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Bernat JL, Khush KK, Shemie SD, Hartwig MG, Reese PP, Dalle Ave A, Parent B, Glazier AK, Capron AM, Craig M, Gofton T, Gordon EJ, Healey A, Homan ME, Ladin K, Messer S, Murphy N, Nakagawa TA, Parker WF, Pentz RD, Rodríguez-Arias D, Schwartz B, Sulmasy DP, Truog RD, Wall AE, Wall SP, Wolpe PR, Fenton KN. Knowledge gaps in heart and lung donation after the circulatory determination of death: Report of a workshop of the National Heart, Lung, and Blood Institute. J Heart Lung Transplant 2024:S1053-2498(24)01499-2. [PMID: 38432523 DOI: 10.1016/j.healun.2024.02.1455] [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: 01/13/2024] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
In a workshop sponsored by the U.S. National Heart, Lung, and Blood Institute, experts identified current knowledge gaps and research opportunities in the scientific, conceptual, and ethical understanding of organ donation after the circulatory determination of death and its technologies. To minimize organ injury from warm ischemia and produce better recipient outcomes, innovative techniques to perfuse and oxygenate organs postmortem in situ, such as thoracoabdominal normothermic regional perfusion, are being implemented in several medical centers in the US and elsewhere. These technologies have improved organ outcomes but have raised ethical and legal questions. Re-establishing donor circulation postmortem can be viewed as invalidating the condition of permanent cessation of circulation on which the earlier death determination was made and clamping arch vessels to exclude brain circulation can be viewed as inducing brain death. Alternatively, TA-NRP can be viewed as localized in-situ organ perfusion, not whole-body resuscitation, that does not invalidate death determination. Further scientific, conceptual, and ethical studies, such as those identified in this workshop, can inform and help resolve controversies raised by this practice.
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Affiliation(s)
- James L Bernat
- Department of Neurology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sam D Shemie
- Division of Critical Care Medicine, Montreal Children's Hospital, McGill University, Montreal, PQ, Canada
| | - Matthew G Hartwig
- Division of Thoracic Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
| | - Peter P Reese
- Center for Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne Dalle Ave
- Kennedy Institute of Ethics, Georgetown University, Washington, District of Columbia
| | - Brendan Parent
- Division of Medical Ethics and Department of Surgery, NYU Grossman School of Medicine, New York, New York
| | - Alexandra K Glazier
- Brown University, School of Public Health, Providence, Rhode Island; New England Donor Services, Waltham, Massachusetts
| | - Alexander M Capron
- Gould School of Law and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matt Craig
- Lung Biology and Disease Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Elisa J Gordon
- Department of Surgery, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew Healey
- Department of Medicine McMaster University and William Osler Health System, Hamilton, Ontario, Canada
| | | | - Keren Ladin
- Research on Ethics, Aging, and Community Health (REACH Lab); Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Simon Messer
- Department of Transplant, Golden Jubilee National Hospital, Clydebank, Scotland UK
| | - Nick Murphy
- Departments of Medicine and Philosophy, Western University, London, Ontario, Canada
| | - Thomas A Nakagawa
- University of Florida College of Medicine-Jacksonville, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Jacksonville, Florida
| | - William F Parker
- Department of Medicine and Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Rebecca D Pentz
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Bryanna Schwartz
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Maryland; Department of Cardiology, Children's National Medical Center, Washington, District of Columbia
| | - Daniel P Sulmasy
- The Kennedy Institute of Ethics and the Departments of Medicine and Philosophy, Georgetown University, Washington, District of Columbia
| | - Robert D Truog
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital; Center for Bioethics, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Anji E Wall
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine; NYU Grossman School of Medicine and Department of Population Health, NYU, New York, New York
| | - Paul R Wolpe
- Center for Ethics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Kathleen N Fenton
- Advanced Technologies and Surgery Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, and Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland
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Msayib Y, Craig M, Simard MA, Larkin JR, Shin DD, Liu TT, Sibson NR, Okell TW, Chappell MA. Robust estimation of quantitative perfusion from multi-phase pseudo-continuous arterial spin labeling. Magn Reson Med 2020; 83:815-829. [PMID: 31429999 PMCID: PMC6899553 DOI: 10.1002/mrm.27965] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Multi-phase PCASL has been proposed as a means to achieve accurate perfusion quantification that is robust to imperfect shim in the labeling plane. However, there exists a bias in the estimation process that is a function of noise in the data. In this work, this bias is characterized and then addressed in animal and human data. METHODS The proposed algorithm to overcome bias uses the initial biased voxel-wise estimate of phase tracking error to cluster regions with different off-resonance phase shifts, from which a high-SNR estimate of regional phase offset is derived. Simulations were used to predict the bias expected at typical SNR. Multi-phase PCASL in 3 rat strains (n = 21) at 9.4 T was considered, along with 20 human subjects previously imaged using ASL at 3 T. The algorithm was extended to include estimation of arterial blood flow velocity. RESULTS Based on simulations, a perfusion estimation bias of 6-8% was expected using 8-phase data at typical SNR. This bias was eliminated when a high-precision estimate of phase error was available. In the preclinical data, the bias-corrected measure of perfusion (107 ± 14 mL/100g/min) was lower than the standard analysis (116 ± 14 mL/100g/min), corresponding to a mean observed bias across strains of 8.0%. In the human data, bias correction resulted in a 15% decrease in the estimate of perfusion. CONCLUSIONS Using a retrospective algorithmic approach, it was possible to exploit common information found in multiple voxels within a whole region of the brain, offering superior SNR and thus overcoming the bias in perfusion quantification from multi-phase PCASL.
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Affiliation(s)
- Y. Msayib
- Department of Engineering ScienceInstitute of Biomedical EngineeringUniversity of OxfordOxfordUnited Kingdom
| | - M. Craig
- Department of Engineering ScienceInstitute of Biomedical EngineeringUniversity of OxfordOxfordUnited Kingdom
| | - M. A. Simard
- Department of OncologyCancer Research UK and Medical Research Council (CRUK/MRC) Oxford Institute for Radiation OncologyUniversity of OxfordOxfordUnited Kingdom
| | - J. R. Larkin
- Department of OncologyCancer Research UK and Medical Research Council (CRUK/MRC) Oxford Institute for Radiation OncologyUniversity of OxfordOxfordUnited Kingdom
| | | | - T. T. Liu
- Center for Functional MRIUniversity of CaliforniaSan DiegoCalifornia
| | - N. R. Sibson
- Department of OncologyCancer Research UK and Medical Research Council (CRUK/MRC) Oxford Institute for Radiation OncologyUniversity of OxfordOxfordUnited Kingdom
- Wellcome Centre for Integrative NeuroimagingFMRIBNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
| | - T. W. Okell
- Wellcome Centre for Integrative NeuroimagingFMRIBNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
| | - M. A. Chappell
- Department of Engineering ScienceInstitute of Biomedical EngineeringUniversity of OxfordOxfordUnited Kingdom
- Wellcome Centre for Integrative NeuroimagingFMRIBNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
