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Pan VA, Tran LT, Madden T, Clasie B, Kooy H, Rosenfeld AB, Depauw N. LET d Optimization Verification With an SOI Microdosimeter. Int J Radiat Oncol Biol Phys 2024:S0360-3016(23)08310-4. [PMID: 38300188 DOI: 10.1016/j.ijrobp.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/30/2023] [Accepted: 12/23/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE A first of its kind experimental verification of dose-averaged linear energy transfer (LETd) optimized treatment plans for proton therapy has been carried out using a silicon-on-insulator microdosimeter at the Massachusetts General Hospital (MGH), Boston, USA. METHODS AND MATERIALS Three clinical treatment plans of a typical ependymoma structure set were designed using the standard clinical approach, the proposed protocol approach, and a one-field approach. The plans were then reoptimized to reduce the LETd-weighted dose in the brain stem. All six plans were delivered in a solid water phantom and the experimental yD‾ measured. RESULTS After LETd optimization, a reduction in yD‾ was found within the brain stem by an average of 12%, 19%, and 4% for the clinical, protocol, and one-field plans, respectively, while maintaining adequate coverage of the tumor structure. The experimental LETd-weighted doses were in agreement with the treatment planning system calculations and Monte Carlo simulations and reinforced the improvement of the optimization. CONCLUSIONS This work demonstrates the first experimental verification of the clinical implementation of LETd optimization for patient treatment with proton therapy.
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Affiliation(s)
- V A Pan
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | - L T Tran
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - T Madden
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - B Clasie
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - H Kooy
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - A B Rosenfeld
- Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - N Depauw
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Hajarizadeh B, Kairouz A, Ottaviano S, Ireland J, Willing A, Cunningham E, Webb P, Colledge-Frisby S, Wheeler A, Leung J, Tran LT, Price O, Vickerman P, Farrell M, Hickman M, Dore GJ, Bergenström A, Degenhardt L, Grebely J. Global, regional, and country-level coverage of testing and treatment for HIV and hepatitis C infection among people who inject drugs: a systematic review. Lancet Glob Health 2023; 11:e1885-e1898. [PMID: 37973339 DOI: 10.1016/s2214-109x(23)00461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND People who inject drugs are disproportionately affected by HIV and hepatitis C virus (HCV) infections, while there is little global data on HIV and HCV testing and treatment coverage of this population. We conducted a systematic review to evaluate country-level, regional, and global coverage of HIV and HCV testing and treatment among people who inject drugs. METHODS We did a systematic review, and searched bibliographic databases (MEDLINE, Embase, and PsycINFO) and grey literature for studies published between Jan 1, 2017, and April 30, 2022, that evaluated the proportion of people who inject drugs who received testing or treatment for HIV or HCV. For each country, we estimated the proportion of people who inject drugs tested for HIV antibodies in the past 12 months (recent), people who inject drugs ever tested for HCV antibodies and HCV RNA, people who inject drugs with HIV currently receiving antiretroviral therapy, and people who inject drugs with HCV ever receiving HCV antiviral treatment. Regional and global estimates, weighted by the population size of people who inject drugs, were generated where sufficient data were available. This study is registered with PROSPERO (CRD42020173974). FINDINGS 512 documents reported data eligible for analyses, including 337 peer-reviewed articles, 27 conference abstracts or presentations, and 148 documents from grey literature or supplementary searches. Data of recent HIV antibody testing were available for 67 countries and ever having had HCV antibody testing were available for 49 countries. Globally, an estimated 48·8% of people who inject drugs were recently tested for HIV antibodies (95% uncertainty interval [UI] 43·3-54·2%; range 0·9-86·0%), and 47·1% had ever been tested for HCV antibodies (95% UI 43·4-51·0%; range 0·0-93·3%). HCV RNA testing data were available from three countries. Coverage of HIV antibody testing was high (>75%) in four countries and for HCV antibody testing in 15 countries. The estimated uptake of current HIV treatment (18 countries) ranged from 2·6% to 81·9%, and the estimated uptake of ever having HCV treatment (23 countries) ranged from 1·8% to 88·6% across countries. Uptake of HIV treatment was high in two countries, and of HCV treatment in one country. INTERPRETATION HIV and HCV testing and treatment uptake among people who inject drugs was highly variable, and suboptimal in most countries. Strategies to improve access to HIV and HCV care among people who inject drugs and the availability of public health surveillance are urgently required. FUNDING Australian National Health and Medical Research Council and UK National Institute for Health and Care Research Health Protection Research Unit in Behavioural Science and Evaluation.
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Affiliation(s)
- Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Abe Kairouz
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sophie Ottaviano
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jeremy Ireland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Alex Willing
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Evan Cunningham
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Paige Webb
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Alice Wheeler
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Janni Leung
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; National Centre For Youth Substance Use Research, The University of Queensland, QLD, Australia
| | - Lucy T Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Olivia Price
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anne Bergenström
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Degenhardt L, Webb P, Colledge-Frisby S, Ireland J, Wheeler A, Ottaviano S, Willing A, Kairouz A, Cunningham EB, Hajarizadeh B, Leung J, Tran LT, Price O, Peacock A, Vickerman P, Farrell M, Dore GJ, Hickman M, Grebely J. Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject drugs: a systematic review. The Lancet Global Health 2023; 11:e659-e672. [PMID: 36996857 DOI: 10.1016/s2214-109x(23)00057-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND People who inject drugs are exposed to various and changing risk environments and are at risk of multiple harms related to injecting drug use (IDU). We aimed to undertake a global systematic review of the prevalence of IDU, key IDU-related harms (including HIV, hepatitis C virus [HCV], and hepatitis B virus [HBV] infection and overdose), and key sociodemographic characteristics and risk exposures for people who inject drugs. METHODS We systematically searched for data published between Jan 1, 2017, and March 31, 2022, in databases of peer-reviewed literature (MEDLINE, Embase, and PsycINFO) and grey literature as well as various agency or organisational websites, and disseminated data requests to international experts and agencies. We searched for data on the prevalence, characteristics, and risks of people who inject drugs, including gender, age, sexuality, drug-use patterns, HIV, HCV, and HBV infections, non-fatal overdose, depression, anxiety, and injecting-related disease. Additional data were extracted from studies identified in our previous review. Meta-analyses were used to pool the data where multiple estimates were available for a country. We present country, regional, and global estimates for each variable examined. FINDINGS We screened 40 427 reports published between 2017 and 2022, and the 871 eligible reports identified were added to the 1147 documents from the previous review. Evidence of IDU was documented in 190 of 207 countries and territories, and 14·8 million people (95% uncertainty interval [UI] 10·0-21·7) aged 15-64 years globally were estimated to inject drugs. Existing evidence suggests that there might be 2·8 million (95% UI 2·4-3·2) women and 12·1 million (95% UI 11·0-13·3) men who inject drugs globally, and that 0·4% (95% CI 0·3-1·3) of people who inject drugs identify as transgender. The amount of available data on key health and social risks among people who inject drugs varied widely across countries and regions. We estimated that 24·8% (95% CI 19·5-31·6) of people who inject drugs globally had experienced recent homelessness or unstable housing, 58·4% (95% CI 52·0-64·8) had a lifetime history of incarceration, and 14·9% (95% CI 8·1-24·3) had recently engaged in sex work, with substantial geographical variation. Injecting and sexual risk behaviour varied considerably geographically, as did risks of harms. Globally, we estimated that 15·2% (95% CI 10·3-20·9) of people who inject drugs are living with HIV, 38·8% (95% CI 31·4-46·9) have current HCV infection, 18·5% (95% CI 13·9-24·1) have recently overdosed, and 31·7% (95% CI 23·6-40·5) have had a recent skin or soft tissue infection. INTERPRETATION IDU is being identified in a growing number of countries and territories that comprise more than 99% of the global population. IDU-related health harms are common, and people who inject drugs continue to be exposed to multiple adverse risk environments. However, quantification of many of these exposure and harms is inadequate and must be improved to allow for better targeting of harm-reduction interventions for these risks. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Paige Webb
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; National Drug Research Institute Melbourne, Curtin University, Melbourne, VIC, Australia
| | - Jeremy Ireland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Alice Wheeler
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sophie Ottaviano
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Alex Willing
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Abe Kairouz
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Evan B Cunningham
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Janni Leung
- National Centre For Youth Substance Use Research, University of Queensland, St Lucia, QLD, Australia
| | - Lucy T Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Olivia Price
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Gregory J Dore
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jason Grebely
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Ferraro CF, Stewart DE, Grebely J, Tran LT, Zhou S, Puca C, Hajarizadeh B, Larney S, Santo T, Higgins JPT, Vickerman P, Degenhardt L, Hickman M, French CE. Association between opioid agonist therapy use and HIV testing uptake among people who have recently injected drugs: a systematic review and meta-analysis. Addiction 2021; 116:1664-1676. [PMID: 33140543 PMCID: PMC8248165 DOI: 10.1111/add.15316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/21/2020] [Accepted: 10/26/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM Globally, nearly one in five people who inject drugs (PWID) are living with HIV, and the rate of new HIV infections in PWID is increasing in some settings. Early diagnosis is crucial for effective HIV control. We reviewed the evidence on the association between opioid agonist therapy (OAT) and HIV testing uptake among PWID. METHODS We conducted a systematic review searching MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and PsycINFO for studies published from January 2000 to March 2019. Reference lists and conference proceedings were hand-searched. Observational and intervention studies were eligible for inclusion. Risk of bias was assessed using the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool. Meta-analyses were conducted using random-effects models. RESULTS Of 13 373 records identified, 11 studies from Australia, Europe, Malaysia and the United States were included. All studies had at least a serious risk of bias, largely due to confounding and selection bias, making it difficult to draw causal conclusions from the evidence. Ten studies provided data on the association between current OAT use and recent HIV testing. Six showed a positive association, while four provided little evidence of an association: pooled odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.28-2.27. Looking at having ever been on OAT and having ever been HIV tested, seven studies showed a positive association and three showed either weak or no evidence of an association: pooled OR = 3.82, 95% CI = 2.96-4.95. CONCLUSIONS Opioid agonist therapy may increase uptake of HIV testing among people who inject drugs, providing further evidence that opioid agonist therapy improves the HIV treatment care cascade.
