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Pereira GV, Boudaud M, Wolter M, Alexander C, De Sciscio A, Grant ET, Trindade BC, Pudlo NA, Singh S, Campbell A, Shan M, Zhang L, Yang Q, Willieme S, Kim K, Denike-Duval T, Fuentes J, Bleich A, Schmidt TM, Kennedy L, Lyssiotis CA, Chen GY, Eaton KA, Desai MS, Martens EC. Opposing diet, microbiome, and metabolite mechanisms regulate inflammatory bowel disease in a genetically susceptible host. Cell Host Microbe 2024; 32:527-542.e9. [PMID: 38513656 DOI: 10.1016/j.chom.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/18/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
Inflammatory bowel diseases (IBDs) are chronic conditions characterized by periods of spontaneous intestinal inflammation and are increasing in industrialized populations. Combined with host genetics, diet and gut bacteria are thought to contribute prominently to IBDs, but mechanisms are still emerging. In mice lacking the IBD-associated cytokine, interleukin-10, we show that a fiber-deprived gut microbiota promotes the deterioration of colonic mucus, leading to lethal colitis. Inflammation starts with the expansion of natural killer cells and altered immunoglobulin-A coating of some bacteria. Lethal colitis is then driven by Th1 immune responses to increased activities of mucin-degrading bacteria that cause inflammation first in regions with thinner mucus. A fiber-free exclusive enteral nutrition diet also induces mucus erosion but inhibits inflammation by simultaneously increasing an anti-inflammatory bacterial metabolite, isobutyrate. Our findings underscore the importance of focusing on microbial functions-not taxa-contributing to IBDs and that some diet-mediated functions can oppose those that promote disease.
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Affiliation(s)
| | - Marie Boudaud
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg
| | - Mathis Wolter
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Celeste Alexander
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alessandro De Sciscio
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg
| | - Erica T Grant
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | | | - Nicholas A Pudlo
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Shaleni Singh
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Austin Campbell
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mengrou Shan
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Li Zhang
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Qinnan Yang
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stéphanie Willieme
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg
| | - Kwi Kim
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Trisha Denike-Duval
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jaime Fuentes
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - André Bleich
- Institute for Laboratory Animal Science, Hanover Medical School, Hanover, Germany
| | - Thomas M Schmidt
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI, USA
| | - Lucy Kennedy
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Costas A Lyssiotis
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Grace Y Chen
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kathryn A Eaton
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mahesh S Desai
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg; Odense Research Center for Anaphylaxis, Department of Dermatology and Allergy Center, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
| | - Eric C Martens
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA.
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Duff C, Kennedy L, Ryan E, James J, Binchy A, O'Donovan D. Introducing LISA: Less Invasive Surfactant Administration. Ir Med J 2023; 116:854. [PMID: 37874313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
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Hunter CL, Yang P, Renner DM, Kennedy L. Effects of Isoflurane Anesthesia on C57BL/6J Pups after Cervical Dislocation of Dams. J Am Assoc Lab Anim Sci 2023; 62:449-452. [PMID: 37751963 PMCID: PMC10597329 DOI: 10.30802/aalas-jaalas-23-000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/20/2023] [Accepted: 05/26/2023] [Indexed: 09/28/2023]
Abstract
Inhalant anesthesia is routinely used for cesarian section in many animal species, allowing the safe delivery of neonates and smooth recovery of dams. However, in mice, inhalant anesthesia in cesarean section may be avoided due to fear of negative health effects on retrieved pups. This study compared the effects of isoflurane anesthesia on pups after cervical dislocation of conscious and anesthetized dams. Time-mated C57BL/6J dams were either anesthetized with 5% isoflurane or were conscious during cervical dislocation. Rederived pups were fostered to Swiss Webster dams and weaned at 21 d. Weights of litters were recorded at birth, and individual pup weights were recorded at weaning. We found no significant difference between the two treatment groups in pup survival until weaning. We also found no significant difference when comparing the average weaning weights of all the male pups to that of all the female. Female pups from isoflurane-treated dams had significantly higher weaning weights than did those from unanesthetized dams; however, the weights of male pups from the two groups were not different at weaning. This study found no immediate negative effects of using isoflurane anesthesia prior to cervical dislocation of C57BL/6J pregnant dams for the purpose of rederivation. Isoflurane can be used for cervical dislocation of pregnant C57BL/6J dams without affecting pup survival.
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Affiliation(s)
- Courtney L Hunter
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Peggy Yang
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Deanna M Renner
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lucy Kennedy
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
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Pereira GV, Boudaud M, Wolter M, Alexander C, De Sciscio A, Grant ET, Trindade BC, Pudlo NA, Singh S, Campbell A, Shan M, Zhang L, Willieme S, Kim K, Denike-Duval T, Bleich A, Schmidt TM, Kennedy L, Lyssiotis CA, Chen GY, Eaton KA, Desai MS, Martens EC. Unravelling specific diet and gut microbial contributions to inflammatory bowel disease. Res Sq 2023:rs.3.rs-2518251. [PMID: 36993463 PMCID: PMC10055531 DOI: 10.21203/rs.3.rs-2518251/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic condition characterized by periods of spontaneous intestinal inflammation and is increasing in industrialized populations. Combined with host genetic predisposition, diet and gut bacteria are thought to be prominent features contributing to IBD, but little is known about the precise mechanisms involved. Here, we show that low dietary fiber promotes bacterial erosion of protective colonic mucus, leading to lethal colitis in mice lacking the IBD-associated cytokine, interleukin-10. Diet-induced inflammation is driven by mucin-degrading bacteria-mediated Th1 immune responses and is preceded by expansion of natural killer T cells and reduced immunoglobulin A coating of some bacteria. Surprisingly, an exclusive enteral nutrition diet, also lacking dietary fiber, reduced disease by increasing bacterial production of isobutyrate, which is dependent on the presence of a specific bacterial species, Eubacterium rectale. Our results illuminate a mechanistic framework using gnotobiotic mice to unravel the complex web of diet, host and microbial factors that influence IBD.
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Affiliation(s)
| | - Marie Boudaud
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg
| | - Mathis Wolter
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Celeste Alexander
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Alessandro De Sciscio
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg
| | - Erica. T. Grant
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | | | - Nicholas A. Pudlo
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shaleni Singh
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Austin Campbell
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mengrou Shan
- Dept. of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Dept. of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Li Zhang
- Dept. of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Dept. of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Stéphanie Willieme
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg
| | - Kwi Kim
- Dept. of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Trisha Denike-Duval
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - André Bleich
- Institute for Laboratory Animal Science, Hanover Medical School, Hanover, Germany
| | - Thomas M. Schmidt
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Dept. of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Dept. of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lucy Kennedy
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Costas A. Lyssiotis
- Dept. of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Dept. of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Grace Y. Chen
- Dept. of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathryn A. Eaton
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mahesh S. Desai
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, Department of Dermatology and Allergy Center, Odense University Hospital, University of Southern Denmark, 5000 Odense, Denmark
| | - Eric C. Martens
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Robinson AV, Kennedy L, Roper T, Khan M, Jaunoo S. The management of chyle leak post-oesophagectomy for oesophageal carcinoma: a systematic review. Ann R Coll Surg Engl 2022; 104:480-489. [PMID: 34860128 PMCID: PMC9246555 DOI: 10.1308/rcsann.2021.0199] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Chyle leak is an uncommon yet potentially fatal complication of oesophagectomy for oesophageal cancer. The management of chyle leak is a debated, controversial topic and to date there is no standardised approach or validated algorithm for its management. This review aims to summarise current treatment algorithms for chyle leak post-oesophagectomy and their outcomes. METHODS A systematic search of Embase, MEDLINE, UpToDate and Cochrane was conducted to identify studies reporting on the management of chyle leak following oesophagectomy for oesophageal cancer. Data on interventional success rate and mortality are reported. FINDINGS Twenty-one studies met the inclusion criteria including over 23,254 oesophagectomies and identifying 838 chyle leaks (incidence <3.6%). The majority of cases were initially managed conservatively (95.3%), with a failure rate of 50.4%. Immediate surgical or radiological management resolved chylothorax in the majority of cases (97.3%), however the numbers were small. Death occurred in 54 cases (6.6%), all of whom underwent conservative management initially. CONCLUSIONS Owing to the heterogeneity of treatment algorithms, timings and indications for interventions, the optimal strategy for managing chyle leak remains unclear. This review has identified an unmet need for prospective multicentre studies assessing the efficacy of predefined algorithms.
