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Kennedy NA, Janjua M, Chanchlani N, Lin S, Bewshea C, Nice R, McDonald TJ, Auckland C, Harries LW, Davies M, Michell S, Kok KB, Lamb CA, Smith PJ, Hart AL, Pollok RC, Lees CW, Boyton RJ, Altmann DM, Sebastian S, Powell N, Goodhand JR, Ahmad T. Vaccine escape, increased breakthrough and reinfection in infliximab-treated patients with IBD during the Omicron wave of the SARS-CoV-2 pandemic. Gut 2023; 72:295-305. [PMID: 35902214 DOI: 10.1136/gutjnl-2022-327570] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/16/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Antitumour necrosis factor (TNF) drugs impair serological responses following SARS-CoV-2 vaccination. We sought to assess if a third dose of a messenger RNA (mRNA)-based vaccine substantially boosted anti-SARS-CoV-2 antibody responses and protective immunity in infliximab-treated patients with IBD. DESIGN Third dose vaccine induced anti-SARS-CoV-2 spike (anti-S) receptor-binding domain (RBD) antibody responses, breakthrough SARS-CoV-2 infection, reinfection and persistent oropharyngeal carriage in patients with IBD treated with infliximab were compared with a reference cohort treated with vedolizumab from the impaCt of bioLogic therApy on saRs-cov-2 Infection and immuniTY (CLARITY) IBD study. RESULTS Geometric mean (SD) anti-S RBD antibody concentrations increased in both groups following a third dose of an mRNA-based vaccine. However, concentrations were lower in patients treated with infliximab than vedolizumab, irrespective of whether their first two primary vaccine doses were ChAdOx1 nCoV-19 (1856 U/mL (5.2) vs 10 728 U/mL (3.1), p<0.0001) or BNT162b2 vaccines (2164 U/mL (4.1) vs 15 116 U/mL (3.4), p<0.0001). However, no differences in anti-S RBD antibody concentrations were seen following third and fourth doses of an mRNA-based vaccine, irrespective of the combination of primary vaccinations received. Post-third dose, anti-S RBD antibody half-life estimates were shorter in infliximab-treated than vedolizumab-treated patients (37.0 days (95% CI 35.6 to 38.6) vs 52.0 days (95% CI 49.0 to 55.4), p<0.0001).Compared with vedolizumab-treated, infliximab-treated patients were more likely to experience SARS-CoV-2 breakthrough infection (HR 2.23 (95% CI 1.46 to 3.38), p=0.00018) and reinfection (HR 2.10 (95% CI 1.31 to 3.35), p=0.0019), but this effect was uncoupled from third vaccine dose anti-S RBD antibody concentrations. Reinfection occurred predominantly during the Omicron wave and was predicted by SARS-CoV-2 antinucleocapsid concentrations after the initial infection. We did not observe persistent oropharyngeal carriage of SARS-CoV-2. Hospitalisations and deaths were uncommon in both groups. CONCLUSIONS Following a third dose of an mRNA-based vaccine, infliximab was associated with attenuated serological responses and more SARS-CoV-2 breakthrough infection and reinfection which were not predicted by the magnitude of anti-S RBD responses, indicative of vaccine escape by the Omicron variant. TRIAL REGISTRATION NUMBER ISRCTN45176516.
