1
|
Backley S, Bergh E, Garnett J, Li R, Maroufy V, Jain R, Fletcher S, Tsao K, Austin M, Johnson A, Papanna R. Fetal cardiovascular changes during open and fetoscopic in-utero spina bifida closure. Ultrasound Obstet Gynecol 2024. [PMID: 38207160 DOI: 10.1002/uog.27579] [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] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Laparotomy-assisted fetoscopic closure of spina bifida utilizing heated-humidified carbon dioxide gas has been associated with less maternal morbidity than open in-utero spina bifida closure. Fetal cardiovascular changes during these surgical interventions are not well defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR)<110 bpm over 10 minutes) and changes in umbilical artery Doppler parameters throughout open in-utero closure with those observed during laparotomy-assisted fetoscopic closure. METHODS We conducted a prospective cohort study of 22 open and 46 fetoscopic consecutive in-utero closures between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and umbilical artery velocimetry were systematically obtained during preoperative assessment, every 5 minutes during the intraoperative period, and in the postoperative assessment. FHR, pulsatility indexes and end-diastolic flows were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocities were measured in the fetoscopic cohort. Each fetal heart rate recording time point was correlated to maternal parameters, including heart rate, systolic and diastolic blood pressures. RESULTS Fetal bradycardia occurred in 4/22 cases (18.2%) of open in-utero closure and in 21/46 cases (45.7%) of fetoscopic closure. FHR gradually decreased in both cohorts after general anesthesia and decreased further during surgery. FHR were significantly lower after two hours of surgery in the fetoscopic closure than in the open in-utero closure group. In addition, the FHR (BPM) change in the final stages of the fetal surgery from the baseline FHR was significantly lower in the fetoscopic cohort (-32.3 (-35.7, -29.1)) compared to the open cohort (-23.5 (-28.1, -18.8)) (p=0.002). Abnormal end-diastolic flow (defined as absent or reversed end-diastolic flow) in the umbilical artery Doppler velocity occurred in 3/22 (13.6%) of the open closure cohort and in 23/46 (50%) of the fetoscopic closure cohort (p=0.004). There were no differences in umbilical artery end-diastolic flow and pulsatility index between closure techniques during the various stages of assessment. CONCLUSIONS We observed a decrease in the FHR and abnormalities in umbilical artery Doppler parameters in both open in-utero and fetoscopic closure groups. Fetal bradycardia was more prominent during fetoscopic closure following heated-humidified carbon dioxide insufflation, but the FHR recovered after cessation of the heated-humidified carbon dioxide. Changes in FHR and umbilical artery Doppler parameters during in-utero spina bifida closure were observed to be transient, no cases required emergency delivery and no fetoscopic closure were converted to open closure. These observations should inform algorithms for perioperative management of fetal bradycardia associated with in-utero spina bifida closure. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - E Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - J Garnett
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Li
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - V Maroufy
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - R Jain
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Division of Pediatric Anesthesia, Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - S Fletcher
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Division of Pediatric Neurosurgery, Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - K Tsao
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M Austin
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| |
Collapse
|
2
|
Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
Collapse
|
3
|
Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
Collapse
|
4
|
Arroll B, Frischtak H, Roskvist R, Mount V, Sundram F, Fletcher S, Kingsford DW, Buttrick L, Bricker J, van der Werf B. FACT effectiveness in primary care; a single visit RCT for depressive symptoms. Int J Psychiatry Med 2022; 57:91-102. [PMID: 33892599 DOI: 10.1177/00912174211010536] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with depressive symptoms are common in primary care. Brief, simple therapies are needed. AIM Is a focussed acceptance and commitment therapy (FACT) intervention more effective than the control group for patients with depressive symptoms in primary care at one week follow up?Design and setting: A randomised, blinded controlled trial at a single primary care clinic in Auckland, New Zealand. METHODS Patients presenting to their primary care practice for any reason were recruited from the clinic waiting room. Eligible patients who scored ≥2 on the PHQ-2 indicating potential depressive symptoms were randomised using a remote computer to intervention or control groups. Both groups received a psychosocial assessment using the "work-love-play" questionnaire. The intervention group received additional FACT-based behavioural activation activities. The primary outcome was the mean PHQ-8 score at one week. RESULTS 57 participants entered the trial and 52 had complete outcome data after one week. Baseline PHQ-8 scores were similar for intervention (11.0) and control (11.7). After one week, the mean PHQ-8 score was significantly lower in the intervention group (7.4 vs 10.1 for control; p<0.039 one sided and 0.078 two sided). The number needed to treat to achieve a PHQ-8 score ≤6 was 4.0 on intention to treat analysis (p = 0.043 two sided). There were no significant differences observed on the secondary outcomes. CONCLUSION This is the first effectiveness study to examine FACT in any population. The results suggest that it is effective compared with control, at one week, for patients with depressive symptoms in primary care.
Collapse
Affiliation(s)
- B Arroll
- Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - H Frischtak
- Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - R Roskvist
- Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - V Mount
- Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - F Sundram
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - S Fletcher
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - D W Kingsford
- Interior Health Authority, Kelowna, British Columbia, Canada
| | - L Buttrick
- Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - J Bricker
- Fred Hutchinson Center, Seattle, WA, USA
| | - B van der Werf
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, School of Population Health, University of Auckland, Auckland, New Zealand
| |
Collapse
|
5
|
Stepanek C, Stapleton A, Haynes J, Fletcher S. PH-0323 clinical evaluation of the myQA SRS detector for stereotactic body radiotherapy plan verification. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Simpson T, Barratt SL, Beirne P, Chaudhuri N, Crawshaw A, Crowley LE, Fletcher S, Gibbons MA, Hallchurch P, Horgan L, Jakaityte I, Lewis T, McLellan T, Myall KJ, Miller R, Smith DJF, Stanel S, Thillai M, Thompson F, Wallis T, Wu Z, Molyneaux PL, West AG. The burden of progressive fibrotic interstitial lung disease across the UK. Eur Respir J 2021; 58:13993003.00221-2021. [PMID: 33678609 PMCID: PMC8264777 DOI: 10.1183/13993003.00221-2021] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 10/19/2020] [Accepted: 02/26/2021] [Indexed: 11/16/2022]
Abstract
While idiopathic pulmonary fibrosis (IPF) remains the exemplar progressive fibrotic lung disease, there remains a cohort of non-IPF fibrotic lung diseases (fILD) which adopt a similar clinical behaviour to IPF despite therapy [1]. This phenotypically related group of conditions, where progression of disease is similar to that seen in IPF, have recently been described as progressive fibrotic interstitial lung diseases (PF-ILD) [2]. Historically, treatments for these cases have been limited though given the phenotypic similarities many cases may have been given a multidisciplinary working diagnosis of IPF based on their disease behaviour [3]. The INBUILD trial broadened the scope of treatable fILD by demonstrating a significant benefit of Nintedanib in patients with fILD and progressive disease [4]. In response to this the European Commission approved an additional indication for nintedanib in adults for the treatment of PF-ILD in July 2020. Almost 15% of new referrals with non-IPF fibrotic ILD go on to develop a progressive fibrotic phenotype and would benefit from antifibrotic therapyhttps://bit.ly/3uPhClN
Collapse
Affiliation(s)
- Thomas Simpson
- Dept of Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shaney L Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS trust, Southmead Hospital, Bristol, UK.,Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Paul Beirne
- Leeds Interstitial Lung Disease Service, St James's University Hospital, Leeds, UK
| | - Nazia Chaudhuri
- North West Lung Centre, Wythenshawe Hospital, Manchester, UK
| | - Anjali Crawshaw
- Birmingham Interstitial Lung Disease Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Louise E Crowley
- Birmingham Interstitial Lung Disease Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sophie Fletcher
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Michael A Gibbons
- South West Peninsula ILD Network, Royal Devon and Exeter Foundation NHS Trust, Exeter, UK
| | - Philippa Hallchurch
- Bristol Interstitial Lung Disease Service, North Bristol NHS trust, Southmead Hospital, Bristol, UK
| | - Laura Horgan
- Leeds Interstitial Lung Disease Service, St James's University Hospital, Leeds, UK
| | - Ieva Jakaityte
- South West Peninsula ILD Network, Royal Devon and Exeter Foundation NHS Trust, Exeter, UK
| | - Thomas Lewis
- Bristol Interstitial Lung Disease Service, North Bristol NHS trust, Southmead Hospital, Bristol, UK
| | - Tom McLellan
- Dept of Interstitial Lung Disease, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Katherine J Myall
- Dept of Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ryan Miller
- South West Peninsula ILD Network, Royal Devon and Exeter Foundation NHS Trust, Exeter, UK
| | | | - Stefan Stanel
- North West Lung Centre, Wythenshawe Hospital, Manchester, UK
| | - Muhunthan Thillai
- Dept of Interstitial Lung Disease, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Fiona Thompson
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Timothy Wallis
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Zhe Wu
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Philip L Molyneaux
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,Contributed equally as last authors
| | - Alex G West
- Dept of Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Contributed equally as last authors
| |
Collapse
|
7
|
Williamson J, Henning AJ, Martin H, Furness T, Fletcher S, Jiang X. Flexible gauge length intrinsic fiber-optic strain sensor using broadband interferometry [Invited]. J Opt Soc Am A Opt Image Sci Vis 2020; 37:1950-1957. [PMID: 33362138 DOI: 10.1364/josaa.403294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/29/2020] [Indexed: 06/12/2023]
Abstract
Monitoring strain is important in precision engineering applications that require maintaining the precise alignments of structures over time, such as those found in machine tools and metrology frames. We present a fiber-optic strain measurement technique based upon broadband interferometry that is variously configurable in terms of gauge length and sensitivity. This is achieved by the use of an unbalanced interrogation interferometer configuration that alleviates the cavity length limit imposed by the temporal coherence of the system. We also demonstrate that dispersion in fiber sensors based on intrinsic Fabry-Perot interferometers must be considered to optimize performance. The possibility of multisensor interrogation using the same optical system is also reported.
