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Pecorelli S, Ferdynus C, Delmas J, Harper L. Appearance of the bladder on initial voiding cystogram in boys with PUV and its relation to pre and postnatal findings. Front Pediatr 2024; 12:1380502. [PMID: 38699154 PMCID: PMC11063334 DOI: 10.3389/fped.2024.1380502] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Bladder profile in boys with Posterior Urethral Valves can be very varied with a spectrum going from high pressure, unstable, hypocompliant small bladders to hypercompliant, large acontractile bladders, with some being near-normal. Our question was whether appearance, specifically of the bladder, on initial VCUG was correlated to prenatal features and whether it could predict early postnatal outcome. Method We used a prospectively gathered database of boys with prenatally suspected PUV. We analyzed whether the appearance, specifically of the bladder, was related to date of prenatal diagnosis, presence of a megacystis on prenatal ultrasound, presence of vesico-ureteral reflux (VUR), presence of abnormal DMSA scan, nadir creatinine or presence of febrile urinary tract infection (fUTI) during the first two years of life. Results The database comprised 90 cystograms. 15% of bladders were judged normal/regular, 54 % were small/diverticular and 31% were large/diverticular. Bladder appearance was not associated with presence of prenatal megacystis, abnormal DMSA scan, VUR, nor rate of fUTI. The only significant associations were normal/regular bladder and early prenatal diagnosis (p = 0.04) and normal/regular bladder and elevated nadir creatinine (>75µmol/l) (p = 0.01). Discussion We believe that when focusing solely on the appearance of the bladder, excluding information about the urethra and presence of reflux, the cystogram alone is insufficient to inform on future bladder function. This could be used as an argument in favor of performing early urodynamics in this population.
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Affiliation(s)
- S. Pecorelli
- Department of Pediatric Urology, Hôpital Pellegrin-Enfants, CHU Bordeaux, France
| | - C. Ferdynus
- Methodological SupportUnit, Reunion University Hospital, La Réunion, France
- Clinical Informatics Department, Reunion University Hospital, La Réunion, France
- Clinical Research Department, INSERM CIC1410, La Réunion, France
| | - J. Delmas
- Department of Pediatric Radiology, Hôpital Pellegrin-Enfants, CHU Bordeaux, France
| | - L. Harper
- Department of Pediatric Urology, Hôpital Pellegrin-Enfants, CHU Bordeaux, France
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2
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Harper L, Wolmer C. Is the urinary tract dilation classification really that good? Reply to Kim et al. Pediatr Radiol 2024:10.1007/s00247-024-05927-3. [PMID: 38625563 DOI: 10.1007/s00247-024-05927-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Affiliation(s)
- L Harper
- Department of Pediatric Urology, Hopital Pellegrin-Enfants, CHU Bordeaux, Place Amelie Raba-Leon, 33000, Bordeaux, France.
| | - C Wolmer
- Department of Pediatric Urology, Hopital Pellegrin-Enfants, CHU Bordeaux, Place Amelie Raba-Leon, 33000, Bordeaux, France
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Fossum M, Kaefer M, Herbst KW, Harper L, Beckers GMA, Nelson CP, Garriboli M, Nieuwhof-Leppink A, Bagli D, Kalfa N. The orchestration of gene expression and the editing role of microRNA. J Pediatr Urol 2022:S1477-5131(22)00631-3. [PMID: 36653199 DOI: 10.1016/j.jpurol.2022.12.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
In this short educational communication the ESPU Research Committee presents the role of non-coding RNA and how these can affect gene expression. In particular we discuss the role of microRNA on post transcriptional changes and how these may cause pathological conditions within Pediatric Urology and how microRNA could be useful in future clinical practice.
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Affiliation(s)
- M Fossum
- Department of Pediatric Surgery, Rigshospitalet, Dept of Medical Sciences, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | | | - C P Nelson
- Department of Urology, Boston Children's Hospital and Department of Surgery, Harvard Medical School, Harvard University, Boston, MA, USA
| | - M Garriboli
- Department of Paediatric Urology, Evelina Children's Hospital, Guy's and St. Thomas NHS Foundation Trust, London, United Kingdom
| | - A Nieuwhof-Leppink
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - N Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France; Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, Montpellier, France
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Prosperi-Porta G, Kiamanesh O, Fine N, Ferland A, Harper L, Solverson K, Boiteau P, Helmerson D, Weatherald J. VENTRICULAR-ARTERIAL DECOUPLING IS ASSOCIATED WITH IN-HOSPITAL ADVERSE EVENTS IN NORMOTENSIVE PULMONARY EMNBOLISM. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.143] [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: 11/02/2022] Open
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King C, Patel R, Mendoza C, Walker JK, Wu EY, Moss P, Morgan MD, O'Dell Bunch D, Harper L, Chanouzas D. Cytomegalovirus infection is a risk factor for venous thromboembolism in ANCA-associated vasculitis. Arthritis Res Ther 2022; 24:192. [PMID: 35948984 PMCID: PMC9364516 DOI: 10.1186/s13075-022-02879-7] [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] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common complication in patients with anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) and confers significant morbidity and mortality. Both acute and past cytomegalovirus (CMV) infection have been identified as risk factors for VTE in immunocompetent and immunosuppressed individuals. Here, we examine whether past exposure to CMV is a risk factor for VTE amongst patients with AAV. METHODS We retrospectively analysed outcomes of patients with a new diagnosis of AAV from a UK cohort. All confirmed cases of VTE where CMV IgG serology was available were recorded. Retrospective collection of the same data for patients at a North American centre was used as a validation cohort. RESULTS VTE was common with 12% of patients from the study cohort (total 259 patients) developing an event during the median follow-up period of 8.5 years of which 60% occurred within the first 12 months following diagnosis. Sixteen percent of CMV seropositive patients developed a VTE compared with 5% of patients who were seronegative (p = 0.007) and CMV seropositivity remained an independent predictor of VTE in multivariable analysis (HR 2.96 [1.094-8.011] p = 0.033). CMV seropositivity at diagnosis was confirmed as a significant risk factor for VTE in the American validation cohort (p = 0.032). CONCLUSIONS VTE is common in patients with AAV, especially within the first year of diagnosis. Past infection with CMV is an independent risk factor associated with VTE in AAV.
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Affiliation(s)
- C King
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK.
- Institute of Immunology and Immunotherapy, University of Birmingham, Cancer Sciences Building, Edgbaston, Birmingham, B15 2TT, UK.
| | - R Patel
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - C Mendoza
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - J K Walker
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - E Y Wu
- University of North Carolina Pediatric Allergy, Immunology, and Rheumatology, Chapel Hill, USA
| | - P Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Cancer Sciences Building, Edgbaston, Birmingham, B15 2TT, UK
| | - M D Morgan
- Hull York Medical School, University of Hull, Hull, UK
| | - D O'Dell Bunch
- University of North Carolina Department of Medicine, Kidney Centre, Chapel Hill, NC, USA
| | - L Harper
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - D Chanouzas
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Hwee J, Fu Q, Harper L, Nirantharakumar K, Goel R, Jakes R. POS0320 EPIDEMIOLOGY AND HEALTHCARE RESOURCE UTILIZATION OF PATIENTS WITH EGPA IN THE UNITED KINGDOM. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundEosinophilic granulomatosis with polyangiitis (EGPA) is characterized by eosinophilic inflammation of small with or without medium arteries. EGPA is a rare disease with varying prevalence and incidence rates globally. To date, limited information is available on the prevalence, incidence and burden of disease in the United Kingdom (UK).ObjectivesThe objectives were to estimate the prevalence and incidence of EGPA, and to describe the healthcare resource utilization (HCRU) among patients with EGPA in the UK.MethodsThis retrospective database study used the UK-based Clinical Practice Research Datalink (CPRD)-AURUM database linked to the Hospital Episode Statistics (HES). Prevalence was estimated from 2005 to 2019, and incidence was estimated from 2006 to 2019. HCRU was assessed in the 12-months following the first recorded diagnosis of EGPA (index date), and included hospitalizations, emergency room visits, procedures, outpatient specialist visits, primary care visits, and oral corticosteroid use.Results764 people were identified with EGPA in the UK. The prevalence of EGPA, reported in the database, increased from 22.7 to 45.6 per 1,000,000 persons from 2005 to 2019 (Figure 1), whereas the incidence of EGPA from 2006 to 2019 ranged from 2.28 to 4.00 per 1,000,000 person-years. 377 patients with EGPA were successfully linked to the CPRD-HES database. Patient characteristics were as follows: mean age (SD) was 57 years (14.2); 49% were male; 81% had asthma; and 11% had peripheral neuropathy prior to the index date. For patients with EGPA, 19% had an EGPA-related hospitalization and 50% had any-cause hospitalization within 1 year of the index date (Table 1). The mean length of stay was, 18 days and 16 days for EGPA-related and any-cause hospitalizations, respectively. 