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Affiliation(s)
- Claire F. Ferraro
- Health Protection Research Unit, Population Health SciencesUniversity of BristolCanynge Hall, 39 Whatley Road, CliftonBristolBS8 2PSUK,National Public Health Speciality Training Programme, South WestBristolUK
| | - Daniel E. Stewart
- Health Protection Research Unit, Population Health SciencesUniversity of BristolCanynge Hall, 39 Whatley Road, CliftonBristolBS8 2PSUK,National Public Health Speciality Training Programme, South WestBristolUK
| | - Jason Grebely
- Kirby Institute, University of South Wales SydneySydneyAustralia
| | - Lucy T. Tran
- National Drug and Alcohol Research CentreUniversity of South Wales Sydney, Sydney, Australia
| | - Shally Zhou
- National Drug and Alcohol Research CentreUniversity of South Wales Sydney, Sydney, Australia
| | - Carla Puca
- National Drug and Alcohol Research CentreUniversity of South Wales Sydney, Sydney, Australia
| | | | - Sarah Larney
- National Drug and Alcohol Research CentreUniversity of South Wales Sydney, Sydney, Australia,Department of Family Medicine and Emergency MedicineUniversité de Montréal and Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM)QuebecCanada
| | - Thomas Santo
- National Drug and Alcohol Research CentreUniversity of South Wales Sydney, Sydney, Australia
| | - Julian P. T. Higgins
- Health Protection Research Unit, Population Health SciencesUniversity of BristolCanynge Hall, 39 Whatley Road, CliftonBristolBS8 2PSUK
| | - Peter Vickerman
- Health Protection Research Unit, Population Health SciencesUniversity of BristolCanynge Hall, 39 Whatley Road, CliftonBristolBS8 2PSUK
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUniversity of South Wales Sydney, Sydney, Australia
| | - Matthew Hickman
- Health Protection Research Unit, Population Health SciencesUniversity of BristolCanynge Hall, 39 Whatley Road, CliftonBristolBS8 2PSUK
| | - Clare E. French
- Health Protection Research Unit, Population Health SciencesUniversity of BristolCanynge Hall, 39 Whatley Road, CliftonBristolBS8 2PSUK
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Larney S, Peacock A, Tran LT, Stockings E, Santomauro D, Santo T, Degenhardt L. All-Cause and Overdose Mortality Risk Among People Prescribed Opioids: A Systematic Review and Meta-analysis. Pain Med 2021; 21:3700-3711. [PMID: 32951045 DOI: 10.1093/pm/pnaa214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate all-cause and overdose crude mortality rates and standardized mortality ratios among people prescribed opioids for chronic noncancer pain and risk of overdose death in this population relative to people with similar clinical profiles but not prescribed opioids. DESIGN Systematic review and meta-analysis. METHODS Medline, Embase, and PsycINFO were searched in February 2018 and October 2019 for articles published beginning 2009. Due to limitations in published studies, we revised our inclusion criteria to include cohort studies of people prescribed opioids, excluding those studies where people were explicitly prescribed opioids for the treatment of opioid use disorder or acute cancer or palliative pain. We estimated pooled all-cause and overdose crude mortality rates using random effects meta-analysis models. No studies reported standardized mortality ratios or relative risks. RESULTS We included 13 cohorts with 6,029,810 participants. The pooled all-cause crude mortality rate, based on 10 cohorts, was 28.8 per 1000 person-years (95% CI = 17.9-46.4), with substantial heterogeneity (I2 = 99.9%). The pooled overdose crude mortality rate, based on six cohorts, was 1.1 per 1000 person-years (95% CI = 0.4-3.4), with substantial heterogeneity (I2 = 99.5%), but indications for opioid prescribing and opioid exposure were poorly ascertained. We were unable to estimate mortality in this population relative to clinically similar populations not prescribed opioids. CONCLUSIONS Methodological limitations in the identified literature complicate efforts to determine the overdose mortality risk of people prescribed opioids. There is a need for large-scale clinical trials to assess adverse outcomes in opioid prescribing, especially for chronic noncancer pain.
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Affiliation(s)
- Sarah Larney
- Department of Family Medicine and Emergency Medicine, Université de Montréal and Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montreal, Quebec, Canada.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; ‡School of Medicine (Psychology), University of Tasmania, Hobart, Tas, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; ‡School of Medicine (Psychology), University of Tasmania, Hobart, Tas, Australia
| | - Lucy T Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; ‡School of Medicine (Psychology), University of Tasmania, Hobart, Tas, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; ‡School of Medicine (Psychology), University of Tasmania, Hobart, Tas, Australia
| | - Damian Santomauro
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia.,Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Thomas Santo
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; ‡School of Medicine (Psychology), University of Tasmania, Hobart, Tas, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; ‡School of Medicine (Psychology), University of Tasmania, Hobart, Tas, Australia
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Bolst D, Guatelli S, Tran LT, Rosenfeld AB. Corrigendum: The impact of sensitive volume thickness for silicon on insulator microdosimeters in hadron therapy (2020 Phys. Med. Biol. 65 035004). Phys Med Biol 2021; 66. [DOI: 10.1088/1361-6560/abe224] [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] [Received: 12/21/2020] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
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Zhu JL, Tran LT, Smith M, Zheng F, Cai L, James JA, Guthridge JM, Chong BF. Modular gene analysis reveals distinct molecular signatures for subsets of patients with cutaneous lupus erythematosus. Br J Dermatol 2021; 185:563-572. [PMID: 33400293 DOI: 10.1111/bjd.19800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune disease with clinical sequelae such as itching, dyspigmentation and scarring. OBJECTIVES We applied a previously described modular analysis approach to assess the molecular heterogeneity of patients with CLE. METHODS Whole-blood transcriptomes of RNA sequencing data from a racially and ethnically diverse group of patients with CLE (n = 62) were used to calculate gene co-expression module scores. An unsupervised cluster analysis and k-means clustering based on these module scores were then performed. We used Fisher's exact tests and Kruskal-Wallis tests to compare characteristics between patient clusters. RESULTS Six unique clusters of patients with CLE were identified from the cluster analysis. We observed that seven inflammation modules were elevated in two clusters of patients with CLE. Additionally, these clusters were characterized by interferon, neutrophil and cell-death signatures, suggesting that interferon-related proteins, neutrophils and cell-death processes could be driving the inflammatory response in these subgroups. Three different clusters had a predominant T-cell signature, which were supported by lymphocyte counts. CONCLUSIONS Our data support a diverse molecular profile in CLE that further adds to the clinical variations of this skin disease, and may affect disease course and treatment selection. Future studies with a larger and diverse cohort of patients with CLE are warranted to confirm these findings.