Collapse
|
8
|
Donepudi R, Brock C, Schulte S, Bundock E, Fletcher S, Johnson A, Papanna R, Chauhan S, Tsao K. Trend in ventricle size during pregnancy and its use for prediction of ventriculoperitoneal shunt in fetal open neural tube defect. Ultrasound Obstet Gynecol 2020; 56:678-683. [PMID: 31763720 DOI: 10.1002/uog.21928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 11/03/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Fetal surgery for repair of open neural tube defect (ONTD) typically results in decreased need for a ventriculoperitoneal shunt (VPS). Our objectives were to determine the trend in ventricle size (VS) during pregnancy and whether VS and change in VS, as assessed by ultrasound, were predictive of the need for VPS in pregnancy with ONTD. METHODS This was a retrospective analysis of prospectively collected data of consecutive pregnancies with ONTD, evaluated in a single center from January 2012 to May 2018. Two groups were identified: the first consisted of pregnancies that underwent in-utero repair (IUR) and the second those that had postnatal repair (PNR). Penalized B splines were used to determine the trend in VS, across 2-week gestational-age (GA) epochs, between 24 and 36 weeks of gestation. VS at each GA epoch and the change in VS between each GA epoch were compared between the IUR and PNR groups. To determine whether VS at any GA was predictive of VPS, receiver-operating-characteristics (ROC) curves were used and the optimal cut-off at each GA epoch was identified. Univariate analysis and multiple logistic regression were used for further analysis. RESULTS ONTD was diagnosed in 110 fetuses, of whom 69 underwent IUR and 41 had PNR. Fetuses in the IUR group were more likely to have Chiari II malformation (100.0% vs 82.9%; P < 0.01), lower GA at delivery (34.9 ± 3.2 vs 37.1 ± 2.1 weeks; P < 0.01) and lower rates of VPS within the first year postpartum (36.2% vs 61.0%; P = 0.02) compared with the PNR group. In both groups, VS increased steadily with GA from the initial evaluation to delivery. In the IUR group, there was a significant change in VS between the 24 + 0 to 25 + 6-week and the 26 + 0 to 27 + 6-week epochs (2.3 (95% CI, 0.4-4.1) mm; P = 0.02). There was a positive trend in the change in VS at later GAs, but this was not significant. Although there was no significant change in VS in the PNR group before 30 weeks, there was a positive trend after that time. On multivariate analysis, each week of advancing GA was associated with a mean increase of 0.74 mm in VS (P < 0.0001) in both groups. VS was not associated with the level or type of lesion, but presence of Chiari II malformation was associated with a mean increase of 5.88 mm (P < 0.0001) in VS in both the IUR and PNR groups. VS was modestly predictive of need for VPS in both groups, with area under ROC curves between 0.68 and 0.76 at the different GA epochs. Change in VS between the first and last measurements was also modestly predictive of the need for VPS, with better performance in the PNR group. CONCLUSIONS VS increased with advancing GA in all fetuses with ONTD, although in the IUR group this increase occurred immediately after fetal surgery and in the PNR group it occurred after 30 weeks of gestation. In-utero surgery was associated with a decreased rate of VPS and was more predictive of need for VPS than was VS. Postnatal factors resulting in increased need for VPS in the PNR group need to be assessed further. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- R Donepudi
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - C Brock
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - S Schulte
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E Bundock
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - S Fletcher
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Pediatric Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - A Johnson
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - R Papanna
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - S Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - K Tsao
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| |
Collapse
|
9
|
Ramesh AV, Pufulete M, Reeves BC, Fletcher S, Tomlinson JW, Gibbison B. Peri‐operative corticosteroid supplementation for patients on therapeutic glucocorticoids: a national survey. Anaesthesia 2020; 75:1396-1398. [DOI: 10.1111/anae.15176] [Citation(s) in RCA: 2] [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] [Accepted: 06/05/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | - S. Fletcher
- Norfolk and Norwich University Hospitals NHS Trust Norwich UK
| | | | | |
Collapse
|
10
|
Fletcher S, Maddock H, James RS, Wallis R, Gharanei M. The cardiac work-loop technique: An in vitro model for identifying and profiling drug-induced changes in inotropy using rat papillary muscles. Sci Rep 2020; 10:5258. [PMID: 32210283 PMCID: PMC7093439 DOI: 10.1038/s41598-020-58935-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/12/2019] [Accepted: 11/26/2019] [Indexed: 11/09/2022] Open
Abstract
The cardiac work-loop technique closely mimics the intrinsic in vivo movement and characteristics of cardiac muscle function. In this study, six known inotropes were profiled using the work-loop technique to evaluate the potential of this method to predict inotropy. Papillary muscles from male Sprague-Dawley rats were mounted onto an organ bath perfused with Krebs-Henseleit buffer. Following optimisation, work-loop contractions were performed that included an initial stabilisation period followed by vehicle control or drug administration. Six known inotropes were tested: digoxin, dobutamine, isoprenaline, flecainide, verapamil and atenolol. Muscle performance was evaluated by calculating power output during work-loop contraction. Digoxin, dobutamine and isoprenaline caused a significant increase in power output of muscles when compared to vehicle control. Flecainide, verapamil and atenolol significantly reduced power output of muscles. These changes in power output were reflected in alterations in work loop shapes. This is the first study in which changes in work-loop shape detailing for example the activation, shortening or passive re-lengthening have been linked to the mechanism of action of a compound. This study has demonstrated that the work-loop technique can provide an important novel method with which to assess detailed mechanisms of drug-induced effects on cardiac muscle contractility.
