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Buono FD, Larkin K, Zempsky WT, Grau LE, Martin S. Understanding chronic pain in Neurofibromatosis Type 1 using the Neurofibromatosis Pain Module (NFPM). Am J Med Genet A 2024; 194:e63541. [PMID: 38234177 DOI: 10.1002/ajmg.a.63541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/13/2023] [Accepted: 01/05/2024] [Indexed: 01/19/2024]
Abstract
Neurofibromatosis Type 1 (NF1) is an autosomal dominant genetic disorder that can cause an individual significant chronic pain (CP). CP affects quality of life and daily functioning, yet there are limited effective treatments for CP within NF1. The current study describes the impact of CP using the Neurofibromatosis Pain Module (NFPM). The NFPM is a self-reported clinical assessment that evaluates the impact of CP across multiple domains (e.g., interference, severity, tolerance, and symptomology) and three prioritized pain regions. A cross-sectional study (N = 242) asked adults with NF1 to describe and rate their pain using the NFPM. The results indicated that they reported moderate pain severity (M = 6.6, SD = 2.0) on a 0-10 scale, that 54% (n = 131) had been in pain at least 24 days in the last 30, for 75% (n = 181) sleep was affected, and 16% reported that nothing was effective in reducing their CP for their primary pain region. The current results extend previously published work on CP within adults with NF1 and indicate that more emphasis on understanding and ameliorating CP is required. The NFPM is a sensitive clinical measure that provides qualitative and quantitative responses to inform medical providers about changes in CP.
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Affiliation(s)
- Frank D Buono
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - William T Zempsky
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | | | - Staci Martin
- National Cancer Institute, Bethesda, Maryland, USA
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2
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Rosenberg E, Andersen TI, Samajdar R, Petukhov A, Hoke JC, Abanin D, Bengtsson A, Drozdov IK, Erickson C, Klimov PV, Mi X, Morvan A, Neeley M, Neill C, Acharya R, Allen R, Anderson K, Ansmann M, Arute F, Arya K, Asfaw A, Atalaya J, Bardin JC, Bilmes A, Bortoli G, Bourassa A, Bovaird J, Brill L, Broughton M, Buckley BB, Buell DA, Burger T, Burkett B, Bushnell N, Campero J, Chang HS, Chen Z, Chiaro B, Chik D, Cogan J, Collins R, Conner P, Courtney W, Crook AL, Curtin B, Debroy DM, Barba ADT, Demura S, Di Paolo A, Dunsworth A, Earle C, Faoro L, Farhi E, Fatemi R, Ferreira VS, Burgos LF, Forati E, Fowler AG, Foxen B, Garcia G, Genois É, Giang W, Gidney C, Gilboa D, Giustina M, Gosula R, Dau AG, Gross JA, Habegger S, Hamilton MC, Hansen M, Harrigan MP, Harrington SD, Heu P, Hill G, Hoffmann MR, Hong S, Huang T, Huff A, Huggins WJ, Ioffe LB, Isakov SV, Iveland J, Jeffrey E, Jiang Z, Jones C, Juhas P, Kafri D, Khattar T, Khezri M, Kieferová M, Kim S, Kitaev A, Klots AR, Korotkov AN, Kostritsa F, Kreikebaum JM, Landhuis D, Laptev P, Lau KM, Laws L, Lee J, Lee KW, Lensky YD, Lester BJ, Lill AT, Liu W, Locharla A, Mandrà S, Martin O, Martin S, McClean JR, McEwen M, Meeks S, Miao KC, Mieszala A, Montazeri S, Movassagh R, Mruczkiewicz W, Nersisyan A, Newman M, Ng JH, Nguyen A, Nguyen M, Niu MY, O'Brien TE, Omonije S, Opremcak A, Potter R, Pryadko LP, Quintana C, Rhodes DM, Rocque C, Rubin NC, Saei N, Sank D, Sankaragomathi K, Satzinger KJ, Schurkus HF, Schuster C, Shearn MJ, Shorter A, Shutty N, Shvarts V, Sivak V, Skruzny J, Smith WC, Somma RD, Sterling G, Strain D, Szalay M, Thor D, Torres A, Vidal G, Villalonga B, Heidweiller CV, White T, Woo BWK, Xing C, Yao ZJ, Yeh P, Yoo J, Young G, Zalcman A, Zhang Y, Zhu N, Zobrist N, Neven H, Babbush R, Bacon D, Boixo S, Hilton J, Lucero E, Megrant A, Kelly J, Chen Y, Smelyanskiy V, Khemani V, Gopalakrishnan S, Prosen T, Roushan P. Dynamics of magnetization at infinite temperature in a Heisenberg spin chain. Science 2024; 384:48-53. [PMID: 38574139 DOI: 10.1126/science.adi7877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 03/01/2024] [Indexed: 04/06/2024]
Abstract
Understanding universal aspects of quantum dynamics is an unresolved problem in statistical mechanics. In particular, the spin dynamics of the one-dimensional Heisenberg model were conjectured as to belong to the Kardar-Parisi-Zhang (KPZ) universality class based on the scaling of the infinite-temperature spin-spin correlation function. In a chain of 46 superconducting qubits, we studied the probability distribution of the magnetization transferred across the chain's center, [Formula: see text]. The first two moments of [Formula: see text] show superdiffusive behavior, a hallmark of KPZ universality. However, the third and fourth moments ruled out the KPZ conjecture and allow for evaluating other theories. Our results highlight the importance of studying higher moments in determining dynamic universality classes and provide insights into universal behavior in quantum systems.
