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Ibraheim MK, Elsensohn A, Kraus C, Dao H, Luke J, Leigh R, Anderson N, Chow C. Satisfaction guaranteed? A need for evidence-based practices pertaining to patient reviews. Int J Dermatol 2024. [PMID: 38634623 DOI: 10.1111/ijd.17193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Affiliation(s)
| | - Ashley Elsensohn
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
- Department of Pathology, Loma Linda University, Loma Linda, CA, USA
| | - Christina Kraus
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Harry Dao
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Janiene Luke
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Rebekah Leigh
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Nancy Anderson
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Conroy Chow
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
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Leigh R, Kim D, Ibraheim MK, Kraus C, Chow C, Luke J, Dao H, Anderson N, Chou FS, Elsensohn A. Perceptions and impact of patient reviews: a survey of academic dermatologists. Int J Dermatol 2024; 63:512-516. [PMID: 38305475 DOI: 10.1111/ijd.17066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Patient reviews (PRs) have emerged as a method to assess patient experiences with healthcare in order to improve the quality of care. Both institutional and third-party organizations collect quantitative data and comments from these patient surveys, usually accessible to the public for review. Our study examined dermatologists' perceptions of PRs and assessed their impact on dermatologists. METHODS A survey was sent to the Association of Professors of Dermatology listserv (response rate 30%). RESULTS Most respondents disagreed with the statements that PRs are good for doctors (63%), good for patients (58%), helpful for doctors (58%), or that high PRs indicate being a good doctor (65%). The majority disagreed that PRs should be available publicly (60%). Respondents agreed that PRs contribute to depersonalization (60%), energy depletion or exhaustion (55%), added stress at work (70%), negativism/cynicism about work (60%), and diminished professional efficacy (29%). Self-identified female respondents were more likely to agree that PRs added stress to work compared to self-identified males (66% vs. 42%, P < 0.05). CONCLUSIONS Overall, these findings suggest that PRs may negatively impact dermatologists' well-being and perceived stress levels.
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Affiliation(s)
- Rebekah Leigh
- Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | - Dahyeon Kim
- Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | | | - Christina Kraus
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Conroy Chow
- Loma Linda University, Department of Dermatology, Loma Linda, CA, USA
| | - Janiene Luke
- Loma Linda University, Department of Dermatology, Loma Linda, CA, USA
| | - Harry Dao
- Loma Linda University, Department of Dermatology, Loma Linda, CA, USA
| | - Nancy Anderson
- Loma Linda University, Department of Dermatology, Loma Linda, CA, USA
| | - Fu-Sheng Chou
- Southern California Permanente Medical Group, Pasadena, CA, USA
- Kaiser Permanente Riverside Medical Center, Riverside, CA, USA
| | - Ashley Elsensohn
- Loma Linda University, Department of Dermatology, Loma Linda, CA, USA
- Loma Linda University, Department of Pathology and Human Anatomy, Loma Linda, CA, USA
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Won MM, Sacks MA, Leigh R, Mendez YS, Goodman LF, Tagge E, Radulescu A. An Unusual Case of Primary Ileal Trichobezoar Causing Intussusception. Am J Case Rep 2022; 23:e935460. [PMID: 35900939 PMCID: PMC9344775 DOI: 10.12659/ajcr.935460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patient: Male, 8-year-old
Final Diagnosis: Intussusception
Symptoms: Abdominal pain • nausea • vomiting
Medication: —
Clinical Procedure: —
Specialty: Surgery
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Affiliation(s)
- Mitchell M. Won
- School of Medicine, Loma Linda University, Loma Linda, USA, CA
| | - Marla A. Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children’s Hospital, Loma Linda, USA, CA
| | - Rebekah Leigh
- School of Medicine, Loma Linda University, Loma Linda, USA, CA
| | - Yomara S. Mendez
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children’s Hospital, Loma Linda, USA, CA
| | - Laura F. Goodman
- Department of Pediatric Surgery, Children’s Hospital Orange County, Orange, USA, CA
| | - Edward Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children’s Hospital, Loma Linda, USA, CA
| | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children’s Hospital, Loma Linda, USA, CA
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Leigh R, Sacks MA, Won MM, Mikael A, Moores D, Radulescu A. Large mesenteric cyst mimicking an ovarian cyst in an 8-year-old: A case report. Int J Surg Case Rep 2021; 89:106566. [PMID: 34773912 PMCID: PMC8593222 DOI: 10.1016/j.ijscr.2021.106566] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Pediatric mesenteric cysts, rare and usually benign intra-abdominal tumors, are a difficult preoperative diagnosis due to ambiguous clinical characteristics. The final diagnosis is typically established only during surgery or histological analysis. CASE PRESENTATION An 8-year-old female presented with five days of worsening abdominal pain, associated with nausea, vomiting, and fever, as well as vague tenderness in the right quadrants on examination. Computed tomography imaging showed a 10.5 × 8.7 × 7 cm abdominal mass, most suspicious for a cystic mass of ovarian origin. Upon diagnostic laparoscopy, a mesenteric cyst extending to the root of the mesentery was visualized and entirely resected after conversion to an exploratory laparotomy. Histopathological examination of both the cystic fluid and specimen suggest a benign mesenteric cyst. CLINICAL DISCUSSION Although mesenteric cysts are noticeably rare, it is important differential to consider in pediatric patients with non-specific symptoms like abdominal pain and distention, intestinal obstruction, or a palpable abdominal mass. Notably, these cysts can be managed successfully by complete surgical resection with an excellent outcome. CONCLUSION This report recounts an interesting case of a large mesenteric cyst that mimicked an ovarian cyst in a pre-pubertal girl.
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Affiliation(s)
- Rebekah Leigh
- Loma Linda University School of Medicine, Loma Linda, CA, United States of America
| | - Marla A Sacks
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Mitchell M Won
- Loma Linda University School of Medicine, Loma Linda, CA, United States of America
| | - Amarseen Mikael
- Department of Surgery, University of California at Riverside School of Medicine, CA, United States of America
| | - Donald Moores
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Andrei Radulescu
- Loma Linda University School of Medicine, Loma Linda, CA, United States of America; Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America.
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Dewey BE, Xu X, Knutsson L, Jog A, Prince JL, Barker PB, van Zijl PCM, Leigh R, Nyquist P. MTT and Blood-Brain Barrier Disruption within Asymptomatic Vascular WM Lesions. AJNR Am J Neuroradiol 2021; 42:1396-1402. [PMID: 34083262 PMCID: PMC8367617 DOI: 10.3174/ajnr.a7165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/13/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE White matter lesions of presumed ischemic origin are associated with progressive cognitive impairment and impaired BBB function. Studying the longitudinal effects of white matter lesion biomarkers that measure changes in perfusion and BBB patency within white matter lesions is required for long-term studies of lesion progression. We studied perfusion and BBB disruption within white matter lesions in asymptomatic subjects. MATERIALS AND METHODS Anatomic imaging was followed by consecutive dynamic contrast-enhanced and DSC imaging. White matter lesions in 21 asymptomatic individuals were determined using a Subject-Specific Sparse Dictionary Learning algorithm with manual correction. Perfusion-related parameters including CBF, MTT, the BBB leakage parameter, and volume transfer constant were determined. RESULTS MTT was significantly prolonged (7.88 [SD, 1.03] seconds) within white matter lesions compared with normal-appearing white (7.29 [SD, 1.14] seconds) and gray matter (6.67 [SD, 1.35] seconds). The volume transfer constant, measured by dynamic contrast-enhanced imaging, was significantly elevated (0.013 [SD, 0.017] minutes-1) in white matter lesions compared with normal-appearing white matter (0.007 [SD, 0.011] minutes-1). BBB disruption within white matter lesions was detected relative to normal white and gray matter using the DSC-BBB leakage parameter method so that increasing BBB disruption correlated with increasing white matter lesion volume (Spearman correlation coefficient = 0.44; P < .046). CONCLUSIONS A dual-contrast-injection MR imaging protocol combined with a 3D automated segmentation analysis pipeline was used to assess BBB disruption in white matter lesions on the basis of quantitative perfusion measures including the volume transfer constant (dynamic contrast-enhanced imaging), the BBB leakage parameter (DSC), and MTT (DSC). This protocol was able to detect early pathologic changes in otherwise healthy individuals.