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Mullane KM, Morrison VA, Camacho LH, Arvin A, McNeil SA, Durrand J, Campbell B, Su SC, Chan ISF, Parrino J, Kaplan SS, Popmihajlov Z, Annunziato PW, Cerana S, Dictar MO, Bonvehi P, Tregnaghi JP, Fein L, Ashley D, Singh M, Hayes T, Playford G, Morrissey O, Thaler J, Kuehr T, Greil R, Pecherstorfer M, Duck L, Van Eygen K, Aoun M, De Prijck B, Franke FA, Barrios CHE, Mendes AVA, Serrano SV, Garcia RF, Moore F, Camargo JFC, Pires LA, Alves RS, Radinov A, Oreshkov K, Minchev V, Hubenova AI, Koynova T, Ivanov I, Rabotilova B, Minchev V, Petrov PA, Chilingirov P, Karanikolov S, Raynov J, Grimard D, McNeil S, Kumar D, Larratt LM, Weiss K, Delage R, Diaz-Mitoma FJ, Cano PO, Couture F, Carvajal P, Yepes A, Torres Ulloa R, Fardella P, Caglevic C, Rojas C, Orellana E, Gonzalez P, Acevedo A, Galvez KM, Gonzalez ME, Franco S, Restrepo JG, Rojas CA, Bonilla C, Florez LE, Ospina AV, Manneh R, Zorica R, Vrdoljak DV, Samarzija M, Petruzelka L, Vydra J, Mayer J, Cibula D, Prausova J, Paulson G, Ontaneda M, Palk K, Vahlberg A, Rooneem R, Galtier F, Postil D, Lucht F, Laine F, Launay O, Laurichesse H, Duval X, Cornely OA, Camerer B, Panse J, Zaiss M, Derigs HG, Menzel H, Verbeek M, Georgoulias V, Mavroudis D, Anagnostopoulos A, Terpos E, Cortes D, Umanzor J, Bejarano S, Galeano RW, Wong RSM, Hui P, Pedrazzoli P, Ruggeri L, Aversa F, Bosi A, Gentile G, Rambaldi A, Contu A, Marei L, Abbadi A, Hayajneh W, Kattan J, Farhat F, Chahine G, Rutkauskiene J, Marfil Rivera LJ, Lopez Chuken YA, Franco Villarreal H, Lopez Hernandez J, Blacklock H, Lopez RI, Alvarez R, Gomez AM, Quintana TS, Moreno Larrea MDC, Zorrilla SJ, Alarcon E, Samanez FCA, Caguioa PB, Tiangco BJ, Mora EM, Betancourt-Garcia RD, Hallman-Navarro D, Feliciano-Lopez LJ, Velez-Cortes HA, Cabanillas F, Ganea DE, Ciuleanu TE, Ghizdavescu DG, Miron L, Cebotaru CL, Cainap CI, Anghel R, Dvorkin MV, Gladkov OA, Fadeeva NV, Kuzmin AA, Lipatov ON, Zbarskaya II, Akhmetzyanov FS, Litvinov IV, Afanasyev BV, Cherenkova M, Lioznov D, Lisukov IA, Smirnova YA, Kolomietz S, Halawani H, Goh YT, Drgona L, Chudej J, Matejkova M, Reckova M, Rapoport BL, Szpak WM, Malan DR, Jonas N, Jung CW, Lee DG, Yoon SS, Lopez Jimenez J, Duran Martinez I, Rodriguez Moreno JF, Solano Vercet C, de la Camara R, Batlle Massana M, Yeh SP, Chen CY, Chou HH, Tsai CM, Chiu CH, Siritanaratkul N, Norasetthada L, Sriuranpong V, Seetalarom K, Akan H, Dane F, Ozcan MA, Ozsan GH, Kalayoglu Besisik SF, Cagatay A, Yalcin S, Peniket A, Mullan SR, Dakhil KM, Sivarajan K, Suh JJG, Sehgal A, Marquez F, Gomez EG, Mullane MR, Skinner WL, Behrens RJ, Trevarthe DR, Mazurczak MA, Lambiase EA, Vidal CA, Anac SY, Rodrigues GA, Baltz B, Boccia R, Wertheim MS, Holladay CS, Zenk D, Fusselman W, Wade III JL, Jaslowsk AJ, Keegan J, Robinson MO, Go RS, Farnen J, Amin B, Jurgens D, Risi GF, Beatty PG, Naqvi T, Parshad S, Hansen VL, Ahmed M, Steen PD, Badarinath S, Dekker A, Scouros MA, Young DE, Graydon Harker W, Kendall SD, Citron ML, Chedid S, Posada JG, Gupta MK, Rafiyath S, Buechler-Price J, Sreenivasappa S, Chay CH, Burke JM, Young SE, Mahmood A, Kugler JW, Gerstner G, Fuloria J, Belman ND, Geller R, Nieva J, Whittenberger BP, Wong BMY, Cescon TP, Abesada-Terk G, Guarino MJ, Zweibach A, Ibrahim EN, Takahashi G, Garrison MA, Mowat RB, Choi BS, Oliff IA, Singh J, Guter KA, Ayrons K, Rowland KM, Noga SJ, Rao SB, Columbie A, Nualart MT, Cecchi GR, Campos LT, Mohebtash M, Flores MR, Rothstein-Rubin R, O'Connor BM, Soori G, Knapp M, Miranda FG, Goodgame BW, Kassem M, Belani R, Sharma S, Ortiz T, Sonneborn HL, Markowitz AB, Wilbur D, Meiri E, Koo VS, Jhangiani HS, Wong L, Sanani S, Lawrence SJ, Jones CM, Murray C, Papageorgiou C, Gurtler JS, Ascensao JL, Seetalarom K, Venigalla ML, D'Andrea M, De Las Casas C, Haile DJ, Qazi FU, Santander JL, Thomas MR, Rao VP, Craig M, Garg RJ, Robles R, Lyons RM, Stegemoller RK, Goel S, Garg S, Lowry P, Lynch C, Lash B, Repka T, Baker J, Goueli BS, Campbell TC, Van Echo DA, Lee YJ, Reyes EA, Senecal FM, Donnelly G, Byeff P, Weiss R, Reid T, Roeland E, Goel A, Prow DM, Brandt DS, Kaplan HG, Payne JE, Boeckh MG, Rosen PJ, Mena RR, Khan R, Betts RF, Sharp SA, Morrison VA, Fitz-Patrick D, Congdon J, Erickson N, Abbasi R, Henderson S, Mehdi A, Wos EJ, Rehmus E, Beltzer L, Tamayo RA, Mahmood T, Reboli AC, Moore A, Brown JM, Cruz J, Quick DP, Potz JL, Kotz KW, Hutchins M, Chowhan NM, Devabhaktuni YD, Braly P, Berenguer RA, Shambaugh SC, O'Rourke TJ, Conkright WA, Winkler CF, Addo FEK, Duic JP, High KP, Kutner ME, Collins R, Carrizosa DR, Perry DJ, Kailath E, Rosen N, Sotolongo R, Shoham S, Chen T. Safety and efficacy of inactivated varicella zoster virus vaccine in immunocompromised patients with malignancies: a two-arm, randomised, double-blind, phase 3 trial. The Lancet Infectious Diseases 2019; 19:1001-1012. [DOI: 10.1016/s1473-3099(19)30310-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022]
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Yourshaw J, Armstrong C, Mishra P, Steinberg D, Ramu B, Craig M, Van Bakel A, Tedford R, Houston B. Effects of Percutaneous LVAD Support on Right Ventricular Load and Adaptation Acutely and Over Time. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.096] [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] Open
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Craig M. Towards Quantitative Systems Pharmacology Models of Chemotherapy-Induced Neutropenia. CPT Pharmacometrics Syst Pharmacol 2017; 6:293-304. [PMID: 28418603 PMCID: PMC5445232 DOI: 10.1002/psp4.12191] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 12/22/2022] Open
Abstract
Neutropenia is a serious toxic complication of chemotherapeutic treatment. For years, mathematical models have been developed to better predict hematological outcomes during chemotherapy in both the traditional pharmaceutical sciences and mathematical biology disciplines. An increasing number of quantitative systems pharmacology (QSP) models that combine systems approaches, physiology, and pharmacokinetics/pharmacodynamics have been successfully developed. Here, I detail the shift towards QSP efforts, emphasizing the importance of incorporating systems-level physiological considerations in pharmacometrics.
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Affiliation(s)
- M Craig
- Program for Evolutionary Dynamics, Harvard UniversityCambridgeMassachusettsUSA
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Affiliation(s)
- M Craig
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick E2L 4L5, Canada
| | - W Hill
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, New Brunswick E3B5A3, Canada
| | - K Englehart
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, New Brunswick E3B5A3, Canada
| | - A Adisesh
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick E2L 4L5, Canada
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McCrickard L, Marlow M, Self JL, Watkins LF, Chatham-Stephens K, Anderson J, Hand S, Taylor K, Hanson J, Patrick K, Luquez C, Dykes J, Kalb SR, Hoyt K, Barr JR, Crawford T, Chambers A, Douthit B, Cox R, Craig M, Spurzem J, Doherty J, Allswede M, Byers P, Dobbs T. Notes from the Field: Botulism Outbreak from Drinking Prison-Made Illicit Alcohol in a Federal Correctional Facility - Mississippi, June 2016. MMWR Morb Mortal Wkly Rep 2017; 65:1491-1492. [PMID: 28056003 DOI: 10.15585/mmwr.mm6552a8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Craig M, Humphries AR, Mackey MC. A Mathematical Model of Granulopoiesis Incorporating the Negative Feedback Dynamics and Kinetics of G-CSF/Neutrophil Binding and Internalization. Bull Math Biol 2016; 78:2304-2357. [PMID: 27324993 DOI: 10.1007/s11538-016-0179-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/19/2016] [Indexed: 11/24/2022]
Abstract
We develop a physiological model of granulopoiesis which includes explicit modelling of the kinetics of the cytokine granulocyte colony-stimulating factor (G-CSF) incorporating both the freely circulating concentration and the concentration of the cytokine bound to mature neutrophils. G-CSF concentrations are used to directly regulate neutrophil production, with the rate of differentiation of stem cells to neutrophil precursors, the effective proliferation rate in mitosis, the maturation time, and the release rate from the mature marrow reservoir into circulation all dependent on the level of G-CSF in the system. The dependence of the maturation time on the cytokine concentration introduces a state-dependent delay into our differential equation model, and we show how this is derived from an age-structured partial differential equation model of the mitosis and maturation and also detail the derivation of the rest of our model. The model and its estimated parameters are shown to successfully predict the neutrophil and G-CSF responses to a variety of treatment scenarios, including the combined administration of chemotherapy and exogenous G-CSF. This concomitant treatment was reproduced without any additional fitting to characterize drug-drug interactions.