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Affiliation(s)
- AV Robinson
- University Hospitals Sussex NHS Foundation Trust, UK
| | - L Kennedy
- University Hospitals Sussex NHS Foundation Trust, UK
| | - T Roper
- University Hospitals Sussex NHS Foundation Trust, UK
| | - M Khan
- University Hospitals Sussex NHS Foundation Trust, UK
| | - S Jaunoo
- University Hospitals Sussex NHS Foundation Trust, UK
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Chan G, Si C, Nichols MR, Kennedy L. Assessment of the Safety and Efficacy of Pre-emptive Use of Extended-release Buprenorphine for Mouse Laparotomy. J Am Assoc Lab Anim Sci 2022; 61:381-387. [PMID: 35803705 PMCID: PMC9674008 DOI: 10.30802/aalas-jaalas-22-000021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Buprenorphine is commonly used to control postoperative pain in rodents. Short-acting formulations of buprenorphine (bup-HCl) require frequent handling and restraint of animals for appropriate dosing, which can be stressful and confound research outcomes. Ethiqa XR (bup-ER) is an FDA-indexed extended-release buprenorphine formulation that is an alternative to bup-HCl in mice and rats. In the current study, we first evaluated the pharmacokinetics of bup-ER in male C57BL/6J mice by sampling blood at 10 time points, ranging from 30 min to 72 h after administration (n = 3 mice per time point). Average plasma concentrations fell below therapeutic levels at 48 h after administration. We also evaluated the safety of bup-ER when administered prior to surgery in combination with common anesthetics and the efficacy of bup-ER in mouse laparotomy. Anesthetic safety was studied by measuring respiratory rate, rectal temperature, and recovery time in groups of mice (n = 8) given bup-HCl, bup-ER, or saline in combination with isoflurane or ketamine-xylazine anesthesia. No differences were seen between analgesic treatment groups with either of the general anesthetics. To evaluate efficacy, mice (n = 10) were randomly allocated to receive either bup-ER (3.25 mg/kg) once presurgically, bup-HCl (0.1 mg/kg) presurgically and then every 8 h, or saline once before surgery. Mice underwent a sham laparotomy and were assessed for pain based on changes in weight, cageside ethogram, nesting consolidation test, rearing frequency, and nociception to von Frey testing at 6, 12, 24, 48, and 72 h after surgery. Cageside ethogram, rearing frequency, and von Frey testing showed significant differences between bup-ER-treated mice and saline controls in the early postoperative period. No significant effects between treatment groups were seen in daily weights or nesting consolidation scores. This study demonstrates that bup-ER can be safely administered before surgery and provides analgesia for up to 48 h after administration based on pharmacokinetic and behavioral data.
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Affiliation(s)
- Goldia Chan
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan,Corresponding Author.
| | - Catherine Si
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
| | - M Russell Nichols
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lucy Kennedy
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
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7
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Ubels S, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen M, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Koshy R, Nieuwenhuijzen G, Polat F, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C, Matthée E, Slootmans CAM, Ultee G, Schouten J, Gisbertz SS, Eshuis WJ, Kalff MC, Feenstra ML, van der Peet DL, Stam WT, van Etten B, Poelmann F, Vuurberg N, van den Berg JW, Martijnse IS, Matthijsen RM, Luyer M, Curvers W, Nieuwenhuijzen T, Taselaar AE, Kouwenhoven EA, Lubbers M, Sosef M, Lecot F, Geraedts TCM, van Esser S, Dekker JWT, van den Wildenberg F, Kelder W, Lubbers M, Baas PC, de Haas JWA, Hartgrink HH, Bahadoer RR, van Sandick JW, Hartemink KJ, Veenhof X, Stockmann H, Gorgec B, Weeder P, Wiezer MJ, Genders CMS, Belt E, Blomberg B, van Duijvendijk P, Claassen L, Reetz D, Steenvoorde P, Mastboom W, Klein Ganseij HJ, van Dalsen AD, Joldersma A, Zwakman M, Groenendijk RPR, Montazeri M, Mercer S, Knight B, van Boxel G, McGregor RJ, Skipworth RJE, Frattini C, Bradley A, Nilsson M, Hayami M, Huang B, Bundred J, Evans R, Grimminger PP, van der Sluis PC, Eren U, Saunders J, Theophilidou E, Khanzada Z, Elliott JA, Ponten J, King S, Reynolds JV, Sgromo B, Akbari K, Shalaby S, Gutschow CA, Schmidt H, Vetter D, Moorthy K, Ibrahim MAH, Christodoulidis G, Räsänen JV, Kauppi J, Söderström H, Manatakis DK, Korkolis DP, Balalis D, Rompu A, Alkhaffaf B, Alasmar M, Arebi M, Piessen G, Nuytens F, Degisors S, Ahmed A, Boddy A, Gandhi S, Fashina O, Van Daele E, Pattyn P, Robb WB, Arumugasamy M, Al Azzawi M, Whooley J, Colak E, Aybar E, Sari AC, Uyanik MS, Ciftci AB, Sayyed R, Ayub B, Murtaza G, Saeed A, Ramesh P, Charalabopoulos A, Liakakos T, Schizas D, Baili E, Kapelouzou A, Valmasoni M, Pierobon ES, Capovilla G, Merigliano S, Silviu C, Rodica B, Florin A, Cristian Gelu R, Petre H, Guevara Castro R, Salcedo AF, Negoi I, Negoita VM, Ciubotaru C, Stoica B, Hostiuc S, Colucci N, Mönig SP, Wassmer CH, Meyer J, Takeda FR, Aissar Sallum RA, Ribeiro U, Cecconello I, Toledo E, Trugeda MS, Fernández MJ, Gil C, Castanedo S, Isik A, Kurnaz E, Videira JF, Peyroteo M, Canotilho R, Weindelmayer J, Giacopuzzi S, De Pasqual CA, Bruna M, Mingol F, Vaque J, Pérez C, Phillips AW, Chmelo J, Brown J, Han LE, Gossage JA, Davies AR, Baker CR, Kelly M, Saad M, Bernardi D, Bonavina L, Asti E, Riva C, Scaramuzzo R, Elhadi M, Abdelkarem Ahmed H, Elhadi A, Elnagar FA, Msherghi AAA, Wills V, Campbell C, Perez Cerdeira M, Whiting S, Merrett N, Das A, Apostolou C, Lorenzo A, Sousa F, Adelino Barbosa J, Devezas V, Barbosa E, Fernandes C, Smith G, Li EY, Bhimani N, Chan P, Kotecha K, Hii MW, Ward SM, Johnson M, Read M, Chong L, Hollands MJ, Allaway M, Richardson A, Johnston E, Chen AZL, Kanhere H, Prasad S, McQuillan P, Surman T, Trochsler MI, Schofield WA, Ahmed SK, Reid JL, Harris MC, Gananadha S, Farrant J, Rodrigues N, Fergusson J, Hindmarsh A, Afzal Z, Safranek P, Sujendran V, Rooney S, Loureiro C, Leturio Fernández S, Díez del Val I, Jaunoo S, Kennedy L, Hussain A, Theodorou D, Triantafyllou T, Theodoropoulos C, Palyvou T, Elhadi M, Abdullah Ben Taher F, Ekheel M, Msherghi AAA. Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background
Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.
Methods
This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.
Results
Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.
Conclusion
The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Centre+ , Maastricht , the Netherlands
| | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT hospital group , Almelo , the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , Birmingham , UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Jan W Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen , Groningen , the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital , Tilburg , the Netherlands
| | - Renol Koshy
- Department of Surgery, Newcastle upon Tyne Hospital NHS Trust , Newcastle upon Tyne , UK
- Department of Surgery, University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Pritam Singh
- Department of Surgery, Nottingham University Hospitals NHS Trust , Nottingham , UK
- Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital , Guildford , UK
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Centre , Rotterdam , the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
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Tierney A, Curran M, Collins L, Kennedy L, McDonnell C, Jurascheck A, Sheikhi A, Walsh C, Button B, Casserly B, Cahalan R. P231 Steps Ahead: optimising physical activity in adults with cystic fibrosis - a pilot randomised trial using wearable technology, goal setting and text message feedback. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00560-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kennedy L, O'Donovan D. Nationwide Survey on High-Flow Nasal Cannula Use in Neonatal Units. Ir Med J 2022; 115:533. [PMID: 35279067] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- L Kennedy
- Department of Neonatology, Galway University Hospital, Galway, Ireland
| | - D O'Donovan
- Department of Neonatology, Galway University Hospital, Galway, Ireland
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Labadzhyan A, Nachtigall LB, Fleseriu M, Gordon MB, Molitch M, Kennedy L, Samson SL, Greenman Y, Biermasz N, Bolanowski M, Haviv A, Ludlam W, Patou G, Strasburger CJ. Correction to: Oral octreotide capsules for the treatment of acromegaly: comparison of 2 phase 3 trial results. Pituitary 2021; 24:954. [PMID: 34347226 PMCID: PMC8550488 DOI: 10.1007/s11102-021-01177-w] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - L B Nachtigall
- MGH Neuroendocrine and Pituitary Center, Chestnut Hill, MA, USA
| | - M Fleseriu
- Pituitary Center, Oregon Health & Sciences University, Portland, OR, USA
| | - M B Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, PA, USA
| | - M Molitch
- Northwestern University, Chicago, IL, USA
| | - L Kennedy
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Y Greenman
- Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - N Biermasz
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - A Haviv
- Chiasma, Inc., Needham, MA, USA
| | - W Ludlam
- Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - G Patou
- Chiasma, Inc., Needham, MA, USA
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Labadzhyan A, Nachtigall LB, Fleseriu M, Gordon MB, Molitch M, Kennedy L, Samson SL, Greenman Y, Biermasz N, Bolanowski M, Haviv A, Ludlam W, Patou G, Strasburger CJ. Oral octreotide capsules for the treatment of acromegaly: comparison of 2 phase 3 trial results. Pituitary 2021; 24:943-953. [PMID: 34173129 PMCID: PMC8550586 DOI: 10.1007/s11102-021-01163-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Results are presented from 2 to 3 trials investigating oral octreotide capsules (OOC) as an alternative to injectable somatostatin receptor ligands (iSRLs) in the treatment of acromegaly. METHODS CH-ACM-01 was an open-label trial (N = 155) and CHIASMA OPTIMAL was a double-blind placebo-controlled (DPC) trial (N = 56), both investigating OOC as maintenance therapy for patients with acromegaly who were biochemical responders receiving iSRLs. RESULTS Baseline characteristics in both trials reflected those expected of patients with acromegaly responding to treatment and were similar between trials, despite differences in inclusion criteria. OOC demonstrated a consistent degree of biochemical response across trials, with 65% of patients in CH-ACM-01 maintaining response during the core period and 64% of patients in CHIASMA OPTIMAL at the end of the DPC. Mean insulin-like growth factor I (IGF-I) levels remained within inclusion criteria at the end of treatment in both trials. Of 110 patients entering the fixed-dose phase in CH-ACM-01, 80% maintained or improved acromegaly symptoms from baseline to the end of treatment. Over 85% of patients in both trials elected to continue into the extension phases. OOC were found to be well tolerated across both trials, and no dose-related adverse events were observed. CONCLUSIONS OOC demonstrated remarkably consistent results for biochemical response, durability of response, and preference to continue with oral treatment across these 2 complementary landmark phase 3 trials, despite differences in the design of each. Trial registration NCT03252353 (August 2017), NCT01412424 (August 2011).