Collapse
Affiliation(s)
- Sophie Fletcher
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, United Kingdom.,InoCardia Ltd, Technocentre, Puma Way, Coventry, CV1 2TT, UK
| | - Helen Maddock
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, United Kingdom. .,InoCardia Ltd, Technocentre, Puma Way, Coventry, CV1 2TT, UK.
| | - Rob S James
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Rob Wallis
- InoCardia Ltd, Technocentre, Puma Way, Coventry, CV1 2TT, UK
| | - Mayel Gharanei
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, United Kingdom.,InoCardia Ltd, Technocentre, Puma Way, Coventry, CV1 2TT, UK
| |
Collapse
|
11
|
Woodcock T, Barker P, Daniel S, Fletcher S, Wass JAH, Tomlinson JW, Misra U, Dattani M, Arlt W, Vercueil A. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK. Anaesthesia 2020; 75:654-663. [PMID: 32017012 DOI: 10.1111/anae.14963] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [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: 11/26/2019] [Indexed: 12/17/2022]
Abstract
These guidelines aim to ensure that patients with adrenal insufficiency are identified and adequately supplemented with glucocorticoids during the peri-operative period. There are two major categories of adrenal insufficiency. Primary adrenal insufficiency is due to diseases of the adrenal gland (failure of the hormone-producing gland), and secondary adrenal insufficiency is due to deficient adrenocorticotropin hormone secretion by the pituitary gland, or deficient corticotropin-releasing hormone secretion by the hypothalamus (failure of the regulatory centres). Patients taking physiological replacement doses of corticosteroids for either primary or secondary adrenal insufficiency are at significant risk of adrenal crisis and must be given stress doses of hydrocortisone during the peri-operative period. Many more patients other than those with adrenal and hypothalamic-pituitary causes of adrenal failure are receiving glucocorticoids as treatment for other medical conditions. Daily doses of prednisolone of 5 mg or greater in adults and 10-15 mg.m-2 hydrocortisone equivalent or greater in children may result in hypothalamo-pituitary-adrenal axis suppression if administered for 1 month or more by oral, inhaled, intranasal, intra-articular or topical routes; this chronic administration of glucocorticoids is the most common cause of secondary adrenal suppression, sometimes referred to as tertiary adrenal insufficiency. A pragmatic approach to adrenal replacement during major stress is required; considering the evidence available, blanket recommendations would not be appropriate, and it is essential for the clinician to remember that adrenal replacement dosing following surgical stress or illness is in addition to usual steroid treatment. Patients with previously undiagnosed adrenal insufficiency sometimes present for the first time following the stress of surgery. Anaesthetists must be familiar with the symptoms and signs of acute adrenal insufficiency so that inadequate supplementation or undiagnosed adrenal insufficiency can be detected and treated promptly. Delays may prove fatal.
Collapse
Affiliation(s)
- T Woodcock
- Co-Chair, Working Party on behalf of the Association of Anaesthetists, Hampshire, UK
| | - P Barker
- Department of Anaesthesia, Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK
| | - S Daniel
- Adult Intensive Care Unit, University Hospital of Wales, Cardiff, Wales
| | - S Fletcher
- Department of Anaesthesia, Norfolk and Norwich University Hospital NHS Trust, on behalf of the Royal College of Anaesthetists, Norfolk, UK
| | - J A H Wass
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Chair Clinical Reference Group for Endocrinology, on behalf of the Royal College of Physicians, Oxford, UK
| | - J W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK
| | - U Misra
- Department of Anaesthesia, Sunderland Royal Hospital, Sunderland, UK
| | - M Dattani
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, London, UK.,Consultant Paediatric Endocrinologist and Head of Clinical Service in Endocrinology, Great Ormond Street Hospital for Children, London, UK
| | - W Arlt
- Institute of Metabolism and Systems Research, University of Birmingham & Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, on behalf of the Society for Endocrinology, Birmingham, UK
| | - A Vercueil
- Department of Intensive Care Medicine, King's College Hospital, Co-Chair, Working Party on behalf of the Association of Anaesthetists, London, UK
| |
Collapse
|
12
|
Beck L, Velthuis JJ, Fletcher S, Haynes JA, Page RF. Using a TRAPS upstream transmission detector to verify multileaf collimator positions during dynamic radiotherapy delivery. Appl Radiat Isot 2020; 156:108951. [PMID: 31790976 DOI: 10.1016/j.apradiso.2019.108951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/25/2019] [Accepted: 10/21/2019] [Indexed: 12/01/2022]
Abstract
With the advancement of high-precision radiotherapy and the increasing use of higher intensity beams, the risk to the patient increases should the radiotherapy machine malfunction. Hence more accurate treatment verification is required. In this paper we provide a solution for real-time monitoring of X-ray beams from radiotherapy linear accelerators using monolithic active pixel sensors. We show that leaf errors can be detected with high precision in static fields and IMRT step and shoot, and accurate leaf tracking is possible in Volumetric Modulated Arc Therapy. The prototype MAPS detector meets the criteria of 1% attenuation acceptable for clinical use.
Collapse
Affiliation(s)
- L Beck
- University of Bristol, H.H. Wills Physics Laboratory, Tyndall Avenue, BS8 1TL, Bristol, United Kingdom.
| | - J J Velthuis
- University of Bristol, H.H. Wills Physics Laboratory, Tyndall Avenue, BS8 1TL, Bristol, United Kingdom; Swansea University Medical School, Singleton Park, Swansea, United Kingdom; University of South China, School of Nuclear Science and Technology, West Changsheng Rd, Hengyang, 421001, China
| | - S Fletcher
- United Hospitals Bristol NHS Foundation Trust (UHB), at the Department of Medical Physics & Bioengineering at Bristol Haematology and Oncology Centre, Horfield Road, Bristol, United Kingdom
| | - J A Haynes
- United Hospitals Bristol NHS Foundation Trust (UHB), at the Department of Medical Physics & Bioengineering at Bristol Haematology and Oncology Centre, Horfield Road, Bristol, United Kingdom
| | - R F Page
- University of Bristol, H.H. Wills Physics Laboratory, Tyndall Avenue, BS8 1TL, Bristol, United Kingdom
| |
Collapse
|
13
|
Toukhsati S, Jones A, Fletcher S, Milligan D, Kwee J, Justice K, Liu M, Hwang J, Duong V, Galea A, Zheng J, Hare D. 642 Psychological Denial is a Risk Factor for All-Cause Unplanned Rehospitalisations Following Acute Myocardial Infarction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Fletcher S, James R, Wallis R, Maddock H, Gharanei M. The cardiac work-loop technique to assess drug-induced changes in cardiac contractility. J Pharmacol Toxicol Methods 2019. [DOI: 10.1016/j.vascn.2019.05.058] [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: 10/25/2022]
|
15
|
Fletcher S, Haynes J, Beck L, Velthuis J, Crawford D. EP-1698 TRAPS upstream transmission detector for tracking mlc positions in VMAT and IMRT radiotherapy fields. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
16
|
Servián-Morilla E, Cabrera-Serrano M, Rivas-Infante E, Carvajal A, Lamont PJ, Pelayo-Negro AL, Ravenscroft G, Junckerstorff R, Dyke JM, Fletcher S, Adams AM, Mavillard F, Fernández-García MA, Nieto-González JL, Laing NG, Paradas C. Altered myogenesis and premature senescence underlie human TRIM32-related myopathy. Acta Neuropathol Commun 2019; 7:30. [PMID: 30823891 PMCID: PMC6396567 DOI: 10.1186/s40478-019-0683-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022] Open
Abstract
TRIM32 is a E3 ubiquitin -ligase containing RING, B-box, coiled-coil and six C-terminal NHL domains. Mutations involving NHL and coiled-coil domains result in a pure myopathy (LGMD2H/STM) while the only described mutation in the B-box domain is associated with a multisystemic disorder without myopathy (Bardet-Biedl syndrome type11), suggesting that these domains are involved in distinct processes. Knock-out (T32KO) and knock-in mice carrying the c.1465G > A (p.D489N) involving the NHL domain (T32KI) show alterations in muscle regrowth after atrophy and satellite cells senescence. Here, we present phenotypical description and functional characterization of mutations in the RING, coiled-coil and NHL domains of TRIM32 causing a muscle dystrophy. Reduced levels of TRIM32 protein was observed in all patient muscle studied, regardless of the type of mutation (missense, single amino acid deletion, and frameshift) or the mutated domain. The affected patients presented with variable phenotypes but predominantly proximal weakness. Two patients had symptoms of both muscular dystrophy and Bardet-Biedl syndrome. The muscle magnetic resonance imaging (MRI) pattern is highly variable among patients and families. Primary myoblast culture from these patients demonstrated common findings consistent with reduced proliferation and differentiation, diminished satellite cell pool, accelerated senescence of muscle, and signs of autophagy activation.