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Affiliation(s)
- M Craig
- Faculté de Pharmacie, Université de Montréal, Montréal, QC, H3T 1J4, Canada.
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, 02138, USA.
| | - A R Humphries
- Department of Mathematics and Statistics, McGill University, Montréal, QC, H3A 0B9, Canada
| | - M C Mackey
- Departments of Mathematics, Physics and Physiology, McGill University, Montréal, QC, H3G 1Y6, Canada
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Veasey T, Strout S, Rieger K, Floroff C, Brisco M, Cook J, Toole J, Craig M, VanBakel A, Heyward D, Uber W, Meadows H. Evaluation of Anticoagulation and Non-Surgical Major Bleeding in Recipients of Continuous-Flow Left Ventricular Assist Devices. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.336] [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: 10/22/2022] Open
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Craig M, González-Sales M, Li J, Nekka F. Approaching Pharmacometrics as a Paleontologist Would: Recovering the Links Between Drugs and the Body Through Reconstruction. CPT Pharmacometrics Syst Pharmacol 2016; 5:158-60. [PMID: 27069779 PMCID: PMC4809624 DOI: 10.1002/psp4.12069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/08/2016] [Accepted: 02/16/2016] [Indexed: 11/08/2022]
Abstract
Our knowledge of dinosaurs comes primarily from the fossil record. Notwithstanding the condition of these vestiges, paleontologists reconstruct early reptilian life by comparison to previously discovered specimens. When relics are missing, reasonable deductions are used to fill in the gaps.
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Affiliation(s)
- M Craig
- Faculté de Pharmacie Université de Montréal Montréal QC Canada; Centre for Applied Mathematics in Bioscience and Medicine (CAMBAM) McGill University Montreal Quebec Canada
| | - M González-Sales
- Faculté de Pharmacie Université de Montréal Montréal QC Canada; inVentiv Health Clinical Montréal Quebec Canada
| | - J Li
- Faculté de Pharmacie Université de Montréal Montréal QC Canada; Centre for Applied Mathematics in Bioscience and Medicine (CAMBAM) McGill University Montreal Quebec Canada
| | - F Nekka
- Faculté de Pharmacie Université de Montréal Montréal QC Canada; Centre for Applied Mathematics in Bioscience and Medicine (CAMBAM) McGill University Montreal Quebec Canada
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Grant EN, Tao W, Craig M, McIntire D, Leveno K. Neuraxial analgesia effects on labour progression: facts, fallacies, uncertainties and the future. BJOG 2014; 122:288-93. [PMID: 25088476 DOI: 10.1111/1471-0528.12966] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 01/31/2023]
Abstract
Approximately 60% of women who labour in the USA receive some form of neuraxial analgesia, but concerns have been raised regarding whether it negatively impacts the labour and delivery process. In this review, we attempt to clarify what has been established as truths, falsities and uncertainties regarding the effects of this form of pain relief on labour progression, negative and/or positive. Additionally, although the term 'epidural' has become synonymous with neuraxial analgesia, we discuss two other techniques, combined spinal-epidural and continuous spinal analgesia, that are gaining popularity, as well as their effects on labour progression.
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Affiliation(s)
- E N Grant
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Tedd KM, Coxon CE, Misstear BDR, Daly D, Craig M, Mannix A, Williams NHH. An integrated pressure and pathway approach to the spatial analysis of groundwater nitrate: a case study from the southeast of Ireland. Sci Total Environ 2014; 476-477:460-476. [PMID: 24486501 DOI: 10.1016/j.scitotenv.2013.12.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 06/03/2023]
Abstract
Excess nitrogen in soil, aquatic and atmospheric environments is an escalating global problem. Eutrophication is the principal threat to surface water quality in the Republic of Ireland. European Union Water Framework Directive (2000/60/EC) water quality status assessments found that 16% of Irish groundwater bodies were 'at risk' of poor status due to the potential deterioration of associated estuarine and coastal water quality by nitrate from groundwater. This paper presents a methodology for evaluating pressure and pathway parameters affecting the spatial distribution of groundwater nitrate, investigated at a regional scale using existing national spatial datasets. The potential for nitrate transfer to groundwater was rated based on the introduced concepts of Pressure Loading and Pathway Connectivity Rating, each based on a combination of selected pressure and pathway parameters respectively. In the region studied, the South Eastern River Basin District of Ireland, this methodology identified that pathway parameters were more important than pressure parameters in understanding the spatial distribution of groundwater nitrate. Statistical analyses supported these findings and further demonstrated that the proportion of poorly drained soils, arable land, karstic flow regimes, regionally important bedrock aquifers and high vulnerability groundwater within the zones of contribution of the monitoring points are statistically significantly related to groundwater nitrate concentrations. Soil type was found to be the most important parameter. Analysis of variance showed that a number of the pressure and pathway parameters are interrelated. The parameters identified by the presented methodology may provide useful insights into the best way to manage and mitigate the influence of nitrate contamination of groundwater in this region. It is suggested that the identification of critical source areas based on the identified parameters would be an appropriate management tool, enabling planning and enforcement resources to be focussed on areas which will yield most benefit.
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Affiliation(s)
- K M Tedd
- Department of Geology, School of Natural Sciences, Trinity College Dublin, Dublin 2, Ireland; Hydrometric & Groundwater Section, Environmental Protection Agency, Richview, Dublin 14, Ireland
| | - C E Coxon
- Department of Geology, School of Natural Sciences, Trinity College Dublin, Dublin 2, Ireland
| | - B D R Misstear
- Department of Civil, Structural and Environmental Engineering, Trinity College Dublin, Dublin 2, Ireland
| | - D Daly
- Hydrometric & Groundwater Section, Environmental Protection Agency, Richview, Dublin 14, Ireland
| | - M Craig
- Hydrometric & Groundwater Section, Environmental Protection Agency, Richview, Dublin 14, Ireland
| | - A Mannix
- Hydrometric & Groundwater Section, Environmental Protection Agency, Richview, Dublin 14, Ireland
| | - N H Hunter Williams
- Groundwater Section, Geological Survey of Ireland, Haddington Road, Dublin 4, Ireland
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Cumpston A, Craig M, Hamadani M, Abraham J, Hobbs GR, Sarwari AR. Extended follow-up of an antibiotic cycling program for the management of febrile neutropenia in a hematologic malignancy and hematopoietic cell transplantation unit. Transpl Infect Dis 2012; 15:142-9. [PMID: 23279656 DOI: 10.1111/tid.12035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/08/2012] [Accepted: 08/09/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Febrile neutropenia is a common complication during treatment of hematological malignancies and hematopoietic cell transplantation. Empiric antibiotic therapy in this setting, while standard of care, commonly leads to microbial resistance. We have previously shown that cycling antibiotics in this patient population is feasible. This report provides long-term follow-up of cycling antibiotics in this patient population. METHODS In a prospective cohort of hematological malignancy patients with neutropenic fever, we sought to evaluate the role of empiric antibiotic cycling in preventing antibiotic resistance. Antibiotic cycling was initiated in March 2002 and, until June 2005, antibiotics were cycled every 8 months (Cycling Period A). From July 2005 to December 2009, antibiotics were cycled every 3 months (Cycling Period B). The rates of bacteremia, resistance, and complications were compared to a retrospective cohort (Pre-cycling Period). RESULTS The rate of gram-negative bacteremia decreased when compared to Cycling Periods A and B (5.3 vs. 2.1 and 3.3 episodes/1000 patient-days, respectively, P < 0.0001), most likely owing to implementation of quinolone prophylaxis. The resistance profile of the gram-negative organisms isolated remained stable over the 3 time periods, with the exception of an increase in quinolone resistance during the cycling periods. Gram-positive bacteremia rates remained stable, but vancomycin-resistant Enterococcus (VRE) increased significantly (0.1 vs. 1.0 and 1.6 episodes/1000 patient-days, respectively, P = 0.005) during cycling periods. Mortality rates were comparable. CONCLUSIONS Antibiotic cycling for neutropenic fever was effectively implemented and followed over an extended time period. Gram-negative resistance remained stable, but there is some concern for selection of resistant gram-positive bacteria, specifically VRE. Although antibiotic cycling did not seem to cause resistance in our study, further study is necessary to clarify the effect of cycling on antibiotic resistance, patient outcomes, and hospital cost.
