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Joeres M, Maksimov P, Höper D, Calvelage S, Calero-Bernal R, Fernández-Escobar M, Koudela B, Blaga R, Vrhovec MG, Stollberg K, Bier N, Sotiraki S, Sroka J, Piotrowska W, Kodym P, Basso W, Conraths FJ, Mercier A, Galal L, Dardé ML, Balea A, Spano F, Schulze C, Peters M, Scuda N, Lundén A, Davidson RK, Terland R, Waap H, de Bruin E, Vatta P, Caccio S, Ortega-Mora LM, Jokelainen P, Schares G. Genotyping of European Toxoplasma gondii strains by a new high-resolution next-generation sequencing-based method. Eur J Clin Microbiol Infect Dis 2024; 43:355-371. [PMID: 38099986 PMCID: PMC10822014 DOI: 10.1007/s10096-023-04721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/16/2023] [Indexed: 01/28/2024]
Abstract
PURPOSE A new high-resolution next-generation sequencing (NGS)-based method was established to type closely related European type II Toxoplasma gondii strains. METHODS T. gondii field isolates were collected from different parts of Europe and assessed by whole genome sequencing (WGS). In comparison to ME49 (a type II reference strain), highly polymorphic regions (HPRs) were identified, showing a considerable number of single nucleotide polymorphisms (SNPs). After confirmation by Sanger sequencing, 18 HPRs were used to design a primer panel for multiplex PCR to establish a multilocus Ion AmpliSeq typing method. Toxoplasma gondii isolates and T. gondii present in clinical samples were typed with the new method. The sensitivity of the method was tested with serially diluted reference DNA samples. RESULTS Among type II specimens, the method could differentiate the same number of haplotypes as the reference standard, microsatellite (MS) typing. Passages of the same isolates and specimens originating from abortion outbreaks were identified as identical. In addition, seven different genotypes, two atypical and two recombinant specimens were clearly distinguished from each other by the method. Furthermore, almost all SNPs detected by the Ion AmpliSeq method corresponded to those expected based on WGS. By testing serially diluted DNA samples, the method exhibited a similar analytical sensitivity as MS typing. CONCLUSION The new method can distinguish different T. gondii genotypes and detect intra-genotype variability among European type II T. gondii strains. Furthermore, with WGS data additional target regions can be added to the method to potentially increase typing resolution.
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Affiliation(s)
- M Joeres
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Greifswald - Insel Riems, Germany
| | - P Maksimov
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Greifswald - Insel Riems, Germany
| | - D Höper
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Diagnostic Virology, Greifswald - Insel Riems, Germany
| | - S Calvelage
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Diagnostic Virology, Greifswald - Insel Riems, Germany
| | - R Calero-Bernal
- SALUVET, Animal Health Department, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - M Fernández-Escobar
- SALUVET, Animal Health Department, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - B Koudela
- Central European Institute of Technology (CEITEC), University of Veterinary Sciences Brno, Brno, Czech Republic
- Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Brno, Czech Republic
| | - R Blaga
- Anses, INRAE, Ecole Nationale Vétérinaire d'Alfort, Laboratoire de Santé Animale, BIPAR, Maisons-Alfort, France
- University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania
| | | | - K Stollberg
- German Federal Institute for Risk Assessment, Department for Biological Safety, Berlin, Germany
| | - N Bier
- German Federal Institute for Risk Assessment, Department for Biological Safety, Berlin, Germany
| | - S Sotiraki
- Veterinary Research Institute, Hellenic Agricultural Organisation-DIMITRA, Thessaloniki, Greece
| | - J Sroka
- Department of Parasitology and Invasive Diseases, National Veterinary Research Institute, Pulawy, Poland
| | - W Piotrowska
- Department of Parasitology and Invasive Diseases, National Veterinary Research Institute, Pulawy, Poland
| | - P Kodym
- Centre of Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - W Basso
- Institute of Parasitology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - F J Conraths
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Greifswald - Insel Riems, Germany
| | - A Mercier
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Centre National de Référence (CNR) Toxoplasmose Centre Hospitalier-Universitaire Dupuytren, Limoges, France
| | - L Galal
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - M L Dardé
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Centre National de Référence (CNR) Toxoplasmose Centre Hospitalier-Universitaire Dupuytren, Limoges, France
| | - A Balea
- University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Faculty of Veterinary Medicine, Department of Parasitology and Parasitic Diseases, Cluj-Napoca, Romania
| | - F Spano
- Italian National Institute of Health, Rome, Italy
| | - C Schulze
- Landeslabor Berlin-Brandenburg, Frankfurt (Oder), Germany
| | - M Peters
- Chemisches und Veterinäruntersuchungsamt Westfalen, Standort Arnsberg, Arnsberg, Germany
| | - N Scuda
- Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - A Lundén
- Department of Microbiology, National Veterinary Institute, Uppsala, Sweden
| | - R K Davidson
- Department of Animal Health, Welfare and Food Safety, Norwegian Veterinary Institute, Tromsø, Norway
| | - R Terland
- Department of Analysis and Diagnostics, Norwegian Veterinary Institute, Ås, Norway
| | - H Waap
- Parasitology Laboratory, Instituto Nacional de Investigação Agrária e Veterinária, Oeiras, Portugal
| | - E de Bruin
- Dutch Wildlife Health Centre, Pathology Division, Department of Pathobiology, Faculty of Veterinary Medicine, University of Utrecht, Utrecht, The Netherlands
| | - P Vatta
- Italian National Institute of Health, Rome, Italy
| | - S Caccio
- Italian National Institute of Health, Rome, Italy
| | - L M Ortega-Mora
- SALUVET, Animal Health Department, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - P Jokelainen
- Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - G Schares
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Greifswald - Insel Riems, Germany.
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2
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van Sleeuwen D, de Man S, Zegers M, Akkermans R, Ricking M, Peters M, van den Boogaard M, van de Laar FA. Post-intensive care syndrome in primary care: The development of new diseases and primary care services utilisation - a prospective cohort study. Eur J Gen Pract 2023; 29:2213476. [PMID: 37248989 DOI: 10.1080/13814788.2023.2213476] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Patients experience long-lasting health problems defined as post-intensive care syndrome (PICS) after Intensive Care Unit (ICU) admission. Little is known about PICS in primary care. OBJECTIVES To investigate whether ICU survivors encounter more new International Classification of Primary Care-2 (ICPC-2) diagnoses and general practitioner (GP) contact compared to patients with similar comorbidity without ICU admission. METHODS Prospective multicentre cohort study in three Dutch general practices. Numbers of disease-episodes and GP contacts of ICU survivors ≥ 16 years admitted between 2008 and 2017 were extracted from GPs' information systems. A non-ICU reference cohort was matched 1:1 for age, sex, follow-up period and comorbidity groups from patients' medical history. Negative binominal regression analysis was used to compare both cohorts 0-3, 3-6, 6-12 months, 1-2 and 2-5 years after ICU admission and 1 year prior to admission. RESULTS ICU survivors (n = 199) encountered more new disease-episodes 1 year before (mean 3.97 (95% confidence interval [CI] 3.50-4.52]]; reference 2.36 [1.28-3.17]) to 2-5 years after ICU admission (3.65 [3.15-4.26]; reference 2.86 [2.52-3.22]). ICU survivors also had more GP contacts 1 year before (mean 19.61 [17.31-22.17]; reference 10.02 [7.81-12.38]) to 2-5 years after ICU admission (18.53 [15.58-21.85]; reference 12.03 [10.33-13.91]). Patients with prior ICU admission did not encounter patterns in specific ICPC-2 chapters compared to non-ICU patients. CONCLUSION Patients admitted to the ICU encounter more new primary care disease-episodes and GP contacts. As patients present their symptoms to their GP first, it is therefore up to the GP to recognise these critical illness-related symptoms.
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Affiliation(s)
- Dries van Sleeuwen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Science, Nijmegen, the Netherlands
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Science, Nijmegen, the Netherlands
| | - Sabine de Man
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Science, Nijmegen, the Netherlands
| | - Marieke Zegers
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Science, Nijmegen, the Netherlands
| | - Reinier Akkermans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Care, Nijmegen, the Netherlands
| | - Michael Ricking
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Care, Nijmegen, the Netherlands
| | - Marco Peters
- Department of Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Science, Nijmegen, the Netherlands
| | - Floris A van de Laar
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Science, Nijmegen, the Netherlands
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Poelchen G, Hellwig J, Peters M, Usachov DY, Kliemt K, Laubschat C, Echenique PM, Chulkov EV, Krellner C, Parkin SSP, Vyalikh DV, Ernst A, Kummer K. Long-lived spin waves in a metallic antiferromagnet. Nat Commun 2023; 14:5422. [PMID: 37669952 PMCID: PMC10480465 DOI: 10.1038/s41467-023-40963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
Collective spin excitations in magnetically ordered crystals, called magnons or spin waves, can serve as carriers in novel spintronic devices with ultralow energy consumption. The generation of well-detectable spin flows requires long lifetimes of high-frequency magnons. In general, the lifetime of spin waves in a metal is substantially reduced due to a strong coupling of magnons to the Stoner continuum. This makes metals unattractive for use as components for magnonic devices. Here, we present the metallic antiferromagnet CeCo2P2, which exhibits long-living magnons even in the terahertz (THz) regime. For CeCo2P2, our first-principle calculations predict a suppression of low-energy spin-flip Stoner excitations, which is verified by resonant inelastic X-ray scattering measurements. By comparison to the isostructural compound LaCo2P2, we show how small structural changes can dramatically alter the electronic structure around the Fermi level leading to the classical picture of the strongly damped magnons intrinsic to metallic systems. Our results not only demonstrate that long-lived magnons in the THz regime can exist in bulk metallic systems, but they also open a path for an efficient search for metallic magnetic systems in which undamped THz magnons can be excited.
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Affiliation(s)
- G Poelchen
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38043, Grenoble, France.
- Institut für Festkörper- und Materialphysik, Technische Universität Dresden, 01062, Dresden, Germany.
- Max Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187, Dresden, Germany.
| | - J Hellwig
- Kristall- und Materiallabor, Physikalisches Institut, Goethe-Universität Frankfurt, Max-von-Laue Strasse 1, 60438, Frankfurt am Main, Germany
| | - M Peters
- Kristall- und Materiallabor, Physikalisches Institut, Goethe-Universität Frankfurt, Max-von-Laue Strasse 1, 60438, Frankfurt am Main, Germany
| | - D Yu Usachov
- Donostia International Physics Center (DIPC), 20018, Donostia-San Sebastián, Spain
| | - K Kliemt
- Kristall- und Materiallabor, Physikalisches Institut, Goethe-Universität Frankfurt, Max-von-Laue Strasse 1, 60438, Frankfurt am Main, Germany
| | - C Laubschat
- Institut für Festkörper- und Materialphysik, Technische Universität Dresden, 01062, Dresden, Germany
| | - P M Echenique
- Donostia International Physics Center (DIPC), 20018, Donostia-San Sebastián, Spain
- IKERBASQUE, Basque Foundation for Science, 48011, Bilbao, Spain
| | - E V Chulkov
- Donostia International Physics Center (DIPC), 20018, Donostia-San Sebastián, Spain
- Centro de Física de Materiales (CFM-MPC), Centro Mixto CSIC-UPV/EHU, 20018, Donostia-San Sebastián, Spain
- Departamento de Polímeros y Materiales Avanzados: Física, Química y Tecnología, Facultad de Ciencias Químicas, Universidad del País Vasco UPV/EHU, 20080, Donostia-San Sebastián, Spain
| | - C Krellner
- Kristall- und Materiallabor, Physikalisches Institut, Goethe-Universität Frankfurt, Max-von-Laue Strasse 1, 60438, Frankfurt am Main, Germany
| | - S S P Parkin
- Max-Planck-Institut für Mikrostrukturphysik, Weinberg 2, 06120, Halle, Germany
| | - D V Vyalikh
- Donostia International Physics Center (DIPC), 20018, Donostia-San Sebastián, Spain
- IKERBASQUE, Basque Foundation for Science, 48011, Bilbao, Spain
| | - A Ernst
- Max-Planck-Institut für Mikrostrukturphysik, Weinberg 2, 06120, Halle, Germany
- Institut für Theoretische Physik, Johannes Kepler Universität, 4040, Linz, Austria
| | - K Kummer
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38043, Grenoble, France.
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4
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Kahharova D, Pappalardo VY, Buijs MJ, de Menezes RX, Peters M, Jackson R, Hara AT, Eckert G, Katz B, Keels MA, Levy SM, Zaura E, Brandt BW, Fontana M. Microbial Indicators of Dental Health, Dysbiosis, and Early Childhood Caries. J Dent Res 2023:220345231160756. [PMID: 37042041 DOI: 10.1177/00220345231160756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Dental caries lesions are a clinical manifestation of disease, preceded by microbial dysbiosis, which is poorly characterized and thought to be associated with saccharolytic taxa. Here, we assessed the associations between the oral microbiome of children and various caries risk factors such as demographics and behavioral and clinical data across early childhood and characterized over time the salivary and dental plaque microbiome of children before clinical diagnosis of caries lesions. Children (N = 266) were examined clinically at ~1, 2.5, 4, and 6.5 y of age. The microbiome samples were collected at 1, 2.5, and 4 y. Caries groups consisted of children who remained caries free (International Caries Detection and Assessment System [ICDAS] = 0) at all time points (CFAT) (n = 50); children diagnosed with caries (ICDAS ≥ 1) at 6.5 y (C6.5), 4 y (C4), or 2.5 y of age (C2.5); and children with early caries or advanced caries lesions at specific time points. Microbial community analyses were performed on zero-radius operational taxonomic units (zOTUs) obtained from V4 of 16S ribosomal RNA gene amplicon sequences. The oral microbiome of the children was affected by various factors, including antibiotic use, demographics, and dietary habits of the children and their caregivers. At all time points, various risk factors explained more of the variation in the dental plaque microbiome than in saliva. At 1 y, composition of saliva of the C4 group differed from that of the CFAT group, while at 2.5 y, this difference was observed only in plaque. At 4 y, multiple salivary and plaque zOTUs of genera Prevotella and Leptotrichia were significantly higher in samples of the C6.5 group than those of the CFAT group. In conclusion, up to 3 y prior to clinical caries detection, the oral microbial communities were already in a state of dysbiosis that was dominated by proteolytic taxa. Plaque discriminated dysbiotic oral ecosystems from healthy ones better than saliva.
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Affiliation(s)
- D Kahharova
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - V Y Pappalardo
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M J Buijs
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R X de Menezes
- Biostatistics Centre, Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Peters
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan, Ann Arbor, MI, USA
| | - R Jackson
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University, Indianapolis, IN, USA
| | - A T Hara
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University, Indianapolis, IN, USA
| | - G Eckert
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, IN, USA
| | - B Katz
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, IN, USA
| | - M A Keels
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - S M Levy
- Department of Preventive and Community Dentistry, College of Dentistry and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - E Zaura
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - B W Brandt
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M Fontana
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan, Ann Arbor, MI, USA
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Sealy M, Fopma K, Peters M, Mulder P, Jager-Wittenaar H. Do Dutch Primary Care Dietitians Advice Medical Nutrition As Recommended By The National Malnutrition Guideline? Preliminary Results From The Monday Study. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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6
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Naaktgeboren R, Zegers M, Peters M, Akkermans R, Peters H, van den Boogaard M, van de Laar FA. The impact of an intensive care unit admission on the health status of relatives of intensive care survivors: A prospective cohort study in primary care. Eur J Gen Pract 2022; 28:48-55. [PMID: 35388714 PMCID: PMC9004533 DOI: 10.1080/13814788.2022.2057947] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Relatives of intensive care unit (ICU) survivors may suffer from various symptoms after ICU admittance of their relative, known as post-intensive care syndrome-family (PICS-F). Studies regarding PICS-F have been performed but its impact in primary care is unknown. Objectives To explore health problems of relatives of ICU survivors in primary care. Methods This is an exploratory prospective cohort study in which we combined data from two hospitals and a primary care research network in the Netherlands. ICU survivors who had been admitted between January 2005 and July 2017 were identified and matched by sex and age with up to four chronically ill (e.g. COPD, cardiovascular disease) patients. In both groups, relatives living in the same household were identified and included in this study. Primary outcome was the number of new episodes of care (International Classification of Primary Care-2) for up to five years. Hazard ratios (HRs) for the total number of new episodes were calculated. Results Relatives of ICU survivors (n = 267, mean age 38.1 years, 41.0% male) had significantly more new care episodes compared to the reference group (n = 705, mean age 36.3 years, 41.1% male) 1–2 years (median 0.11 vs. 0.08, HR 1.26; 95% confidence interval (CI) 1.03–1.54) and 2–5 years (median 0.18 vs. 0.13, HR 1.28; 95%CI 1.06–1.56) after ICU discharge. No differences were found in the period before ICU admission. Conclusion Relatives of ICU survivors present more morbidity in primary care than relatives of chronically ill patients up to five years after ICU discharge.