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Affiliation(s)
| | - L B Nachtigall
- MGH Neuroendocrine and Pituitary Center, Chestnut Hill, MA, USA
| | - M Fleseriu
- Pituitary Center, Oregon Health & Sciences University, Portland, OR, USA
| | - M B Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, PA, USA
| | - M Molitch
- Northwestern University, Chicago, IL, USA
| | - L Kennedy
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Y Greenman
- Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - N Biermasz
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - A Haviv
- Chiasma, Inc., Needham, MA, USA
| | - W Ludlam
- Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - G Patou
- Chiasma, Inc., Needham, MA, USA
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12
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Curran M, Tierney AC, Button B, Collins L, Kennedy L, McDonnell C, Casserly B, Cahalan R. The effectiveness of exercise interventions to increase physical activity in Cystic Fibrosis: A systematic review. J Cyst Fibros 2021; 21:272-281. [PMID: 34753671 DOI: 10.1016/j.jcf.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
Physical activity (PA) and exercise have numerous benefits in Cystic Fibrosis (CF) including improved lung function, exercise capacity and quality of life. Despite these benefits, the effectiveness of interventions to promote PA in this population are still largely unknown. The objective of this review was to synthesise existing research and determine whether exercise interventions are effective in promoting PA in people with CF. Using the PRISMA guidelines, a comprehensive search was conducted. Fifteen studies (463 participants) met the inclusion criteria. Eleven studies demonstrated improvements in PA in both short- and long-term interventions. However, the interventions were variable across the included studies, with a large inconsistency in PA assessment tools used. Aerobic training and activity counselling were the two elements identified in this review which most consistently improved PA. Future research should consider larger sample sizes and the use of accurate instruments to assess and track PA levels longitudinally.
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Affiliation(s)
- M Curran
- School of Allied Health, University of Limerick, Limerick, Ireland; University Hospital Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - A C Tierney
- School of Allied Health, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia; Health Implementation Science and Technology Research Group, Health Research Institute, University of Limerick, Limerick, Ireland
| | - B Button
- Departments of Respiratory Medicine and Physiotherapy, The Alfred, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - L Collins
- University Hospital Limerick, Limerick, Ireland
| | - L Kennedy
- University Hospital Limerick, Limerick, Ireland
| | - C McDonnell
- University Hospital Limerick, Limerick, Ireland
| | - B Casserly
- University Hospital Limerick, Limerick, Ireland
| | - R Cahalan
- School of Allied Health, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
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Kennedy L, Van Swearingen AE, Sheng J, Zhang D, Qin X, Lipp ES, Kumar S, Zhang G, Hanks BA, Davies MA, Owzar K, Anders CK, Salama AK. An immunogenomic analysis of melanoma brain metastases (MBM) compared to extracranial metastases (ECM). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9521 Background: Previous work has shown that MBM have a unique molecular profile compared to ECM. Description of the biology of MBM will facilitate the design of rational therapies for patients (pts) with MBM. Methods: We analyzed a previously published dataset from MD Anderson Cancer Center, which includes RNA-seq on surgically resected FFPE MBM (88 tumors from 74 pts) and surgically resected ECM from the same pts (50 from 34 pts). WES on 18 matched pairs of MBM and ECM was available. The STAR pipeline was used to estimate mRNA abundance. The DESeq2 package was used to perform differential gene expression (DGE) analyses. Pathway analysis was performed using Gene Set Enrichment Analysis (GSEA). Paired DGE and GSEA analyses comparing MBM vs. lymph node metastases (LN mets, n = 16) and MBM vs. skin mets (n = 10) were performed. CIBERSORT estimated relative abundance of immune cell types in MBM and ECM. The GATK Mutect2 pipeline was used to call somatic mutations using paired normal tumor samples. Mutations were annotated using the Ensembl Variant Effect Predictor and visualized using the Maftools package in R. RNA-seq was available on 54 primary cutaneous melanoma (CM) pt samples, including 19 CM which did not recur, 19 CM which recurred as MBM, and 16 CM which recurred as ECM. Gene Ontology or KEGG Pathway analysis was performed using goana function of limma package in R. Results: Comparing MBM vs. LN and MBM vs. skin mets, paired DGE identified 136 and 89 up-regulated genes with a fold change > 2 and false-discovery rate (FDR) q-value < 0.05. Moreover, 308 and 659 down-regulated genes with a fold change < 0.5 were identified in MBM vs. LN and MBM vs. skin mets, respectively (q < 0.05). Paired GSEA found that autophagy signaling pathways may be up-regulated in MBM vs. LN and MBM vs. skin mets. On a single-gene level, comparing both MBM vs. LN and skin mets, the most strongly up-regulated genes in autophagy pathways were GFAP and HBB, whereas fold changes in the majority of other autophagy-related genes were low and did not reach significance. Comparison between CM which recurred in brain vs. CM which did not recur identified up-regulation of autophagy pathways. No difference in autophagy pathway expression was observed comparing between CM with any recurrence vs. without recurrence. CIBERSORT identified an increased proportion of immune suppressive M2 macrophages compared to tumor suppressive M1 macrophages in both MBMs and ECMs. Conclusions: Up-regulation of autophagy pathways was observed in pt-matched MBM vs. LN and skin mets. This finding seemed to be driven by up-regulation of GFAP and HBB, which could reflect changes in the tumor microenvironment (TME). Future studies using single-cell RNA-seq or spatial transcriptomic technology will dissect the TME. A higher M2:M1 ratio may contribute to an immune suppressive tumor microenvironment in MBM and ECM and is targetable. Validation of our findings in an independent Duke dataset is ongoing.
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Affiliation(s)
| | | | - Jeff Sheng
- Duke University Medical Center, Durham, NC
| | | | - Xiaodi Qin
- Duke University Medical Center, Durham, NC
| | | | | | - Gao Zhang
- Duke University Medical Center, Durham, NC
| | | | | | | | - Carey K. Anders
- Duke University Medical Center, Duke Cancer Institute, Durham, NC
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Curran M, Tierney A, Collins L, Kennedy L, McDonnell C, Jurascheck A, Sheikhi A, Button B, Casserly B, Cahalan R. P198 Physical activity is associated with aerobic capacity and lung function in adults with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01223-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Curran M, Tierney A, Collins L, Kennedy L, McDonnell C, Button B, Casserly B, Cahalan R. P201 The effectiveness of exercise interventions to increase physical activity in cystic fibrosis: a systematic review. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01226-1] [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: 10/21/2022]
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Kennedy L, Nicholson T, MacDonald B, Jago E, Mah C. Healthy Eating Policy for a provincial health authority in Atlantic Canada. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Issue
Poor diets, the global leading cause of death and disability, are influenced by individual and community factors. Community health care settings have the potential to shape dietary behavior through food and beverage environments, and a healthy eating culture that supports the healthier choice as the easier choice.
Description of the Problem
The Nova Scotia Health Authority (NSHA) is a provincial government health authority in Atlantic Canada, responsible for delivering services to nearly 1 million people in 10 hospitals, 8 ERs, and 135 community locations. The NSHA employs over 23,400 health workers. In 2015, the NSHA centralized its governance, merging 9 regional health districts into one. Policies and procedures were re-written with a provincial focus, including a new Healthy Eating Policy (HEP) adopted in 2018. In this paper, we discuss the implementation of the HEP as a case study for how healthy eating can be fostered through continuous quality improvement.
Results
The policy upholds NSHA as a community leader working collaboratively with internal and external partners. To be a credible leader in changing the landscape around healthy eating, NSHA agrees to “walk the talk” and model an evidence-based healthy eating policy. A hospital in Halifax piloted pricing, placement and promotion interventions to further support healthier eating. These have been expanded to other sites across NS.
Lessons
1) Internal Capacity Building - A Healthy Eating Steering Committee promotes healthy eating across the health system, including initiatives in partnership with auxiliaries, foundations and staff. 2) Improving Evaluation Infrastructure- The interventions led to strategic thinking of future point of sale systems and ways to improve data collection for evaluation 3) Academic Partnerships - NSHA and Dalhousie University formed a collaborative partnership to strengthen evaluation capacity making use of the latest evidence and methods from food environments research.
Key messages
The Nova Scotia Health Authority’s Health Eating Policy supports healthy eating across the province, and promotes supportive environments where the healthier choice is the easier choice. A hospital site in Halifax, NS, implemented a variety of pricing, placement and promotion interventions to promote a healthy workplace environment for employees and community members.