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Affiliation(s)
- A Cumpston
- Pharmacy Department, West Virginia University Healthcare, Morgantown, West Virginia 26506, USA.
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Srinivasan A, Craig M, Cardo D. The Power of Policy Change, Federal Collaboration, and State Coordination in Healthcare-Associated Infection Prevention. Clin Infect Dis 2012; 55:426-31. [DOI: 10.1093/cid/cis407] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Rogers JE, Cumpston A, Newton M, Craig M. Onset and complications of varicella zoster reactivation in the autologous hematopoietic cell transplant population. Transpl Infect Dis 2011; 13:480-4. [PMID: 21615848 DOI: 10.1111/j.1399-3062.2011.00655.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Varicella zoster virus (VZV) infections are a common complication in patients receiving autologous or allogeneic hematopoietic cell transplant (HCT). Recent guideline revisions suggest extending VZV prophylaxis to 1 year after autologous HCT. We retrospectively evaluated reactivation at our center, before implementation of extended acyclovir prophylaxis, to determine onset and outcome in the autologous HCT population. METHODS Inclusion criteria consisted of adult patients who received an autologous HCT with documentation for at least 1 year post transplant. Those excluded from review were patients who received acyclovir prophylaxis for >30 days post transplant or subsequently received an allogeneic transplant within 1 year. For patients in whom reactivation occurred, the severity of infection, the timing of onset, treatment of the reactivation, and any complications were recorded. RESULTS In the final analysis, 56 patients were assessed. Reactivation of zoster occurred in 16% of recipients with a median onset of 4.5 months post transplant. Complications that were observed include postherpetic neuralgia, severe pain, scarring, and motor weakness. Two patients required hospitalization for treatment, with 1 patient requiring 6 months of rehabilitation for motor weakness following the infection. CONCLUSIONS Our study revealed a 16% incidence of VZV reactivation in our autologous HCT population. The onset of these occurrences ranged from 2 to 10 months post transplant, with significant VZV-associated complications. We consider VZV reactivation a serious concern in the autologous transplant setting, requiring extended prophylaxis.
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Affiliation(s)
- J E Rogers
- Department of Pharmacy, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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Faderl S, Wetzler M, Rizzieri D, Schiller GJ, Jagasia MH, Stuart RK, Ganguly S, Avigan D, Craig M, Collins R, Maris MB, Kovacsovics T, Goldberg S, Seiter K, Hari P, Ravandi F, Wang ES, Eckert S, Huebner D, Kantarjian H. Clofarabine plus cytarabine compared to cytarabine alone in older patients with relapsed or refractory (R/R) acute myelogenous leukemia (AML): Results from the phase III CLASSIC 1 trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Awan FT, Osman S, Kochuparambil ST, Gibson L, Remick SC, Abraham J, Craig M, Jillella A, Hamadani M. Impact of response to thalidomide-, lenalidomide- or bortezomib- containing induction therapy on the outcomes of multiple myeloma patients undergoing autologous transplantation. Bone Marrow Transplant 2011; 47:146-8. [DOI: 10.1038/bmt.2011.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kanate A, Chaudhary L, Cumpston A, Leadmon S, Bunner P, Bulian D, Gibson L, Tse W, Abraham J, Remick S, Craig M, Hamadani M. High Rates of Non-Relapse Mortality and Graft-Versus-Host Disease in Patient Undergoing Allogeneic Stem Cell Transplantation (ASCT) Following Non-Myeloablative (NMA) Conditioning With TLI/ATG. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.476] [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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Osman S, Kanate A, Bunner P, Leadmon S, Hart K, Goff L, Tse W, Cumpston A, Remick S, Abraham J, Craig M, Hamadani M. Cyclophosphamide (CY)/G-CSF Cannot Completely Overcome Imid-Induced Impairment of Peripheral Blood Stem Cell (PBSC) Mobilization (Mob) in Patients With Multiple Myeloma (MM). Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.159] [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: 11/16/2022]
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Kanate A, Osman S, Cumpston A, Hobbs G, Leadmon S, Bunner P, Gibson L, Tse W, Abraham J, Remick S, Craig M, Hamadani M. In Vivo T-Cell Depletion (TCD) Does Not Improve Rates of Graft-Versus-Host Disease (GVHD) and Transplantation Outcomes in Patients Undergoing Peripheral Blood Allogeneic Hematopoietic Cell Transplant (AHCT). Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.465] [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: 11/16/2022]
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Abstract
The evaluation of patients for hematopoietic stem cell transplantation is a complex process. The decision to recommend transplantation is not simply dependent on patient diagnosis; instead it is a specialized analytic decision process intricately dependent on a number of variables including patient age, performance status, medical comorbidities, family support structure, socioeconomic viability and motivation to participate in self-care, to name a few. The process of pre-transplant patient evaluation has substantial variability across different transplant centers, owing to lack of formal published guidelines. This review summarizes the process of pre-transplant patient evaluation and workup, and aims to describe components of a well-organized and evidenced-based patient selection process for SCT.
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Affiliation(s)
- M Hamadani
- Department of Medicine, The Osborn Blood and Marrow Transplantation Program, Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV 26506, USA.
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Harding J, Craig M, Jakeman N, Young R, Jabarin C, Kendall J. Emergency physician interpretation of head CT in trauma and suspected subarachnoid haemorrhage--is it viable? An audit of current practice. Emerg Med J 2010; 27:116-20. [DOI: 10.1136/emj.2008.071688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hamadani M, Craig M, Abraham J, Tse W, Cumpston A, Stotler C, Remick S, Bunner P, Leadmon S, Elder P, Hofmeister C, Penza S, Andritsos L, Blum Benson W, Jr D, Devine S. Evaluation Of Busulfan's Dose-Intensity In Patients Undergoing Allogeneic Stem Cell Transplantation (ASCT) With Two Different Fludarabine/Busulfan/ATG (FBA)-Based Reduced Intensity Conditioning (RIC) Regimens. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.373] [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: 11/26/2022]
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Robertson D, Craig M, van Amelsvoort T, Daly E, Moore C, Simmons A, Whitehead M, Morris R, Murphy D. Effects of estrogen therapy on age-related differences in gray matter concentration. Climacteric 2009; 12:301-9. [DOI: 10.1080/13697130902730742] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sharma M, Cumpston A, Craig M. 335: Radiation Followed by Mylotarg Plus DLI for Extramedullary Relapse from Acute Myeloid Leukemia Post-allogeneic Transplant. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.345] [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: 11/26/2022]
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Loberg RD, Ying C, Craig M, Day LL, Sargent E, Neeley C, Wojno K, Snyder LA, Yan L, Pienta KJ. Targeting CCL2 with systemic delivery of neutralizing antibodies induces prostate cancer tumor regression in vivo. Cancer Res 2007; 67:9417-24. [PMID: 17909051 DOI: 10.1158/0008-5472.can-07-1286] [Citation(s) in RCA: 259] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The identification of novel tumor-interactive chemokines and the associated insights into the molecular and cellular basis of tumor-microenvironment interactions have continued to stimulate the development of targeted cancer therapeutics. Recently, we have identified monocyte chemoattractant protein 1 (MCP-1; CCL2) as a prominent regulator of prostate cancer growth and metastasis. Using neutralizing antibodies to human CCL2 (CNTO888) and the mouse homologue CCL2/JE (C1142), we show that treatment with anti-CCL2/JE antibody (2 mg/kg, twice weekly i.p.) attenuated PC-3Luc-mediated overall tumor burden in our in vivo model of prostate cancer metastasis by 96% at 5 weeks postintracardiac injection. Anti-CCL2 inhibition was not as effective as docetaxel (40 mg/kg, every week for 3 weeks) as a single agent, but inhibition of CCL2 in combination with docetaxel significantly reduced overall tumor burden compared with docetaxel alone, and induced tumor regression relative to initial tumor burden. These data suggest an interaction between tumor-derived chemokines and host-derived chemokines acting in cooperation to promote tumor cell survival, proliferation, and metastasis.