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Affiliation(s)
- J L Zhu
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - L T Tran
- Arthritis and Clinical Research Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - M Smith
- Arthritis and Clinical Research Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - F Zheng
- Arthritis and Clinical Research Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - L Cai
- Department of Population and Data Sciences, Quantitative Biomedical Research Center, Dallas, TX, USA
| | - J A James
- Arthritis and Clinical Research Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - J M Guthridge
- Arthritis and Clinical Research Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - B F Chong
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
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Dermer E, Spahr A, Tran LT, Mirchi A, Pelletier F, Guerrero K, Ahmed S, Brais B, Braverman N, Buhas D, Chandratre S, Chenier S, Chrestian N, Desmeules M, Dilenge ME, Laflamme J, Larbrisseau A, Legault G, Lim KY, Maftei C, Major P, Malvey-Dorn E, Marois P, Mitchell J, Nadeau A, Osterman B, Paradis I, Pohl D, Reggin J, Riou E, Roedde G, Rossignol E, Sébire G, Shevell M, Srour M, Sylvain M, Tarnopolsky M, Venkateswaran S, Sullivan M, Bernard G. Stress in Parents of Children With Genetically Determined Leukoencephalopathies: A Pilot Study. J Child Neurol 2020; 35:901-907. [PMID: 32720856 DOI: 10.1177/0883073820938645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Genetically determined leukoencephalopathies comprise a group of rare inherited white matter disorders. The majority are progressive diseases resulting in early death. We performed a cross-sectional pilot study including 55 parents from 36 families to assess the level of stress experienced by parents of patients with genetically determined leukoencephalopathies, aged 1 month to 12 years. Thirty-four mothers and 21 fathers completed the Parenting Stress Index-4th Edition. One demographic questionnaire was completed per family. Detailed clinical data was gathered on all patients. Statistical analysis was performed with total stress percentile score as the primary outcome. Mothers and fathers had significantly higher stress levels compared with the normative sample; 20% of parents had high levels of stress whereas 11% had clinically significant levels of stress. Mothers and fathers had comparable total stress percentile scores. We identified pediatric behavioral difficulties and gross motor function to be factors influencing stress in mothers. Our study is the first to examine parental stress in this population and highlights the need for parental support early in the disease course. In this pilot study, we demonstrated that using the Parenting Stress Index-4th Edition to assess stress levels in parents of patients with genetically determined leukoencephalopathies is feasible, leads to valuable and actionable results, and should be used in larger, prospective studies.
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Affiliation(s)
- E Dermer
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada.,E. Dermer and A. Spahr are co-first authors of this article
| | - A Spahr
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada.,E. Dermer and A. Spahr are co-first authors of this article
| | - L T Tran
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - A Mirchi
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - F Pelletier
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - K Guerrero
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - S Ahmed
- 27364North Bay Regional Health Centre, North Bay, Ontario, Canada
| | - B Brais
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada
| | - N Braverman
- Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - D Buhas
- Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada
| | - S Chandratre
- Department of Pediatric Neurology, 6397Oxford University Hospitals, Oxford, United Kingdom
| | - S Chenier
- Department of Medical Genetics, 7321University of Sherbrooke, Sherbrooke, Québec, Canada
| | - N Chrestian
- Division of Pediatric Neurology, 12369Centre Mère-Enfant Soleil du CHU de Québec-Université Laval, Québec, Canada.,Department of Pediatrics, 12369Centre Mère-Enfant Soleil du CHU de Québec-Université Laval, Québec, Canada
| | - M Desmeules
- Department of Pediatrics, Saguenay, Chicoutimi, Québec, Canada
| | - M E Dilenge
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada
| | - J Laflamme
- Department of Pediatrics, 12369Centre Mère-Enfant Soleil du CHU de Québec-Université Laval, Québec, Canada
| | - A Larbrisseau
- Department of Pediatrics, 5622University of Montreal, Montréal, Québec, Canada.,Department of Neurology, CHU Saint-Justine, Montréal, Québec, Canada
| | - G Legault
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada
| | - K Y Lim
- Department of Pediatric Neurology, Providence Pediatric Neurology-St. Vincent, Portland, OR, USA
| | - C Maftei
- Department of Pediatrics, Division of Medical Genetics, CHU Saint-Justine, Montreal University, Montréal, Québec, Canada
| | - P Major
- Department of Pediatrics, 5622University of Montreal, Montréal, Québec, Canada
| | - E Malvey-Dorn
- Department of Pediatrics, All About Children Pediatrics Eden Prairie, St. Louis Park, MN, USA
| | - P Marois
- Department of Pediatrics, 5622University of Montreal, Montréal, Québec, Canada
| | - J Mitchell
- Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - A Nadeau
- Department of Pediatric Neurology, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - B Osterman
- Department of Pediatrics, 5622University of Montreal, Montréal, Québec, Canada.,Department of Neurology, CHU Saint-Justine, Montréal, Québec, Canada
| | - I Paradis
- CIUSSS de l'Est-de-l'Île-de-Montréal, CLSC de Rivière-des-Prairies, Montréal, Québec, Canada
| | - D Pohl
- Division of Neurology, 274065Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - J Reggin
- Department of Pediatric Neurology, Providence Child Neurology, Spokane, Washington, United States
| | - E Riou
- Department of Pediatric Neurology, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - G Roedde
- Latchford Medical Centre, Latchford, Ontario, Canada
| | - E Rossignol
- Brain and Child Development, CHU Saint-Justine Research Center, Montréal, Québec, Canada
| | - G Sébire
- Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - M Shevell
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - M Srour
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
| | - M Sylvain
- Division of Pediatric Neurology, 12369Centre Mère-Enfant Soleil du CHU de Québec-Université Laval, Québec, Canada.,Department of Pediatrics, 12369Centre Mère-Enfant Soleil du CHU de Québec-Université Laval, Québec, Canada
| | - M Tarnopolsky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - S Venkateswaran
- Department of Pediatrics, CHEO Research Institute, Ottawa, Ontario, Canada
| | - M Sullivan
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - G Bernard
- Department of Neurology and Neurosurgery, 54473McGill University, Montréal, Québec Canada.,Department of Pediatrics, 54473McGill University, Montréal, Québec Canada.,Department of Human Genetics, 54473McGill University, Montréal, Québec, Canada.,Department of Specialized Medicine, Division of Medical Genetics, 507266McGill University Health Centre, Montréal, Québec, Canada.,Child Health and Human Development Program, 507266Research Institute of the McGill University Health Center, Montréal, Québec, Canada
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9
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Bórquez A, Rich K, Farrell M, Degenhardt L, McKetin R, Tran LT, Cepeda J, Silva‐Santisteban A, Konda K, Cáceres CF, Kelly S, Altice FL, Martin NK. Integrating HIV pre-exposure prophylaxis and harm reduction among men who have sex with men and transgender women to address intersecting harms associated with stimulant use: a modelling study. J Int AIDS Soc 2020; 23 Suppl 1:e25495. [PMID: 32562365 PMCID: PMC7305413 DOI: 10.1002/jia2.25495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/27/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Among men who have sex with men (MSM) and transgender women (TW), stimulant use is high and has been associated with an increased risk of HIV infection, suicide and cardiovascular disease (CVD) mortality. We used epidemic modelling to investigate these intersecting health harms among MSM/TW in Lima, Peru and assess whether they could be mitigated by prioritizing HIV pre-exposure prophylaxis (PrEP) and harm reduction interventions among MSM/TW who use stimulants. METHODS We adapted a dynamic model of HIV transmission among MSM/TW in Lima to incorporate stimulant use and increased HIV risk, suicide and CVD mortality. Among 6% to 24% of MSM/TW using stimulants (mostly cocaine), we modelled an increased risk of unprotected anal sex (RR = 1.35 [95%CI: 1.17 to 1.57]) obtained from local data, and increased risk of suicide (SMR = 6.26 [95%CI: 2.84 to 13.80]) and CVD (SMR = 1.83 [95%CI: 0.39 to 8.57]) mortality associated with cocaine use based on a global systematic review. We estimated the proportion of health harms occurring among MSM/TW who use stimulants in the next year (01-2020/01-2021). We also investigated the 10-year impact (01-2020/01-2030) of: (1) PrEP prioritization for stimulant-using MSM/TW compared to random allocation, and (2) integrating PrEP with a theoretical intervention halving stimulant-associated risk. RESULTS MSM/TW in Lima will experience high HIV incidence, suicide mortality and CVD mortality (1.6/100 py, and 0.018/100 py, 0.13/100 py respectively) in 2020. Despite stimulant using MSM/TW comprising an estimated 9.5% (95%CI: 7.8 to 11.5) of all MSM/TW, in the next year, 11% 95%CI (i.e. 2.5% to 97.5% percentile) 10% to 13%) of new HIV infections, 39% (95%CI: 18% to 60%) of suicides and 15% (95%CI: 3% to 44%) of CVD deaths could occur among this group. Scaling up PrEP among all stimulant using MSM/TW could prevent 19% (95%CI: 11% to 31%) more HIV infections over 10 years compared to random allocation. Integrating PrEP and an intervention to halve stimulant-associated risks could reduce new HIV infections by 20% (95%CI: 10% to 37%), suicide deaths by 14% (95%CI: 5% to 27%) and CVD deaths by 3% (95%CI: 0% to 16%) over a decade. CONCLUSIONS MSM/TW who use stimulants experience a disproportionate burden of health harms. Prioritizing PrEP based on stimulant use, in addition to sexual behaviour/gender identity criteria, could increase its impact. Integrated substance use, harm reduction, mental health and HIV care among MSM/TW is needed.