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Affiliation(s)
- B E Dewey
- From the Department of Electrical and Computer Engineering (B.E.D., J.L.P.), Johns Hopkins University, Baltimore, Maryland
- F.M. Kirby Research Center for Functional Brain Imaging (B.E.D., X.X., P.B.B., P.C.M.v.Z.), Kennedy Krieger Institute, Baltimore, Maryland
| | - X Xu
- F.M. Kirby Research Center for Functional Brain Imaging (B.E.D., X.X., P.B.B., P.C.M.v.Z.), Kennedy Krieger Institute, Baltimore, Maryland
- Department of Radiology and Radiological Science (X.X., L.K., J.L.P., P.B.B., P.C.M.v.Z.), Division of MRI Research, Johns Hopkins University, Baltimore, Maryland
| | - L Knutsson
- Department of Radiology and Radiological Science (X.X., L.K., J.L.P., P.B.B., P.C.M.v.Z.), Division of MRI Research, Johns Hopkins University, Baltimore, Maryland
- Department of Medical Radiation Physics (L.K.), Lund University, Lund, Sweden
| | - A Jog
- Athinoula A. Martinos Center for Biomedical Imaging (A.J.), Harvard University Medical School, Boston Massachusetts
| | - J L Prince
- From the Department of Electrical and Computer Engineering (B.E.D., J.L.P.), Johns Hopkins University, Baltimore, Maryland
- Department of Radiology and Radiological Science (X.X., L.K., J.L.P., P.B.B., P.C.M.v.Z.), Division of MRI Research, Johns Hopkins University, Baltimore, Maryland
| | - P B Barker
- F.M. Kirby Research Center for Functional Brain Imaging (B.E.D., X.X., P.B.B., P.C.M.v.Z.), Kennedy Krieger Institute, Baltimore, Maryland
- Department of Radiology and Radiological Science (X.X., L.K., J.L.P., P.B.B., P.C.M.v.Z.), Division of MRI Research, Johns Hopkins University, Baltimore, Maryland
| | - P C M van Zijl
- F.M. Kirby Research Center for Functional Brain Imaging (B.E.D., X.X., P.B.B., P.C.M.v.Z.), Kennedy Krieger Institute, Baltimore, Maryland
- Department of Radiology and Radiological Science (X.X., L.K., J.L.P., P.B.B., P.C.M.v.Z.), Division of MRI Research, Johns Hopkins University, Baltimore, Maryland
| | - R Leigh
- Department of Neurology (R.L., P.N.), Electrical and Computer Engineering (B.E.D., J.L.P.), Johns Hopkins University, Baltimore, Maryland
| | - P Nyquist
- Department of Neurology (R.L., P.N.), Electrical and Computer Engineering (B.E.D., J.L.P.), Johns Hopkins University, Baltimore, Maryland
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Chambers L, Finch J, Edwards K, Jeanjean A, Leigh R, Gonem S. Effects of personal air pollution exposure on asthma symptoms, lung function and airway inflammation. Clin Exp Allergy 2018. [PMID: 29526044 DOI: 10.1111/cea.13130] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is evidence that air pollution increases the risk of asthma hospitalizations and healthcare utilization, but the effects on day-to-day asthma control are not fully understood. OBJECTIVE We undertook a prospective single-centre panel study to test the hypothesis that personal air pollution exposure is associated with asthma symptoms, lung function and airway inflammation. METHODS Thirty-two patients with a clinical diagnosis of asthma were provided with a personal air pollution monitor (Cairclip NO2 /O3 ) which was kept on or around their person throughout the 12-week follow-up period. Ambient levels of NO2 and particulate matter were modelled based upon satellite imaging data. Directly measured ozone, NO2 and particulate matter levels were obtained from a monitoring station in central Leicester. Participants made daily electronic records of asthma symptoms, peak expiratory flow and exhaled nitric oxide. Spirometry and asthma symptom questionnaires were completed at fortnightly study visits. Data were analysed using linear mixed effects models and cross-correlation. RESULTS Cairclip exposure data were of good quality with clear evidence of diurnal variability and a missing data rate of approximately 20%. We were unable to detect consistent relationships between personal air pollution exposure and clinical outcomes in the group as a whole. In an exploratory subgroup analysis, total oxidant exposure was associated with increased daytime symptoms in women but not men. CONCLUSIONS AND CLINICAL RELEVANCE We did not find compelling evidence that air pollution exposure impacts on day-to-day clinical control in an unselected asthma population, but further studies are required in larger populations with higher exposure levels. Women may be more susceptible than men to the effects of air pollution, an observation which requires confirmation in future studies.
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Affiliation(s)
- L Chambers
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - J Finch
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - K Edwards
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - A Jeanjean
- Department of Physics and Astronomy, University of Leicester, Leicester, UK
| | - R Leigh
- Department of Physics and Astronomy, University of Leicester, Leicester, UK
| | - S Gonem
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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Karhu ST, Valimaki M, Jumppanen M, Pohjolainen L, Leigh R, Foldes G, Boije Af Gennas G, Yli-Kauhaluoma J, Ruskoaho H, Talman V. P293Toxicity profiling of cardiac transcription factor-targeted compounds in various cardiac and stem cell types reveals cell type- and compound-dependent toxicity. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S T Karhu
- University of Helsinki, Faculty of Pharmacy, Drug Research Program and Division of Pharmacology and Pharmacotherapy, Helsinki, Finland
| | - M Valimaki
- University of Helsinki, Faculty of Pharmacy, Drug Research Program and Division of Pharmacology and Pharmacotherapy, Helsinki, Finland
| | - M Jumppanen
- University of Helsinki, Faculty of Pharmacy, Drug Research Program and Division of Pharmaceutical Chemistry and Technology, Helsinki, Finland
| | - L Pohjolainen
- University of Helsinki, Faculty of Pharmacy, Drug Research Program and Division of Pharmacology and Pharmacotherapy, Helsinki, Finland
| | - R Leigh
- University of Helsinki, Faculty of Pharmacy, Drug Research Program and Division of Pharmacology and Pharmacotherapy, Helsinki, Finland
| | - G Foldes
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - G Boije Af Gennas
- University of Helsinki, Faculty of Pharmacy, Drug Research Program and Division of Pharmaceutical Chemistry and Technology, Helsinki, Finland
| | - J Yli-Kauhaluoma
- University of Helsinki, Faculty of Pharmacy, Drug Research Program and Division of Pharmaceutical Chemistry and Technology, Helsinki, Finland
| | - H Ruskoaho
- University of Helsinki, Faculty of Pharmacy, Drug Research Program and Division of Pharmacology and Pharmacotherapy, Helsinki, Finland
| | - V Talman
- University of Helsinki, Faculty of Pharmacy, Drug Research Program and Division of Pharmacology and Pharmacotherapy, Helsinki, Finland
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Silkoff PE, Laviolette M, Singh D, FitzGerald JM, Kelsen S, Backer V, Porsbjerg CM, Girodet PO, Berger P, Kline JN, Chupp G, Susulic VS, Barnathan ES, Baribaud F, Loza MJ, Lam S, Eich A, Ludwig-Sengpiel A, Leigh R, Dransfield M, Calhoun W, Hussaini A, Chanez P. Identification of airway mucosal type 2 inflammation by using clinical biomarkers in asthmatic patients. J Allergy Clin Immunol 2017; 140:710-719. [PMID: 28089872 DOI: 10.1016/j.jaci.2016.11.038] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 11/06/2016] [Accepted: 11/21/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Airways Disease Endotyping for Personalized Therapeutics (ADEPT) study profiled patients with mild, moderate, and severe asthma and nonatopic healthy control subjects. OBJECTIVE We explored this data set to define type 2 inflammation based on airway mucosal IL-13-driven gene expression and how this related to clinically accessible biomarkers. METHODS IL-13-driven gene expression was evaluated in several human cell lines. We then defined type 2 status in 25 healthy subjects, 28 patients with mild asthma, 29 patients with moderate asthma, and 26 patients with severe asthma based on airway mucosal expression of (1) CCL26 (the most differentially expressed gene), (2) periostin, or (3) a multigene IL-13 in vitro signature (IVS). Clinically accessible biomarkers included fraction of exhaled nitric oxide (Feno) values, blood eosinophil (bEOS) counts, serum CCL26 expression, and serum CCL17 expression. RESULTS Expression of airway mucosal CCL26, periostin, and IL-13-IVS all facilitated segregation of subjects into type 2-high and type 2-low asthmatic groups, but in the ADEPT study population CCL26 expression was optimal. All subjects with high airway mucosal CCL26 expression and moderate-to-severe asthma had Feno values (≥35 ppb) and/or high bEOS counts (≥300 cells/mm3) compared with a minority (36%) of subjects with low airway mucosal CCL26 expression. A combination of Feno values, bEOS counts, and serum CCL17 and CCL26 expression had 100% positive predictive value and 87% negative predictive value for airway mucosal CCL26-high status. Clinical variables did not differ between subjects with type 2-high and type 2-low status. Eosinophilic inflammation was associated with but not limited to airway mucosal type 2 gene expression. CONCLUSION A panel of clinical biomarkers accurately classified type 2 status based on airway mucosal CCL26, periostin, or IL-13-IVS gene expression. Use of Feno values, bEOS counts, and serum marker levels (eg, CCL26 and CCL17) in combination might allow patient selection for novel type 2 therapeutics.
