first phase of this work we optimized the flow rate and seeding of hepatocytes with non-parenchymal cells (NPCs) from fresh human liver resections. We found that higher flow rates produced poorer tissue formation and increased stress fibers/actin filaments. We maintained functioning hepatocytes in the MPS through 15 days. Hepatocyte function and injury was measured by urea, lactate, AST, ALT, A1AT, fibrinogen and cyp p450 assays. NPCs survived through the 15 day endpoint with immunofluorescent microscopy visualizing leukocytes, endothelial cells and macrophages. The proliferative MDA MB 231 BC cell line showed preliminary evidence of growth attenuation after 12 days of culture in a subpopulation of cells in our MPS. Luminex cancer panel studies are underway with systems biology modeling to describe a communication network in the early microenvironment of micrometastases.
In parallel we are piloting hydrogel scaffolds that support tissue formation but provide a more physiologic rheology; stiff supporting materials yield an inflammatory phenotype in the NPC which forces even well-differentiated BC cells towards a mesenchymal phenotype. We found that hydrogels support hepatocytes through 15 days and incorporate cancer cells. Micropumps are also being developed by Draper Laboratories to allow for physiologic diurnal variations of hormones and nutrients to liver tissues to accurately assess dormancy and chemotherapy response. The completion of these studies will provide insights into the tumor biology of dormant micrometastases and an accessible tool for testing of therapeutics against metastatic BC in a metabolically competent system.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-04-08.
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Affiliation(s)
- SE Wheeler
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - DP Taylor
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - AM Clark
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - JT Borenstein
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - MR Ebrahimkhani
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - W Inman
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - T Nguyen
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - VC Pillai
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - R Prantil-Baun
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - TA Ulrich
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - R Venkataramanan
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - DA Lauffenburger
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - L Griffith
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - DB Stolz
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
| | - A Wells
- University of Pittsburgh, Pittsburgh, PA; The Charles Stark Draper Laboratory, Inc, Cambridge, MA; Massachusetts Institute of Technology, Cambridge, MA
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Tan C, Lee Y, Tan H, Choolani M, Griffith L, Chan J. CD 26/DPPIV downregulation under hypoxia could enhance migration in endometrial stromal cells in endometriosis. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.765] [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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Tan C, Lee Y, Tan H, Choolani M, Griffith L, Chan J. Proteomic study of endometrial stromal and bone marrow stromal cells shows derangement in endometriosis. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.782] [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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Tan CW, Lee YH, Choolani M, Tan HH, Griffith L, Chan J, Chuang PC, Wu MH, Lin YJ, Tsai SJ, Rahmati M, Petitbarat M, Dubanchet S, Bensussan A, Chaouat G, Ledee N, Bissonnette L, Haouzi D, Monzo C, Traver S, Bringer S, Faidherbe J, Perrochia H, Ait-Ahmed O, Dechaud H, Hamamah S, Ibrahim MG, de Arellano MLB, Sachtleben M, Chiantera V, Frangini S, Younes S, Schneider A, Plendl J, Mechsner S, Ono M, Hamai H, Chikawa A, Teramura S, Takata R, Sugimoto T, Iwahashi K, Ohhama N, Nakahira R, Shigeta M, Park IH, Lee KH, Sun HG, Kim SG, Lee JH, Kim YY, Kim HJ, Jeon GH, Kim CM, Bocca S, Wang H, Anderson S, Yu L, Horcajadas J, Oehninger S, Bastu E, Mutlu MF, Celik C, Yasa C, Dural O, Buyru F, Quintana F, Cobo A, Remohi J, Ferrando M, Matorras R, Bermejo A, Iglesias C, Cerrillo M, Ruiz M, Blesa D, Simon C, Garcia-Velasco JA, Chamie L, Ribeiro DMF, Riboldi M, Pereira R, Rosa MB, Gomes C, de Mello PH, Fettback P, Domingues T, Cambiaghi A, Soares ACP, Kimati C, Motta ELA, Serafini P, Hapangama DK, Valentijn AJ, Al-Lamee H, Palial K, Drury JA, von Zglinicki T, Saretzki G, Gargett CE, Liao CY, Lee KH, Sung YJ, Li HY, Morotti M, Remorgida V, Venturini PL, Ferrero S, Nabeta M, Iki A, Hashimoto H, Koizumi M, Matsubara Y, Hamada K, Fujioka T, Matsubara K, Kusanagi Y, Nawa A, Zanatta A, Riboldi M, da Rocha AM, Guerra JL, Cogliati B, Pereira R, Motta ELA, Serafini P, Bianchi PDM, Zanatta A, Riboldi M, da Rocha AM, Cogliati B, Guerra JL, Pereira R, Motta ELA, Serafini P, Prieto B, Exposito A, Mendoza R, Rabanal A, Matorras R, Bedaiwy M, Yi L, Dahoud W, Liu J, Hurd W, Falcone T, Biscotti C, Mesiano S, Sugiyama R, Nakagawa K, Nishi Y, Kuribayashi Y, Akira S, Germeyer A, Rosner S, Jauckus J, Strowitzki T, von Wolff M, Khan KN, Kitajima M, Fujishita A, Nakashima M, Masuzaki H, Kajihara T, Ishihara O, Brosens J, Ledee N, Petitbarat M, Rahmati M, Vezmar K, Savournin V, Dubanchet S, Chaouat G, Balet R, Bensussan A, Chaouat G, Lee YH, Loh SF, Tannenbaum SR, Chan JKY, Scarella A, Chamy V, Devoto L, Abrao M, Sovino H, Krasnopolskaya K, Popov A, Kabanova D, Beketova A, Ivakhnenko V, Shohayeb A, Wahba A, Abousetta A, al-inany H, Wahba A, El Daly A, Zayed M, Kvaskoff M, Han J, Missmer SA, Navarro P, Meola J, Ribas CP, Paz CP, Ferriani RA, Donabela FC, Tafi E, Maggiore ULR, Scala C, Remorgida V, Venturini PL, Ferrero S, Hackl J, Strehl J, Wachter D, Dittrich R, Cupisti S, Hildebrandt T, Lotz L, Attig M, Hoffmann I, Renner S, Hartmann A, Beckmann MW, Urquiza F, Ferrer C, Incera E, Azpiroz A, Junovich G, Pappalardo C, Guerrero G, Pasqualini S, Gutierrez G, Corti L, Sanchez AM, Bordignon PP, Santambrogio P, Levi