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Affiliation(s)
- Rick Naaktgeboren
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marco Peters
- Department of Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Peters
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris A van de Laar
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Smit JM, Exterkate L, van Tienhoven AJ, Haaksma ME, Heldeweg MLA, Fleuren L, Thoral P, Dam TA, Heunks LMA, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, Vlaar AP, Dongelmans DA, de Jong R, Peters M, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Arbous S, Vonk B, Machado T, Girbes ARJ, Sieswerda E, Elbers PWG, Tuinman PR. INCIDENCE, RISK FACTORS, AND OUTCOME OF SUSPECTED CENTRAL VENOUS CATHETER-RELATED INFECTIONS IN CRITICALLY ILL COVID-19 PATIENTS: A MULTICENTER RETROSPECTIVE COHORT STUDY. Shock 2022; 58:358-365. [PMID: 36155964 DOI: 10.1097/shk.0000000000001994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ABSTRACT Background: Aims of this study were to investigate the prevalence and incidence of catheter-related infection, identify risk factors, and determine the relation of catheter-related infection with mortality in critically ill COVID-19 patients. Methods: This was a retrospective cohort study of central venous catheters (CVCs) in critically ill COVID-19 patients. Eligible CVC insertions required an indwelling time of at least 48 hours and were identified using a full-admission electronic health record database. Risk factors were identified using logistic regression. Differences in survival rates at day 28 of follow-up were assessed using a log-rank test and proportional hazard model. Results: In 538 patients, a total of 914 CVCs were included. Prevalence and incidence of suspected catheter-related infection were 7.9% and 9.4 infections per 1,000 catheter indwelling days, respectively. Prone ventilation for more than 5 days was associated with increased risk of suspected catheter-related infection; odds ratio, 5.05 (95% confidence interval 2.12-11.0). Risk of death was significantly higher in patients with suspected catheter-related infection (hazard ratio, 1.78; 95% confidence interval, 1.25-2.53). Conclusions: This study shows that in critically ill patients with COVID-19, prevalence and incidence of suspected catheter-related infection are high, prone ventilation is a risk factor, and mortality is higher in case of catheter-related infection.
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Affiliation(s)
| | - Lotte Exterkate
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | | | | | | | - Lucas Fleuren
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Patrick Thoral
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Tariq A Dam
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Leo M A Heunks
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Olaf L Cremer
- Intensive Care, UMC Utrecht, Utrecht, the Netherlands
| | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alexander P Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Remko de Jong
- Intensive Care, Bovenij Ziekenhuis, Amsterdam, the Netherlands
| | - Marco Peters
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Marlijn J A Kamps
- Intensive Care, Catharina Ziekenhuis Eindhoven, Eindhoven, the Netherlands
| | | | - Ralph Nowitzky
- Intensive Care, HagaZiekenhuis, Den Haag, the Netherlands
| | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | | | - Ellen G M Smit
- Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, the Netherlands
| | | | - Tom Dormans
- Intensive care, Zuyderland MC, Heerlen, the Netherlands
| | | | | | | | | | - Auke C Reidinga
- ICU, SEH, BWC, Martiniziekenhuis, Groningen, the Netherlands
| | | | - Gert B Brunnekreef
- Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Alexander D Cornet
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Walter van den Tempel
- Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, the Netherlands
| | - Age D Boelens
- Anesthesiology, Antonius Ziekenhuis Sneek, Sneek, the Netherlands
| | - Peter Koetsier
- Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands
| | - Judith Lens
- ICU, IJsselland Ziekenhuis, Capelle aan den IJssel, the Netherlands
| | | | - A Karakus
- Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Robert Entjes
- Department of Intensive Care, Adrz, Goes, the Netherlands
| | - Paul de Jong
- Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, the Netherlands
| | - Thijs C D Rettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Ziekenhuis, Breda, the Netherlands
| | - Sesmu Arbous
- Department of Intensive Care, LUMC, Leiden, the Netherlands
| | - Bas Vonk
- Pacmed, Amsterdam, the Netherlands
| | | | - Armand R J Girbes
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Elske Sieswerda
- Department of Medical Microbiology, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Paul W G Elbers
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
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8
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Nadalin S, Peters M, Königsrainer A. [Liver metastases of neuroendocrine tumors]. Chirurgie (Heidelb) 2022; 93:659-666. [PMID: 35713676 DOI: 10.1007/s00104-022-01656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
Neuroendocrine liver metastases (NELM) are very heterogeneous with respect to the clinical presentation and the prognosis. The treatment of NELMs requires a multidisciplinary approach and patients with NELM should be referred to a specialized center. When possible, the resection of NELMs provides the best long-term results. The general selection criteria for liver resection include an acceptable general physical condition for a large liver operation, tumors with a favorable differentiation grade 1 or 2, a lack of extrahepatic lesions, a sufficient residual liver volume and the possibility to resect at least 70% of the metastases. Supplementary treatment, including simultaneous liver ablation, are generally safe and can increase the number of patients who can be considered for surgery. For patients with resectable NELM, the resection of the primary tumor is recommended either in a 2-stage or combined procedure. In selected patients with nonresectable NELM a liver transplantation can be carried out, which can be associated with excellent long-term results.
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Affiliation(s)
- S Nadalin
- Klinik für Allgemeine, Viszeral- Und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland.
| | - M Peters
- Klinik für Allgemeine, Viszeral- Und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
| | - A Königsrainer
- Klinik für Allgemeine, Viszeral- Und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
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9
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Loid M, Obukhova D, Derks K, Meltsov A, Kask K, Altmäe S, Saare M, Peters M, Esteki MZ, Salumets A. P-322 Does endometrium age? The endometrial transcriptome of advanced reproductive age patients reveals the signs of cellular ageing, altered immune response and compromised receptivity. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.074] [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: 11/14/2022] Open
Abstract
Abstract
Study question
What changes occur in the endometrium during ageing and how they may affect fertility?
Summary answer
The endometrial transcriptome of women of advanced maternal age is significantly different from the young women, indicating specific pathways involved in endometrial ageing.
What is known already
A woman’s peak reproductive years are considered in her twenties. Trending postponed family planning, unfortunately, brings more women in their late forties to fertility specialists to seek for assisted conception. In vitro fertilization (IVF) using donated oocytes is a common approach to overcome the impact of maternal age on ovarian reserve. However, even with the implementation of embryo that underwent pre-implantation genetic testing, the IVF success rate drops significantly in the late forties. It still remains unclear which age-related molecular processes take place in the endometrium and whether it may impact the ability to support embryo implantation.
Study design, size, duration
Endometrial transcriptome profiling was done in 44 women undergoing endometrial receptivity evaluation at hormonal replacement therapy before IVF. Patients younger than 29 were considered as young maternal age group (YMA, age 23-27) and women older than 45 were considered as advanced maternal age group (AMA, age 47-50).
Participants/materials, setting, methods
Endometrial biopsies were obtained on day 5 of progesterone treatment and RNA was extracted. All endometrial samples were evaluated as receptive based on the expression of 57 common endometrial receptivity markers. Study group samples (12 YMA + 12 AMA) were subject to Illumina RNA sequencing. The sequences were annotated using the RefSeq database and differential expression analysis was performed using DeSeq2.We validated our results (10 YMA + 10 AMA) usingquantitative-PCR and histological validation.
Main results and the role of chance
A total of 37228 mRNA transcripts were expressed in the analyzed endometrial samples. After multiple testing corrections, 144 significantly differentially expressed(DE) transcripts (92 up-regulated, 52 down-regulated) were identified in the endometrium of the AMA versus YMAgroup. Overexpressed genes were associated with decidualization (ALDH3A1), endometrial receptivity (EML5, GALNT12), cell cycle (CDKN2A) and signal transduction, while down-regulated genes included sugar metabolism and inflammation (C2CD4B, NFKB), cellular motility (SPAG6)and progesterone signaling (RPL9). The pathways most affected by age were cellular remodeling, cell motility and migration, and immune response. Interestingly, some of the identified DE genes have been previously associated with ageing. Our results suggest the involvement of p16-associated cellular senescence and the suppression of metabolic and inflammatory processes essential for endometrial preparation for embryo transfer.
Limitations, reasons for caution
The study includes only patients undergoing hormonal replacement therapy and it is unclear whether the same processes are affected by age in the natural cycles.
Wider implications of the findings
These findings allow us to explain the age-related molecular changes that take place in the endometrial tissue. Understanding these alterations and using them in assisted reproductive technology may help to improve infertility management in women with advanced reproductive age.
Trial registration number
None
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Affiliation(s)
- M Loid
- University of Tartu, Department of Obstetrics and Gynecology- Institute of Clinical Medicine , Tartu, Estonia
- Competence Centre on Health Technologies, Competence Centre on Health Technologies , Tartu, Estonia
| | - D Obukhova
- Maastricht University Medical Center+, Department of Clinical Genetics , Maastricht, The Netherlands
| | - K Derks
- Maastricht University Medical Center+, Department of Clinical Genetics , Maastricht, The Netherlands
| | - A Meltsov
- Competence Centre on Health Technologies, Competence Centre on Health Technologies , Tartu, Estonia
| | - K Kask
- University of Tartu, Department of Obstetrics and Gynecology- Institute of Clinical Medicine , Tartu, Estonia
- Competence Centre on Health Technologies, Competence Centre on Health Technologies , Tartu, Estonia
| | - S Altmäe
- Competence Centre on Health Technologies, Competence Centre on Health Technologies , Tartu, Estonia
- University of Granada, Department of Biochemistry and Molecular Biology , Granada, Spain
| | - M Saare
- University of Tartu, Department of Obstetrics and Gynecology- Institute of Clinical Medicine , Tartu, Estonia
- Competence Centre on Health Technologies, Competence Centre on Health Technologies , Tartu, Estonia
| | - M Peters
- University of Tartu, Department of Obstetrics and Gynecology- Institute of Clinical Medicine , Tartu, Estonia
- Competence Centre on Health Technologies, Competence Centre on Health Technologies , Tartu, Estonia
| | - M Z Esteki
- Maastricht University Medical Center+, Department of Clinical Genetics , Maastricht, The Netherlands
| | - A Salumets
- University of Tartu, Department of Obstetrics and Gynecology- Institute of Clinical Medicine , Tartu, Estonia
- Competence Centre on Health Technologies, Competence Centre on Health Technologies , Tartu, Estonia
- University of Tartu, Estonian Genome Center- Institute of Genomics , Tartu, Estonia
- Division of Obstetrics and Gynecology- Department of Clinical Science- Intervention and Technology CLINTEC, Karolinska Institutet , Stockholm, Sweden
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10
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Von Grothusen C, Frisendahl C, Vijayachitra M, Parameswaran Grace L, Peters M, Faridani O, Andres S, Rao Boggavarapu N, Gemzell-Danielsson K. P-420 Dysregulated microRNAs in uterine fluid from women with recurrent implantation failure are linked to endometrial receptivity and implantation. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.397] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Is the microRNA content different in uterine fluid (UF) from women with recurrent implantation failure (RIF) compared to healthy fertile women?
Summary answer
The miRNA content is altered in the UF of women with RIF compared to healthy fertile women.
What is known already
Previous studies indicate that microRNAs secreted from endometrial cells into the UF are involved in endometrial receptivity and embryo implantation. Moreover, endometrial miRNAs are dysregulated in women with RIF and poor endometrial receptivity has been suggested as a putative cause of the condition.
Study design, size, duration
This is a descriptive experimental case-control study where microRNA abundancy in UF was compared between women with RIF (n = 34) and healthy fertile women (n = 17). Study participants were recruited at two university clinics in Stockholm, Sweden, and Tartu, Estonia. UF samples were collected vaginally in the receptive phase on day LH + 7-9 by flushing the uterine cavity with sterile saline. RIF was defined as three failed in vitro fertilization (IVF) cycles with good-quality embryos.
Participants/materials, setting, methods
To identify miRNAs in UF we performed small RNA sequencing. Differential expression analysis (DESeq2) was used to compare the abundancy of miRNAs in UF between the two groups. Dysregulated miRNAs were externally validated using relevant published datasets and further analyzed using tools such as target gene prediction (miRTarBase) and biological KEGG pathway analysis (g:Profiler). Technical validation was performed on two miRNAs with quantitative real-time PCR (RT-PCR).
Main results and the role of chance
In total, we identified 61 differentially abundant UF microRNAs with a false discovery rate of < 0.05 and fold change (FC) of -2 or 2. Out of these, 34 were up-regulated and 27 were down-regulated. External validation based on published literature showed that several of the dysregulated miRNAs are expressed in endometrial epithelial cells and have been described in extracellular vesicles from the endometrium and in the context of endometrial receptivity and RIF. Using publicly available single-cell transcriptome data, we found that the predicted target genes of our microRNAs are expressed both in the trophectoderm of human blastocysts and in epithelial cells of mid-secretory endometrium. Furthermore, the predicted miRNA target genes were significantly enriched in 25 pathways critical for endometrial receptivity and embryo implantation. Technical validation of hsa-miR-486-5p (FC -20.32; p-value=0.004) and hsa-miR-92b-3p (FC -9.72; p-value=0.004) were successfully in line with the sequencing data.
Limitations, reasons for caution
The sample size of this descriptive study was limited. A larger study cohort should be used to validate the differentially abundant microRNAs. Moreover, further in-vitro and in-vivo studies are needed to establish the role of identified miRNAs and their predicted target genes and enriched pathways in the pathogenesis of RIF.
Wider implications of the findings
RIF represents a true challenge in the IVF clinic. We show that total miRNAs can be comprehensively mapped in UF and constitute a promising source of non-invasive biomarkers for RIF that could be further evaluated for its clinical utility. Our findings also give insight into the molecular mechanisms of RIF.