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Affiliation(s)
- L Kennedy
- School of Health Administration, Dalhousie University, Halifax, Canada
- Food & Nutrition Services, Nova Scotia Health Authority, Halifax, Canada
| | - T Nicholson
- Food & Nutrition Services, Nova Scotia Health Authority, Halifax, Canada
| | - B MacDonald
- Food & Nutrition Services, Nova Scotia Health Authority, Halifax, Canada
| | - E Jago
- School of Health Administration, Dalhousie University, Halifax, Canada
| | - C Mah
- School of Health Administration, Dalhousie University, Halifax, Canada
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Curran M, Tierney A, Collins L, Kennedy L, McDonnell C, Sheikhi A, Walsh C, Casserly B, Cahalan R. ePS3.10 Reliability and validity of the ActivPAL and Fitbit Charge 2 as a measure of step count in cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30268-1] [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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18
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Brosnahan CL, Munday JS, Davie PS, Kennedy L, Preece M, Barnes S, Jones JB, McDonald WL. Pathogenicity of the bacterium New Zealand rickettsia-like organism (NZ-RLO2) in Chinook salmon Oncorhynchus tshawytscha smolt. Dis Aquat Organ 2019; 134:175-187. [PMID: 31120035 DOI: 10.3354/dao03364] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Farmed New Zealand Chinook salmon Oncorhynchus tshawytscha Walbaum have been found to be infected by rickettsia-like organisms (NZ-RLO). While these Gram-negative intra-cellular bacteria are closely related to Piscirickettsia salmonis, a significant pathogen for farmed salmon globally, the pathogenicity of NZ-RLO is unknown. The aim of the present study was to determine if one strain, NZ-RLO2, causes disease in Chinook salmon. Post-smolt salmon were inoculated with NZ-RLO2 by intraperitoneal injection at high, medium and low doses and observed for 30 d. All fish in the high and medium dosed groups died by the end of the study and 63% of the low dose group died within 30 d of inoculation. Necropsy revealed the fish inoculated with NZ-RLO2 had internal multifocal haemorrhages. The most consistent histological finding in fish inoculated with NZ-RLO2 was neutrophilic and necrotizing pancreatitis and steatitis with intra-cytoplasmic organisms often visible within areas of inflammation. Other histological lesions included multifocal hepatic necrosis, haematopoietic cell necrosis and splenic and renal lymphoid depletion. The presence of NZ-RLO2 within the inoculated fish was confirmed by replication in cell culture and qPCR. The results suggest NZ-RLO2 can cause disease in Chinook salmon and therefore could be a significant pathogen in farmed Chinook salmon.
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Affiliation(s)
- C L Brosnahan
- Animal Health Laboratory, Ministry for Primary Industries, Ward Street, Wallaceville, Upper Hutt, 5018, New Zealand
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Valaitis R, Markle-Reid M, Ploeg J, Butt M, Ganann R, Bookey-Bassett S, Kennedy L, Murray N. “IT’S NOT A JOB YOU APPLY FOR”: A MIXED-METHOD EVALUATION OF THE ‘HEALTH LINKS’ CAREGIVER EXPERIENCE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | - L Kennedy
- Aging, Community and Health Research Unit
| | - N Murray
- School of Nursing, McMaster University
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20
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Kennedy L, Bejarano S, Larochelle E, Tsongalis G. An Organized Approach to Multi-Organ Screening in Rural Honduras. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.31100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Poverty, poor healthcare infrastructure and geographic location contribute to a total lack of cancer screening for most residents of rural Honduras. Three projects built upon each other to develop, with local leaders, multiorgan screening events that mitigated barriers to screening-based early detection of cancers. Targeted barriers included transportation, cost, community perception and convenience. Aim: To test a novel system of multiorgan screening for feasibility, acceptability and effectiveness. Methods: Leveraging well-known brigade-style medical outreach methods, two large-scale weekend programs for women and one for men over four years in the same rural location screened women for cancers of the cervix, breast, oral cavity, thyroid; and men for cancers of the testes, oral cavity, skin, prostate and colon; and connected participants with follow-up care at a Honduran cancer center. Screening methods ranged from simple throat palpation for thyroid lesions to molecular screening for high risk HPV. Generally, screening began with low-tech methods onsite to triage the participants and identify those at high-risk for cancer who should have more technical follow-up at an equipped clinic. Well-trained Honduran medical students provided screening capacity and community leaders were solely responsible for promoting the screening opportunities. Masking was not possible onsite, but data analysis in the U.S. was anonymized. Results: Participants were accrued to each program's capacity (n=400) in 2013 and 2016 and near capacity in 2017 with high levels of participants completing the screening programs, community engagement with the process, and compliance with referrals for clinical follow-up at a collaborating cancer center located three hours away. Participants identified at the screenings for clinical follow-up included for women: breast 2.7% (2013) and 4.2% (2016), thyroid 1.7% (2016), cervix/positive for high risk HPV 8.2% (2013) and 11.8% (2016); and for men all in 2017: skin 0%, testes 7%, colorectal 1%, oropharynx 1 participant, and prostate 6.7%. The dominant local narrative predicted men would not participate in screening, yet 326 participated and of that group, 239 self-identified as having possible colorectal symptoms based on seeing an advertising flyer with questions about symptoms of constipation, bloody stools, or unintended weight loss. That self-identified subset took the initiative to see the local nurse in advance, obtain a colorectal sample kit, collect three days of stool samples, and bring them to the screening event. Conclusion: With community engagement and attention to planning for organized and rapid throughput, large-scale multiorgan cancer screening may be feasible in low-income rural communities. Funding: The Jornada studies were funded by Norris Cotton Cancer Center at Dartmouth's Geisel School of Medicine and a special grant from Geisel's Munck-Pfefferkorn Fund.
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Affiliation(s)
- L. Kennedy
- Norris Cotton Cancer Center at Dartmouth, Lebanon, NH
| | - S. Bejarano
- Norris Cotton Cancer Center at Dartmouth, Lebanon, NH
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21
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Turner S, Studwell C, Deharvengt S, Lyons K, Plata J, LaRochelle E, Zapata A, Kennedy L, Bejarano S. High-Risk HPV Genotypes Identified in Northern Honduras: Evidence for Prevention. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.85200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Cervical cancer is one of the most prevalent cancers in Honduran women. Lacking national or population-based registries, we rely on hospital registries to establish incidence: San Felipe General Hospital in 2012 diagnosed 38% of 998 women and The League against Cancer Hospital (LCC) in 2016 diagnosed 54.4% of 695 women with cervical cancer CC. According to PAHO's Honduras Profile 2013, screening coverage with Pap was 48.1%. Bruni in 2010 reported a prevalence of high risk HPV (hrHPV) infection for Central America of 13%, identifying genotypes 16, 18, 52, 31 and 58 as most frequent. Information about pathogenesis of hrHPV to induce cervical lesions is based on models of genotypes 16 and 18 only. Aim: Inform evidence of hrHPV genotypes collected in Honduras from an urban and a rural population, generate discussion and subsequent improvement of cervical cancer control strategies in our country. Methods: In 2016, 2 clinical studies funded by Norris Cotton Cancer Center at Dartmouth College and the LCC accrued 913 women: 401 in Locomapa Valley (rural), 111 in La Mosquitia (remote rural), and 401 in a textile factory in San Pedro Sula (urban). Women were consented, to obtain 3 cervical samples, during a cervical cancer screening brigade. One sample for conventional cytology, and 2 for hrHPV by PCR genotyping. One local with our customized PCR device and the second at Dartmouth. An educational component and survey were included. Positive patients identified with hrHPV, pre or invasive cancer were referred to LCC for treatment and follow-up. Results: In Locomapa and the factory (rural and urban sites) 13% of participants were positive for hrHPV. Only 15% had HPV 16. The following common genotypes varied by location: urban factory HPV 59, 12% in rural location HPV 58, 10%; HPV 31, 9%; HPV 39 8%; HPV 35 and 66, 7%; HPV 45 and 51, 6%; HPV 18 and 56, 3%; HPV 33 and 52, 1%. 17% of women had multiple hrHPV coinfection. 7.7% had abnormal Pap tests. In La Mosquitia (remote rural), 24% of women were positive for hrHPV: HPV 52, 29%; HPV 16, 23%; HPV 39, 10%; HPV 68, 6%; HPV 58, 6%; HPV 45, 6%; HPV 51 and HPV 31, 18, 66, 59 and 35, 3% each. 1.8% had abnormal Pap tests; all participants identified with hrHPV were referred for follow-up. The average age was 40.3 years, parity, 3 children, education 6.0 years; and 15% were first-time users of a cervical screening program. Conclusion: Associate the burden of disease, with risk factors, will help us to generate models of prevention and care that are reproducible and effective to reduce morbi-mortality. Brigade-type screening models, with trained providers working at a community location over a single day, can offer improved access for women at risk and facilitate educational activities for health promotion. Introducing tests as hrHPV DNA detection, effectively reduces the volume of women to follow. Strengthening the capacity of primary care with novel screening techniques and ensure diligent follow-up is essential.