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Affiliation(s)
- Annick Bórquez
- Department of MedicineUniversity of California San DiegoLa JollaCAUSA
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
| | | | - Michael Farrell
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
| | - Rebecca McKetin
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
| | - Lucy T. Tran
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
| | - Javier Cepeda
- Department of MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Alfonso Silva‐Santisteban
- Centro de Investigación Interdisciplinaria en SexualidadSIDA y SociedadUniversidad Peruana Cayetano HerediaLimaPeru
| | - Kelika Konda
- Centro de Investigación Interdisciplinaria en SexualidadSIDA y SociedadUniversidad Peruana Cayetano HerediaLimaPeru
| | - Carlos F. Cáceres
- Centro de Investigación Interdisciplinaria en SexualidadSIDA y SociedadUniversidad Peruana Cayetano HerediaLimaPeru
| | - Sherrie Kelly
- Modelling and BiostatisticsBurnet InstituteMelbourneVICAustralia
| | - Frederick L. Altice
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
- Yale University Center for Interdisciplinary Research on AIDSNew HavenCTUSA
- Centre of Excellence in Research on AIDSFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Natasha K. Martin
- Department of MedicineUniversity of California San DiegoLa JollaCAUSA
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
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10
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Bolst D, Guatelli S, Tran LT, Chartier L, Davis J, Biasi G, Prokopovich DA, Pogossov A, Reinhard MI, Petasecca M, Lerch MLF, Matsufuji N, Povoli M, Summanwar A, Kok A, Jackson M, Rosenfeld AB. Validation of Geant4 for silicon microdosimetry in heavy ion therapy. ACTA ACUST UNITED AC 2020; 65:045014. [DOI: 10.1088/1361-6560/ab586a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Black N, Campbell G, Tran LT, Farrell M, Hall W, Degenhardt L. Cannabinoids for the treatment of mental disorders - Author's reply. Lancet Psychiatry 2020; 7:127-128. [PMID: 31981535 DOI: 10.1016/s2215-0366(19)30526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Nicola Black
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW 2052, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW 2052, Australia
| | - Lucy T Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW 2052, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW 2052, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane QLD, Australia; National Addiction Centre, Kings College London, London, UK
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW 2052, Australia.
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12
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Bolst D, Guatelli S, Tran LT, Rosenfeld AB. The impact of sensitive volume thickness for silicon on insulator microdosimeters in hadron therapy. Phys Med Biol 2020; 65:035004. [PMID: 31842007 DOI: 10.1088/1361-6560/ab623f] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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]
Abstract
Compact silicon on insulator (SOI) microdosimeters have been used to characterise the radiation field of many different hadron therapy beams. SOI devices are particularly attractive in hadron therapy fields due to their spatial resolution being well suited to the sharp dose gradients at the end of the primary beam's range. Due to the small size of SOI's sensitive volumes (SVs), which are usually ∼1-10 [Formula: see text]m thick, the fabrication of these devices can present challenges which are not as common for more conventional thickness silicon devices such as silicon spectroscopy detectors. Microdosimetry is the study of the energy deposition in micrometre sized volumes representing biological sites and is a powerful approach to estimate the biological effect of radiation on the micron-scale level, in a cell. However, cell sizes vary extensively translating in different energy deposition spectra. This work studies SV thicknesses between 1 and 100 [Formula: see text]m using Geant4 and examines the impact of SV dimensions on microdosimetric quantities. The quantities studied were the frequency mean lineal energy, [Formula: see text], and the dose mean lineal energy, [Formula: see text]. Additionally the relative biological effectiveness (RBE), estimated by the microdosimetric kinetic model (MKM), is also investigated. To study the impact of the SV thickness, SOI microdosimeters were irradiated with proton, [Formula: see text] and [Formula: see text] ion beams with ranges of ∼160 mm, with the microdosimeter being set at various positions along the Bragg curve. It was found that [Formula: see text] was influenced the least in proton beams and increased for heavier ion beams. Conversely, [Formula: see text] was impacted by the SV thickness the most in proton beams and [Formula: see text] was the least. Similar to [Formula: see text], protons were impacted the most by the SV thickness when estimating the RBE using the MKM. The cause of these differences was largely due to the different densities of the delta electron track structure for the case of [Formula: see text] and the energy transferred to the medium from the primary beam for [Formula: see text].
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Affiliation(s)
- D Bolst
- Author to whom any correspondence should be addressed
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13
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Black N, Stockings E, Campbell G, Tran LT, Zagic D, Hall WD, Farrell M, Degenhardt L. Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. Lancet Psychiatry 2019; 6:995-1010. [PMID: 31672337 PMCID: PMC6949116 DOI: 10.1016/s2215-0366(19)30401-8] [Citation(s) in RCA: 223] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Medicinal cannabinoids, including medicinal cannabis and pharmaceutical cannabinoids and their synthetic derivatives, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), have been suggested to have a therapeutic role in certain mental disorders. We analysed the available evidence to ascertain the effectiveness and safety of all types of medicinal cannabinoids in treating symptoms of various mental disorders. METHODS For this systematic review and meta-analysis we searched MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Clinical Trials, and the Cochrane Database of Systematic Reviews for studies published between Jan 1, 1980, and April 30, 2018. We also searched for unpublished or ongoing studies on ClinicalTrials.gov, the EU Clinical Trials Register, and the Australian and New Zealand Clinical Trials Registry. We considered all studies examining any type and formulation of a medicinal cannabinoid in adults (≥18 years) for treating depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder, or psychosis, either as the primary condition or secondary to other medical conditions. We placed no restrictions on language, publication status, or study type (ie, both experimental and observational study designs were included). Primary outcomes were remission from and changes in symptoms of these mental disorders. The safety of medicinal cannabinoids for these mental disorders was also examined. Evidence from randomised controlled trials was synthesised as odds ratios (ORs) for disorder remission, adverse events, and withdrawals and as standardised mean differences (SMDs) for change in symptoms, via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. This study is registered with PROSPERO (CRD42017059372, CRD42017059373, CRD42017059376, CRD42017064996, and CRD42018102977). FINDINGS 83 eligible studies (40 randomised controlled trials, n=3067) were included: 42 for depression (23 randomised controlled trials; n=2551), 31 for anxiety (17 randomised controlled trials; n=605), eight for Tourette syndrome (two randomised controlled trials; n=36), three for ADHD (one randomised controlled trial; n=30), 12 for post-traumatic stress disorder (one randomised controlled trial; n=10), and 11 for psychosis (six randomised controlled trials; n=281). Pharmaceutical THC (with or without CBD) improved anxiety symptoms among individuals with other medical conditions (primarily chronic non-cancer pain and multiple sclerosis; SMD -0·25 [95% CI -0·49 to -0·01]; seven studies; n=252), although the evidence GRADE was very low. Pharmaceutical THC (with or without CBD) worsened negative symptoms of psychosis in a single study (SMD 0·36 [95% CI 0·10 to 0·62]; n=24). Pharmaceutical THC (with or without CBD) did not significantly affect any other primary outcomes for the mental disorders examined but did increase the number of people who had adverse events (OR 1·99 [95% CI 1·20 to 3·29]; ten studies; n=1495) and withdrawals due to adverse events (2·78 [1·59 to 4·86]; 11 studies; n=1621) compared with placebo across all mental disorders examined. Few randomised controlled trials examined the role of pharmaceutical CBD or medicinal cannabis. INTERPRETATION There is scarce evidence to suggest that cannabinoids improve depressive disorders and symptoms, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis. There is very low quality evidence that pharmaceutical THC (with or without CBD) leads to a small improvement in symptoms of anxiety among individuals with other medical conditions. There remains insufficient evidence to provide guidance on the use of cannabinoids for treating mental disorders within a regulatory framework. Further high-quality studies directly examining the effect of cannabinoids on treating mental disorders are needed. FUNDING Therapeutic Goods Administration, Australia; Commonwealth Department of Health, Australia; Australian National Health and Medical Research Council; and US National Institutes of Health.
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Affiliation(s)
- Nicola Black
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Lucy T Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Dino Zagic
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane QLD, Australia; National Addiction Centre, Kings College London, London, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia.