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Affiliation(s)
- Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Malik Janjua
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Neil Chanchlani
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Simeng Lin
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Claire Bewshea
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Rachel Nice
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
- Department of Biochemistry, Exeter Clinical Laboratory International, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Timothy J McDonald
- Department of Biochemistry, Exeter Clinical Laboratory International, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Cressida Auckland
- Department of Microbiology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Lorna W Harries
- Institute of Biomedical and Clinical Sciences, University of Exeter, Exeter, UK
| | - Merlin Davies
- Institute of Biomedical and Clinical Sciences, University of Exeter, Exeter, UK
| | - Stephen Michell
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Klaartje B Kok
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Christopher A Lamb
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational & Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Philip J Smith
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ailsa L Hart
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Richard Cg Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
- Institute for Infection & Immunity, St George's University of London, London, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
- Institute of Genetic and Molecular Medicine, University of Edinburgh Western General Hospital, Edinburgh, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Shaji Sebastian
- IBD Unit, Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Hull York Medical School, University of Hull, Hull, UK
| | - Nicholas Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - James R Goodhand
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
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Lin S, Chanchlani N, Carbery I, Janjua M, Nice R, McDonald TJ, Bewshea C, Kennedy NA, Ahmad T, Selinger CP, Goodhand JR. Understanding anti-TNF treatment failure: does serum triiodothyronine-to-thyroxine (T3/T4) ratio predict therapeutic outcome to anti-TNF therapies in biologic-naïve patients with active luminal Crohn's disease? Aliment Pharmacol Ther 2022; 56:783-793. [PMID: 35768996 PMCID: PMC9540440 DOI: 10.1111/apt.17089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/10/2022] [Accepted: 06/02/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND During illness, adaptations of the hypothalamic-pituitary-thyroid axis reduce energy expenditure, protein catabolism and modulate immune responses to promote survival. Lower serum free triiodothyronine-to-thyroxine (fT3/fT4) ratio has been linked to non-response to treatment in a range of diseases, including in biologic-treated patients with inflammatory bowel disease. AIM To assess whether baseline serum fT3/fT4 ratio predicted primary non-response (PNR) and non-remission to infliximab and adalimumab in patients with Crohn's disease METHODS: Thyroid function tests were undertaken in stored serum from biologic-naïve adult patients with active luminal Crohn's disease immediately prior to treatment with infliximab (427 originator; 122 biosimilar) or adalimumab (448) in the Personalised Anti-TNF Therapy in Crohn's Disease study (PANTS). RESULTS Baseline median [IQR] fT3/fT4 ratios were lower in women than men (0.30 [0.27-0.34] vs 0.32 [0.28-0.36], p < 0.001), in patients with more severe inflammatory disease, and in patients receiving corticosteroids (0.28 [0.25-0.33] vs. 0.32 [0.29-0.36], p < 0.001). Multivariable logistic regression analysis demonstrated that fT3/fT4 ratio was independently associated with PNR at week 14 (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.31-0.85, p = 0.009), but not non-remission or changes in faecal calprotectin concentrations at week 54. The optimal threshold to determine PNR was 0.31 (area under the curve 0.57 [95% CI 0.54-0.61], sensitivity 0.62 [95% CI 0.41-0.74], and specificity 0.53 [95% CI 0.42-0.73]). CONCLUSIONS Lower baseline serum fT3/fT4 ratio was associated with female sex, corticosteroid use and disease activity. It predicted PNR to anti-TNF treatment at week 14, but not non-remission at week 54.
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Affiliation(s)
- Simeng Lin
- GastroenterologyRoyal Devon and Exeter NHS Foundation TrustExeterUK,Exeter Inflammatory Bowel Disease and Pharmacogenetics Research GroupUniversity of ExeterExeterUK
| | - Neil Chanchlani
- GastroenterologyRoyal Devon and Exeter NHS Foundation TrustExeterUK,Exeter Inflammatory Bowel Disease and Pharmacogenetics Research GroupUniversity of ExeterExeterUK
| | - Isabel Carbery
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS TrustLeedsUK,The Leeds Institute of Research at St James'University of LeedsLeedsUK
| | - Malik Janjua
- GastroenterologyRoyal Devon and Exeter NHS Foundation TrustExeterUK,Exeter Inflammatory Bowel Disease and Pharmacogenetics Research GroupUniversity of ExeterExeterUK
| | - Rachel Nice
- Biochemistry, Exeter Clinical Laboratory InternationalRoyal Devon and Exeter NHS Foundation TrustExeterUK
| | - Timothy J. McDonald
- Biochemistry, Exeter Clinical Laboratory InternationalRoyal Devon and Exeter NHS Foundation TrustExeterUK
| | - Claire Bewshea
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research GroupUniversity of ExeterExeterUK