S, Persico P, Vigano P, Papaleo E, Ferrari S, Candiani M, van der Houwen LEE, Schreurs AMF, Lambalk CB, Schats R, Hompes PGA, Mijatovic V, Xu SY, Li J, Chen XY, Chen SQ, Guo LY, Mathew D, Nunes Q, Lane B, Fernig D, Hapangama D, Lind T, Hammarstrom M, Golmann D, Rodriguez-Wallberg K, Hestiantoro A, Cakra A, Aulia A, Al-Inany H, Houston B, Farquhar C, Abousetta A, Tagliaferri V, Gagliano D, Immediata V, Tartaglia C, Zumpano A, Campagna G, Lanzone A, Guido M, Matsuzaki S, Darcha C, Botchorishvili R, Pouly JL, Mage G, Canis M, Shivhare SB, Bulmer JN, Innes BA, Hapangama DK, Lash GE, de Graaff AA, Zandstra H, Smits LJ, Van Beek JJ, Dunselman GAJ, Bozdag G, Calis PT, Demiralp DO, Ayhan B, Igci N, Yarali H, Acar N, Er H, Ozmen A, Ustunel I, Korgun ET, Kuroda K, Kuroda M, Arakawa A, Kitade M, Brosens AI, Brosens JJ, Takeda S, Yao T. Endometriosis, endometrium, implantation and fallopian tube. Hum Reprod 2013. [DOI: 10.1093/humrep/det211] [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] Open
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Nesbitt-Hawes E, Campbell N, Won H, Maley P, Henry A, Abbott J, Potdar N, Mason-Birks S, Elson CJ, Gelbaya TA, Nardo LG, Stavroulis A, Nnoaham K, Hummelshoj L, Zondervan K, Saridogan E, GSWH Consortium WERF, Chamie LP, Soares ACP, Kimati CT, Gomes C, Fettback P, Riboldi M, Serafini P, Lalitkumar S, Menezes J, Evdokia D, Gemzell-Danielsson K, Lalitkumar PGL, Bailey J, Newman TA, Johnston A, Zisimopoulou K, White M, Sadek K, Shreeve N, Macklon N, Cheong Y, Al-Akoum M, Akoum A, Giles J, Garrido N, Vidal C, Mondion M, Gallo C, Ramirez J, Pellicer A, Remohi J, Ghosh S, Chattopadhyay R, Jana S, Goswami SK, Bose G, Chakravarty M, Chowdhuri K, Chakravarty BN, Kendirci Ceviren A, Ozcelik Tanriverdi N, Urfan A, Donmez L, Isikoglu M, Romano A, Schreinemacher MH, Backes WH, Slenter JM, Xanthoulea SA, Delvoux B, van Winden L, Beets-Tan RG, Evers JLH, Dunselman GAJ, Jana SK, Chaudhury K, Chattopadhyay R, Chakravarty BN, Maruyama T, Yamasaki A, Miyazaki K, Arase T, Uchida H, Yoshimura Y, Kaser D, Ginsburg E, Missmer S, Correia K, Racowsky C, Streuli I, Chouzenoux S, de Ziegler D, Chereau C, Weill B, Chapron C, Batteux F, Arianmanesh M, Fowler PA, Al-Gubory KH, Urata Y, Osuga Y, Izumi G, Nagai M, Takamura M, Yamamoto N, Saito A, Hasegawa A, Takemura Y, Harada M, Hirata T, Hirota Y, Yoshino O, Koga K, Taketani Y, Mohebbi A, Janan A, Nasri S, Lakpour MR, Ramazanali F, Moini A, Aflatoonian R, Germeyer A, Novak O, Renke T, Jung M, Jackus J, Toth B, Strowitzki T, Bhattacharya J, Mitra A, Kundu S, Pal M, Kundu A, Gumusel A, Basar M, Yaprak E, Aslan E, Arda O, Ilvan S, Kayisli U, Guzel E, Haouzi D, Monzo C, Lehmann S, Hirtz C, Tiers L, Hamamah S, Choi D, Choi J, Jo M, Lee E, Shen X, Wang BIN, Li X, Tamura I, Maekawa R, Asada H, Tamura H, Sugino N, Tamura H, Tamura I, Maekawa R, Asada H, Sugino N, Liu H, Jiang Y, Chen J, Zhu L, Shen X, Wang B, Yan G, Sun H, Coughlan C, Sinagra M, Ledger W, Li TC, Laird SM, Dafopoulos K, Vrekoussis T, Chalvatzas N, Messini CI, Kalantaridou S, Georgoulias P, Messinis IE, Makrigiannakis A, Xue Q, Xu Y, Zuo WL, Zhang L, Shang J, Zhu SN, Bulun SE, Tomassetti C, Geysenbergh B, Meuleman C, Fieuws S, D'Hooghe T, Suginami K, Sato Y, Horie A, Matsumoto H, Fujiwara H, Konishi I, Jung Y, Cho S, Choi Y, Lee B, Seo S, Urman B, Yakin K, Oktem O, Alper E, Taskiran C, Aksoy S, Takeuchi K, Kurematsu T, Yu-ki Y, Fukumoto Y, Homan Y, Sata Y, Kuroki Y, Takeuchi M, Awata S, Muneyyirci-Delale O, Charles C, Anopa J, Osei-Tutu N, Dalloul M, Weedon J, Muney A, Stratton P, Yilmaz B, Kilic S, Aksakal O, Kelekci S, Aksoy Y, Lordlar N, Sut N, Gungor T, Chan J, Tan CW, Lee YH, Tan HH, Choolani M, Griffith L, Oldeweme J, Barcena de Arellano ML, Reichelt U, Schneider A, Mechsner S, Barcena de Arellano ML, Munch S, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Santoro L, D'Onofrio F, Campo S, Ferraro PM, Tondi P, Gasbarrini A, Santoliquido A, Jung MH, Kim HY, Barcena de Arellano ML, Arnold J, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Arnold J, Barcena de Arellano ML, Buttner A, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Karaer A, Celik O, Bay Karabulut A, Celik E, Kiran TR, Simsek OY, Yilmaz E, Turkcuoglu I, Tanrikut E, Alieva K, Kulakova E, Ipatova M, Smolnikova V, Kalinina E. ENDOMETRIOSIS, ENDOMETRIUM, IMPLANTATION AND FALLOPIAN TUBE. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.78] [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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Palial KK, Drury J, Heathcote L, Valentijin A, Farquharson RG, Gazvani R, Rudland PS, Hapangama DK, Celik N, Celik O, Aktan E, Ozerol E, Celik E, Bozkurt K, Paran H, Hascalik S, Ozerol I, Arase T, Maruyama T, Uchida H, Miyazaki K, Oda H, Uchida-Nishikawa S, Kagami M, Yamazaki A, Tamaki K, Yoshimura Y, De Vos M, Ortega C, Smitz J, Van Vaerenbergh I, Bourgain C, Devroey P, Luciano D, Exacoustos C, Zupi E, Luciano AA, Arduini D, Palomino WA, Argandona F, Kohen P, Azua R, Scarella A, Devoto L, McKinnon B, Bersinger NA, Mueller MD, Bonavita M, Mattila M, Ferreira FP, Maia-Filho V, Rocha AM, Serafini P, Motta ELA, Kim H, Kim CH, You RM, Nah HY, Lee JW, Kang HJ, Kang BM, Letur - Koenirsch H, Haouzi D, Olivennes F, Rouleau C, Cohen-Bacri P, Dechaud H, Hamamah S, D'Hooghe T, Hummelshoj L, Dunselman GAJ, Dirksen CD, EndoCost Consortium WERF, Simoens S, Novembri R, Luisi S, Carrarelli P, Rocha ALL, Toti P, Reis FM, Florio P, Petraglia F, Bruce KD, Sadek KH, Macklon N, Cagampang FR, Cheong Y, Goudakou M, Kalogeraki A, Matalliotakis I, Papatheodorou A, Pasadaki T, Karkanaki A, Prapas I, Prapas I, Kalogeraki A, Matalliotakis I, Panagiotidis I, Kasapi E, Karkanaki A, Goudakou M, Barlow D, Oliver J, Loumaye E, Khanmohammadi M, kazemnejad S, darzi S, Khanjani S, Zarnani A, Akhondi M, Tan CW, Ng CP, Loh SF, Tan HH, Choolani M, Griffith L, Chan J, Andersson KL, Sundqvist J, Scarselli G, Gemzell-Danielsson K, Lalitkumar PG, Jana S, Chattopadhyay R, Datta Ray C, Chaudhury K, Chakravarty BN, Hannan N, Evans J, Hincks C, Rombauts LJF, Salamonsen LA, Choi D, Lee J, Park J, Chang H, Kim M, Hwang K, Takeuchi K, Kurematsu T, Fukumoto Y, Yuki Y, Kuroki Y, Homan Y, Sata Y, Takeuchi M, Munoz Munoz