Trial registration number
Not applicable
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Affiliation(s)
- C Von Grothusen
- Karolinska Institutet, Department of Women's and Children's health , Stockholm, Sweden
| | - C Frisendahl
- Karolinska Institutet, Department of Women's and Children's health , Stockholm, Sweden
| | - M Vijayachitra
- University of Tartu, Department of Obstetrics and Gynaecology , Tartu, Estonia
| | - L Parameswaran Grace
- Karolinska Institutet, Department of Women's and Children's health , Stockholm, Sweden
| | - M Peters
- University of Tartu, Department of Obstetrics and Gynaecology , Tartu, Estonia
| | - O Faridani
- Karolinska Institutet, Department of Women's and Children's health , Stockholm, Sweden
| | - S Andres
- University of Tartu, Department of Obstetrics and Gynaecology , Tartu, Estonia
| | - N Rao Boggavarapu
- Karolinska Institutet, Department of Women's and Children's health , Stockholm, Sweden
| | - K Gemzell-Danielsson
- Karolinska Institutet, Department of Women's and Children's health , Stockholm, Sweden
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11
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Peters M, Mikeltadze I, Karro H, Saare M, Salumets A, Mägi R, Laisk T. Endometriosis and irritable bowel syndrome: similarities and differences in the spectrum of comorbidities. Hum Reprod 2022; 37:2186-2196. [PMID: 35713579 DOI: 10.1093/humrep/deac140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Do the spectrum and prevalence of comorbidities of endometriosis and irritable bowel syndrome (IBS) overlap? SUMMARY ANSWER Despite several overlapping symptoms, the most significantly associated comorbidities of endometriosis and IBS are different and are rather related to the organ systems primarily involved in the index diagnosis. WHAT IS KNOWN ALREADY Endometriosis and IBS both have several similar unspecific symptoms, such as recurrent abdominal pain, cramping and anxiety, and both diseases affect young women and are associated with a number of comorbidities causing a poor quality of life. However, a detailed study, revealing the full spectrum of endometriosis and IBS comorbidities in the same study population, is lacking. STUDY DESIGN, SIZE, DURATION This article presents a retrospective in silico analysis of the data from a large nationwide biobank-based cohort consisting of 121 773 women. After excluding all first- and second-degree relatives, the data of up to 65 421 women were analyzed. PARTICIPANTS/MATERIALS, SETTING, METHODS International Classification of Disease-10 diagnosis main codes associated with endometriosis (N80) and IBS (K58) diagnoses were identified from the Estonian Biobank dataset by linking with the Estonian Health Insurance Fund and other relevant registries. The associations between N80 and K58 and other diagnosis codes were tested using logistic regression, adjusting for age at recruitment and 10 genetic principal components to account for potential population stratification. Bonferroni correction was applied to account for multiple testing. MAIN RESULTS AND THE ROLE OF CHANCE Both women with endometriosis and IBS suffered from more conditions compared to the control group, with 226 and 428 diagnosis codes statistically significantly more frequent in women with respective diagnosis compared to controls. Women suffering from both conditions had 275 significantly associated comorbidities. A remarkable proportion of women with IBS or endometriosis suffered also from endometriosis (9.0%) or IBS (13.6%), respectively. In endometriosis, the most prevalent diagnoses were related to diseases of the genitourinary system (33 N-category codes) and in women with IBS, the most associated diagnoses were related to digestive disorders and gastrointestinal tract (52 codes from K-category). Among the most significant diagnoses in endometriosis were uterine leiomyomas (D25), menstrual disorders (N92) and infertility (N97) (P < 1 × 10-315 for all), and in IBS, lactose intolerance (E73), gastritis and duodenitis (K29) and functional dyspepsia (K30) were in the top list of most significant comorbidities (P < 1 × 10-315 for all). LIMITATIONS, REASONS FOR CAUTION The information about the severity stages of endometriosis and subtypes of IBS was not available for analysis. The findings may not be fully extrapolated to all female populations, because all participants were from one geographic area and had good access to health services. WIDER IMPLICATIONS OF THE FINDINGS These findings support previous studies that have found a high prevalence of pre-selected comorbidities in women with endometriosis and IBS. However, taking into account the differences in the full spectrum of comorbidities of endometriosis and IBS may aid in diagnosing these disorders. Women and healthcare providers need to be aware that women with endometriosis are at high risks of complications during pregnancy and should be carefully monitored. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Estonian Research Council (grant PRG1076), Horizon 2020 innovation grant (ERIN, grant no. EU952516), Enterprise Estonia (grant no. EU48695), MSCA-RISE-2020 project TRENDO (grant no. 101008193) and by the European Union through the European Regional Development Fund (Projects no. 2014-2020.4.01.15-0012 and no. 2014-2020.4.01.16-0125). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Peters
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia
| | - I Mikeltadze
- Department of Oncosurgery, Tartu University Hospital Haematology and Oncology Clinic, Tartu, Estonia
| | - H Karro
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Tartu University Hospital Women's Clinic, Tartu, Estonia
| | - M Saare
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia
| | | | - A Salumets
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia.,Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia.,Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - R Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - T Laisk
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
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12
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Esagoff A, Stevens D, Bray M, Bryant B, Daneshvari N, Jung D, Rodriguez C, Richey L, Luna L, Sair H, Peters M. Neuroimaging Correlates of Post-Traumatic Stress Disorder in Traumatic Brain Injury: A Systematic Review of the Literature. Eur Psychiatry 2022. [PMCID: PMC9567129 DOI: 10.1192/j.eurpsy.2022.1198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Neuroimaging has been a highly utilized technique for studying traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) independently of one another, however, neuroimaging has increasingly been identified as a useful tool in better understanding TBI-related psychiatric conditions, such as PTSD. Objectives To complete a systematic review of the literature examining neuroimaging findings in TBI-related PTSD and to highlight the current literature’s limitations in order to strengthen future research. Methods A PRISMA compliant literature search was conducted in PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases prior to May of 2019. The initial database query yielded 4388 unique articles, which were narrowed down based on specified inclusion criteria (e.g., clear TBI definition, clinician-diagnosed PTSD, statistically analyzed relationship between neuroimaging and PTSD, quantified time interval between TBI and neuroimaging). Results A final cohort of 10 articles met inclusion criteria, comprising the findings of 482 participants with TBI. Key neuroanatomical findings among the included articles suggest that PTSD is associated with significant changes in whole-brain networks of resting state connectivity and disruptions in bilateral frontal and temporal white matter tracts, fronto-limbic pathways, the internal capsule, and the uncinate fasciculus (Figure 1).
Neuroimaging Findings in TBI-related PTSD. ![]() Replicated Neuroimaging Findings in TBI-related PTSD in the Right Uncinate Fasciculus. ![]() Conclusions Additional inquiry with attention to specified imaging timing post-injury, consistent TBI definitions, clinician-diagnosed TBI and PTSD, and control groups is crucial to extrapolating discrepancies between primary and TBI-related PTSD. Prospective studies could further differentiate predisposing factors from sequelae of TBI-related
PTSD. Disclosure No significant relationships.
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13
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Bray M, Bryant B, Esagoff A, Richey L, Rodriguez C, Krieg A, Cullum C, Lobue C, Ismail Z, Peters M. Traumatic brain injury alters presentation of mild behavioral impairment domains across progression of all-cause dementia. Eur Psychiatry 2022. [PMCID: PMC9566826 DOI: 10.1192/j.eurpsy.2022.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Traumatic brain injury (TBI) may alter dementia progression, although co-occurring neuropsychiatric symptoms (NPS) have received less attention. The mild behavioral impairment (MBI) construct relates NPS to underlying neural circuit disruptions, representing an important area of inquiry regarding TBI and dementia. Objectives (1) to examine the influence of prior TBI history (preceding study enrollment) on MBI incidence in all-cause dementia (prior to dementia diagnosis, i.e. MBI’s original definition) and (2) to utilize MBI domains as a construct for examining the influence of TBI on related NPS across the course of dementia onset and progression. Methods Using National Alzheimer’s Coordinating Center data, individuals progressing from normal cognition to all-cause dementia over 7.6±3.0 years were studied to estimate MBI incidence and symptom domains in 124 participants with prior TBI history compared to 822 without. Results Moderate-severe TBI was associated with the social inappropriateness MBI domain (ORadj.=4.034; p=0.024) prior to dementia onset, and the abnormal perception/thought content domain looking across dementia progression (HRadj.=3.703,
p=0.005). TBI (all severities) was associated with the decreased motivation domain looking throughout dementia progression (HRadj.=1.546,
p=0.014). Conclusions TBI history is associated with particular MBI domains prior to onset and throughout progression of dementia. Understanding TBI’s impact on inter-related NPS may help elucidate underlying neuropathology. Disclosure No significant relationships.
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14
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Bray M, Krieg A, Esagoff A, Bryant B, Salas R, Rao V, Peters M. Polysomnography Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Eur Psychiatry 2022. [PMCID: PMC9567999 DOI: 10.1192/j.eurpsy.2022.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Sleep disturbances are common following traumatic brain injury (TBI) worsening morbidity and other neuropsychiatric symptoms. Post-TBI alterations in sleep architecture require further study.
Objectives
(1) To evaluate polysomnographic measures of sleep architecture in participants with history of TBI compared to controls and as meta-analyses of pooled means. (2) To evaluate effects of timing and severity of TBI on polysomnographic outcomes.
Methods
PRISMA compliant systematic review was conducted of MEDLINE, PsycINFO, EMBASE and Scopus. Inclusion criteria: 1) reporting polysomnography in the context of TBI and 2) operationalizing TBI using clear/formalized criteria. Data were pooled in random-effects meta-analyses with outcomes expressed as mean differences (MD).
Results
In participants with TBI, sleep was comprised of 19.39% REM sleep, 8.13% N1, 51.18% N2, and 17.53% N3, as determined by meta-analyses of single means. Total sleep time was reduced in chronic (>6 months) TBI compared to acute-intermediate TBI (<6 months) (p=0.01). Compared to controls, participants with TBI differed with increased N1 sleep (MD=0.64%; 95%CI=0.02,1.25; p=0.04), reduced sleep efficiency (MD=-1.65%; 95%CI=-3.18,-0.12; p=0.03), and reduced sleep latency on the multiple sleep latency test (MD=-5.90mins; 95%CI=-10.09,-1.72; p<0.01). On sub-group analyses, participants with mild TBI differed from controls with reduced total sleep time (MD=-29.22mins, 95%CI=-54.16,-4.27; p=0.02). Similarly, participants with acute-intermediate TBI exhibited increased sleep latency compared to controls (MD=8.96mins; 95%CI=4.07,13.85; p<0.01) and differed significantly from participants with chronic TBI (X2(1,N=608)=6.54; p=0.01).
Conclusions
Sleep architecture is altered following TBI with potential implications regarding functional outcomes and recovery. These alterations appear to differ based on severity of injury and time since injury.
Disclosure
No significant relationships.
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15
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Peters M, Eldred-Evans D, Connor M, Bertoncelli Tanaka M, Bhola-Stewart H, T Shah T, Ahmad S, Noureldin M, Wong K, Tam H, Hrouda D, Winkler M, van Rossum P, Kurver P, Gordon S, Qazi H, Ahmed H, Giovanni Falagario U, Jambor I, Briganti A, Nordström T, Carrieri G, Powell L, Joshi S, Pegers E. PD-0416 Derivation and external validation of a RAPID Risk score for predicting significant prostate cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02851-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Tomassen M, Damen P, Verkooijen H, Peters M, van der Stap J, van Lindert A, Verhoeff J, van Rossum P. PD-0669 Feasibility and first results of the trials-within-cohorts design in patients with lung cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02916-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Heesterbeek MR, Luijten MAJ, Gouw SC, Limperg PF, Fijnvandraat K, Coppens M, Kruip MJHA, Eikenboom J, Grootenhuis MA, Flens G, Terwee CB, Peters M, Haverman L. Measuring anxiety and depression in young adult men with haemophilia using PROMIS. Haemophilia 2022; 28:e79-e82. [PMID: 35305286 DOI: 10.1111/hae.14534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
- M R Heesterbeek
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Amsterdam, The Netherlands
| | - M A J Luijten
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Amsterdam, The Netherlands.,Amsterdam UMC, Epidemiology and Data Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - S C Gouw
- Emma Children's Hospital, Amsterdam UMC, Paediatric Haematology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - P F Limperg
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Amsterdam, The Netherlands
| | - K Fijnvandraat
- Emma Children's Hospital, Amsterdam UMC, Paediatric Haematology, University of Amsterdam, Amsterdam, The Netherlands
| | - M Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - M J H A Kruip
- Erasmus MC, Department of Haematology Rotterdam, Erasmus University Medical Centre, The Netherlands
| | - J Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - M A Grootenhuis
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - G Flens
- Alliance for Quality in Mental Health Care, Utrecht, The Netherlands
| | - C B Terwee
- Emma Children's Hospital, Amsterdam UMC, Paediatric Haematology, University of Amsterdam, Amsterdam, The Netherlands
| | - M Peters
- Amsterdam UMC, Epidemiology and Data Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - L Haverman
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Amsterdam, The Netherlands
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Reddy D, Peters M, Shah T, Van Son M, Bertoncelli Tanaka M, Huber P, Lomas D, Rakauskas A, Miah S, Eldred-Evans D, Hosking-Jervis F, Engle R, Dudderidge T, Mccracken S, Greene D, Nigam R, Mccartan N, Valerio M, Orczyk C, Virdi J, Arya M, Ahmed H. Primary focal cryotherapy for non-metastatic prostate cancer: Update from the UK ICE registry. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Plečko D, Bennett N, Mårtensson J, Dam TA, Entjes R, Rettig TCD, Dongelmans DA, Boelens AD, Rigter S, Hendriks SHA, Jong R, Kamps MJA, Peters M, Karakus A, Gommers D, Ramnarain D, Wils E, Achterberg S, Nowitzky R, Tempel W, Jager CPC, Nooteboom FGCA, Oostdijk E, Koetsier P, Cornet AD, Reidinga AC, Ruijter W, Bosman RJ, Frenzel T, Urlings‐Strop LC, Jong P, Smit EG, Cremer OL, Mehagnoul‐Schipper DJ, Faber HJ, Lens J, Brunnekreef GB, Festen‐Spanjer B, Dormans T, Bruin DP, Lalisang RCA, Vonk SJJ, Haan ME, Fleuren LM, Thoral PJ, Elbers PWG, Bellomo R. Rapid Evaluation of Coronavirus Illness Severity (RECOILS) in intensive care: Development and validation of a prognostic tool for in-hospital mortality. Acta Anaesthesiol Scand 2022; 66:65-75. [PMID: 34622441 PMCID: PMC8652966 DOI: 10.1111/aas.13991] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/16/2021] [Accepted: 09/27/2021] [Indexed: 01/08/2023]
Abstract
Background The prediction of in‐hospital mortality for ICU patients with COVID‐19 is fundamental to treatment and resource allocation. The main purpose was to develop an easily implemented score for such prediction. Methods This was an observational, multicenter, development, and validation study on a national critical care dataset of COVID‐19 patients. A systematic literature review was performed to determine variables possibly important for COVID‐19 mortality prediction. Using a logistic multivariable model with a LASSO penalty, we developed the Rapid Evaluation of Coronavirus Illness Severity (RECOILS) score and compared its performance against published scores. Results Our development (validation) cohort consisted of 1480 (937) adult patients from 14 (11) Dutch ICUs admitted between March 2020 and April 2021. Median age was 65 (65) years, 31% (26%) died in hospital, 74% (72%) were males, average length of ICU stay was 7.83 (10.25) days and average length of hospital stay was 15.90 (19.92) days. Age, platelets, PaO2/FiO2 ratio, pH, blood urea nitrogen, temperature, PaCO2, Glasgow Coma Scale (GCS) score measured within +/−24 h of ICU admission were used to develop the score. The AUROC of RECOILS score was 0.75 (CI 0.71–0.78) which was higher than that of any previously reported predictive scores (0.68 [CI 0.64–0.71], 0.61 [CI 0.58–0.66], 0.67 [CI 0.63–0.70], 0.70 [CI 0.67–0.74] for ISARIC 4C Mortality Score, SOFA, SAPS‐III, and age, respectively). Conclusions Using a large dataset from multiple Dutch ICUs, we developed a predictive score for mortality of COVID‐19 patients admitted to ICU, which outperformed other predictive scores reported so far.