52% of patients with EGPA had undergone a medical procedure, 89% of patients with EGPA had an outpatient visit to a specialist. Almost all patients with EGPA visited a general practitioner within 1 year of their EGPA diagnosis (97%) and averaged 16.0 visits in 1 year. A significant proportion of the EGPA population were prescribed OCS; most EGPA patients had a prescription in the 0–3 months after the index date (64%), and patients on average had a prescription for OCS for 6 out of the 12 months after the index date.Table 1.HCRU among patients with EGPAHCRUNumber of patients N (%) [total days]Number of events per patient, Mean (SD)Total EGPA cohort (N)377 EGPA-specific hospitalizations72 (19.10)1.2 (1) EGPA-specific hospitalizations length of stay[1283]17.8 (23.3) Any-cause hospitalizations188 (49.87)1.7 (1) Any-cause hospitalizations length of stay[2992]15.9 (23.7) Any-cause A & E events19 (5.04)1.8 (2) Any-cause outpatient visits334 (88.59)9.8 (7) Any procedures undertaken196 (51.99)6.8 (6) General Practitioner visits366 (97.08)16.0 (11)A&E, Accident and Emergency; EGPA, eosinophilic granulomatosis with polyangiitis; HCRU, healthcare resource utilization.Figure 1.Prevalence of EGPA in the UK from 2005 to 2019Prevalence is expressed as cases per 1,000,000 persons. EGPA, eosinophilic granulomatosis with polyangiitis; UK, United Kingdom.ConclusionThe prevalence of EGPA increased over the study period in the UK, and the data show significant HCRU within 1 year of the first recorded diagnosis of EGPA. Almost all of the patients with EGPA were found to frequently visit the primary care physician and seek specialist care, and almost half required hospitalization. Funding: GSK [207888]AcknowledgementsFunding: GSK [207888]Disclosure of InterestsJeremiah Hwee Shareholder of: GSK, Employee of: GSK, Qinggong Fu Shareholder of: GSK, Employee of: GSK, Lorraine Harper Speakers bureau: Viopharm (2021), Roche (2017), Consultant of: GSK (2021), Viopharm (2021), Grant/research support from: Viopharm (researcher initiated project), MSD (researcher initiated project), Krishnarajah Nirantharakumar Consultant of: Boehringer Ingelheim (Consultancy on real world evidence), Grant/research support from: AstraZeneca, Vifor and Boehringer Ingelheim (Investigator led grants), Ruchika Goel: None declared, Rupert Jakes Shareholder of: GSK, Employee of: GSK
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Delefortrie T, Ferdynus C, Paye-Jaouen A, Peycelon M, Michel JL, Dobremez E, El Ghoneimi A, Harper L. Nadir creatinine predicts long-term bladder function in boys with posterior urethral valves. J Pediatr Urol 2022; 18:186.e1-186.e4. [PMID: 35184944 DOI: 10.1016/j.jpurol.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Posterior urethral valves (PUV) cause lower urinary tract obstruction leading to increased intravesical pressure during fetal urinary tract development. Though the bladder and kidneys are separate organs, with different embryological origins, they are complementary and influence each other both before and after birth. We aimed to assess the relationship between renal and bladder function in boys with PUV and whether early renal markers could predict future bladder function. PATIENTS AND METHODS We included all boys with prenatally suspected lower urinary tract obstruction, born between 2000 and 2013, in two University Hospitals, with at least 5 years follow-up. We excluded patients who presented a Lower Urinary Tract Obstruction other than PUV, children who presented multiple birth defects and neonatal deaths and those with incomplete long-term renal or bladder function data. We included data on nadir creatinine (NC), long-term renal function and long-term bladder function (defined by Uroflow parameters). Boys with PUV were divided into three severity groups for renal function according to their NC and three severity groups for bladder function as determined by Uroflow. RESULTS We included 73 boys. Average nadir creatinine was 43.4 ± 26.1 μmol/L. Twenty-nine boys (49.3%) presented a NC < 35 μmol/L, thirty-eight (52.1%) a NC between 35 and 75 μmol/L, and 6 (8.2%) a NC > 75 μmol/L. Thirty-eight (52.1%) presented normal bladder function, 23 (31.5%) presented moderately impaired bladder function and 12 (16.4%) presented severely impaired bladder function. 41.4% of boys with NC < 35 had abnormal bladder function vs 46.2% of those with an NC between 35 and 75 μmol/L and 83.3% of boys with NC > 75 μmol/L. Nadir creatinine both predicted both bladder function and renal status (table 1). Correlation between presence of grade 3-5 CKD and poor uroflow was also significant (p < 0.005). DISCUSSION Nadir creatinine was significantly correlated to bladder function at 5 years of age. What this study suggests is that as nadir creatinine increases so does the risk of severe bladder dysfunction. Our results, though limited to flowmeter and renal function, could help pediatric urologist tailor bladder function monitoring, and indicate which patients could benefit from more aggressive bladder therapy. CONCLUSION Bladder and renal function are linked in boys with posterior urethral valves. Boys with high nadir creatinine could benefit from early bladder function evaluation and management.
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Affiliation(s)
- T Delefortrie
- Department of Pediatric Surgery and Urology, Hôpital Universitaire Robert Debré, APHP, Université de Paris, Paris, France; Department of Pediatric Surgery, CHU F Guyon, Saint-Denis de La Réunion, France; Department of Pediatric Surgery, CHU Pellegrin-Enfants, Bordeaux, France; Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), France
| | - C Ferdynus
- Unité de Soutien Méthodologique, CHU F Guyon, Saint-Denis de La Réunion, France
| | - A Paye-Jaouen
- Department of Pediatric Surgery and Urology, Hôpital Universitaire Robert Debré, APHP, Université de Paris, Paris, France; Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), France
| | - M Peycelon
- Department of Pediatric Surgery and Urology, Hôpital Universitaire Robert Debré, APHP, Université de Paris, Paris, France; Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), France
| | - J L Michel
- Department of Pediatric Surgery, CHU F Guyon, Saint-Denis de La Réunion, France
| | - E Dobremez
- Department of Pediatric Surgery, CHU Pellegrin-Enfants, Bordeaux, France
| | - A El Ghoneimi
- Department of Pediatric Surgery and Urology, Hôpital Universitaire Robert Debré, APHP, Université de Paris, Paris, France; Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), France
| | - L Harper
- Department of Pediatric Surgery, CHU Pellegrin-Enfants, Bordeaux, France.
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Harper L, Alshammari D. Response to comment "Deepithelized glans reconfiguration: A kaleidoscopic view considering the protopathic sensibility of the glans penis". J Pediatr Urol 2022; 18:106. [PMID: 34998695 DOI: 10.1016/j.jpurol.2021.12.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- L Harper
- Department of Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France.
| | - D Alshammari
- Department of Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France
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Pelet H, Tunon de Lara S, Pfirrmann C, Meynard P, Harper L, Angelliaume A, Berard X, Lefèvre Y. False aneurysm of the popliteal artery revealing a solitary osteochondroma of the distal femur in an 11-year-old boy. Acta Chir Belg 2022; 122:63-66. [PMID: 32253993 DOI: 10.1080/00015458.2020.1753150] [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: 10/24/2022]
Abstract
An 11-year-old boy presented with pain in the right knee, intermittent reverse ischemia of the right foot and paraesthesia of the right toes. An angio-CT showed a false aneurysm of the right superior popliteal artery, and a solitary osteochondroma of the posterior aspect of the distal femur. Excision of the aneurysm and the osteochondroma was performed in two-stages. The patient was clinically well at 1-year follow up.
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Affiliation(s)
- H. Pelet
- Service de chirurgie pédiatrique, CHU de Bordeaux, Place du Amélie Raba-Leon, Bordeaux, France
| | - S. Tunon de Lara
- Service de chirurgie pédiatrique, CHU de Bordeaux, Place du Amélie Raba-Leon, Bordeaux, France
| | - C. Pfirrmann
- Service de chirurgie pédiatrique, CHU de Bordeaux, Place du Amélie Raba-Leon, Bordeaux, France
| | - P. Meynard
- Service de chirurgie pédiatrique, CHU de Bordeaux, Place du Amélie Raba-Leon, Bordeaux, France
| | - L. Harper
- Service de chirurgie pédiatrique, CHU de Bordeaux, Place du Amélie Raba-Leon, Bordeaux, France
| | - A. Angelliaume
- Service de chirurgie pédiatrique, CHU de Bordeaux, Place du Amélie Raba-Leon, Bordeaux, France
| | - X. Berard
- Service de chirurgie vasculaire, CHU de Bordeaux, Place du Amélie Raba-Leon, Bordeaux, France
| | - Y. Lefèvre
- Service de chirurgie pédiatrique, CHU de Bordeaux, Place du Amélie Raba-Leon, Bordeaux, France
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Fouladi F, Bulik-Sullivan EC, Glenny EM, Thornton LM, Reed KK, Thomas S, Kleiman S, Watters A, Oakes J, Huh EY, Tang Q, Liu J, Djukic Z, Harper L, Trillo-Ordoñez Y, Sun S, Blakely I, Mehler PS, Fodor AA, Tarantino LM, Bulik CM, Carroll IM. Reproducible changes in the anorexia nervosa gut microbiota following inpatient therapy remain distinct from non-eating disorder controls. Gut Microbes 2022; 14:2143217. [PMID: 36398862 PMCID: PMC9678007 DOI: 10.1080/19490976.2022.2143217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The composition of the gut microbiota in patients with anorexia nervosa (AN), and the ability of this microbial community to influence the host, remains uncertain. To achieve a broader understanding of the role of the intestinal microbiota in patients with AN, we collected fecal samples before and following clinical treatment at two geographically distinct eating disorder units (Center of Excellence for Eating Disorders [UNC-CH] and ACUTE Center for Eating Disorders [Denver Health]). Gut microbiotas were characterized in patients with AN, before and after inpatient treatment, and in non-eating disorder (non-ED) controls using shotgun metagenomic sequencing. The impact of inpatient treatment on the AN gut microbiota was remarkably consistent between eating disorder units. Although weight in patients with AN showed improvements, AN microbiotas post-treatment remained distinct from non-ED controls. Additionally, AN gut microbiotas prior to treatment exhibited more fermentation pathways and a lower ability to degrade carbohydrates than non-ED controls. As the intestinal microbiota can influence nutrient metabolism, our data highlight the complex microbial communities in patients with AN as an element needing further attention post inpatient treatment. Additionally, this study defines the effects of renourishment on the AN gut microbiota and serves as a platform to develop precision nutrition approaches to potentially mitigate impediments to recovery.