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Affiliation(s)
- E Rosenberg
- Google Research, Mountain View, CA, USA
- Department of Physics, Cornell University, Ithaca, NY, USA
| | | | - R Samajdar
- Department of Physics, Princeton University, Princeton, NJ, USA
- Princeton Center for Theoretical Science, Princeton University, Princeton, NJ, USA
| | | | - J C Hoke
- Department of Physics, Stanford University, Stanford, CA, USA
| | - D Abanin
- Google Research, Mountain View, CA, USA
| | | | - I K Drozdov
- Google Research, Mountain View, CA, USA
- Department of Physics, University of Connecticut, Storrs, CT, USA
| | | | | | - X Mi
- Google Research, Mountain View, CA, USA
| | - A Morvan
- Google Research, Mountain View, CA, USA
| | - M Neeley
- Google Research, Mountain View, CA, USA
| | - C Neill
- Google Research, Mountain View, CA, USA
| | - R Acharya
- Google Research, Mountain View, CA, USA
| | - R Allen
- Google Research, Mountain View, CA, USA
| | | | - M Ansmann
- Google Research, Mountain View, CA, USA
| | - F Arute
- Google Research, Mountain View, CA, USA
| | - K Arya
- Google Research, Mountain View, CA, USA
| | - A Asfaw
- Google Research, Mountain View, CA, USA
| | - J Atalaya
- Google Research, Mountain View, CA, USA
| | - J C Bardin
- Google Research, Mountain View, CA, USA
- Department of Electrical and Computer Engineering, University of Massachusetts, Amherst, MA, USA
| | - A Bilmes
- Google Research, Mountain View, CA, USA
| | - G Bortoli
- Google Research, Mountain View, CA, USA
| | | | - J Bovaird
- Google Research, Mountain View, CA, USA
| | - L Brill
- Google Research, Mountain View, CA, USA
| | | | | | - D A Buell
- Google Research, Mountain View, CA, USA
| | - T Burger
- Google Research, Mountain View, CA, USA
| | - B Burkett
- Google Research, Mountain View, CA, USA
| | | | - J Campero
- Google Research, Mountain View, CA, USA
| | - H-S Chang
- Google Research, Mountain View, CA, USA
| | - Z Chen
- Google Research, Mountain View, CA, USA
| | - B Chiaro
- Google Research, Mountain View, CA, USA
| | - D Chik
- Google Research, Mountain View, CA, USA
| | - J Cogan
- Google Research, Mountain View, CA, USA
| | - R Collins
- Google Research, Mountain View, CA, USA
| | - P Conner
- Google Research, Mountain View, CA, USA
| | | | - A L Crook
- Google Research, Mountain View, CA, USA
| | - B Curtin
- Google Research, Mountain View, CA, USA
| | | | | | - S Demura
- Google Research, Mountain View, CA, USA
| | | | | | - C Earle
- Google Research, Mountain View, CA, USA
| | - L Faoro
- Google Research, Mountain View, CA, USA
| | - E Farhi
- Google Research, Mountain View, CA, USA
| | - R Fatemi
- Google Research, Mountain View, CA, USA
| | | | | | - E Forati
- Google Research, Mountain View, CA, USA
| | | | - B Foxen
- Google Research, Mountain View, CA, USA
| | - G Garcia
- Google Research, Mountain View, CA, USA
| | - É Genois
- Google Research, Mountain View, CA, USA
| | - W Giang
- Google Research, Mountain View, CA, USA
| | - C Gidney
- Google Research, Mountain View, CA, USA
| | - D Gilboa
- Google Research, Mountain View, CA, USA
| | | | - R Gosula
- Google Research, Mountain View, CA, USA
| | | | - J A Gross
- Google Research, Mountain View, CA, USA
| | | | - M C Hamilton
- Google Research, Mountain View, CA, USA
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
| | - M Hansen
- Google Research, Mountain View, CA, USA
| | | | | | - P Heu
- Google Research, Mountain View, CA, USA
| | - G Hill
- Google Research, Mountain View, CA, USA
| | | | - S Hong
- Google Research, Mountain View, CA, USA
| | - T Huang