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Affiliation(s)
- Drago Plečko
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
- Department of Mathematics Seminar for Statistics ETH Zürich Zurich Switzerland
| | - Nicolas Bennett
- Department of Mathematics Seminar for Statistics ETH Zürich Zurich Switzerland
| | - Johan Mårtensson
- Department of Physiology and Pharmacology Section of Anaesthesia and Intensive Care Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Tariq A. Dam
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | - Robert Entjes
- Department of Intensive Care Admiraal De Ruyter Ziekenhuis Goes The Netherlands
| | | | - Dave A. Dongelmans
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care St. Antonius Hospital Nieuwegein The Netherlands
| | | | - Remko Jong
- Intensive Care Bovenij Ziekenhuis Amsterdam The Netherlands
| | | | - Marco Peters
- Intensive Care Canisius Wilhelmina Ziekenhuis Nijmegen The Netherlands
| | - Attila Karakus
- Department of Intensive Care Diakonessenhuis Hospital Utrecht The Netherlands
| | - Diederik Gommers
- Department of Intensive Care Erasmus Medical Center Rotterdam The Netherlands
| | | | - Evert‐Jan Wils
- Department of Intensive Care Franciscus Gasthuis & Vlietland Rotterdam The Netherlands
| | | | | | - Walter Tempel
- Department of Intensive Care Ikazia Ziekenhuis Rotterdam Rotterdam The Netherlands
| | | | | | | | - Peter Koetsier
- Intensive Care Medisch Centrum Leeuwarden Leeuwarden The Netherlands
| | - Alexander D. Cornet
- Department of Intensive Care Medisch Spectrum Twente Enschede The Netherlands
| | | | - Wouter Ruijter
- Department of Intensive Care Medicine Northwest Clinics Alkmaar The Netherlands
| | | | - Tim Frenzel
- Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands
| | | | - Paul Jong
- Department of Anesthesia and Intensive Care Slingeland Ziekenhuis Doetinchem The Netherlands
| | - Ellen G.M. Smit
- Intensive Care Spaarne GasthuisHaarlem en Hoofddorp The Netherlands
| | | | | | | | - Judith Lens
- ICU ICU, IJsselland ZiekenhuisCapelle aan den IJssel The Netherlands
| | | | | | - Tom Dormans
- Intensive care Zuyderland MC Heerlen The Netherlands
| | | | | | | | - Martin E. Haan
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | - Lucas M. Fleuren
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | - Patrick J. Thoral
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | - Paul W. G. Elbers
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research CentreSchool of Public Health and Preventative MedicineMonash University Melbourne Australia
- Department of Critical Care The University of Melbourne Melbourne Australia
- Data Analytics Research and Evaluation Centre Department of Medicine and Radiology The University of Melbourne
- Austin Hospital Melbourne Australia
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20
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Fleuren LM, Dam TA, Tonutti M, de Bruin DP, Lalisang RCA, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, Dongelmans DA, de Jong R, Peters M, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Arbous S, Vonk SJJ, Fornasa M, Machado T, Houwert T, Hovenkamp H, Noorduijn Londono R, Quintarelli D, Scholtemeijer MG, de Beer AA, Cinà G, Kantorik A, de Ruijter T, Herter WE, Beudel M, Girbes ARJ, Hoogendoorn M, Thoral PJ, Elbers PWG. Predictors for extubation failure in COVID-19 patients using a machine learning approach. Crit Care 2021; 25:448. [PMID: 34961537 PMCID: PMC8711075 DOI: 10.1186/s13054-021-03864-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/13/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Determining the optimal timing for extubation can be challenging in the intensive care. In this study, we aim to identify predictors for extubation failure in critically ill patients with COVID-19. METHODS We used highly granular data from 3464 adult critically ill COVID patients in the multicenter Dutch Data Warehouse, including demographics, clinical observations, medications, fluid balance, laboratory values, vital signs, and data from life support devices. All intubated patients with at least one extubation attempt were eligible for analysis. Transferred patients, patients admitted for less than 24 h, and patients still admitted at the time of data extraction were excluded. Potential predictors were selected by a team of intensive care physicians. The primary and secondary outcomes were extubation without reintubation or death within the next 7 days and within 48 h, respectively. We trained and validated multiple machine learning algorithms using fivefold nested cross-validation. Predictor importance was estimated using Shapley additive explanations, while cutoff values for the relative probability of failed extubation were estimated through partial dependence plots. RESULTS A total of 883 patients were included in the model derivation. The reintubation rate was 13.4% within 48 h and 18.9% at day 7, with a mortality rate of 0.6% and 1.0% respectively. The grandient-boost model performed best (area under the curve of 0.70) and was used to calculate predictor importance. Ventilatory characteristics and settings were the most important predictors. More specifically, a controlled mode duration longer than 4 days, a last fraction of inspired oxygen higher than 35%, a mean tidal volume per kg ideal body weight above 8 ml/kg in the day before extubation, and a shorter duration in assisted mode (< 2 days) compared to their median values. Additionally, a higher C-reactive protein and leukocyte count, a lower thrombocyte count, a lower Glasgow coma scale and a lower body mass index compared to their medians were associated with extubation failure. CONCLUSION The most important predictors for extubation failure in critically ill COVID-19 patients include ventilatory settings, inflammatory parameters, neurological status, and body mass index. These predictors should therefore be routinely captured in electronic health records.
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Affiliation(s)
- Lucas M. Fleuren
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tariq A. Dam
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Olaf L. Cremer
- Department of Intensive Care, UMC Utrecht, Utrecht, The Netherlands
| | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Remko de Jong
- Intensive Care, Bovenij Ziekenhuis, Amsterdam, The Netherlands
| | - Marco Peters
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | | | | | - Ralph Nowitzky
- Intensive Care, HagaZiekenhuis, Den Haag, The Netherlands
| | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Ellen G. M. Smit
- Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands
| | | | - Tom Dormans
- Intensive Care, Zuyderland MC, Heerlen, The Netherlands
| | | | | | | | | | | | | | - Gert B. Brunnekreef
- Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Alexander D. Cornet
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Walter van den Tempel
- Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, The Netherlands
| | | | - Peter Koetsier
- Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Judith Lens
- ICU, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | | | - A. Karakus
- Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Robert Entjes
- Department of Intensive Care, Adrz, Goes, The Netherlands
| | - Paul de Jong
- Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | - Thijs C. D. Rettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Ziekenhuis, Breda, The Netherlands
| | - Sesmu Arbous
- Department of Intensive Care, LUMC, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, Universiteit Van Amsterdam, Amsterdam, The Netherlands
| | - Armand R. J. Girbes
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mark Hoogendoorn
- Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Patrick J. Thoral
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul W. G. Elbers
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Butink M, Boonen A, Dona D, Peters M, Senden T, Baadjou V, de Rijk A. Work-related support in clinical care for patients with chronic diseases: intervention development. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.722] [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: 11/13/2022] Open
Abstract
Abstract
Background
Labor participation among patients with chronic diseases is lagging behind, particularly in the Netherlands. Most workers with a chronic disease might be able to deal with their disease and work participation, but a specific group needs support preferably. This study focuses on the development of a work-related support intervention in clinical care to promote sustainable work participation of patients with chronic diseases who regularly visit the outpatient clinic.
Methods
The first four steps of the Intervention Mapping (IM) approach were used to develop the intervention for a Dutch university hospital. A needs assessment based on a literature review, expert opinions and experiences, a qualitative study with healthcare professionals (n = 9) and consultation with financial staff (Step 1) was used to formulate objectives of the intervention (Step 2). Guided by theory-based methods and practical applications (Step 3), an intervention program, including training and tools for healthcare professionals (medical specialists and nurse specialists), was developed (Step 4).
Results
The needs assessment revealed the importance of stepped care comprising: screening; risk stratification; and if targeted, a problem assessment and providing tailored work-related support, including follow-up. In order to provide work-related support in clinical care, behavioral change of healthcare professionals is necessary. To change their behavior, a program, two training sessions for healthcare professionals and practical tools (screening list, conversation cards and a map with work-related support options) were developed.
Conclusions
To provide work-related support in clinical care for patients with chronic diseases, healthcare professionals need information, skill building training and tools. Despite providing support in care-as-usual, additional time is needed and must be financed. Cost effectiveness evaluation of the intervention is a necessary next step.
Key messages
Healthcare professionals should discuss ‘work’ with targeted patients. To provide work-related support in clinical care, healthcare professionals need knowledge, skills, tools and time.
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Affiliation(s)
- M Butink
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - A Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - D Dona
- Department of Human Resources, Occupational Health Services, Radboud University Medical Centre, Nijmegen, Netherlands
| | - M Peters
- Department of Human Resources, Occupational Health Services, Radboud University Medical Centre, Nijmegen, Netherlands
| | - T Senden
- Department of Human Resources, Occupational Health Services, Radboud University Medical Centre, Nijmegen, Netherlands
| | - V Baadjou
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Adelante Rehabilitation Centre, Maastricht, Netherlands
| | - A de Rijk
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Arias de la Torre J, Ronaldson A, Vilagut G, Peters M, Valderas JM, Serrano-Blanco A, Martín V, Dregan A, Alonso J. Prevalence of Major Depressive Episode in 27 European Countries. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.391] [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: 11/13/2022] Open
Abstract
Abstract
Background
Information about the prevalence of current Major Depressive Episode (MDE) across European countries is essential for its monitoring and for the development of evidence- based mental health policies. The aims were to: 1) estimate the prevalence of MDE by country in Europe; and 2) assess variations in prevalence between countries.
Methods
Data from participants of 27 countries that completed the questionnaire of the second wave of the European Health Interview Survey (EHIS-2) were analysed (n = 258,888). The prevalence of MDE was quantified using the Patient Health Questionnaire-8 (PHQ-8) with a cut-off score of ≥ 10. Prevalence and 95% Confidence Intervals (CI) were estimated for each country. Variation in prevalence (country vs the rest) was evaluated using bivariable and multivariable negative binomial regression models considering the specific country as the main explanatory variable. From these models, crude Prevalence Ratios (PR) and adjusted Prevalence Ratios (aPR) were obtained.
Results
The overall prevalence of current MDE in Europe was 6.38% (6.24%-6.52%). The country with the lowest prevalence was the Czech Republic (2.58%, 2.14%-3.02%) and the country with highest prevalence Iceland (10.33%, 9.33%-11.32%). In all the countries (except for Finland and Croatia) prevalence was higher in women than in men. The countries with the highest aPR were Germany (aPR: 1.80, 95% CI: 1.71-1.89) and Luxembourg (aPR: 1.50, 95% CI: 1.35-1.66), while Slovakia (aPR: 0.28, 95% CI: 0.24-0.33) and the Czech Republic (aPR: 0.32, 95% CI: 0.27-0.38) exhibited the lowest aPR.
Conclusions
Considerable variability in the prevalence of MDE by country in Europe was observed without a clear pattern. These results serve as baseline for monitoring the prevalence of MDE at a European level and suggest a need for developing preventive strategies against depression, particularly in those countries identified with the highest prevalence.
Key messages
The results of this study show that the overall prevalence of MDE is high (6.38%), with important variation across countries (ranging from 2.58% in the Czech Republic to 10.33% in Iceland). The results found could serve as a reference for the monitoring of MDE in Europe and for the development of screening and preventive strategies both at European level as well as at a country level.
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Affiliation(s)
- J Arias de la Torre
- Psychological Medicine, King's College London, London, UK
- CIBERESP, Madrid, Spain
- Universidad de León, León, Spain
| | - A Ronaldson
- Psychological Medicine, King's College London, London, UK
| | - G Vilagut
- CIBERESP, Madrid, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - M Peters
- University of Oxford, Oxford, UK
| | | | - A Serrano-Blanco
- CIBERESP, Madrid, Spain
- Parc Sanitari Sant Joan de Deu, Sant Boi del Llobregat, Spain
| | - V Martín
- CIBERESP, Madrid, Spain
- Universidad de León, León, Spain
| | - A Dregan
- Psychological Medicine, King's College London, London, UK
| | - J Alonso
- CIBERESP, Madrid, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
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Wichmann F, Budde S, Busse H, Brandes M, Müllmann S, Peters M, Pischke C, Zeeb H. Eine Online-Plattform zur Unterstützung der Evaluation von Präventionsprojekten - www.devacheck.de. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- F Wichmann
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS
| | - S Budde
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS
| | - H Busse
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS
| | - M Brandes
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS
| | - S Müllmann
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS
| | - M Peters
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS
- Wissenschaftsschwerpunkt Gesundheitswissenschaften, Universität Bremen
| | - C Pischke
- Institut für Medizinische Soziologie, Centre for Health and Society, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
| | - H Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS
- Wissenschaftsschwerpunkt Gesundheitswissenschaften, Universität Bremen
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Fleuren LM, Dam TA, Tonutti M, de Bruin DP, Lalisang RCA, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, Dongelmans DA, de Jong R, Peters M, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Arbous S, Vonk SJJ, Fornasa M, Machado T, Houwert T, Hovenkamp H, Noorduijn-Londono R, Quintarelli D, Scholtemeijer MG, de Beer AA, Cina G, Beudel M, Herter WE, Girbes ARJ, Hoogendoorn M, Thoral PJ, Elbers PWG. The Dutch Data Warehouse, a multicenter and full-admission electronic health records database for critically ill COVID-19 patients. Crit Care 2021; 25:304. [PMID: 34425864 PMCID: PMC8381710 DOI: 10.1186/s13054-021-03733-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/16/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has underlined the urgent need for reliable, multicenter, and full-admission intensive care data to advance our understanding of the course of the disease and investigate potential treatment strategies. In this study, we present the Dutch Data Warehouse (DDW), the first multicenter electronic health record (EHR) database with full-admission data from critically ill COVID-19 patients. METHODS A nation-wide data sharing collaboration was launched at the beginning of the pandemic in March 2020. All hospitals in the Netherlands were asked to participate and share pseudonymized EHR data from adult critically ill COVID-19 patients. Data included patient demographics, clinical observations, administered medication, laboratory determinations, and data from vital sign monitors and life support devices. Data sharing agreements were signed with participating hospitals before any data transfers took place. Data were extracted from the local EHRs with prespecified queries and combined into a staging dataset through an extract-transform-load (ETL) pipeline. In the consecutive processing pipeline, data were mapped to a common concept vocabulary and enriched with derived concepts. Data validation was a continuous process throughout the project. All participating hospitals have access to the DDW. Within legal and ethical boundaries, data are available to clinicians and researchers. RESULTS Out of the 81 intensive care units in the Netherlands, 66 participated in the collaboration, 47 have signed the data sharing agreement, and 35 have shared their data. Data from 25 hospitals have passed through the ETL and processing pipeline. Currently, 3464 patients are included in the DDW, both from wave 1 and wave 2 in the Netherlands. More than 200 million clinical data points are available. Overall ICU mortality was 24.4%. Respiratory and hemodynamic parameters were most frequently measured throughout a patient's stay. For each patient, all administered medication and their daily fluid balance were available. Missing data are reported for each descriptive. CONCLUSIONS In this study, we show that EHR data from critically ill COVID-19 patients may be lawfully collected and can be combined into a data warehouse. These initiatives are indispensable to advance medical data science in the field of intensive care medicine.