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Affiliation(s)
| | - Michel Laviolette
- Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada
| | - Dave Singh
- Centre for Respiratory Medicine and Allergy, University of Manchester, and the Medicines Evaluation Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - J Mark FitzGerald
- Institute for Heart and Lung Health, Lung Centre, Gordon and Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada
| | - Steven Kelsen
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, Pa
| | - Vibeke Backer
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Celeste M Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Pierre-Olivier Girodet
- Université Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Patrick Berger
- Université Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Joel N Kline
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa
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Gauvreau GM, Boulet LP, FitzGerald JM, Cockcroft DW, Davis BE, Leigh R, Tanaka M, Fourre JA, Tanaka M, Nabata T, O'Byrne PM. A dual CysLT 1/2 antagonist attenuates allergen-induced airway responses in subjects with mild allergic asthma. Allergy 2016; 71:1721-1727. [PMID: 27444660 DOI: 10.1111/all.12987] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND The cysteinyl leukotrienes (cysLTs) play a key role in the pathophysiology of asthma. In addition to functioning as potent bronchoconstrictors, cysLTs contribute to airway inflammation through eosinophil and neutrophil chemotaxis, plasma exudation, and mucus secretion. We tested the activity of the dual cysLT1/2 antagonist, ONO-6950, against allergen-induced airway responses. METHODS Subjects with documented allergen-induced early (EAR) and late asthmatic response (LAR) were randomized in a three-way crossover study to receive ONO-6950 (200 mg) or montelukast (10 mg) or placebo q.d. on days 1-8 of the three treatment periods. Allergen was inhaled on day 7 two hours postdose, and forced expiratory volume in 1 s (FEV1 ) was measured for 7 h following challenge. Sputum eosinophils and airway hyperresponsiveness were measured before and after allergen challenge. The primary outcome was the effect of ONO-6950 vs placebo on the EAR and LAR. RESULTS Twenty-five nonsmoking subjects with mild allergic asthma were enrolled and 20 subjects completed all three treatment periods per protocol. ONO-6950 was well tolerated. Compared to placebo, ONO-6950 significantly attenuated the maximum % fall in FEV1 and area under the %FEV1 /time curve during the EAR and LAR asthmatic responses (P < 0.05) and allergen-induced sputum eosinophils. There were no significant differences between ONO-6950 and montelukast. CONCLUSIONS Attenuation of EAR, LAR, and airway inflammation is consistent with cysLT1 blockade. Whether dual cysLT1/2 antagonism offers additional benefit for treatment of asthma requires further study.
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Affiliation(s)
- G. M. Gauvreau
- Department of Medicine; McMaster University; Hamilton ON Canada
| | - L.-P. Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec; Quebec City QC Canada
| | - J. M. FitzGerald
- Department of Medicine; University of British Columbia; Vancouver BC Canada
| | - D. W. Cockcroft
- Department of Medicine; University of Saskatchewan; Saskatoon SK Canada
| | - B. E. Davis
- Department of Medicine; University of Saskatchewan; Saskatoon SK Canada
| | - R. Leigh
- Department of Medicine; University of Calgary; Calgary AB Canada
| | - M. Tanaka
- ONO Pharmaceutical Co., Ltd.; Osaka Japan
| | | | - M. Tanaka
- ONO Pharmaceutical Co., Ltd.; Osaka Japan
| | - T. Nabata
- ONO Pharmaceutical Co., Ltd.; Osaka Japan
| | - P. M. O'Byrne
- Department of Medicine; McMaster University; Hamilton ON Canada
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Silkoff PE, Strambu I, Laviolette M, Singh D, FitzGerald JM, Lam S, Kelsen S, Eich A, Ludwig-Sengpiel A, Hupp GC, Backer V, Porsbjerg C, Girodet PO, Berger P, Leigh R, Kline JN, Dransfield M, Calhoun W, Hussaini A, Khatri S, Chanez P, Susulic VS, Barnathan ES, Curran M, Das AM, Brodmerkel C, Baribaud F, Loza MJ. Asthma characteristics and biomarkers from the Airways Disease Endotyping for Personalized Therapeutics (ADEPT) longitudinal profiling study. Respir Res 2015; 16:142. [PMID: 26576744 PMCID: PMC4650115 DOI: 10.1186/s12931-015-0299-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/31/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Asthma is a heterogeneous disease and development of novel therapeutics requires an understanding of pathophysiologic phenotypes. The purpose of the ADEPT study was to correlate clinical features and biomarkers with molecular characteristics, by profiling asthma (NCT01274507). This report presents for the first time the study design, and characteristics of the recruited subjects. METHODS Patients with a range of asthma severity and healthy non-atopic controls were enrolled. The asthmatic subjects were followed for 12 months. Assessments included history, patient questionnaires, spirometry, airway hyper-responsiveness to methacholine, fractional exhaled nitric oxide (FENO), and biomarkers measured in induced sputum, blood, and bronchoscopy samples. All subjects underwent sputum induction and 30 subjects/cohort had bronchoscopy. RESULTS Mild (n = 52), moderate (n = 55), severe (n = 51) asthma cohorts and 30 healthy controls were enrolled from North America and Western Europe. Airflow obstruction, bronchodilator response and airways hyperresponsiveness increased with asthma severity, and severe asthma subjects had reduced forced vital capacity. Asthma control questionnaire-7 (ACQ7) scores worsened with asthma severity. In the asthmatics, mean values for all clinical and biomarker characteristics were stable over 12 months although individual variability was evident. FENO and blood eosinophils did not differ by asthma severity. Induced sputum eosinophils but not neutrophils were lower in mild compared to the moderate and severe asthma cohorts. CONCLUSIONS The ADEPT study successfully enrolled asthmatics across a spectrum of severity and non-atopic controls. Clinical characteristics were related to asthma severity and in general asthma characteristics e.g. lung function, were stable over 12 months. Use of the ADEPT data should prove useful in defining biological phenotypes to facilitate personalized therapeutic approaches.