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Affiliation(s)
- S. Turner
- Dartmouth Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, Lebanon, NH
| | - C. Studwell
- Dartmouth Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, Lebanon, NH
| | - S. Deharvengt
- Dartmouth Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, Lebanon, NH
| | - K.D. Lyons
- Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - J.A. Plata
- Liga Contra el Cancer - Honduras, Department of Pathology, San Pedro Sula, Honduras
| | - E. LaRochelle
- Dartmouth Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, Lebanon, NH
| | - A.M. Zapata
- Liga Contra el Cancer - Honduras, Programa de Prevención y Educación en Salud y Cáncer PESCA, San Pedro Sula, Honduras
| | - L. Kennedy
- Dartmouth Hitchcock Medical Center, Community Affairs, Lebanon, NH
| | - S. Bejarano
- Liga Contra el Cancer - Honduras, Programa de Prevención y Educación en Salud y Cáncer PESCA, San Pedro Sula, Honduras
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Flynn T, Altamirano CD, García HR, Campos RB, Moya JZ, Larochelle E, Romano M, Cervinski M, Lyons K, Spaller M, Kennedy L, Bejarano S, Tsongalis G, Huyck K. Reducing Dermal Exposure to Agrochemical Carcinogens Using a Fluorescent Dye-Based Intervention Among Subsistence Farmers in Rural Honduras. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.72800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Occupational exposure to agrochemicals, some of which are known or suspected carcinogens, is a major health hazard for subsistence agricultural workers and their families. These impacts are more prevalent in low-and-middle income countries (LMICs) due to weak regulations, lack of awareness of the risks of contamination, general lack of personal protective equipment (PPE), and low literacy about proper agrochemical application techniques. Fluorescent tracer dyes have been described as a means of visualizing and quantifying dermal exposure to agricultural chemicals, and dye techniques adapted for LMICs have been developed previously. These tracer dyes have also been used in educational demonstrations about pesticide safety. However, studies evaluating the efficacy of these educational dye interventions in reducing exposure have been lacking. Aim: To evaluate whether observing one's own chemical contamination after applying agrochemicals changed the amount of occupational dermal exposure during a subsequent chemical application. Methods: We used a multimodal community intervention in a rural village in Honduras that incorporated chemical safety education and use of a fluorescent tracer dye during pesticide application and compared dermal exposure between the intervention group (previous dye experience and safety education) and the control group (safety education only). Results: Mean total visual score (TVS) of the tracer dye, which accounts for both extent and intensity of contamination, was lower among those who had previously experienced the dye intervention (mean TVS=41.3) than among participants who were dye-naïve (mean TVS=78.4), with a difference between means of -37.10 (95% CI [-66.26, -7.95], P = 0.02). Conclusion: That workers who had experienced the dye demonstration once before were significantly less contaminated on average when compared with the dye-naïve group indicates that a multimodal community intervention that utilizes fluorescent dye visualization may be effective in reducing dermal exposure to carcinogenic agrochemicals among subsistence farmers in LMICs.
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Affiliation(s)
- T.G. Flynn
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | | | | | | | | | | | - M. Romano
- Norris Cotton Cancer Center at Dartmouth, Lebanon, NH
- Geisel School of Medicine at Dartmouth, Department of Epidemiology, Hanover, NH
| | - M. Cervinski
- Geisel School of Medicine at Dartmouth, Department of Pathology and Laboratory Medicine, Hanover, NH
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Lebanon, NH
| | - K. Lyons
- Norris Cotton Cancer Center at Dartmouth, Lebanon, NH
- Dartmouth-Hitchcock Medical Center, Department of Psychiatry, Lebanon, NH
| | - M. Spaller
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Norris Cotton Cancer Center at Dartmouth, Lebanon, NH
| | - L. Kennedy
- Norris Cotton Cancer Center at Dartmouth, Lebanon, NH
| | - S. Bejarano
- La Liga Contra Cancer, Department of Oncology, San Pedro Sula, Honduras
| | - G.J. Tsongalis
- Norris Cotton Cancer Center at Dartmouth, Lebanon, NH
- Dartmouth-Hitchcock Medical Center, Department of Pathology–Clinical Genomics and Advanced Technology, Lebanon, NH
| | - K. Huyck
- Norris Cotton Cancer Center at Dartmouth, Lebanon, NH
- Geisel School of Medicine, Department of Medicine, Lebanon, NH
- Dartmouth-Hitchcock Medical Center, Department of Primary Care, Lebanon, NH
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Kennedy L, Wrigley S, Kennedy M, Pellegrino V. Extracorporeal membrane oxygenation retrieval factors and survival to intensive care unit discharge. Emerg Med Australas 2018; 31:280-282. [DOI: 10.1111/1742-6723.13182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/26/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Lucy Kennedy
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne Melbourne Victoria Australia
| | - Scott Wrigley
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne Melbourne Victoria Australia
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Ball B, Loux S, Kennedy L, Kalbfleisch T, Scoggin K, Esteller-Vico A, Horohov D, Erol E, Carter C, Smith J. Transcriptomic Analysis of the Chorioallantois from Mares with Nocardioform Placentitis. J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2018.05.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Khosla S, Kennedy L, Forde M, Manifold D. Staging laparoscopy in oesophagogastric malignancy: Our experience of its impact on patient management. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Patel R, Qing Y, Kennedy L, Yan Y, Pink J, Aguila B, Desai A, Gerson SL, Welford SM. MMR Deficiency Does Not Sensitize or Compromise the Function of Hematopoietic Stem Cells to Low and High LET Radiation. Stem Cells Transl Med 2018; 7:513-520. [PMID: 29656536 PMCID: PMC6052615 DOI: 10.1002/sctm.17-0295] [Citation(s) in RCA: 3] [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: 12/15/2017] [Accepted: 03/20/2018] [Indexed: 12/12/2022] Open
Abstract
One of the major health concerns on long-duration space missions will be radiation exposure to the astronauts. Outside the earth's magnetosphere, astronauts will be exposed to galactic cosmic rays (GCR) and solar particle events that are principally composed of protons and He, Ca, O, Ne, Si, Ca, and Fe nuclei. Protons are by far the most common species, but the higher atomic number particles are thought to be more damaging to biological systems. Evaluation and amelioration of risks from GCR exposure will be important for deep space travel. The hematopoietic system is one of the most radiation-sensitive organ systems, and is highly dependent on functional DNA repair pathways for survival. Recent results from our group have demonstrated an acquired deficiency in mismatch repair (MMR) in human hematopoietic stem cells (HSCs) with age due to functional loss of the MLH1 protein, suggesting an additional risk to astronauts who may have significant numbers of MMR deficient HSCs at the time of space travel. In the present study, we investigated the effects gamma radiation, proton radiation, and 56 Fe radiation on HSC function in Mlh1+/+ and Mlh1-/- marrow from mice in a variety of assays and have determined that while cosmic radiation is a major risk to the hematopoietic system, there is no dependence on MMR capacity. Stem Cells Translational Medicine 2018;7:513-520.
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Affiliation(s)
| | - Yulan Qing
- Case Comprehensive Cancer Center, National Center for Regenerative Medicine, Seidman Cancer Center, University Hospitals Cleveland Medical center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Lucy Kennedy
- Unit for Laboratory and Animal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yan Yan
- Case Comprehensive Cancer Center, National Center for Regenerative Medicine, Seidman Cancer Center, University Hospitals Cleveland Medical center and Case Western Reserve University, Cleveland, Ohio, USA
| | - John Pink
- Case Comprehensive Cancer Center, National Center for Regenerative Medicine, Seidman Cancer Center, University Hospitals Cleveland Medical center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Brittany Aguila
- Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio, USA
| | - Amar Desai
- Case Comprehensive Cancer Center, National Center for Regenerative Medicine, Seidman Cancer Center, University Hospitals Cleveland Medical center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Stanton L Gerson
- Case Comprehensive Cancer Center, National Center for Regenerative Medicine, Seidman Cancer Center, University Hospitals Cleveland Medical center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Scott M Welford
- Department of Radiation Oncology, Sylvester Cancer Center, University of Miami, Miami, Florida, USA
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27
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Kennedy L. Response to Protocol Review Scenario: Adverse events and deficiencies. Lab Anim (NY) 2016; 45:356. [PMID: 27654682 DOI: 10.1038/laban.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lucy Kennedy
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI
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Mann GB, Pitcher M, Shanahan K, Storer L, Rio I, Bell B, Hookey S, Hickey M, Kennedy L, Curwen-Walker R, Vij S, Park A, Bell C. Abstract P3-08-04: Survivorship care involving a nurse-led survivorship consultation, community support and shared care with primary practitioners. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-08-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Survivorship care (SC) has gained prominence as the number of patients disease free after breast cancer treatment increases, the specific needs of those patients become recognised, and funding to meet these demands is constrained. Involvement of Primary Care Practitioners in SC is seen as a solution, but models of Shared Care have met varying degrees of success. We report on a model that involves Specialist centres, Primary Care Practitioners and organisations, and a community based patient support organisation.
Patients and Methods
A consortium comprising two hospital based breast services – the Royal Melbourne/Royal Women's and Western Hospitals – a regional consortium of Primary Care Physicians, and BreaCan, a non-government peer support organisation for women diagnosed with breast cancer, collaborated to obtain and implement a government-supported Survivorship Care Program. Patients completing definitive treatment for early breast cancer were invited to a Nurse-led consultation where the disease, its pathology, treatment and follow-up were reviewed. Psychosocial and other issues were explored and a personalised SC plan was devised and agreed upon. This plan included Shared Care with the Primary Care Practitioner in the majority of cases. Unmet needs were identified and addressed. The SC plan was signed off by a senior breast cancer clinician and forwarded to the primary care physician for ratification. Evaluation included satisfaction surveys and interviews with patients and primary care physicians. Intensity of use of hospital based services was calculated and compared to a previous cohort of early breast cancer patients.