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Affiliation(s)
- Robert D Loberg
- Department of Urology, University of Michigan Urology Center, Ann Arbor, Michigan 48109-0946, USA.
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Loberg RD, Ying C, Craig M, Yan L, Snyder LA, Pienta KJ. CCL2 as an important mediator of prostate cancer growth in vivo through the regulation of macrophage infiltration. Neoplasia 2007; 9:556-62. [PMID: 17710158 PMCID: PMC1939930 DOI: 10.1593/neo.07307] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 05/09/2007] [Accepted: 05/13/2007] [Indexed: 11/18/2022] Open
Abstract
The ability of CCL2 to influence prostate cancer tumorigenesis and metastasis may occur through two distinct mechanisms: 1) a direct effect on tumor cell growth and function, and 2) an indirect effect on the tumor microenvironment by the regulation of macrophage mobilization and infiltration into the tumor bed. We have previously demonstrated that CCL2 exerts a direct effect on prostate cancer epithelial cells by the regulation of their growth, invasion, and migration, resulting in enhanced tumorigenesis and metastasis. Here we describe an indirect effect of CCL2 on prostate cancer growth and metastasis by regulating monocyte/macrophage infiltration into the tumor microenvironment and by stimulating a phenotypic change within these immune cells to promote tumor growth (tumor-associated macrophages). VCaP prostate cancer cells were subcutaneously injected in male SCID mice and monitored for tumor volume, CD68(+) macrophage infiltration, and microvascular density. Systemic administration of anti-CCL2 neutralizing antibodies (CNTO888 and C1142) significantly retarded tumor growth and attenuated CD68(+) macrophage infiltration, which was accompanied by a significant decrease in microvascular density. These data suggest that CCL2 contributes to prostate cancer growth through the regulation of macrophage infiltration and enhanced angiogenesis within the tumor.
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Affiliation(s)
- Robert D Loberg
- Department of Urology, University of Michigan Urology Center, Ann Arbor, MI 48109-0946, USA.
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Craig M, Cumpston AD, Hobbs GR, Devetten MP, Sarwari AR, Ericson SG. The clinical impact of antibacterial prophylaxis and cycling antibiotics for febrile neutropenia in a hematological malignancy and transplantation unit. Bone Marrow Transplant 2007; 39:477-82. [PMID: 17322937 DOI: 10.1038/sj.bmt.1705591] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Febrile neutropenia is an expected complication during treatment of aggressive hematological malignancies and hematopoietic cell transplantation. We conducted a prospective cohort trial to determine the effects and safety of prophylactic fluoroquinolone administration, and rotation of empiric antibiotics for neutropenic fever in this patient population. From March 2002 through 2004, patients were treated with prophylactic levofloxacin during prolonged neutropenia, and a cycling schedule of empiric antibiotic therapy for neutropenic fever was initiated. The rates of bacteremia, resistance and complications were compared to a retrospective cohort of previously treated patients. The rate of gram-negative bacteremia decreased after the initiation of prophylactic levofloxacin (4.7 vs 1.8 episodes/1000 patient days, P<0.05). Gram-positive bacteremia rates remained unchanged, but more isolates of Enterococcus faecium were resistant to vancomycin after the intervention began. Resistance to the antibiotic agents used in the rotation did not emerge. There was no change in mortality during the intervention period. A prophylactic and cycling antibiotic schedule was successfully implemented on a hematological malignancy and hematopoietic cell transplant unit. gram-negative bacteremia was significantly decreased, without emergence of resistance. Concerns with Gram-positive resistance will require further observation.
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Affiliation(s)
- M Craig
- Department of Medicine, Mary Babb Randolph Cancer Center, West Virginia University Hospitals, Morgantown, WV 26506-9162, USA.
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29
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Strippoli GFM, Bonifati C, Craig M, Navaneethan SD, Craig JC. Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease. Cochrane Database Syst Rev 2006; 2006:CD006257. [PMID: 17054288 PMCID: PMC6956646 DOI: 10.1002/14651858.cd006257] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor antagonists (AIIRA) are considered to be equally effective for patients with diabetic kidney disease (DKD), but renal and not mortality outcomes have usually been considered. OBJECTIVES To evaluate the benefits and harms ACEi and AIIRA in patients with DKD. SEARCH STRATEGY We searched MEDLINE (1966 to December 2005), EMBASE (1980 to December 2005), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library issue 4 2005) and contacted known investigators. SELECTION CRITERIA Studies comparing ACEi or AIIRA with placebo or each other in patients with DKD were included. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and results expressed as relative risk (RR) with 95% confidence intervals (CI). Heterogeneity among studies was explored using the Cochran Q statistic and the I(2) test, subgroup analyses and random effects metaregression. MAIN RESULTS Fifty studies (13,215 patients) were identified. Thirty eight compared ACEi with placebo, five compared AIIRA with placebo and seven compared ACEi and AIIRA directly. There was no significant difference in the risk of all-cause mortality for ACEi versus placebo (RR 0.91, 95% CI 0.71 to 1.17) and AIIRA versus placebo (RR 0.99, 95% CI 0.85 to 1.17). A subgroup analysis of studies using full-dose ACEi versus studies using half or less than half the maximum tolerable dose of ACEi showed a significant reduction in the risk of all-cause mortality with the use of full-dose ACEi (RR 0.78, 95% CI 0.61 to 0.98). Baseline mortality rates were similar in the ACEi and AIIRA studies. The effects of ACEi and AIIRA on renal outcomes (ESKD, doubling of creatinine, prevention of progression of micro- to macroalbuminuria, remission of micro- to normoalbuminuria) were similarly beneficial. Reliable estimates of effect of ACEi versus AIIRA could not be obtained from the three studies in which they were compared directly because of their small sample size. AUTHORS' CONCLUSIONS Although the survival benefits of ACEi are known for patients with DKD, the relative effects on survival of ACEi with AIIRA are unknown due to the lack of adequate direct comparison studies. In placebo controlled studies, only ACEi (at the maximum tolerable dose, but not lower so-called renal doses) were found to significantly reduce the risk of all-cause mortality. Renal and toxicity profiles of these two classes of agents were not significantly different.
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Affiliation(s)
- G F M Strippoli
- NHMRC Centre for Clinical Research Excellence in Renal Medicine, Cochrane Renal Group, Centre for Kidney Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia.
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Stea B, Shaw E, Pintér T, Hackman J, Craig M, May J, Steffen RP, Suh JH. Efaproxiral red blood cell concentration predicts efficacy in patients with brain metastases. Br J Cancer 2006; 94:1777-84. [PMID: 16773073 PMCID: PMC2361352 DOI: 10.1038/sj.bjc.6603169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Efaproxiral (Efaproxyn™, RSR13), a synthetic allosteric modifier of haemoglobin (Hb), decreases Hb-oxygen (O2) binding affinity and enhances oxygenation of hypoxic tumours during radiation therapy. This analysis evaluated the Phase 3, Radiation Enhancing Allosteric Compound for Hypoxic Brain Metastases; RT-009 (REACH) study efficacy results in relation to efaproxiral exposure (efaproxiral red blood cell concentration (E-RBC) and number of doses). Recursive partitioning analysis Class I or II patients with brain metastases from solid tumours received standard whole-brain radiation therapy (3 Gy/fraction × 10 days), plus supplemental O2 (4 l/min), either with efaproxiral (75 or 100 mg/kg daily) or without (control). Efaproxiral red blood cell concentrations were linearly extrapolated to all efaproxiral doses received. Three patient populations were analysed: (1) all eligible, (2) non-small-cell lung cancer (NSCLC) as primary cancer, and (3) breast cancer primary. Efficacy endpoints were survival and response rate. Brain metastases patients achieving sufficient E-RBC (⩾483 μg/ml) and receiving at least seven of 10 efaproxiral doses were most likely to experience survival and response benefits. Patients with breast cancer primary tumours generally achieved the target efaproxiral exposure and therefore gained greater benefit from efaproxiral treatment than NSCLC patients. This analysis defined the efaproxiral concentration-dependence in survival and response rate improvement, and provided a clearer understanding of efaproxiral dosing requirements.
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Affiliation(s)
- B Stea
- Department of Radiation Oncology, The University of Arizona Health Sciences Center, Tucson, 85724, USA.