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Affiliation(s)
- P E Silkoff
- Janssen Research & Development LLC, 1400 McKean Rd, Springhouse, PA, 19477, USA.
| | - I Strambu
- Arensia Exploratory Medicine, Sos. Viilor 90, Bucharest, 050159, Romania.
| | - M Laviolette
- Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), 2725, Chemin Ste-Foy, Québec, G1V 4G5, Canada.
| | - D Singh
- Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, University of Manchester, Southmoor Road, Manchester, M23 9QZ, UK.
| | - J M FitzGerald
- Institute for Heart and Lung Health, The Lung Centre, 7th Floor, Gordon, Canada. .,Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - S Lam
- Institute for Heart and Lung Health, The Lung Centre, 7th Floor, Gordon, Canada.,Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - S Kelsen
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, 3401 N. Broad St., Philadelphia, PA, 19140, USA.
| | - A Eich
- IKF Pneumologie Frankfurt, Institut für klinische Forschung Pneumologie, Clinical Research Centre Respiratory Diseases, Schaumainkai 101-103, Stresemannallee, 360596, Frankfurt, Germany.
| | - A Ludwig-Sengpiel
- KLB Gesundheitsforschung Lübeck GmbH, Sandstr. 18, 23552, Lübeck, Germany.
| | - G C Hupp
- Yale Center for Asthma and Airway Disease, Division of Pulmonary and Critical Care and Sleep Medicine, Yale School of Medicine, TAC 441, 300 Cedar Street, New Haven, CT, 06520, USA.
| | - V Backer
- Department of Respiratory Medicine, Respiratory Research Unit, Bispebjerg University Hospital, Bispebjerg bakke 23, DK-2400, Copenhagen, NV, Denmark.
| | - C Porsbjerg
- Department of Respiratory Medicine, Respiratory Research Unit, Bispebjerg University Hospital, Bispebjerg bakke 23, DK-2400, Copenhagen, NV, Denmark.
| | - P O Girodet
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, CIC 1401, F-33000, Bordeaux, France
| | - P Berger
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, CIC 1401, F-33000, Bordeaux, France.
| | - R Leigh
- Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - J N Kline
- Division of Pulmonary, C ritical Care, and Occupational Medicine, University of Iowa, W219B GH UIHC, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - M Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham & Birmingham VA Medical Center, 422 THT, 1900 University Blvd, Birmingham, AL, 35294, USA.
| | - W Calhoun
- 4.116 John Sealy Annex, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0568, USA.
| | - A Hussaini
- Parexel International, Shelton Simmons (MD), 3001 S Hanover St #7, Brooklyn, MD, 21225, USA.
| | - S Khatri
- Department of Pulmonary and Critical Care, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - P Chanez
- Department of Respiratory Diseases and CIC Nord AP-HM, UMR INSERM U1067 CNRS 7733, Aix-Marseille Université, Marseille, France.
| | - V S Susulic
- Janssen Research & Development LLC, 1400 McKean Rd, Springhouse, PA, 19477, USA
| | - E S Barnathan
- Janssen Research & Development LLC, 1400 McKean Rd, Springhouse, PA, 19477, USA
| | - M Curran
- Janssen Research & Development LLC, 1400 McKean Rd, Springhouse, PA, 19477, USA
| | - A M Das
- Janssen Research & Development LLC, 1400 McKean Rd, Springhouse, PA, 19477, USA
| | - C Brodmerkel
- Janssen Research & Development LLC, 1400 McKean Rd, Springhouse, PA, 19477, USA
| | - F Baribaud
- Janssen Research & Development LLC, 1400 McKean Rd, Springhouse, PA, 19477, USA
| | - M J Loza
- Janssen Research & Development LLC, 1400 McKean Rd, Springhouse, PA, 19477, USA
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Kennedy MD, Davidson WJ, Wong LE, Traves SL, Leigh R, Eves ND. Airway inflammation, cough and athlete quality of life in elite female cross-country skiers: A longitudinal study. Scand J Med Sci Sports 2015; 26:835-42. [PMID: 26283581 DOI: 10.1111/sms.12527] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2015] [Indexed: 01/04/2023]
Abstract
The aim of this study was to investigate the effect of a season of cross-country training and racing on airway inflammation, cough symptoms, and athlete quality of life in female skiers. Eighteen elite female skiers performed sputum induction and completed the Leicester Cough Questionnaire (LCQ) and the Recovery-Stress Questionnaire (REST-Q) at three time points (T1 - May/Jun, T2 - Oct/Nov, T3 - Jan-Mar) during the year. No changes were observed between T1 and T2. However, an increase in sputum eosinophils and lymphocytes (P < 0.05) and a significant change in all three domains of the LCQ were observed between T1 and T3 (P < 0.05). A significant association was found between the total yearly hours of training and the change in the total cell count (r(2) = 0.74; P = 0.006), and a number of other sputum cell counts between T1 and T3. No changes were observed for any domain of the REST-Q. The results of this study demonstrate that airway inflammation and cough symptoms are significantly increased in elite female cross-country skiers across a year of training and racing. The increase in airway inflammation is related to the total amount of training and is worse during the winter months when athletes are training and racing in cold, dry air.
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Affiliation(s)
- M D Kennedy
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - W J Davidson
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - L E Wong
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
| | - S L Traves
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R Leigh
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - N D Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
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Dauletbaev N, Das M, Cammisano M, Kooi C, Leigh R, Beaudoin T, Rousseau S, Lands L. 125 Viral load is high despite preserved interferon-β response in rhinovirus-infected CF cells. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Phinyomark A, Osis S, Hettinga BA, Leigh R, Ferber R. Gender differences in gait kinematics in runners with iliotibial band syndrome. Scand J Med Sci Sports 2015; 25:744-53. [DOI: 10.1111/sms.12394] [Citation(s) in RCA: 19] [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] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- A. Phinyomark
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
| | - S. Osis
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
- Running Injury Clinic; Calgary Alberta Canada
| | - B. A. Hettinga
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
- Running Injury Clinic; Calgary Alberta Canada
| | - R. Leigh
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
| | - R. Ferber
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
- Running Injury Clinic; Calgary Alberta Canada
- Faculty of Nursing; University of Calgary; Calgary Alberta Canada
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14
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Neighbour H, Boulet LP, Lemiere C, Sehmi R, Leigh R, Sousa AR, Martin J, Dallow N, Gilbert J, Allen A, Hall D, Nair P. Safety and efficacy of an oral CCR3 antagonist in patients with asthma and eosinophilic bronchitis: a randomized, placebo-controlled clinical trial. Clin Exp Allergy 2014; 44:508-16. [PMID: 24286456 DOI: 10.1111/cea.12244] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/20/2013] [Accepted: 11/26/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Several chemokines, notably eotaxin, mediate the recruitment of eosinophils into tissues via the CCR3 receptor. OBJECTIVE In this study, we investigated the role of CCR3 agonists in asthma by observing the effect of a small molecule antagonist of the CCR3 receptor (GW766994) on sputum eosinophil counts in patients with eosinophilic asthma. METHODS Clinical and physiological outcomes, the chemotactic activity of sputum supernatant for eosinophils and the presence of eosinophil progenitors in sputum and blood samples were also studied. RESULTS In a double-blind parallel group study, 60 patients with asthma were randomized to 300 mg of GW766994 twice daily or matching placebo for 10 days followed by prednisone 30 mg for 5 days. Of these patients, 53 had a sputum eosinophil count > 4.9% at baseline. Despite plasma concentrations of drug consistent with > 90% receptor occupancy during the dosing period, the CCR3 antagonist did not significantly reduce eosinophils or eosinophil progenitor cells (CD34(+) 45(+) IL-5Rα(+)) in sputum or in blood. The ex vivo chemotactic effect of sputum supernatants on eosinophils was attenuated by GW766944 compared to placebo. There was no improvement in FEV1 ; however, there was a modest but statistically significant improvement in PC20 methacholine (0.66 doubling dose) and ACQ scores, (0.43). Whilst the improvement in PC20 is statistically significant, it is not of clinical significance. CONCLUSIONS AND CLINICAL RELEVANCE In conclusion, this study calls into question the role of CCR3 in airway eosinophilia in asthma and suggests that other cellular mechanisms mediated by the CCR3 receptor may contribute to airway hyperresponsiveness.