Collapse
|
17
|
Richeldi L, Fletcher S, Adamali H, Chaudhuri N, Wiebe S, Wind S, Hohl K, Baker A, Schlenker-Herceg R, Stowasser S, Maher TM. No relevant pharmacokinetic drug-drug interaction between nintedanib and pirfenidone. Eur Respir J 2019; 53:13993003.01060-2018. [PMID: 30442716 DOI: 10.1183/13993003.01060-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/28/2018] [Indexed: 01/08/2023]
Abstract
Nintedanib and pirfenidone are approved treatments for idiopathic pulmonary fibrosis (IPF). This open-label, two-group trial investigated the pharmacokinetic drug-drug interaction between these two drugs in patients with IPF.Subjects not treated with antifibrotics at screening (group 1, n=20) received a single nintedanib dose (150 mg) followed by pirfenidone (titrated to 801 mg thrice daily) for 3 weeks, with a further single nintedanib dose (150 mg) on the last day (day 23). Subjects treated with pirfenidone at screening (group 2, n=17) continued to receive pirfenidone alone (801 mg thrice daily) for 7 days, then co-administered with nintedanib (150 mg twice daily) for a further 7 days, before single doses of both treatments on day 16.In group 1, adjusted geometric mean (gMean) ratios (with/without pirfenidone) were 88.6% and 80.6% for nintedanib area under the plasma concentration-time curve (AUC) and maximum plasma concentration (Cmax), respectively. In group 2, gMean ratios (with/without nintedanib) were 97.2% and 99.5% for pirfenidone AUC and Cmax, respectively. For all parameters, the 90% confidence intervals included 100%, suggesting similar exposure for administration alone and when co-administered. Both treatments were well tolerated.These data indicate there is no relevant pharmacokinetic drug-drug interaction between nintedanib and pirfenidone when co-administered in IPF patients.
Collapse
Affiliation(s)
- Luca Richeldi
- Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy.,Dept of Respiratory Medicine, University Hospital Southampton and Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
| | - Sophie Fletcher
- Dept of Respiratory Medicine, University Hospital Southampton and Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK.,Translational Research Collaboration - Inflammatory Respiratory Disease Centre, Manchester, UK
| | - Huzaifa Adamali
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Nazia Chaudhuri
- Translational Research Collaboration - Inflammatory Respiratory Disease Centre, Manchester, UK.,North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Sven Wind
- Boehringer Ingelheim Pharma, Biberach, Germany
| | | | | | | | | | - Toby M Maher
- Translational Research Collaboration - Inflammatory Respiratory Disease Centre, Manchester, UK.,National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, and Fibrosis Research group, National Heart and Lung Institute, Imperial College, London, UK
| |
Collapse
|
18
|
Sgalla G, Larici AR, Sverzellati N, Bartholmai B, Walsh SL, Nikolic D, Barney A, Fletcher S, Jones M, Davies DD, Richeldi L. Quantitative analysis of lung sounds for monitoring idiopathic pulmonary fibrosis: a prospective pilot study. Eur Respir J 2018; 53:13993003.02093-2018. [DOI: 10.1183/13993003.02093-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/14/2018] [Indexed: 11/05/2022]
|
19
|
Sgalla G, Walsh SLF, Sverzellati N, Fletcher S, Cerri S, Dimitrov B, Nikolic D, Barney A, Pancaldi F, Larcher L, Luppi F, Jones MG, Davies D, Richeldi L. "Velcro-type" crackles predict specific radiologic features of fibrotic interstitial lung disease. BMC Pulm Med 2018; 18:103. [PMID: 29914454 PMCID: PMC6006991 DOI: 10.1186/s12890-018-0670-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/12/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND "Velcro-type" crackles on chest auscultation are considered a typical acoustic finding of Fibrotic Interstitial Lung Disease (FILD), however whether they may have a role in the early detection of these disorders has been unknown. This study investigated how "Velcro-type" crackles correlate with the presence of distinct patterns of FILD and individual radiologic features of pulmonary fibrosis on High Resolution Computed Tomography (HRCT). METHODS Lung sounds were digitally recorded from subjects immediately prior to undergoing clinically indicated chest HRCT. Audio files were independently assessed by two chest physicians and both full volume and single HRCT sections corresponding to the recording sites were extracted. The relationships between audible "Velcro-type" crackles and radiologic HRCT patterns and individual features of pulmonary fibrosis were investigated using multivariate regression models. RESULTS 148 subjects were enrolled: bilateral "Velcro-type" crackles predicted the presence of FILD at HRCT (OR 13.46, 95% CI 5.85-30.96, p < 0.001) and most strongly the Usual Interstitial Pneumonia (UIP) pattern (OR 19.8, 95% CI 5.28-74.25, p < 0.001). Extent of isolated reticulation (OR 2.04, 95% CI 1.62-2.57, p < 0.001), honeycombing (OR 1.88, 95% CI 1.24-2.83, < 0.01), ground glass opacities (OR 1.74, 95% CI 1.29-2.32, p < 0.001) and traction bronchiectasis (OR 1.55, 95% CI 1.03-2.32, p < 0.05) were all independently associated with the presence of "Velcro-type" crackles. CONCLUSIONS "Velcro-type" crackles predict the presence of FILD and directly correlate with the extent of distinct radiologic features of pulmonary fibrosis. Such evidence provides grounds for further investigation of lung sounds as an early identification tool in FILD.
Collapse
Affiliation(s)
- Giacomo Sgalla
- Division of Respiratory Medicine, University Hospital “A. Gemelli”, Catholic University of Sacred Heart, Rome, Italy
- National Institute for Health Research Southampton Respiratory Biomedical Research Unit and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | | | | | - Sophie Fletcher
- National Institute for Health Research Southampton Respiratory Biomedical Research Unit and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Stefania Cerri
- Centre for Rare Lung Disease, University Hospital of Modena, Modena, Italy
| | - Borislav Dimitrov
- Medical Statistics, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dragana Nikolic
- Institute for Sound and Vibration Research, University of Southampton, Southampton, UK
| | - Anna Barney
- Institute for Sound and Vibration Research, University of Southampton, Southampton, UK
| | | | - Luca Larcher
- DISMI, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Fabrizio Luppi
- Centre for Rare Lung Disease, University Hospital of Modena, Modena, Italy
| | - Mark G. Jones
- National Institute for Health Research Southampton Respiratory Biomedical Research Unit and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Donna Davies
- National Institute for Health Research Southampton Respiratory Biomedical Research Unit and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Luca Richeldi
- Division of Respiratory Medicine, University Hospital “A. Gemelli”, Catholic University of Sacred Heart, Rome, Italy
- National Institute for Health Research Southampton Respiratory Biomedical Research Unit and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
20
|
Fletcher S, Sinclair C, Rhee J, Goh D, Auret K. Rural health professionals' experiences in implementing advance care planning: a focus group study. Aust J Prim Health 2018; 22:423-427. [PMID: 26330201 DOI: 10.1071/py15004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/28/2015] [Indexed: 11/23/2022]
Abstract
Advance care planning (ACP) is described as an ongoing discussion between a patient, their family and healthcare professionals (HCPs) to understand a patient's wishes for future health care. Legislation supporting ACP in Western Australia is relatively new and HCPs are still learning about the process and implementation. This study aimed to provide a rich description of rural health professionals' perceptions and experiences with ACP within the context of their professional role and to identify systemic issues and training needs. Ten focus groups were conducted throughout 2014 with a total of 55 rural participants including general practitioners (n=15), general practice registrars (n=6), practice nurses (n=18), community nurses (n=4) and hospital nurses (n=12) in the south-western regions of Western Australia. Thematic analysis has identified the following themes regarding ACP: benefits to patients and families; professional roles in ACP; barriers and enablers; and systems for communicating ACP. HCPs have self-determined their roles in the ACP process, which currently leaves some components of the process unaccounted for, suggesting that collaboration between HCPs working together in a rural health setting and a standardised system for distributing these documents may assist with the implementation of ACP.