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Abstract
OBJECTIVES Transport of the critically ill patient to or from the emergency department (ED) is a frequent occurrence. This study was designed to determine whether UK EDs currently have appropriate equipment, monitoring, staff training systems, and processes of care for transportation of the critically ill patient. METHODS A postal questionnaire regarding ED transfer patients was sent to 247 UK EDs, followed by repeat mailing and telephone follow up of non-responders. RESULTS In total, 139 EDs (56%) responded. An estimated 20-30 critically ill patients are transferred from and <20 are received by each ED annually. Processes of care are poorly developed; only 79 EDs (56%) have transfer guidelines available. Audit of transfers is ongoing in 59 EDs (42%), and critical incident reporting is ongoing in 122 (88%). There is a lack of immediately available transport equipment; for example, 17 EDs (12%) have no transport ventilator, 9 (6%) have no transport monitor, and 9 (6%) have no syringe pump. Transport equipment is invariably not standardised. Anaesthetic staff of specialist registrar (74 doctors; 53%) or senior house officer (36 doctors; 26%) grades carry out the majority of ED transfers accompanied by a D or E grade nurse. Both invariably have no formal transfer training. CONCLUSIONS This study highlights inadequacies in provision of equipment and monitoring during interhospital transfer from the ED. Training and processes of care for transport of the critically ill are also suboptimum. Many departments are currently reviewing these processes to formalize and improve transfer training procedures and protocols.
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Affiliation(s)
- A Stevenson
- Emergency Department, Southern General Hospital, Glasgow, UK
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Abstract
BACKGROUND Twenty to sixty percent of diabetic patients are affected by hypertension and antihypertensive agents are used to treat this condition. These agents are also used to prevent the onset of kidney disease both in normotensive and hypertensive diabetics. OBJECTIVES To evaluate the comparative effects of antihypertensive agents in patients with diabetes and normoalbuminuria. SEARCH STRATEGY MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, conference proceedings, and contact with investigators were used to identify relevant trials. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing any antihypertensive agent with placebo or another agent in hypertensive or normotensive patients with diabetes and no kidney disease (albumin excretion rate < 30 mg/d) were included. DATA COLLECTION AND ANALYSIS Two investigators independently extracted data on renal outcomes and other patient relevant outcomes (all-cause mortality, serious cardiovascular events), and assessed quality of trials. Analysis was by a random effects model and results expressed as relative risk (RR) and 95% confidence intervals (CI). MAIN RESULTS Sixteen trials (7603 patients) were identified, six of angiotensin converting enzyme inhibitors (ACEi) versus placebo, six of ACEi versus calcium channel blockers (CCBs), one of ACEi versus CCBs or combined ACEi and CCBs and three of ACEi versus other agents. Compared to placebo, ACEi significantly reduced the development of microalbuminuria (six trials, 3840 patients: RR 0.60, 95% CI 0.43 to 0.84) but not doubling of creatinine (three trials, 2683 patients: RR 0.81, 95% CI 0.24 to 2.71) or all-cause mortality (four trials, 3284 patients: RR 0.81, 95% CI 0.64 to 1.03). Compared to CCBs, ACEi significantly reduced progression to microalbuminuria (four trials, 1210 patients: RR 0.58, 95% CI 0.40 to 0.84). AUTHORS' CONCLUSIONS A significant reduction in the risk of developing microalbuminuria in normoalbuminuric patients with diabetes has been demonstrated for ACEi only. It appears that the effect of ACEi is independent of baseline blood pressure, renal function and type of diabetes, but data is too sparse to be confident that these are not important effect modifiers and an individual patient data meta-analysis is required.
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Affiliation(s)
- G F M Strippoli
- NHMRC Centre for Clinical Research Excellence in Renal Medicine, Cochrane Renal Group, Centre for Kidney Research, Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia 2145.
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Abstract
BACKGROUND Quantitative description and mapping of malaria seasonality is important for timely spatial targeting of interventions and for modelling malaria risk. There is a need for seasonality models that predict quantitative variation in transmission between months. METHODS We use Zimbabwe as an example for developing an empirical map of malaria seasonality. We describe the relationship between seasonality in malaria and environmental covariates for the period 1988--1999, by fitting a spatial-temporal regression model within a Bayesian framework to provide smoothed maps of the seasonal trend. We adapt a seasonality concentration index used previously for rainfall to quantify malaria case load during the peak transmission season based on monthly values. RESULTS Combinations of mean monthly temperature (range 28--32 degrees C), maximum temperature (24--28 degrees C) and high rainfall provide suitable conditions for seasonal transmission. High monthly maximum and mean monthly minimum temperatures limit months of high transmission. The intensity of seasonal transmission was highest in the north western part of the country from February to May with the peak in April and lowest in the whole country from July to December. The north western lowlands had the highest concentration of malaria cases (>25%) followed by some districts in the north central and eastern part with a moderate concentration of cases (20-25%). The central highlands and south eastern part of the country had the lowest concentration of malaria cases (<20%). This pattern was closely associated to the geographic variation in the seasonality of climatic covariates particularly rainfall and temperature. Conclusions Our modelling approach quantifies the geographical variation in seasonal trend and the concentration of cases during the peak transmission season and therefore has potential application in malaria control. The use of a covariate adjusted empirical model may prove useful for predicting the seasonal risk pattern across southern Africa.
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Affiliation(s)
- M L H Mabaso
- Malaria Research Programme, Medical Research Council, Durban, South Africa.
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Shaw E, Stea B, Pinter T, Hammoud Y, Cagnoni PJ, Hackman J, Boyd A, Craig M, Marks J, Suh J. Pharmacokinetics (PK) of RSR13 (efaproxiral) predict survival in patients with brain metastases randomized to receive whole brain radiation therapy (WBRT) with or without RSR13 (REACH RT-009). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.1561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Shaw
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - B. Stea
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - T. Pinter
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - Y. Hammoud
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - P. J. Cagnoni
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - J. Hackman
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - A. Boyd
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - M. Craig
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - J. Marks
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - J. Suh
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
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New PZ, Grossman S, Mikkelsen T, Batchelor T, Phuphanich S, Carson K, Fisher J, Craig M, Cagnoni P. Evaluation of safety and tolerance of escalating doses of RSR13 administered with a fixed dose of BCNU every six weeks in patients with recurrent malignant glioma: Results of the phase I NABTT 9806 clinical trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. Z. New
- Baylor College of Medicine, Houston, TX; Johns Hopkins Cancer Center, Baltimore, MA; Henry Ford Hospital, Detroit, MI; Massachusetts General Hospital, Boston, MA; Emory University, Atlanta, GA; Johns Hopkins Oncology Center, Baltimore, MD; Johns Hopkins Cancer Center, Baltimore, MD; Allos Therapeutics, Inc., Westminster, CO
| | - S. Grossman
- Baylor College of Medicine, Houston, TX; Johns Hopkins Cancer Center, Baltimore, MA; Henry Ford Hospital, Detroit, MI; Massachusetts General Hospital, Boston, MA; Emory University, Atlanta, GA; Johns Hopkins Oncology Center, Baltimore, MD; Johns Hopkins Cancer Center, Baltimore, MD; Allos Therapeutics, Inc., Westminster, CO
| | - T. Mikkelsen
- Baylor College of Medicine, Houston, TX; Johns Hopkins Cancer Center, Baltimore, MA; Henry Ford Hospital, Detroit, MI; Massachusetts General Hospital, Boston, MA; Emory University, Atlanta, GA; Johns Hopkins Oncology Center, Baltimore, MD; Johns Hopkins Cancer Center, Baltimore, MD; Allos Therapeutics, Inc., Westminster, CO
| | - T. Batchelor
- Baylor College of Medicine, Houston, TX; Johns Hopkins Cancer Center, Baltimore, MA; Henry Ford Hospital, Detroit, MI; Massachusetts General Hospital, Boston, MA; Emory University, Atlanta, GA; Johns Hopkins Oncology Center, Baltimore, MD; Johns Hopkins Cancer Center, Baltimore, MD; Allos Therapeutics, Inc., Westminster, CO
| | - S. Phuphanich
- Baylor College of Medicine, Houston, TX; Johns Hopkins Cancer Center, Baltimore, MA; Henry Ford Hospital, Detroit, MI; Massachusetts General Hospital, Boston, MA; Emory University, Atlanta, GA; Johns Hopkins Oncology Center, Baltimore, MD; Johns Hopkins Cancer Center, Baltimore, MD; Allos Therapeutics, Inc., Westminster, CO
| | - K. Carson
- Baylor College of Medicine, Houston, TX; Johns Hopkins Cancer Center, Baltimore, MA; Henry Ford Hospital, Detroit, MI; Massachusetts General Hospital, Boston, MA; Emory University, Atlanta, GA; Johns Hopkins Oncology Center, Baltimore, MD; Johns Hopkins Cancer Center, Baltimore, MD; Allos Therapeutics, Inc., Westminster, CO
| | - J. Fisher
- Baylor College of Medicine, Houston, TX; Johns Hopkins Cancer Center, Baltimore, MA; Henry Ford Hospital, Detroit, MI; Massachusetts General Hospital, Boston, MA; Emory University, Atlanta, GA; Johns Hopkins Oncology Center, Baltimore, MD; Johns Hopkins Cancer Center, Baltimore, MD; Allos Therapeutics, Inc., Westminster, CO
| | - M. Craig
- Baylor College of Medicine, Houston, TX; Johns Hopkins Cancer Center, Baltimore, MA; Henry Ford Hospital, Detroit, MI; Massachusetts General Hospital, Boston, MA; Emory University, Atlanta, GA; Johns Hopkins Oncology Center, Baltimore, MD; Johns Hopkins Cancer Center, Baltimore, MD; Allos Therapeutics, Inc., Westminster, CO
| | - P. Cagnoni
- Baylor College of Medicine, Houston, TX; Johns Hopkins Cancer Center, Baltimore, MA; Henry Ford Hospital, Detroit, MI; Massachusetts General Hospital, Boston, MA; Emory University, Atlanta, GA; Johns Hopkins Oncology Center, Baltimore, MD; Johns Hopkins Cancer Center, Baltimore, MD; Allos Therapeutics, Inc., Westminster, CO
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Abstract
The results of parasitological surveys have shown that both urinary and intestinal schistosomiasis occur widely among the human residents of South Africa. The national data on both diseases have now been incorporated into a geographical information system, to develop new maps based on defined temperature constraints. The disease data, obtained from a 'hard-copy' atlas of schistosomiasis, were used as a template to select temperature regimes that were (1) suitable and (2) unsuitable for the transmission of schistosomes to humans in South Africa. The regimes were derived from the published results of investigations in which the biology of larval schistosomes (i.e. schistosome transmission) was related to temperature in South Africa. Those regimes that were based on the estimated temperature minima for transmission corresponded more closely to the disease-distribution data than those based on the corresponding maxima. An estimate of the number of children living in the climate-suitable areas was made but, within the context of the spatial methodology used and the limitations of the available disease data, it was not possible to predict the prevalences of schistosomiasis.