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14
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Peracchi S, Guatelli S, Tran LT, Rosenfeld AB. Simulation of cosmic radiation spectra for personal microdosimetry at the International Space Station’s altitude. ACTA ACUST UNITED AC 2019. [DOI: 10.1088/1742-6596/1154/1/012020] [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: 11/12/2022]
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15
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Abstract
Silicon-on-insulator (SOI) microdosimeters offer a promising method for routine quality assurance (QA) for hadron therapy due to their ease of operation and high spatial resolution. However, one complication which has been shown previously is that the traditional use of the mean chord length, [Formula: see text], calculated using Cauchy's formula, for SOI devices in clinical carbon ion fields is not appropriate due to the strong directionality of the radiation field. In a previous study, we demonstrated that the mean path length, [Formula: see text], which is the mean path of charged particles in the sensitive volume (SV), is a more appropriate method to obtain microdosimetric quantities and biological relevant values, namely the relative biological effectiveness (RBE) by means of the microdosimetric kinetic model. The previous work, which was limited to mono-energetic [Formula: see text] ion beams typical of heavy ion therapy (HIT), is extended here to investigate the [Formula: see text] in a pristine proton beam as well as for spread out Bragg peaks (SOBP) for both proton and carbon ion clinical beams. In addition, the angular dependence of the SOI device for a number of different SV designs is also investigated to quantify the effects which the alignment has on the [Formula: see text]. It is demonstrated that the [Formula: see text] can be accurately estimated along the depth of a pristine or SOBP using the energy deposition spectra for both proton and [Formula: see text] ion beams. This observation allows a quick and accurate estimation of the [Formula: see text] for experimental use.
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Affiliation(s)
- D Bolst
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
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16
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Chartier L, Tran LT, Bolst D, Guatelli S, Pogossov A, Prokopovich DA, Reinhard MI, Perevertaylo V, Anderson S, Beltran C, Matsufuji N, Jackson M, Rosenfeld AB. MICRODOSIMETRIC APPLICATIONS IN PROTON AND HEAVY ION THERAPY USING SILICON MICRODOSIMETERS. Radiat Prot Dosimetry 2018; 180:365-371. [PMID: 29069515 DOI: 10.1093/rpd/ncx226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Indexed: 06/07/2023]
Abstract
Using the CMRP 'bridge' μ+ probe, microdosimetric measurements were undertaken out-of-field using a therapeutic scanning proton pencil beam and in-field using a 12C ion therapy field. These measurements were undertaken at Mayo Clinic, Rochester, USA and at HIMAC, Chiba, Japan, respectively. For a typical proton field used in the treatment of deep-seated tumors, we observed dose-equivalent values ranging from 0.62 to 0.99 mSv/Gy at locations downstream of the distal edge. Lateral measurements at depths close to the entrance and along the SOBP plateau were found to reach maximum values of 3.1 mSv/Gy and 5.3 mSv/Gy at 10 mm from the field edge, respectively, and decreased to ~0.04 mSv/Gy 120 mm from the field edge. The ability to measure the dose-equivalent with high spatial resolution is particularly relevant to healthy tissue dose calculations in hadron therapy treatments. We have also shown qualitatively and quantitively the effects critical organ motion would have in treatment using microdosimetric spectra. Large differences in spectra and RBE10 were observed for treatments where miscalculations of 12C ion range would result in critical structures being irradiated, showing the importance of motion management.
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Affiliation(s)
- L Chartier
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - L T Tran
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - D Bolst
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - S Guatelli
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - A Pogossov
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - D A Prokopovich
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Ionising Radiation, Nuclear Stewardship Platform, NSTLI, ANSTO, Lucas Heights, NSW, Australia
| | - M I Reinhard
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Ionising Radiation, Nuclear Stewardship Platform, NSTLI, ANSTO, Lucas Heights, NSW, Australia
| | | | - S Anderson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - C Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - N Matsufuji
- National Institute for Quantum and Radiological Science and Technology, Japan
| | - M Jackson
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- School of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - A B Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
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17
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Tran LT, Worner SP, Hale RJ, Teulon DAJ. Estimating development rate and thermal requirements of Bactericera cockerelli (Hemiptera: Triozidae) reared on potato and tomato by using linear and nonlinear models. Environ Entomol 2012; 41:1190-1198. [PMID: 23068177 DOI: 10.1603/en12124] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The temperature-dependent development of tomato psyllid (also called potato psyllid), Bactericera cockerelli (Sulc), was studied in the laboratory at seven constant temperatures (8, 10, 15, 20, 23, 27, and 31°C), 50-60% RH, and a photoperiod of 16:8 (L:D) h on leaves of whole potato (Solanum tuberosum L.) and tomato (Solanum lycopersicum L.) plants. Developmental time in days for immature stages and total development (egg to adult) on both host species were inversely proportional to temperature between 8 and 27°C but increased at 31°C. One linear and two nonlinear models were fitted to the data. The lower developmental thresholds, calculated using the linear model for egg, total nymph, and total development (from oviposition to adult emergence) were 7.9, 4.2, and 7.1°C (reared on potato) and 7.2, 5.3, and 7.5°C (reared on tomato), respectively. The thermal constant (K) for total development was 358 (reared on potato), and 368 (reared on tomato) degree-days (DD). Two nonlinear models, Briere and Lactin, fit the data well as measured by goodness-of-fit criteria, the residual sum of square (RSS) and Akaike information criterion (AIC). Temperature threshold parameters for these nonlinear models (T(0), T(opt), and T(max)) were estimated for eggs, total nymphal stages, and total development time (egg to adult). The Briere model is highly recommended for the description of temperature-dependent development of tomato psyllid. Results from this study will provide basic information on the biology of tomato psyllid and have potential for the development of predictive models of the seasonal progress of this invasive pest.
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Affiliation(s)
- L T Tran
- Bio-Protection Research Centre, PO Box 84, Lincoln University 7674, Christchurch, New Zealand.
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18
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Tran LT, MacLeod KM, McNeill JH. Endothelin-1 modulates angiotensin II in the development of hypertension in fructose-fed rats. Mol Cell Biochem 2009; 325:89-97. [PMID: 19139972 DOI: 10.1007/s11010-008-0023-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 12/30/2008] [Indexed: 02/07/2023]
Abstract
Two of the most potent vasoconstrictors, endothelin-1 (ET-1) and angiotensin II (Ang II), are upregulated in fructose hypertensive rats. It is unknown whether an interrelationship exists between these peptides that may contribute to the development of fructose-induced hypertension. The objective of this study was to investigate the existence of an interaction between the endothelin and renin angiotensin systems that may play a role in the development of fructose-induced hypertension. High fructose feeding and treatment with either bosentan, a dual endothelin receptor antagonist, or with L-158,809, an angiotensin type 1 receptor antagonist, were initiated simultaneously in male Wistar rats. Systolic blood pressure, fasted plasma parameters, insulin sensitivity, plasma Ang II, and vascular ET-1-immunoreactivity were determined following 6 weeks of high fructose feeding. Rats fed with a high fructose diet exhibited insulin resistance, hyperinsulinemia, hypertriglyceridemia, hypertension, and elevated plasma Ang II. Treatment with either bosentan or L-158,809 significantly attenuated the rise in blood pressure with no effect on insulin levels or insulin sensitivity in fructose-fed rats. Bosentan treatment significantly reduced plasma Ang II levels, while L-158,809 treatment significantly increased vascular ET-1-immunoreactivity in fructose-fed rats. Thus, treatment with the endothelin receptor antagonist prevented the development of fructose-induced hypertension and decreased plasma Ang II levels. These data suggest that ET-1 contributes to the development of fructose-induced hypertension through modulation of Ang II levels.
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Affiliation(s)
- L T Tran
- Division of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences, University of British Columbia, 2146 East Mall, Vancouver, BC, V6T 1Z3, Canada
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19
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Abstract
The purpose of this study was to determine whether decreased day lengths affect reproduction or the immune system in inbred mice. Irrespective of a nocturnal pineal melatonin rise, the signal for day length information, body and testis weights were the same in various strains 8 weeks after transfer from long to short days (16 to 8 h of light/day) compared to mice that remained in long days. Serum testosterone was unaffected by the photoperiod shift. The second goal was to determine whether the shift from long to short days influenced lymphocyte populations in spleen or blood, as well as innate and cell-mediated immune cell functions in C3H/HeN mice, an inbred strain with a robust melatonin rhythm. By flow cytometry, a stable percentage and number of B cells, T cells, and natural killer cells were identified in spleen from mice in both long and short days during the day and night. This complement of immunophenotypes in spleen suggests that equivalent functional capabilities persist in secondary lymphoid tissue of mice irrespective of day length. This was supported by findings that cytolytic activity by splenic natural killer cells (innate immunity) and antigen-induced T cell-dependent B cell antibody production (adaptive immunity) were similar in mice in long and short days. In blood, cell numbers but not helper T cell subset percentages (i.e., naive, memory, cytotoxic, or activated) were augmented in mice in short compared to long days, a consequence of increased circulating B cells. Day length differences in certain immunophenotypes in circulation may forecast photoperiod-mediated alterations in responsiveness to pathogens that are associated with a change in season. At night, the reduced proportion of cytotoxic T cells (long and short days), as well as increases in the percentage of activated T cells (long days), B cells (short days), and NK cell activity (long and short days) relative to daytime, suggests that surveillance and function by select immunophenotypes may adapt to circadian transitions even in highly inbred species. Thus, inbred mice retain capabilities for photoperiod to influence trait-specific aspects of immune cell but not reproductive function.