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Affiliation(s)
- H Neighbour
- Division of Respirology, McMaster University, Hamilton, ON, Canada
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Zaheer RS, Wiehler S, Hudy MH, Traves SL, Pelikan JB, Leigh R, Proud D. Human rhinovirus-induced ISG15 selectively modulates epithelial antiviral immunity. Mucosal Immunol 2014; 7:1127-38. [PMID: 24448099 PMCID: PMC4137743 DOI: 10.1038/mi.2013.128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 12/23/2013] [Indexed: 02/04/2023]
Abstract
Human rhinovirus (HRV) infections trigger exacerbations of lower airway diseases. HRV infects human airway epithelial cells and induces proinflammatory and antiviral molecules that regulate the response to HRV infection. Interferon (IFN)-stimulated gene of 15 kDa (ISG15) has been shown to regulate other viruses. We now show that HRV-16 infection induces both intracellular epithelial ISG15 expression and ISG15 secretion in vitro. Moreover, ISG15 protein levels increased in nasal secretions of subjects with symptomatic HRV infections. HRV-16-induced ISG15 expression is transcriptionally regulated via an IFN regulatory factor pathway. ISG15 does not directly alter HRV replication but does modulate immune signaling via the viral sensor protein RIG-I to impact production of CXCL10, which has been linked to innate immunity to viruses. Extracellular ISG15 also alters CXCL10 production. We conclude that ISG15 has a complex role in host defense against HRV infection, and that additional studies are needed to clarify the role of this molecule.
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Affiliation(s)
- R S Zaheer
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases, Departments of Physiology and Pharmacology, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - S Wiehler
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases, Departments of Physiology and Pharmacology, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - M H Hudy
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases, Departments of Physiology and Pharmacology, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - S L Traves
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases, Departments of Physiology and Pharmacology, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - J B Pelikan
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases, Departments of Physiology and Pharmacology, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - R Leigh
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases, Departments of Physiology and Pharmacology, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada,Airway Inflammation Research Group, Snyder Institute for Chronic Diseases, Department of Medicine, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - D Proud
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases, Departments of Physiology and Pharmacology, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada,()
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Lam J, Kelly M, Leigh R, Parkins M. Granulomatous PJP presenting as a solitary lung nodule in an immune competent female. Respir Med Case Rep 2014; 11:4-6. [PMID: 26029519 PMCID: PMC3969607 DOI: 10.1016/j.rmcr.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/02/2013] [Revised: 10/04/2013] [Accepted: 10/14/2013] [Indexed: 11/18/2022] Open
Abstract
Pneumocystis jiroveci pneumonia (PJP) opportunistically targets immunosuppressed patients, most notably those with advanced HIV/AIDS. Radiologically, PJP typically appears as bilateral diffuse pulmonary infiltrates. Herein an unusual case of an immunocompetent woman developing granulomatous PJP in the absence of evident risk factors is described. PJP may be an under-recognized cause of pulmonary nodules in immune competent individuals.
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Affiliation(s)
- J. Lam
- Department of Medicine, The University of Calgary, Calgary, AB, Canada
| | - M.M. Kelly
- Department of Pathology and Laboratory Medicine, The University of Calgary, Calgary, AB, Canada
| | - R. Leigh
- Department of Medicine, The University of Calgary, Calgary, AB, Canada
| | - M.D. Parkins
- Department of Medicine, The University of Calgary, Calgary, AB, Canada
- Department of Microbiology & Infectious Diseases, The University of Calgary, Calgary, AB, Canada
- Corresponding author. 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada. Tel.: +1 403 210 7913; fax: +1 403 270 2772.
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Hampshire R, Wharton H, Leigh R, Wright A, Dodson P. Screening for diabetic retinopathy in pregnancy using photographic review clinics. Diabet Med 2013; 30:475-7. [PMID: 23252726 DOI: 10.1111/dme.12077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 10/12/2012] [Accepted: 11/22/2012] [Indexed: 01/19/2023]
Abstract
AIMS To assess the efficacy and value of the National Institute for Health and Clinical Excellence guidelines for digital photographic screening for diabetic retinopathy in pregnancy using photographic review clinics. METHODS Pregnant patients (n = 186) with known diabetes were screened at first antenatal visit and at 28 weeks' gestation, if no retinopathy was noted at first visit, or at other intervals if retinopathy was present. Two 45° images (disc-centred and macula-centred views) were taken in both eyes and graded by trained graders and by an ophthalmologist. RESULTS Ninety-three patients (50%) remained free of diabetic retinopathy throughout pregnancy. Eighteen (10%) presented with sight-threatening retinopathy at their first antenatal screen and were referred to the hospital eye service. Fifty patients (27%) were shown to have relatively stable retinopathy throughout pregnancy, with only two patients deteriorating and requiring referral to hospital eye service. Twenty-three (12%) failed to complete the screening protocol after their first screen. CONCLUSIONS The study showed that pregnant patients screened for retinopathy in an ophthalmic photographic diabetic review clinic achieved National Institute for Health and Clinical Excellence guidelines in the majority and were clinically safe. Only 1% of patients required referral to ophthalmology after their initial screen, thus avoiding unnecessary hospital eye service appointments.
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Affiliation(s)
- R Hampshire
- Birmingham, Solihull and Black Country Diabetic Retinal Screening Programme, Heart of England Diabetic Retinopathy Screening Centre, Birmingham Heartlands Hospital, Birmingham, UK
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18
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Kelly MM, King EM, Rider CF, Gwozd C, Holden NS, Eddleston J, Zuraw B, Leigh R, O'Byrne PM, Newton R. Corticosteroid-induced gene expression in allergen-challenged asthmatic subjects taking inhaled budesonide. Br J Pharmacol 2012; 165:1737-1747. [PMID: 21827450 DOI: 10.1111/j.1476-5381.2011.01620.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Inhaled corticosteroids (ICS) are the cornerstone of asthma pharmacotherapy and, acting via the glucocorticoid receptor (GR), reduce inflammatory gene expression. While this is often attributed to a direct inhibitory effect of the GR on inflammatory gene transcription, corticosteroids also induce the expression of anti-inflammatory genes in vitro. As there are no data to support this effect in asthmatic subjects taking ICS, we have assessed whether ICS induce anti-inflammatory gene expression in subjects with atopic asthma. EXPERIMENTAL APPROACH Bronchial biopsies from allergen-challenged atopic asthmatic subjects taking inhaled budesonide or placebo were subjected to gene expression analysis using real-time reverse transcriptase-PCR for the corticosteroid-inducible genes (official gene symbols with aliases in parentheses): TSC22D3 [glucocorticoid-induced leucine zipper (GILZ)], dual-specificity phosphatase-1 (MAPK phosphatase-1), both anti-inflammatory effectors, and FKBP5 [FK506-binding protein 51 (FKBP51)], a regulator of GR function. Cultured pulmonary epithelial and smooth muscle cells were also treated with corticosteroids before gene expression analysis. KEY RESULTS Compared with placebo, GILZ and FKBP51 mRNA expression was significantly elevated in budesonide-treated subjects. Budesonide also increased GILZ expression in human epithelial and smooth muscle cells in culture. Immunostaining of bronchial biopsies revealed GILZ expression in the airways epithelium and smooth muscle of asthmatic subjects. CONCLUSIONS AND IMPLICATIONS Expression of the corticosteroid-induced genes, GILZ and FKBP51, is up-regulated in the airways of allergen-challenged asthmatic subjects taking inhaled budesonide. Consequently, the biological effects of corticosteroid-induced genes should be considered when assessing the actions of ICS. Treatment modalities that increase or decrease GR-dependent transcription may correspondingly affect corticosteroid efficacy.