E, Ortiz Olivera G, Fernandez Lopez I, Martinez Martinez B, Aguilar Prieto J, Portela Perez S, Pellicer Martinez A, Keltz M, Sauerbrun M, Breborowicz A, Gonzales E, Vicente-Munoz S, Puchades-Carrasco L, Morcillo I, Hidalgo JJ, Gilabert-Estelles J, Novella-Maestre E, Pellicer A, Pineda-Lucena A, Yavorovskaya KA, Okhtyrskaya TA, Demura TA, Faizulina NM, Ezhova LS, Kogan EA, Bilibio JP, Souza CAB, Rodini GP, Genro V, Andreoli CG, de Conto E, Cunha-Filho JSL, Saare M, Soritsa D, Jarva L, Vaidla K, Palta P, Laan M, Karro H, Soritsa A, Salumets A, Peters M, Miskova A, Pilmane M, Rezeberga D, Haouzi D, Dechaud H, Assou S, Letur H, Olivennes F, Hamamah S, Piomboni P, Stendardi A, Gambera L, De Leo V, Petraglia F, Focarelli R, Tamm K, Simm J, Salumets A, Metsis M, Vodolazkaia A, Fassbender A, Kyama CM, Bokor A, Schols D, Huskens D, Meuleman C, Peeraer K, Tomassetti C, D'Hooghe TM, Machens K, Afhuppe W, Schulz A, Diefenbach K, Schutt B, Faustmann T, Reischl J, Peters M, Altmae S, Reimand J, Laisk T, Saare M, Hovatta O, Kolde R, Vilo J, Stavreus-Evers A, Salumets A, Lee JH, Kim SG, Kim YY, Park IH, Sun HG, Lee KH, Ezoe K, Kawano H, Yabuuchi A, Ochiai K, Nagashima H, Osada H, Kagawa N, Kato O, Tamura I, Asada H, Taketani T, Tamura H, Sugino N, Garcia Velasco J, Prieto L, Quesada JF, Cambero O, Toribio M, Pellicer A, Hur CY, Lim KS, Lee WD, Lim JH, Germeyer A, Nelson L, Graham A, Jauckus J, Strowitzki T, Lessey B, Gyulmamedova I, Illina O, Illin I, Mogilevkina I, Chaika A, Nosenko O, Boykova I, Gulmamedova E, Isik H, Moraloglu O, Seven ALI, Kilic S, Erkayiran U, Caydere M, Batioglu S, Alhalabi M, Samawi S, Taha A, Kafri N, Modi S, Khatib A, Sharif J, Othman A, Lancuba S, Branzini C, Lopez M, Baricalla A, Cristina C, Chen J, Jiang Y, Zhen X, Hu Y, Yan G, Sun H, Mizumoto J, Ueno J, Carvalho FM, Casals G, Ordi J, Guimera M, Creus M, Fabregues F, Casamitjana R, Carmona F, Balasch J, Choi YS, Kim KC, Lee WD, Kim KH, Lee BS, Kim SH, Fassbender A, Overbergh L, Verdrengh E, Kyama C, Vodolazkaia A, Bokor A, Meuleman C, Peeraer K, Tomassetti C, Waelkens E, Mathieu C, D'Hooghe T, Iwasa T, Hatano K, Hasegawa E, Ito H, Isaka K, L. Rocha AL, Luisi S, Carrarelli P, Novembri R, Florio P, Reis F, Petraglia F, Lee KS, Joo JK, Son JB, Choi JR, Vidali A, Barad DH, Gleicher N, Jiang Y, Chen J, Zhen X, Hu Y, Sun H, Yan G, Sayyah-Melli M, Kazemi-Shishvan M. POSTER VIEWING SESSION - ENDOMETRIOSIS, ENDOMETRIUM, IMPLANTATION AND FALLOPIAN TUBE. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.80] [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: 11/14/2022] Open
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Griffith L, Müller C. The role of Cytochrome P450 genetic disposition and patient reaction to therapy in a cohort controlled study in private practice-preliminary results from the MORE study. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ammons B, Griffith L, Giglia L, Mahony J, Chong S, Luinstra K, Smieja M. P288 Estimating the disruptive effects of respiratory viruses on a child's family. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70507-2] [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: 10/20/2022]
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Langlois LE, Shannon HS, Griffith L, Haines T, Cortina LM, Geldart S, Chen WC, Chiu HJ, Hwu HG, Wang JD, Myers DJM, De Raeve L, Jansen NWH, van den Brandt PA, Vasse RM, Kant I, Kling R, Yassi A, Lovato C, Smailes E, Koehoorn M. Violence. Occup Environ Med 2007. [DOI: 10.1136/oem.64.12.e24] [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: 11/04/2022]
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Griffin GE, Abbott WE, Pride MP, Muntwyler E, Mautz FR, Griffith L. Plasma Volume, "Available (Thiocyanate) Volume" and Total Circulating Plasma Proteins in Normal Adults. Ann Surg 2007; 121:352-60. [PMID: 17858576 PMCID: PMC1618086 DOI: 10.1097/00000658-194503000-00009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cranney A, Adachi JD, Griffith L, Guyatt G, Krolicki N, Robinson VA, Shea BJ, Wells G. WITHDRAWN: Etidronate for treating and preventing postmenopausal osteoporosis. Cochrane Database Syst Rev 2007:CD003376. [PMID: 17636719 DOI: 10.1002/14651858.cd003376.pub2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Osteoporosis is a clinical syndrome of reduced bone mass and increased fracture susceptibility. There are now a number of options, including etidronate which can decrease the risk of fractures. OBJECTIVES To systematically review the efficacy of etidronate on bone density, fractures and toxicity in postmenopausal women. SEARCH STRATEGY We searched MEDLINE from 1966 to December 1998, examined citations of relevant articles, and the proceedings of international osteoporosis meetings. We contacted osteoporosis investigators to identify additional studies, primary authors, and pharmaceutical industry sources for unpublished data. SELECTION CRITERIA We included thirteen trials (with 1010 participants) that randomized women to etidronate or an alternative (placebo or calcium and/or vitamin D) and measured bone density for at least one year. DATA COLLECTION AND ANALYSIS For each trial, three independent reviewers assessed the methodological quality and abstracted data. MAIN RESULTS The data suggested a reduction in vertebral fractures with a pooled relative risk of 0.60% (95% CI 0.41 to 0.88). There was no effect on non-vertebral fractures (pooled relative risk 1.00, (95% CI 0.68 to 1.42)). Etidronate, relative to control, increased bone density after three years of treatment in the lumbar spine by 4.27% (95% CI 2.66 to 5.88), in the femoral neck by 2.19% (95% CI 0.43, 3.95) and in the total body by 0.97% (95% CI 0.39, 1.55). Effects were larger at 4 years, though the number of patients followed was much smaller. AUTHORS' CONCLUSIONS Etidronate increases bone density in the lumbar spine and femoral neck. The pooled estimates of fracture reduction with etidronate are consistent with a reduction in vertebral fractures, but no effect on non-vertebral fractures.
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Affiliation(s)
- A Cranney
- Ottawa Hospital, Division of Rheumatology, 1053 Carling Ave, Ottawa, Ontario, Canada, K1Y 4E9.