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Affiliation(s)
- Lucas M. Fleuren
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tariq A. Dam
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Remko de Jong
- Intensive Care, Bovenij Ziekenhuis, Amsterdam, The Netherlands
| | - Marco Peters
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | | | | | - Ralph Nowitzky
- Intensive Care, HagaZiekenhuis, Den Haag, The Netherlands
| | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Ellen G. M. Smit
- Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands
| | | | - Tom Dormans
- Intensive Care, Zuyderland MC, Heerlen, The Netherlands
| | | | | | | | | | | | | | - Gert B. Brunnekreef
- Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Alexander D. Cornet
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Walter van den Tempel
- Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, The Netherlands
| | - Age D. Boelens
- Anesthesiology, Antonius Ziekenhuis Sneek, Sneek, The Netherlands
| | - Peter Koetsier
- Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Judith Lens
- ICU, ICU, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | | | - A. Karakus
- Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Robert Entjes
- Department of Intensive Care, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands
| | - Paul de Jong
- Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Sesmu Arbous
- Department of Intensive Care, LUMC, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | | | - Armand R. J. Girbes
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mark Hoogendoorn
- Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, Vrjie Universiteit, Amsterdam, The Netherlands
| | - Patrick J. Thoral
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul W. G. Elbers
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Lodeweges J, van Rossum P, Bartels M, van Lindert A, Pomp J, Peters M, Verhoeff J. PO-1172 Ultra-central lung tumors: safety and efficacy of protracted stereotactic body radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Damen P, Kroese T, van Hillegersberg R, Schuit E, Peters M, Verhoeff J, Lin S, van Rossum P. PO-1515 Meta-analysis on the influence of radiation-induced lymphopenia on overall survival in solid tumors. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Werensteijn-Honingh A, Wevers A, Peters M, Kroon P, Intven M, Eppinga W, Jürgenliemk-Schulz I. PD-0745 Outcomes & predictors of progression: SBRT for lymph node oligorecurrent prostate cancer on PSMA-PET. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peters M, van Son M, Rasing M, Lagendijk J, Moerland M, van de Pol S, Eppinga W, Jonges T, Wessels F, de Keizer B, Noteboom J, van der Voort van Zyp J. PO-1373 Targeted biopsies are redundant in mp-MRI and PSMA-PET proven radiorecurrent prostate cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07824-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boersma H, Peters M, Cahn W, Verhoeff J. PO-1504 The effect of psychiatric comorbidities on treatment decisions for - and survival after radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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van Joolingen H, Rasing M, Peters M, van Lindert A, de Heer L, Aarts M, Verhoeff J, van Rossum P. PH-0273 Chemoradiotherapy for NSCLC patients with a high predicted risk of irradical resection. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bartels M, van der Velden J, Pielkenrood B, Gerlich S, Bras M, Verlaan J, Monninkhof E, Peters M, van der Linden Y, Verkooijen H. OC-0407 Quality of Life after Palliative Radiotherapy for Bone Metastases: Analysis of the PRESENT-cohort. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06894-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Moerland MA, van Schelven LJ, van Lier A, Boskovic E, Peters M, van Son MJ, van der Voort van Zyp JRN, Lagendijk JJW. MR compatibility, safety and accuracy of the redesigned UMC Utrecht single needle implant device. Phys Med Biol 2021; 66. [PMID: 34010820 DOI: 10.1088/1361-6560/ac02d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/19/2021] [Indexed: 11/11/2022]
Abstract
Purpose. The Utrecht single needle implant device (SNID) was redesigned to increase needle insertion velocity. The purpose of this study is to evaluate the magnetic resonance compatibility, safety and accuracy of the implant device preparing its application in a patient study to investigate the feasibility of inserting a brachytherapy needle into the prostate to a defined tumor target point.Methods. Several experiments were performed to evaluate the mechanical and radiofrequency safety of the needle system, the magnetic field perturbation, the calibration of the implant device in the MR coordinate system, functioning of the implant device during imaging and accuracy of needle insertion.Results. Endurance experiments showed the mechanical safety of the needle system. Magnetic field perturbation was acceptable with induced image distortions smaller than 0.5 mm for clinical MR sequences. Calibration of the implant device in the MR coordinate system was reproducible with average error (mean±standard deviation) of 0.2 ± 0.4 mm, 0.1 ± 0.3 mm and 0.6 ± 0.6 mm in thex,y- andz- direction, respectively. The RF safety measurement showed for clinical MR imaging sequences maximum temperature rises of 0.2 °C at the entry and tip points of the needle. Simultaneous functioning of the implant device and imaging is possible albeit with some intensity band artifacts in the fast field echo images. Finally, phantom measurements showed deviations amounting 2.5-3.6 mm measured as target-to-needle distance at a depth of 12 cm.Conclusions. This preclinical evaluation showed that the MR compatibility, safety and accuracy of the redesigned UMC Utrecht SNID allow its application in a patient study on the feasibility of inserting a brachytherapy needle into the prostate to a defined tumor target point.
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Affiliation(s)
- M A Moerland
- Radiation Oncology Department, University Medical Center Utrecht, The Netherlands
| | - L J van Schelven
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, The Netherlands
| | - A van Lier
- Radiation Oncology Department, University Medical Center Utrecht, The Netherlands
| | - E Boskovic
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, The Netherlands
| | - M Peters
- Radiation Oncology Department, University Medical Center Utrecht, The Netherlands
| | - M J van Son
- Radiation Oncology Department, University Medical Center Utrecht, The Netherlands
| | | | - J J W Lagendijk
- Radiation Oncology Department, University Medical Center Utrecht, The Netherlands
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Specker C, Aringer M, Burmester GR, Peters M, Hofmann MW, Kellner H, Moosig F, Tony HP, Fliedner G. POS0615 TOCILIZUMAB IS SAFE AND EFFECTIVE IN ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Average life spans of patients with rheumatoid arthritis (RA) are approaching those of the general population. This results in a large proportion of RA patients being elderly at some point and underlines effective RA treatments needed for this population. Pivotal clinical trials have demonstrated the efficacy of tocilizumab (TCZ) for the treatment of RA. However, real-world studies that explore the effectiveness of TCZ especially in the elderly are lacking. ICHIBAN was a large, observational study that followed patients with RA treated with TCZ under real-world conditions in Germany for up to 2 years.Objectives:In this analysis of ICHIBAN, we examined the safety and effectiveness of long-term TCZ treatment according to patient baseline (BL) age (<50, 50–65, >65 years).Methods:ICHIBAN (NCT01194401) was a prospective, non-interventional study that observed adult patients with active moderate to severe RA in German rheumatology clinics and practices. Patients were treated with TCZ according to the local label. The safety analyses set (SAF) included all patients who received at least one dose of TCZ. The effectiveness set (EFF) included all patients from the SAF who had no prior TCZ therapy. Patient-reported outcomes (PROs) were assessed using the visual analogue scale. Last observation carried forward was used to substitute for missing values.Results:At baseline (BL), 3,164 patients were included in the SAF: 29.2% <50 years, 47.3% 50–65 years, and 23.5% >65 years old (1.2% ≥80 years). Patients >65 years old were not only the most likely to have comorbidities such as hypertension, anaemia, renal insufficiency, osteoporosis, diabetes, and coronary heart disease, but also had the highest BL disease activity according to Disease Activity Score-28 erythrocyte sedimentation rate (DAS28-ESR) and Clinical Disease Activity Index (CDAI) (Table 1).Proportions of patients with adverse events (AEs) considered related to treatment were similar in patients <50 (22.3%), 50–65 (21.9%) and >65 years (22.2%). More patients >65 years (20.2%) and 50–65 years (14.4%) experienced serious AEs (SAEs) than patients <50 years (11.5%). Slightly more patients >65 years old experienced infectious SAEs (4.8%) than younger patients (<50 years, 3.2% and 50–65 years, 3.1%). Yet, similar proportions of patients across all age groups discontinued TCZ due to AE (7.0% <50 years; 9.6% 50–65 years; 7.8% >65 years).2,902 patients were included in the EFF. Patients <50 years experienced DAS28-ESR remission at least once during the treatment period (65.4%) more often than patients aged 50–65 years (59.8%) or >65 years (59.5%). However, patients >65 years had numerically greater improvements in DAS28-ESR (Table 1). Patients <50 years had the best physical functioning at BL and the greatest reduction in Health Assessment Questionnaire Disease Index (HAQ-DI) score (Figure 1A). All age groups had similar improvements in PROs such as fatigue, strength of pain, and sleep disturbances (Figure 1B).Table 1.Model summary for prediction of DAS28CRP using time and etanercept originator (relative to biosimilar)<50 years50–65 years>65 yearsDAS28-ESR, mean ± SDn*7771237617BL4.9 ± 1.45.3 ± 1.35.4 ± 1.3Last visit2.8 ± 1.73.1 ± 1.73.2 ± 1.7Change from BL-2.0 ± 1.7-2.2 ± 1.7-2.2 ± 1.8CDAI, mean ± SDn*7681217590BL25.7 ± 12.828.4 ± 13.328.8 ± 12.8Last visit13.3 ± 12.814.6 ± 13.214.5 ± 12.8Change from BL-12.5 ± 13.6-13.8 ± 14.0-14.3 ± 13.8*271 patients with missing data at BL**327 patients with missing data at BLConclusion:Although elderly patients experienced a higher rate of infections, the proportion of patients withdrawing due to AE was not higher than in the other age groups. Starting with higher baseline disease activity, patients >65 years had similar benefits to disease activity and PROs when compared with younger patients. Overall, these results indicate that long-term TCZ treatment of elderly patients is effective and has an acceptable safety profile.Disclosure of Interests:Christof Specker Speakers bureau: AbbVie, Celgene, Chugai, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Chugai, Lilly, Novartis, Sobi, and UCB, Grant/research support from: Boehringer, Chugai, GSK, and Roche, Martin Aringer Speakers bureau: Roche and Chugai, Consultant of: Roche and Chugai, Grant/research support from: Roche, Gerd Rüdiger Burmester Consultant of: Lilly, Pfizer, Sanofi, and Roche, Grant/research support from: Roche, Marvin Peters Employee of: Roche Pharma AG, Michael W. Hofmann Employee of: Chugai Pharma Germany GmbH, Herbert Kellner Consultant of: Roche, Grant/research support from: Roche, Frank Moosig Grant/research support from: Roche, Hans-Peter Tony Speakers bureau: Roche, Abbvie, BMS, Chugai, Janssen, Novartis, Sanofi, and Lilly, Consultant of: Roche, Abbvie, BMS, Chugai, Janssen, Novartis, Sanofi, and Lilly, Grant/research support from: Roche, Gerhard Fliedner Grant/research support from: Roche, Chugai, Abbvie, and Lilly
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Rakauskas A, Peters M, Martel P, La Rosa S, Meuwly JY, Roth B, Valerio M. Tranperineal vs. transrectal micro-ultrasound and mpMRI targeted prostate biopsies: propensity score-matched study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Reddy D, Peters M, Shah T, Van Son M, Huber P, Lomas D, Rakauskas A, Miah S, Guillaumier S, Dudderidge T, Hindley R, Emara A, Nigam R, Valerio M, Afzal N, Lewi H, Orczyk C, Ogden C, Persad R, Virdi J, Moore C, Arya M, Winkler M, Emberton M, Ahmed H. Cancer control outcomes following focal therapy using HIFU in 1,829 men with non-metastatic prostate cancer treated over 15 years. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peters M, van Son M, Moerland M, Lagendijk J, Eppinga W, Shah T, Ahmed H, van der Voort van Zyp J. OC-0037 Updated results of focal salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Peters M, van Son M, Moerland M, Lagendijk J, Shah T, Ahmed H, van der Voort van Zyp J. PO-0230 Subdomains of erectile and urinary function after ultrafocal HDR-brachytherapy for prostate cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Newman C, Egan AM, Ahern T, Al-Kiyumi M, Balan G, Brassill MJ, Brosnan E, Carmody L, Clarke H, Coogan Kelly C, Culliney L, Davern R, Durkan M, Fenlon M, Ferry P, Hanlon G, Higgins T, Hoashi S, Khamis A, Kinsley B, Kirwan B, Kyithar P, Liew A, Matthews L, McGurk C, McHugh C, Murphy MS, Murphy P, Nagodra D, Noctor E, Nolan M, O'Connor E, O'Halloran D, O'Mahoney L, O'Sullivan E, Peters M, Roberts G, Rooney H, Smyth A, Tarachand B, Todd M, Tuthill A, Wan Mahmood WA, Yousif O, Dunne FP. Diabetes care and pregnancy outcomes for women with pregestational diabetes in Ireland. Diabetes Res Clin Pract 2021; 173:108685. [PMID: 33548336 DOI: 10.1016/j.diabres.2021.108685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
AIMS Pre-gestational diabetes mellitus (PGDM) is associated with adverse outcomes. We aimed to examine pregnancies affected by PGDM; report on these pregnancy outcomes and compare outcomes for patients with type 1 versus type 2 diabetes mellitus; compare our findings to published Irish and United Kingdom (UK) data and identify potential areas for improvement. METHODS Between 2016 and 2018 information on 679 pregnancies from 415 women with type 1 Diabetes Mellitus and 244 women with type 2 diabetes was analysed. Data was collected on maternal characteristics; pregnancy preparation; glycaemic control; pregnancy related complications; foetal and maternal outcomes; unscheduled hospitalisations; congenital anomalies and perinatal deaths. RESULTS Only 15.9% of women were adequately prepared for pregnancy. Significant deficits were identified in availability and attendance at pre-pregnancy clinic, use of folic acid, attaining appropriate glycaemic targets and appropriate retinal screening. The majority of pregnancies (n = 567, 83.5%) resulted in a live birth but the large number of infants born large for gestational age (LGA) (n = 280, 49.4%), born prematurely <37 weeks and requiring neonatal intensive care unit (NICU) admission continue to be significant issues. CONCLUSIONS This retrospective cohort study identifies multiple targets for improvements in the provision of care to women with pre-gestational DM which are likely to translate into better pregnancy outcomes.
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Affiliation(s)
- C Newman
- Galway University Hospital, Galway, Ireland.
| | - A M Egan
- Division of Endocrinology Mayo Clinic, Rochester, United States
| | - T Ahern
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
| | - M Al-Kiyumi
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - G Balan
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - M J Brassill
- South Tipperary General Hospital, Clonmel, Co Tipperary, Ireland
| | - E Brosnan
- Mayo University Hospital, Castlebar, Co Mayo, Ireland
| | - L Carmody
- Galway University Hospital, Galway, Ireland
| | - H Clarke
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - C Coogan Kelly
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - L Culliney
- Cork University Hospital, Cork, Co Cork, Ireland
| | - R Davern
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - M Durkan
- Bons Secours Hospital, Cork, Co Cork, Ireland
| | - M Fenlon
- Wexford General Hospital, Co Wexford, Ireland
| | - P Ferry
- Letterkenny General Hospital, Letterkenny, Co Donegal, Ireland
| | - G Hanlon
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - T Higgins
- University Hospital Kerry, Tralee, Co Kerry, Ireland
| | - S Hoashi
- Mullingar Regional Hospital, Mullingar, Co Westmeath, Ireland
| | - A Khamis
- Letterkenny General Hospital, Letterkenny, Co Donegal, Ireland
| | - B Kinsley
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - B Kirwan
- Galway University Hospital, Galway, Ireland
| | - P Kyithar
- Portlaoise General Hospital, Portlaoise, Co Laois, Ireland
| | - A Liew
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - L Matthews
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
| | - C McGurk
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - C McHugh
- Sligo University Hospital, Co Sligo, Ireland
| | - M S Murphy
- South Infirmary Victoria Hospital, Cork, Co Cork, Ireland
| | - P Murphy
- Cork University Hospital, Cork, Co Cork, Ireland
| | - D Nagodra
- Portlaoise General Hospital, Portlaoise, Co Laois, Ireland
| | - E Noctor
- Limerick University Hospital, Co Limerick, Ireland
| | - M Nolan
- University Hospital Kerry, Tralee, Co Kerry, Ireland
| | - E O'Connor
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - D O'Halloran
- Cork University Hospital, Cork, Co Cork, Ireland
| | - L O'Mahoney
- Cork University Hospital, Cork, Co Cork, Ireland
| | | | - M Peters
- University Hospital Waterford, Co Waterford, Ireland
| | - G Roberts
- University Hospital Waterford, Co Waterford, Ireland
| | - H Rooney
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - A Smyth
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - B Tarachand
- University Hospital Waterford, Co Waterford, Ireland
| | - M Todd
- Mayo University Hospital, Castlebar, Co Mayo, Ireland
| | - A Tuthill
- Cork University Hospital, Cork, Co Cork, Ireland
| | - W A Wan Mahmood
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - O Yousif
- Wexford General Hospital, Co Wexford, Ireland
| | - F P Dunne
- Galway University Hospital, Galway, Ireland
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Paes D, Xie K, Wheeler DG, Zook D, Prickaerts J, Peters M. Inhibition of PDE2 and PDE4 synergistically improves memory consolidation processes. Neuropharmacology 2021; 184:108414. [PMID: 33249120 DOI: 10.1016/j.neuropharm.2020.108414] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/21/2020] [Accepted: 11/23/2020] [Indexed: 01/10/2023]
Abstract
Phosphodiesterases (PDE) are the only enzymes that degrade cAMP and cGMP which are second messengers crucial to memory consolidation. Different PDE inhibitors have been developed and tested for their memory-enhancing potential, but the occurrence of side effects has hampered clinical progression. As separate inhibition of the PDE2 and PDE4 enzyme family has been shown to enhance memory, we investigated whether concurrent treatment with a PDE2 and PDE4 inhibitor can have synergistic effects on memory consolidation processes. We found that combined administration of PF-999 (PDE2 inhibitor) and roflumilast (PDE4 inhibitor) increases the phosphorylation of the AMPA receptor subunit GluR1 and induces CRE-mediated gene expression. Moreover, when combined sub-effective and effective doses of PF-999 and roflumilast were administered after learning, time-dependent forgetting was abolished in an object location memory task. Pharmacokinetic assessment indicated that combined treatment does not alter exposure of the individual compounds. Taken together, these findings suggest that combined PDE2 and PDE4 inhibition has synergistic effects on memory consolidation processes at sub-effective doses, which could therefore provide a therapeutic strategy with an improved safety profile.