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Affiliation(s)
- M M Kelly
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - E M King
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - C F Rider
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - C Gwozd
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - N S Holden
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - J Eddleston
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - B Zuraw
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - R Leigh
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - P M O'Byrne
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - R Newton
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
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Federighi P, Ramat S, Zee D, Leigh R, Piu P, Rufa A. Dynamic Properties of Saccades Identify Forms of Spinocerebellar Ataxia (S48.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s48.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rosini F, Federighi P, Serra A, Leigh R, Piu P, Federico A, Rufa A. Memantine Improves Fixation Stability in Recessive Cerebellar Ataxia with Saccadic Intrusions (P02.262). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pretegiani E, Leigh R, Zee D, Federico A, Piu P, Rufa A. Saccadic Abnormalities in Familial Parkinson's Disease Associated with -Synuclein (SNCA) Gene Mutation (PARK1) (P02.258). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Edwards P, Evans MJ, Commane R, Ingham T, Stone D, Mahajan AS, Oetjen H, Dorsey JR, Hopkins JR, Lee JD, Moller SJ, Leigh R, Plane JMC, Carpenter LJ, Heard DE. Hydrogen oxide photochemistry in the northern Canadian spring time boundary layer. ACTA ACUST UNITED AC 2011. [DOI: 10.1029/2011jd016390] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- P. Edwards
- School of Chemistry; University of Leeds; Leeds UK
| | - M. J. Evans
- School of Earth and Environment; University of Leeds; Leeds UK
| | - R. Commane
- School of Chemistry; University of Leeds; Leeds UK
| | - T. Ingham
- School of Chemistry; University of Leeds; Leeds UK
- National Centre for Atmospheric Science; University of Leeds; Leeds UK
| | - D. Stone
- School of Chemistry; University of Leeds; Leeds UK
| | | | - H. Oetjen
- School of Chemistry; University of Leeds; Leeds UK
| | - J. R. Dorsey
- School of Earth, Atmospheric and Environmental Sciences; University of Manchester; Manchester UK
| | - J. R. Hopkins
- Department of Chemistry; University of York; Heslington UK
- National Centre for Atmospheric Science; University of York; Heslington UK
| | - J. D. Lee
- Department of Chemistry; University of York; Heslington UK
- National Centre for Atmospheric Science; University of York; Heslington UK
| | - S. J. Moller
- Department of Chemistry; University of York; Heslington UK
| | - R. Leigh
- Department of Physics and Astronomy; University of Leicester; Leicester UK
| | | | | | - D. E. Heard
- School of Chemistry; University of Leeds; Leeds UK
- National Centre for Atmospheric Science; University of Leeds; Leeds UK
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Lougheed MD, Lemière C, Dell SD, Ducharme FM, Fitzgerald JM, Leigh R, Licskai C, Rowe BH, Bowie D, Becker A, Boulet LP. Canadian Thoracic Society Asthma Management Continuum--2010 Consensus Summary for children six years of age and over, and adults. Can Respir J 2010; 17:15-24. [PMID: 20186367 PMCID: PMC2866209 DOI: 10.1155/2010/827281] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/OBJECTIVE To integrate new evidence into the Canadian Asthma Management Continuum diagram, encompassing both pediatric and adult asthma. METHODS The Canadian Thoracic Society Asthma Committee members, comprised of experts in pediatric and adult respirology, allergy and immunology, emergency medicine, general pediatrics, family medicine, pharmacoepidemiology and evidence-based medicine, updated the continuum diagram, based primarily on the 2008 Global Initiative for Asthma guidelines, and performed a focused review of literature pertaining to key aspects of asthma diagnosis and management in children six years of age and over, and adults. RESULTS In patients six years of age and over, management of asthma begins with establishing an accurate diagnosis, typically by supplementing medical history with objective measures of lung function. All patients and caregivers should receive self-management education, including a written action plan. Inhaled corticosteroids (ICS) remain the first-line controller therapy for all ages. When asthma is not controlled with a low dose of ICS, the literature supports the addition of long-acting beta2-agonists in adults, while the preferred approach in children is to increase the dose of ICS. Leukotriene receptor antagonists are acceptable as second-line monotherapy and as an alternative add-on therapy in both age groups. Antiimmunoglobulin E therapy may be of benefit in adults, and in children 12 years of age and over with difficult to control allergic asthma, despite high-dose ICS and at least one other controller. CONCLUSIONS The foundation of asthma management is establishing an accurate diagnosis based on objective measures (eg, spirometry) in individuals six years of age and over. Emphasis is placed on the similarities and differences between pediatric and adult asthma management approaches to achieve asthma control.
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Leigh R. Shadows in wonderland: a hospital odyssey. Med Humanit 2008; 34:116-117. [PMID: 23674593 DOI: 10.1136/jmh.2008.000935] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- R Leigh
- Anglia Ruskin University, Chelmsford, UK;
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Rottach K, Wohlgemuth W, Sträube A, Leigh R. Der Einfluß von Lidschlägen auf die Genauigkeit und Geschwindigkeit von Sakkaden - Eine Untersuchung mit der magnetischen Search-Coil-Technik. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Giembycz MA, Kaur M, Leigh R, Newton R. A Holy Grail of asthma management: toward understanding how long-acting beta(2)-adrenoceptor agonists enhance the clinical efficacy of inhaled corticosteroids. Br J Pharmacol 2007; 153:1090-104. [PMID: 18071293 DOI: 10.1038/sj.bjp.0707627] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
There is unequivocal evidence that the combination of an inhaled corticosteroid (ICS) -- i.e. glucocorticoid -- and an inhaled long-acting beta(2)-adrenoceptor agonist (LABA) is superior to each component administered as a monotherapy alone in the clinical management of asthma. Moreover, Calverley and colleagues (Lancet 2003, 361: 449-456; N Engl J Med 2007, 356: 775-789) reporting for the 'TRial of Inhaled STeroids ANd long-acting beta(2)-agonists (TRISTAN)' and 'TOwards a Revolution in COPD Health (TORCH)' international study groups also demonstrated the superior efficacy of LABA/ICS combination therapies over ICS alone in the clinical management of chronic obstructive pulmonary disease. This finding has been independently confirmed indicating that the therapeutic benefit of LABA/ICS combination therapies is not restricted to asthma and may be extended to other chronic inflammatory diseases of the airways. Despite the unquestionable benefit of LABA/ICS combination therapies, there is a vast gap in our understanding of how these two drugs given together deliver superior clinical efficacy. In this article, we review the history of LABA/ICS combination therapies and critically evaluate how these two classes of drugs might interact at the biochemical level to suppress pro-inflammatory responses. Understanding the molecular basis of this fundamental clinical observation is a Holy Grail of current respiratory diseases research as it could permit the rational exploitation of this effect with the development of new 'optimized' LABA/ICS combination therapies.
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Affiliation(s)
- M A Giembycz
- Department of Pharmacology and Therapeutics, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Leigh R, Pizzichini MMM, Morris MM, Maltais F, Hargreave FE, Pizzichini E. Stable COPD: predicting benefit from high-dose inhaled corticosteroid treatment. Eur Respir J 2006; 27:964-71. [PMID: 16446316 DOI: 10.1183/09031936.06.00072105] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The role of inhaled corticosteroids in the management of chronic obstructive pulmonary disease (COPD) remains controversial. The purpose of this study was to evaluate whether sputum eosinophilia (defined as eosinophils > or = 3%) predicts clinical benefit from inhaled corticosteroid treatment in patients with smoking-related clinically stable moderate-to-severe COPD. Forty consecutive patients with effort dyspnoea (mean age 67 yrs; 52 pack-yr smoking history; post-bronchodilator forced expiratory volume in one second (FEV1) <60% predicted, consistent with moderate-to-severe smoking-related chronic airflow limitation) were enrolled. Subjects were treated with inhaled placebo followed by inhaled budesonide (Pulmicort Turbuhaler 1,600 microg.day(-1)), each given for 4 weeks. While the treatment was single-blind (subject level), sputum cell counts before and after treatment interventions were double-blind, thus removing bias. Outcome variables included spirometry, quality-of-life assessment and 6-min walk test. Sputum eosinophilia was present in 38% of subjects. In these, budesonide treatment normalised the eosinophil counts and, in comparison to placebo treatment, resulted in clinically significant improvement in the dyspnoea domain of the disease-specific chronic respiratory questionnaire (0.8 versus 0.3) and a small but statistically significant improvement in post-bronchodilator spirometry (FEV1 100 mL versus 0 mL; p<0.05). In conclusion, sputum eosinophilia predicts short-term clinical benefit from high-dose inhaled corticosteroid treatment in patients with stable moderate-to-severe chronic obstructive pulmonary disease.