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Affiliation(s)
- Farnaz Fouladi
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, NC28223, USA
| | - Emily C. Bulik-Sullivan
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Elaine M. Glenny
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Laura M. Thornton
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Kylie K. Reed
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Stephanie Thomas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Susan Kleiman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Ashlie Watters
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, University of Colorado School of Medicine, Denver, CO80204, USA
| | - Judy Oakes
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Department of Medicine, Medical Intensive Care Unit, Denver Health Hospital Authority, Denver, CO80204, USA
| | - Eun-Young Huh
- Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Quyen Tang
- Graduate School of Professional Psychology, Morrison Family College of Health, University of St. Thomas, Minneapolis, MN, USA
| | - Jintong Liu
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Zorka Djukic
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Lauren Harper
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Yesel Trillo-Ordoñez
- Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Shan Sun
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, NC28223, USA
| | - Ivory Blakely
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, NC28223, USA
| | - Philip S. Mehler
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, University of Colorado School of Medicine, Denver, CO80204, USA
| | - Anthony A. Fodor
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, NC28223, USA
| | - Lisa M. Tarantino
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA,Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Cynthia M. Bulik
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA,Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ian M. Carroll
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA,Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA,CONTACT Ian M. Carroll Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
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Delefortrie T, Ferdynus C, Paye-Jaouen A, Michel JL, Dobremez E, Peycelon M, El Ghoneimi A, Harper L. Evaluating the impact of pop-off mechanisms in boys with posterior urethral valves. Front Pediatr 2022; 10:1014422. [PMID: 36330367 PMCID: PMC9622767 DOI: 10.3389/fped.2022.1014422] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Posterior urethral valves are urethral leaflets that cause Lower Urinary Tract Obstruction (LUTO) in boys and are associated with congenital renal dysplasia and abnormal bladder function. They affect 1:4,000 to 1:25,000 births and can be responsible for End-Stage Renal Failure in childhood. There have been several studies on the effect of pop-off mechanisms in boys with posterior urethral valves, but results are contradictory. We aimed to assess and discuss the effect of pop-off mechanisms on renal function in a large cohort of patients. PATIENTS AND METHOD Boys with PUV with and without pop-off mechanisms (urinoma, VURD or giant bladder diverticula) were divided into three severity groups for renal function according to their nadir creatinine (low-risk NC < 35 μmol/L, intermediate-risk NC between 35 and 75 μmol/L, and high-risk NC > 75 μmol/L). We compared children with and children without pop-off mechanisms for mean renal function as well as patient distribution within each severity group. RESULTS We included 137 boys of which 39 had a pop-off mechanism. Patients had complete data for at least 5 years follow-up. Though there was no significant statistical difference in mean renal function between the pop-off and non-pop-off group, patient distribution within each severity group varied according to whether patients had a pop-off mechanism or not. CONCLUSION Though there was no significant difference in mean renal function between boys with and without pop-off mechanisms, it is possible that these are two different patient populations and direct comparison is not possible.
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Affiliation(s)
- T Delefortrie
- Department of Pediatric Surgery, Hôpital Robert Debré, Paris, France.,Department of Pediatric Surgery, CHU F Guyon, Saint-Denis de La Réunion, France.,Department of Pediatric Surgery, CHU Pellegrin-Enfants, Bordeaux, France
| | - C Ferdynus
- Unité de Soutien Méthodologique, CHU F Guyon, Saint-Denis de La Réunion, France
| | - A Paye-Jaouen
- Department of Pediatric Surgery, Hôpital Robert Debré, Paris, France.,Hôpital Robert Debré, Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), Paris, France
| | - J L Michel
- Department of Pediatric Surgery, CHU F Guyon, Saint-Denis de La Réunion, France
| | - E Dobremez
- Department of Pediatric Surgery, CHU Pellegrin-Enfants, Bordeaux, France
| | - M Peycelon
- Department of Pediatric Surgery, Hôpital Robert Debré, Paris, France
| | - A El Ghoneimi
- Department of Pediatric Surgery, Hôpital Robert Debré, Paris, France.,Hôpital Robert Debré, Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), Paris, France
| | - L Harper
- Department of Pediatric Surgery, CHU F Guyon, Saint-Denis de La Réunion, France.,Department of Pediatric Surgery, CHU Pellegrin-Enfants, Bordeaux, France
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12
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Antonelou M, Abro A, Heath R, Iacovou A, Ashley C, Caplan J, Morgan MD, Logan S, Harper L, Salama AD. Comparison of outcomes using the rituximab originator MabThera with the biosimilar Truxima in patients with ANCA-associated vasculitis. Scand J Rheumatol 2021; 51:135-141. [PMID: 34474634 DOI: 10.1080/03009742.2021.1926318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The use of rituximab (MabThera®), an anti-CD20 monoclonal antibody, is the most significant development in the management of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) since the introduction of cytotoxic therapy in 1950. Truxima® is the first anti-CD20 biosimilar approved for the same indications, and has been available in the UK since 2017. Significant cost savings have been reported when switching to biosimilars, which could lead to greater patient access to such treatment. Therefore, it is important to know whether patients' clinical and laboratory parameters respond equally well to biosimilars as to reference medicines, tested in clinical trials. METHOD We retrospectively reviewed the clinical outcomes and laboratory parameters in 257 consecutive patients treated with anti-CD20 depletion therapy using MabThera or Truxima, for induction and maintenance of remission, in two tertiary renal centres between 2010 and 2019. RESULTS We demonstrated no difference between patients treated with MabThera or Truxima in rates of remission, relapse, and hospitalization with infection when used for either induction or maintenance of remission of AAV. In one hospital subgroup analysis, we showed comparable levels of hypogammaglobulinaemia, B-cell depletion, and frequency of infusion reactions, with no significant differences. CONCLUSION The efficacy and safety of the rituximab biosimilar Truxima are not inferior to the originator MabThera in patients with AAV. Truxima represents a cheaper and safe therapeutic alternative that could increase patient access to rituximab.
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Affiliation(s)
- M Antonelou
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - A Abro
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - R Heath
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - A Iacovou
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - C Ashley
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK.,Pharmacy Department, Royal Free Hospital, London, UK
| | - J Caplan
- Department of Renal Medicine, University Hospital Birmingham, Birmingham, UK
| | - M D Morgan
- Department of Renal Medicine, University Hospital Birmingham, Birmingham, UK
| | - S Logan
- Department of Renal Medicine, University Hospital Birmingham, Birmingham, UK
| | - L Harper
- Department of Renal Medicine, University Hospital Birmingham, Birmingham, UK
| | - A D Salama
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
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13
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Harper L, Bagli D, Kaefer M, Kalfa N, Beckers GMA, Nieuwhof-Leppink AJ, Fossum M, Herbst KW. COVID-19 and research in pediatric urology. J Pediatr Urol 2021; 17:569-570. [PMID: 33966999 PMCID: PMC8053218 DOI: 10.1016/j.jpurol.2021.04.004] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/11/2021] [Indexed: 11/07/2022]
Abstract
COVID-19 began in December 2019 then spread worldwide. Providers, including pediatric urologists, had to adapt their clinical processes, and many non-covid research activities were suspended. COVID-19 impacts how research is financed, performed, and published, and is itself the subject of intense research. We present current research and publications specifically related to the urinary tract and the pediatric population.
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Affiliation(s)
- L Harper
- Department of Pediatric Urology and Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France.
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada.
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States.
| | - N Kalfa
- Department of Pediatric Urology and Pediatric Surgery, Hopital Lapeyronie, CHU de Montpellier et Université de Montpellier, France and Institut Desbrest d'Epidemiologie et de Santé Publique IDESP, Université de Montpellier, France.
| | - G M A Beckers
- Department of Urology, Section of Pediatric Urology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO box 85090, 3508 AB, Utrecht, the Netherlands.
| | - M Fossum
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, DK-2100, Denmark; Department of Women's and Children's Health, Bioclinicum, Floor 10, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
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Harper L. Commentary to 'Burnout syndrome in pediatric urology: A perspective during the COVID-19 pandemic - Ibero-American survey'. J Pediatr Urol 2021; 17:403. [PMID: 33785284 DOI: 10.1016/j.jpurol.2021.01.051] [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] [Received: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 10/21/2022]
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15
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Bulik CM, Thornton LM, Parker R, Kennedy H, Baker JH, MacDermod C, Guintivano J, Cleland L, Miller AL, Harper L, Larsen JT, Yilmaz Z, Grove J, Sullivan PF, Petersen LV, Jordan J, Kennedy MA, Martin NG. The Eating Disorders Genetics Initiative (EDGI): study protocol. BMC Psychiatry 2021; 21:234. [PMID: 33947359 PMCID: PMC8097919 DOI: 10.1186/s12888-021-03212-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/17/2021] [Accepted: 04/13/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The Eating Disorders Genetics Initiative (EDGI) is an international investigation exploring the role of genes and environment in anorexia nervosa, bulimia nervosa, and binge-eating disorder. METHODS A total of 14,500 individuals with eating disorders and 1500 controls will be included from the United States (US), Australia (AU), New Zealand (NZ), and Denmark (DK). In the US, AU, and NZ, participants will complete comprehensive online phenotyping and will submit a saliva sample for genotyping. In DK, individuals with eating disorders will be identified by the National Patient Register, and genotyping will occur using bloodspots archived from birth. A genome-wide association study will be conducted within EDGI and via meta-analysis with other data from the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED). DISCUSSION EDGI represents the largest genetic study of eating disorders ever to be conducted and is designed to rapidly advance the study of the genetics of the three major eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder). We will explicate the genetic architecture of eating disorders relative to each other and to other psychiatric and metabolic disorders and traits. Our goal is for EDGI to deliver "actionable" findings that can be transformed into clinically meaningful insights. TRIAL REGISTRATION EDGI is a registered clinical trial: clinicaltrials.gov NCT04378101 .