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Shea B, Wells G, Cranney A, Zytaruk N, Robinson V, Griffith L, Hamel C, Ortiz Z, Peterson J, Adachi J, Tugwell P, Guyatt G. WITHDRAWN: Calcium supplementation on bone loss in postmenopausal women. Cochrane Database Syst Rev 2007; 2006:CD004526. [PMID: 17636765 PMCID: PMC10687496 DOI: 10.1002/14651858.cd004526.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although calcium is one the simplest and least expensive strategies for preventing osteoporotic fractures calcium supplementation is nevertheless not without controversy (Kanis 1989; Nordin 1990). The Food and Drug Administration in the US has permitted a bone health claim for calcium-rich foods, and the NIH in its Consensus Development Process approved a statement that high calcium intake reduces the risk of osteoporosis. OBJECTIVES To assess the effects of calcium on bone density and fractures in postmenopausal women. SEARCH STRATEGY We searched Cochrane Controlled Register, MEDLINE and EMBASE up to 2001, and examined citations of relevant articles and proceedings of international meetings. SELECTION CRITERIA Trials that randomized postmenopausal women to calcium supplementation or usual calcium intake in the diet and reported bone mineral density of the total body, vertebral spine, hip, or forearm or recorded the number of fractures, and followed patients for at least one year were considered for inclusion. DATA COLLECTION AND ANALYSIS Three independent reviewers assessed the methodologic quality and extracted data for each trial. For each bone density site (lumbar spine, total body, combined hip and combined forearm), we calculated the weighted mean difference in bone density between treatment and control groups using the percentage change from baseline. We constructed regression models in which the independent variables were year and dose, and the dependent variable was the effect size. This regression was used to determine the years across which pooling was appropriate. Heterogeneity was assessed. For each fracture analysis we calculated a risk ratio. MAIN RESULTS Fifteen trials, representing 1806 participants, were included. Calcium was more effective than placebo in reducing rates of bone loss after two or more years of treatment. The pooled difference in percentage change from baseline was 2.05% (95% CI 0.24 to 3.86) for total body bone density, 1.66% (95% CI 0.92 to 2.39) for the lumbar spine at 2 years, 1.60% (95% CI 0.78 to 2.41) for the hip, and 1.91% (95% CI 0.33 to 3.50) for the distal radius. The relative risk of fractures of the vertebrae was 0.79 (95% CI 0.54 to 1.09); the relative risk for non-vertebral fractures was 0.86 (95% CI 0.43 to 1.72). AUTHORS' CONCLUSIONS Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but it is unclear if calcium reduces the incidence of non vertebral fractures.
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Affiliation(s)
- B Shea
- University of Ottawa, Institute of Population Health, 1 Stewart St., Room 312, Ottawa, Onatrio, Canada K1N 6N5.
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Abstract
We developed scalable microreactors that foster the development of 3D microscopic pieces of tissue. By integrating microreactors, reservoirs, and pumps in the multiwell cell culture plate format, we created a high throughput cell culture system. However, in contrast to commonly used 2D static cell culture in multiwell plates, our new system allows 3D perfused cell culture. The system provides a means to conduct assays for toxicology and metabolism and can be used as a model for human diseases such as hepatic diseases, exposure-related pathologies, and cancer.
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Affiliation(s)
- K Domansky
- Biological Engineering Division and Biotechnology Process Engineering Center.
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Bhandari M, Tornetta P, Sprague S, Najibi S, Petrisor B, Griffith L, Guyatt G. Predictors of reoperation following operative management of fractures of the tibial shaft. ACTA ACUST UNITED AC 2006. [DOI: 10.1055/s-2006-954996] [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: 10/23/2022]
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McMullin J, Cook D, Griffith L, McDonald E, Clarke F, Guyatt G, Gibson J, Crowther M. Minimizing errors of omission: Behavioural rEenforcement of Heparin to Avert Venous Emboli: The BEHAVE Study*. Crit Care Med 2006; 34:694-9. [PMID: 16505655 DOI: 10.1097/01.ccm.0000201886.84135.cb] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To improve patient safety by increasing heparin thromboprophylaxis for medical-surgical intensive care unit patients using a multiple-method approach to evidence-based guideline development and implementation. DESIGN Prospective longitudinal observational study. SETTING Medical-surgical intensive care unit. PARTICIPANTS Multidisciplinary clinicians caring for critically ill patients in a 15-bed medical-surgical closed intensive care unit. INTERVENTIONS Phase 1 was a 3-month baseline period during which we documented anticoagulation and mechanical thromboprophylaxis. Phase 2 was a 1-yr period in which we implemented a thromboprophylaxis guideline using a) interactive multidisciplinary educational in-services; b) verbal reminders to the intensive care unit team; c) computerized daily nurse recording of thromboprophylaxis; d) weekly graphic feedback to individual intensivists on guideline adherence; and e) publicly displayed graphic feedback on group performance. Phase 3 was a 3-month follow-up period 10 months later, during which we documented thromboprophylaxis. Computerized daily nurse recording of thromboprophylaxis continued in this period. MEASUREMENTS AND MAIN RESULTS Intensive care unit and hospital mortality rates were similar across phases, although patients in phase 2 had higher Acute Physiology and Chronic Health Evaluation II scores than patients in phases 1 and 3. The proportion (median % [interquartile range]) of intensive care unit patient-days of heparin thromboprophylaxis in phases 1, 2, and 3 was 60.0 (0, 100), 90.9 (50, 100), and 100.0 (60, 100), respectively (p=.01). The proportion (median % [interquartile range]) of days during which heparin thromboprophylaxis was omitted in error in phases 1, 2, and 3 was 20 (0, 53.8), 0 (0, 6.3), and 0 (0, 0), respectively (p<.001). CONCLUSIONS After development and implementation of an evidence-based thromboprophylaxis guideline, we found significantly more patients receiving heparin thromboprophylaxis. Guideline adherence was maintained 1 yr later. Further research is needed on which are the most effective strategies to implement patient safety initiatives in the intensive care unit.
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Affiliation(s)
- J McMullin
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Rabbat C, Mcdonald E, Griffith L, Clarke F, Cook D. Crit Care 2005; 9:P356. [DOI: 10.1186/cc3419] [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: 11/10/2022] Open
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Lim W, Griffith L, Crowther M, Devereaux P, Cook D. Crit Care 2005; 9:P311. [DOI: 10.1186/cc3374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Shea B, Wells G, Cranney A, Zytaruk N, Robinson V, Griffith L, Hamel C, Ortiz Z, Peterson J, Adachi J, Tugwell P, Guyatt G. Calcium supplementation on bone loss in postmenopausal women. Cochrane Database Syst Rev 2004:CD004526. [PMID: 14974070 DOI: 10.1002/14651858.cd004526.pub2] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although calcium is one the simplest and least expensive strategies for preventing osteoporotic fractures calcium supplementation is nevertheless not without controversy (Kanis 1989; Nordin 1990). The Food and Drug Administration in the US has permitted a bone health claim for calcium-rich foods, and the NIH in its Consensus Development Process approved a statement that high calcium intake reduces the risk of osteoporosis. OBJECTIVES To assess the effects of calcium on bone density and fractures in postmenopausal women. SEARCH STRATEGY We searched Cochrane Controlled Register, MEDLINE and EMBASE up to 2001, and examined citations of relevant articles and proceedings of international meetings. SELECTION CRITERIA Trials that randomized postmenopausal women to calcium supplementation or usual calcium intake in the diet and reported bone mineral density of the total body, vertebral spine, hip, or forearm or recorded the number of fractures, and followed patients for at least one year were considered for inclusion. DATA COLLECTION AND ANALYSIS Three independent reviewers assessed the methodologic quality and extracted data for each trial. For each bone density site (lumbar spine, total body, combined hip and combined forearm), we calculated the weighted mean difference in bone density between treatment and control groups using the percentage change from baseline. We constructed regression models in which the independent variables were year and dose, and the dependent variable was the effect size. This regression was used to determine the years across which pooling was appropriate. Heterogeneity was assessed. For each fracture analysis we calculated a risk ratio. MAIN RESULTS Fifteen trials, representing 1806 participants, were included. Calcium was more effective than placebo in reducing rates of bone loss after two or more years of treatment. The pooled difference in percentage change from baseline was 2.05% (95% CI 0.24 to 3.86) for total body bone density, 1.66% (95% CI 0.92 to 2.39) for the lumbar spine at 2 years, 1.60% (95% CI 0.78 to 2.41) for the hip, and 1.91% (95% CI 0.33 to 3.50) for the distal radius. The relative risk of fractures of the vertebrae was 0.79 (95% CI 0.54 to 1.09); the relative risk for non-vertebral fractures was 0.86 (95% CI 0.43 to 1.72). REVIEWER'S CONCLUSIONS Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but it is unclear if calcium reduces the incidence of non vertebral fractures.
