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Pisanti D, Goel A, Gupta G, Arya M, Byron B, Chahat N, Lazio J, Goldsmith P, Bandyopadhyay S. Modelling science return from the lunar crater radio telescope on the far side of the moon. Philos Trans A Math Phys Eng Sci 2024; 382:20230073. [PMID: 38522463 DOI: 10.1098/rsta.2023.0073] [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] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
The era following the separation of CMB photons from matter, until the emergence of the first stars and galaxies, is known as the Cosmic Dark Ages. Studying the electromagnetic radiation emitted by neutral hydrogen having the 21 cm rest wavelength is the only way to explore this significant phase in the Universe's history, offering opportunities to investigate essential questions about dark matter physics, the standard cosmological model and inflation. Due to cosmological redshift, this signal is now only observable at frequencies inaccessible from the Earth's surface due to ionospheric absorption and reflection. With the Lunar Crater Radio Telescope (LCRT), we aim to conduct unprecedented measurements of the sky-averaged redshifted signal spectrum in the 4.7-47 MHz band, by deploying a 350 m diameter parabolic reflector mesh inside a lunar crater on the far side of the Moon and suspending a receiver at its focus. This work discusses the feasibility of the LCRT science goals through the development of a science model, with emphasis on post-processing techniques to extract the Dark Ages signal from the galactic foreground dominating the expected raw data. This model can be used to vary critical instrument and mission parameters to understand their effect on the quality of the retrieved signal. This article is part of a discussion meeting issue 'Astronomy from the Moon: the next decades (part 2)'.
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Affiliation(s)
- Dario Pisanti
- Scuola Superiore Meridionale, Naples 80138, Italy
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91101, USA
| | - Ashish Goel
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91101, USA
| | - Gaurangi Gupta
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91101, USA
| | - Manan Arya
- Stanford University, Stanford, CA 94305, USA
| | | | - Nacer Chahat
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91101, USA
| | - Joseph Lazio
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91101, USA
| | - Paul Goldsmith
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91101, USA
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2
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Nightingale K, Clough E, Goldsmith P, Burke JR. Peritoneal inclusion cyst presenting as an umbilical hernia: case report and systematic review of the literature. J Surg Case Rep 2024; 2024:rjae258. [PMID: 38706476 PMCID: PMC11068417 DOI: 10.1093/jscr/rjae258] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Peritoneal inclusion cysts (PICs) are a rare and benign condition of uncertain pathogenesis. The fluid-filled, mesothelial-lined cysts manifest within the abdominopelvic cavity. This case report details an unusual occurrence of a 97 mm PIC- presenting as an umbilical hernia- in a 26-year-old male patient with no prior surgical history. Following pre-operative cross-sectional imaging, this was managed through open excision without complication. A systematic review of the literature highlighted 30 previous cases [26F, 4M] with a mean age of 34 years (std ±15.4) and a median diameter of 93 mm [IQR, 109 mm]. A total of 53% (n = 16) of cases had a history of previous abdominal surgery. Surgical excision is safe and laparoscopic modality should be considered (<1% recurrence). Accepting the limited evidence base, image guided drainage should be avoided (50% recurrence, n = 2).
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Affiliation(s)
- Katie Nightingale
- Department of Emergency General Surgery, Manchester University NHS Foundation Trust, Oxford Road, Manchester M139WL, United Kingdom
| | - Emily Clough
- Department of Emergency General Surgery, Manchester University NHS Foundation Trust, Oxford Road, Manchester M139WL, United Kingdom
| | - Paul Goldsmith
- Department of Emergency General Surgery, Manchester University NHS Foundation Trust, Oxford Road, Manchester M139WL, United Kingdom
| | - Joshua Richard Burke
- Department of Emergency General Surgery, Manchester University NHS Foundation Trust, Oxford Road, Manchester M139WL, United Kingdom
- Leeds Institute Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, West Yorkshire, United Kingdom
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3
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Collier DJ, Taylor M, Godec T, Shiel J, James R, Chowdury Y, Ebano P, Monk V, Patel M, Pheby J, Pheby R, Foubister A, David C, Saxena M, Richardson L, Siddle J, Timlin G, Goldsmith P, Deeming N, Poulter NR, Gabe R, McManus RJ, Caulfield MJ. Personalized Antihypertensive Treatment Optimization With Smartphone-Enabled Remote Precision Dosing of Amlodipine During the COVID-19 Pandemic (PERSONAL-CovidBP Trial). J Am Heart Assoc 2024; 13:e030749. [PMID: 38323513 PMCID: PMC11010092 DOI: 10.1161/jaha.123.030749] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/30/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The objective of the PERSONAL-CovidBP (Personalised Electronic Record Supported Optimisation When Alone for Patients With Hypertension: Pilot Study for Remote Medical Management of Hypertension During the COVID-19 Pandemic) trial was to assess the efficacy and safety of smartphone-enabled remote precision dosing of amlodipine to control blood pressure (BP) in participants with primary hypertension during the COVID-19 pandemic. METHODS AND RESULTS This was an open-label, remote, dose titration trial using daily home self-monitoring of BP, drug dose, and side effects with linked smartphone app and telemonitoring. Participants aged ≥18 years with uncontrolled hypertension (5-7 day baseline mean ≥135 mm Hg systolic BP or ≥85 mm Hg diastolic BP) received personalized amlodipine dose titration using novel (1, 2, 3, 4, 6, 7, 8, 9 mg) and standard (5 and 10 mg) doses daily over 14 weeks. The primary outcome of the trial was mean change in systolic BP from baseline to end of treatment. A total of 205 participants were enrolled and mean BP fell from 142/87 (systolic BP/diastolic BP) to 131/81 mm Hg (a reduction of 11 (95% CI, 10-12)/7 (95% CI, 6-7) mm Hg, P<0.001). The majority of participants achieved BP control on novel doses (84%); of those participants, 35% were controlled by 1 mg daily. The majority (88%) controlled on novel doses had no peripheral edema. Adherence to BP recording and reported adherence to medication was 84% and 94%, respectively. Patient retention was 96% (196/205). Treatment was well tolerated with no withdrawals from adverse events. CONCLUSIONS Personalized dose titration with amlodipine was safe, well tolerated, and efficacious in treating primary hypertension. The majority of participants achieved BP control on novel doses, and with personalization of dose there were no trial discontinuations due to drug intolerance. App-assisted remote clinician dose titration may better balance BP control and adverse effects and help optimize long-term care. REGISTRATION URL: clinicaltrials.gov. Identifier: NCT04559074.
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Affiliation(s)
- David J. Collier
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | | | - Thomas Godec
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Julian Shiel
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Rebecca James
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Yasmin Chowdury
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Patrizia Ebano
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Vivienne Monk
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Mital Patel
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Jane Pheby
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Ruby Pheby
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Amanda Foubister
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Clovel David
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | - Manish Saxena
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
| | | | | | | | | | | | - Neil R. Poulter
- Imperial College Clinical Trials Unit, School of Public Health, Imperial College LondonLondonUK
| | - Rhian Gabe
- Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Mark J. Caulfield
- William Harvey Research InstituteQueen Mary University of LondonLondonUK
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4
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Sedley W, Kumar S, Jones S, Levy A, Friston K, Griffiths T, Goldsmith P. Migraine as an allostatic reset triggered by unresolved interoceptive prediction errors. Neurosci Biobehav Rev 2024; 157:105536. [PMID: 38185265 DOI: 10.1016/j.neubiorev.2024.105536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
Until now, a satisfying account of the cause and purpose of migraine has remained elusive. We explain migraine within the frameworks of allostasis (the situationally-flexible, forward-looking equivalent of homeostasis) and active inference (interacting with the environment via internally-generated predictions). Due to its multimodality, and long timescales between cause and effect, allostasis is inherently prone to catastrophic error, which might be impossible to correct once fully manifest, an early indicator which is elevated prediction error (discrepancy between prediction and sensory input) associated with internal sensations (interoception). Errors can usually be resolved in a targeted manner by action (correcting the physiological state) or perception (updating predictions in light of sensory input); persistent errors are amplified broadly and multimodally, to prioritise their resolution (the migraine premonitory phase); finally, if still unresolved, progressive amplification renders further changes to internal or external sensory inputs intolerably intense, enforcing physiological stability, and facilitating accurate allostatic prediction updating. As such, migraine is an effective 'failsafe' for allostasis, however it has potential to become excessively triggered, therefore maladaptive.
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Affiliation(s)
- William Sedley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom.
| | - Sukhbinder Kumar
- Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA
| | - Siobhan Jones
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Andrew Levy
- Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, United Kingdom
| | - Karl Friston
- Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, United Kingdom
| | - Tim Griffiths
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, United Kingdom; Department of Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - Paul Goldsmith
- Department of Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, United Kingdom; Institute of Global Health Innovation, Imperial College, London, United Kingdom
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5
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Harper S, Grodzicki L, Mealing S, Gemmill E, Goldsmith P, Ahmed A. Budget Impact of RefluxStop™ as a Treatment for Patients with Refractory Gastro-oesophageal Reflux Disease in the United Kingdom. J Health Econ Outcomes Res 2024; 11:1-7. [PMID: 38222857 PMCID: PMC10787539 DOI: 10.36469/001c.90924] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/07/2023] [Indexed: 01/16/2024]
Abstract
Background: Gastro-oesophageal reflux disease (GORD) is a common condition associated with heartburn and regurgitation. Standard of care for GORD patients in the UK involves initial treatment with proton pump inhibitors (PPIs) and laparoscopic antireflux surgery in patients unwilling to continue or intolerant of long-term PPI treatment. Recently, RefluxStop™, a novel, implantable medical device, has proven to be an efficacious and cost-effective treatment for patients with GORD. The current analysis aimed to describe the budget impact of introducing RefluxStop™ within National Health Service (NHS) England and Wales. Objectives: To estimate the more immediate, short-term clinical and economic effects of introducing RefluxStop™ as a therapeutic option for patients with GORD treated within NHS England and Wales. Methods: A model adherent to international best practice guidelines was developed to estimate the budget impact of introducing RefluxStop™ over a 5-year time horizon, from an NHS perspective. Two hypothetical scenarios were considered, one without RefluxStop™ (comprising PPI treatment, laparoscopic Nissen fundoplication, and magnetic sphincter augmentation using the LINX® system) and one with RefluxStop™ (adding RefluxStop™ to the aforementioned treatment options). Clinical benefits and costs associated with each intervention were included in the analysis. Results: Over 5 years, introducing RefluxStop™ allowed the avoidance of 347 surgical failures, 39 reoperations, and 239 endoscopic esophageal dilations. The financial impact of introducing RefluxStop™ was £3 029 702 in year 5, corresponding to a 1.68% increase in annual NHS spending on GORD treatment in England and Wales. Discussion: While the time horizon was too short to capture some of the adverse events of PPIs and complications of GORD, such as the development of Barrett's esophagus or esophageal cancer, the use of RefluxStop™ was associated with a substantial reduction in surgical complications, including surgical failures, reoperations, and endoscopic esophageal dilations. This favorable clinical profile resulted in cost offsets for the NHS and contributed to the marginal budget impact of RefluxStop™ estimated in the current analysis. Conclusions: Introducing RefluxStop™ as a treatment option for patients with GORD in England and Wales may be associated with clinical benefits at the expense of a marginal budget impact on the NHS.