Results
282 patients completing definitive treatment were offered Nurse-led survivorship consultation. 29 declined, and 28 cancelled. At 31 May 2013, 148 care plans were completed, 38 were in preparation and 39 appointments were booked. Response to this initiative from hospital based specialists was positive. All believed that this program would reduce the amount of routine consultations and increase capacity for new or returning patients requiring specialist care. Primary care doctors overwhelmingly believed the survivorship care plan contained information needed to allow them to manage breast cancer survivors, and gave them confidence to take on this role, although there was some uncertainty regarding role delineation between Primary Care and hospital. Patient evaluation of the Nurse-led clinics was strongly positive. All reported finding out something during the consultation, and 94% said they considered the hospital and GP to be partners in their on-going follow-up care. Modelling suggests that about 5 fewer hospital appointments will be required for each patient managed under this program compared to routine hospital-based care.
Conclusions
Hospital based specialists embrace Survivorship care including shared care and patients expect it, while Primary physicians will participate if offered education, support and specific direction. A model including an end-of –treatment consultation and Shared care with Primary Practitioners appears to address many of the requirements for a successful Survivorship program.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-04.
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Affiliation(s)
- GB Mann
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - M Pitcher
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - K Shanahan
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - L Storer
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - I Rio
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - B Bell
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - S Hookey
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - M Hickey
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - L Kennedy
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - R Curwen-Walker
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - S Vij
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - A Park
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
| | - C Bell
- Royal Womens Hospital, Parkville, Victoria, Australia; Western Hospital, Sunshine, Victoria, Australia; The Royal Melbourne Hospital, Parkville, Victoria, Australia; BreaCan, Melbourne, Victoria, Australia
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Stell FM, Roe RM, Arellano C, Kennedy L, Thornton H, Saavedra-Rodriguez K, Wesson DM, Black WC, Apperson CS. Proof of concept for a novel insecticide bioassay based on sugar feeding by adult Aedes aegypti (Stegomyia aegypti). Med Vet Entomol 2013; 27:284-297. [PMID: 23077986 DOI: 10.1111/j.1365-2915.2012.01048.x] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aedes aegypti L. (Stegomyia aegypti) (Diptera: Culicidae) is the principal vector of dengue and yellow fever viruses in tropical and subtropical regions of the world. Disease management is largely based on mosquito control achieved by insecticides applied to interior resting surfaces and through space sprays. Population monitoring to detect insecticide resistance is a significant component of integrated disease management programmes. We developed a bioassay method for assessing insecticide susceptibility based on the feeding activity of mosquitoes on plant sugars. Our prototype sugar-insecticide feeding bioassay system was composed of inexpensive, disposable components, contained minimal volumes of insecticide, and was compact and highly transportable. Individual mosquitoes were assayed in a plastic cup that contained a sucrose-permethrin solution. Trypan blue dye was added to create a visual marker in the mosquito's abdomen for ingested sucrose-permethrin solution. Blue faecal spots provided further evidence of solution ingestion. With the sugar-insecticide feeding bioassay, the permethrin susceptibility of Ae. aegypti females from two field-collected strains was characterized by probit analysis of dosage-response data. The field strains were also tested by forced contact of females with permethrin residues on filter paper. Dosage-response patterns were similar, indicating that the sugar-insecticide feeding bioassay had appropriately characterized the permethrin susceptibility of the two strains.
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Affiliation(s)
- F M Stell
- Department of Entomology, North Carolina State University, Raleigh, NC 27695, U.S.A
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Niskanen A, Kennedy L, Kojola I, Lohi H, Ruokonen M, Aspi J. Immune gene diversity in grey wolves (Canis lupus). J Vet Behav 2013. [DOI: 10.1016/j.jveb.2013.04.022] [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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Kennedy B, Gargoum FS, Kennedy L, Khan F, Curran DR, O'Connor TM. Emerging anticoagulants. Curr Med Chem 2012; 19:3388-416. [PMID: 22680641 DOI: 10.2174/092986712801215847] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 03/28/2012] [Accepted: 04/02/2012] [Indexed: 11/22/2022]
Abstract
Warfarin, heparin and their derivatives have been the traditional anticoagulants used for prophylaxis and treatment of venous thromboembolism. While the modern clinician is familiar with the efficacy and pharmacokinetics of these agents, their adverse effects have provided the impetus for the development of newer anticoagulants with improved safety, ease of administration, more predictable pharmacodynamics and comparable efficacy. Research into haemostasis and the coagulation cascade has made the development of these newer anticoagulants possible. These drugs include the factor Xa inhibitors and IIa (thrombin) inhibitors. Direct and indirect factor Xa inhibitors are being developed with a relative rapid onset of action and stable pharmacokinetic profiles negating the need for close monitoring; this potentially makes them a more attractive option than heparin or warfarin. Examples of direct factor Xa inhibitors include apixaban, rivaroxaban, otamixaban, betrixaban and edoxaban. Examples of indirect factor Xa inhibitors include fondaparinux, idraparinux and idrabiotaparinux. Direct thrombin inhibitors (factor IIa inhibitors) were developed with the limitations of standard heparin and warfarin in mind. Examples include recombinant hirudin (lepirudin), bivalirudin, ximelagatran, argatroban, and dabigatran etexilate. This review will discuss emerging novel anticoagulants and their use for the prophylaxis and management of venous thromboembolism, for stroke prevention in nonvalvular atrial fibrillation and for coronary artery disease.
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Affiliation(s)
- B Kennedy
- Department of Respiratory Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland
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Kaupisch A, Kennedy L, Stelmanis V, Tye B, Kane NM, Mountford JC, Courtney A, Baker AH. Derivation of vascular endothelial cells from human embryonic stem cells under GMP-compliant conditions: towards clinical studies in ischaemic disease. J Cardiovasc Transl Res 2012; 5:605-17. [PMID: 22855254 DOI: 10.1007/s12265-012-9379-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 05/15/2012] [Indexed: 12/11/2022]
Abstract
Revascularisation of ischaemic tissue remains an area of substantial unmet clinical need in cardiovascular disease. Strategies to induce therapeutic angiogenesis are therefore attractive. Our recent focus has been on human embryonic stem cell (hESC) strategies since hESC can be maintained in a pluripotent state or differentiated into any desired cell type, including endothelial cells (EC), under defined differentiation culture conditions. We recently published a protocol for non-good manufacturing practice (GMP) feeder- and serum-free hESC-EC-directed monolayer differentiation to vascular EC demonstrating the potential to generate hESC-derived EC in a GMP-compliant manner suitable for use in clinical trials. In this study we modified that laboratory protocol to GMP compliance. EC production was confirmed by flow cytometry, qRT-PCR and production of vascular structures in Matrigel®, yielding approximately 30 % mature VE-cadherin(+)/PECAM-1(+) cells using the GMP-compliant hESC line RC13. In conclusion, we have successfully demonstrated the production of vascular EC under GMP-compliant conditions suitable for clinical evaluation.
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Affiliation(s)
- A Kaupisch
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 126 University Place, Glasgow, UK
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Skipworth JRA, Morkane C, Raptis DA, Kennedy L, Johal K, Pendse D, Brennand DJ, Olde Damink S, Malago M, Shankar A, Imber C. Coil migration--a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms. Ann R Coll Surg Engl 2011; 93:e19-23. [PMID: 21944789 DOI: 10.1308/003588411x13008844298652] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION We describe a case of metallic, angiographic coil migration, following radiological exclusion of a gastroduodenal artery pseudoaneurysm secondary to chronic pancreatitis. PATIENTS AND METHODS A 55-year-old man presented to the out-patient clinic with chronic, intermittent, post-prandial, abdominal pain, associated with nausea, vomiting and weight loss. He was known to have chronic pancreatitis and liver disease secondary to alcohol abuse and previously underwent angiographic exclusion of a gastroduodenal artery pseudoaneurysm. During subsequent radiological and endoscopic investigation, an endovascular coil was discovered in the gastric pylorus, associated with ulceration and cavitation. This patient was managed conservatively and enterally fed via naso-jejunal catheter endoscopically placed past the site of the migrated coil. This patient is currently awaiting biliary bypass surgery for chronic pancreatitis, and definitive coil removal will occur concurrently. CONCLUSIONS Literature review reveals that this report is only the eighth to describe coil migration following embolisation of a visceral artery pseudoaneurysm or aneurysm. Endovascular embolisation of pseudoaneurysms and aneurysms is generally safe and effective. More common complications of visceral artery embolisation include rebleeding, pseudoaneurysm reformation and pancreatitis.
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Affiliation(s)
- J R A Skipworth
- Department of Hepatopancreaticobiliary Surgery, University College London Hospital, UK.