Collapse
Affiliation(s)
- Sophie Fletcher
- The Rural Clinical School of Western Australia, UWA Albany Centre, 31 Stirling Terrace, Albany, WA 6330, Australia
| | - Craig Sinclair
- The Rural Clinical School of Western Australia, UWA Albany Centre, 31 Stirling Terrace, Albany, WA 6330, Australia
| | - Joel Rhee
- UNSW Medicine, UNSW Australia, Sydney, NSW 2052, Australia
| | - Desiree Goh
- The Rural Clinical School of Western Australia, M701, Hackett Avenue, Crawley, WA 6009, Australia
| | - Kirsten Auret
- The Rural Clinical School of Western Australia, UWA Albany Centre, 31 Stirling Terrace, Albany, WA 6330, Australia
| |
Collapse
|
21
|
Meek J, Fletcher S, Bezold S, Borja-Cacho D, Meek M. Abstract No. 534 Temporary balloon occlusion for hepatic arterial flow redistribution during Y90 radioembolization: a novel technique for treatment of centrally located hepatic tumors. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
22
|
Fletcher S, Hughes R, Pickstock S, Auret K. Advance Care Planning Discussions with Adolescent and Young Adult Cancer Patients Admitted to a Community Palliative Care Service: A Retrospective Case-Note Audit. J Adolesc Young Adult Oncol 2018; 7:112-119. [DOI: 10.1089/jayao.2017.0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Sophie Fletcher
- Silver Chain Hospice Community Service, Perth, Western Australia
| | - Rachel Hughes
- Youth Cancer Services, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Sarah Pickstock
- Silver Chain Hospice Community Service, Perth, Western Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia (Albany), University of Western Australia, Albany, Western Australia
| |
Collapse
|
23
|
Rogan A, McCarthy K, McGregor G, Hamborg T, Evans G, Hewins S, Aldridge N, Fletcher S, Krishnan N, Higgins R, Zehnder D, Ting SM. Correction: Quality of life measures predict cardiovascular health and physical performance in chronic renal failure patients. PLoS One 2017; 12:e0189382. [PMID: 29206877 PMCID: PMC5716600 DOI: 10.1371/journal.pone.0189382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
24
|
Rogan A, McCarthy K, McGregor G, Hamborg T, Evans G, Hewins S, Aldridge N, Fletcher S, Krishnan N, Higgins R, Zehnder D, Ting SM. Quality of life measures predict cardiovascular health and physical performance in chronic renal failure patients. PLoS One 2017; 12:e0183926. [PMID: 28910330 PMCID: PMC5598960 DOI: 10.1371/journal.pone.0183926] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/14/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with advanced chronic kidney disease (CKD) experience complex functional and structural changes of the cardiopulmonary and musculoskeletal system. This results in reduced exercise tolerance, quality of life and ultimately premature death. We investigated the relationship between subjective measures of health related quality of life and objective, standardised functional measures for cardiovascular and pulmonary health. METHODS Between April 2010 and January 2013, 143 CKD stage-5 or CKD5d patients (age 46.0±1.1y, 62.2% male), were recruited prospectively. A control group of 83 healthy individuals treated for essential hypertension (HTN; age 53.2±0.9y, 48.22% male) were recruited at random. All patients completed the SF-36 health survey questionnaire, echocardiography, vascular tonometry and cardiopulmonary exercise testing. RESULTS Patients with CKD had significantly lower SF-36 scores than the HTN group; for physical component score (PCS; 45.0 vs 53.9, p<0.001) and mental component score (MCS; 46.9 vs. 54.9, p<0.001). CKD subjects had significantly poorer exercise tolerance and cardiorespiratory performance compared with HTN (maximal oxygen uptake; VO2peak 19.9 vs 25.0ml/kg/min, p<0.001). VO2peak was a significant independent predictor of PCS in both groups (CKD: b = 0.35, p = 0.02 vs HTN: b = 0.27, p = 0.001). No associations were noted between PCS scores and echocardiographic characteristics, vascular elasticity and cardiac biomarkers in either group. No associations were noted between MCS and any variable. The interaction effect of study group with VO2peak on PCS was not significant (ΔB = 0.08; 95%CI -0.28-0.45, p = 0.7). However, overall for a given VO2peak, the measured PCS was much lower for patients with CKD than for HTN cohort, a likely consequence of systemic uremia effects. CONCLUSION In CKD and HTN, objective physical performance has a significant effect on quality of life; particularly self-reported physical health and functioning. Therefore, these quality of life measures are indeed a good reflection of physical health correlating highly with objective physical performance measures.
Collapse
Affiliation(s)
- A. Rogan
- Department of Emergency Medicine, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand
- Department of Renal Medicine and Transplantation, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- * E-mail:
| | - K. McCarthy
- Department of Renal Medicine and Transplantation, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - G. McGregor
- Department of Renal Medicine and Transplantation, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Department of Cardiac Rehabilitation and Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - T. Hamborg
- Division of Health Sciences Statistics and Epidemiology, University of Warwick, Coventry, United Kingdom
| | - G. Evans
- Department of Renal Medicine and Transplantation, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S. Hewins
- Department of Renal Medicine and Transplantation, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - N. Aldridge
- Department of Renal Medicine and Transplantation, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S. Fletcher
- Department of Renal Medicine and Transplantation, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - N. Krishnan
- Department of Renal Medicine and Transplantation, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - R. Higgins
- Department of Renal Medicine and Transplantation, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - D. Zehnder
- Department of Acute Medicine, North Cumbria University Hospital NHS Trust, Carlisle, United Kingdom
- Division of Translational Medicine, University of Warwick, Coventry, United Kingdom
| | - S. M. Ting
- Division of Translational Medicine, University of Warwick, Coventry, United Kingdom
- Department of Acute Medicine, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
25
|
Kitchener H, Gittins M, Cruickshank M, Moseley C, Fletcher S, Albrow R, Gray A, Brabin L, Torgerson D, Crosbie EJ, Sargent A, Roberts C. A cluster randomized trial of strategies to increase uptake amongst young women invited for their first cervical screen: The STRATEGIC trial. J Med Screen 2017; 25:88-98. [PMID: 28530513 PMCID: PMC5956569 DOI: 10.1177/0969141317696518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Indexed: 01/22/2023]
Abstract
Objectives To measure the feasibility and effectiveness of interventions to increase cervical screening uptake amongst young women. Methods A two-phase cluster randomized trial conducted in general practices in the NHS Cervical Screening Programme. In Phase 1, women in practices randomized to intervention due for their first invitation to cervical screening received a pre-invitation leaflet and, separately, access to online booking. In Phase 2, non-attenders at six months were randomized to one of: vaginal self-sample kits sent unrequested or offered; timed appointments; nurse navigator; or the choice between nurse navigator or self-sample kits. Primary outcome was uplift in intervention vs. control practices, at 3 and 12 months post invitation. Results Phase 1 randomized 20,879 women. Neither pre-invitation leaflet nor online booking increased screening uptake by three months (18.8% pre-invitation leaflet vs. 19.2% control and 17.8% online booking vs. 17.2% control). Uptake was higher amongst human papillomavirus vaccinees at three months (OR 2.07, 95% CI 1.69–2.53, p < 0.001). Phase 2 randomized 10,126 non-attenders, with 32–34 clusters for each intervention and 100 clusters as controls. Sending self-sample kits increased uptake at 12 months (OR 1.51, 95% CI 1.20–1.91, p = 0.001), as did timed appointments (OR 1.41, 95% CI 1.14–1.74, p = 0.001). The offer of a nurse navigator, a self-sample kits on request, and choice between timed appointments and nurse navigator were ineffective. Conclusions Amongst non-attenders, self-sample kits sent and timed appointments achieved an uplift in screening over the short term; longer term impact is less certain. Prior human papillomavirus vaccination was associated with increased screening uptake.