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Affiliation(s)
- Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160 USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160 USA
| | - Richard Parker
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Herston, QLD 4029 Australia
| | - Hannah Kennedy
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jessica H. Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160 USA
| | - Casey MacDermod
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160 USA
| | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160 USA
| | - Lana Cleland
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Allison L. Miller
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Lauren Harper
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160 USA
| | - Janne T. Larsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Zeynep Yilmaz
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Jakob Grove
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, CGPM, and Center for Integrative Sequencing, iSEQ, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Patrick F. Sullivan
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160 USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Liselotte V. Petersen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Martin A. Kennedy
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Nicholas G. Martin
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Herston, QLD 4029 Australia
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16
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Alshammari D, Harper L. Deepithelialized glans reconfiguration (DeGRe) for distal hypospadias repair. J Pediatr Urol 2021; 17:59.e1-59.e8. [PMID: 33144075 DOI: 10.1016/j.jpurol.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/04/2020] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Our objective was to present our experience with a novel technique for distal hypospadias repair consisting of deepithelialized glans reconfiguration. PATIENTS AND METHOD We reviewed the clinical data of all patients who underwent distal hypospadias using Deepithelialized Glans Reconfiguration between January 2015 and December 2019. We noted age at surgery, position of meatus, duration of urethral catheterization and hospitalization, as well as early and late complications. Standard postoperative care included follow-up examination at 1, 6 and 12 months. Successful repair was defined as a patient presenting with a straight penis with an apical meatus, no stricture nor fistula. RESULTS Sixty-seven patients were included. Average age at surgery was 12.5 months (6-23 months). All patients presented distal hypospadias (3 glanular, 61 coronal, 3 subcoronal). 36% of patients were operated as day case surgery. No intra-operative complications were recorded. Eleven patients did not complete the designated follow up. They attended the post-operative appointment at six months but not the one-year visit. All patients presented satisfactory urinary streams according to the parents. All parents were satisfied with the cosmetic appearance of their child's penis. Two patients presented with glans dehiscence (3%). The mean HOPE score for the last 10 patients was 47.4 ± 3.2 out of a maximum of 50. DISCUSSION Deepithelialized Glans Reconfiguration is a simple technique with satisfactory results. Though it has similarities with existing techniques, it contains specific aspects not described previously. Contrary to the MAGPI technique, there is no meatal advancement, no rotation of the glans wings, and it is the glans lateral and proximal to the meatus which is approximated in the midline. As opposed to the GAP procedure, there is no closure of the ventral aspect of the urethra. We rely on secondary healing within the glans to reconstruct the missing ventral aspect of the urethra. We reserve this technique for coronal hypospadias with a wide, deep glanular groove. Deepithelialization favours rapid healing of the glans wings on the midline. There is no formal urethroplasty. The limits to this study include lack of long-term (>1 year) follow-up and uroflow. Though careful observation did not identify fistulas, the absence of functional stenosis has to be more clearly evaluated at a later age. Finally, this technique is not suitable for the completely flat glans as it relies on being able to approximate the glans ridges in the midline. CONCLUSION Deepithelialized Glans Reconfiguration is a simple technique which achieves good cosmetic results, without complications associated with meatal or urethral advancement or formal urethroplasty.
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Affiliation(s)
- D Alshammari
- Department of Pediatric Surgery and Pediatric Urology, CHU Bordeaux, Bordeaux, France
| | - L Harper
- Department of Pediatric Surgery and Pediatric Urology, CHU Bordeaux, Bordeaux, France.
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17
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Freguja R, Bamford A, Zanchetta M, Del Bianco P, Giaquinto C, Harper L, Dalzini A, Cressey TR, Compagnucci A, Saidi Y, Riault Y, Ford D, Gibb D, Klein N, De Rossi A. Long-term clinical, virological and immunological outcomes following planned treatment interruption in HIV-infected children. HIV Med 2020; 22:172-184. [PMID: 33124144 PMCID: PMC8436743 DOI: 10.1111/hiv.12986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 08/22/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Planned treatment interruption (PTI) of antiretroviral therapy (ART) in adults is associated with adverse outcomes. The PENTA 11 trial randomized HIV-infected children to continuous ART (CT) vs. CD4-driven PTIs. We report 5 years' follow-up after the end of main trial. METHODS Post-trial, all children resumed ART. Clinical, immunological, virological and treatment data were collected annually. A sub-study investigated more detailed immunophenotype. CT and PTI arms were compared using intention-to-treat. Laboratory parameters were compared using linear regression, adjusting for baseline values; mixed models were used to include all data over time. RESULTS In all, 101 children (51 CT, 50 PTI) contributed a median of 7.6 years, including 5.1 years of post-trial follow-up. Post-trial, there were no deaths, one pulmonary tuberculosis and no other CDC stage B/C events. At 5 years post-trial, 90% of children in the CT vs. 82% in the PTI arm had HIV RNA < 50 copies/mL (P = 0.26). A persistent increase in CD8 cells was observed in the PTI arm. The sub-study (54 children) suggested that both naïve and memory populations contributed to higher CD8 cells following PTI. Mean CD4/CD8 ratios at 5 years post-trial were 1.22 and 1.08 in CT and PTI arms, respectively [difference (CT - PTI) = -0.15; 95% CI: -0.34-0.05), P = 0.14]. The sub-study also suggested that during the trial and at early timepoints after the end of the trial, reduction in CD4 in the PTI arm was mainly from loss of CD4 memory cells. CONCLUSIONS Children tolerated PTI with few long-term clinical, virological or immunological consequences.
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Affiliation(s)
- R Freguja
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - A Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,MRC Clinical Trials Unit, London, UK
| | - M Zanchetta
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - P Del Bianco
- Clinical Trials and Biostatistic Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - C Giaquinto
- Department of Mother and Child Health, University of Padova, Padova, Italy
| | - L Harper
- MRC Clinical Trials Unit, London, UK
| | - A Dalzini
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - T R Cressey
- PHPT/IRD 174, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Immunology & Infectious Diseases, Harvard T.H Chan School of Public Health, Boston, MA, USA.,Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - A Compagnucci
- INSERMSC10-US019, Essais thérapeutiques et maladies Infectieuses, Villejuif, France
| | - Y Saidi
- INSERMSC10-US019, Essais thérapeutiques et maladies Infectieuses, Villejuif, France
| | - Y Riault
- INSERMSC10-US019, Essais thérapeutiques et maladies Infectieuses, Villejuif, France
| | - D Ford
- MRC Clinical Trials Unit, London, UK
| | - D Gibb
- MRC Clinical Trials Unit, London, UK
| | - N Klein
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - A De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
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18
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Herbst KW, Beckers GMA, Harper L, Bägli DJ, Nieuwhof-Leppink AJ, Kaefer M, Fossum M, Kalfa N. Don't be mean, be above average: Understanding data distribution and descriptive statistics. J Pediatr Urol 2020; 16:712. [PMID: 33011086 DOI: 10.1016/j.jpurol.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States.
| | - G M A Beckers
- Department of Urology, Section of Pediatric Urology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - L Harper
- Department of Pediatric Urology and Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France
| | - D J Bägli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, the Netherlands
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - M Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - N Kalfa
- Service de chirurgie et urologie pédiatrique, hôpital Lapeyronie, CHU de Montpellier et Université de Montpellier, France
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19
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Affiliation(s)
- L Harper
- Department of Pediatric Urology and Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France.
| | - N Kalfa
- Service de chirurgie et urologie pédiatrique, hôpital Lapeyronie, CHU de Montpellier et Université de Montpellier, France.
| | - G M A Beckers
- Department of Urology, Section of Pediatric Urology, AmsterdamUMC, Location VUmc, Amsterdam, the Netherlands.
| | - M Kaefer
- Indiana University, 702 Barnhill Drive, Suite 4230, Indianapolis, IN, USA.
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO box 85090, 3508 AB, Utrecht, the Netherlands.
| | - Magdalena Fossum
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, DK-2100, Denmark; Department of Women's and Children's Health, Bioclinicum, Floor 10, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
| | - D Bagli
- Hospital for Sick Chidlren, Univeristy of Toronto, Canada.