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Fennell D, Nicolson M, Ferry D, O'Byrne K, Moore S, McErlean S, Kennedy L, Murray N, Das M, Kerr K. PP 56 Suitability of advanced non-small cell lung cancer biopsies for prospective, multiple molecular analyses in clinical trials. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72654-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Rhoads GG, Dain MP, Zhang Q, Kennedy L. Two-year glycaemic control and healthcare expenditures following initiation of insulin glargine versus neutral protamine Hagedorn insulin in type 2 diabetes. Diabetes Obes Metab 2011; 13:711-7. [PMID: 21410859 DOI: 10.1111/j.1463-1326.2011.01394.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To compare 2-year glycaemic control, hypoglycaemia and healthcare expenditures following insulin glargine (glargine, n = 2105) or neutral protamine Hagedorn (NPH) insulin (NPH, n = 734) initiation in patients with type 2 diabetes (T2D). METHODS Retrospective cohort study using an integrated US health insurance administrative database was conducted. Individuals with a diabetes diagnostic claim and initiated basal insulin therapy with glargine or NPH from 2001 to 2005 dispensed at least one oral antidiabetic drug prescription during 6 months prior to basal insulin initiation and enrolled in the same health insurance plan from 6 months before to 12 months or more after insulin initiation were identified. Repeated measures mixed-effects models evaluated glycaemic and financial outcomes to account for factors potentially contributing to selection of insulin therapy, that is, age, gender, baseline HbA1c level, health expenditures, co-morbidities, healthcare utilization, pharmacy co-payment and follow-up antidiabetic medications. RESULTS Adjusted mean HbA1c value in the first year following insulin initiation was significantly lower for glargine versus NPH initiators (Δ = -0.43, p = 0.006); this difference diminished in the second year (Δ = -0.16, p = 0.375). First-year adjusted quarterly hypoglycaemia incidence rates were lower for glargine (2.1%) versus NPH (2.4%) (p = 0.02) as was the second-year quarterly rate (1.8 vs. 2.2%; p = 0.01). Both the first- and second-year adjusted total healthcare expenditures were lower in the glargine versus NPH group (year 1: $18,720 vs. $19,996, p = 0.005; year 2: $15,008 vs. $17,336; p < 0.001). CONCLUSIONS Glargine therapy may be an effective long-term option for improving glycaemic control, with lower rates of hypoglycaemia and healthcare costs in patients with T2D.
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Affiliation(s)
- G G Rhoads
- School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ 08854, USA.
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Schneeweiss A, Marmé F, Ruiz A, Manikhas A, Bottini A, Wolf M, Sinn HP, Mansouri K, Kennedy L, Bauknecht T. A randomized phase II trial of doxorubicin plus pemetrexed followed by docetaxel versus doxorubicin plus cyclophosphamide followed by docetaxel as neoadjuvant treatment of early breast cancer. Ann Oncol 2011; 22:609-617. [DOI: 10.1093/annonc/mdq400] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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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Zerikly RK, Amiri L, Faiman C, Gupta M, Singh RJ, Nutter B, Kennedy L, Hatipoglu B, Weil RJ, Hamrahian AH. Diagnostic characteristics of late-night salivary cortisol using liquid chromatography-tandem mass spectrometry. J Clin Endocrinol Metab 2010; 95:4555-9. [PMID: 20631023 DOI: 10.1210/jc.2009-2458] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of the study was to describe the diagnostic performance of a commercially available late-night salivary cortisol (NSC) assay using liquid chromatography tandem mass spectrometry. METHODS We retrospectively identified 90 patients who had one or more NSC determinations: 52 patients in whom Cushing syndrome (CS) was excluded or could not be confirmed [group 1 (G1)] and 38 patients in whom CS was confirmed [group 2 (G2)]. Eighteen healthy volunteers served as controls. RESULTS Baseline demographics in all groups were similar with regards to age, ethnicity, gender, and body mass index. NSC levels [median (range)] were higher in G2, 381 (64-13,500) ng/dl [10.51 (1.77-372.46) nmol/liter], compared with controls, 19.3 (2.1-416) ng/dl [0.53 (0.06-11.48) nmol/liter], and G1, 26 (4-176) ng/dl [0.72 (0.11-4.86) nmol/liter, P < 0.001]. The highest combined sensitivity (92%) and specificity (92%) was achieved at a cut point of 107 ng/dl (2.95 nmol/liter). Two or more NSCs were done in 32 of 52 G1 and 31 of 38 G2 patients. In G1 eight of 32 (25%) had at least one elevated [>100 ng/dl (2.76 nmol/liter)] NSC including two in whom both NSCs were elevated. In contrast, four of 31 (13%) in G2 had at least one normal NSC including one with four of five normal NSC values. None of the patients with CS had a NSC less than 60 ng/dl (<1.66 nmol/liter). Comparing G1 and G2, obtaining more than one saliva sample did not improve the diagnostic accuracy of NSC measurement (P = 0.64). CONCLUSION The liquid chromatography tandem mass spectrometry assay to measure NSC is a simple and reliable test to screen patients suspected to have CS. Clinicians should be aware of appropriate cutoff values for proper interpretation of NSC and use additional tests when necessary.
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Affiliation(s)
- R Kurdi Zerikly
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Plumer KD, Kennedy L, Trojan A. Evaluating the implementation of the WHO Healthy Cities Programme across Germany (1999-2002). Health Promot Int 2010; 25:342-54. [DOI: 10.1093/heapro/daq028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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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Kennedy L. Public health nutrition: from principles to practice, by M. Lawrence and T. Worsley. Critical Public Health 2009. [DOI: 10.1080/09581590902938271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Schneeweiss A, Ruiz A, Rovira P, Bottini A, Manikhas A, Wacker J, Schumacher T, Wolf M, Segui M, Sinn P, Kennedy L, Mansouri K, Bauknecht T. 0178 Results of clinical endpoints of a randomized phase II trial with doxorubicin + pemetrexed followed by docetaxel versus doxorubicin + cyclophosphamide followed by docetaxel as primary systemic therapy for early breast cancer. Breast 2009. [DOI: 10.1016/s0960-9776(09)70201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Darby A, Hay P, Quirk F, Mond J, Buettner PG, Paxton SJ, Kennedy L. Better psychological health is associated with weight stability in women with eating disorders. Eat Weight Disord 2009; 14:13-22. [PMID: 19367136 DOI: 10.1007/bf03327790] [Citation(s) in RCA: 3] [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] [Indexed: 11/24/2022] Open
Abstract
AIM To explore the associations between changes in weight, eating disorder psychopathology and psychological distress in a community sample of women with eating disorders over two years. METHOD One hundred and twenty two women identified with disordered eating in a baseline population survey agreed to participate in a follow-up study, of whom 87 (71%), mean age 28+/-6.2, completed the two-year follow-up. Body mass index, eating disorder psychopathology, psychological distress, and demographic details were assessed at both time points. RESULTS Over the two years there was a mean weight gain of 1.76 kg (SD=7.03), 11 (13%) women lost > or =5 kg, 25 (29%) gained > or =5 kg, and 49 (58%) remained weight stable (i.e., within 5 kg of baseline weight). Comparisons between those who had lost, gained and remained weight stable showed few significant differences, however, women who remained weight stable were the least psychologically distressed at baseline and those who lost weight had the greatest reduction in shape concern. Body mass index at baseline, and change in level of binge eating episodes were not associated with weight change. CONCLUSIONS Disordered eating behaviours have little influence on weight change over two years in community women with disordered eating. Low levels of psychological distress at baseline may promote weight stability. Concerns about shape are likely to increase with increased weight.
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Affiliation(s)
- A Darby
- School of Medicine, James Cook University, Queensland, Australia
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Woods A, Pala D, Kennedy L, McLean S, Rockel JS, Wang G, Leask A, Beier F. Rac1 signaling regulates CTGF/CCN2 gene expression via TGFbeta/Smad signaling in chondrocytes. Osteoarthritis Cartilage 2009; 17:406-13. [PMID: 18760941 DOI: 10.1016/j.joca.2008.07.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [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: 03/12/2008] [Accepted: 07/07/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Connective tissue growth factor (CTGF) has been implicated in regulation of chondrocyte differentiation at multiple steps and has been implicated in the progression of diseases such as scleroderma and osteoarthritis. However, the pathways mediating the expression of CTGF/CCN2 and related factors in cartilage are not fully understood. We have previously shown that the Rho family of proteins and the actin cytoskeleton regulate both early and late chondrocyte differentiation. RESULTS Here we demonstrate that several CTGF/Cyr61/Nov (CCN) family members are differentially affected by either inhibition of actin polymerization (cytochalasin D treatment), promotion of actin polymerization (jasplakinolide treatment), inhibition of RhoA/rho kinase (ROCK) signaling (Y27632 treatment) and Rac1 signaling. We also show that the Smad site in the CTGF/CCN2 promoter is responsive to both Rac1 inhibition and cytochalasin D treatment, suggesting a role of TGFbeta/Smad signaling in mediating the effects of actin dynamics and Rac1. CONCLUSION Collectively, these data show that Rac1 and actin pathways control CTGF/CCN2 expression in chondrocytes which might be relevant to both skeletal development and associated diseases such as osteoarthritis.
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Affiliation(s)
- A Woods
- CIHR Group in Skeletal Development and Remodeling, Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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Trifilio SM, Bennett CL, Yarnold PR, McKoy JM, Parada J, Mehta J, Chamilos G, Palella F, Kennedy L, Mullane K, Tallman MS, Evens A, Scheetz MH, Blum W, Kontoyiannis DP. Breakthrough zygomycosis after voriconazole administration among patients with hematologic malignancies who receive hematopoietic stem-cell transplants or intensive chemotherapy. Bone Marrow Transplant 2007; 39:425-9. [PMID: 17310132 DOI: 10.1038/sj.bmt.1705614] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Zygomycosis is increasingly reported as a cause of life-threatening fungal infections. A higher proportion of cases reported over the last decades have been in cancer patients, with or without hematopoietic stem cell transplantation (HSCT). The new anti-fungal agent voriconazole is a recently identified risk factor for developing zygomycosis. We reviewed the clinical characteristics and outcomes of a large cohort of cancer patients who developed zygomycosis after exposure to voriconazole. Health care professionals at 13 large cancer centers provided clinical information on cancer patients with zygomycosis and prior exposure to voriconazole. Criteria for inclusion were 5 days or more of voriconazole use and diagnostic confirmation with tissue or histology. Fifty-eight cases were identified among patients with hematologic malignancies, 62% including patients who underwent a HSCT procedure. Fifty-six patients received voriconazole for primary or secondary prophylaxis against fungal infection. In addition to prior exposure to voriconazole, patients also had several of the previously established risk factors for zygomycosis. Amphotericin B was the most commonly prescribed anti-fungal therapy. Overall mortality was 73%. We conclude that zygomycosis after exposure to voriconazole is a recently described entity that is frequently fatal, despite treatment with currently available anti-fungal agents and surgery.