Collapse
Affiliation(s)
- H Kitchener
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - M Gittins
- 2 Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - M Cruickshank
- 3 Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK
| | - C Moseley
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - S Fletcher
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - R Albrow
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - A Gray
- 4 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - L Brabin
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - D Torgerson
- 5 Department of Health Sciences, University of York, York, UK
| | - E J Crosbie
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - A Sargent
- 6 Virology Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - C Roberts
- 2 Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, UK
| |
Collapse
|
26
|
Schnell F, Donoghue C, Dworzak J, Charleston J, Frank D, Wilton S, Fletcher S, Lewis S, Mendell J, Rodino-Klapac L, Sahenk Z. Development of a validated Western blot method for quantification of human dystrophin protein used in phase 2 and 3 clinical trials of eteplirsen for the treatment of Duchenne muscular dystrophy. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30264-x] [Citation(s) in RCA: 2] [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: 11/24/2022]
|
27
|
Abstract
INTRODUCTION Antisense nucleic acid analogues can interact with pre-mRNA motifs and influence exon or splice site selection and thereby alter gene expression. Design of antisense molecules to target specific motifs can result in either exon exclusion or exon inclusion during splicing. Novel drugs exploiting the antisense concept are targeting rare, life-limiting diseases; however, the potential exists to treat a wide range of conditions by antisense-mediated splice intervention. Areas covered: In this review, the authors discuss the clinical translation of novel molecular therapeutics to address the fatal neuromuscular disorders Duchenne muscular dystrophy and spinal muscular atrophy. The review also highlights difficulties posed by issues pertaining to restricted participant numbers, variable phenotype and disease progression, and the identification and validation of study endpoints. Expert opinion: Translation of novel therapeutics for Duchenne muscular dystrophy and spinal muscular atrophy has been greatly advanced by multidisciplinary research, academic-industry partnerships and in particular, the engagement and support of the patient community. Sponsors, supporters and regulators are cooperating to deliver new drugs and identify and define meaningful outcome measures. Non-conventional and adaptive trial design could be particularly suited to clinical evaluation of novel therapeutics and strategies to treat serious, rare diseases that may be problematic to study using more conventional clinical trial structures.
Collapse
Affiliation(s)
- S Fletcher
- a Centre for Neuromuscular and Neurological Disorders , University of Western Australia , Nedlands , Western Australia , Australia.,b Western Australian Neuroscience Research Institute , Nedlands , Western Australia , Australia.,c Centre for Comparative Genomics , Murdoch University , Western Australia , Australia
| | - M I Bellgard
- b Western Australian Neuroscience Research Institute , Nedlands , Western Australia , Australia.,c Centre for Comparative Genomics , Murdoch University , Western Australia , Australia
| | - L Price
- a Centre for Neuromuscular and Neurological Disorders , University of Western Australia , Nedlands , Western Australia , Australia.,b Western Australian Neuroscience Research Institute , Nedlands , Western Australia , Australia.,c Centre for Comparative Genomics , Murdoch University , Western Australia , Australia
| | - A P Akkari
- b Western Australian Neuroscience Research Institute , Nedlands , Western Australia , Australia.,c Centre for Comparative Genomics , Murdoch University , Western Australia , Australia.,d Shiraz Pharmaceuticals, Inc , Chapel Hill , NC , USA
| | - S D Wilton
- a Centre for Neuromuscular and Neurological Disorders , University of Western Australia , Nedlands , Western Australia , Australia.,b Western Australian Neuroscience Research Institute , Nedlands , Western Australia , Australia.,c Centre for Comparative Genomics , Murdoch University , Western Australia , Australia
| |
Collapse
|
28
|
Khavari R, Karmonik C, Shy M, Fletcher S, Boone T. Functional Magnetic Resonance Imaging with Concurrent Urodynamic Testing Identifies Brain Structures Involved in Micturition Cycle in Patients with Multiple Sclerosis. J Urol 2016; 197:438-444. [PMID: 27664581 DOI: 10.1016/j.juro.2016.09.077] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 09/06/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE Neurogenic lower urinary tract dysfunction, which is common in patients with multiple sclerosis, has a significant impact on quality of life. In this study we sought to determine brain activity processes during the micturition cycle in female patients with multiple sclerosis and neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS We report brain activity on functional magnetic resonance imaging and simultaneous urodynamic testing in 23 ambulatory female patients with multiple sclerosis. Individual functional magnetic resonance imaging activation maps at strong desire to void and at initiation of voiding were calculated and averaged at Montreal Neuroimaging Institute. Areas of significant activation were identified in these average maps. Subgroup analysis was performed in patients with elicitable neurogenic detrusor overactivity or detrusor-sphincter dyssynergia. RESULTS Group analysis of all patients at strong desire to void yielded areas of activation in regions associated with executive function (frontal gyrus), emotional regulation (cingulate gyrus) and motor control (putamen, cerebellum and precuneus). Comparison of the average change in activation between previously reported healthy controls and patients with multiple sclerosis showed predominantly stronger, more focal activation in the former and lower, more diffused activation in the latter. Patients with multiple sclerosis who had demonstrable neurogenic detrusor overactivity and detrusor-sphincter dyssynergia showed a trend toward distinct brain activation at full urge and at initiation of voiding respectively. CONCLUSIONS We successfully studied brain activation during the entire micturition cycle in female patients with neurogenic lower urinary tract dysfunction and multiple sclerosis using a concurrent functional magnetic resonance imaging/urodynamic testing platform. Understanding the central neural processes involved in specific parts of micturition in patients with neurogenic lower urinary tract dysfunction may identify areas of interest for future intervention.
Collapse
Affiliation(s)
- Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, Texas.
| | | | - Michael Shy
- Innovative Urology Practice of New York, Queens, New York
| | | | - Timothy Boone
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| |
Collapse
|
29
|
Fletcher S, Jones MG, Spinks K, Sgalla G, Marshall BG, Limbrey R, Richeldi L. The safety of new drug treatments for idiopathic pulmonary fibrosis. Expert Opin Drug Saf 2016; 15:1483-1489. [DOI: 10.1080/14740338.2016.1218470] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Sophie Fletcher
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
| | - Mark G. Jones
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
- Academic Unit of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, UK
| | - Katherine Spinks
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
| | - Giacomo Sgalla
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
- Academic Unit of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, UK
| | - Ben G. Marshall
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
| | - Rachel Limbrey
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
| | - Luca Richeldi
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
- Academic Unit of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, UK
| |
Collapse
|
30
|
Khavari R, Karmonik C, Potter T, Shy M, Fletcher S, Boone T. MP17-09 TRENDS IN SUPRASPINAL VARIATION IN PATIENTS WITH MULTIPLE SCLEROSIS AND DETRUSOR SPHINCTER DYSSENERGIA. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2677] [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: 11/25/2022]
|
31
|
Glover G, Fletcher S, Esquinas A. Prediction of Non-invasive Mechanical Ventilation Response. Moving from Art to Science? Methods Inf Med 2016; 55:200-1. [PMID: 26928232 DOI: 10.3414/me15-04-0006] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 01/19/2016] [Indexed: 11/09/2022]
Abstract
Predicting the outcome from NIV is important and the study by Martin-Gonzalez and colleagues applies data mining techniques to improve our understanding of the field. Nevertheless, the predictor variables must be robust and reliably available before NIV is applied. A predictive model must be generalisable in other clinical settings. Until models such as this are extremely robust in their predictive ability and have been shown to positively influence patient centered outcomes, they may be able to assist decision making but cannot replace clinical judgement by an experienced bedside clinician.