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Affiliation(s)
- Sam Harper
- York Health Economics Consortium, York, UK
| | | | | | | | - Paul Goldsmith
- Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Ahmed Ahmed
- Department of Surgery and Cancer Imperial College London, London, UK
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Chan A, Stathakis P, Goldsmith P, Smith S, Macutkiewicz C. The reorganisation of emergency general surgery services during the COVID-19 pandemic in the UK: outcomes of delayed presentation, socio-economic deprivation and Black, Asian and Minority Ethnic patients. Ann R Coll Surg Engl 2023; 105:S46-S53. [PMID: 35639022 PMCID: PMC10390243 DOI: 10.1308/rcsann.2022.0022] [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] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic is a global public health emergency. Lockdown restrictions and the reconfiguration of healthcare systems to accommodate an increase in critical care capacity have had an impact on 'non-COVID' specialties. This study characterises the utilisation of emergency general surgery (EGS) services during the UK lockdown period at a university teaching hospital with a catchment population that represents one of the most deprived and ethnically diverse areas in the UK. METHODS EGS admissions during the UK lockdown period (March to May 2020) were compared with the same period in 2019. Patient demographics were recorded together with clinical presentation, hospital stay and treatment outcomes, and readmission data. RESULTS The study included 645 patients, comprising 223 in the COVID-19 period and 422 in the non-COVID-19 period. There was no difference in age, sex, comorbidity or socio-economic status. A lower proportion of patients of Black, Asian and Minority Ethnicity (BAME) were admitted during the pandemic (20.6% vs 35.4%, p < 0.05). The duration of symptoms prior to presentation was longer, and admission clinical parameters and serum inflammatory markers. More patients presented with an acute kidney injury (9.9% vs 4.7%, p = 0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p = 0.023). CONCLUSIONS The reorganisation of EGS to a senior-led model has been successful in terms of outcomes and access to treatment despite a more unwell population. There was a significantly lower proportion of BAME admissions suggesting additional barriers to healthcare access under pandemic lockdown conditions.
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Affiliation(s)
- A Chan
- Manchester University NHS Foundation Trust, UK
| | - P Stathakis
- Manchester University NHS Foundation Trust, UK
| | - P Goldsmith
- Manchester University NHS Foundation Trust, UK
| | - S Smith
- Manchester University NHS Foundation Trust, UK
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7
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Wynn M, Gibson R, Goldsmith P. Multidisciplinary management of a complex abdominal wound post necrotising fasciitis: a case study. J Wound Care 2022; 31:924-929. [DOI: 10.12968/jowc.2022.31.11.924] [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]
Abstract
A 59-year-old male patient presented with abdominal necrotising fasciitis secondary to a bowel perforation through a previous drain site that he had waited at home with for two weeks. Enteric contents were found within the abdominal wall. Surgery required extensive abdominal wall debridement and the formation of a double-barrel ileostomy within the debrided area. The resulting abdominal wound was large, initially covering an area of approximately 424cm2, and had continuous contamination from enteric leakage that could not be isolated. Achieving wound healing was challenging due to the enteric output and resultant continuous contamination of the wound bed.
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Affiliation(s)
| | - Ruth Gibson
- Manchester University NHS Foundation Trust, UK
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8
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Westerman R, Stathakis P, Goldsmith P, Smith S, Macutkiewicz C, Chan A. TH7.8 Delayed Diagnosis of Duodenal Injury in Blunt Abdominal Trauma following a normal initial Computed Tomography scan: A Systematic Review. Br J Surg 2022. [DOI: 10.1093/bjs/znac248.261] [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: 11/05/2022]
Abstract
Abstract
Aims
Isolated duodenal injury and perforation can result from blunt abdominal trauma (BAT) in approximately 5% of patients with intrabdominal injuries. Modern major trauma pathways mandate computed tomography (CT) as part of the primary assessment. The evolution of a duodenal injury to a perforation can be delayed. The aim of this review is to ascertain the proportion of false negative CTs for duodenal perforation in BAT.
Methods
A systematic review of the literature was conducted using PubMed, Embase and OvidSP databases to include search terms “blunt abdo*”, “duoden*”, “trauma”, and “computed tomography” combined with Boolean operators. Data were extracted from studies that report data on patients following BAT with a normal initial CT who subsequently develop a perforation. Studies were limited to the last 10 years.
Results
There were 315 articles identified, which after excluding duplicates and screening, 18 articles were reviewed in detail and 6 articles (3 case studies and 3 retrospective cohort studies) included in the final review. Across the 6 studies, a total of 159 patients suffered BAT with 29 patients (18%) having a normal CT on admission. The majority of patients underwent a repeat CT within 24 hours which then subsequently revealed radiological signs of a duodenal injury/perforation.
Conclusion
Patients who present with following BAT should be closely observed for delayed clinical signs of visceral perforation. CT (preferably with oral contrast) should be performed if there is any clinical suspicion of perforation, even if the timeframe is within 24 hours of the initial CT scan.
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Taylor M, Godec T, Shiel J, James R, Chowdury Y, Ebano P, Monk V, Patel M, Pheby J, Enobakhare E, Foubister A, David C, Saxena M, Siddle J, Timlin G, Goldsmith P, Deeming N, Poulter NR, Gabe R, McManus R, Collier DJ. WHOSE DOSE IS IT ANYWAY? INDIVIDUAL PATIENT DOSE-RESPONSE CURVES FROM THE REMOTE-CARE PERSONAL-COVIDBP TRIAL. J Am Coll Cardiol 2022. [PMCID: PMC8972411 DOI: 10.1016/s0735-1097(22)02988-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Hao J, Beck J, Zhou X, Lackner GL, Johnston R, Reinhard M, Goldsmith P, Hollinshead S, Dehlinger V, Filla SA, Wang XS, Richardson J, Posada M, Mohutsky M, Schober D, Katner JS, Chen Q, Hu B, Remick DM, Coates DA, Mathes BM, Hawk MK, Svensson KA, Hembre E. Synthesis and Preclinical Characterization of LY3154885, a Human Dopamine D1 Receptor Positive Allosteric Modulator with an Improved Nonclinical Drug-Drug Interaction Risk Profile. J Med Chem 2022; 65:3786-3797. [PMID: 35175768 DOI: 10.1021/acs.jmedchem.1c01887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Results from recently completed clinical studies suggest the dopamine D1 receptor positive allosteric modulator (PAM) mevidalen (1) could offer unique value for lewy body dementia (LBD) patients. In nonclinical assessments, 1 was mainly eliminated by CYP3A4-mediated metabolism, therefore at the risk of being a victim of drug-drug interactions (DDI) with CYP3A4 inhibitors and inducers. An effort was initiated to identify a new D1 PAM with an improved DDI risk profile. While attempts to introduce additional metabolic pathways mediated by other CYP isoforms failed to provide molecules with an acceptable profile, we discovered that the relative contribution of CYP-mediated oxidation and UGT-mediated conjugation could be tuned to reduce the CYP3A4-mediated victim DDI risk. We have identified LY3154885 (5), a D1 PAM that possesses similar in vitro and in vivo pharmacologic properties as 1, but is metabolized mainly by UGT, predicting it could potentially offer lower victim DDI risk in clinic.
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11
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Lowe SL, Goldsmith P, Phipps KM, Kevin DB, Biglan K, Mancini M, Nuthall HN, Mergott DJ, Kielbasa W. Single and multiple ascending dose studies in healthy volunteers to assess the safety and PK of LY3372689, an inhibitor of the O‐GlcNAcase (OGA) enzyme. Alzheimers Dement 2021. [DOI: 10.1002/alz.057728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Kielbasa W, Shcherbinin S, Goldsmith P, Phipps KM, Biglan K, Mancini M, Russell D, Constantinescu C, Gunn RN, Nuthall HN, Mergott DJ, Lowe SL, Collins EC. Brain target occupancy of LY3372689, an inhibitor of the O‐GlcNAcase (OGA) enzyme, following administration of single and multiple doses to healthy volunteers. Alzheimers Dement 2021. [DOI: 10.1002/alz.057774] [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: 11/06/2022]
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13
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Chan A, Stathakis P, Goldsmith P, Smith S, Macutkiewicz C. TP10.1.5The reorganisation of Emergency General Surgery services during the COVID-19 pandemic in the UK: Outcomes of delayed presentation, mortality and BAME patients. Br J Surg 2021. [DOI: 10.1093/bjs/znab362.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
The COVID-19 pandemic is a global public health emergency. The reconfiguration of local healthcare systems to accommodate the increase in Critical Care capacity has put strain on ‘non-COVID’ specialities. This study characterises the utilisation of Emergency General Surgery (EGS) services at a busy UK university teaching hospital during the COVID-19 lockdown period to evaluate outcomes and to identify patient groups with worse outcomes.
Method
This retrospective study compares EGS admissions during the UK’s lockdown period (23rd March-28th May 2020) to the same period in 2019. Patient demographics were recorded together with details of their hospital stay and treatment outcomes.
Results
A total of 645 patients were included, comprising 223 in the COVID-19 and 422 in the non-COVID-19 periods. There was no difference in age, sex, co-morbidity or socioeconomical status. A lower proportion of Black, Asian and Minority Ethnic (BAME) patients were admitted during the COVID-19 period (20.6% vs 35.4%, p < 0.05). The duration of symptoms prior to presentation were longer, and admission Early Warning Scores and serum inflammatory markers were higher. More patients present with acute kidney injury (9.9% vs 4.7%, p = 0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p = 0.023).
Conclusion
We show that the UK reorganisation of EGS services has been successful in terms of outcomes and access to services despite a more unwell population. There was a lower proportion of BAME admissions suggesting additional barriers to access to healthcare under pandemic lockdown conditions.