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Affiliation(s)
- S M Trifilio
- Department of Pharmacy, Division of Hematology/Oncology, Northwestern Memorial Hospital, Chicago, IL, USA
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Bhandare N, Kennedy L, Morris C, Malyapa R, Mendenhall W. 1099. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.364] [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: 11/28/2022]
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Trifilio S, Bennett C, Yarnold P, Mehta J, Palella F, Kennedy L, Parada J, Blum W, Kontoyiannis D. Risk factors associated with mortality among persons with breakthrough zygomycosis and prior voriconazole exposure. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kennedy L, Bittel DC, Kibiryeva N, Kalra SP, Torto R, Butler MG. Circulating adiponectin levels, body composition and obesity-related variables in Prader-Willi syndrome: comparison with obese subjects. Int J Obes (Lond) 2006; 30:382-7. [PMID: 16231029 PMCID: PMC6704478 DOI: 10.1038/sj.ijo.0803115] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND People with obesity and/or the metabolic syndrome have an increased risk for developing diabetes and cardiovascular disease and may have low adiponectin levels. The obesity associated with Prader-Willi syndrome (PWS) would be expected to have similar complications. However, it was recently reported that, despite their adiposity, people with PWS have reduced visceral fat and are less likely to develop diabetes mellitus or the metabolic syndrome compared with people with simple obesity. OBJECTIVE To determine if plasma adiponectin levels and other variables relevant to diabetes and cardiovascular risk are different in a cohort of PWS subjects with known genetic subtypes compared with age-, sex- and weight-matched control subjects. RESULTS Fasting plasma glucose, C-peptide, triglycerides, leptin and cholesterol levels were similar in PWS and obese subjects. Our 20 PWS subjects (mean age = 27.7 years) had higher percent body fat (54.1 vs 48.5%) determined by DEXA measurements and lower percent lean mass (45.9 vs 51.5%) compared with 14 obese controls (mean age = 26.9 year). Plasma adiponectin levels were significantly higher in PWS (15.5 +/- 8.2 microg/ml) than in obese controls (7.5 +/- 2.7 microg/ml). A significant positive correlation was found with insulin sensitivity in PWS subjects (r = 0.75, P = 0.0003) but not in obese controls (r = 0.36, P = 0.20). DISCUSSION Our study confirmed an earlier observation of higher adiponectin levels in PWS subjects and less insulin resistance proportionate to their obesity status than found in subjects with simple obesity. Furthermore, no differences were seen in PWS subjects with the chromosome 15 deletion or maternal disomy 15. The reported excessive visceral adiposity in subjects with simple obesity compared with PWS may be associated with decreased production and lower circulating levels of adiponectin.
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Affiliation(s)
- L Kennedy
- Department of Medicine, Division of Endocrinology, University of Florida, Gainesville, FL, USA
| | - DC Bittel
- Children’s Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - N Kibiryeva
- Children’s Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - SP Kalra
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - R Torto
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - MG Butler
- Children’s Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Lambert M, Haro JM, Novick D, Edgell ET, Kennedy L, Ratcliffe M, Naber D. Olanzapine vs. other antipsychotics in actual out-patient settings: six months tolerability results from the European Schizophrenia Out-patient Health Outcomes study. Acta Psychiatr Scand 2005; 111:232-43. [PMID: 15701108 DOI: 10.1111/j.1600-0447.2004.00451.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The European Schizophrenia Out-patient Health Outcomes study is an observational study investigating treatment in schizophrenia. We report treatment-emergent adverse events during the first 6 months of treatment. METHOD The rate of extrapyramidal symptoms (EPS), anticholinergic use, weight gain and sexual related dysfunctions were assessed in 8,400 out-patients. RESULTS Patients typical antipsychotics and risperidone experienced significantly more EPS and anticholinergic use than patients in the clozapine, olanzapine, and quetiapine cohorts. Patients treated with amisulpride, typical antipsychotics and risperidone were significantly more likely to have sexual related dysfunctions and/or amenorrhea. Increases in weight and body mass index occurred in all cohorts, but were significantly greater in the olanzapine and clozapine cohorts. CONCLUSION Patients treated with olanzapine, quetiapine and clozapine had better tolerability outcomes regarding EPS and sexual related dysfunctions compared with patients receiving risperidone, amisulpride and typicals. Patients treated with olanzapine and clozapine had higher weight increases than patients treated with risperidone, quetiapine and typicals.
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Affiliation(s)
- M Lambert
- Centre for Psychosocial Medicine, Department for Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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Haro JM, Edgell ET, Novick D, Alonso J, Kennedy L, Jones PB, Ratcliffe M, Breier A. Effectiveness of antipsychotic treatment for schizophrenia: 6-month results of the Pan-European Schizophrenia Outpatient Health Outcomes (SOHO) study. Acta Psychiatr Scand 2005; 111:220-31. [PMID: 15701107 DOI: 10.1111/j.1600-0447.2004.00450.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To present the 6-month outcomes associated with antipsychotic treatment of patients participating in the Schizophrenia Outpatient Health Outcomes (SOHO) study. METHOD SOHO is a 3-year, prospective, observational study of the health outcomes associated with antipsychotic treatment in 10 European countries. The study included over 10,000 out-patients who were initiating or changing their antipsychotic medication. RESULTS Clinical Global Impression (CGI)-severity and quality of life (QOL) scores improved in all treatment cohorts. There was a higher response in the CGI-overall symptoms and in the CGI-schizophrenia positive, negative, cognitive and depressive symptom scales in the olanzapine (Olz) and clozapine (Cloz) cohorts compared with other treatment cohorts. Changes were associated with an improvement in QOL. CONCLUSION Patients starting Olz and Cloz tend to have better outcomes at 6 months than patients who start other antipsychotics in actual out-patient clinical practice. The results should be interpreted conservatively because of the non-randomized study design.
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Affiliation(s)
- J M Haro
- Sant Joan de Déu-Serveis de Salut Mental, Sant Boi, Barcelona, Spain.
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Rydberg E, Gudmundsson P, Kennedy L, Erhardt L, Willenheimer R. Left atrioventricular plane displacement but not left ventricular ejection fraction is influenced by the degree of aortic stenosis. Heart 2004; 90:1151-5. [PMID: 15367511 PMCID: PMC1768471 DOI: 10.1136/hrt.2003.020628] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIMS To examine how left atrioventricular plane displacement (AVPD), a widely used measure of left ventricular (LV) function, is related to presence and degree of aortic stenosis. METHODS AND RESULTS Cardiac dimensions, LV filling, left AVPD, LV ejection fraction (LVEF), and valve function were assessed by echocardiography/Doppler in 182 patients with various cardiac diseases (mean (SD) age 69 (12) years, 36% women), 49 consecutive with and 133 consecutive without aortic stenosis. In an analysis of covariance, neither left AVPD nor LVEF was independently correlated with the presence of aortic stenosis. However, looking separately at patients with aortic stenosis, left AVPD (p = 0.03) but not LVEF correlated independently with degree of aortic stenosis in multiple linear regression analysis. In patients with aortic stenosis, an abnormal left AVPD had 94% sensitivity and 90% negative predictive value with regard to severe aortic stenosis, compared with 56% and 62%, respectively, for LVEF. CONCLUSION In patients with cardiac disease, neither left AVPD nor LVEF correlated independently with presence of aortic stenosis. However, in patients with aortic stenosis, left AVPD but not LVEF correlated with the degree of aortic valve obstruction and left AVPD but not LVEF had high sensitivity and negative predictive value with regard to severe aortic stenosis. Compared with LVEF, left AVPD is an earlier and more sensitive marker of LV haemodynamic load in patients with aortic stenosis.
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Affiliation(s)
- E Rydberg
- Department of Cardiology, Malmö University Hospital, S-205 02 Malmö, Sweden.
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Soubhi Nizam M, Kennedy L. Co-occurrence of thyroid binding globulin excess and a pituitary macroadenoma containing thyroid stimulating hormone-producing cells. Postgrad Med J 2004; 80:114-5. [PMID: 14970304 PMCID: PMC1742921 DOI: 10.1136/pmj.2003.009514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A patient is described in whom thyroid binding globulin (TBG) excess was found in association with a pituitary macroadenoma containing thyroid stimulating hormone (TSH)-producing cells, and the potential for diagnostic confusion arising from this unusual combination of endocrine disorders is discussed. The patient presented with visual field disturbance, and magnetic resonance imaging led to the diagnosis of a pituitary tumour. Raised levels of total thyroxine and triiodothyronine along with normal TSH levels suggested the possibility of a TSH-secreting pituitary adenoma. Immunostaining of the tumour removed at transsphenoidal surgery confirmed the presence of TSH-producing cells. When raised total thyroxine and triiodothyronine levels persisted postoperatively, the diagnosis of TBG excess was confirmed. Use of free, rather than total, thyroid hormone assays would almost certainly have prevented the diagnostic confusion concerning possible TSH-secreting pituitary adenoma, but may have resulted in the TBG excess being overlooked entirely.
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Affiliation(s)
- M Soubhi Nizam
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida, USA
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