Collapse
Affiliation(s)
- G Glover
- Guy Glover, Guy's and St Thomas' NHS Foundation Trust, Critical Care, Westminster Bridge Road, London SE1 7EH, UK, E-mail:
| | | | | |
Collapse
|
32
|
Papanna R, Moise KJ, Mann LK, Fletcher S, Schniederjan R, Bhattacharjee MB, Stewart RJ, Kaur S, Prabhu SP, Tseng SCG. Cryopreserved human umbilical cord patch for in-utero spina bifida repair. Ultrasound Obstet Gynecol 2016; 47:168-176. [PMID: 26489897 DOI: 10.1002/uog.15790] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To identify a patch system to repair surgically created spina bifida in a sheep model for its efficacy in healing the skin defect, protecting the underlying spinal cord and reducing the Chiari II malformation. METHODS Spina bifida was created surgically in 16 fetuses from eight timed-pregnant sheep at gestational age of 75 days. Two fetuses did not survive the procedure. Repeat hysterotomy was performed at 95 days' gestation to cover the defect with either biocellulose film with underwater adhesive (BCF-adhesive) (n = 7) or human umbilical cord with suture (HUC-suture) (n = 7). Three fetuses without formation of the defect served as reference controls. The skin healing was examined by direct visualization after a planned Cesarean section at term, followed by histological analysis using hematoxylin and eosin and Masson's trichrome stains. Mid-sagittal sections of the fetal cranium and upper cervical spine were analyzed by a pediatric neuroradiologist who was blinded to the type of patch received. RESULTS Three fetuses that received the BCF-adhesive and six fetuses that received the HUC-suture survived to term for final analysis. As a result of dislodgment of the BCF-adhesive, all spina bifida defects repaired using BCF-adhesive were not healed and showed exposed spinal cord with leakage of cerebrospinal fluid. In contrast, all spinal defects repaired by HUC-suture were healed with complete regrowth of epidermal, dermal and subdermal tissue components, with no exposed spinal cord. The maximal skin wound width was 21 ± 3.6 mm in the BCF-adhesive group but 3 ± 0.8 mm in the HUC-suture group (P < 0.001). The spinal cord area (P = 0.001) and the number of anterior horn cells (P = 0.03) was preserved to a greater degree in the HUC-suture group than in the BCF-adhesive group, whilst psammoma bodies, signifying neuronal degeneration, were only observed in the BCF-adhesive group. Anatomic changes, indicative of Chiari II malformation, were seen in all three fetuses of the BCF-adhesive group but in none of the HUC-suture group (P < 0.01). CONCLUSION Cryopreserved umbilical cord graft is a promising regenerative patch for intrauterine repair of spina bifida.
Collapse
Affiliation(s)
- R Papanna
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UT Health School of Medicine, Houston, TX, USA
- Fetal Center, Houston, TX, USA
| | - K J Moise
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UT Health School of Medicine, Houston, TX, USA
- Fetal Center, Houston, TX, USA
| | - L K Mann
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UT Health School of Medicine, Houston, TX, USA
- Department of Pathology and Laboratory Services, UT Health School of Medicine, Houston, TX, USA
| | - S Fletcher
- Department of Pediatrics, Division of Pediatric Neurosurgery, UT Health School of Medicine, Houston, TX, USA
| | - R Schniederjan
- Department of Pediatric Surgery, UT Health School of Medicine, Houston, TX, USA
| | - M B Bhattacharjee
- Department of Pediatric Surgery, UT Health School of Medicine, Houston, TX, USA
| | - R J Stewart
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - S Kaur
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - S P Prabhu
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - S C G Tseng
- Ocular Surface Center and TissueTech, Inc., Miami, FL, USA
| |
Collapse
|
33
|
Chen L, Wilder PT, Drennen B, Tran J, Roth BM, Chesko K, Shapiro P, Fletcher S. Structure-based design of 3-carboxy-substituted 1,2,3,4-tetrahydroquinolines as inhibitors of myeloid cell leukemia-1 (Mcl-1). Org Biomol Chem 2016; 14:5505-10. [DOI: 10.1039/c5ob02063h] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A novel Mcl-1 inhibitor chemotype based on a tetrahydroquinoline carboxylic acid was developed utilizing structure-based design, which was subsequently validated by a fluorescence polarization competition assay and HSQC NMR analysis.
Collapse
Affiliation(s)
- L. Chen
- Department of Pharmaceutical Sciences
- University of Maryland School of Pharmacy
- Baltimore
- USA
| | - P. T. Wilder
- Department of Biochemistry and Molecular Biology
- University of Maryland School of Medicine
- Baltimore
- USA
- University of Maryland Greenebaum Cancer Center
| | - B. Drennen
- Department of Pharmaceutical Sciences
- University of Maryland School of Pharmacy
- Baltimore
- USA
| | - J. Tran
- PharmD Program
- University of Maryland School of Pharmacy
- Baltimore
- USA
| | - B. M. Roth
- Department of Biochemistry and Molecular Biology
- University of Maryland School of Medicine
- Baltimore
- USA
- University of Maryland Greenebaum Cancer Center
| | - K. Chesko
- Department of Pharmaceutical Sciences
- University of Maryland School of Pharmacy
- Baltimore
- USA
| | - P. Shapiro
- Department of Pharmaceutical Sciences
- University of Maryland School of Pharmacy
- Baltimore
- USA
- University of Maryland Greenebaum Cancer Center
| | - S. Fletcher
- Department of Pharmaceutical Sciences
- University of Maryland School of Pharmacy
- Baltimore
- USA
- University of Maryland Greenebaum Cancer Center
| |
Collapse
|
34
|
Lanning ME, Wilder PT, Bailey H, Drennen B, Cavalier M, Chen L, Yap JL, Raje M, Fletcher S. Towards more drug-like proteomimetics: two-faced, synthetic α-helix mimetics based on a purine scaffold. Org Biomol Chem 2015. [PMID: 26204921 DOI: 10.1039/c5ob00478k] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Mimicry of two faces of an α-helix might yield more potent and more selective inhibitors of aberrant, helix-mediated protein-protein interactions (PPI). Herein, we demonstrate that a 2,6,9-tri-substituted purine is capable of disrupting the Mcl-1-Bak-BH3 PPI through effective mimicry of key residues on opposing faces of the Bak-BH3 α-helix.
Collapse
Affiliation(s)
- M E Lanning
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 N. Pine St., Baltimore, MD 21201, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Glegg G, Jefferson R, Fletcher S. Marine governance in the English Channel (La Manche): Linking science and management. Mar Pollut Bull 2015; 95:707-718. [PMID: 25819447 DOI: 10.1016/j.marpolbul.2015.02.020] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 12/14/2014] [Accepted: 02/12/2015] [Indexed: 06/04/2023]
Abstract
The English Channel is one of the world's busiest sea areas with intense shipping and port activity juxtaposed with recreation, communications and important conservation areas. Opportunities for marine renewable energy vie with existing activities for space. The current governance of the English Channel is reviewed and found to lack integration between countries, sectors, legislation and scientific research. Recent developments within the EU's marine management frameworks are significantly altering our approach to marine governance and this paper explores the implications of these new approaches to management of the English Channel. Existing mechanisms for cross-Channel science and potential benefits of an English Channel scale perspective are considered. In conclusion, current management practices are considered against the 12 Malawi Principles of the ecosystem approach resulting in proposals for enhancing governance of the region through science at the scale of the English Channel.