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14
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Lawrence E, Stathakis P, Goldsmith P, Smith S, Macutkiewicz C, Chan A. EP.WE.238Implications of COVID-19 on Laparoscopic General Surgery: a single site experience. Br J Surg 2021. [PMCID: PMC8574331 DOI: 10.1093/bjs/znab308.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction and Aims The COVID-19 pandemic has had an unprecedented impact on service provision in Emergency General Surgery. Due to the unknown risk of COVID-19 transmission, the use of laparoscopic surgery was cautioned against in favour of open surgery or conservative management. This study looks at the impact of service reconfiguration on rates of laparoscopic surgery. Methods The management and outcomes were audited of all patients admitted to our unit during the UK COVID-19 lockdown period and compared against the same period last year. Results In total, 645 patients (223 COVID-19 period, 422 non-COVID) were included. Less surgery was performed during the pandemic (32.3% vs 39.3%), with only 2 cases of laparoscopic surgery (0.9% vs 16.1%). Despite a change to conservative management, we report no differences in complication rates or length of stay and 30-day mortality (excluding deaths from COVID-19 pneumonitis). Re-admission rates were higher following conservative management (10.6% vs 4.7%). Conclusion There is a significant reduction in surgery (particularly laparoscopic surgery) during the COVID-19 pandemic. There are no differences in outcomes, but we show higher re-admission rates for patients treated conservatively. Together with emerging evidence on the safety of laparoscopic surgery, these findings help inform service re-configuration for future pandemic responses.
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15
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Hickey L, Goldsmith P. EP.FRI.1040 Management of Acute Colonic Diverticulitis According to The WSES (World Society of Emergency Surgery) Classification in a Tertiary Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab312.150] [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]
Abstract
Abstract
Aims
Debate remains regarding management of complicated diverticulitis. The WSES acute diverticulitis working group published in 2015 a CT-guided classification of left colon acute diverticulitis, divided into uncomplicated (Stage 0) and complicated (Stage 1a-4). Using this classification, we reviewed our management of CT-proven acute colonic diverticulitis.
Methods
A single-centre retrospective review of management of CT-proven acute colonic diverticulitis over 12 months based on the WSES classification.
Results
24 males and 31 females presented (median age=56, IQR 45-68). Median white cell count=12 (IQR 10-16) and median C-reactive protein=88 (IQR 41-157).
Based on CT, 25 (45.5%) patients =stage 0, 14 (25.5%) =stage 1a, 6 (11%) =stage 1b, 4 (7%) =stage 2a, 6 (11%) =stage 2b, and none staged 3/4.
15% (8/55) patients had an operation, remainder were conservatively managed. 2 patients had laparoscopic washout/drainage (stages 1b and 2b). 6 patients had Hartmanns (x1 stage 1a, x1 stage 1b, x4 stage 2b).
Median length of stay=5 days (IQR 4-8). There was 1 related reattendance declining readmission (stage 1a managed conservatively) and 2 readmissions (1 stage 0 managed conservatively, other initially stage 1a managed conservatively but on readmission staged 2b proceeding to Hartmanns). 30-day mortality included 3 deaths (stages 1b/2a/2b all managed conservatively).
Conclusions
Hartmanns resection is advocated as treatment of choice for complicated acute diverticulitis, particularly for Stage 2b or above.
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Affiliation(s)
- Lorraine Hickey
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust
| | - Paul Goldsmith
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust
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16
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Chan A, Goldsmith P, Watson A, Stathakis P, Smith S, Macutkiewicz C. EP.FRI.1067 Exploring the Patient Journey and Social Care following Emergency Laparotomy in the Elderly: A Systematic Review of Qualitative Studies. Br J Surg 2021. [DOI: 10.1093/bjs/znab312.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Frailty is associated with high morbidity following emergency laparotomy. Objective scores such as P-POSSUM are well recognised in predicting outcomes such as morbidity and mortality. Qualitative factors affecting recovery and rehabilitation are less established. This review explores the lived experiences of elderly patients following emergency laparotomy to identify factors to improve post-hospital care.
Methods
A systematic review of the medical and nursing literature was performed using MEDLINE, Web of Science Core Collection and CINAHL Plus in January 2020. Qualitative and phenomenological studies were identified using keywords ‘emergency’, ‘laparotomy’, ‘abdo*’ and ‘surgery’. Cancer studies were excluded. Themes were extracted for ‘lines of argument’ synthesis to build a general interpretation of findings. The review is registered with PROSPERO (CRD42019159751).
Results
The search identified 569 unique citations of which 551 were excluded after screening and 17 excluded following full-text review. One study was included (Thomsen et al, 2014) exploring postoperative care for 18 patients following emergency abdominal surgery. Thematic analysis was limited to the hospital setting. Patients described Critical Care as a safe environment for recovery and rehabilitation because of higher nursing ratios. Patients placed emphasis on ready access to staff and timely interventions which was particularly poor on surgical wards. Specific barriers, particularly patient concerns regarding recovery, were not explored.
Conclusions
This review highlights the importance of easy access to staff and inpatient services following emergency laparotomy but demonstrates the lack of qualitative evidence exploring the lived experience of the immediate post-discharge period that impacts on rehabilitation back to normal activities.
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Affiliation(s)
- Anthony Chan
- Department of General Surgery, Manchester University NHS Foundation Trust
| | - Paul Goldsmith
- Department of General Surgery, Manchester University NHS Foundation Trust
| | - Andrew Watson
- Department of Elderly Medicine, Manchester University NHS Foundation Trust
| | - Panos Stathakis
- Department of General Surgery, Manchester University NHS Foundation Trust
| | - Stella Smith
- Department of General Surgery, Manchester University NHS Foundation Trust
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17
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Liu Q, Schwartz JB, Slattum PW, Lau SWJ, Guinn D, Madabushi R, Burckart G, Califf R, Cerreta F, Cho C, Cook J, Gamerman J, Goldsmith P, van der Graaf PH, Gurwitz JH, Haertter S, Hilmer S, Huang SM, Inouye SK, Kanapuru B, Pirmohamed M, Posner P, Radziszewska B, Keipp Talbot H, Temple R. Roadmap to 2030 for Drug Evaluation in Older Adults. Clin Pharmacol Ther 2021; 112:210-223. [PMID: 34656074 DOI: 10.1002/cpt.2452] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/04/2021] [Indexed: 12/17/2022]
Abstract
Changes that accompany older age can alter the pharmacokinetics (PK), pharmacodynamics (PD), and likelihood of adverse effects (AEs) of a drug. However, older adults, especially the oldest or those with multiple chronic health conditions, polypharmacy, or frailty, are often under-represented in clinical trials of new drugs. Deficits in the current conduct of clinical evaluation of drugs for older adults and potential steps to fill those knowledge gaps are presented in this communication. The most important step is to increase clinical trial enrollment of older adults who are representative of the target treatment population. Unnecessary eligibility criteria should be eliminated. Physical and financial barriers to participation should be removed. Incentives could be created for inclusion of older adults. Enrollment goals should be established based on intended treatment indications, prevalence of the condition, and feasibility. Relevant clinical pharmacology data need to be obtained early enough to guide dosing and reduce risk for participation of older adults. Relevant PK and PD data as well as patient-centered outcomes should be measured during trials. Trial data should be analyzed for differences in PK, PD, effectiveness, and safety arising from differences in age or from the presence of conditions common in older adults. Postmarket evaluations with real-world evidence and drug labeling updates throughout the product lifecycle reflecting new knowledge are also needed. A comprehensive plan is needed to ensure adequate evaluation of the safety and effectiveness of drugs in older adults.
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Affiliation(s)
- Qi Liu
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Janice B Schwartz
- Departments of Medicine, Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Patricia W Slattum
- Department of Pharmacotherapy and Outcomes Science and Virginia Center on Aging, Virginia Commonwealth University, Richmond, Virginia, USA
| | - S W Johnny Lau
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Daphne Guinn
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rajanikanth Madabushi
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Gilbert Burckart
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Robert Califf
- Verily and Google Health (Alphabet), South San Francisco, California, USA
| | - Francesca Cerreta
- Portfolio office, European Medicines Agency (EMA), Amsterdam, The Netherlands
| | - Carolyn Cho
- Oncology Early Development and Translational Research, Merck & Co., Kenilworth, New Jersey, USA
| | - Jack Cook
- Department of Clinical Pharmacology, Pfizer Global Research and Development, Groton, Connecticut, USA
| | - Jamie Gamerman
- Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Paul Goldsmith
- Lilly Exploratory Medicine and Pharmacology, Bracknell, UK
| | | | - Jerry H Gurwitz
- Meyers Health Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA
| | - Sebastian Haertter
- Boehringer Ingelheim Pharma, Translational Medicine & Clinical Pharmacology, Ingelheim, Germany
| | - Sarah Hilmer
- Kolling Institute, University of Sydney and Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - Shiew-Mei Huang
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sharon K Inouye
- Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston. Massachusetts, USA
| | - Bindu Kanapuru
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Phil Posner
- Patient-Centered Outcomes Research Institute Ambassador, Gainesville, Florida, USA
| | - Barbara Radziszewska
- National Institute of Aging, National Institute of Health, Bethesda, Maryland, USA
| | - H Keipp Talbot
- Departments of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert Temple
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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18
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Gao JM, Goiriz R, Rajpopat S, Goldsmith P. Occupational dermatoses during the second wave of the COVID-19 pandemic: a UK prospective study of 805 healthcare workers. Br J Dermatol 2021; 186:374-376. [PMID: 34608626 PMCID: PMC8652738 DOI: 10.1111/bjd.20779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- J M Gao
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - R Goiriz
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - S Rajpopat
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - P Goldsmith
- Department of Dermatology, Barts Health NHS Trust, London, UK
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19
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Gonzalez Hernandez F, Carter SJ, Iso-Sipilä J, Goldsmith P, Almousa AA, Gastine S, Lilaonitkul W, Kloprogge F, Standing JF. An automated approach to identify scientific publications reporting pharmacokinetic parameters. Wellcome Open Res 2021; 6:88. [PMID: 34381873 PMCID: PMC8343403 DOI: 10.12688/wellcomeopenres.16718.1] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/29/2022] Open
Abstract
Pharmacokinetic (PK) predictions of new chemical entities are aided by prior knowledge from other compounds. The development of robust algorithms that improve preclinical and clinical phases of drug development remains constrained by the need to search, curate and standardise PK information across the constantly-growing scientific literature. The lack of centralised, up-to-date and comprehensive repositories of PK data represents a significant limitation in the drug development pipeline.In this work, we propose a machine learning approach to automatically identify and characterise scientific publications reporting PK parameters from in vivo data, providing a centralised repository of PK literature. A dataset of 4,792 PubMed publications was labelled by field experts depending on whether in vivo PK parameters were estimated in the study. Different classification pipelines were compared using a bootstrap approach and the best-performing architecture was used to develop a comprehensive and automatically-updated repository of PK publications. The best-performing architecture encoded documents using unigram features and mean pooling of BioBERT embeddings obtaining an F1 score of 83.8% on the test set. The pipeline retrieved over 121K PubMed publications in which in vivo PK parameters were estimated and it was scheduled to perform weekly updates on newly published articles. All the relevant documents were released through a publicly available web interface (https://app.pkpdai.com) and characterised by the drugs, species and conditions mentioned in the abstract, to facilitate the subsequent search of relevant PK data. This automated, open-access repository can be used to accelerate the search and comparison of PK results, curate ADME datasets, and facilitate subsequent text mining tasks in the PK domain.