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Affiliation(s)
- S M Yellon
- Center for Perinatal Biology, Department of Physiology, Loma Linda University School of Medicine, CA 92350, USA.
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20
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Sajjan US, Tran LT, Sole N, Rovaldi C, Akiyama A, Friden PM, Forstner JF, Rothstein DM. P-113D, an antimicrobial peptide active against Pseudomonas aeruginosa, retains activity in the presence of sputum from cystic fibrosis patients. Antimicrob Agents Chemother 2001; 45:3437-44. [PMID: 11709321 PMCID: PMC90850 DOI: 10.1128/aac.45.12.3437-3444.2001] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [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: 11/20/2022] Open
Abstract
Antimicrobial peptides are a source of novel agents that could be useful for treatment of the chronic lung infections that afflict cystic fibrosis (CF) patients. Efficacy depends on antimicrobial activity against the major pathogens of CF patients, Pseudomonas aeruginosa, Staphylococcus aureus, and Haemophilus influenzae, in the environment of the CF patient's airway. We describe the in vitro efficacies of derivatives of histatins, which are histidine-rich peptides produced by the salivary glands of humans and higher primates. P-113, a peptide containing 12 of the 24 amino acid residues of the parent molecule, histatin 5, retained full antibacterial activity and had a good spectrum of activity in vitro against the prominent pathogens of CF patients. However, P-113 was not active in the presence of purulent sputum from CF patients. In contrast, P-113D, the mirror-image peptide with the amino acid residues in the D configuration, was stable in sputum, was as active as P-113 against pathogens of CF patients in the absence of sputum and retained significant activity in the presence of sputum from CF patients. Recombinant human DNase, which effectively liquefies sputum, enhanced the activity of P-113D in undiluted sputum against both exogenous (added) bacteria and endogenous bacteria. Because of its properties, P-113D shows potential as an inhalant in chronic suppressive therapy for CF patients.
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Affiliation(s)
- U S Sajjan
- The Hospital for Sick Children, Toronto, Ontario, Canada
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21
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Prendergast BJ, Yellon SM, Tran LT, Nelson RJ. Photoperiod modulates the inhibitory effect of in vitro melatonin on lymphocyte proliferation in female Siberian hamsters. J Biol Rhythms 2001; 16:224-33. [PMID: 11407782 DOI: 10.1177/074873040101600305] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Siberian hamsters (Phodopus sungorus), short days suppress reproductive function and lymphocyte proliferation. To determine whether melatonin influences cell-mediated immunity through a direct action on lymphocyte proliferation, in vitro responsiveness to mitogens and melatonin was assessed in systemic and splenic lymphocytes from adult female Siberian hamsters housed in either long or short days for 13 weeks. Short days provoked reproductive regression and reduced lymphocyte proliferation. Physiological concentrations of melatonin (50 pg/ml) inhibited in vitro proliferation of circulating lymphocytes, whereas higher concentrations (> or = 500 pg/ml) were required to inhibit proliferation of splenic lymphocytes. Immunomodulatory effects of melatonin were restricted to lymphocytes from long-day hamsters-in vitro melatonin had no effect on circulating or splenic lymphocytes from females in short days. Responsiveness to melatonin in short-day lymphocytes may be restrained by the already expanded nightly pattern of melatonin secretion in short days. These data support the hypothesis that melatonin acts directly on lymphocytes from long-day hamsters to suppress blastogenesis.
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Affiliation(s)
- B J Prendergast
- Department of Psychology and Neuroscience, The Ohio State University, Columbus 43210, USA.
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22
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Rothstein DM, Spacciapoli P, Tran LT, Xu T, Roberts FD, Dalla Serra M, Buxton DK, Oppenheim FG, Friden P. Anticandida activity is retained in P-113, a 12-amino-acid fragment of histatin 5. Antimicrob Agents Chemother 2001; 45:1367-73. [PMID: 11302797 PMCID: PMC90475 DOI: 10.1128/aac.45.5.1367-1373.2001] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Through the analysis of a series of 25 peptides composed of various portions of the histatin 5 sequence, we have identified P-113, a 12-amino-acid fragment of histatin 5, as the smallest fragment that retains anticandidal activity comparable to that of the parent compound. Amidation of the P-113 C terminus increased the anticandidal activity of P-113 approximately twofold. The three histidine residues could be exchanged for three hydrophobic residues, with the fragment retaining anticandidal activity. However, the change of two or more of the five basic (lysine and arginine) residues to uncharged residues resulted in a substantial loss of anticandidal activity. A synthetic D-amino-acid analogue, P-113D, was as active against Candida albicans as the L-amino-acid form. In vitro MIC tests in low-ionic-strength medium showed that P-113 has potent activity against Candida albicans, Candida glabrata, Candida parapsilosis, and Candida tropicalis. These results identify P-113 as a potential antimicrobial agent in the treatment of oral candidiasis.
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Crittenden RG, Morris LF, Harvey ML, Tran LT, Mitchell HL, Playne MJ. Selection of a Bifidobacterium strain to complement resistant starch in a synbiotic yoghurt. J Appl Microbiol 2001; 90:268-78. [PMID: 11168730 DOI: 10.1046/j.1365-2672.2001.01240.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [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: 11/20/2022]
Abstract
AIMS To employ an in vitro screening regime to select a probiotic Bifidobacterium strain to complement resistant starch (Hi-maizetrade mark) in a synbiotic yoghurt. METHODS AND RESULTS Of 40 Bifidobacterium isolates examined, only B. lactis Laftitrade mark B94 possessed all of the required characteristics. This isolate hydrolysed Hi-maizetrade mark, survived well in conditions simulating passage through the gastrointestinal tract and possessed technological properties suitable for yoghurt manufacture. It grew well at temperatures up to 45 degrees C, and grew to a high cell yield in an industrial growth medium. In addition to resistant starch, the organism was able to utilize a range of prebiotics including inulin, and fructo-, galacto-, soybean- and xylo-oligosaccharides. Pulse field gel electrophoresis of restriction enzyme cut chromosomal DNA revealed that B. lactis Laftitrade mark B94 was very closely related to the B. lactis Type Strain (DSM 10140), and to the commercial strains B. lactis Bb-12 and B. lactis DS 920. However, B. lactis Laftitrade mark B94 was the only one of these isolates that could hydrolyse Hi-maizetrade mark. This phenotypic difference did not appear to be due to the presence of plasmid encoded amylase. Bifidobacterium lactis Laftitrade mark B94 survived without substantial loss of viability in synbiotic yoghurt containing Hi-maizetrade mark during storage at 4 degrees C for six weeks. CONCLUSION Bifidobacterium lactis Laftitrade mark B94 is a promising new yoghurt culture that warrants further investigation to assess its probiotic potential. SIGNIFICANCE AND IMPACT OF THE STUDY In vitro screening procedures can be used to integrate complementary probiotic and prebiotic ingredients for new synbiotic functional food products.
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Leung P, Tran LT, Fast AW. A logistic regression of risk factors for disease occurrence on Asian shrimp farms. Dis Aquat Organ 2000; 41:65-76. [PMID: 10907140 DOI: 10.3354/dao041065] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Serious shrimp-disease outbreaks have reduced shrimp production and slowed industry growth since 1991. This paper tests factors such as farm sitting and design, and farm-management practices for relationships with disease occurrence. Logistic regression is used to analyze farm-level data from 3951 shrimp farms in 13 Asian countries. Disease occurrence is modeled as a 0-1 variable where 1 = disease loss of > or = 20% to any 1 crop, and 0 = losses of < 20%. Logistic regression is performed for each of 3 levels of shrimp culture intensity, i.e. extensive, semi-intensive, and intensive. Attempts to apply logistic regression models to each country were not successful due to insufficient data for most countries. Factors affecting disease occurrences were quite different for different farming intensities. Farms that had larger pond production areas, with larger number of farms discharging effluent into their water supply canals, and removed silt had greater disease occurrence. On the other hand, farms that practiced polyculture and took water from the sea through a canal had lower disease occurrence.
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Affiliation(s)
- P Leung
- Department of Biosystems Engineering, University of Hawaii at Manoa, Honolulu 96822, USA.