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Affiliation(s)
- I Moodley
- Malaria Research Programme, Medical Research Council, P.O. Box 70380, Overport, Durban 4067, South Africa.
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Strippoli GFM, Craig M, Schena FP, Craig JC. Antihypertensive agents for preventing diabetic kidney disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2003. [DOI: 10.1002/14651858.cd004136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Buhler MM, Craig M, Donaghue KC, Badhwar P, Willis J, Manolios N, Tait BD, Silink M, Bennetts BH, Stewart GJ. CCR5 genotyping in an Australian and New Zealand type 1 diabetes cohort. Autoimmunity 2002; 35:457-61. [PMID: 12688247 DOI: 10.1080/0891693021000041088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 10/27/2022]
Abstract
Infiltration of pancreatic tissue by autoreactive T-cells involves secretion of multiple cytokines and chemokine receptor expression. Genetically determined variation in cell surface expression of the chemokine receptor CCR5 may result in differences in inflammatory cell migration in response to relevant chemokines. Adolescents with type 1 diabetes (T1D) from Australia and New Zealand were genotyped for CCR5-delta32 (n = 626). The allele frequency was compared with that of 253 non-diabetic Australian adolescents and with that of 92 adults with systemic lupus erythematosus. A reduced allele frequency was seen in T1D compared with controls (0.092 vs. 0.123, p = 0.05). This difference was not seen for the cohort of patients with SLE (freq = 0.114). A reduction in the number of CCR5-delta32/delta32 homozygotes, who lack CCR5, in the T1D cohort was also seen and while not statistically significant (2 observed compared to 5.25 expected; p = 0.12) is interesting. These results suggest a partial protection from T1D for CCR5-delta32 homozygous individuals is possible and that CCR5 has a potential role in the pathogenesis of T1D.
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Affiliation(s)
- M M Buhler
- Insitute for Immunology and Allergy Research, Westmead Millennium Institute, Westmead Hospital, and The University of Sydney, Sydney, NSW Australia.
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39
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Abstract
In this study 81 women with recurrent miscarriages completed questionnaires designed to assess depression, anxiety and general health. This data was matched with data from their medical notes to ascertain demographic and reproductive variables. The results indicated that 33% of patients could be classified as depressed with 9.9% of women being moderately depressed and 7.4% suffering from severe depression. Twenty-one percent of patients had levels of anxiety that were equal or higher to a typical psychiatric outpatient population. Neither age, cigarette consumption, alcohol intake, previous live birth, number of miscarriages, lateness of miscarriage nor length of time since last miscarriage were found to affect the degree of psychiatric morbidity. These findings add to our understanding of the degree to which recurrent miscarriage can affect mental health.
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Affiliation(s)
- M Craig
- Department of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF.
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40
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Abstract
BACKGROUND Most hip fractures are treated surgically, with use of either internal fixation or prosthetic replacement of the femoral head. The presence of these implants increases the risk of a later femoral fracture in susceptible osteoporotic patients. The purpose of this study was to analyze the incidence of and risk factors for implant-related fractures of the femur after previous hip fracture surgery. METHODS Over a ten-year period from January 1988 to December 1997, 6230 patients (median age, eighty-two years; male:female ratio, 1247:4983) who sustained a total of 6696 hip fractures were admitted to the Edinburgh Orthopaedic Trauma Unit. Demographic information on the patients and details of the original treatment of the hip fracture were prospectively coded and entered into a trauma database. All subsequent readmissions due to a femoral fracture related to the implant were prospectively audited and extracted for the purposes of this study. RESULTS One hundred and forty-one patients sustained an ipsilateral fracture of the femur at a median of twenty-four weeks following the original hip fracture surgery. Survivorship analysis of the hip fracture population revealed an overall rate of subsequent femoral fracture of 2.9% at five years, which increased to 5.1% at ten years. The median age and gender distribution of the patients who sustained a subsequent femoral fracture were similar to those of the hip fracture population as a whole. Two-thirds of the fractures propagated from the tip of the implant. Analysis of the subsequent fractures according to the type of implant used to treat the original fracture revealed considerable differences in incidence. The incidence was relatively high in the patients initially treated with a Gamma nail (18.74 fractures per 1000 person-years) or a cementless hemiarthroplasty (11.72 per 1000 person-years) and was relatively low in those treated with a compression hip screw (4.46 per 1000 person-years), cannulated screws (4.50 per 1000 person-years), or a primary arthroplasty with cement (6.2 per 1000 person-years). The highest incidence of fracture was seen in the patients who had required an arthroplasty with cement as a revision procedure following failure of a primary implant (22.39 per 1000 person-years). CONCLUSIONS Implant-related fractures following hip fracture surgery are more common than has previously been appreciated. The risk of later ipsilateral femoral fracture is increased by the use of a Gamma nail or a cementless hemiarthroplasty to treat the original hip fracture.
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Affiliation(s)
- C M Robinson
- Department of Orthopaedic Trauma, The Royal Infirmary of Edinburgh, Scotland, UK.
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Abstract
BACKGROUND Endometriosis can occur in unusual sites, liver involvement being first described in 1986. Extra-uterine malignant transformation in endometriosis has been reported, occurring mainly in the ovary. Liver involvement with endometrial stromal sarcoma (ESS) has not been previously reported. CASE OUTLINE Two patients presenting with symptomatic liver masses related to endometriosis, who successfully underwent surgical intervention, are presented. CASE 1 A 31-year-old woman previously had been treated with hysterectomy and bilateral salpingoophorectomy for severe pelvic endometriosis. Six years later, she presented with malaise from bilobar liver involvement with endometrial deposits. She proceeded acutely to hilar obstruction with obstructive jaundice and portal vein thrombosis. CASE 2 A 59-year-old post-menopausal woman had earlier presented acutely from a ruptured mesenteric cyst, which showed features of endometrial stromal sarcoma (ESS). Two years later, she presented with symptoms from a large ESS occupying the right lobe. DISCUSSION Endometriosis per se, as well as malignant transformation into ESS can involve the liver.These should be considered in women with hepatic space occupying lesions of unknown etiology.