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Patel R, Griffith L, Mead M, Mehta S, Hodder R, Martin C, Heyland D, Marshall J, Rocker G, Peters S, Clarke F, Mcdonald E, Soth M, Muscadere J, Campbell N, Guyatt G, Cook D. Crit Care 2004; 8:P103. [DOI: 10.1186/cc2570] [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: 11/10/2022] Open
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Clarke F, Mcdonald E, Griffith L, Cook D, Mead M, Guyatt G, Rabbat C, Geerts W, Arnold D, Warkentin T, Crowther M. Crit Care 2004; 8:P125. [DOI: 10.1186/cc2592] [Citation(s) in RCA: 2] [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: 11/10/2022] Open
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Shea B, Wells G, Cranney A, Zytaruk N, Robinson V, Griffith L, Hamel C, Ortiz Z, Peterson J, Adachi J, Tugwell P, Guyatt G. Calcium supplementation on bone loss in postmenopausal women. Cochrane Database Syst Rev 2003:CD004526. [PMID: 14584022 DOI: 10.1002/14651858.cd004526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although calcium is one the simplest and least expensive strategies for preventing osteoporotic fractures calcium supplementation is nevertheless not without controversy (Kanis 1989; Nordin 1990). The Food and Drug Administration in the US has permitted a bone health claim for calcium-rich foods, and the NIH in its Consensus Development Process approved a statement that high calcium intake reduces the risk of osteoporosis. OBJECTIVES To assess the effects of calcium on bone density and fractures in postmenopausal women. SEARCH STRATEGY We searched Cochrane Controlled Register, MEDLINE and EMBASE up to 2001, and examined citations of relevant articles and proceedings of international meetings. SELECTION CRITERIA Trials that randomized postmenopausal women to calcium supplementation or usual calcium intake in the diet and reported bone mineral density of the total body, vertebral spine, hip, or forearm or recorded the number of fractures, and followed patients for at least one year were considered for inclusion. DATA COLLECTION AND ANALYSIS Three independent reviewers assessed the methodologic quality and extracted data for each trial. For each bone density site (lumbar spine, total body, combined hip and combined forearm), we calculated the weighted mean difference in bone density between treatment and control groups using the percentage change from baseline. We constructed regression models in which the independent variables were year and dose, and the dependent variable was the effect size. This regression was used to determine the years across which pooling was appropriate. Heterogeneity was assessed. For each fracture analysis we calculated a risk ratio. MAIN RESULTS Fifteen trials, representing 1806 participants, were included. Calcium was more effective than placebo in reducing rates of bone loss after two or more years of treatment. The pooled difference in percentage change from baseline was 2.05% (95% CI 0.24 to 3.86) for total body bone density, 1.66% (95% CI 0.92 to 2.39) for the lumbar spine at 2 years, 1.60% (95% CI 0.78 to 2.41) for the hip, and 1.91% (95% CI 0.33 to 3.50) for the distal radius. The relative risk of fractures of the vertebrae was 0.79 (95% CI 0.54 to 1.09); the relative risk for non-vertebral fractures was 0.86 (95% CI 0.43 to 1.72). REVIEWER'S CONCLUSIONS Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but it is unclear if calcium reduces the incidence of non vertebral fractures.
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Affiliation(s)
- B Shea
- Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, K1N 6N5, Ontario, CANADA.
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Griffith L, Cook D, Hanna S, Rocker G, Sjokvist P, Dodek P, Marshall J, Levy M, Varon J, Finfer S, Jaeschke R, Buckingham L, Guyatt G. Crit Care 2003; 7:P252. [DOI: 10.1186/cc2141] [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: 11/10/2022] Open
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Abstract
OBJECTIVE To review the effectiveness of primary prevention strategies aimed at delaying sexual intercourse, improving use of birth control, and reducing incidence of unintended pregnancy in adolescents. DATA SOURCES 12 electronic bibliographic databases, 10 key journals, citations of relevant articles, and contact with authors. STUDY SELECTION 26 trials described in 22 published and unpublished reports that randomised adolescents to an intervention or a control group (alternate intervention or nothing). DATA EXTRACTION Two independent reviewers assessed methodological quality and abstracted data. DATA SYNTHESIS The interventions did not delay initiation of sexual intercourse in young women (pooled odds ratio 1.12; 95% confidence interval 0.96 to 1.30) or young men (0.99; 0.84 to 1.16); did not improve use of birth control by young women at every intercourse (0.95; 0.69 to 1.30) or at last intercourse (1.05; 0.50 to 2.19) or by young men at every intercourse (0.90; 0.70 to 1.16) or at last intercourse (1.25; 0.99 to 1.59); and did not reduce pregnancy rates in young women (1.04; 0.78 to 1.40). Four abstinence programmes and one school based sex education programme were associated with an increase in number of pregnancies among partners of young male participants (1.54; 1.03 to 2.29). There were significantly fewer pregnancies in young women who received a multifaceted programme (0.41; 0.20 to 0.83), though baseline differences in this study favoured the intervention. CONCLUSIONS Primary prevention strategies evaluated to date do not delay the initiation of sexual intercourse, improve use of birth control among young men and women, or reduce the number of pregnancies in young women.
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Affiliation(s)
- Alba DiCenso
- School of Nursing, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.
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Abstract
We identified 10 randomized trials that compared alternative management approaches to patient care during and following cardiovascular surgery. One overall strategy involved a modification of anesthesia, in particular, a reduction in the dosage of fentanyl and benzodiazepine or the substitution of fentanyl for propofol (five randomized controlled trials [RCTs]). Pooled results show a shorter duration of ventilation (7 h) and a shorter duration of hospital stay (approximately 1 day) associated with lower anesthetic doses. The second strategy involved early vs late extubation once patients were admitted to the ICU (five RCTs). Pooled results show a shorter duration of ventilation (13 h) and a shorter duration of ICU stay (half a day) associated with early extubation. An additional 8 nonrandomized trials had findings that were consistent with the 10 RCTs. Reintubation, complications, and mortality rates were too low to draw conclusions about these outcomes. Overall, these studies indicate that anesthetic, sedation, and early-extubation strategies in selected cardiac surgery patients are associated with a shorter duration of mechanical ventilation and shorter lengths of ICU and hospital stays.