Collapse
Affiliation(s)
- G Glegg
- Centre for Marine and Coastal Policy Research, Plymouth University, Drake Circus, Plymouth PL4 8AA, UK.
| | - R Jefferson
- Centre for Marine and Coastal Policy Research, Plymouth University, Drake Circus, Plymouth PL4 8AA, UK; RSPB Centre for Conservation Science, RSPB, The Lodge, Sandy, Bedfordshire SG19 2DL, UK.
| | - S Fletcher
- Centre for Marine and Coastal Policy Research, Plymouth University, Drake Circus, Plymouth PL4 8AA, UK.
| |
Collapse
|
36
|
Wilton SD, Veedu RN, Fletcher S. The emperor's new dystrophin: finding sense in the noise. Trends Mol Med 2015; 21:417-26. [PMID: 26051381 DOI: 10.1016/j.molmed.2015.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 03/17/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 01/16/2023]
Abstract
Targeted dystrophin exon removal is a promising therapy for Duchenne muscular dystrophy (DMD); however, dystrophin expression in some reports is not supported by the associated data. As in the account of 'The Emperor's New Clothes', the validity of such claims must be questioned, with critical re-evaluation of available data. Is it appropriate to report clinical benefit and induction of dystrophin as dose dependent when the baseline is unclear? The inability to induce meaningful levels of dystrophin does not mean that dystrophin expression as an end point is irrelevant, nor that induced exon skipping as a strategy is flawed, but demands that drug safety and efficacy, and study parameters be addressed, rather than questioning the strategy or the validity of dystrophin as a biomarker.
Collapse
Affiliation(s)
- S D Wilton
- Centre for Comparative Genomics, Murdoch University, 90 South Street, Murdoch, WA 6009, Australia; West Australian Neuroscience Research Institute, Murdoch University, 90 South Street, Murdoch, WA 6009, Australia.
| | - R N Veedu
- Centre for Comparative Genomics, Murdoch University, 90 South Street, Murdoch, WA 6009, Australia; West Australian Neuroscience Research Institute, Murdoch University, 90 South Street, Murdoch, WA 6009, Australia
| | - S Fletcher
- Centre for Comparative Genomics, Murdoch University, 90 South Street, Murdoch, WA 6009, Australia; West Australian Neuroscience Research Institute, Murdoch University, 90 South Street, Murdoch, WA 6009, Australia
| |
Collapse
|
37
|
Fletcher S. Book review: War, art and surgery – the work of Henry Tonks and Julia Midgley. Br Dent J 2015. [DOI: 10.1038/sj.bdj.2015.362] [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: 11/09/2022]
|
38
|
Everitt J, Fletcher S, Caird-Daley A. Task analysis of discrete and continuous skills: a dual methodology approach to human skills capture for automation. Theoretical Issues in Ergonomics Science 2015. [DOI: 10.1080/1463922x.2015.1028508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
39
|
Shy M, Karmonik C, Anderson J, Alkattan A, Boone T, Fung S, Fletcher S, Khavari R. PD10-02 HIGHER NEURAL CORRELATES AT INITIATION OF VOIDING IN PATIENTS WITH MULTIPLE SCLEROSIS WITH NEUROGENIC BLADDER DYSFUNCTION VIA CONCURRENT FUNCTIONAL MAGNETIC RESONANCE IMAGING (FMRI) AND URODYNAMIC STUDIES. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
40
|
Martin A, Bovill WD, Percy CD, Herde D, Fletcher S, Kelly A, Neate SM, Sutherland MW. Markers for seedling and adult plant crown rot resistance in four partially resistant bread wheat sources. Theor Appl Genet 2015; 128:377-85. [PMID: 25471673 DOI: 10.1007/s00122-014-2437-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 11/21/2014] [Indexed: 05/24/2023]
Abstract
QTL identified for seedling and adult plant crown rot resistance in four partially resistant hexaploid wheat sources. PCR-based markers identified for use in marker-assisted selection. Crown rot, caused by Fusarium pseudograminearum, is an important disease of wheat in many wheat-growing regions globally. Complete resistance to infection by F. pseudograminearum has not been observed in a wheat host, but germplasm with partial resistance to this pathogen has been identified. The partially resistant wheat hexaploid germplasm sources 2-49, Sunco, IRN497 and CPI133817 were investigated in both seedling and adult plant field trials to identify markers associated with the resistance which could be used in marker-assisted selection programs. Thirteen different quantitative trait loci (QTL) conditioning crown rot resistance were identified in the four different sources. Some QTL were only observed in seedling trials whereas others appeared to be adult plant specific. For example while the QTL on chromosomes 1AS, 1BS, and 4BS contributed by 2-49 and on 2BS contributed by Sunco were detected in both seedling and field trials, the QTL on 1DL present in 2-49 and the QTL on 3BL in IRN497 were only detected in seedling trials. Genetic correlations between field trials of the same population were strong, as were correlations between seedling trials of the same population. Low to moderate correlations were observed between seedling and field trials. Flanking markers, most of which are less than 10 cM apart, have now been identified for each of the regions associated with crown rot resistance.
Collapse
Affiliation(s)
- A Martin
- Centre for Crop Health, University of Southern Queensland, Toowoomba, QLD, 4350, Australia,
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Fletcher S. SUPER SUPERVISORS. Midwives 2015; 18:27. [PMID: 26665791] [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]
|
42
|
Abstract
Recent advancements in the condensation of alcohols with pronucleophiles by the Mitsunobu reaction are described.
Collapse
Affiliation(s)
- S. Fletcher
- Department of Pharmaceutical Sciences
- University of Maryland School of Pharmacy
- Baltimore
- USA
- University of Maryland Greenebaum Cancer Center
| |
Collapse
|
43
|
Johnstone V, Viola H, Adams A, Wilton S, Fletcher S, Hool L. Optimising morpholino oligomer therapy in the treatment of mdx cardiomyopathy. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
44
|
Dye J, Scallon A, Qian F, Fletcher S. Musculoskeletal disorder among oral and maxillofacial surgeons and operating position. J Oral Maxillofac Surg 2014. [DOI: 10.1016/j.joms.2014.06.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
45
|
Fletcher S, Nosek MA, Rizk DEE. Mobility impairments and pelvic health disorders in women: the need for innovative treatment and research. Int Urogynecol J 2014; 25:1003-4. [PMID: 24928502 DOI: 10.1007/s00192-014-2428-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Sophie Fletcher
- Department of Urology, Kaiser Permanente, 401 Bicentennial Way, Santa Rosa, CA, 95403, USA,
| | | | | |
Collapse
|
46
|
Longstaff A, Fletcher S, Parkinson S, Myers A. The role of measurement and modelling of machine tools in improving product quality. Int J Metrol Qual Eng 2014. [DOI: 10.1051/ijmqe/2013054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
47
|
Burghes A, McGovern V, Porensky P, Arnold W, Mitrpant C, Price L, Fletcher S, Wilton S. O10 Development of PMO antisense oligonucleotides for treatment of Spinal muscular atrophy. Neuromuscul Disord 2014. [DOI: 10.1016/s0960-8966(14)70011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
48
|
Velthuis J, Page R, Hugtenburg R, Blake S, Crawford D, Fletcher S, Saunders M, Stevens P. 207: An Intensity Modulated Radiotherapy Beam Monitoring System using a Monolithic Active Pixel Sensor. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)34228-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
49
|
Blake S, Fletcher S, Stevens P, Velthuis J, Page R, Hugtenberg R. OC-0509: Early results for a novel IMRT verification system based on an upstream MAPS detector. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
50
|
|