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25
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Abstract
Candida infections involve multiple risk factors. Among the independent risk factors identified, the degree of colonization of Candida spp. allows the prediction of subsequent severe candidosis in surgical patients. The aim of this study was to assess among 13 selected variables, those that would best predict the perioperative variation of the colonization index (CI) of Candida spp. in cardiovascular surgical patients. The colonization index took into account the number of sites colonized and the density of growth. The results showed that 56.8% of our patients were colonized perioperatively. A total of 116 isolates were identified and Candida albicans accounted for 76.7% of the strains. Among the patients who developed post-surgical Candida infections, 57.1% had an increase of the CI early after the operation. By univariate analysis, three factors were significantly associated with an increase of the CI in patients after surgery; sex (female), the duration of central intravascular catheterization and the length of stay in the surgical intensive care unit (SICU). Epidemiological data could help predict those patients who are at risk of developing Candida infections.
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Affiliation(s)
- L T Tran
- Montreal Heart Institute, Quebec, Canada
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26
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Rau SE, Bend JR, Arnold MO, Tran LT, Spence JD, Bailey DG. Grapefruit juice-terfenadine single-dose interaction: magnitude, mechanism, and relevance. Clin Pharmacol Ther 1997; 61:401-9. [PMID: 9129557 DOI: 10.1016/s0009-9236(97)90190-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the single dose-response effects of grapefruit juice on terfenadine disposition and electrocardiographic measurements. METHODS Twelve healthy males received 250 ml water or regular- or double-strength grapefruit juice with 60 mg terfenadine in a randomized crossover trial. Plasma concentrations of the cardiotoxic agent terfenadine and the active antihistaminic metabolite terfenadine carboxylate were determined over 8 hours. The QTc interval was monitored. RESULTS Terfenadine concentrations were measurable (> 1 ng/ml) in 27 (20%; p < 0.001) and 39 (30%; p < 0.001) samples from individuals treated with regular- and double-strength grapefruit juice, respectively, compared to only four (3%) samples with water. Terfenadine plasma peak drug concentration (Cmax) was also higher. Terfenadine carboxylate area under the plasma drug concentration-time curve (AUC), Cmax, and time to reach Cmax (tmax) were increased by both strengths of juice. However, terfenadine carboxylate apparent elimination half-life (t1/2) was not altered. The magnitude of the interaction of terfenadine carboxylate AUC and Cmax ranged severalfold and correlated among individuals for regular-strength (r2 = 0.87; p < 0.0001) and double-strength (r2 = 0.78; p < 0.0001) grapefruit juice. No differences in the pharmacokinetics of terfenadine and terfenadine carboxylate were observed between the two strengths of grapefruit juice. QTc interval was not altered. CONCLUSIONS A normal amount of regular-strength grapefruit juice produced maximum single-dose effects on terfenadine and carboxylic acid metabolite pharmacokinetics. The mechanism likely involved reduced presystemic drug elimination by inhibition of more than one metabolic pathway. The extent of the interaction was not sufficient to produce electrocardiographic changes. However, the pharmacokinetic effects were highly variable among individuals. This study further enhances the awareness of the potential for a serious interaction between grapefruit juice and terfenadine.
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Affiliation(s)
- S E Rau
- Department of Pharmacology and Toxicology, University of Western Ontario, London, Canada
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27
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Bailey DG, Bend JR, Arnold JM, Tran LT, Spence JD. Erythromycin-felodipine interaction: magnitude, mechanism, and comparison with grapefruit juice. Clin Pharmacol Ther 1996; 60:25-33. [PMID: 8689808 DOI: 10.1016/s0009-9236(96)90163-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate a potentially marked effect by erythromycin on felodipine pharmacokinetics, to characterize the mechanism, and to compare the interaction with that between grapefruit juice and felodipine. METHODS Felodipine, 10 mg extended release, was administered with 250 ml water, 250 mg erythromycin, or 250 ml grapefruit juice in a randomized crossover study of 12 healthy men. Erythromycin base, 250 mg four times a day, was started the day before and continued on that study day. Pharmacokinetic values of felodipine, the primary metabolite dehydrofelodipine, and the major secondary derivative M3 metabolite were studied. RESULTS Compared with water, erythromycin produced severalfold higher felodipine area under the plasma drug concentration-time profile (AUC), plasma peak drug concentration (Cmax), and apparent elimination half-life (t1/2); however, the effect was variable among individuals. Erythromycin augmented dehydrofelodipine AUC, Cmax, and t1/2 but decreased dehydrofelodipine/felodipine ratios. The AUC of the M3 metabolite and the M3 metabolite/dehydrofelodipine ratios were reduced. These findings support inhibition of both metabolic pathways likely mediated by CYP3A4. Grapefruit juice produced similar mean effects but did not prolong felodipine or dehydrofelodipine t1/2. Individually, felodipine AUC with erythromycin was greater than or similar to that with grapefruit juice. Relative felodipine AUC (erythromycin compared with grapefruit juice) correlated with relative felodipine Cmax but not with relative felodipine t1/2, suggesting felodipine AUC differed between these treatments, mainly from factors affecting presystemic drug elimination. CONCLUSIONS Erythromycin produced an important pharmacokinetic interaction with felodipine by inhibition of drug metabolism. Although erythromycin and grapefruit juice shared a common mechanism, erythromycin likely reduced felodipine biotransformation at the gut wall and liver, whereas single-dose grapefruit juice had an effect mainly at the gut wall.
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Affiliation(s)
- D G Bailey
- Victoria Hospital, University of Western Ontario
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28
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Inoue Y, Tran LT, Kamakura M, Izawa S, Miki T, Tsujimoto Y, Kimura A. Oxidative stress response in yeast: glutathione peroxidase of Hansenula mrakii is bound to the membrane of both mitochondria and cytoplasm. Biochim Biophys Acta 1995; 1245:325-30. [PMID: 8541308 DOI: 10.1016/0304-4165(95)00117-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The yeast Hansenula mrakii IFO 0895 induces glutathione peroxidase (GPx) when the cells are exposed to the oxidative stress such as lipid hydroperoxide, superoxide- and hydroxy radical-generating conditions. To clarify the localization of GPx in H. mrakii cell, distribution of the enzyme was investigated. After centrifugation of the yeast protoplast homogenates at 2500 x g for 10 min, 67% of total GPx activity was recovered from the supernatant (Sup. 1) and 33% was from the pellet (Pellet 1). When the Sup. 1 was fractionated by sucrose density gradient ultracentrifugation, GPx activity was essentially recovered from the mitochondria fraction. Submitochondrial localization of the enzyme showed that 95% and 2.5% of the enzyme was recovered from the inner and outer membrane, respectively. No GPx activity was detected neither in intermembrane space nor in matrix of mitochondria. On the other hand, at least 12% of total GPx activity was recovered from the purified plasma membrane which was obtained from the Pellet 1 by successive sucrose density gradient centrifugation. Thus, the GPx of H. mrakii is present in the inner and outer membrane of mitochondria as well as the plasma membrane.
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Affiliation(s)
- Y Inoue
- Research Institute for Food Science, Kyoto University, Japan
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29
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Abstract
An abnormal increase in intestinal paracellular permeability may be an important pathogenic factor in various intestinal diseases. The intracellular factors and processes that regulate and cause alteration of intestinal paracellular permeability are not well understood. The purpose of this study was to examine some of the intracellular processes involved in cytoskeletal regulation of intestinal epithelial paracellular permeability using the filter-grown Caco-2 intestinal epithelial monolayers. Cytochalasin-b and colchicine were used to disrupt the cytoskeletal elements, actin microfilaments, and microtubules. Cytochalasin-b (5 micrograms/ml) and colchicine (2 x 10(-5) M) at the doses used caused marked depolymerization and disruption of actin microfilaments and microtubules, respectively. Cytochalasin-b-induced disruption of actin microfilaments resulted in perturbation of tight junctions and desmosomes and an increase in Caco-2 monolayer paracellular permeability. The cytochalasin-b-induced disruption of actin microfilaments and subsequent changes in intercellular junctional complexes and paracellular permeability were not affected by inhibitors of protein synthesis (actinomycin-D or cycloheximide) or microtubule function (colchicine), but were inhibited by metabolic energy inhibitors (2,4-dinitrophenol or sodium azide). The cytochalasin-b-induced disturbance in Caco-2 actin microfilaments and intercellular junctional complexes and increase in paracellular permeability were rapidly reversed. The paracellular pathway "re-tightening" following cytochalasin-b removal was not affected by actinomycin-D, cycloheximide, or colchicine, but was inhibited by 2,4-dinitrophenol and sodium azide. The colchicine-induced disruption of microtubules did not have significant effect on actin microfilaments, intercellular junctions, or paracellular permeability. These findings suggest that cytochalasin-b-induced increase in Caco-2 monolayer paracellular permeability was due to actin microfilament mediated perturbation of intercellular junctional complexes. The re-tightening of paracellular pathways (following removal of cytochalasin-b) resulted from energy-mediated re-assembly of pre-existing actin microfilaments and intercellular junctional complexes. This re-closure process did not require protein synthesis or microtubule-mediated shuttling process.