- Google Research, Mountain View, CA, USA
| | - A Huff
- Google Research, Mountain View, CA, USA
| | | | - L B Ioffe
- Google Research, Mountain View, CA, USA
| | | | - J Iveland
- Google Research, Mountain View, CA, USA
| | - E Jeffrey
- Google Research, Mountain View, CA, USA
| | - Z Jiang
- Google Research, Mountain View, CA, USA
| | - C Jones
- Google Research, Mountain View, CA, USA
| | - P Juhas
- Google Research, Mountain View, CA, USA
| | - D Kafri
- Google Research, Mountain View, CA, USA
| | - T Khattar
- Google Research, Mountain View, CA, USA
| | - M Khezri
- Google Research, Mountain View, CA, USA
| | - M Kieferová
- Google Research, Mountain View, CA, USA
- QSI, Faculty of Engineering & Information Technology, University of Technology Sydney, Ultimo, NSW, Australia
| | - S Kim
- Google Research, Mountain View, CA, USA
| | - A Kitaev
- Google Research, Mountain View, CA, USA
| | - A R Klots
- Google Research, Mountain View, CA, USA
| | - A N Korotkov
- Google Research, Mountain View, CA, USA
- Department of Electrical and Computer Engineering, University of California, Riverside, CA, USA
| | | | | | | | - P Laptev
- Google Research, Mountain View, CA, USA
| | - K-M Lau
- Google Research, Mountain View, CA, USA
| | - L Laws
- Google Research, Mountain View, CA, USA
| | - J Lee
- Google Research, Mountain View, CA, USA
- Department of Chemistry, Columbia University, New York, NY, USA
| | - K W Lee
- Google Research, Mountain View, CA, USA
| | | | | | - A T Lill
- Google Research, Mountain View, CA, USA
| | - W Liu
- Google Research, Mountain View, CA, USA
| | | | - S Mandrà
- Google Research, Mountain View, CA, USA
| | - O Martin
- Google Research, Mountain View, CA, USA
| | - S Martin
- Google Research, Mountain View, CA, USA
| | | | - M McEwen
- Google Research, Mountain View, CA, USA
| | - S Meeks
- Google Research, Mountain View, CA, USA
| | - K C Miao
- Google Research, Mountain View, CA, USA
| | | | | | | | | | | | - M Newman
- Google Research, Mountain View, CA, USA
| | - J H Ng
- Google Research, Mountain View, CA, USA
| | - A Nguyen
- Google Research, Mountain View, CA, USA
| | - M Nguyen
- Google Research, Mountain View, CA, USA
| | - M Y Niu
- Google Research, Mountain View, CA, USA
| | | | - S Omonije
- Google Research, Mountain View, CA, USA
| | | | - R Potter
- Google Research, Mountain View, CA, USA
| | - L P Pryadko
- Department of Physics and Astronomy, University of California, Riverside, CA, USA
| | | | | | - C Rocque
- Google Research, Mountain View, CA, USA
| | - N C Rubin
- Google Research, Mountain View, CA, USA
| | - N Saei
- Google Research, Mountain View, CA, USA
| | - D Sank
- Google Research, Mountain View, CA, USA
| | | | | | | | | | | | - A Shorter
- Google Research, Mountain View, CA, USA
| | - N Shutty
- Google Research, Mountain View, CA, USA
| | - V Shvarts
- Google Research, Mountain View, CA, USA
| | - V Sivak
- Google Research, Mountain View, CA, USA
| | - J Skruzny
- Google Research, Mountain View, CA, USA
| | | | - R D Somma
- Google Research, Mountain View, CA, USA
| | | | - D Strain
- Google Research, Mountain View, CA, USA
| | - M Szalay
- Google Research, Mountain View, CA, USA
| | - D Thor
- Google Research, Mountain View, CA, USA
| | - A Torres
- Google Research, Mountain View, CA, USA
| | - G Vidal
- Google Research, Mountain View, CA, USA
| | | | | | - T White
- Google Research, Mountain View, CA, USA
| | - B W K Woo
- Google Research, Mountain View, CA, USA
| | - C Xing
- Google Research, Mountain View, CA, USA
| | | | - P Yeh
- Google Research, Mountain View, CA, USA
| | - J Yoo