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Affiliation(s)
- R Leigh
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare and McMaster University, Hamilton, ON, Canada
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Leigh R, Barker S, Murray N, Hurel SJ. The Kerraboot®
: A novel wound dressing device for the management of leg and foot ulcers. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/pdi.572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Van Driessche G, Vandenberghe I, Devreese B, Samyn B, Meyer TE, Leigh R, Cusanovich MA, Bartsch RG, Fischer U, Van Beeumen JJ. Amino Acid Sequences and Distribution of High-Potential Iron–Sulfur Proteins That Donate Electrons to the Photosynthetic Reaction Center in Phototropic Proteobacteria. J Mol Evol 2003; 57:181-99. [PMID: 14562962 DOI: 10.1007/s00239-003-2465-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2002] [Accepted: 03/05/2003] [Indexed: 11/28/2022]
Abstract
High-potential iron-sulfur protein (HiPIP) has recently been shown to function as a soluble mediator in photosynthetic electron transfer between the cytochrome bc1 complex and the reaction-center bacteriochlorophyll in some species of phototrophic proteobacteria, a role traditionally assigned to cytochrome c2. For those species that produce more than one high-potential electron carrier, it is unclear which protein functions in cyclic electron transfer and what characteristics determine reactivity. To establish how widespread the phenomenon of multiple electron donors might be, we have studied the electron transfer protein composition of a number of phototrophic proteobacterial species. Based upon the distribution of electron transfer proteins alone, we found that HiPIP is likely to be the electron carrier of choice in the purple sulfur bacteria in the families Chromatiaceae and Ectothiorhodospiraceae, but the majority of purple nonsulfur bacteria are likely to utilize cytochrome c2. We have identified several new species of phototrophic proteobacteria that may use HiPIP as electron donor and a few that may use cytochromes c other than c2. We have determined the amino acid sequences of 14 new HiPIPs and have compared their structures. There is a minimum of three sequence categories of HiPIP based upon major insertions and deletions which approximate the three families of phototrophic proteobacteria and each of them can be further subdivided prior to construction of a phylogenetic tree. The comparison of relationships based upon HiPIP and RNA revealed several discrepancies.
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Affiliation(s)
- G Van Driessche
- Department of Biochemistry, Physiology and Microbiology, Laboratory for Protein Biochemistry and Protein Engineering, University of Ghent, 9000 Ghent, Belgium
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Leigh R, Ostuni J, Pham D, Goldszal A, Lewis BK, Howard T, Richert N, McFarland H, Frank JA. Estimating cerebral atrophy in multiple sclerosis patients from various MR pulse sequences. Mult Scler 2002; 8:420-9. [PMID: 12356210 DOI: 10.1191/1352458502ms801oa] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE The purpose of this study was to determine how measures reflecting cerebral atrophy (CA) are influenced by pulse sequence (PS) and segmentation algorithm (SA) used in multiple sclerosis (MS) patients and healthy control (HC)s. METHODS Magnetic resonance imaging (MRI) scans from 10 relapsing-remitting MS (RRMS) patients and five HCs were used to determine the change in brain fractional volume (BFV) over a two-year period. T1-weighted, fluid-attenuated inversion recovery (FLAIR), and proton density (PD)/T2-weighted sequences were analysed Image segmentation to determine brain volume was performed using the following a histogram SA, an adaptive fuzzy c-means algorithm (AFCM), and an adaptive Bayesian segmentation with a K-means clustering. RESULTS Combinations of the SA and PS in MS patents demonstrated significant differences in the per cent change in BFV from baseline. For the combination of PS and SA the per cent change in BFV for year one and year two varied from +2.05% to - 1.6% and +0.79% to -3.11%, respectively. Analysis of the HCs data revealed fluctuations in BFV varying from +0.26% to -0.29%. CONCLUSIONS MRI estimates of CA are dependent on both the type of PS and SA; therefore, the choice of SA technique and PS should be consistent during an MS treatment trial. The progression of CA in MS should only be used as a secondary or tertiary outcome measure in treatment trials until a better understanding of how this measurement is affected by the disease, the image acquisition and analysis techniques.
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Affiliation(s)
- R Leigh
- Neuroimmunology Branch, National Institutes of Neurological Diseases and Stroke, National Institutes of Health, Clinical Center, Bethesda, Maryland 20892, USA
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Kelly MM, Keatings V, Leigh R, Peterson C, Shute J, Venge P, Djukanović R. Analysis of fluid-phase mediators. Eur Respir J Suppl 2002; 37:24s-39s. [PMID: 12361360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- M M Kelly
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada.
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Affiliation(s)
- E Pizzichini
- NUPAIVA (Asthma Research Centre), University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
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Kelly MM, Leigh R, Carruthers S, Horsewood P, Gleich GJ, Hargreave FE, Cox G. Increased detection of interleukin-5 in sputum by addition of protease inhibitors. Eur Respir J 2001; 18:685-91. [PMID: 11716175 DOI: 10.1183/09031936.01.00098501] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The measurement of interleukin (IL)-5 in sputum is problematic, with interfering factors affecting immunoassay. The authors investigated whether sputum proteases could be acting as interfering factors by studying the effect of protease inhibitors (PI) on sputum IL-5 measurement. Induced sputa from 20 subjects with asthma were divided into aliquots, processed with and without protease inhibitors (in low and high concentrations) and the levels of IL-5 (spiked and endogenous) measured by enzyme immunoassay were compared. The concentration of sputum IL-5 was significantly increased by PI, with median (interquartile range) levels processed with no, low and high PI concentrations being 0 (0), 41.8 (75.6) and 66.1 (124.4) pg x mL(-1), respectively. There was also a significant increase in percentage recovery of spiked IL-5. Although high concentrations of PI reduced cell viability, there was no effect on total or differential cell counts and low concentrations of PI had no effect on cell counts or viability. Levels of endogenous interleukin-5 in sputum of asthmatic subjects can be significantly increased by the addition of protease inhibitors, and samples which would be regarded as negative for interleukin-5 without protease inhibitors may instead have considerable amounts of interleukin-5 detected.
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Affiliation(s)
- M M Kelly
- Dept of Medicine, St. Joseph's Hospital-McMaster University, Hamilton, Ontario, Canada
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Leigh R. Information for patients. Inhaled corticosteroids in asthma. Can Respir J 2001; 8:331-2. [PMID: 11762301 DOI: 10.1155/2001/315135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- R Leigh
- Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Ontario
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Leigh R. Information for patients (number 4). Environmental control as part of asthma management. Can Respir J 2001; 8:228-30. [PMID: 11565514 DOI: 10.1155/2001/875069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- R Leigh
- Firestone Regional Chest and Allergy Unit, St Joseph's Hospital, Hamilton, Ontario
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Abstract
The authors first review issues related to the life cycle and the significance of time for older adults. They then consider the types of psychopathological problems that can occur in older individuals and discuss the indications for and the goals and effectiveness of psychodynamic psychotherapy in older patients. The next section of the paper addresses technical aspects of psychotherapy with older patients, including transference, countertransference, and process issues. The article concludes with a consideration of practical problems (e.g., vision or hearing deficits) as well as other types of challenges that may need to be dealt with in providing psychotherapy to older patients.