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Affiliation(s)
- AW Khan
- Department of Surgery, Royal Free HospitalLondonUK
| | - M Craig
- Department of Surgery, Royal Free HospitalLondonUK
| | | | - BR Davidson
- Department of Surgery, Royal Free HospitalLondonUK
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42
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Abstract
The most recent Confidential Enquiry into the causes of maternal deaths during the perinatal period in England and Wales (1994-1996) revealed that psychological illness was at least as important as hypertensive disorders. It is therefore important for obstetricians to be aware of a variety of psychiatric conditions as well as the psychotropic medication prescribed and sequelae of continuation or withdrawal of these drugs. Best management, of this particularly vulnerable group of women, requires close liaison with the psychiatric team. This chapter considers four groups of women most likely to be prescribed psychoactive drugs during the perinatal period: (i) women with mental illness wishing to conceive, (ii) women with mental illness who conceive while taking medication, (iii) those who become mentally ill while pregnant, and (iv) those who become unwell postnatally. Guidelines for treatment are discussed.
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Affiliation(s)
- M Craig
- Maudsley Hospital, Denmark Hill, London SE5 8AF, UK
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43
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Abstract
Our current understanding into the role of stress in unexplained recurrent miscarriages comes from two different research strategies. The majority of research has examined the role of psychological support within this patient population. This support has been provided in a number of ways ranging from weekly interviews with a psychiatrist or gynaecologist and or visual re-assurance in the form of ultrasound scans. A comparison of psychological support with an absence of such intervention has found differences in successful pregnancy outcome varying from as great as 84 versus 26%, respectively. It has been assumed that psychological support reduces the miscarriage rate by reducing “stress”within this patient population. In addition it provides indirect support for a role of stress in the aetiology of unexplained recurrent miscarriage. Other studies have attempted to directly assess the effect of personality characteristics on miscarriage rate; these studies have yielded conflicting results.The mechanism by which stress may be causal in the aetiology of unexplained recurrent miscarriage has not been examined in humans. Animal studies, however, have found that psychological distress can alter immune parameters that may be intricately involved with implantation. These parameters include an elevation of the “abortive” cytokine TNF-a and a reduction in the “anti-abortive” cytokine TGF-P2. Cells that are involved in the release of TNF-a at the feto-maternal interface include T cells, macrophages and mast cells.Mechanisms through which stress may act on these cells are explored and an integrated model is postulated.
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Affiliation(s)
- M Craig
- Maudsley Hospital, Denmark Hill, London SES 8AE UK.
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Kumar VA, Craig M, Depner TA, Yeun JY. Extended daily dialysis: A new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis 2000; 36:294-300. [PMID: 10922307 DOI: 10.1053/ajkd.2000.8973] [Citation(s) in RCA: 197] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Continuous venovenous hemofiltration (CVVH) is an effective form of renal replacement therapy for acute renal failure (ARF) that offers greater hemodynamic stability and better volume control than conventional hemodialysis in the critically ill, hypotensive patient. However, the application of CVVH in the intensive care unit (ICU) has several disadvantages, including intensive nursing requirements, continuous anticoagulation, patient immobility, and expense. We describe a new approach to the treatment of ARF in the ICU, which we have termed extended daily dialysis (EDD). In this study, EDD was compared with CVVH in 42 patients: 25 patients were treated with EDD for a total of 367 treatment days, and 17 patients were treated with CVVH for a total of 113 days. Median treatment time per day was 7.5 hours for EDD (range, 6 to 8 hours, 25th to 75th percentile) versus 19.5 hours for CVVH (range, 13.4 to 24 hours; P < 0.001). Mean arterial blood pressures (MAPs) did not differ significantly for patients treated with EDD when measured predialysis (median MAP, 70 versus 67 mm Hg for CVVH; P = 0.078), midway through daily treatment (70 versus 68 mm Hg for CVVH; P = 0.083), or at the end of treatment (71 versus 69 mm Hg for CVVH; P = 0.07). Net daily ultrafiltration was similar for the two treatment modalities (EDD, median, 3,000 mL/d; range, 1,763 to 4,445 mL/d; CVVH, 3,028 mL/d; range, 1,785 to 4,707 mL/d; P = 0.514). Anticoagulation requirements were significantly less for patients treated with EDD (median dose of heparin, 4,000 U/d; range, 0 to 5,800 U/d versus 21,100 U/d; range, 8,825 to 31,275 U/d for patients treated with CVVH; P < 0.001). We found that EDD eliminated the need for constant supervision of the dialysis machine by a subspecialty dialysis nurse, allowing one nurse to manage more than one treatment. Overall, EDD was well tolerated by the majority of patients, offered many of the same benefits provided by CVVH, and was technically easier to perform.
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Affiliation(s)
- V A Kumar
- Department of Medicine, Division of Nephrology, University of California Davis, Sacramento 95817, USA.
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45
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Abstract
BACKGROUND Good maps of malaria risk have long been recognized as an important tool for malaria control. The production of such maps relies on modelling to predict the risk for most of the map, with actual observations of malaria prevalence usually only known at a limited number of specific locations. Estimation is complicated by the fact that there is often local variation of risk that cannot be accounted for by the known covariates and because data points of measured malaria prevalence are not evenly or randomly spread across the area to be mapped. METHOD We describe, by way of an example, a simple two-stage procedure for producing maps of predicted risk: we use logistic regression modelling to determine approximate risk on a larger scale and we employ geo-statistical ('kriging') approaches to improve prediction at a local level. Malaria prevalence in children under 10 was modelled using climatic, population and topographic variables as potential predictors. After the regression analysis, spatial dependence of the model residuals was investigated. Kriging on the residuals was used to model local variation in malaria risk over and above that which is predicted by the regression model. RESULTS The method is illustrated by a map showing the improvement of risk prediction brought about by the second stage. The advantages and shortcomings of this approach are discussed in the context of the need for further development of methodology and software.
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Affiliation(s)
- I Kleinschmidt
- Medical Research Council (South Africa), Congella, Durban.
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46
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Abstract
The distribution of malaria vector mosquitoes, especially those belonging to species complexes that contain non-vector species, is important for strategic planning of malaria control programmes. Geographical information systems have allowed researchers to visualize distribution data on maps together with environmental parameters, such as rainfall and temperature. Here, Maureen Coetzee, Marlies Craig and David le Sueur review our current knowledge on the distribution of the members of the Anopheles gambiae complex.
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Affiliation(s)
- M Coetzee
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the South African Institute for Medical Research, University of the Witwatersrand, Johannesburg 2000, South Africa.
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Upshaw J, Upshaw M, Craig M. Interview: a staffing agency that meets the needs of workers and institutions. Continuum Soc Soc Work Leadersh Health Care 1999; 19:1, 3-8. [PMID: 11183608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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48
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Snow RW, Craig M, Deichmann U, Marsh K. Estimating mortality, morbidity and disability due to malaria among Africa's non-pregnant population. Bull World Health Organ 1999; 77:624-40. [PMID: 10516785 PMCID: PMC2557714] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
The contribution of malaria to morbidity and mortality among people in Africa has been a subject of academic interest, political advocacy, and speculation. National statistics for much of sub-Saharan Africa have proved to be an unreliable source of disease-specific morbidity and mortality data. Credible estimates of disease-specific burdens are required for setting global and national priorities for health in order to rationalize the use of limited resources and lobby for financial support. We have taken an empirical approach to defining the limits of Plasmodium falciparum transmission across the continent and interpolated the distributions of projected populations in 1995. By combining a review of the literature on malaria in Africa and models of acquired functional immunity, we have estimated the age-structured rates of the fatal, morbid and disabling sequelae following exposure to malaria infection under different epidemiological conditions.
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Affiliation(s)
- R W Snow
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust, Collaborative Programme, Nairobi, Kenya.
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49
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Craig M, Snow R, Tanser F, Fraser C, Binka F, TourJ Y, Lemardeley P, Lengeler C, deSavigny D, Teuscher T, Omumbo J, Adjuik M, Bagayoko M, Fondjo E, leSueur D. Progress of the MARA/ARMA (mapping malaria risk in Africa) project. Parasitol Int 1998. [DOI: 10.1016/s1383-5769(98)80157-8] [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: 10/17/2022]
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50
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Craig M. Applications in continuous venous to venous hemofiltration. Interactive case studies in the adult patient. Crit Care Nurs Clin North Am 1998; 10:209-14. [PMID: 9764014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- M Craig
- University of California Davis Medical Center, Sacramento, USA
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