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Affiliation(s)
| | - Simon J Carter
- Institute of Pharmacy, Uppsala University, Uppsala, Sweden.,Institute for Global Health, University College London, London, UK
| | | | | | | | - Silke Gastine
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Watjana Lilaonitkul
- Institute of Health Informatics, University College London, London, UK.,Health Data Research, London, UK
| | - Frank Kloprogge
- Institute for Global Health, University College London, London, UK
| | - Joseph F Standing
- Great Ormond Street Institute of Child Health, University College London, London, UK
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20
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Steele L, Jeetle S, Kok K, Cunningham M, Goldsmith P. Pyodermatitis vegetans-pyostomatitis vegetans with ocular involvement. Clin Exp Dermatol 2020; 46:223-226. [PMID: 32975854 DOI: 10.1111/ced.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- L Steele
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Jeetle
- Department of, Histopathology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Kok
- Department of, Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Cunningham
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - P Goldsmith
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
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21
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Lou Y, Goldsmith P, Rheey J, Berg PE. Abstract P5-01-25: Potential prognostic value of exosomal Beta Protein 1 in breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-01-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Beta protein 1 (BP1), discovered in our lab, is an isoform protein of the DLX4 gene that is a member of the homeobox gene family. Previous work showed BP1 mRNA was activated in 80% of invasive ductal breast (IDC) tumors, where 100% of estrogen receptor (ER) negative tumor tissues and 73% of ER positive tumor tissues were BP1 positive. Moreover, high BP1 levels were associated with tumor cell survival, breast cancer aggressiveness and metastasis. BP1 overexpression was found to stimulate known oncogenes including BCL2 and c-Myc. Exosomes are nano-sized membrane-bound vesicles released by various cells and play important roles in intercellular communication. In addition, researchers found that exosomal proteins have unique characteristics compared to traditional biomarkers for carcinoma diagnosis and prognosis. Therefore, we hypothesized that BP1 protein may be packed in exosomes, and analysis of exosomal BP1 protein could provide a novel biomarker for diagnosis or prognosis of breast cancer.
Materials and Methods: Exosomes were isolated using the commercially available Exosome Precipitation Solution. In cell line experiments, fluorescent immunohistochemistry was used to detect the location of BP1 protein. Levels of BP1 protein were determined in cell extracts (CE) and conditioned media (CM) using Western Blot analysis. The hypothesis that exosomal BP1 protein may be related to the development of breast cancer was investigated with clinical serum samples purchased from Capital Bioscience. Total exosomal protein levels in the serum were analyzed using BCA assay, and exosomal BP1 protein levels were determined using Western blot. In order to develop a method that could be easily used in the clinic, an ELISA assay was also designed to assess exosomal BP1 protein concentrations in the serum from metastatic breast cancer patients and normal controls.
Results: It was observed that BP1 protein is localized to the nucleus, the cytoplasm and the conditioned media of MCF-7 cells. In addition, experiments with cell lines showed that the secreted BP1 protein could be internalized by cells and exhibited mitogenic activity, which is related to cancer metastasis. Moreover, it was observed that exosomal BP1 is included in secreted BP1 protein in the conditioned media. Experiments with serum samples demonstrated that the total exosomal protein levels have no significant differences between that in breast cancer patients and in normal controls. However, the results of Western blot and ELISA both showed exosomal BP1 protein levels were significantly higher in breast cancer samples compared to normal controls (P < 0.05). Moreover, Western blot results suggested that ER positive patients have much more (P < 0.05) exosomal BP1 protein in the serum compared to ER negative patients.
Conclusion: It was shown for the first time that BP1 protein is exosomally packaged in breast cancer patients’ serum. The significant difference in the exosomal BP1 protein levels between the serum from women with metastatic breast cancer and that from normal controls indicated that exosomal BP1 protein in the serum could be a potential prognostic biomarker for breast cancer. Furthermore, the ELISA assay, designed to be easily used for exosomal BP1 protein quantification, may have many uses in the clinic through aiding in prognosis, monitoring therapy and early detection.
Citation Format: Yaoxian Lou, Paul Goldsmith, Jinguen Rheey, Patricia E. Berg. Potential prognostic value of exosomal Beta Protein 1 in breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-01-25.
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Affiliation(s)
- Yaoxian Lou
- The George Washington University, Washington, DC
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22
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Bhangu A, Nepogodiev D, Ives N, Magill L, Glasbey J, Forde C, Bisgaard T, Handley K, Mehta S, Morton D, Pinkney T, Mehta S, Handley K, Ives N, Bhangu A, Brown J, Forde C, Futaba K, Glasbey J, Handley K, Ives N, Khan S, Magill L, Mehta S, Morton D, Nepogodiev D, Pallan A, Patel A, Ashdown-Phillips S, Roberts T, Jowett S, Munetsi L, Pinkney T, Torrance A, Brown J, Handley K, Hilken N, Hill M, Hunter M, Ives N, Khan S, Leek S, Lilly H, Magill L, Mehta S, Sawant A, Vince A, Walters M, Bemelman W, Blussé M, Borstlap W, Busch ORC, Buskens C, Klaver C, Marsman H, van Ruler O, Tanis P, Westerduin E, Wicherts D, Das P, Essapen S, Frost V, Glennon A, Gray C, Hussain A, McNichol L, Nisar P, Scott H, Trickett J, Trivedi P, White D, Amarnath T, Ardley R, Gupta R, Hall E, Hodgkins K, Narula H, Sewell TA, Simms JM, Toms J, White T, Atkinson A, Beral D, Lancaster N, Mackenzie F, Wilson T, Cruttenden-Wood D, Gibbins J, Halls M, Hill D, Hogben K, Jones S, Lamparelli MJ, Lewis M, Moreton S, Ng P, Oglesby A, Orbell J, Stubbs B, Subramanian K, Talwar A, Wilsher S, Al-Rashedy M, Fensom C, Gok M, Hardstaff L, Malik K, Sadat M, Townley B, Wilkinson L, Cosier T, Mangam S, Rabie M, Broadley G, Canny J, Fallis S, Green N, Hawash A, Karandikar S, Mirza M, Rawstorne E, Reddan J, Richardson J, Thompson C, Waite K, Youssef H, Bisgaard T, De Nes L, Rosenstock S, Strandfelt P, Westen M, Aryal K, Kshatriya KS, Lal R, Velchuru V, Wilhelmsen E, Akbar A, Antoniou A, Clark S, Datt P, Goh J, Jenkins I, Kennedy R, Maeda Y, Nastro P, Owen H, Phillips RKS, Warusavitarne J, Bradley-Potts J, Charleston P, Clouston H, Duff S, Fatayer T, Gipson A, Heywood N, Junejo M, Kennedy J, Lalor H, Manning C, McCormick R, Parmar K, Preston S, Ramesh A, Sharma A, Telford K, Adeosun A, Hammond T, Smolen S, Topliffe J, Docherty JG, Lim M, Lim M, Macleod K, Monaghan E, Patience L, Thomas I, Walker KG, Walker M, Watson AJM, Burgess A, Ghanem Y, Glister G, Kapur S, Paily A, Pal A, Ravikumar R, Rosbergen M, Sargen K, Speakman C, Agarwal AK, Banerjee A, Borowski D, Garg D, Gill T, Johnston T, Kelsey S, Munipalle PC, Tabaqchali M, Wilson D, Acheson A, Cripps H, El-Sharkawy A, Ng O, Sharma P, Ward K, Chandler D, Courtney E, Bunni J, Butcher K, Dalton S, Flindall I, Katebe J, Roy P, Tate J, Vincent T, Williamson MER, Wood J, Bignell M, Branagan G, Broardhurst J, Chave H, Dean H, D'Souza N, Foster G, Sleight S, Sutaria R, Ahmed I, Budhoo MR, Colley J, Cruickshank N, Gill K, Hayes A, Joy H, Kamabjha C, Plowright J, Radley S, Rea M, Thumbe V, Torrance A, Varghese P, Wilkin R, Zulueta E, Allsop L, Atkari B, Badrinath K, Daliya P, Dube M, Heeley C, Hind R, Nash D, Palfreman A, Peacock O, Watson N, Blodwell M, Javaid A, Mohamad A, Muhammad K, Qureshi N, Ridgway S, Siddiqui K, Solkar M, Vere J, Wordie A, Chang J, Elgaddal S, Green M, Hollyman M, Mirza N, Rankin J, Williams G, Ali W, Hardwick A, Mohamed Z, Navid A, Netherton K, Obreja M, Rao M, Stringer J, Tennakoon A, Bullen T, Butt M, Dawson R, Dawson S, Farmer M, Garimella V, Gates Z, Wilkings L, Yeomans N, Adedeji O, Alalawi R, Al Araimi A, Ashraf S, Bach S, Beggs A, Cagigas C, Dattani M, Dimitriou N, Futaba K, Ghods-Ghorbani M, Glasbey J, Gourevitch D, Haydon G, Ismail T, Keh C, Morton DG, Narewal M, Nepogodiev D, Papettas T, Pinkney T, Poh A, Ranstorne E, Royle TJ, Shah T, Singh J, Smart C, Suggett N, Tayyab M, Vijayan D, Vohra R, Wairaich N, Yeung D, Bamford R, Chambers J, Cotton D, Houlihan R, Kynaston J, Longman R, Lowe A, Messenger D, Owais A, Phillpott C, Shabbir J, Baragwanath P, El-Sayed C, Gaunt A, Khatri C, McCullough P, Patel A, Ward S, Wilkin R, Obukofe R, Stroud R, Mason D, Williams N, Wong LS, Chaudhri S, Cooke J, Cunha M, Fairey H, Norwood M, Singh B, Thomasset S, Abbott S, Addison S, Archer J, Bhangu A, Church R, Holford E, Lenehan F, Odogwu S, Richardson L, Sidebotham J, Swan E, Tilley A, Wagstaff L, Amey I, Baird Y, Cripps N, Greenslade S, Harris G, Levy B, Mckenzie P, Misselbrook A, Moore S, Skull A, Nicol D, Reddy B, Thrush J, Iglesias Vecchio M, Dunn Y, Williams C, Furtado S, Gill M, Gilmore L, Goldsmith P, Kocialkowski C, Loganathan S, Nath R, Paraoan M, Taylor T, Allison A, Allison J, Curtis N, Dalton R, D'Costa C, Dennison G, Foster J, Francis N, Gibbons J, Hamdan M, Lewis A, Ockrim J, Sharma R, Spurdle K, Varadharajan S, Aghahoseini A, Alexander DJ, Bandyopadhyay D, Bradford I, Chitsabesan P, Coleman Z, Gibson A, Lasithiotakis K, Panagiotou D, Polyzois K, Stojkovic S, Woodcock N, Wright M, Hargest R, Jackson R, Rajesh A, Ogunbiyi O, Slater A, Yu LM. Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial. Lancet 2020; 395:417-426. [PMID: 32035551 PMCID: PMC7016509 DOI: 10.1016/s0140-6736(19)32637-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. METHODS In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. FINDINGS Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43-0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26-0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60-1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54-1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. INTERPRETATION Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. FUNDING National Institute for Health Research Research for Patient Benefit and Allergan.