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Affiliation(s)
- Dean Paes
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Universiteitssingel 50, 6229, ER Maastricht, the Netherlands
| | - Keqiang Xie
- In Vitro Pharmacology, Dart Neuroscience, LLC, 12278 Scripps Summit Drive, San Diego, CA, 92131, USA
| | - Damian G Wheeler
- Target Discovery & Behavioral Pharmacology, Dart Neuroscience, LLC, 12278 Scripps Summit Drive, San Diego, CA, 92131, USA
| | - Douglas Zook
- DMPK, Dart Neuroscience, LLC, 12278 Scripps Summit Drive, San Diego, CA, 92131, USA
| | - Jos Prickaerts
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Universiteitssingel 50, 6229, ER Maastricht, the Netherlands
| | - Marco Peters
- Target Discovery & Behavioral Pharmacology, Dart Neuroscience, LLC, 12278 Scripps Summit Drive, San Diego, CA, 92131, USA; Neurobiology and Behavior & Center for the Neurobiology of Learning and Memory, University of California Irvine, 213 Qureshey Research Lab, Irvine, CA, 92697, USA.
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Atiq F, Saes J, Punt M, van Galen K, Schutgens R, Meijer K, Cnossen M, Laros-Van Gorkom B, Peters M, Nieuwenhuizen L, Kruip M, de Meris J, van der Bom J, van der Meer F, Fijnvandraat K, Kruis I, van Heerde W, Eikenboom H, Leebeek FW, Schols S. Major differences in clinical presentation, diagnosis and management of men and women with autosomal inherited bleeding disorders. EClinicalMedicine 2021; 32:100726. [PMID: 33554093 PMCID: PMC7848767 DOI: 10.1016/j.eclinm.2021.100726] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 10/29/2020] [Revised: 12/23/2020] [Accepted: 01/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In recent years, more awareness is raised about sex-specific dilemmas in inherited bleeding disorders. However, no large studies have been performed to assess differences in diagnosis, bleeding phenotype and management of men and women with bleeding disorders. Therefore, we investigated sex differences in a large cohort of well-defined patients with autosomal inherited bleeding disorders (von Willebrand disease (VWD), rare bleeding disorders (RBDs) and congenital platelet defects (CPDs)). METHODS We included patients from three nationwide cross-sectional studies on VWD, RBDs and CPDs in the Netherlands, respectively the WiN, RBiN and TiN study. In all studies a bleeding score (BS) was obtained, and patients filled in an extensive questionnaire on the management and burden of their disorder. FINDINGS We included 1092 patients (834 VWD; 196 RBD; 62 CPD), of whom 665 (60.9%) were women. Women were more often referred because of a bleeding diathesis than men (47.9% vs 36.6%, p = 0.002). Age of first bleeding was similar between men and women, respectively 8.9 ± 13.6 (mean ±sd) years and 10.6 ± 11.3 years (p = 0.075). However, the diagnostic delay, which was defined as time from first bleeding to diagnosis, was longer in women (11.6 ± 16.4 years) than men (7.7 ± 16.6 years, p = 0.002). Similar results were found when patients referred for bleeding were analyzed separately. Of women aging 12 years or older, 469 (77.1%) had received treatment because of sex-specific bleeding. INTERPRETATION Women with autosomal inherited bleeding disorders are more often referred for bleeding, have a longer diagnostic delay, and often require treatment because of sex-specific bleeding. FUNDING The WiN study was supported (in part) by research funding from the Dutch Hemophilia Foundation (Stichting Haemophilia), Shire (Takeda), and CSL Behring (unrestricted grant).
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Affiliation(s)
- F. Atiq
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J.L. Saes
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M.C. Punt
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - K.P.M. van Galen
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - R.E.G. Schutgens
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - K. Meijer
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - M.H. Cnossen
- Department of Pediatric Hematology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - B.A.P. Laros-Van Gorkom
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M. Peters
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric-Hematology, Amsterdam, the Netherlands
| | - L. Nieuwenhuizen
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Maxima Medical Center Eindhoven, Eindhoven, the Netherlands
| | - M.J.H.A. Kruip
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J. de Meris
- Netherlands Hemophilia Society, Leiden, the Netherlands
| | - J.G. van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, the Netherlands
| | - F.J.M. van der Meer
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - K. Fijnvandraat
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric-Hematology, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | - I.C. Kruis
- Netherlands Hemophilia Society, Leiden, the Netherlands
| | - W.L. van Heerde
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Enzyre BV, Novio Tech Campus, Nijmegen, the Netherlands
| | - H.C.J. Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank W.G. Leebeek
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S.E.M. Schols
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - For the WiN, RBiN and TiN study groups
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pediatric Hematology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric-Hematology, Amsterdam, the Netherlands
- Department of Hematology, Maxima Medical Center Eindhoven, Eindhoven, the Netherlands
- Netherlands Hemophilia Society, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, the Netherlands
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
- Enzyre BV, Novio Tech Campus, Nijmegen, the Netherlands
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Peters M, De Leeuw A, Pötter R, Nomden C, Tanderup K, Kirchheiner K, Schmid M, Fortin I, Haie-Meder C, Lindegaard J, Sturdza A, Mahantshetty U, Hoskin P, Segedin B, Bruheim K, Rai B, Huang F, Cooper R, Van der Steen-Banasik E, Van Limbergen E, Nout R, Jürgenliemk-Schulz I. OC-0566: Risk factors for nodal failure in the EMBRACE study cohort. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00588-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kanthabalan A, Arya M, Freeman A, Mitra AV, Payne H, Peters M, Shah TT, Emberton M, Ahmed HU. Intraprostatic Cancer Recurrence following Radical Radiotherapy on Transperineal Template Mapping Biopsy: Implications for Focal Ablative Salvage Therapy. J Urol 2020; 204:950-955. [PMID: 32602770 DOI: 10.1097/ju.0000000000001201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Men in whom external beam radiotherapy fails are usually placed on delayed hormone therapy. Some of these men have localized recurrence that might be suitable for further local therapy. We describe patterns of recurrence and suitability for focal ablative therapy in those undergoing transperineal template prostate mapping biopsies. MATERIALS AND METHODS The study included 145 consecutive patients (December 2007 to May 2014) referred with suspicion of recurrence due to rising prostate specific antigen after external beam radiotherapy or brachytherapy who underwent transperineal template prostate mapping biopsies. Suitability for focal ablative therapy required the cancer to be unifocal or unilateral, or bilateral/multifocal with 1 dominant index lesion and secondary lesions with Gleason score 3+3=6 with no more than 3 mm cancer core involvement. RESULTS Mean patient age was 70.7 (SD 5.8) years. Median prostate specific antigen at time of transperineal template prostate mapping biopsy was 4.5 ng/ml (IQR 2.5-7.7). Overall 75.9% (110) were suitable for a form of focal salvage treatment, 40.7% (59) were suitable for quadrant ablation, 14.5% (21) hemiablation, 14.5% (21) bilateral focal ablation and 6.2% (9) for index lesion ablation. CONCLUSIONS Three-quarters of patients who have localized radiorecurrent prostate cancer may be suitable for focal ablative therapy to the prostate based on transperineal template prostate mapping biopsies.
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Affiliation(s)
- A Kanthabalan
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - M Arya
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - A Freeman
- Department of Histopathology, UCLH NHS Foundation Trust, London, United Kingdom
| | - A V Mitra
- Department of Clinical Oncology, UCLH NHS Foundation Trust, London, United Kingdom
| | - H Payne
- Department of Clinical Oncology, UCLH NHS Foundation Trust, London, United Kingdom
| | - M Peters
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - T T Shah
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M Emberton
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - H U Ahmed
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
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43
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Jonkman AH, Frenzel T, McCaughey EJ, McLachlan AJ, Boswell-Ruys CL, Collins DW, Gandevia SC, Girbes ARJ, Hoiting O, Kox M, Oppersma E, Peters M, Pickkers P, Roesthuis LH, Schouten J, Shi ZH, Veltink PH, de Vries HJ, Shannon Weickert C, Wiedenbach C, Zhang Y, Tuinman PR, de Man AME, Butler JE, Heunks LMA. Breath-synchronized electrical stimulation of the expiratory muscles in mechanically ventilated patients: a randomized controlled feasibility study and pooled analysis. Crit Care 2020; 24:628. [PMID: 33126902 PMCID: PMC7596623 DOI: 10.1186/s13054-020-03352-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Expiratory muscle weakness leads to difficult ventilator weaning. Maintaining their activity with functional electrical stimulation (FES) may improve outcome. We studied feasibility of breath-synchronized expiratory population muscle FES in a mixed ICU population ("Holland study") and pooled data with our previous work ("Australian study") to estimate potential clinical effects in a larger group. METHODS Holland: Patients with a contractile response to FES received active or sham expiratory muscle FES (30 min, twice daily, 5 days/week until weaned). Main endpoints were feasibility (e.g., patient recruitment, treatment compliance, stimulation intensity) and safety. Pooled: Data on respiratory muscle thickness and ventilation duration from the Holland and Australian studies were combined (N = 40) in order to estimate potential effect size. Plasma cytokines (day 0, 3) were analyzed to study the effects of FES on systemic inflammation. RESULTS Holland: A total of 272 sessions were performed (active/sham: 169/103) in 20 patients (N = active/sham: 10/10) with a total treatment compliance rate of 91.1%. No FES-related serious adverse events were reported. Pooled: On day 3, there was a between-group difference (N = active/sham: 7/12) in total abdominal expiratory muscle thickness favoring the active group [treatment difference (95% confidence interval); 2.25 (0.34, 4.16) mm, P = 0.02] but not on day 5. Plasma cytokine levels indicated that early FES did not induce systemic inflammation. Using a survival analysis approach for the total study population, median ventilation duration and ICU length of stay were 10 versus 52 (P = 0.07), and 12 versus 54 (P = 0.03) days for the active versus sham group. Median ventilation duration of patients that were successfully extubated was 8.5 [5.6-12.2] versus 10.5 [5.3-25.6] days (P = 0.60) for the active (N = 16) versus sham (N = 10) group, and median ICU length of stay was 10.5 [8.0-14.5] versus 14.0 [9.0-19.5] days (P = 0.36) for those active (N = 16) versus sham (N = 8) patients that were extubated and discharged alive from the ICU. During ICU stay, 3/20 patients died in the active group versus 8/20 in the sham group (P = 0.16). CONCLUSION Expiratory muscle FES is feasible in selected ICU patients and might be a promising technique within a respiratory muscle-protective ventilation strategy. The next step is to study the effects on weaning and ventilator liberation outcome. TRIAL REGISTRATION ClinicalTrials.gov, ID NCT03453944. Registered 05 March 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03453944 .