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Affiliation(s)
- T Y Ma
- Department of Medicine, Long Beach Veterans Administration Medical Center, California 90822, USA
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30
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Bailey DG, Arnold JM, Bend JR, Tran LT, Spence JD. Grapefruit juice-felodipine interaction: reproducibility and characterization with the extended release drug formulation. Br J Clin Pharmacol 1995; 40:135-40. [PMID: 8562295 PMCID: PMC1365172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
1. Felodipine 10 mg extended release was administered with 250 ml regular-strength grapefruit juice or water in a randomized crossover manner followed by a second grapefruit juice treatment in 12 healthy men. The pharmacokinetics of felodipine and primary oxidative metabolite, dehydrofelodipine, were evaluated. 2. Initial grapefruit juice treatment increased felodipine AUC (mean +/- s.d.; 56.6 +/- 21.9 vs 28.1 +/- 11.5 ng ml-1 h; P < 0.001) and Cmax (8.1 +/- 2.5 vs 3.3 +/- 1.2 ng ml-1; P < 0.001) compared with water. Felodipine tmax (median; 2.8 vs 3.0 h) and t1/2 (7.3 +/- 3.7 vs 6.9 +/- 3.6 h) were not altered. 3. Readministration of felodipine with grapefruit juice produced mean felodipine AUC (61.5 +/- 32.2 ng ml-1 h) and Cmax (8.4 +/- 4.8 ng ml-1) which were similar to the initial grapefruit juice treatment 1-3 weeks previously. Felodipine AUC (r = 0.73, P < 0.01) and Cmax (r = 0.69, P < 0.02) correlated between grapefruit juice treatments among individuals. 4. The % increase in felodipine AUC with the initial grapefruit juice treatment compared with water correlated with the % increase in felodipine Cmax among individuals (r = 0.80, P < 0.01). Dehydrofelodipine AUC (74.7 +/- 28.7 vs 48.5 +/- 16.3 ng ml-1 h; P < 0.01) and Cmax (12.1 +/- 2.9 vs 7.9 +/- 2.6 ng ml-1; P < 0.01) were augmented with grapefruit juice compared with water.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D G Bailey
- Victoria Hospital, University of Western Ontario, London, Canada
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31
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Clement JG, Bailey DG, Madill HD, Tran LT, Spence JD. The acetylcholinesterase oxime reactivator HI-6 in man: pharmacokinetics and tolerability in combination with atropine. Biopharm Drug Dispos 1995; 16:415-25. [PMID: 8527690 DOI: 10.1002/bdd.2510160506] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In a double-blind, placebo-controlled, single-dose ascending pharmacokinetics and tolerance study, we evaluated the bispyridinium oxime HI-6 dichloride monohydrate (62.5, 125, 250, and 500 mg), administered intramuscularly with atropine sulphate, 2 mg, in 24 healthy male volunteers. The plasma HI-6 peak concentration (Cmax) and area under the concentration-time curve (AUC) demonstrated linear pharmacokinetics with low intradose variability, suggestive of uniformity of effect among subjects. HI-6 (500 mg) attained plasma drug concentrations that appeared adequate for practical use as an antidote. The mean +/- SD time to maximum plasma HI-6 concentration (tmax = 0.69 +/- 0.21 h, n = 16), and absorption half-life (t/2a = 0.17 +/- 0.05 h) indicated rapid onset of effect. The volume of distribution (Vd = 0.25 +/- 0.04 L kg-1 TBW) approximated the extracellular fluid volume. A high total body clearance (CL = 252 +/- 52 mL min-1) and short apparent elimination half-life (t/2e = 1.15 +/- 0.19 h) were expected for this polar quaternary ammonium drug. The renal clearance CLr = 137 +/- 33 mL min-1), which approximated the expected glomerular filtration rate, and 24 h urinary excretion of unchanged drug (55 +/- 10%) indicated substantial non-renal elimination. Blood pressure, heart rate, respiratory rate, electrocardiographic parameters, mental acuity, and vision were not altered. Adverse events and changes in serum, urine, and semen laboratory tests were mild. The pharmacokinetics, safety, and apparent efficacy of HI-6 suggest it may be a superior oxime antidote against nerve agent poisoning.
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Affiliation(s)
- J G Clement
- Defence Research Establishment Suffield, Ralston, Alberta, Canada
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32
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Tran LT, Inoue Y, Kimura A. Oxidative stress response in yeast: purification and some properties of a membrane-bound glutathione peroxidase from Hansenula mrakii. Biochim Biophys Acta 1993; 1164:166-72. [PMID: 8329447 DOI: 10.1016/0167-4838(93)90244-l] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Glutathione peroxidase was purified from the total membrane fractions of a yeast, Hansenula mrakii IFO 0895. The purified enzyme gave a single protein band with a molecular mass of 28 kDa on SDS-PAGE. The enzyme showed activity to various lipid hydroperoxides and their methyl esters. The enzyme was also active toward phosphatidylcholine hydroperoxide and cholesterol hydroperoxide. Since the enzyme was not active on hydrogen peroxide, the enzyme was thought to be a kind of glutathione S-transferase, although the purified enzyme did not show the glutathione-conjugating activity with electrophilic compounds such as 1-chloro-2,4-dinitrobenzene and o-dinitrobenzene, which are used as the substrate of glutathione S-transferase in yeast. The glutathione peroxidase in H. mrakii was then suggested to be a novel type of glutathione peroxidase in substrate specificity and intracellular localization, being different from those of other sources purified so far.
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Affiliation(s)
- L T Tran
- Research Institute for Food Science, Kyoto University, Japan
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33
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Inoue Y, Kobayashi S, Yoshikawa K, Tran LT, Kimura A. Lipid hydroperoxide-resistance gene in Saccharomyces cerevisiae: utilization as a selectable marker gene for yeast transformation. Biotechnol Appl Biochem 1993; 17:305-10. [PMID: 8338639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Two kinds of DNA fragments concerned with resistance against lipid hydroperoxide were cloned from the yeast Saccharomyces cerevisiae. When the recombinant plasmid carrying the DNA fragment was introduced into the cells of S. cerevisiae which do not have an appropriate auxotrophic marker, the transformants could be selected by their resistance to t-butyl hydroperoxide. By Southern hybridization analysis, such transformants were found to contain the recombinant plasmid, suggesting that the DNA fragment could be used as a selection marker for the transformation of S. cerevisiae.
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Affiliation(s)
- Y Inoue
- Research Institute for Food Science, Kyoto University, Japan
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Patel JP, Tran LT, Sinai WJ, Carr LJ. Activity of urokinase diluted in 0.9% sodium chloride injection or 5% dextrose injection and stored in glass or plastic syringes. Am J Hosp Pharm 1991; 48:1511-4. [PMID: 1882883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The effects of the diluent, the container, the i.v. set, and the drug concentration on the adsorption of urokinase to i.v. administration systems were studied, along with the compatibility of urokinase with plastic and glass syringes. Solutions of urokinase 1500 and 5000 IU/mL in 0.9% sodium chloride injection and 5% dextrose injection in glass and polyvinyl chloride (PVC) containers were sampled at 2 and 30 minutes. Administration sets were attached to PVC containers containing the urokinase-5% dextrose injection solutions, and samples were collected at 90 and 150 minutes. Glass and polypropylene syringes containing urokinase 5000 IU/mL in 0.9% sodium chloride injection or 5% dextrose injection were sampled at 0, 4, 8, and 24 hours. Urokinase activity was measured by an in vitro clot lysis assay. No urokinase diluted in 0.9% sodium chloride injection adsorbed to glass or PVC containers. For urokinase 1500 IU/mL in 5% dextrose injection, a loss of 15% to 20% occurred almost instantaneously in PVC containers; additional losses to the infusion sets were minimal. However, for urokinase 5000 IU/mL in 5% dextrose injection, no losses were observed in the PVC systems. No drug loss to glass bottles was seen for urokinase 1500 or 5000 IU/mL in 5% dextrose injection. Urokinase potency remained constant in polypropylene and glass syringes for 24 hours. To minimize urokinase sorption to PVC containers, higher concentrations of urokinase diluted in 5% dextrose injection should be used, provided that clinical safety and efficacy are not compromised. The use of 0.9% sodium chloride injection as a diluent also prevents sorption losses.
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Affiliation(s)
- J P Patel
- Sterile Products Section, Abbott Laboratories, North Chicago, IL 60064
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