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20
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Karangizi AHK, Chanouzas D, Fenton A, Moss P, Cockwell P, Ferro CJ, Harper L. Response to: Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis-dependent chronic kidney disease. QJM 2020; 113:702-703. [PMID: 32531065 DOI: 10.1093/qjmed/hcaa195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A H K Karangizi
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - D Chanouzas
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - A Fenton
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - P Moss
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - P Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - C J Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - L Harper
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
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21
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Williams M, Barclay Y, Harper L, Marchant C, Seamark L, Hickson M. Feasibility, acceptability and cost efficiency of using webinars to deliver first‐line patient education for people with Irritable Bowel Syndrome as part of a dietetic‐led gastroenterology service in primary care. J Hum Nutr Diet 2020; 33:758-766. [DOI: 10.1111/jhn.12799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Affiliation(s)
- M. Williams
- Community Dietetics Service Somerset NHS Foundation Trust Taunton UK
| | - Y. Barclay
- Community Dietetics Service Somerset NHS Foundation Trust Taunton UK
| | - L. Harper
- Community Dietetics Service Somerset NHS Foundation Trust Taunton UK
| | - C. Marchant
- Community Dietetics Service Somerset NHS Foundation Trust Taunton UK
| | - L. Seamark
- Community Dietetics Service Somerset NHS Foundation Trust Taunton UK
| | - M. Hickson
- Institute of Health and Community University of Plymouth Plymouth UK
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Harper L, Mahar E, Webster G. 051 Effectiveness of App Based Intervention for the Treatment of Female Sexual Dysfunction. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.287] [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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Harper L. Commentary to: Posterior urethral valves are more common in boys with hypospadias. J Pediatr Urol 2020; 16:304. [PMID: 32418780 DOI: 10.1016/j.jpurol.2020.03.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
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Grobman WA, Sandoval G, Reddy UM, Tita AT, Silver RM, Mallett G, Hill K, Rice MM, El-Sayed YY, Wapner RJ, Rouse DJ, Saade GR, Thorp JM, Chauhan SP, Iams JD, Chien EK, Casey BM, Gibbs RS, Srinivas SK, Swamy GK, Simhan HN, Macones GA, Peaceman A, Plunkett B, Paycheck K, Dinsmoor M, Harris S, Sheppard J, Biggio J, Harper L, Longo S, Servay C, Varner M, Sowles A, Coleman K, Atkinson D, Stratford J, Dellermann S, Meadows C, Esplin S, Martin C, Peterson K, Stradling S, Willson C, Lyell D, Girsen A, Knapp R, Gyamfi C, Bousleiman S, Perez-Delboy A, Talucci M, Carmona V, Plante L, Tocci C, Leopanto B, Hoffman M, Dill-Grant L, Palomares K, Otarola S, Skupski D, Chan R, Allard D, Gelsomino T, Rousseau J, Beati L, Milano J, Werner E, Salazar A, Costantine M, Chiossi G, Pacheco L, Saad A, Munn M, Jain S, Clark S, Clark K, Boggess K, Timlin S, Eichelberger K, Moore A, Beamon C, Byers H, Ortiz F, Garcia L, Sibai B, Bartholomew A, Buhimschi C, Landon M, Johnson F, Webb L, McKenna D, Fennig K, Snow K, Habli M, McClellan M, Lindeman C, Dalton W, Hackney D, Cozart H, Mayle A, Mercer B, Moseley L, Gerald J, Fay-Randall L, Garcia M, Sias A, Price J, Hale K, Phipers J, Heyborne K, Craig J, Parry S, Sehdev H, Bishop T, Ferrara J, Bickus M, Caritis S, Thom E, Doherty L, de Voest J. Health resource utilization of labor induction versus expectant management. Am J Obstet Gynecol 2020; 222:369.e1-369.e11. [PMID: 31930993 DOI: 10.1016/j.ajog.2020.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/26/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although induction of labor of low-risk nulliparous women at 39 weeks reduces the risk of cesarean delivery compared with expectant management, concern regarding more frequent use of labor induction remains, given that this intervention historically has been thought to incur greater resource utilization. OBJECTIVE The objective of the study was to determine whether planned elective labor induction at 39 weeks among low-risk nulliparous women, compared with expectant management, was associated with differences in health care resource utilization from the time of randomization through 8 weeks postpartum. STUDY DESIGN This is a planned secondary analysis of a multicenter randomized trial in which low-risk nulliparous women were assigned to induction of labor at 39 weeks or expectant management. We assessed resource utilization after randomization in 3 time periods: antepartum, delivery admission, and discharge through 8 weeks postpartum. RESULTS Of 6096 women with data available, those in the induction of labor group (n = 3059) were significantly less likely in the antepartum period after randomization to have at least 1 ambulatory visit for routine prenatal care (32.4% vs 68.4%), unanticipated care (0.5% vs 2.6%), or urgent care (16.2% vs 44.3%), or at least 1 antepartum hospitalization (0.8% vs 2.2%, P < .001 for all). They also had fewer tests (eg, sonograms, blood tests) and treatments (eg, antibiotics, intravenous hydration) prior to delivery. During the delivery admission, women in the induction of labor group spent a longer time in labor and delivery (median, 0.83 vs 0.57 days), but both women (P = .002) and their neonates (P < .001) had shorter postpartum stays. Women and neonates in both groups had similar frequencies of postpartum urgent care and hospital readmissions (P > .05 for all). CONCLUSION Women randomized to induction of labor had longer durations in labor and delivery but significantly fewer antepartum visits, tests, and treatments and shorter maternal and neonatal hospital durations after delivery. These results demonstrate that the health outcome advantages associated with induction of labor are gained without incurring uniformly greater health care resource use.
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Karangizi AHK, Chanouzas D, Fenton A, Moss P, Cockwell P, Ferro CJ, Harper L. Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis dependent chronic kidney disease. QJM 2020; 113:253-257. [PMID: 31613364 DOI: 10.1093/qjmed/hcz258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/29/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of early death in patients with chronic kidney disease (CKD). Previous work has described an association between Cytomegalovirus (CMV) seropositivity and CVD amongst patients with dialysis dependent end stage renal disease. Whether CMV seropositivity is associated with CVD in non-dialysis dependent CKD has not been established. AIM Investigate whether past CMV infection is associated with prevalent CVD in patients with non-dialysis dependent CKD. DESIGN A retrospective observational study using the Renal Impairment in Secondary Care cohort, a study evaluating bio-clinical determinants of outcomes in patients with progressive CKD. METHODS We assayed cryopreserved serum samples collected at inception for anti-CMV IgG antibodies from 764 patients with stages 2 to 5 CKD (pre-dialysis) and investigated its relationship with prevalent CVD. RESULTS Median estimated glomerular filtration was 24 ml/min/1.73 m2 (IQR 19-32). Sixty-eight percent of patients were CMV seropositive. CMV seropositivity was associated with older age, non-Caucasian ethnicity, diabetes and higher social deprivation index score. On univariable analysis, CMV seropositivity correlated with higher systolic blood pressure (P = 0.044), prevalent CVD (P < 0.001), ischaemic heart disease (P < 0.001) and cerebrovascular disease (P = 0.022). On multivariable analysis, CMV seropositive patients nearly twice as likely to have CVD compared to seronegative patients [Odds Ratio (OR) = 1.998, CI 1.231-3.242, P = 0.005]. CONCLUSIONS In patients with non-dialysis CKD, CMV seropositivity is independently associated with a higher prevalence of CVD.
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Affiliation(s)
- A H K Karangizi
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - D Chanouzas
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - A Fenton
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - P Moss
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - P Cockwell
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - C J Ferro
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - L Harper
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
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Harper L, Herbst KW, Bagli D, Kaefer M, Beckers GMA, Fossum M, Kalfa N. The battle between fake news and science. J Pediatr Urol 2020; 16:114-115. [PMID: 32094094 DOI: 10.1016/j.jpurol.2019.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/03/2019] [Indexed: 11/18/2022]
Affiliation(s)
- L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - M Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - N Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
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Abstract
Deficits in the ability to encode small differences in contrast between adjacent parts of an image (contrast sensitivity) are well documented in schizophrenic patients. In the present study, we sought to determine whether contrast sensitivity deficits reported in schizophrenic patients are also evident in those who exhibit high schizotypy scores in a typical (i.e., non-schizophrenic) population. Using the O-Life Questionnaire, we determined the effects of schizotypy on spatial (0.5, 2 and 8 c/deg) and spatiotemporal (0.5 and 8 c/deg at 0.5 and 8 Hz) contrast sensitivity in 73 young (18-26 years), majority female (n = 68) participants. We found differences in contrast sensitivity that were spatial, spatiotemporal and O-Life subscale specific. Spatial contrast sensitivity was significantly lower in high, compared to low schizotypes at low spatial frequencies (0.5 c/deg) in those who scored highly on the Unusual Experiences and Cognitive Disorganisation O-Life subscales. For moving stimuli, individuals with high scores on the Unusual Experiences subscale exhibited lower spatiotemporal contrast sensitivity for 0.5 and 8 c/deg patterns drifting at 8 Hz. Although the effects reported here were relatively small, this is the first report of reduced contrast sensitivity in schizotypy.
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Affiliation(s)
- Lauren Harper
- Department of Neuroscience, Psychology and Behaviour, College of Life Sciences, University of Leicester, Leicester, UK
| | - Emily Spencer
- Department of Neuroscience, Psychology and Behaviour, College of Life Sciences, University of Leicester, Leicester, UK
| | - Colin Davidson
- School of Pharmacy and Biomedical Sciences, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - Claire V Hutchinson
- Department of Neuroscience, Psychology and Behaviour, College of Life Sciences, University of Leicester, Leicester, UK.