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Affiliation(s)
- Annemijn H Jonkman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Euan J McCaughey
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia
| | | | - Claire L Boswell-Ruys
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia
| | | | - Simon C Gandevia
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Armand R J Girbes
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Oscar Hoiting
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline Oppersma
- Cardiovascular and Respiratory Physiology Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Marco Peters
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisanne H Roesthuis
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zhong-Hua Shi
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Heder J de Vries
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cyndi Shannon Weickert
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Psychiatry, University of New South Wales, Kensington, NSW, 2052, Australia.,Department of Neuroscience and Physiology, Upstate Medical University, New York, 13210, USA
| | - Carsten Wiedenbach
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Yingrui Zhang
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Angélique M E de Man
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jane E Butler
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands. .,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
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Angus DC, Derde L, Al-Beidh F, Annane D, Arabi Y, Beane A, van Bentum-Puijk W, Berry L, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Buzgau A, Cheng AC, de Jong M, Detry M, Estcourt L, Fitzgerald M, Goossens H, Green C, Haniffa R, Higgins AM, Horvat C, Hullegie SJ, Kruger P, Lamontagne F, Lawler PR, Linstrum K, Litton E, Lorenzi E, Marshall J, McAuley D, McGlothin A, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Parker J, Rowan K, Sanil A, Santos M, Saunders C, Seymour C, Turner A, van de Veerdonk F, Venkatesh B, Zarychanski R, Berry S, Lewis RJ, McArthur C, Webb SA, Gordon AC, Al-Beidh F, Angus D, Annane D, Arabi Y, van Bentum-Puijk W, Berry S, Beane A, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Cheng A, De Jong M, Derde L, Estcourt L, Goossens H, Gordon A, Green C, Haniffa R, Lamontagne F, Lawler P, Litton E, Marshall J, McArthur C, McAuley D, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Rowan K, Seymour C, Turner A, van de Veerdonk F, Webb S, Zarychanski R, Campbell L, Forbes A, Gattas D, Heritier S, Higgins L, Kruger P, Peake S, Presneill J, Seppelt I, Trapani T, Young P, Bagshaw S, Daneman N, Ferguson N, Misak C, Santos M, Hullegie S, Pletz M, Rohde G, Rowan K, Alexander B, Basile K, Girard T, Horvat C, Huang D, Linstrum K, Vates J, Beasley R, Fowler R, McGloughlin S, Morpeth S, Paterson D, Venkatesh B, Uyeki T, Baillie K, Duffy E, Fowler R, Hills T, Orr K, Patanwala A, Tong S, Netea M, Bihari S, Carrier M, Fergusson D, Goligher E, Haidar G, Hunt B, Kumar A, Laffan M, Lawless P, Lother S, McCallum P, Middeldopr S, McQuilten Z, Neal M, Pasi J, Schutgens R, Stanworth S, Turgeon A, Weissman A, Adhikari N, Anstey M, Brant E, de Man A, Lamonagne F, Masse MH, Udy A, Arnold D, Begin P, Charlewood R, Chasse M, Coyne M, Cooper J, Daly J, Gosbell I, Harvala-Simmonds H, Hills T, MacLennan S, Menon D, McDyer J, Pridee N, Roberts D, Shankar-Hari M, Thomas H, Tinmouth A, Triulzi D, Walsh T, Wood E, Calfee C, O’Kane C, Shyamsundar M, Sinha P, Thompson T, Young I, Bihari S, Hodgson C, Laffey J, McAuley D, Orford N, Neto A, Detry M, Fitzgerald M, Lewis R, McGlothlin A, Sanil A, Saunders C, Berry L, Lorenzi E, Miller E, Singh V, Zammit C, van Bentum Puijk W, Bouwman W, Mangindaan Y, Parker L, Peters S, Rietveld I, Raymakers K, Ganpat R, Brillinger N, Markgraf R, Ainscough K, Brickell K, Anjum A, Lane JB, Richards-Belle A, Saull M, Wiley D, Bion J, Connor J, Gates S, Manax V, van der Poll T, Reynolds J, van Beurden M, Effelaar E, Schotsman J, Boyd C, Harland C, Shearer A, Wren J, Clermont G, Garrard W, Kalchthaler K, King A, Ricketts D, Malakoutis S, Marroquin O, Music E, Quinn K, Cate H, Pearson K, Collins J, Hanson J, Williams P, Jackson S, Asghar A, Dyas S, Sutu M, Murphy S, Williamson D, Mguni N, Potter A, Porter D, Goodwin J, Rook C, Harrison S, Williams H, Campbell H, Lomme K, Williamson J, Sheffield J, van’t Hoff W, McCracken P, Young M, Board J, Mart E, Knott C, Smith J, Boschert C, Affleck J, Ramanan M, D’Souza R, Pateman K, Shakih A, Cheung W, Kol M, Wong H, Shah A, Wagh A, Simpson J, Duke G, Chan P, Cartner B, Hunter S, Laver R, Shrestha T, Regli A, Pellicano A, McCullough J, Tallott M, Kumar N, Panwar R, Brinkerhoff G, Koppen C, Cazzola F, Brain M, Mineall S, Fischer R, Biradar V, Soar N, White H, Estensen K, Morrison L, Smith J, Cooper M, Health M, Shehabi Y, Al-Bassam W, Hulley A, Whitehead C, Lowrey J, Gresha R, Walsham J, Meyer J, Harward M, Venz E, Williams P, Kurenda C, Smith K, Smith M, Garcia R, Barge D, Byrne D, Byrne K, Driscoll A, Fortune L, Janin P, Yarad E, Hammond N, Bass F, Ashelford A, Waterson S, Wedd S, McNamara R, Buhr H, Coles J, Schweikert S, Wibrow B, Rauniyar R, Myers E, Fysh E, Dawda A, Mevavala B, Litton E, Ferrier J, Nair P, Buscher H, Reynolds C, Santamaria J, Barbazza L, Homes J, Smith R, Murray L, Brailsford J, Forbes L, Maguire T, Mariappa V, Smith J, Simpson S, Maiden M, Bone A, Horton M, Salerno T, Sterba M, Geng W, Depuydt P, De Waele J, De Bus L, Fierens J, Bracke S, Reeve B, Dechert W, Chassé M, Carrier FM, Boumahni D, Benettaib F, Ghamraoui A, Bellemare D, Cloutier È, Francoeur C, Lamontagne F, D’Aragon F, Carbonneau E, Leblond J, Vazquez-Grande G, Marten N, Wilson M, Albert M, Serri K, Cavayas A, Duplaix M, Williams V, Rochwerg B, Karachi T, Oczkowski S, Centofanti J, Millen T, Duan E, Tsang J, Patterson L, English S, Watpool I, Porteous R, Miezitis S, McIntyre L, Brochard L, Burns K, Sandhu G, Khalid I, Binnie A, Powell E, McMillan A, Luk T, Aref N, Andric Z, Cviljevic S, Đimoti R, Zapalac M, Mirković G, Baršić B, Kutleša M, Kotarski V, Vujaklija Brajković A, Babel J, Sever H, Dragija L, Kušan I, Vaara S, Pettilä L, Heinonen J, Kuitunen A, Karlsson S, Vahtera A, Kiiski H, Ristimäki S, Azaiz A, Charron C, Godement M, Geri G, Vieillard-Baron A, Pourcine F, Monchi M, Luis D, Mercier R, Sagnier A, Verrier N, Caplin C, Siami S, Aparicio C, Vautier S, Jeblaoui A, Fartoukh M, Courtin L, Labbe V, Leparco C, Muller G, Nay MA, Kamel T, Benzekri D, Jacquier S, Mercier E, Chartier D, Salmon C, Dequin P, Schneider F, Morel G, L’Hotellier S, Badie J, Berdaguer FD, Malfroy S, Mezher C, Bourgoin C, Megarbane B, Voicu S, Deye N, Malissin I, Sutterlin L, Guitton C, Darreau C, Landais M, Chudeau N, Robert A, Moine P, Heming N, Maxime V, Bossard I, Nicholier TB, Colin G, Zinzoni V, Maquigneau N, Finn A, Kreß G, Hoff U, Friedrich Hinrichs C, Nee J, Pletz M, Hagel S, Ankert J, Kolanos S, Bloos F, Petros S, Pasieka B, Kunz K, Appelt P, Schütze B, Kluge S, Nierhaus A, Jarczak D, Roedl K, Weismann D, Frey A, Klinikum Neukölln V, Reill L, Distler M, Maselli A, Bélteczki J, Magyar I, Fazekas Á, Kovács S, Szőke V, Szigligeti G, Leszkoven J, Collins D, Breen P, Frohlich S, Whelan R, McNicholas B, Scully M, Casey S, Kernan M, Doran P, O’Dywer M, Smyth M, Hayes L, Hoiting O, Peters M, Rengers E, Evers M, Prinssen A, Bosch Ziekenhuis J, Simons K, Rozendaal W, Polderman F, de Jager 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Davies G, Puxty K, McCue C, Cathcart S, Hickey N, Ireland J, Yusuff H, Isgro G, Brightling C, Bourne M, Craner M, Watters M, Prout R, Davies L, Pegler S, Kyeremeh L, Arbane G, Wilson K, Gomm L, Francia F, Brett S, Sousa Arias S, Elin Hall R, Budd J, Small C, Birch J, Collins E, Henning J, Bonner S, Hugill K, Cirstea E, Wilkinson D, Karlikowski M, Sutherland H, Wilhelmsen E, Woods J, North J, Sundaran D, Hollos L, Coburn S, Walsh J, Turns M, Hopkins P, Smith J, Noble H, Depante MT, Clarey E, Laha S, Verlander M, Williams A, Huckle A, Hall A, Cooke J, Gardiner-Hill C, Maloney C, Qureshi H, Flint N, Nicholson S, Southin S, Nicholson A, Borgatta B, Turner-Bone I, Reddy A, Wilding L, Chamara Warnapura L, Agno Sathianathan R, Golden D, Hart C, Jones J, Bannard-Smith J, Henry J, Birchall K, Pomeroy F, Quayle R, Makowski A, Misztal B, Ahmed I, KyereDiabour T, Naiker K, Stewart R, Mwaura E, Mew L, Wren L, Willams F, Innes R, Doble P, Hutter J, Shovelton C, Plumb B, Szakmany T, Hamlyn V, Hawkins 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Keenan S, Baker E, Cherian S, Cutler S, Roynon-Reed A, Harrington K, Raithatha A, Bauchmuller K, Ahmad N, Grecu I, Trodd D, Martin J, Wrey Brown C, Arias AM, Craven T, Hope D, Singleton J, Clark S, Rae N, Welters I, Hamilton DO, Williams K, Waugh V, Shaw D, Puthucheary Z, Martin T, Santos F, Uddin R, Somerville A, Tatham KC, Jhanji S, Black E, Dela Rosa A, Howle R, Tully R, Drummond A, Dearden J, Philbin J, Munt S, Vuylsteke A, Chan C, Victor S, Matsa R, Gellamucho M, Creagh-Brown B, Tooley J, Montague L, De Beaux F, Bullman L, Kersiake I, Demetriou C, Mitchard S, Ramos L, White K, Donnison P, Johns M, Casey R, Mattocks L, Salisbury S, Dark P, Claxton A, McLachlan D, Slevin K, Lee S, Hulme J, Joseph S, Kinney F, Senya HJ, Oborska A, Kayani A, Hadebe B, Orath Prabakaran R, Nichols L, Thomas M, Worner R, Faulkner B, Gendall E, Hayes K, Hamilton-Davies C, Chan C, Mfuko C, Abbass H, Mandadapu V, Leaver S, Forton D, Patel K, Paramasivam E, Powell M, Gould R, Wilby E, Howcroft C, Banach D, Fernández de Pinedo Artaraz Z, Cabreros L, White I, Croft M, Holland N, Pereira R, Zaki A, Johnson D, Jackson M, Garrard H, Juhaz V, Roy A, Rostron A, Woods L, Cornell S, Pillai S, Harford R, Rees T, Ivatt H, Sundara Raman A, Davey M, Lee K, Barber R, Chablani M, Brohi F, Jagannathan V, Clark M, Purvis S, Wetherill B, Dushianthan A, Cusack R, de Courcy-Golder K, Smith S, Jackson S, Attwood B, Parsons P, Page V, Zhao XB, Oza D, Rhodes J, Anderson T, Morris S, Xia Le Tai C, Thomas A, Keen A, Digby S, Cowley N, Wild L, Southern D, Reddy H, Campbell A, Watkins C, Smuts S, Touma O, Barnes N, Alexander P, Felton T, Ferguson S, Sellers K, Bradley-Potts J, Yates D, Birkinshaw I, Kell K, Marshall N, Carr-Knott L, Summers C. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA 2020. [PMID: 32876697 DOI: 10.1001/jama.2020.1702221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. OBJECTIVE To determine whether hydrocortisone improves outcome for patients with severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. INTERVENTIONS The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). MAIN OUTCOMES AND MEASURES The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). RESULTS After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. CONCLUSIONS AND RELEVANCE Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
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Affiliation(s)
- Derek C Angus
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Farah Al-Beidh
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Paris, France
- Simone Veil School of Medicine, University of Versailles, Versailles, France
- University Paris Saclay, Garches, France
| | - Yaseen Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abigail Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Wilma van Bentum-Puijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Zahra Bhimani
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Charlotte Bradbury
- Bristol Royal Informatory, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | - Frank Brunkhorst
- Center for Clinical Studies and Center for Sepsis Control and Care (CSCC), Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Meredith Buxton
- Global Coalition for Adaptive Research, San Francisco, California
| | - Adrian Buzgau
- Helix, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Menno de Jong
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | | | - Lise Estcourt
- NHS Blood and Transplant, Bristol, United Kingdom
- Transfusion Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | | | - Herman Goossens
- Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Horvat
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Sebastiaan J Hullegie
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Patrick R Lawler
- Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Linstrum
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edward Litton
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | | | - John Marshall
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Daniel McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | | | - Shay McGuinness
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Bryan McVerry
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie Montgomery
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Paul Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Srinivas Murthy
- University of British Columbia School of Medicine, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane Parker
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kathryn Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | | | - Marlene Santos
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Christopher Seymour
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Anne Turner
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Frank van de Veerdonk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Balasubramanian Venkatesh
- Southside Clinical Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Ryan Zarychanski
- Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Roger J Lewis
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Department of Emergency Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Colin McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- St John of God Hospital, Subiaco, Western Australia, Australia
| | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
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Angus DC, Derde L, Al-Beidh F, Annane D, Arabi Y, Beane A, van Bentum-Puijk W, Berry L, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Buzgau A, Cheng AC, de Jong M, Detry M, Estcourt L, Fitzgerald M, Goossens H, Green C, Haniffa R, Higgins AM, Horvat C, Hullegie SJ, Kruger P, Lamontagne F, Lawler PR, Linstrum K, Litton E, Lorenzi E, Marshall J, McAuley D, McGlothin A, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Parker J, Rowan K, Sanil A, Santos M, Saunders C, Seymour C, Turner A, van de Veerdonk F, Venkatesh B, Zarychanski R, Berry S, Lewis RJ, McArthur C, Webb SA, Gordon AC, Al-Beidh F, Angus D, Annane D, Arabi Y, van Bentum-Puijk W, Berry S, Beane A, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Cheng A, De Jong M, Derde L, Estcourt L, Goossens H, Gordon A, Green C, Haniffa R, Lamontagne F, Lawler P, Litton E, Marshall J, McArthur C, McAuley D, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Rowan K, Seymour C, Turner A, van de Veerdonk F, Webb S, Zarychanski R, Campbell L, Forbes A, Gattas D, Heritier S, Higgins L, Kruger P, Peake S, Presneill J, Seppelt I, Trapani T, Young P, Bagshaw S, Daneman N, Ferguson N, Misak C, Santos M, Hullegie S, Pletz M, Rohde G, Rowan K, Alexander B, Basile K, Girard T, Horvat C, Huang D, Linstrum K, Vates J, Beasley R, Fowler R, McGloughlin S, Morpeth S, Paterson D, Venkatesh B, Uyeki T, Baillie K, Duffy E, Fowler R, Hills T, Orr K, Patanwala A, Tong S, Netea M, Bihari S, Carrier M, Fergusson D, Goligher E, Haidar G, Hunt B, Kumar A, Laffan M, Lawless P, Lother S, McCallum P, Middeldopr S, McQuilten Z, Neal M, Pasi J, Schutgens R, Stanworth S, Turgeon A, Weissman A, Adhikari N, Anstey M, Brant E, de Man A, Lamonagne F, Masse MH, Udy A, Arnold D, Begin P, Charlewood R, Chasse M, Coyne M, Cooper J, Daly J, Gosbell I, Harvala-Simmonds H, Hills T, MacLennan S, Menon D, McDyer J, Pridee N, Roberts D, Shankar-Hari M, Thomas H, Tinmouth A, Triulzi D, Walsh T, Wood E, Calfee C, O’Kane C, Shyamsundar M, Sinha P, Thompson T, Young I, Bihari S, Hodgson C, Laffey J, McAuley D, Orford N, Neto A, Detry M, Fitzgerald M, Lewis R, McGlothlin A, Sanil A, Saunders C, Berry L, Lorenzi E, Miller E, Singh V, Zammit C, van Bentum Puijk W, Bouwman W, Mangindaan Y, Parker L, Peters S, Rietveld I, Raymakers K, Ganpat R, Brillinger N, Markgraf R, Ainscough K, Brickell K, Anjum A, Lane JB, Richards-Belle A, Saull M, Wiley D, Bion J, Connor J, Gates S, Manax V, van der Poll T, Reynolds J, van Beurden M, Effelaar E, Schotsman J, Boyd C, Harland C, Shearer A, Wren J, Clermont G, Garrard W, Kalchthaler K, King A, Ricketts D, Malakoutis S, Marroquin O, Music E, Quinn K, Cate H, Pearson K, Collins J, Hanson J, Williams P, Jackson S, Asghar A, Dyas S, Sutu M, Murphy S, Williamson D, Mguni N, Potter A, Porter D, Goodwin J, Rook C, Harrison S, Williams H, Campbell H, Lomme K, Williamson J, Sheffield J, van’t Hoff W, McCracken P, Young M, Board J, Mart E, Knott C, Smith J, Boschert C, Affleck J, Ramanan M, D’Souza R, Pateman K, Shakih A, Cheung W, Kol M, Wong H, Shah A, Wagh A, Simpson J, Duke G, Chan P, Cartner B, Hunter S, Laver R, Shrestha T, Regli A, Pellicano A, McCullough J, Tallott M, Kumar N, Panwar R, Brinkerhoff G, Koppen C, Cazzola F, Brain M, Mineall S, Fischer R, Biradar V, Soar N, White H, Estensen K, Morrison L, Smith J, Cooper M, Health M, Shehabi Y, Al-Bassam W, Hulley A, Whitehead C, Lowrey J, Gresha R, Walsham J, Meyer J, Harward M, Venz E, Williams P, Kurenda C, Smith K, Smith M, Garcia R, Barge D, Byrne D, Byrne K, Driscoll A, Fortune L, Janin P, Yarad E, Hammond N, Bass F, Ashelford A, Waterson S, Wedd S, McNamara R, Buhr H, Coles J, Schweikert S, Wibrow B, Rauniyar R, Myers E, Fysh E, Dawda A, Mevavala B, Litton E, Ferrier J, Nair P, Buscher H, Reynolds C, Santamaria J, Barbazza L, Homes J, Smith R, Murray