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23
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Yurgelun-Todd DA, Renshaw PF, Goldsmith P, Uz T, Macek TA. A randomized, placebo-controlled, phase 1 study to evaluate the effects of TAK-063 on ketamine-induced changes in fMRI BOLD signal in healthy subjects. Psychopharmacology (Berl) 2020; 237:317-328. [PMID: 31773211 PMCID: PMC7018803 DOI: 10.1007/s00213-019-05366-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/22/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE Phosphodiesterase 10A inhibitor TAK-063 has shown effects that suggest efficacy in schizophrenia treatment. OBJECTIVE This randomized, double-blind, placebo-controlled, incomplete-crossover study investigated effects of single oral administration of TAK-063 on ketamine-induced changes in blood oxygen level-dependent (BOLD) signal in healthy males. METHODS Healthy men aged 18 to 45 years with normal magnetic resonance imaging (MRI) scans and electroencephalogram measurements at screening were eligible. Each subject was randomized to one of nine treatment schedules: all subjects received placebo and two of three doses of TAK-063 followed by ketamine. The primary endpoint was ketamine-induced brain activity in select regions of the brain during resting state. Secondary endpoints included pharmacokinetic parameters of TAK-063, proportion of subjects with treatment-emergent adverse events (AEs), and percentage of subjects meeting criteria for abnormal safety laboratory tests and vital sign measurements. RESULTS The study comprised 27 subjects. Prior to ketamine infusion, TAK-063 exerted region-specific effects on resting state functional MRI (fMRI) BOLD signal. After ketamine administration, TAK-063 reduced the Cohen's effect size for resting-state fMRI BOLD signal in key brain regions examined, and exerted similar effects on BOLD signal during the working memory task across all doses. TAK-063 was safe and well tolerated. CONCLUSIONS Our results are consistent with non-clinical studies of ketamine and TAK-063 and clinical studies of ketamine and risperidone. It is unknown whether these data are predictive of potential antipsychotic efficacy, and further analyses are required.
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Affiliation(s)
| | - Perry F Renshaw
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT, 84108, USA
| | - Paul Goldsmith
- Takeda Development Center Europe, Ltd., 61 Aldwych, London, WC2B 4AE, UK
| | - Tolga Uz
- Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA
| | - Thomas A Macek
- Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA
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Bolton C, Goldsmith P. Complaints from patients with functional neurological disorders: a cross-sectional UK survey of why patients complain and the effect on the clinicians who look after them. BMJ Open 2018; 8:e021573. [PMID: 30413498 PMCID: PMC6231557 DOI: 10.1136/bmjopen-2018-021573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To evaluate the nature of complaints from patients with functional neurological disorders and understand the reaction of UK neurology consultants to receiving complaints from this patient group. METHODS A voluntary online retrospective survey was advertised to UK consultant neurologists. Questions asked about the nature of the complaint, how it was dealt with, how it affected their emotional well-being and attitude to work, and whether it influenced their clinical practice. Responses were anonymised. The frequency of responses and percentage of total responses were analysed. Respondents were also given opportunities to add personal comments. RESULTS Responses from 58 clinicians were received. Patient disagreement with the diagnosis was a factor in 90% of complaints received. Only 77% of complaints were resolved within 6 months and 61% of clinicians received no feedback about the outcome. 31% of clinicians reported their most problematic complaint had an adverse effect on their mood. 67% of respondents changed their practice following the complaint with 59% investigating more frequently or due to perceived pressure from patients. CONCLUSIONS Complaints from patients with functional neurological disorders appear to be primarily due to disagreement with the diagnosis. They are more difficult to resolve than other complaints, and clinicians who deal with them often become the 'second victim' in the process leading to potentially adverse effects on patient care. Strategies to tackle these issues are discussed.
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Affiliation(s)
- Clare Bolton
- Neurology Department, James Cook University Hospital, Middlesbrough, UK
| | - Paul Goldsmith
- Neurology Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Chousalkar KK, Sexton M, McWhorter A, Hewson K, Martin G, Shadbolt C, Goldsmith P. Salmonella typhimurium in the Australian egg industry: Multidisciplinary approach to addressing the public health challenge and future directions. Crit Rev Food Sci Nutr 2017; 57:2706-2711. [DOI: 10.1080/10408398.2015.1113928] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Kapil K. Chousalkar
- School of Animal and Veterinary Science, The University of Adelaide, Roseworthy, South Australia, Australia
| | - Margaret Sexton
- Primary Industries and Regions, Adelaide, South Australia, Australia
| | - Andrea McWhorter
- School of Animal and Veterinary Science, The University of Adelaide, Roseworthy, South Australia, Australia
| | - Kylie Hewson
- Australian Egg Corporation Limited, North Sydney, Sydney, New South Wales, Australia
| | - Glen Martin
- Food and Controlled Drugs Branch, SA Health, Adelaide, South Australia, Australia
| | - Craig Shadbolt
- NSW Food Authority, Sydney, Sydney, New South Wales, Australia
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Brown F, Goldsmith P, Green HF, Holt A, Parham AG. Measurements of the Water Vapour, Tritium and Carbon-14 Content of the Middle Stratosphere over Southern England. ACTA ACUST UNITED AC 2016. [DOI: 10.3402/tellusa.v13i3.9504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- F. Brown
- Atomic Weapons Research Establishment, Aldermaston, England
| | - P. Goldsmith
- Atomic Energy Research Establishment, Harwell, England
| | - H. F. Green
- Atomic Weapons Research Establishment, Aldermaston, England
| | - A. Holt
- Atomic Weapons Research Establishment, Aldermaston, England
| | - A. G. Parham
- Atomic Energy Research Establishment, Harwell, England
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Manson HJ, Goh YM, Goldsmith P, Scott P, Turner P. Congenital diaphragmatic hernia causing cardiac arrest in a 30-year-old woman. Ann R Coll Surg Engl 2016; 99:e75-e77. [PMID: 27869490 DOI: 10.1308/rcsann.2016.0345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Congenital diaphragmatic hernia (CDH) usually presents in infancy with respiratory failure requiring urgent surgical correction. Mortality in this group of patients remains poor and persistent pulmonary hypertension is a significant contributor. It is therefore rare for patients to reach adulthood undiagnosed. CDH is often identified incidentally in adults but when symptoms arise, they relate to the organ involved, and include gastrointestinal symptoms of dyspepsia and obstruction, as well as respiratory complaints such as dyspnoea. We present the case of a 30-year-old woman who was admitted with non-specific symptoms of upper abdominal discomfort but whose deteriorating condition culminated in a cardiac arrest, as an unreported presentation of CDH. The patient presented initially with severe left upper quadrant pain. Her chest x-ray on admission suggested a raised left hemidiaphragm. She went on to have computed tomography (CT) of the thorax and abdomen as well as oesophagogastroduodenoscopy, which raised the suspicion of diaphragmatic eventration. Repeat CT was performed after the patient collapsed on the ward five days following admission, revealing tracheal deviation, and a strangulated Bochdalek hernia containing stomach and spleen. After transfer to the anaesthetic room, she suffered a cardiac arrest. Advanced life support was required to return spontaneous cardiac function. She was intubated and ventilated, and a needle thoracostomy was performed to decompress the tension gastrothorax. Emergency laparotomy revealed a gangrenous stomach and spleen. Total gastrectomy with primary Roux-en-Y reconstruction, splenectomy and insertion of a feeding jejunostomy were performed. The patient recovered well postoperatively and was discharged two weeks following surgery.
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Affiliation(s)
- H J Manson
- Lancashire Teaching Hospitals NHS Foundation Trust , UK
| | - Y M Goh
- Lancashire Teaching Hospitals NHS Foundation Trust , UK
| | - P Goldsmith
- Lancashire Teaching Hospitals NHS Foundation Trust , UK
| | - P Scott
- East Lancashire Hospitals NHS Trust , UK
| | - P Turner
- Lancashire Teaching Hospitals NHS Foundation Trust , UK
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Takano A, Stenkrona P, Stepanov V, Amini N, Martinsson S, Tsai M, Goldsmith P, Xie J, Wu J, Uz T, Halldin C, Macek TA. A human [ 11 C]T-773 PET study of PDE10A binding after oral administration of TAK-063, a PDE10A inhibitor. Neuroimage 2016; 141:10-17. [DOI: 10.1016/j.neuroimage.2016.06.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/24/2016] [Indexed: 01/22/2023] Open
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29
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Erpenbeck VJ, Popov TA, Miller D, Weinstein SF, Spector S, Magnusson B, Osuntokun W, Goldsmith P, Weiss M, Beier J. Data on the oral CRTh2 antagonist QAW039 (fevipiprant) in patients with uncontrolled allergic asthma. Data Brief 2016; 9:199-205. [PMID: 27656673 PMCID: PMC5021787 DOI: 10.1016/j.dib.2016.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/10/2016] [Accepted: 08/19/2016] [Indexed: 11/25/2022] Open
Abstract
This article contains data on clinical endpoints (Peak Flow Expiratory Rate, fractional exhaled nitric oxide and total IgE serum levels) and plasma pharmacokinetic parameters concerning the use of the oral CRTh2 antagonist QAW039 (fevipiprant) in mild to moderate asthma patients. Information on experimental design and methods on how this data was obtained is also described. Further interpretation and discussion of this data can be found in the article "The oral CRTh2 antagonist QAW039 (fevipiprant): a phase II study in uncontrolled allergic asthma" (Erpenbeck et al., in press) [1].