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Affiliation(s)
- M O Meade
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Abstract
We identified 65 observational studies of weaning predictors that had been reported in 70 publications. After grouping predictors with similar names but different thresholds, the following predictors met our relevance criteria: heterogeneous populations, 51; COPD patients, 21; and cardiovascular ICU patients, 45. Many variables were of no use in predicting the results of weaning. Moreover, few variables had been studied in > 50 patients or had results presented to generate estimates of predictive power. For stepwise reductions in mechanical support, the most promising predictors were a rapid shallow breathing index (RSBI) < 65 breaths/min/L (measured using the ventilator settings that were in effect at the time that the prediction was made) and a pressure time product < 275 cm H2O/L/s. The pooled likelihood ratios (LRs) were 1.1 (95% confidence interval [CI], 0.95 to 1.28) for a respiratory rate [RR] of < 38 breaths/min and 0.32 (95% CI, 0.06 to 1.71) for an RR of > 38 breaths/min, which indicate that an RR of < 38 breaths/min leaves the probability of successful weaning virtually unchanged but that a value of > 38 breaths/min leads to a small reduction in the probability of success in weaning the level of mechanical support. For trials of unassisted breathing, the most promising weaning predictors include the following: RR; RSBI; a product of RSBI and occlusion pressure < 450 cm H2O breaths/min/L; maximal inspiratory pressure (PImax) < 20 cm H2O; and a knowledge-based system for adjusting pressure support. Pooled results for the power of a positive test result for both RR and RSBI were limited (highest LR, 2.23), while the power of a negative test result was substantial (ie, LR, 0.09 to 0.23). Summary data suggest a similar predictive power for RR and RSBI. In the prediction of successful extubation, an RR of < 38 breaths/min (sensitivity, 88%; specificity, 47%), an RSBI < 100 or 105 breaths/min/L (sensitivity, 65 to 96%; specificity, 0 to 73%), PImax, and APACHE (acute physiology and chronic health evaluation) II scores that are obtained at hospital admission appear to be the most promising. After pooling, two variables appeared to have some value. An RR of > 38 breaths/min and an RSBI of > 100 breaths/min/L appear to reduce the probability of successful extubation, and PImax < 0.3, for which the pooled LR is 2.23 (95% CI, 1.15 to 4.34), appears to marginally increase the likelihood of successful extubation. Judging by areas under the receiver operator curve for all variables, none of these variables demonstrate more than modest accuracy in predicting weaning outcome. Why do most of these tests perform so poorly? The likely explanation is that clinicians have already considered the results when they choose patients for trials of weaning.
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Affiliation(s)
- M Meade
- Department of Medicine, McMaster University, Hamilton, Canada
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Abstract
We identified 16 randomized controlled trials (RCTs) of methods for weaning patients from mechanical ventilation, 8 of which were trials of discontinuation assessment strategies, 5 of which were trials of stepwise reduction in mechanical ventilatory support, and 3 of which were trials comparing alternative ventilation modes for weaning periods lasting < 48 h. We found that different thresholds for deciding when a patient is ready for a trial of spontaneous breathing, different criteria for a successful trial, and different thresholds for extubation may overwhelm the impact of alternative ventilation strategies. Nevertheless, the results of these studies suggest the possibility that multiple daily T-piece weaning or pressure support may be superior to synchronized intermittent mandatory ventilation. Other RCTs suggest that early extubation with the back-up institution of noninvasive positive-pressure ventilation as needed may be a useful strategy in selected patients.
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Affiliation(s)
- M Meade
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Affiliation(s)
- M Meade
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Abstract
Osteocompatibility of porous polylactic-glycolic acid (PLGA) disks coated with synthetic peptides was assessed in 5-mm diameter unicortical tibial osseous wounds in rats. The coatings consisted of various ratios of peptides including the tripeptide arginine-glycine-aspartic acid (RGD) and the inactive arginine-glycine-glutamic acid (RGE). When left empty, the tibial wounds healed spontaneously with proliferation of intramedullary woven bone within 1 week. The reactive bone was resorbed, and by 3 weeks, the cortical wound was healed with lamellar bone, and the medullary space was repopulated with marrow. When PLGA disks were implanted there was a delay in repair with reduced bone fill and no bone bridging at 3 weeks. When disks were coated with increasing amounts of RGD peptide, there was a biphasic effect on osteocompatibility and on osseous ingrowth. Evaluation at 10 days showed a dose-dependent increase, with 1.5-fold greater osteocompatibility (p < 0.05) and 1.6-fold more osseous ingrowth into the polymer (p < 0.01) than uncoated disks. With more RGD and with undiluted RGE, osteocompatibility and osseous ingrowth were the same as with uncoated disks. At 3 weeks, there were no significant differences among all the groups. These data indicate that RGD coating enhanced early stages of osteocompatibility and ingrowth.
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Affiliation(s)
- K Eid
- Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA
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Abstract
Few investigations have explored the extent to which a number of less serious problems contribute to health-related quality of life (HRQL) impairment beyond a smaller number of more serious problems. Our study examined the relative impact of the number and severity of patient problems on HRQL. This study analyzed results from 100 patients with irritable bowel syndrome (IBS) and 100 women with polycystic ovary syndrome (PCOS). We compared an aggregation method that generated scores using all items that could affect HRQL as the denominator (all items) to a second method that considered only items that patients experienced as problems (problem items). For each IBS and PCOS questionnaire domain, we used regression analysis to examine the relative contribution of scores from the all-items and problem-items approaches to prediction of scores on the other instruments. Of 57 correlations between IBS domains and scores on the other questionnaires, the all-items method explained a statistically significant additional proportion of the variance beyond the problem items in 29 cases and the problem items a significant additional proportion of the variance between the all items in 7 (p < 0.001). Of the 28 correlations between the PCOS and the other questionnaires, the all-items approach explained a significant additional proportion of the variance in 21 cases and the problem items approach in 5 (p < 0.001). With IBS and PCOS, including all potential items in calculating a domain score provided a more accurate portrayal of HRQL than a selected approach focusing on problem items
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Affiliation(s)
- E Wong
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Amyloid myopathy is a well-described, increasingly recognized clinical entity. Similar to inflammatory myopathies, amyloid myopathy presents with proximal muscle weakness and can be associated with elevated levels of muscle enzymes. We report the case of a 58-year-old woman who, at presentation to her physician with proximal muscle weakness and congestive heart failure, was antinuclear antibody positive and had muscle biopsy findings "consistent with inflammatory myopathy." She was referred to Johns Hopkins University Medical Center with the diagnosis of polymyositis. Further investigation revealed a monoclonal gammopathy, a unique patterning of subcutaneous fat reticulation and hypodense bone marrow changes on magnetic resonance imaging (MRI), and an endocardial biopsy sample that was positive for light chain amyloid deposition. Paraffin sections of the muscle biopsy sample from the time of her original presentation were obtained, and Congo red staining showed diffuse amyloid deposition throughout the sample, but no inflammation. This case not only illustrates that proximal muscle weakness due to primary amyloid myopathy (as found in light chain amyloidosis and transthyretin amyloidosis) can mimic that of polymyositis, but also shows that unique findings on MRI can alert the clinician to the diagnosis of amyloidosis prior to muscle biopsy.
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Affiliation(s)
- K M Hull
- National Institutes of Health, Bethesda, Maryland 20892, USA
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Swindle CS, Tran KT, Johnson TD, Banerjee P, Mayes AM, Griffith L, Wells A. Epidermal growth factor (EGF)-like repeats of human tenascin-C as ligands for EGF receptor. J Cell Biol 2001; 154:459-68. [PMID: 11470832 PMCID: PMC2150768 DOI: 10.1083/jcb.200103103] [Citation(s) in RCA: 230] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2001] [Revised: 05/24/2001] [Accepted: 05/29/2001] [Indexed: 01/25/2023] Open
Abstract
Signaling through growth factor receptors controls such diverse cell functions as proliferation, migration, and differentiation. A critical question has been how the activation of these receptors is regulated. Most, if not all, of the known ligands for these receptors are soluble factors. However, as matrix components are highly tissue-specific and change during development and pathology, it has been suggested that select growth factor receptors might be stimulated by binding to matrix components. Herein, we describe a new class of ligand for the epidermal growth factor (EGF) receptor (EGFR) found within the EGF-like repeats of tenascin-C, an antiadhesive matrix component present during organogenesis, development, and wound repair. Select EGF-like repeats of tenascin-C elicited mitogenesis and EGFR autophosphorylation in an EGFR-dependent manner. Micromolar concentrations of EGF-like repeats induced EGFR autophosphorylation and activated extracellular signal-regulated, mitogen-activated protein kinase to levels comparable to those induced by subsaturating levels of known EGFR ligands. EGFR-dependent adhesion was noted when the ligands were tethered to inert beads, simulating the physiologically relevant presentation of tenascin-C as hexabrachion, and suggesting an increase in avidity similar to that seen for integrin ligands upon surface binding. Specific binding to EGFR was further established by immunofluorescence detection of EGF-like repeats bound to cells and cross-linking of EGFR with the repeats. Both of these interactions were abolished upon competition by EGF and enhanced by dimerization of the EGF-like repeat. Such low affinity behavior would be expected for a matrix-"tethered" ligand; i.e., a ligand which acts from the matrix, presented continuously to cell surface EGF receptors, because it can neither diffuse away nor be internalized and degraded. These data identify a new class of "insoluble" growth factor ligands and a novel mode of activation for growth factor receptors.