| | - Nicholas A. Kennedy
- GastroenterologyRoyal Devon and Exeter NHS Foundation TrustExeterUK,Exeter Inflammatory Bowel Disease and Pharmacogenetics Research GroupUniversity of ExeterExeterUK
| | - Tariq Ahmad
- GastroenterologyRoyal Devon and Exeter NHS Foundation TrustExeterUK,Exeter Inflammatory Bowel Disease and Pharmacogenetics Research GroupUniversity of ExeterExeterUK
| | - Christian P. Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS TrustLeedsUK,The Leeds Institute of Research at St James'University of LeedsLeedsUK
| | - James R. Goodhand
- GastroenterologyRoyal Devon and Exeter NHS Foundation TrustExeterUK,Exeter Inflammatory Bowel Disease and Pharmacogenetics Research GroupUniversity of ExeterExeterUK
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Lin S, Kennedy NA, Saifuddin A, Sandoval DM, Reynolds CJ, Seoane RC, Kottoor SH, Pieper FP, Lin KM, Butler DK, Chanchlani N, Nice R, Chee D, Bewshea C, Janjua M, McDonald TJ, Sebastian S, Alexander JL, Constable L, Lee JC, Murray CD, Hart AL, Irving PM, Jones GR, Kok KB, Lamb CA, Lees CW, Altmann DM, Boyton RJ, Goodhand JR, Powell N, Ahmad T. Antibody decay, T cell immunity and breakthrough infections following two SARS-CoV-2 vaccine doses in inflammatory bowel disease patients treated with infliximab and vedolizumab. Nat Commun 2022; 13:1379. [PMID: 35296643 PMCID: PMC8927425 DOI: 10.1038/s41467-022-28517-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/26/2022] [Indexed: 12/15/2022] Open
Abstract
Anti tumour necrosis factor (anti-TNF) drugs increase the risk of serious respiratory infection and impair protective immunity following pneumococcal and influenza vaccination. Here we report SARS-CoV-2 vaccine-induced immune responses and breakthrough infections in patients with inflammatory bowel disease, who are treated either with the anti-TNF antibody, infliximab, or with vedolizumab targeting a gut-specific anti-integrin that does not impair systemic immunity. Geometric mean [SD] anti-S RBD antibody concentrations are lower and half-lives shorter in patients treated with infliximab than vedolizumab, following two doses of BNT162b2 (566.7 U/mL [6.2] vs 4555.3 U/mL [5.4], p <0.0001; 26.8 days [95% CI 26.2 - 27.5] vs 47.6 days [45.5 - 49.8], p <0.0001); similar results are also observed with ChAdOx1 nCoV-19 vaccination (184.7 U/mL [5.0] vs 784.0 U/mL [3.5], p <0.0001; 35.9 days [34.9 - 36.8] vs 58.0 days [55.0 - 61.3], p value < 0.0001). One fifth of patients fail to mount a T cell response in both treatment groups. Breakthrough SARS-CoV-2 infections are more frequent (5.8% (201/3441) vs 3.9% (66/1682), p = 0.0039) in patients treated with infliximab than vedolizumab, and the risk of breakthrough SARS-CoV-2 infection is predicted by peak anti-S RBD antibody concentration after two vaccine doses. Irrespective of the treatments, higher, more sustained antibody levels are observed in patients with a history of SARS-CoV-2 infection prior to vaccination. Our results thus suggest that adapted vaccination schedules may be required to induce immunity in at-risk, anti-TNF-treated patients.
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Affiliation(s)
- Simeng Lin
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Aamir Saifuddin
- Department of Gastroenterology, St Marks Hospital and Academic Institute, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | | | | - Rocio Castro Seoane
- Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Sherine H Kottoor
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | | - Kai-Min Lin
- Department of Infectious Disease, Imperial College London, London, UK
| | - David K Butler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Neil Chanchlani
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Rachel Nice
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
- Department of Biochemistry, Exeter Clinical Laboratory International, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Desmond Chee
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Claire Bewshea
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Malik Janjua
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Timothy J McDonald
- Department of Biochemistry, Exeter Clinical Laboratory International, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Shaji Sebastian
- IBD Unit, Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Hull York Medical School, University of Hull, Hull, UK
| | - James L Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Laura Constable
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - James C Lee
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
- Genetic Mechanisms of Disease Laboratory, The Francis Crick Institute, London, UK
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Charles D Murray
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | - Ailsa L Hart
- Department of Gastroenterology, St Marks Hospital and Academic Institute, London, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Gareth-Rhys Jones
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK
- Centre for Inflammation Research, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Klaartje B Kok
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Christopher A Lamb
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK
- Institute of Genetic and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK
- Lung Division, Royal Brompton Hospital and Harefield Hospitals, London, UK
| | - James R Goodhand
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK.