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Affiliation(s)
| | - Todor A Popov
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria
| | | | - Steven F Weinstein
- Allergy & Immunology, Allergy and Asthma Specialists Medical Group and Research Center, CA, United States
| | - Sheldon Spector
- Allergy & Asthma, California Allergy and Asthma Medical Group Inc, CA, United States
| | | | | | | | | | - Jutta Beier
- INSAF, Respiratory Research Institute GmbH, Wiesbaden, Germany
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Erpenbeck VJ, Vets E, Gheyle L, Osuntokun W, Larbig M, Neelakantham S, Sandham D, Dubois G, Elbast W, Goldsmith P, Weiss M. Pharmacokinetics, Safety, and Tolerability of Fevipiprant (QAW039), a Novel CRTh2 Receptor Antagonist: Results From 2 Randomized, Phase 1, Placebo-Controlled Studies in Healthy Volunteers. Clin Pharmacol Drug Dev 2016; 5:306-13. [PMID: 27310331 PMCID: PMC5071756 DOI: 10.1002/cpdd.244] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 07/28/2015] [Revised: 11/19/2015] [Accepted: 12/01/2015] [Indexed: 12/22/2022]
Abstract
We evaluated the pharmacokinetics (PK), safety, and tolerability of a novel oral CRTh2 antagonist, fevipiprant (QAW039), in healthy subjects. Peak concentrations of fevipiprant in plasma were observed 1‒3 hours postdosing. Concentrations declined in a multiexponential manner, followed by an apparent terminal phase (t1/2, ∼20 hours). Steady state was achieved in 4 days with <2‐fold accumulation. Elimination was partly by renal excretion (≤30% of the dose) and glucuronidation. Food had minimal impact on the PK of fevipiprant, and it was well tolerated at single and multiple oral doses up to 500 mg/day. No dose‐dependent adverse events were observed, and all the events were mild or moderate in severity. Systemic concentrations were sufficiently high to achieve relevant target occupancy, considering in vitro pharmacology data. In summary, the data support further development as a once‐daily oral therapy for allergic diseases.
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Affiliation(s)
| | - Eva Vets
- SGS-Life Sciences, Antwerp, Belgium
| | | | - Wande Osuntokun
- Novartis Institutes for Biomedical Research, Horsham, United Kingdom
| | | | | | - David Sandham
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Gerald Dubois
- Novartis Institutes for Biomedical Research, Horsham, United Kingdom
| | | | - Paul Goldsmith
- Novartis Institutes for Biomedical Research, Horsham, United Kingdom
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31
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Affiliation(s)
- A. J. Ryan
- Department of Dermatology; The Royal London Hospital; Barts Health NHS Trust; London UK
| | - R. Cerio
- Department of Dermatology; The Royal London Hospital; Barts Health NHS Trust; London UK
| | - D. Paige
- Department of Dermatology; The Royal London Hospital; Barts Health NHS Trust; London UK
| | - P. Goldsmith
- Department of Dermatology; The Royal London Hospital; Barts Health NHS Trust; London UK
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32
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Goldsmith P, Moon J, Anderson P, Kirkup S, Williams S, Gray M. Do clinical incidents, complaints and medicolegal claims overlap? Int J Health Care Qual Assur 2015; 28:864-71. [DOI: 10.1108/ijhcqa-06-2015-0081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Error reporting by healthcare staff, patient-derived complaints and patient-derived medico-legal claims are three separate processes present in most healthcare systems. It is generally assumed that all relate to the same cases. Given the high costs associated with these processes and strong desire to maximise quality and standards, the purpose of this paper is to see whether it was indeed the case that most complaints and claims related to medical errors and the relative resource allocation to each group.
Design/methodology/approach
– Electronic databases for clinical error recording, patient complaints and medico-legal claims in a large NHS healthcare provider organisation were reviewed and case overlap analysed.
Findings
– Most complaints and medico-legal claims do not associate with a prior clinical error. Disproportionate resource is required for a small number of complaints and the medico-legal claims process. Most complaints and claims are not upheld.
Research limitations/implications
– The authors have only looked at data from one healthcare provider and for one period. It would be useful to analyse other healthcare organisations over a longer time period. The authors were unable to access data on secondary staffing costs, which would have been informative. As the medico-legal process can go on for many years, the authors do not know the ultimate outcomes for all cases. The authors also do not know how many medico-legal cases were settled out of court pragmatically to minimise costs.
Practical implications
– Staff error reporting systems and patient advisory services seem to be efficient and working well. However, the broader complaints and claims process is costing considerable time and money, yet may not be useful in driving up standards. System changes to maximise helpful complaints and claims, from a quality and standards perspective, and minimise unhelpful ones are recommended.
Originality/value
– This study provides important data on the lack of overlap between errors, complaints and claims cases.
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Goldsmith P. ON ERROR REPORTING. Why the gap between anecdote and fact? Health Serv J 2015; 125:16-17. [PMID: 26642587] [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: 06/05/2023]
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34
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Martikainen MH, Gorman GS, Goldsmith P, Burn DJ, Turnbull DM, Schaefer AM. Adult-onset myoclonus ataxia associated with the mitochondrial m.8993T>C "NARP" mutation. Mov Disord 2015; 30:1432-3. [PMID: 26265210 PMCID: PMC4737103 DOI: 10.1002/mds.26358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/29/2015] [Accepted: 07/13/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mika H Martikainen
- Wellcome Trust Center for Mitochondrial Research, United Kingdom, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Grainne S Gorman
- Wellcome Trust Center for Mitochondrial Research, United Kingdom, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul Goldsmith
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David J Burn
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Doug M Turnbull
- Wellcome Trust Center for Mitochondrial Research, United Kingdom, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew M Schaefer
- Wellcome Trust Center for Mitochondrial Research, United Kingdom, Newcastle University, Newcastle upon Tyne, United Kingdom
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35
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Symes S, Goldsmith P, Haines H. Microbiological Safety and Food Handling Practices of Seed Sprout Products in the Australian State of Victoria. J Food Prot 2015; 78:1387-91. [PMID: 26197293 DOI: 10.4315/0362-028x.jfp-14-566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Seed sprouts have been implicated as vehicles for numerous foodborne outbreaks worldwide. Seed sprouts pose a unique food safety concern because of the ease of microbiological seed contamination, the inherent ability of the sprouting process to support microbial growth, and their consumption either raw or lightly cooked. To examine seed sprout safety in the Australian state of Victoria, a survey was conducted to detect specific microbes in seed sprout samples and to investigate food handling practices relating to seed sprouts. A total of 298 seed sprout samples were collected from across 33 local council areas. Escherichia coli was detected in 14.8%, Listeria spp. in 12.3%, and Listeria monocytogenes in 1.3% of samples analyzed. Salmonella spp. were not detected in any of the samples. A range of seed sprout handling practices were identified as potential food safety issues in some food businesses, including temperature control, washing practices, length of storage, and storage in proximity to unpackaged ready-to-eat potentially hazardous foods.
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Affiliation(s)
- Sally Symes
- Department of Health and Human Services, 50 Lonsdale Street, Melbourne, 3000, Victoria, Australia.
| | - Paul Goldsmith
- Department of Health and Human Services, 50 Lonsdale Street, Melbourne, 3000, Victoria, Australia
| | - Heather Haines
- Department of Health and Human Services, 50 Lonsdale Street, Melbourne, 3000, Victoria, Australia
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36
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Seo YM, Shirley YL, Goldsmith P, Ward-Thompson D, Kirk JM, Schmalzl M, Lee JE, Friesen R, Langston G, Masters J, Garwood RW. AN AMMONIA SPECTRAL MAP OF THE L1495-B218 FILAMENTS IN THE TAURUS MOLECULAR CLOUD. I. PHYSICAL PROPERTIES OF FILAMENTS AND DENSE CORES. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/805/2/185] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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37
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Ou O, Huppi K, Chakka S, Gehlhaus K, Dubois W, Patel J, Chen J, Mackiewicz M, Jones TL, Pitt JJ, Martin SE, Goldsmith P, Simmons JK, Mock BA, Caplen NJ. Loss-of-function RNAi screens in breast cancer cells identify AURKB, PLK1, PIK3R1, MAPK12, PRKD2, and PTK6 as sensitizing targets of rapamycin activity. Cancer Lett 2014; 354:336-47. [PMID: 25193464 PMCID: PMC4240001 DOI: 10.1016/j.canlet.2014.08.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 02/05/2023]
Abstract
The use of molecularly targeted drugs as single agents has shown limited utility in many tumor types, largely due to the complex and redundant nature of oncogenic signaling networks. Targeting of the PI3K/AKT/mTOR pathway through inhibition of mTOR in combination with aromatase inhibitors has seen success in particular sub-types of breast cancer and there is a need to identify additional synergistic combinations to maximize the clinical potential of mTOR inhibitors. We have used loss-of-function RNAi screens of the mTOR inhibitor rapamycin to identify sensitizers of mTOR inhibition. RNAi screens conducted in combination with rapamycin in multiple breast cancer cell lines identified six genes, AURKB, PLK1, PIK3R1, MAPK12, PRKD2, and PTK6 that when silenced, each enhanced the sensitivity of multiple breast cancer lines to rapamycin. Using selective pharmacological agents we confirmed that inhibition of AURKB or PLK1 synergizes with rapamycin. Compound-associated gene expression data suggested histone deacetylation (HDAC) inhibition as a strategy for reducing the expression of several of the rapamycin-sensitizing genes, and we tested and validated this using the HDAC inhibitor entinostat in vitro and in vivo. Our findings indicate new approaches for enhancing the efficacy of rapamycin including the use of combining its application with HDAC inhibition.