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Affiliation(s)
- C S Swindle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Cranney A, Welch V, Adachi JD, Guyatt G, Krolicki N, Griffith L, Shea B, Tugwell P, Wells G. Etidronate for treating and preventing postmenopausal osteoporosis. Cochrane Database Syst Rev 2001:CD003376. [PMID: 11687195 DOI: 10.1002/14651858.cd003376] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To systematically review the efficacy of etidronate on bone density, fractures and toxicity in postmenopausal women. SEARCH STRATEGY We searched MEDLINE from 1966 to December 1998, examined citations of relevant articles, and the proceedings of international osteoporosis meetings. We contacted osteoporosis investigators to identify additional studies, primary authors, and pharmaceutical industry sources for unpublished data. SELECTION CRITERIA We included thirteen trials (with 1010 participants) that randomized women to etidronate or an alternative (placebo or calcium and/or vitamin D) and measured bone density for at least one year. DATA COLLECTION AND ANALYSIS For each trial, three independent reviewers assessed the methodological quality and abstracted data. MAIN RESULTS The data suggested a reduction in vertebral fractures with a pooled relative risk of 0.60% (95% CI 0.41 to 0.88). There was no effect on non-vertebral fractures (pooled relative risk 1.00, (95% CI 0.68 to 1.42)). Etidronate, relative to control, increased bone density after three years of treatment in the lumbar spine by 4.27% (95% CI 2.66 to 5.88), in the femoral neck by 2.19% (95% CI 0.43, 3.95) and in the total body by 0.97% (95% CI 0.39, 1.55). Effects were larger at 4 years, though the number of patients followed was much smaller. REVIEWER'S CONCLUSIONS Etidronate increases bone density in the lumbar spine and femoral neck. The pooled estimates of fracture reduction with etidronate are consistent with a reduction in vertebral fractures, but no effect on non-vertebral fractures.
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Affiliation(s)
- A Cranney
- Medicine - Rheumatology, Ottawa Hospital, Civic Campus, 461, 737 Parkdale Ave, Ottawa, Ontario, Canada, K1Y 1J8.
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Cranney A, Guyatt G, Krolicki N, Welch V, Griffith L, Adachi JD, Shea B, Tugwell P, Wells G. A meta-analysis of etidronate for the treatment of postmenopausal osteoporosis. Osteoporos Int 2001; 12:140-51. [PMID: 11303715 DOI: 10.1007/s001980170147] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of the study was to review the effect of etidronate on bone density and fractures in postmenopausal women. We searched MEDLINE from 1966 to 1998, examined citations of relevant articles, and the proceedings of international osteoporosis meetings. We contacted osteoporosis investigators to identify additional studies, primary authors, and pharmaceutical industry sources for unpublished data. We included 13 trials that randomized women to etidronate or an alternative (placebo or calcium and/or vitamin D) and measured bone density for at least 1 year. For each trial, three independent reviewers assessed the methodologic quality and abstracted data. The data suggested a reduction in vertebral fractures with a pooled relative risk of 0.63 (95% CI 0.44 to 0.92). There was no effect on nonvertebral fractures (relative risk 0.99, (95% CI 0.69 to 1.42). Etidronate, relative to control, increased bone density after 1-3 years of treatment in the lumbar spine by 4.06% (95% CI 3.12 to 5.00), in the femoral neck by 2.35% (95% CI 1.66 to 3.04) and in the total body by 0.97% (95% CI 0.39 to 1.55). Effects were larger at 4 years, though the number of patients followed much smaller. Etidronate increases bone density in the lumbar spine and femoral neck for up to 4 years. The pooled estimates of fracture reduction with etidronate suggest a reduction in vertebral fractures, but no effect on nonvertebral fractures.
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Affiliation(s)
- A Cranney
- Department of Medicine and Clinical Epidemiology, Loeb Research Institute, University of Ottawa, Canada
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Adams EM, Becker JA, Griffith L, Segal A, Plotz PH, Raben N. Glycogenosis type II: a juvenile-specific mutation with an unusual splicing pattern and a shared mutation in African Americans. Hum Mutat 2000; 10:128-34. [PMID: 9259196 DOI: 10.1002/(sici)1098-1004(1997)10:2<128::aid-humu5>3.0.co;2-g] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The recessively inherited deficiency of acid alpha-glucosidase (GAA) called Glycogenosis Type II is expressed as three different phenotypes: infantile, juvenile, and adult. At the molecular level, infantile and adult forms of the disease have been extensively studied, but little is known regarding the genetic defects associated with the juvenile form. We describe a novel mutation that defines the intermediate juvenile phenotype in a compound heterozygous patient. A transversion of t to g in intron 6 at position -22 creates a cryptic acceptor site and results in unusual splicing abnormality: insertion of 21 nucleotides of the intronic sequence into mRNA and removal of exon 6 without disruption of the reading frame. The second mutation, Arg854Stop in exon 18, had been previously identified in another African-American patient (Hermans et al., 1993a). Family study indicates that a silent allele harboring the Arg854Stop mutation in our patient is inherited from the patient's father, who is also African-American, thus suggesting a common mutation in this population.
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Affiliation(s)
- E M Adams
- Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
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Cook D, Meade M, Guyatt G, Griffith L, Booker L. Criteria for weaning from mechanical ventilation. Evid Rep Technol Assess (Summ) 2000:1-4. [PMID: 10932958 PMCID: PMC4781077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Abstract
The objective of this study is to compare the results of randomized trials and observational studies of interventions to prevent adolescent pregnancy. We identified published and unpublished reports through computerized searches of CATLINE, CINAHL, CONFERENCE PAPERS INDEX, DISSERTATION ABSTRACTS ONLINE, EMBASE, ERIC, MEDLINE, NTIS, POPLINE, PsycINFO, and SOCIOLOGICAL ABSTRACTS; manual searches of eight relevant journals; reference lists from primary articles; and contact with content experts. We included randomized trials and observational studies that evaluated the impact of primary prevention interventions including sex education classes, school-based clinics, free-standing clinics, physician/nurse practitioner practice-based service, improved access, and community-based programs on four outcomes: sexual intercourse, birth control use, responsible sexual behavior, or pregnancy in adolescents. One investigator abstracted the data and a second conducted a detailed review of the abstraction. We identified 13 randomized trials and 17 observational studies. We generated estimates of the impact of the interventions separately for males and females for all four outcomes for both observational studies and randomized trials. For six of the eight outcomes the summary odds ratios for the observational studies showed a significant intervention benefit (P<0.05) while the randomized trials did not show a benefit for any outcome in either females or males. The difference between the results of the observational studies and randomized trials was statistically significant in two of the eight outcomes (P<0.05 for initiation of intercourse and pregnancy in females). Observational studies yield systematically greater estimates of treatment effects than randomized trials of adolescent pregnancy prevention interventions. Public policy or individual patient treatment decisions should be based on observational studies only when randomized trials are unavailable and only with careful consideration of possible biases.
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Affiliation(s)
- G H Guyatt
- Department of Clinical Epidemiology & Biostatistics, Room 2C12, McMaster University Faculty of Health Sciences, 1200 Main Street West, Hamilton, Ontario, Canada.