- Google Research, Mountain View, CA, USA
| | - G Young
- Google Research, Mountain View, CA, USA
| | - A Zalcman
- Google Research, Mountain View, CA, USA
| | - Y Zhang
- Google Research, Mountain View, CA, USA
| | - N Zhu
- Google Research, Mountain View, CA, USA
| | - N Zobrist
- Google Research, Mountain View, CA, USA
| | - H Neven
- Google Research, Mountain View, CA, USA
| | - R Babbush
- Google Research, Mountain View, CA, USA
| | - D Bacon
- Google Research, Mountain View, CA, USA
| | - S Boixo
- Google Research, Mountain View, CA, USA
| | - J Hilton
- Google Research, Mountain View, CA, USA
| | - E Lucero
- Google Research, Mountain View, CA, USA
| | - A Megrant
- Google Research, Mountain View, CA, USA
| | - J Kelly
- Google Research, Mountain View, CA, USA
| | - Y Chen
- Google Research, Mountain View, CA, USA
| | | | - V Khemani
- Department of Physics, Stanford University, Stanford, CA, USA
| | | | - T Prosen
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
| | - P Roushan
- Google Research, Mountain View, CA, USA
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3
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John L, Singh G, Dombi E, Wolters PL, Martin S, Baldwin A, Steinberg SM, Bernstein J, Whitcomb P, Pichard DC, Dufek A, Gillespie A, Heisey K, Bornhorst M, Fisher MJ, Weiss BD, Kim A, Widemann BC, Gross AM. Development and pilot validation of a novel disfigurement severity scale for plexiform neurofibromas in children with neurofibromatosis type 1. Clin Trials 2024; 21:189-198. [PMID: 37877369 PMCID: PMC11003851 DOI: 10.1177/17407745231206402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND/AIMS We developed an observer disfigurement severity scale for neurofibroma-related plexiform neurofibromas to assess change in plexiform neurofibroma-related disfigurement and evaluated its feasibility, reliability, and validity. METHODS Twenty-eight raters, divided into four cohorts based on neurofibromatosis type 1 familiarity and clinical experience, were shown photographs of children in a clinical trial (NCT01362803) at baseline and 1 year on selumetinib treatment for plexiform neurofibromas (n = 20) and of untreated participants with plexiform neurofibromas (n = 4). Raters, blinded to treatment and timepoint, completed the 0-10 disfigurement severity score for plexiform neurofibroma on each image (0 = not at all disfigured, 10 = very disfigured). Raters evaluated the ease of completing the scale, and a subset repeated the procedure to assess intra-rater reliability. RESULTS Mean baseline disfigurement severity score for plexiform neurofibroma ratings were similar for the selumetinib group (6.23) and controls (6.38). Mean paired differences between pre- and on-treatment ratings was -1.01 (less disfigurement) in the selumetinib group and 0.09 in the control (p = 0.005). For the disfigurement severity score for plexiform neurofibroma ratings, there was moderate-to-substantial agreement within rater cohorts (weighted kappa range = 0.46-0.66) and agreement between scores of the same raters at repeat sessions (p > 0.05). In the selumetinib group, change in disfigurement severity score for plexiform neurofibroma ratings was moderately correlated with change in plexiform neurofibroma volume with treatment (r = 0.60). CONCLUSION This study demonstrates that our observer-rated disfigurement severity score for plexiform neurofibroma was feasible, reliable, and documented improvement in disfigurement in participants with plexiform neurofibroma shrinkage. Prospective studies in larger samples are needed to validate this scale further.