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Janjua M, Knuiman M, Divitini M, McQuillan B, Olynyk JK, Jeffrey GP, Adams LA. Alcohol Consumption and Cardiovascular Outcomes in Patients With Nonalcoholic Fatty Liver Disease: A Population-Based Cohort Study. Hepatol Commun 2022; 6:526-534. [PMID: 34931492 PMCID: PMC8870048 DOI: 10.1002/hep4.1828] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Low-level alcohol consumption is associated with reduced cardiovascular disease (CVD) in the general population. It is unclear whether this association is seen in patients with nonalcoholic fatty liver disease (NAFLD) who have an increased risk of CVD. We examined the association between alcohol consumption and CVD-related outcomes in subjects with NAFLD from a general population cohort. Subjects participating in the 1994-1995 Busselton Health survey underwent clinical and biochemical assessment. NAFLD was identified using the Fatty Liver Index of >60, and alcohol consumption quantified using a validated questionnaire. CVD hospitalizations and death during the ensuing 20 years were ascertained using the Western Australian data linkage system. A total of 659 of 4,843 patients were diagnosed with NAFLD. The average standard drinks per week was 8.0 for men and 4.0 for women. Men consuming 8-21 drinks per week had a 38% (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.43-0.90) lower risk of CVD hospitalization as compared with men consuming 1-7 drinks per week. With both men and women combined, consumption of 8-21 drinks per week was associated with a 32% (HR 0.68, 95% CI 0.49-0.93) reduction in CVD hospitalization in minimally adjusted and 29% (HR 0.71, 95% CI 0.51-0.99) in fully adjusted models. No protective association was observed with binge drinking. There was no association between alcohol consumption and CVD death. Conclusion: Low to moderate alcohol consumption is associated with fewer CVD hospitalizations but not CVD death in subjects with NAFLD.
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Affiliation(s)
- Malik Janjua
- Department of HepatologySir Charles Gairdner HospitalNedlandsWAAustralia
| | - Matthew Knuiman
- School of Population and global HealthUniversity of Western AustraliaNedlandsWAAustralia
| | - Mark Divitini
- School of Population and global HealthUniversity of Western AustraliaNedlandsWAAustralia
| | - Brendan McQuillan
- Medical SchoolUniversity of Western AustraliaNedlandsWAAustralia.,Department of Cardiovascular MedicineSir Charles Gairdner HospitalNedlandsWAAustralia
| | - John K Olynyk
- Department of GastroenterologyFiona Stanley HospitalMurdochWAAustralia.,School of Medical and Health SciencesEdith Cowan UniversityJoondalupWAAustralia
| | - Gary P Jeffrey
- Department of HepatologySir Charles Gairdner HospitalNedlandsWAAustralia.,Medical SchoolUniversity of Western AustraliaNedlandsWAAustralia
| | - Leon A Adams
- Department of HepatologySir Charles Gairdner HospitalNedlandsWAAustralia.,Medical SchoolUniversity of Western AustraliaNedlandsWAAustralia
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Singh P, Hossain M, Gurupatham SK, Shah K, Amah E, Ju D, Janjua M, Nudurupati S, Fischer I. Molecular-like hierarchical self-assembly of monolayers of mixtures of particles. Sci Rep 2014; 4:7427. [PMID: 25510331 PMCID: PMC4267201 DOI: 10.1038/srep07427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/19/2014] [Indexed: 11/09/2022] Open
Abstract
We present a technique that uses an externally applied electric field to self-assemble monolayers of mixtures of particles into molecular-like hierarchical arrangements on fluid-liquid interfaces. The arrangements consist of composite particles (analogous to molecules) which are arranged in a pattern. The structure of a composite particle depends on factors such as the relative sizes of the particles and their polarizabilities, and the electric field intensity. If the particles sizes differ by a factor of two or more, the composite particle has a larger particle at its core and several smaller particles form a ring around it. The number of particles in the ring and the spacing between the composite particles depend on their polarizabilities and the electric field intensity. Approximately same sized particles form chains (analogous to polymeric molecules) in which positively and negatively polarized particles alternate.