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Wong C, Visram F, Cook D, Griffith L, Randall J, O'Brien B, Higgins D. Development, dissemination, implementation and evaluation of a clinical pathway for oxygen therapy. CMAJ 2000; 162:29-33. [PMID: 11216195 PMCID: PMC1232226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Oxygen is commonly administered to patients in hospital, but prescribing and monitoring of such therapy may be suboptimal. The objective of this study was to develop, disseminate, implement and evaluate a multidisciplinary clinical pathway for the administration of oxygen. METHODS The authors developed a clinical pathway for the ordering, titration and discontinuation of oxygen, which was disseminated through teaching sessions, in-service training sessions and information posters in a medical clinical teaching unit (CTU). Implementation of the pathway was ensured by means of reminders and patient-centred audit and feedback to CTU nurses and house staff. During a 3-month intervention phase, consecutive patients requiring supplemental oxygen were treated according to the pathway. During a 1-month "wash-out" phase followed by a 3-month non-intervention phase, patients were treated at the discretion of the CTU team. Clinical and economic data were collected in both phases. RESULTS In the 2 phases, patient characteristics, the concentration and duration of oxygen prescribed, the frequency of oxygen saturation monitoring, the frequency of arterial blood gas testing and the clinical outcomes were similar. However, there were more discontinuation orders in the intervention phase (p < 0.001). In the intervention phase, costs were higher for monitoring of oxygen saturation ($44.95/patient v. $36.17/patient, p = 0.048) and for order transcription ($2.71/patient v. $1.28/patient, p < 0.001); total costs, including those for personnel, were also higher in the intervention phase ($76.93/patient v. $56.67/patient, p = 0.02). The cost of education about the oxygen pathway was $45.71/patient. When the education cost was included, the total cost of oxygen therapy during the intervention phase was $122.64/patient; this was significantly higher than the total cost of oxygen therapy during the non-intervention phase ($56.67/patient) (p < 0.001). INTERPRETATION This multidisciplinary, multimethod oxygen pathway led to changes in oxygen-prescribing behaviour, consumed more resources than standard management and was not associated with changes in patient outcome. Appropriate management of oxygen prescribing and monitoring by physicians and nurses take time and costs money.
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Affiliation(s)
- C Wong
- Department of Medicine, McMaster University, Hamilton, Ont
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Cook D, Heyland D, Griffith L, Cook R, Marshall J, Pagliarello J. Risk factors for clinically important upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. Crit Care Med 1999; 27:2812-7. [PMID: 10628631 DOI: 10.1097/00003246-199912000-00034] [Citation(s) in RCA: 165] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the incidence and risk factors for clinically important upper gastrointestinal bleeding in critically ill patients requiring mechanical ventilation. DESIGN In duplicate, blinded adjudicators determined the presence of clinically important gastrointestinal bleeding using a priori criteria, evaluating relevant clinical, laboratory, and diagnostic data. Cox proportional hazards regression analyses were used to examine baseline and time-dependent risk factors for bleeding. SETTING Sixteen university-affiliated intensive care units (ICUs) in Canada. PATIENTS A total of 1,077 critically ill ICU patients ventilated for at least 48 hrs. INTERVENTIONS Patients were randomized to stress ulcer prophylaxis with intravenous ranitidine or nasogastric sucralfate; otherwise, management was at the discretion of the ICU team. MEASUREMENTS AND MAIN RESULTS Demographic data included patient characteristics, Acute Physiology and Chronic Health Evaluation II score, and multiple organ dysfunction (MOD) score. Each day in the ICU, physiologic measurements including MOD score, feeding, and other treatment variables were recorded. The significant risk factors for upper gastrointestinal bleeding in the univariable analyses were low platelet count, maximum serum creatinine, maximum MOD score, maximum pulmonary component of the MOD score, maximum hepatic component of the MOD score, maximum renal component of the MOD score, enteral nutrition, and stress ulcer prophylaxis with ranitidine. The only independent predictors of bleeding in the multivariable analysis were maximum serum creatinine (relative risk = 1.16 [95% confidence interval = 1.02-1.32]), enteral nutrition (relative risk = 0.30 [95% confidence interval = 0.13-0.67]), and ranitidine administration (relative risk = 0.39 [95% confidence interval = 0.17-0.83]). CONCLUSIONS In critically ill ventilated patients, renal failure was independently associated with an increased risk of clinically important gastrointestinal bleeding, whereas enteral nutrition and stress ulcer prophylaxis with ranitidine conferred significantly lower bleeding rates.
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Affiliation(s)
- D Cook
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am J Respir Crit Care Med 1999; 159:1249-56. [PMID: 10194173 DOI: 10.1164/ajrccm.159.4.9807050] [Citation(s) in RCA: 531] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To evaluate the attributable morbidity and mortality of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, we conducted a prospective, matched cohort study. Patients expected to be ventilated for > 48 h were prospectively followed for the development of VAP. To determine the excess ICU stay and mortality attributable to VAP, we matched patients with VAP to patients who did not develop clinically suspected pneumonia. We also conducted sensitivity analyses to examine the effect of different populations, onset of pneumonia, diagnostic criteria, causative organisms, and adequacy of empiric treatment on the outcome of VAP. One hundred and seventy-seven patients developed VAP. As compared with matched patients who did not develop VAP, patients with VAP stayed in the ICU for 4.3 d (95% confidence interval [CI]: 1.5 to 7. 0 d) longer and had a trend toward an increase in risk of death (absolute risk increase: 5.8%; 95% CI: -2.4 to 14.0 d; relative risk (RR) increase: 32.3%; 95% CI: -20.6 to 85.1%). The attributable ICU length of stay was longer for medical than for surgical patients (6. 5 versus 0.7 d, p < 0.004), and for patients infected with "high risk" organisms as compared with "low risk" organisms (9.1 d versus 2.9 d). The attributable mortality was higher for medical patients than for surgical patients (RR increase of 65% versus -27.3%, p = 0. 04). Results were similar for three different VAP diagnostic criteria. We conclude that VAP prolongs ICU length of stay and may increase the risk of death in critically ill patients. The attributable risk of VAP appears to vary with patient population and infecting organism.
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Affiliation(s)
- D K Heyland
- Department of Medicine, Queen's University, Kingston, ON, Canada.
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Cook D, Walter S, Freitag A, Guyatt G, Devitt H, Meade M, Griffith L, Sarabia A, Fuller H, Turner M, Gough K. Adjudicating ventilator-associated pneumonia in a randomized trial of critically ill patients. J Crit Care 1998; 13:159-63. [PMID: 9869541 DOI: 10.1016/s0883-9441(98)90000-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate an adjudication strategy for diagnosing ventilator-associated pneumonia (VAP) in a randomized trial. MATERIALS AND METHODS In a double-blind trial of sucralfate versus ranitidine, one of four pairs of adjudicators examined each case of clinically suspected VAP. Nurse and physician notes and all relevant laboratory data were allocated to each adjudication pair in groups of five patients. Each reader in the pair decided whether the patient had VAP; differences were resolved by consensus discussion. RESULTS The overall unadjusted study odds ratio for VAP was 0.82 (P = .21) representing a trend toward less pneumonia with sucralfate compared with ranitidine. The odds ratio adjusted for adjudication pair was 0.85 (P = .27). The proportion of charts adjudicated as VAP positive among pairs ranged from 50% to 92%; crude agreement between readers in each pair varied from 50% to 82%. When adjudicators disagreed, the final consensus was split evenly between the two adjudicators' initial opinions in two pairs; in the other two pairs, the final decision reflected one dominant initial opinion. Personnel time to adjudicate all patients with a suspicion of VAP was 74 days. CONCLUSIONS Though adjudication of outcomes such as VAP is time-consuming, consistent decision-making requires strict criteria, training, and calibration. Patients should be assigned to adjudication teams through random allocation.
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Affiliation(s)
- D Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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