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Affiliation(s)
- R Leigh
- University of Queensland and Princess Alexandra Hospital, Brisbane, Australia
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Leigh R. Information for patient. An overview of asthma treatment. Can Respir J 2001; 8:79-80. [PMID: 11394360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Affiliation(s)
- R Leigh
- Firestone Regional Chest and Allergy Unit, St Joseph's Hospital, Hamilton, Ontario
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Leigh R. Applications of bio- and chemo-informatics. IDrugs 2001; 4:177-8. [PMID: 16032479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- R Leigh
- Brunel University, Department of Electronic & Computer Engineering, Uxbridge, Middlesex, UB8 3PH, UK.
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Abstract
It has previously been reported that sputum induction is successful and safe in the clinical research setting. The authors examined the success and safety of sputum induction in routine clinical practice in patients with asthma or chronic airflow limitation of varying severity. Records of 304 patients with asthma and 25 with smoking related chronic airflow limitation were examined retrospectively. All had sputum induced as part of their routine clinical evaluation. When the baseline post salbutamol forced expiratory volume in one second (FEV1) was > or =70% predicted, the inductions consisted of inhalation of an aerosol of 3%, 4% and 5% saline, each given for 7 min. If the FEV1 was <70%, or there were other reasons for concern, the inductions were initiated with normal saline for shorter periods. Inhalations were discontinued when sputum was obtained or when there was a fall in FEV1 > or =20%. Success was identified by obtaining nonsquamous total and differential cell counts containing macrophages, and safety by the fall in FEV1. The overall success was 93%. The procedure was safe even amongst patients with an FEV1 of <60% and <1 L. Of 77 patients with an FEV1 between 40-59%, 8% fell by > or =20% and of 35 patients with an FEV1 <40%, 6% fell by 20%. Carefully standardized sputum induction can be successful and safe in patients with asthma or chronic airflow limitation in clinical practice, even when moderate or severe airflow limitation is present.
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Affiliation(s)
- H Vlachos-Mayer
- Firestone Regional Chest and Allergy Unit, St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada
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Leigh R, Belda J, Kelly MM, Cox G, Squillace DL, Gleich GJ, Hargreave FE. Eosinophil cationic protein relates to sputum neutrophil counts in healthy subjects. J Allergy Clin Immunol 2000; 106:593-4. [PMID: 10984384 DOI: 10.1067/mai.2000.109057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- R Leigh
- Asthma Research Group, Department of Medicine, St Joseph's Hospital-McMaster University, Hamilton, Ontario, Canada
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Abstract
Fabry's disease is a rare inherited metabolic disorder caused by a deficiency in the enzyme alpha-galactosidase A. It can affect almost every organ, including the lungs. Confirmation of lung involvement has depended on invasive bronchial biopsy specimens or brushings to confirm the presence of typical lamellar inclusion bodies within bronchial epithelial cells. We report a patient with known Fabry's disease in whom these inclusion bodies were identified by examination of induced sputum.
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Affiliation(s)
- M M Kelly
- Asthma Research Group, Department of Medicine, St Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada
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Leigh R, Kelly M, Hargreave FE. Bronchial hyperresponsiveness and airway inflammation markers in nonasthmatics with allergic rhinitis. Eur Respir J 2000; 16:374. [PMID: 10968518 DOI: 10.1034/j.1399-3003.2000.16b30.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
BACKGROUND IL-5 measurement in the fluid phase of induced sputum is considered to be important in the assessment of asthma, but the validity of these measurements is uncertain. OBJECTIVE We investigated the validity of sputum IL-5 measurements through a series of spiking experiments and examined the effect of dithiothreitol (DTT) on these measurements. METHODS Induced sputum from 26 asthmatic subjects was spiked with IL-5 and processed, and the percentage of recovery was measured by means of immunoassay. In 6 of the 26 samples the effect of adding albumin to the processing fluids was studied. In 3 separate samples radiolabeled IL-5 was added, and the recovery measured by means of gamma counting and immunoassay were compared. In addition, the effect of DTT on the immunoassay was examined. RESULTS The mean +/- SD recovery of spiked IL-5 was 26.1% +/- 14.6% measured by means of immunoassay; adding albumin increased the recovery to 47.7% +/- 8.0% (P <.001). The mean recovery measured by means of gamma counting was 84.8% +/- 5.7% (P <.001); adding albumin had no effect on recovery. DTT had no significant effect on IL-5 measurement. CONCLUSION The validity of IL-5 measurement by means of current methods is poor. The discrepancy in recovery as measured by gamma counting compared with immunoassay suggests that there is a problem with the recognition of IL-5 epitopes by immunoassay in induced sputum. This cannot be attributed to DTT but may be due to other interfering substances present in sputum, such as sputum proteases, soluble receptors, or autoantibodies.
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Affiliation(s)
- M M Kelly
- Asthma Research Group, Departments of Medicine and Pathology, St Joseph's Hospital-McMaster University, Hamilton, Ontario, Canada
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Abstract
Induced sputum cell counts provide a relatively noninvasive method to evaluate the presence, type, and degree of inflammation in the airways of the lungs. Their interpretation requires a knowledge of normal values from a healthy population. The objective was to examine the total and differential cell counts in induced sputum from a sample of healthy adults. A total of 118 healthy nonsmoking adults were studied. None had asthma or airflow obstruction (negative history, FEV(1) >/= 80% predicted, ratio of FEV(1) to vital capacity [FEV(1)/VC] >/= 80%, methacholine PC(20) >/= 16 mg/ml). Forty-six were atopic. Sputum induction produced an adequate sample in 96 subjects [53 males, mean age (range) 36 (18 to 60) yr]. The expectorate was processed within 2 h; sputum was selected, treated with dithiothreitol, filtered, and examined in a hemocytometer for total cell count and viability and on Wright-stained cytospins for a differential cell count. The mean, median (90th percentile) total cell count was 4.1, 2.4 (9.7) x 10(6) cells/g and cell viability was 69.6, 72.0 (89.7)%. The proportions of eosinophils were 0.4, 0.0 (1.1)%, neutrophils 37.5, 36.7 (64.0)%, macrophages 58.8, 60.8 (86.1)%, lymphocytes 1.0, 0.5 (2.6)%, metachromatic cells 0.0, 0.0 (0.04)%, and bronchial epithelial cells 1.6, 0.3 (4.4)%, respectively. Female gender and atopy were associated with a significant elevation of eosinophils; mean difference between male/female was 0.3% (p = 0.043) and between atopic/nonatopic 0.4% (p = 0.024). This study has identified reference values for total and differential cell counts in induced sputum of healthy adults.
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Affiliation(s)
- J Belda
- Asthma Research Group, Department of Medicine, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada
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Abstract
The application of sputum induction and refined methods of sputum examination has provided the opportunity to examine cell and molecular markers of airway inflammation in asthma, COPD, and other airway diseases. The measurements are relatively noninvasive and can be applied safely, with care, even in more severe exacerbations of asthma and severe COPD. Induced sputum examination can be applied at random and repeatedly and gives results that are reproducible, valid, and responsive to changes in treatment. An eosinophilic bronchitis, defined as sputum eosinophilia, is typical of asthma but can also occur in patients with a chronic cough without asthma, and in some patients with COPD in whom the classic inflammatory response is neutrophilic without eosinophilia. When eosinophilia occurs in COPD, it has been considered to be the result of cigarette smoking but it may be due to other causes. The clinical importance of eosinophilic bronchitis is that it responds to treatment with corticosteroid. In contrast, there is increasing evidence that an absence of sputum eosinophilia is associated with steroid resistance. Hargreave FE, Leigh R. Induced sputum, eosinophilic bronchitis, and chronic obstructive pulmonary disease.
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Affiliation(s)
- F E Hargreave
- Asthma Research Group, Departments of Medicine and Paediatrics, St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada
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