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Valbuena GN, Apostolidou S, Roberts R, Barnes J, Alderton W, Harper L, Jacobs I, Menon U, Keun HC. The 14q32 maternally imprinted locus is a major source of longitudinally stable circulating microRNAs as measured by small RNA sequencing. Sci Rep 2019; 9:15787. [PMID: 31673048 PMCID: PMC6823392 DOI: 10.1038/s41598-019-51948-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023] Open
Abstract
Understanding the normal temporal variation of serum molecules is a critical factor for identifying useful candidate biomarkers for the diagnosis and prognosis of chronic disease. Using small RNA sequencing in a longitudinal study of 66 women with no history of cancer, we determined the distribution and dynamics (via intraclass correlation coefficients, ICCs) of the miRNA profile over 3 time points sampled across 2-5 years in the course of the screening trial, UKCTOCS. We were able to define a subset of longitudinally stable miRNAs (ICC >0.75) that were individually discriminating of women who had no cancer over the study period. These miRNAs were dominated by those originating from the C14MC cluster that is subject to maternal imprinting. This assessment was not significantly affected by common confounders such as age, BMI or time to centrifugation nor alternative methods to data normalisation. Our analysis provides important benchmark data supporting the development of miRNA biomarkers for the impact of life-course exposure as well as diagnosis and prognostication of chronic disease.
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Affiliation(s)
- Gabriel N Valbuena
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, W12 0NN, United Kingdom
| | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, Gower Street, London, UK
| | - Rhiannon Roberts
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, Gower Street, London, UK
| | - Julie Barnes
- Abcodia Ltd, PO Box 268, Royston, SG8 1EL, Hertfordshire, UK
| | - Wendy Alderton
- Abcodia Ltd, PO Box 268, Royston, SG8 1EL, Hertfordshire, UK
- Early Detection Programme, Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Lauren Harper
- Cancer Research UK, Angel Building, 407 St John Street, London, UK
| | - Ian Jacobs
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, Gower Street, London, UK
- University of New South Wales, Sydney, New South Wales, Australia
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, Gower Street, London, UK
| | - Hector C Keun
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, W12 0NN, United Kingdom.
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Kaefer M, Castagnetti M, Herbst K, Bagli D, Beckers GMA, Harper L, Kalfa N, Fossum M. Evidence-based medicine III: level of evidence. J Pediatr Urol 2019; 15:407-408. [PMID: 31130505 DOI: 10.1016/j.jpurol.2019.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/17/2022]
Abstract
The present article is the third installment in a five-part series related to evidence-based medicine (EBM) provided by the European Society for Paediatric Urology Research Committee. It will present the different levels of evidence (i.e. systematic review, randomized controlled trial, cohort study) available to clinicians and researchers and describe the strengths of each study type. While EBM provides a valuable construct to aid in medical decision-making, it remains imperative that this information be interpreted and applied in the clinical context with a good dose of common sense.
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Affiliation(s)
- M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - M Castagnetti
- Section of Pediatric Urology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padua, Italy
| | - K Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - N Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - M Fossum
- Division of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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30
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Beckers GMA, Herbst K, Kaefer M, Harper L, Castagnetti M, Bagli D, Kalfa N, Fossum M. Evidence Based Medicine IV: how to find an evidence-based answer to a clinical question? Make a critically appraised topic! J Pediatr Urol 2019; 15:409-411. [PMID: 31266683 DOI: 10.1016/j.jpurol.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 02/04/2023]
Abstract
This manuscript is the fourth in a five part series related to evidence based medicine (EBM) provided by the European society of pediatric urology (ESPU) research committee. It will present a way to come to a quick and critical appraisal of available evidence on a specific topic: a CAT (critically appraised topic). The way how to write a cat is described for interventions to be compared to a control group, and for other, more generalized clinical questions. While systematic reviews provide a throughout overview of all evidence available, a CAT provides a shorter way to come to quick insights based on EBM.
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Affiliation(s)
- G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands.
| | - K Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - M Castagnetti
- Section of Pediatric Urology, University Hospital of Padova, Padua, Italy
| | - D Bagli
- Division of Urology, Department of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - N Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - M Fossum
- Division of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Castagnetti M, Herbst KW, Bagli D, Beckers GMA, Harper L, Kaefer M, Kalfa N, Fossum M. EBM II: How to perform a literature search. J Pediatr Urol 2019; 15:268-269. [PMID: 30956125 DOI: 10.1016/j.jpurol.2019.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 11/30/2022]
Abstract
The present article is a second part related to evidence based medicine (EBM) in a series of five by the European society for paediatric urology (ESPU) research committee. It will present the different databases/search engines available to clinicians and researchers and describe strategies to focus the search to one's particular needs. Indeed, databases/search engines used and search strategy should vary according to the goal of the research. If the aim is to address a clinical problem, the search should allow to identify a small number of most pertinent articles (high specificity); if the search is for research purposes, instead, it should ensure no meaningful articles are overlooked (high sensitivity).
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Affiliation(s)
- M Castagnetti
- Section of Pediatric Urology, University Hospital of Padova, Padua, Italy
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - N Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université, de Montpellier, France
| | - M Fossum
- Division of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Poellabauer E, Angermayr R, Behre U, Zhang P, Harper L, Schmitt HJ, Erber W. Seropersistence and booster response following vaccination with FSME-IMMUN in children, adolescents, and young adults. Vaccine 2019; 37:3241-3250. [PMID: 30928173 DOI: 10.1016/j.vaccine.2019.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/15/2019] [Accepted: 03/16/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Tick-borne encephalitis (TBE) is a viral disease that can have a severe clinical course and considerable long-term morbidity. As no curative treatment exists, vaccination is the primary means of prevention. Long-term antibody seropersistence 2-5 years after the 3-dose primary immunization and 3-10 years after first booster was evaluated, as well as booster responses in children, adolescents and young adults. METHODS Subjects who participated in these phase 4 prospective, open-label follow-up studies received all vaccinations with FSME-IMMUN. After 3-dose primary immunization, subjects were followed for 2-5 years. Overall, 205 out of 358 subjects (57%) received the first booster and 179 of these subjects (87%) enrolled in a further 10-year follow-up. Antibody seropersistence was assessed annually. Subjects with a TBE antibody titer below a pre-specified cut-off at the yearly blood draw received a booster. Seropositivity rates and geometric mean fold rises (GMFRs) were assessed. RESULTS In children who received their 3-dose primary immunization between 1 and 15 years of age, the seropositivity rate 5 years after the 3rd dose was 84.9% by NT and 72.0% by ELISA. One month post-first booster, all subjects were seropositive by NT and 98.5% by ELISA. Response to first booster by GMFR ranged from 3.7 to 11.4. At 5 years post-first booster, seropositivity was 99.4% by NT and 97.5% by ELISA, and at 10 years, was 90.3% by NT and 87.7% by ELISA. Although seropositivity rates differed between age groups, all subjects (100%) who received a second booster responded with a robust increase of TBEV antibodies. DISCUSSION Long-lasting seropersistence of TBEV antibodies after the 3-dose primary immunization and first booster was demonstrated as well as a competent immune memory response in those who received a first or second booster at any time during the 15-year follow-up. Therefore, an extension of FSME-IMMUN booster interval up to 10 years after the 3-dose primary immunization seems warranted. ClinicalTrials.gov Identifier: NCT00894686.
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Affiliation(s)
- E Poellabauer
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria
| | | | - U Behre
- Private Practice, Kehl, Germany
| | - P Zhang
- Pfizer Inc., Collegeville, PA, USA
| | - L Harper
- Pfizer Inc., Collegeville, PA, USA
| | | | - W Erber
- Pfizer Inc., Vienna, Austria.
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Hokkanen L, Lettner S, Barbosa F, Constantinou M, Harper L, Kasten E, Mondini S, Persson B, Varako N, Hessen E. Training models and status of clinical neuropsychologists in Europe: Results of a survey on 30 countries. Clin Neuropsychol 2018; 33:32-56. [PMID: 29923448 DOI: 10.1080/13854046.2018.1484169] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aims of the study were to analyze the current European situation of specialist education and training within clinical neuropsychology, and the legal and professional status of clinical neuropsychologists in different European countries. METHOD An online survey was prepared in 2016 by a Task Force established by the European Federation of Psychological Associations, and representatives of 30 countries gave their responses. Response rate was 76%. RESULTS Only three countries were reported to regulate the title of clinical neuropsychologist as well as the education and practice of clinical neuropsychologists by law. The most common university degree required to practice clinical neuropsychology was the master's degree; a doctoral degree was required in two countries. The length of the specialist education after the master's degree varied between 12 and 60 months. In one third of the countries, no commonly agreed upon model for specialist education existed. A more systematic training model and a longer duration of training were associated with independence in the work of clinical neuropsychologists. CONCLUSIONS As legal regulation is mostly absent and training models differ, those actively practicing clinical neuropsychology in Europe have a very heterogeneous educational background and skill level. There is a need for a European standardization of specialist training in clinical neuropsychology. Guiding principles for establishing the common core requirements are presented.
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Affiliation(s)
- Laura Hokkanen
- a Department of Psychology and Logopedics, Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - Sandra Lettner
- b Clinical Neuropsychology Unit , Hospital of the Sisters of Charity , Ried , Austria
| | - Fernando Barbosa
- c Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences , University of Porto , Porto , Portugal
| | | | - Lauren Harper
- e Western Health and Social Care Trust, Rivendell, Tyrone & Fermanagh Hospital , Omagh , UK
| | - Erich Kasten
- f Department of Psychology , MSH University of Applied Sciences & Medical University , Hamburg , Germany
| | - Sara Mondini
- g Department of General Psychology , University of Padova , Padova , Italy
| | - Bengt Persson
- h Department of Psychology , Linnaeus University , Växjö , Sweden
| | - Nataliya Varako
- i Research Center of Neurology, Lomonosov Moscow State University , Moscow , Russia
| | - Erik Hessen
- j Department of Psychology , University of Oslo , Oslo , Norway.,k Department of Neurology , Akershus University Hospital , Oslo , Norway
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Harper L. Re: Urinary tract infection in children: Diagnosis, treatment, imaging - Comparison of current guidelines. J Pediatr Urol 2018; 14:300. [PMID: 29501379 DOI: 10.1016/j.jpurol.2018.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 11/18/2022]
Affiliation(s)
- L Harper
- Department Pediatric Surgery, Hospital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France.