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Affiliation(s)
- P Singh
- Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, 200 Central Avenue, Newark, NJ 07102
| | - M Hossain
- Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, 200 Central Avenue, Newark, NJ 07102
| | - S K Gurupatham
- Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, 200 Central Avenue, Newark, NJ 07102
| | - K Shah
- Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, 200 Central Avenue, Newark, NJ 07102
| | - E Amah
- Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, 200 Central Avenue, Newark, NJ 07102
| | - D Ju
- Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, 200 Central Avenue, Newark, NJ 07102
| | - M Janjua
- Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, 200 Central Avenue, Newark, NJ 07102
| | - S Nudurupati
- Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, 200 Central Avenue, Newark, NJ 07102
| | - I Fischer
- Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, 200 Central Avenue, Newark, NJ 07102
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Badshah A, Janjua M, Younas F, DeGregorio M, Halabi A, Cotant J. Long fusiform aneurysm. Neth Heart J 2010; 18:45-46. [PMID: 20111644 PMCID: PMC2810036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- A. Badshah
- Department of Internal Medicine, Saint Joseph Mercy-Oakland; Pontiac, MI, USA
| | - M. Janjua
- Department of Internal Medicine, Saint Joseph Mercy-Oakland; Pontiac, MI, USA
| | - F. Younas
- Department of Internal Medicine, Saint Joseph Mercy-Oakland; Pontiac, MI, USA
| | - M. DeGregorio
- Department of Cardiology, Saint Joseph Mercy-Oakland. Pontiac, MI, USA
| | - A.R. Halabi
- Department of Cardiology, Saint Joseph Mercy-Oakland. Pontiac, MI, USA
| | - J.F. Cotant
- Department of Cardiology, Saint Joseph Mercy-Oakland. Pontiac, MI, USA
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Nudurupati S, Janjua M, Singh P, Aubry N. Electrohydrodynamic removal of particles from drop surfaces. Phys Rev E Stat Nonlin Soft Matter Phys 2009; 80:010402. [PMID: 19658639 DOI: 10.1103/physreve.80.010402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 05/11/2009] [Indexed: 05/28/2023]
Abstract
A uniform electric field is used for cleaning drops of the particles they often carry on their surface. In a first step, particles migrate to either the drop's poles or equator. This is due to the presence of an electrostatic force for which an analytical expression is derived. In a second step, particles concentrated near the poles are released into the ambient liquid via tip streaming, and those near the equator are removed by stretching the drop and breaking it into several droplets. In the latter case, particles are all concentrated in a small middle daughter droplet.
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Affiliation(s)
- S Nudurupati
- Department of Mechanical Engineering, New Jersey Institute of Technology, Newark, New Jersey 07102, USA
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Kloecker GH, Janjua M, Day J, Lee D. Expectations of cancer patients about clinical trials in multidisciplinary clinics. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e17563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17563 Background: Progress in cancer treatment is very much dependent on the effective interaction of several specialties. To facilitate the process, more and more multidisciplinary clinics have been created over the last decade, especially in academic settings. This approach has been more established in the academic setting to help facilitate better patient accrual to clinical trials. Although there are studies confirming the effectiveness of this approach in fulfilling practice guidelines, there is however no study of patients’ expectations at a multidisciplinary clinic, especially in regard to the patients’ attitude towards clinical trials. This study examines patients’ preferences for services offered in an academic Methods: Surveys were handed to patients at the time of the first clinic visit and at time of progressive disease. The surveys were designed as a self directed questionnaire with the following questions that were rated on an ordinate scale from not at all important (score 1) to extremely important value (score 7): to see all doctors the same day; to be treated at a university-based cancer center; to have everything completely explained; to have the first appointment within 10 days; to know your cases will be discussed at conference; to have help with transportation and medical costs; and to participate in clinical trials. Results: 94 patients were surveyed at the GI and Thoracic Multimodality Clinic. Among patients the highest preference was “to have every thing explained,” score 6.7 (6.5–7.0, CI), immediately followed by the discussion at the multidisciplinary conference, score 6.6 (6.5–6.8, CI). Clinical trials ranked lowest, score 4.8 (4.4–5.2,CI). The difference was statistically significant, p = 0.012. There was no difference between GI and Thoracic Multimodality Clinic patients. Patients with progressive cancers showed a slightly higher interest in clinical trials, but still ranking trials below most other services. Conclusions: Patients value complete explanations of the disease and management plan far more than they value clinical trials. Considering that nationwide less than 5% of cancer patients are enrolled in clinical studies, it is important for physicians to explain the merit of clinical trials to patients and public. No significant financial relationships to disclose.
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Affiliation(s)
| | - M. Janjua
- University of Louisville, Louisville, KY
| | - J. Day
- University of Louisville, Louisville, KY
| | - D. Lee
- University of Louisville, Louisville, KY
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Ilyas M, Peracha MA, Ahmad R, Khan N, Ali N, Janjua M. Prevalence and pattern of rheumatic heart disease in the frontier province of Pakistan. J Pak Med Assoc 1979; 29:165-8. [PMID: 117145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ilyas M, Jafary MH, Peracha MA, Janjua M, Khan N. Double blind trial of propranolol and pindolol in angina pectoris. J PAK MED ASSOC 1975; 25:165-6. [PMID: 815634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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