L, Brailsford J, Forbes L, Maguire T, Mariappa V, Smith J, Simpson S, Maiden M, Bone A, Horton M, Salerno T, Sterba M, Geng W, Depuydt P, De Waele J, De Bus L, Fierens J, Bracke S, Reeve B, Dechert W, Chassé M, Carrier FM, Boumahni D, Benettaib F, Ghamraoui A, Bellemare D, Cloutier È, Francoeur C, Lamontagne F, D’Aragon F, Carbonneau E, Leblond J, Vazquez-Grande G, Marten N, Wilson M, Albert M, Serri K, Cavayas A, Duplaix M, Williams V, Rochwerg B, Karachi T, Oczkowski S, Centofanti J, Millen T, Duan E, Tsang J, Patterson L, English S, Watpool I, Porteous R, Miezitis S, McIntyre L, Brochard L, Burns K, Sandhu G, Khalid I, Binnie A, Powell E, McMillan A, Luk T, Aref N, Andric Z, Cviljevic S, Đimoti R, Zapalac M, Mirković G, Baršić B, Kutleša M, Kotarski V, Vujaklija Brajković A, Babel J, Sever H, Dragija L, Kušan I, Vaara S, Pettilä L, Heinonen J, Kuitunen A, Karlsson S, Vahtera A, Kiiski H, Ristimäki S, Azaiz A, Charron C, Godement M, Geri G, Vieillard-Baron A, Pourcine F, Monchi M, Luis D, Mercier R, Sagnier A, Verrier N, Caplin C, Siami S, Aparicio C, Vautier S, Jeblaoui A, Fartoukh M, Courtin L, Labbe V, Leparco C, Muller G, Nay MA, Kamel T, Benzekri D, Jacquier S, Mercier E, Chartier D, Salmon C, Dequin P, Schneider F, Morel G, L’Hotellier S, Badie J, Berdaguer FD, Malfroy S, Mezher C, Bourgoin C, Megarbane B, Voicu S, Deye N, Malissin I, Sutterlin L, Guitton C, Darreau C, Landais M, Chudeau N, Robert A, Moine P, Heming N, Maxime V, Bossard I, Nicholier TB, Colin G, Zinzoni V, Maquigneau N, Finn A, Kreß G, Hoff U, Friedrich Hinrichs C, Nee J, Pletz M, Hagel S, Ankert J, Kolanos S, Bloos F, Petros S, Pasieka B, Kunz K, Appelt P, Schütze B, Kluge S, Nierhaus A, Jarczak D, Roedl K, Weismann D, Frey A, Klinikum Neukölln V, Reill L, Distler M, Maselli A, Bélteczki J, Magyar I, Fazekas Á, Kovács S, Szőke V, Szigligeti G, Leszkoven J, Collins D, Breen P, Frohlich S, Whelan R, McNicholas B, Scully M, Casey S, Kernan M, Doran P, O’Dywer M, Smyth M, Hayes L, Hoiting O, Peters M, Rengers E, Evers M, Prinssen A, Bosch Ziekenhuis J, Simons K, Rozendaal W, Polderman F, de Jager P, Moviat M, Paling A, Salet A, Rademaker E, Peters AL, de Jonge E, Wigbers J, Guilder E, Butler M, Cowdrey KA, Newby L, Chen Y, Simmonds C, McConnochie R, Ritzema Carter J, Henderson S, Van Der Heyden K, Mehrtens J, Williams T, Kazemi A, Song R, Lai V, Girijadevi D, Everitt R, Russell R, Hacking D, Buehner U, Williams E, Browne T, Grimwade K, Goodson J, Keet O, Callender O, Martynoga R, Trask K, Butler A, Schischka L, Young C, Lesona E, Olatunji S, Robertson Y, José N, Amaro dos Santos Catorze T, de Lima Pereira TNA, Neves Pessoa LM, Castro Ferreira RM, Pereira Sousa Bastos JM, Aysel Florescu S, Stanciu D, Zaharia MF, Kosa AG, Codreanu D, Marabi Y, Al Qasim E, Moneer Hagazy M, Al Swaidan L, Arishi H, Muñoz-Bermúdez R, Marin-Corral J, Salazar Degracia A, Parrilla Gómez F, Mateo López MI, Rodriguez Fernandez J, Cárcel Fernández S, Carmona Flores R, León López R, de la Fuente Martos C, Allan A, Polgarova P, Farahi N, McWilliam S, Hawcutt D, Rad L, O’Malley L, Whitbread J, Kelsall O, Wild L, Thrush J, Wood H, Austin K, Donnelly A, Kelly M, O’Kane S, McClintock D, Warnock M, Johnston P, Gallagher LJ, Mc Goldrick C, Mc Master M, Strzelecka A, Jha R, Kalogirou M, Ellis C, Krishnamurthy V, Deelchand V, Silversides J, McGuigan P, Ward K, O’Neill A, Finn S, Phillips B, Mullan D, Oritz-Ruiz de Gordoa L, Thomas M, Sweet K, Grimmer L, Johnson R, Pinnell J, Robinson M, Gledhill L, Wood T, Morgan M, Cole J, Hill H, Davies M, Antcliffe D, Templeton M, Rojo R, Coghlan P, Smee J, Mackay E, Cort J, Whileman A, Spencer T, Spittle N, Kasipandian V, Patel A, Allibone S, Genetu RM, Ramali M, Ghosh A, Bamford P, London E, Cawley K, Faulkner M, Jeffrey H, Smith T, Brewer C, Gregory J, Limb J, Cowton A, O’Brien J, Nikitas N, Wells C, Lankester L, Pulletz M, Williams P, Birch J, Wiseman S, Horton S, Alegria A, Turki S, Elsefi T, Crisp N, Allen L, McCullagh I, Robinson P, Hays C, Babio-Galan M, Stevenson H, Khare D, Pinder M, Selvamoni S, Gopinath A, Pugh R, Menzies D, Mackay C, Allan E, Davies G, Puxty K, McCue C, Cathcart S, Hickey N, Ireland J, Yusuff H, Isgro G, Brightling C, Bourne M, Craner M, Watters M, Prout R, Davies L, Pegler S, Kyeremeh L, Arbane G, Wilson K, Gomm L, Francia F, Brett S, Sousa Arias S, Elin Hall R, Budd J, Small C, Birch J, Collins E, Henning J, Bonner S, Hugill K, Cirstea E, Wilkinson D, Karlikowski M, Sutherland H, Wilhelmsen E, Woods J, North J, Sundaran D, Hollos L, Coburn S, Walsh J, Turns M, Hopkins P, Smith J, Noble H, Depante MT, Clarey E, Laha S, Verlander M, Williams A, Huckle A, Hall A, Cooke J, Gardiner-Hill C, Maloney C, Qureshi H, Flint N, Nicholson S, Southin S, Nicholson A, Borgatta B, Turner-Bone I, Reddy A, Wilding L, Chamara Warnapura L, Agno Sathianathan R, Golden D, Hart C, Jones J, Bannard-Smith J, Henry J, Birchall K, Pomeroy F, Quayle R, Makowski A, Misztal B, Ahmed I, KyereDiabour T, Naiker K, Stewart R, Mwaura E, Mew L, Wren L, Willams F, Innes R, Doble P, Hutter J, Shovelton C, Plumb B, Szakmany T, Hamlyn V, Hawkins N, Lewis S, Dell A, Gopal S, Ganguly S, Smallwood A, Harris N, Metherell S, Lazaro JM, Newman T, Fletcher S, Nortje J, Fottrell-Gould D, Randell G, Zaman M, Elmahi E, Jones A, Hall K, Mills G, Ryalls K, Bowler H, Sall J, Bourne R, Borrill Z, Duncan T, Lamb T, Shaw J, Fox C, Moreno Cuesta J, Xavier K, Purohit D, Elhassan M, Bakthavatsalam D, Rowland M, Hutton P, Bashyal A, Davidson N, Hird C, Chhablani M, Phalod G, Kirkby A, Archer S, Netherton K, Reschreiter H, Camsooksai J, Patch S, Jenkins S, Pogson D, Rose S, Daly Z, Brimfield L, Claridge H, Parekh D, Bergin C, Bates M, Dasgin J, McGhee C, Sim M, Hay SK, Henderson S, Phull MK, Zaidi A, Pogreban T, Rosaroso LP, Harvey D, Lowe B, Meredith M, Ryan L, Hormis A, Walker R, Collier D, Kimpton S, Oakley S, Rooney K, Rodden N, Hughes E, Thomson N, McGlynn D, Walden A, Jacques N, Coles H, Tilney E, Vowell E, Schuster-Bruce M, Pitts S, Miln R, Purandare L, Vamplew L, Spivey M, Bean S, Burt K, Moore L, Day C, Gibson C, Gordon E, Zitter L, Keenan S, Baker E, Cherian S, Cutler S, Roynon-Reed A, Harrington K, Raithatha A, Bauchmuller K, Ahmad N, Grecu I, Trodd D, Martin J, Wrey Brown C, Arias AM, Craven T, Hope D, Singleton J, Clark S, Rae N, Welters I, Hamilton DO, Williams K, Waugh V, Shaw D, Puthucheary Z, Martin T, Santos F, Uddin R, Somerville A, Tatham KC, Jhanji S, Black E, Dela Rosa A, Howle R, Tully R, Drummond A, Dearden J, Philbin J, Munt S, Vuylsteke A, Chan C, Victor S, Matsa R, Gellamucho M, Creagh-Brown B, Tooley J, Montague L, De Beaux F, Bullman L, Kersiake I, Demetriou C, Mitchard S, Ramos L, White K, Donnison P, Johns M, Casey R, Mattocks L, Salisbury S, Dark P, Claxton A, McLachlan D, Slevin K, Lee S, Hulme J, Joseph S, Kinney F, Senya HJ, Oborska A, Kayani A, Hadebe B, Orath Prabakaran R, Nichols L, Thomas M, Worner R, Faulkner B, Gendall E, Hayes K, Hamilton-Davies C, Chan C, Mfuko C, Abbass H, Mandadapu V, Leaver S, Forton D, Patel K, Paramasivam E, Powell M, Gould R, Wilby E, Howcroft C, Banach D, Fernández de Pinedo Artaraz Z, Cabreros L, White I, Croft M, Holland N, Pereira R, Zaki A, Johnson D, Jackson M, Garrard H, Juhaz V, Roy A, Rostron A, Woods L, Cornell S, Pillai S, Harford R, Rees T, Ivatt H, Sundara Raman A, Davey M, Lee K, Barber R, Chablani M, Brohi F, Jagannathan V, Clark M, Purvis S, Wetherill B, Dushianthan A, Cusack R, de Courcy-Golder K, Smith S, Jackson S, Attwood B, Parsons P, Page V, Zhao XB, Oza D, Rhodes J, Anderson T, Morris S, Xia Le Tai C, Thomas A, Keen A, Digby S, Cowley N, Wild L, Southern D, Reddy H, Campbell A, Watkins C, Smuts S, Touma O, Barnes N, Alexander P, Felton T, Ferguson S, Sellers K, Bradley-Potts J, Yates D, Birkinshaw I, Kell K, Marshall N, Carr-Knott L, Summers C. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA 2020; 324:1317-1329. [PMID: 32876697 PMCID: PMC7489418 DOI: 10.1001/jama.2020.17022] [Citation(s) in RCA: 542] [Impact Index Per Article: 135.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. OBJECTIVE To determine whether hydrocortisone improves outcome for patients with severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. INTERVENTIONS The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). MAIN OUTCOMES AND MEASURES The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). RESULTS After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. CONCLUSIONS AND RELEVANCE Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
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Affiliation(s)
- Derek C Angus
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Farah Al-Beidh
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Paris, France
- Simone Veil School of Medicine, University of Versailles, Versailles, France
- University Paris Saclay, Garches, France
| | - Yaseen Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abigail Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Wilma van Bentum-Puijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Zahra Bhimani
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Charlotte Bradbury
- Bristol Royal Informatory, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | - Frank Brunkhorst
- Center for Clinical Studies and Center for Sepsis Control and Care (CSCC), Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Meredith Buxton
- Global Coalition for Adaptive Research, San Francisco, California
| | - Adrian Buzgau
- Helix, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Menno de Jong
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | | | - Lise Estcourt
- NHS Blood and Transplant, Bristol, United Kingdom
- Transfusion Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | | | - Herman Goossens
- Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Horvat
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Sebastiaan J Hullegie
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Patrick R Lawler
- Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Linstrum
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edward Litton
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | | | - John Marshall
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Daniel McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | | | - Shay McGuinness
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Bryan McVerry
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie Montgomery
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Paul Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Srinivas Murthy
- University of British Columbia School of Medicine, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane Parker
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kathryn Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | | | - Marlene Santos
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Christopher Seymour
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Anne Turner
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Frank van de Veerdonk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Balasubramanian Venkatesh
- Southside Clinical Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Ryan Zarychanski
- Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Roger J Lewis
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Department of Emergency Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Colin McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- St John of God Hospital, Subiaco, Western Australia, Australia
| | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
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46
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Hudson AR, Santora VJ, Petroski RE, Almos TA, Anderson G, Barido R, Basinger J, Bellows CL, Bookser BC, Broadbent NJ, Cabebe C, Chai CK, Chen M, Chow S, Chung DM, Heger L, Danks AM, Freestone GC, Gitnick D, Gupta V, Hoffmaster C, Kaplan AP, Kennedy MR, Lee D, Limberis J, Ly K, Mak CC, Masatsugu B, Morse AC, Na J, Neul D, Nikpur J, Renick J, Sebring K, Sevidal S, Tabatabaei A, Wen J, Xia S, Yan Y, Yoder ZW, Zook D, Peters M, Breitenbucher JG. Azetidine-based selective glycine transporter-1 (GlyT1) inhibitors with memory enhancing properties. Bioorg Med Chem Lett 2020; 30:127214. [PMID: 32527538 DOI: 10.1016/j.bmcl.2020.127214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022]
Abstract
A strategy to conformationally restrain a series of GlyT1 inhibitors identified potent analogs that exhibited slowly interconverting rotational isomers. Further studies to address this concern led to a series of azetidine-based inhibitors. Compound 26 was able to elevate CSF glycine levels in vivo and demonstrated potency comparable to Bitopertin in an in vivo rat receptor occupancy study. Compound 26 was subsequently shown to enhance memory in a Novel Object Recognition (NOR) behavioral study after a single dose of 0.03 mg/kg, and in a contextual fear conditioning (cFC) study after four QD doses of 0.01-0.03 mg/kg.
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Affiliation(s)
- Andrew R Hudson
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States.
| | - Vincent J Santora
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Robert E Petroski
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Theresa A Almos
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Gary Anderson
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Richard Barido
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Jillian Basinger
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Chris L Bellows
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Brett C Bookser
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Nicola J Broadbent
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Clifford Cabebe
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Chih-Kun Chai
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Mi Chen
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Stephine Chow
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - De Michael Chung
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Lindsay Heger
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Anne M Danks
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Graeme C Freestone
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Dany Gitnick
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Varsha Gupta
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | | | - Alan P Kaplan
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Michael R Kennedy
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Dong Lee
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - James Limberis
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Kiev Ly
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Chi Ching Mak
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Brittany Masatsugu
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Andrew C Morse
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Jim Na
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - David Neul
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - John Nikpur
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Joel Renick
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Kristen Sebring
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Samantha Sevidal
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Ali Tabatabaei
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Jenny Wen
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Shouzhen Xia
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Yingzhuo Yan
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Zachary W Yoder
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Douglas Zook
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - Marco Peters
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
| | - J Guy Breitenbucher
- Dart Neuroscience, 12278 Scripps Summit Dr, San Diego, CA 92131, United States
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47
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Gao C, Peters M, Jayaraajan K, Todd M, Cashman S, Nambiar A, Cumberbatch M, Lamb B, Peacock A, Van Son M, Van Rossum P, Pickard R, Erotocritou P, Smith D, Kasivisvanathan V, Shah T. Development of a risk calculator to predict spontaneous stone passage in patients with acute ureteric colic. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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48
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Khoo C, Eldred-Evans D, Peters M, Hosking-Jervis F, Connor M, Reddy D, Bertoncelli Tanaka M, Bhola-Stewart H, Maynard W, Bass E, Shah T, Lee J, Sri D, Powell L, Ahmad S, Noureldin M, Joshi S, Pegers E, Wong K, Tam H, Hrouda D, Winkler M, Gordon S, Qazi H, Ahmed H. Man vs machine: Comparative effectiveness of cognitive targeted and image-fusion targeted transperineal prostate biopsy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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49
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Eldred-Evans D, Peters M, Bertoncelli Tanaka M, Hosking-Jervis F, Connor M, Reddy D, Shah T, Khoo C, Maynard W, Bass E, Lee J, Sri D, Bhola-Stewart H, Powell L, Ahmad S, Joshi S, Pegers E, Wong K, Tam H, Hrouda D, Winkler M, Qazi H, Gordon S, Ahmed H. The RAPID risk model: A novel risk score to predict significant prostate cancer in men with an mpMRI lesion. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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50
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Khoo C, Scott A, Peters M, Maynard W, Chamberlain G, Fooks P, Hrouda D, Minhas S. A contemporary analysis of radical orchidectomy for testis cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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