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Angelliaume A, Harper L, Lalioui A, Delgove A, Lefèvre Y. Tailor-made management of thoracic scoliosis with cervical hyperextension in muscular dystrophy. Eur Spine J 2017; 27:264-269. [DOI: 10.1007/s00586-017-5113-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/25/2017] [Indexed: 11/29/2022]
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Conway J, Conroy L, Harper L, Scheifele M, Smith W, Graham T, Phan T, Li H, Olivotto I. PO-0870: DIBH produces a meaningful reduction in lung dose for some women with right-sided breast cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31307-5] [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: 10/19/2022]
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Tóth F, Torrison JL, Harper L, Bussieres D, Wilson ME, Crenshaw TD, Carlson CS. Osteochondrosis prevalence and severity at 12 and 24 weeks of age in commercial pigs with and without organic-complexed trace mineral supplementation. J Anim Sci 2016; 94:3817-3825. [DOI: 10.2527/jas.2015-9950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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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Bouty A, Lefevre Y, Harper L, Dobremez E. Urethral duplication in girls: Three cases associating an accessory epispadiac urethra and a main hypospadiac urethra. J Pediatr Urol 2016; 12:209.e1-5. [PMID: 27267991 DOI: 10.1016/j.jpurol.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/01/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Urethral duplication is extremely rare in girls, with less than 40 cases reported so far. Most of them present as a prepubic sinus. Literature is scare regarding aetiology, classification and management in other forms. This study presents three cases of sagittal urethral duplication in girls presenting a main hypospadiac urethra and an accessory epispadiac urethra. PATIENTS AND METHODS Medical records were retrospectively reviewed of three girls with urethral duplication managed over a 30-year period at a single institution. Circumstances of diagnosis, management and outcomes were analysed. RESULTS The oldest case presented as a neonatal retrovesical mass with an accessory clitoral stream, whereas the two more recent cases presented with antenatal hydrocolpos and bilateral ureterohydronephrosis. Cases 1 and 3 had an incomplete duplication, while Case 2 had a complete form. In Case 3, the duplication was associated with a urogenital sinus and an anteriorly placed anus. Management involved resection of the epispadiac accessory urethra to achieve continence, with dilatation and/or mobilisation of the hypospadiac one. All girls are now aged >5 years old and are continent, and one is old enough to have normal menstruation. Renal function is normal in all. The summary table presents the schematic anatomical description as shown on micturating cystourethrogram and endoscopy, as well as the management for each patient. DISCUSSION Step-by-step management is necessary in urethral duplication. The neonatal emergency is to release the urinary tract compression by evacuating urinary retention or hydrocolpos. Later in infancy, decision has to be taken regarding the urethras. If the resection of the epispadiac accessory urethra seems acceptable to achieve continence, the attitude towards the hypospadiac channel is more controversial and should be individualised. Embryologic and aetiopathogenic pathways are still missing to uniformly characterise the malformation. CONCLUSION Paediatric urologists should remember that there is a wide spectrum of urethral duplication in girls, and that various presentations exist beside the more classic prepubic sinus.
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Affiliation(s)
- A Bouty
- Department of Urology, Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Australia.
| | - Y Lefevre
- Department of Paediatric Surgery, Hôpital Pellegrin enfants-CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - L Harper
- Department of Paediatric Surgery, CHU Saint Denis de La Reunion, Bellepierre, 97400 Saint Denis, France
| | - E Dobremez
- Department of Paediatric Surgery, Hôpital Pellegrin enfants-CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France
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Shabir S, Smith H, Kaul B, Pachnio A, Jham S, Kuravi S, Ball S, Chand S, Moss P, Harper L, Borrows R. Cytomegalovirus-Associated CD4(+) CD28(null) Cells in NKG2D-Dependent Glomerular Endothelial Injury and Kidney Allograft Dysfunction. Am J Transplant 2016; 16:1113-28. [PMID: 26603521 DOI: 10.1111/ajt.13614] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 01/25/2023]
Abstract
Emerging data suggest that expansion of a circulating population of atypical, cytotoxic CD4(+) T cells lacking costimulatory CD28 (CD4(+) CD28(null) cells) is associated with latent cytomegalovirus (CMV) infection. The purpose of the current study was to increase the understanding of the relevance of these cells in 100 unselected kidney transplant recipients followed prospectively for a median of 54 months. Multicolor flow cytometry of peripheral blood mononuclear cells before transplantation and serially posttransplantation was undertaken. CD4(+) CD28(null) cells were found predominantly in CMV-seropositive patients and expanded in the posttransplantation period. These cells were predominantly effector-memory phenotype and expressed markers of endothelial homing (CX3CR1) and cytotoxicity (NKG2D and perforin). Isolated CD4(+) CD27(-) CD28(null) cells proliferated in response to peripheral blood mononuclear cells previously exposed to CMV-derived (but not HLA-derived) antigens and following such priming incubation with glomerular endothelium resulted in signs of endothelial damage and apoptosis (release of fractalkine and von Willebrand factor; increased caspase 3 expression). This effect was mitigated by NKG2D-blocking antibody. Increased CD4(+) CD28(null) cell frequencies were associated with delayed graft function and lower estimated glomerular filtration rate at end follow-up. This study suggests an important role for this atypical cytotoxic CD4(+) CD28(null) cell subset in kidney transplantation and points to strategies that may minimize the impact on clinical outcomes.
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Affiliation(s)
- S Shabir
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - H Smith
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - B Kaul
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK.,School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - A Pachnio
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S Jham
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - S Kuravi
- Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - S Ball
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - S Chand
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - P Moss
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - L Harper
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - R Borrows
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
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Chand S, McKnight AJ, Shabir S, Chan W, McCaughan JA, Maxwell AP, Harper L, Borrows R. Analysis of single nucleotide polymorphisms implicate mTOR signalling in the development of new-onset diabetes after transplantation. BBA Clin 2016; 5:41-5. [PMID: 27051588 PMCID: PMC4802392 DOI: 10.1016/j.bbacli.2015.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/07/2015] [Accepted: 12/17/2015] [Indexed: 12/13/2022]
Abstract
Introduction Despite excellent first year outcomes in kidney transplantation, there remain significant long-term complications related to new-onset diabetes after transplantation (NODAT). The purpose of this study was to validate the findings of previous investigations of candidate gene variants in patients undergoing a protocolised, contemporary immunosuppression regimen, using detailed serial biochemical testing to identify NODAT development. Methods One hundred twelve live and deceased donor renal transplant recipients were prospectively followed-up for NODAT onset, biochemical testing at days 7, 90, and 365 after transplantation. Sixty-eight patients were included after exclusion for non-white ethnicity and pre-transplant diabetes. Literature review to identify candidate gene variants was undertaken as described previously. Results Over 25% of patients developed NODAT. In an adjusted model for age, sex, BMI, and BMI change over 12 months, five out of the studied 37 single nucleotide polymorphisms (SNPs) were significantly associated with NODAT: rs16936667:PRDM14 OR 10.57;95% CI 1.8–63.0;p = 0.01, rs1801282:PPARG OR 8.5; 95% CI 1.4–52.7; p = 0.02, rs8192678:PPARGC1A OR 0.26; 95% CI 0.08–0.91; p = 0.03, rs2144908:HNF4A OR 7.0; 95% CI 1.1–45.0;p = 0.04 and rs2340721:ATF6 OR 0.21; 95%CI 0.04–1.0; p = 0.05. Conclusion This study represents a replication study of candidate SNPs associated with developing NODAT and implicates mTOR as the central regulator via altered insulin sensitivity, pancreatic β cell, and mitochondrial survival and dysfunction as evidenced by the five SNPs. General significance Highlights the importance of careful biochemical phenotyping with oral glucose tolerance tests to diagnose NODAT in reducing time to diagnosis and missed cases. This alters potential genotype:phenotype association. The replication study generates the hypothesis that mTOR signalling pathway may be involved in NODAT development.