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Affiliation(s)
- Oliver Ou
- Genetics Branch, National Institutes of Health, Bethesda, MD 20892, USA
| | - Konrad Huppi
- Genetics Branch, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sirisha Chakka
- Genetics Branch, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kristen Gehlhaus
- Genetics Branch, National Institutes of Health, Bethesda, MD 20892, USA
| | - Wendy Dubois
- Laboratory of Cancer Biology and Genetics, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jyoti Patel
- Laboratory of Cancer Biology and Genetics, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jinqiu Chen
- Office of Science and Technology Partnerships, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mark Mackiewicz
- Genetics Branch, National Institutes of Health, Bethesda, MD 20892, USA
| | - Tamara L Jones
- Genetics Branch, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jason J Pitt
- Genetics Branch, National Institutes of Health, Bethesda, MD 20892, USA
| | - Scott E Martin
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD 20850, USA
| | - Paul Goldsmith
- Office of Science and Technology Partnerships, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - John K Simmons
- Laboratory of Cancer Biology and Genetics, National Institutes of Health, Bethesda, MD 20892, USA
| | - Beverly A Mock
- Laboratory of Cancer Biology and Genetics, National Institutes of Health, Bethesda, MD 20892, USA
| | - Natasha J Caplen
- Genetics Branch, National Institutes of Health, Bethesda, MD 20892, USA.
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Grantham HJ, Goldsmith P. Adult-Onset Alcohol Suppressible Cervical Dystonia: A Case Report. Mov Disord Clin Pract 2014; 2:102-103. [PMID: 30363810 DOI: 10.1002/mdc3.12098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/08/2014] [Accepted: 09/10/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Paul Goldsmith
- Department of Neurology Newcastle Hospitals NHS Foundation Trust Newcastle-upon-Tyne United Kingdom
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Bertoli M, Evangelista T, Sarkozy A, Schaefer A, Goldsmith P, Barresi R, Straub V, Muntoni F, Bushby K, Lochmuller H. G.P.313. Neuromuscul Disord 2014. [DOI: 10.1016/j.nmd.2014.06.403] [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: 10/24/2022]
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40
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Whitehouse MEA, Wilson LJ, Davies AP, Cross D, Goldsmith P, Thompson A, Harden S, Baker G. Target and nontarget effects of novel "triple-stacked" Bt-transgenic cotton 1: canopy arthropod communities. Environ Entomol 2014; 43:218-41. [PMID: 24472211 DOI: 10.1603/en13167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Transgenic cotton varieties (Bollgard II) expressing two proteins (Cry1Ac and Cry2Ab) from Bacillus thuringiensis (Bt) have been widely adopted in Australia to control larvae of Helicoverpa. A triple-stacked Bt-transgenic cotton producing Cry1Ac, Cry2Ab, and Vip3A proteins (Genuity Bollgard III) is being developed to reduce the chance that Helicoverpa will develop resistance to the Bt proteins. Before its introduction, nontarget effects on the agro-ecosystem need to be evaluated under field conditions. By using beatsheet and suction sampling methods, we compared the invertebrate communities of unsprayed non-Bt-cotton, Bollgard II, and Bollgard III in five experiments across three sites in Australia. We found significant differences between invertebrate communities of non-Bt and Bt (Bollgard II and Bollgard III) cotton only in experiments where lepidopteran larval abundance was high. In beatsheet samples where lepidopterans were absent (Bt crops), organisms associated with flowers and bolls in Bt-cotton were more abundant. In suction samples, where Lepidoptera were present (i.e., in non-Bt-cotton), organisms associated with damaged plant tissue and frass were more common. Hence in our study, Bt- and non-Bt-cotton communities only differed when sufficient lepidopteran larvae were present to exert both direct and indirect effects on species assemblages. There was no overall significant difference between Bollgard II and III communities, despite the addition of the Vip gene in Bollgard III. Consequently, the use of Bollgard III in Australian cotton provides additional protection against the development of resistance by Helicoverpa to Bt toxins, while having no additional effect on cotton invertebrate communities.
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Affiliation(s)
- M E A Whitehouse
- CSIRO Ecosystem Sciences, Australian Cotton Research Institute, Locked Bag 59, Narrabri, NSW 2390, Australia
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41
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Anderson KN, Goldsmith P, Gardiner A. A pilot evaluation of an online cognitive behavioral therapy for insomnia disorder - targeted screening and interactive Web design lead to improved sleep in a community population. Nat Sci Sleep 2014; 6:43-9. [PMID: 24669197 PMCID: PMC3962311 DOI: 10.2147/nss.s57852] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Computerized or online cognitive behavioral therapies (CBTs) are increasingly being developed to deliver insomnia therapy (CBT-i). They seek to address the difficulty of delivering an evidence-based technology to a large number of patients at low cost. Previous online applications have shown significant but variable improvements in sleep efficiency and a decrease in insomnia severity when compared with control groups. The best online methodology remains debated, and there are no such applications currently available within the UK National Health Service. METHOD Evaluation of treatment outcomes in 75 participants with insomnia disorder using an open-access, novel, interactive online therapy. Rigorous screening was first undertaken to exclude those with probable sleep apnea, restless legs, circadian rhythm disorder, or significant anxiety or depression prior to commencing therapy. A modern interactive video-based website was used to encourage compliance by personalizing therapy based on response. Sleep efficiency, sleep latency, total sleep time, and sleep quality were all assessed prior to and after intervention. RESULTS Of those who accessed therapy, 62% were excluded based on a likely diagnosis of another sleep disorder (788/1281). Participants who completed therapy all had severe insomnia disorder, with a group mean sleep efficiency of 55%. After intervention there was a significant increase in sleep efficiency and sleep latency, with modest nonsignificant improvements in total sleep time. The majority of users reported improved sleep quality, and compliance with therapy was very good, with over 64/75 completing >90% of sleep diary entries. CONCLUSION Online CBT-i can be designed to deliver personalized therapy with good reported outcomes and high compliance rates in those who start therapy. This initial evaluation also suggests that screening for other sleep disorders and mental health problems is necessary as many other sleep disorders are detected in those who self-refer with insomnia. This would inform the development of any larger-scale applications within the psychological therapies used in the health care system.
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Affiliation(s)
| | - Paul Goldsmith
- Regional Sleep Service, Freeman Hospital, Newcastle upon Tyne, UK
| | - Alison Gardiner
- Regional Sleep Service, Freeman Hospital, Newcastle upon Tyne, UK
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Fleming A, Diekmann H, Goldsmith P. Functional characterisation of the maturation of the blood-brain barrier in larval zebrafish. PLoS One 2013; 8:e77548. [PMID: 24147021 PMCID: PMC3797749 DOI: 10.1371/journal.pone.0077548] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [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: 04/11/2013] [Accepted: 09/05/2013] [Indexed: 01/05/2023] Open
Abstract
Zebrafish are becoming increasingly popular as an organism in which to model human disease and to study the effects of small molecules on complex physiological and pathological processes. Since larvae are no more than a few millimetres in length, and can live in volumes as small as 100 microliters, they are particularly amenable to high-throughput and high content compound screening in 96 well plate format. There is a growing literature providing evidence that many compounds show similar pharmacological effects in zebrafish as they do in mammals, and in particular humans. However, a major question regarding their utility for small molecule screening for neurological conditions is whether a molecule will reach its target site within the central nervous system. Studies have shown that Claudin-5 and ZO-1, tight-junction proteins which are essential for blood-brain barrier (BBB) integrity in mammals, can be detected in some cerebral vessels in zebrafish from 3 days post-fertilisation (d.p.f.) onwards and this timing coincides with the retention of dyes, immunoreactive tracers and fluorescent markers within some but not all cerebral vessels. Whilst these findings demonstrate that features of a BBB are first present at 3 d.p.f., it is not clear how quickly the zebrafish BBB matures or how closely the barrier resembles that of mammals. Here, we have combined anatomical analysis by transmission electron microscopy, functional investigation using fluorescent markers and compound uptake using liquid chromatography/tandem mass spectrometry to demonstrate that maturation of the zebrafish BBB occurs between 3 d.p.f. and 10 d.p.f. and that this barrier shares both structural and functional similarities with that of mammals.
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Affiliation(s)
- Angeleen Fleming
- DanioLabs Ltd., Cambridge Research Park, Cambridge, United Kingdom
| | - Heike Diekmann
- DanioLabs Ltd., Cambridge Research Park, Cambridge, United Kingdom
| | - Paul Goldsmith
- DanioLabs Ltd., Cambridge Research Park, Cambridge, United Kingdom
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Shan Z, Shakoori A, Bodaghi S, Goldsmith P, Jin J, Wiest JS. TUSC1, a putative tumor suppressor gene, reduces tumor cell growth in vitro and tumor growth in vivo. PLoS One 2013; 8:e66114. [PMID: 23776618 PMCID: PMC3679066 DOI: 10.1371/journal.pone.0066114] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 03/07/2013] [Accepted: 04/05/2013] [Indexed: 12/31/2022] Open
Abstract
We previously reported the identification of TUSC1 (Tumor Suppressor Candidate 1), as a novel intronless gene isolated from a region of homozygous deletion at D9S126 on chromosome 9p in human lung cancer. In this study, we examine the differential expression of TUSC1 in human lung cancer cell lines by western blot and in a primary human lung cancer tissue microarray by immunohistochemical analysis. We also tested the functional activities and mechanisms of TUSC1 as a tumor suppressor gene through growth suppression in vitro and in vivo. The results showed no expression of TUSC1 in TUSC1 homozygously deleted cells and diminished expression in some tumor cell lines without TUSC1 deletion. Interestingly, the results from a primary human lung cancer tissue microarray suggested that higher expression of TUSC1 was correlated with increased survival times for lung cancer patients. Our data demonstrated that growth curves of tumor cell lines transfected with TUSC1 grew slower in vitro than those transfected with the empty vector. More importantly, xenograph tumors in nude mice grew significantly slower in vivo in cells stably transfected with TUSC1 than those transfected with empty vector. In addition, results from confocal microscopy and immunohistochemical analyses show distribution of TUSC1 in the cytoplasm and nucleus in tumor cell lines and in normal and tumor cells in the lung cancer tissue microarray. Taken together, our results support TUSC1 has tumor suppressor activity as a candidate tumor suppressor gene located on chromosome 9p.
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Affiliation(s)
- Zhihong Shan
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Abbas Shakoori
- Advanced Genome Technology Center, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
| | - Sohrab Bodaghi
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Paul Goldsmith
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Jen Jin
- Advanced Genome Technology Center, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
| | - Jonathan S. Wiest
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, United States of America
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Fleming JM, Ginsburg E, McAndrew CW, Heger CD, Cheston L, Rodriguez-Canales J, Vonderhaar BK, Goldsmith P. Characterization of Δ7/11, a functional prolactin-binding protein. J Mol Endocrinol 2013; 50:79-90. [PMID: 23048206 PMCID: PMC3561765 DOI: 10.1530/jme-12-0201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Prolactin is essential for normal mammary gland development and differentiation, and has been shown to promote tumor cell proliferation and chemotherapeutic resistance. Soluble isoforms of the prolactin receptor (PrlR) have been reported to regulate prolactin bioavailability by functioning as 'prolactin-binding proteins'. Included in this category is Δ7/11, a product of alternate splicing of the PrlR primary transcript. However, the direct interactions of prolactin with Δ7/11, and the resulting effect on cell behavior, have not been investigated. Herein, we demonstrate the ability of Δ7/11 to bind prolactin using a novel proximity ligation assay and traditional immunoprecipitation techniques. Biochemical analyses demonstrated that Δ7/11 was heavily glycosylated, similar to the extracellular domain of the primary PrlR, and that glycosylation regulated the cellular localization and secretion of Δ7/11. Low levels of Δ7/11 were detected in serum samples of healthy volunteers, but were undetectable in human milk samples. Expression of Δ7/11 was also detected in six of the 62 primary breast tumor biopsies analyzed; however, no correlation was found with Δ7/11 expression and tumor histotype or other patient demographics. Functional analysis demonstrated the ability of Δ7/11 to inhibit prolactin-induced cell proliferation as well as alter prolactin-induced rescue of cell cycle arrest/early senescence events in breast epithelial cells. Collectively, these data demonstrate that Δ7/11 is a novel regulatory mechanism of prolactin bioavailability and signaling.
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Affiliation(s)
- J M Fleming
- Mammary Biology and Tumorigenesis Laboratory, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Gerin M, Levrier F, Falgarone E, Godard B, Hennebelle P, Le Petit F, De Luca M, Neufeld D, Sonnentrucker P, Goldsmith P, Flagey N, Lis DC, Persson CM, Black JH, Goicoechea JR, Menten KM. Hydride spectroscopy of the diffuse interstellar medium: new clues on the gas fraction in molecular form and cosmic ray ionization rate in relation to H3+. Philos Trans A Math Phys Eng Sci 2012; 370:5174-5185. [PMID: 23028164 DOI: 10.1098/rsta.2012.0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Herschel-guaranteed time key programme PRobing InterStellar Molecules with Absorption line Studies (PRISMAS)(1) is providing a survey of the interstellar hydrides containing the elements C, O, N, F and Cl. As the building blocks of interstellar molecules, hydrides provide key information on their formation pathways. They can also be used as tracers of important physical and chemical properties of the interstellar gas that are difficult to measure otherwise. This paper presents an analysis of two sight-lines investigated by the PRISMAS project, towards the star-forming regions W49N and W51. By combining the information extracted from the detected spectral lines, we present an analysis of the physical properties of the diffuse interstellar gas, including the electron abundance, the fraction of gas in molecular form, and constraints on the cosmic ray ionization rate and the gas density.
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Affiliation(s)
- M Gerin
- LERMA, Observatoire de Paris, CNRS UMR8112 and ENS, Paris, France.
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Chen JQ, Lee JH, Herrmann M, Wang Y, Park KS, Heldman M, Goldsmith P, Giaccone G. A nanofluidic immunoassay system to develop proteomic responsive biomarkers in non-small cell lung cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.30_suppl.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
27 Background: Molecular targeted therapy is widely used to treat non-small cell lung cancer (NSCLC). However, errors in predicting response to targeted therapies are 20-30%, based on sequencing or FISH, and patient specimen are at times not sufficient for conventional protein technologies. Developing clinically feasible proteomic biomarkers may be valuable to identify patients who may benefit from targeted therapy. Methods: NanoPro technology (ProteinSimple), is a capillary-based isoelectric-focusing (IEF) immunoassay system, which detects and quantifies multiple protein phosphorylation isoforms that are not readily assessed by traditional immunoassays. The platform only uses nanograms of protein for analysis. Results: We studied dynamic phosphoprotein activities in NSCLC cells (PC9, H827, H4006, H2122 and H322) treated with EGFR or/and MEK inhibitors. In MEK inhibitor (PD325901) treated cells, NanoPro showed that the drug efficiently inhibited Erk phosphorylation, and also revealed a complex MEK response profile which was not detectable by Western blotting, demonstrating its on-target effect. NanoPro also identified a MEK2 signature that associated with erlotinib sensitivity and distinguished erlotinib sensitive from resistant cells. This MEK2 signature was further confirmed in acquired resistant cells to erlotinib (H827R, H4006R). In a H827 xenograft study, NanoPro was able to detect and distinguish human Erk1 isoform from mouse Erk1 based on their pI difference, and clearly demonstrated that erlotinib effectively inhibited Erk phosphorylation in human xenograft cancer cells but not in surrounding mouse stromal cells. We further demonstrated that Nanopro could monitor erlotinib and AZD2644 response in a KrasG12C NSCLC patient (NCT01229150) by profiling 18 signaling molecules with as little as 4ug tumor material. Conclusions: NanoPro provides a valuable platform to monitor signaling response to targeted therapy. Nanopro assesses protein phosphorylation both qualitatively and quantitatively using small sample size, thus creates new opportunities for pharmacodynamic biomarker assessment in clinical studies.
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Affiliation(s)
- Jin-Qiu Chen
- Collaborative Protein Technology Resource, Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jih-hsiang Lee
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - Michelle Herrmann
- Collaborative Protein Technology Resource, Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Yisong Wang
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - Kang-seo Park
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Madeleine Heldman
- Collaborative Protein Technology Resource, Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Paul Goldsmith
- Office of Science and Technology Partnership, Office of the Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Chen JQ, Heldman M, Herrmann M, Kedei N, Blumberg P, Goldsmith P. A fully automated capillary western system for absolute quantitation of endogenous PKC proteins: An approach to correlate protein quantity with function. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.30_suppl.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
31 Background: The human prostate cell line LNCaP and the human myelocytic leukemia cell line U937 differ dramatically in their responses to the two protein kinase C (PKC) targeted ligands phorbol 12-myristate 13-acetate (PMA) and bryostatin 1 and show complex differences in the patterns of transcriptional responses that they induce. Quantitation of relative abundance of individual PKC isoforms in the two cell lines may help to link the downstream effects of the two compounds to these isoforms. Methods: Simple Western is a capillary-based automated Western system recently developed by ProteinSimple. All steps following sample preparation are fully automated in the Simple Western system, including sample loading, size-based protein separation, immunoprobing, washing, detection and data analysis. Simple Western is gel-free and blot-free, uses less amount of samples, and produces highly quantitative, reproducible information that cannot be generated using regular Western assays. Using the Simple Western system, we developed a method for absolute quantitation of endogenous proteins in cell lysates and quantified PKC isoforms in LNCaP and U937 cells. Results: PKC isoforms were measured at levels of picogram or sub-picogram per nanogram cell lysate. PKC delta was identified as the dominant PKC isoforms in both cell lines. In LNCaP cells, PKC delta expression is ~20-fold higher than PKC alpha, ~40-fold higher than PKC epsilon, and at least 20-fold higher than PKC beta. In U937 cells, PKC delta expression is similar to PKC beta, at least 200 fold higher than PKC alpha, and ~50-fold higher than PKC epsilon. Conclusions: The Simple Western system, with its high-quality data quantitation and excellent assay reproducibility, allowed us to detect both the relative abundance of the PKC isoforms and their absolute quantitation in the tested cells. It circumvents the problem that antibodies of different affinities for different proteins yield a misleading impression of relative abundance and it provides an approach to accurately correlate protein quantities with their function.
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Affiliation(s)
- Jin-Qiu Chen
- Collaborative Protein Technology Resource, Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Madeleine Heldman
- Collaborative Protein Technology Resource, Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Michelle Herrmann
- Collaborative Protein Technology Resource, Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Noemi Kedei
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter Blumberg
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Paul Goldsmith
- Office of Science and Technology Partnership, Office of the Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Jing F, Chakpitak N, Goldsmith P, Sureephong P, Kunarucks T. Creating a Knowledge Supply Chain for e-Tourism Curriculum Design. International Journal of Knowledge Management 2012. [DOI: 10.4018/jkm.2012100104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Higher education, as one of the most important knowledge providers and service suppliers to the society, is obliged to produce qualified intellectual products through the process of knowledge transfer and creation, which depends largely on the quality of knowledge and the way it is delivered within a curriculum. This research takes e-tourism, a relatively new discipline, as a case study, highlighting a knowledge supply chain is the potential solution to leverage the understanding of tourism industry needs and tourism curriculum provision. The paper begins with a competency gap analysis between knowledge demand and supply. It then applies the Supply Chain Operations Reference (SCOR) model to analyze the “as-is” situation of the present knowledge flow in curriculum design, and finally proposes a “to-be” conceptual framework by integrating tools and methods of knowledge management and supply chain management in a knowledge supply chain (KSC). This demonstrates that a KSC can help in achieving e-tourism requirements of higher education stakeholders at both industrial and academic levels.
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Affiliation(s)
- Fu Jing
- College of Art, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Paul Goldsmith
- College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Pradorn Sureephong
- Knowledge Innovation Center, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
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Sutherlin DP, Baker S, Bisconte A, Blaney PM, Brown A, Chan BK, Chantry D, Castanedo G, DePledge P, Goldsmith P, Goldstein DM, Hancox T, Kaur J, Knowles D, Kondru R, Lesnick J, Lucas MC, Lewis C, Murray J, Nadin AJ, Nonomiya J, Pang J, Pegg N, Price S, Reif K, Safina BS, Salphati L, Staben S, Seward EM, Shuttleworth S, Sohal S, Sweeney ZK, Ultsch M, Waszkowycz B, Wei B. Potent and selective inhibitors of PI3Kδ: Obtaining isoform selectivity from the affinity pocket and tryptophan shelf. Bioorg Med Chem Lett 2012; 22:4296-302. [DOI: 10.1016/j.bmcl.2012.05.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/03/2012] [Accepted: 05/08/2012] [Indexed: 11/24/2022]
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