Oral glucose tolerance tests reduce time to NODAT diagnosis and missed cases Biochemical testing changes genotype:phenotype association mTOR signalling pathway may be involved in NODAT development
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Key Words
- ATF6, Activated transcription factor
- BMI, Body mass index
- GWAS, Genome-wide association study
- HLA, Human leucocyte antigen
- HNF4, Hepatocyte nuclear factor 4
- NODAT, New-onset diabetes after transplantation
- New-onset diabetes after transplantation
- PI3, Phospho-inositide 3-kinase
- PPARGC1α, Peroxisome proliferator-activated receptor gamma co-activator 1 alpha
- PPARy, Peroxisome proliferator-activated receptor gamma
- PRDM14, PR domain zinc protein 14
- SNP, Single nucleotide polymorphism
- mTOR
- mTOR, Mammalian target of rapamycin
- single nucleotide polymorphisms
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Affiliation(s)
- S Chand
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital, Birmingham B15 2WB, United Kingdom; Centre for Translational Inflammation Research, University of Birmingham, Birmingham B15 2WB, United Kingdom
| | - A J McKnight
- Regional Nephrology Unit, Belfast City Hospital, Belfast BT9 7AB, Northern Ireland
| | - S Shabir
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital, Birmingham B15 2WB, United Kingdom; Centre for Translational Inflammation Research, University of Birmingham, Birmingham B15 2WB, United Kingdom
| | - W Chan
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital, Birmingham B15 2WB, United Kingdom
| | - J A McCaughan
- Regional Nephrology Unit, Belfast City Hospital, Belfast BT9 7AB, Northern Ireland
| | - A P Maxwell
- Regional Nephrology Unit, Belfast City Hospital, Belfast BT9 7AB, Northern Ireland
| | - L Harper
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital, Birmingham B15 2WB, United Kingdom; Centre for Translational Inflammation Research, University of Birmingham, Birmingham B15 2WB, United Kingdom
| | - R Borrows
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital, Birmingham B15 2WB, United Kingdom; Centre for Translational Inflammation Research, University of Birmingham, Birmingham B15 2WB, United Kingdom
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Harper L, Choleris E, Ervin K, Fureix C, Reynolds K, Walker M, Mason G. Stereotypic mice are aggressed by their cage-mates, and tend to be poor demonstrators in social learning tasks. Anim Welf 2015. [DOI: 10.7120/09627286.24.4.463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Farrer K, Lal S, Teubner A, Harper L, Abraham A, Myers A, Carlson G. Fistuloclysis and distal enteral feeding in acute intestinal failure. Clin Nutr ESPEN 2015; 10:e189. [DOI: 10.1016/j.clnesp.2015.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shabir S, Girdlestone J, Briggs D, Kaul B, Smith H, Daga S, Chand S, Jham S, Navarrete C, Harper L, Ball S, Borrows R. Transitional B lymphocytes are associated with protection from kidney allograft rejection: a prospective study. Am J Transplant 2015; 15:1384-91. [PMID: 25808898 DOI: 10.1111/ajt.13122] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [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: 06/18/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 01/25/2023]
Abstract
Recent cross-sectional studies suggest an important role for transitional B lymphocytes (CD19 + CD24hiCD38hi) in promoting transplant tolerance, and protecting from late antibody-mediated rejection (ABMR). However, prospective studies are lacking. This study enrolled 73 de novo transplant recipients, and collected serial clinical, immunological and biochemical information over 48 ± 6 months. Cell phenotyping was conducted immediately prior to transplantation, and then on five occasions during the first year posttransplantation. When modeled as a time-dependent covariate, transitional B cell frequencies (but not total B cells or "regulatory" T cells) were associated with protection from acute rejection (any Banff grade; HR: 0.60; 95% CI: 0.37-0.95; p = 0.03). No association between transitional B cell proportions and either de novo donor-specific or nondonor-specific antibody (dnDSA; dnNDSA) formation was evident, although preserved transitional B cell proportions were associated with reduced rejection rates in those patients developing dnDSA. Three episodes of ABMR occurred, all in the context of nonadherence, and all associated with in vitro anti-HLA T cell responses in an ELISPOT assay (p = 0.008 versus antibody-positive patients not experiencing ABMR). This prospective study supports the potential relevance of transitional ("regulatory") B cells as a biomarker and therapeutic intervention in transplantation, and highlights relationships between humoral immunity, cellular immunity and nonadherence.
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Affiliation(s)
- S Shabir
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, UK; Centre for Translational Inflammation Research, University of Birmingham, UK
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Wong L, Harper L, Little MA. Getting the balance right: adverse events of therapy in anti-neutrophil cytoplasm antibody vasculitis. Nephrol Dial Transplant 2015; 30 Suppl 1:i164-70. [DOI: 10.1093/ndt/gfu406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Slattery C, Beck J, Harper L, Adamson G, Abdi Z, Uphill J, Campbell T, Druyeh R, Mahoney C, Rohrer J, Kenny J, Lowe J, Leung K, Barnes J, Clegg S, Blair M, Nicholas J, Guerreiro R, Rowe J, Ponto C, Zerr I, Kretzschmar H, Gambetti P, Crutch S, Warren J, Rossor M, Fox N, Collinge J, Schott J, Mead S. TREM2 VARIANTS INCREASE RISK OF TYPICAL EARLY-ONSET ALZHEIMER'S DISEASE BUT NOT OF PRION OR FRONTOTEMPORAL DEMENTIA. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-308883.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jayne D, Bruchfeld A, Schaier M, Ciechanowski K, Harper L, Jadoul M, Segelmark M, Selga D, Szombati I, Venning M, Hugo C, Van Daele P, Viklicky O, Potarca A, Schall T, Bekker P. OP0227 Oral C5a Receptor Antagonist CCX168 Phase 2 Clinical TRIAL in Anca-Associated Renal Vasculitis:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jayne DRW, Bruchfeld A, Schaier M, Ciechanowski K, Harper L, Jadoul M, Segelmark M, Selga D, Szombati I, Venning M, Hamilton P, Hugo C, Van Daele PLA, Viklicky O, Potarca A, Schall TJ, Bekker P, Loirat C, Legendre CM, Ogawa M, Bedrosian CL, Kincaid JF, Fakhouri F, Guillevin L, Karras A, Pagnoux C, Carron PL, Quemeneur T, Gobert P, Daugas E, Mouthon L, Whatmough S, Fernandez S, Sweeney N, Dhaygude A, Rathi M, Goyal A, Gupta PK, Jaryal A, Sharma A, Jha V, Ramachandran R, Kumar V, Kohli HS, Gupta KL, Sakhuja V. GLOMERULONEPHRITIDES. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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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Martin M, Vanichseni S, Suntharasamai P, Sangkum U, Mock PA, Gvetadze RJ, Curlin ME, Leethochawalit M, Chiamwongpaet S, Cherdtrakulkiat T, Anekvorapong R, Leelawiwat W, Chantharojwong N, McNicholl JM, Paxton LA, Kittimunkong S, Choopanya K, Choopanya K, Na Ayudhya SS, Chiamwongpaet S, Kaewnil K, Kitisin P, Kukavejworakit M, Leethochawalit M, Natrujirote P, Simakajorn S, Subhachaturas W, Vanichseni S, Prasittipol B, Sangkum U, Suntharasamai P, Anekvorapong R, Khoomphong C, Koocharoenprasit S, Manomaipiboon P, Manotham S, Saicheua P, Smutraprapoot P, Sonthikaew S, Srisuwanvilai LO, Tanariyakul S, Thongsari M, Wattana W, Yongvanitjit K, Angwandee S, Kittimunkong S, Aueaksorn W, Chaipung B, Chantharojwong N, Chaowanachan T, Cherdtrakulkiat T, Chonwattana W, Chuachoowong R, Curlin M, Disprayoon P, Kamkong K, Kittinunvorakoon C, Leelawiwat W, Linkins R, Martin M, McNicholl J, Mock P, Na-Pompet S, Plipat T, Sa-nguansat A, Sittidech P, Tararut P, Thongtew R, Worrajittanon D, Utenpitak C, Warapornmongkholkul A, Wasinrapee P, Brannon J, Brown M, Gvetadze R, Harper L, Paxton L, Rose C, Hendrix C, Marzinke M. Renal Function of Participants in the Bangkok Tenofovir Study--Thailand, 2005-2012. Clin Infect Dis 2014; 59:716-24. [DOI: 10.1093/cid/ciu355] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DRW, Flossmann O, McLaren J, Kumar V, Erwig LP, Reid DM, Macfarlane GJ, Jones GT. Markers for work disability in anti-neutrophil cytoplasmic antibody-associated vasculitis. Rheumatology (Oxford) 2014; 53:953-6. [DOI: 10.1093/rheumatology/ket483] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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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Harper L, Bourquard D, Grosos C, Abbo O, Ferdynus C, Michel JL, Dunand O, Sauvat F. Cortical transit time as a predictive marker of the need for surgery in children with pelvi-ureteric junction stenosis: preliminary study. J Pediatr Urol 2013; 9:1054-8. [PMID: 23602207 DOI: 10.1016/j.jpurol.2013.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 03/07/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Postnatal management of prenatally detected hydronephrosis remains controversial. It has been suggested that cortical transit time (CTT) could successfully predict deterioration in children with pelvi-ureteric junction (PUJ) obstruction. We decided to conduct a retrospective study in our hydronephrosis population to evaluate whether initial CTT was significantly correlated with the need for surgery. PATIENTS AND METHOD We reviewed the charts of all our patients managed for significant PUJ obstruction (>12 mm) between 2007 and 2010 and determined CTT retrospectively, on the first diuretic scan of each of these patients. We then determined the relationship between initial CTT and the need for surgery. RESULTS We identified 37 patients with hydronephrosis (pelvic size >12 mm) of which 26 were diagnosed prenatally. Out of 22 patients with an initial abnormal CTT, 20 underwent surgery. Out of 15 children with a normal initial CTT, 4 underwent surgery (OR 27.5 (IC95%: 4.3-174.9)). CONCLUSION Initial CTT could be a reliable prognostic factor for future evolution of renal function in children with hydronephrosis. CTT is easy to determine on diuretic renal scan. A prospective trial is being devised to confirm what role it could have in the management of children with hydronephrosis.
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Affiliation(s)
- L Harper
- Department of Pediatric Surgery, CHU F Guyon, Bellepierre, Saint-Denis de La Réunion, Reunion Island, France.
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