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Affiliation(s)
- Liny John
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gurbani Singh
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eva Dombi
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Baldwin
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jessica Bernstein
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Patricia Whitcomb
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dominique C Pichard
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anne Dufek
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andy Gillespie
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kara Heisey
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Miriam Bornhorst
- Center for Cancer and Blood Disorders, Children’s National Hospital, Washington, DC, USA
| | - Michael J Fisher
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian D Weiss
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - AeRang Kim
- Center for Cancer and Blood Disorders, Children’s National Hospital, Washington, DC, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea M Gross
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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4
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Healy D, Rizkallal C, Rossanese M, McLarnon P, Vallefuoco R, Murgia D, Ryan T, Howes C, Anderson O, Charlesworth T, Cinti F, Martin S, Das S, Cantatore M. Surgical treatment of canine urethral prolapse via urethropexy or resection and anastomosis. J Small Anim Pract 2024; 65:206-213. [PMID: 38081729 DOI: 10.1111/jsap.13690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/07/2023] [Accepted: 11/05/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES The objective was to report and compare the complications and recurrence rates of urethral prolapse in dogs when treated with urethropexy, resection and anastomosis or a combined surgical technique. STUDY DESIGN Retrospective study. MATERIALS AND METHODS A total of 86 dogs were identified from the medical records of 10 veterinary referral hospitals from February 2012 and October 2022. Dogs were included if they underwent surgery for a urethral prolapse at first presentation. Complications were classified as minor or major based on the necessity of further surgical intervention. Complications leading to death were also considered major complications. RESULTS Seventy-nine dogs were included, urethropexy (n=44), resection and anastomosis (n=27) and a combined surgical technique (n=8). Minor complications were identified in 41 of 79 dogs (51.9%): urethropexy 19 of 44 (43.2%), resection and anastomosis 18 of 27 (66.6%) and a combined surgical technique four of eight (50%). Major complications occurred in 23 dogs (29.1%), of which 21 were recurrence (26.6%). Recurrence occurred in 17 of 44 dogs following a urethropexy (38.6%), three of 27 dogs following resection and anastomosis (11.1%) and one of eight dogs treated with a combined surgical technique (12.5%). Recurrence of a urethral prolapse was significantly more likely following urethropexy in comparison to resection and anastomosis. CLINICAL SIGNIFICANCE Resection and anastomosis was associated with a lower recurrence rate in comparison to urethropexy for the surgical treatment of urethral prolapse. Based on these results, we concluded that resection and anastomosis may be preferable to urethropexy for treatment of urethral prolapse at first presentation. Urethropexy, and resection and anastomosis combined surgical technique was associated with low recurrence rate; however, further studies will be needed to clarify if it provides any benefit over resection and anastomosis.
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Affiliation(s)
- D Healy
- Anderson Moores Veterinary Specialists, Winchester, UK
| | | | - M Rossanese
- Queen Mother Hospital for Animals Royal Veterinary College, Hatfield, UK
| | - P McLarnon
- Davies Veterinary Specialists, Hertfordshire, UK
| | | | - D Murgia
- Dick White Referrals, Cambridgeshire, UK
| | - T Ryan
- Southern Counties Veterinary Specialists, Ringwood, UK
| | - C Howes
- Bristol Veterinary Specialists, Central Park, Avonmouth, Bristol, UK
| | - O Anderson
- Bristol Veterinary Specialists, Central Park, Avonmouth, Bristol, UK
| | | | - F Cinti
- San Marco Veterinary Clinic and Laboratory, 35130 Veggiano, Padova, Italy
| | - S Martin
- Veterinary Specialists Ireland, Meath, Ireland
| | - S Das
- Davies Veterinary Specialists, Hertfordshire, UK
| | - M Cantatore
- Anderson Moores Veterinary Specialists, Winchester, UK
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5
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Siegel A, Lockridge R, Struemph KL, Toledo-Tamula MA, Little P, Wolters PL, Dufek A, Tibery C, Baker M, Wideman BC, Martin S. Perceived transition readiness among adolescents and young adults with neurofibromatosis type 1 and plexiform neurofibromas: a cross-sectional descriptive study. J Pediatr Psychol 2024:jsae006. [PMID: 38366576 DOI: 10.1093/jpepsy/jsae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Neurofibromatosis type 1 (NF1) is a genetic cancer predisposition syndrome that can impact multiple organ systems and is associated with plexiform neurofibroma tumors, requiring care from birth through adulthood. Adolescents and young adults (AYAs) with NF1 face several barriers to transition from pediatric to adult care. This cross-sectional study aimed to assess transition readiness in this population and to evaluate relationships between specific NF1 symptoms and transition readiness. METHODS AYAs (aged 16-24) enrolled in existing studies related to NF1 were eligible. AYAs and their parents completed measures of transition readiness (Transition Readiness Assessment Questionnaire version 4 [TRAQ-4]), and AYAs also completed a transition readiness interview (UNC TRxANSITION). RESULTS Thirty-eight AYAs (mean age = 19.95 ± 2.68 years) participated in the study. Average TRAQ scores indicated that AYAs were still learning Self-Management skills (M = 3.37, SD = 1.08) and Self-Advocacy skills (M = 3.98, SD = 0.67). Older AYAs had higher TRAQ scores for Self-Management (r = 0.70, p < .001) and Self-Advocacy (r = 0.41, p = .011) than younger AYAs. Parents and AYAs had similar TRAQ scores. About one third of AYAs (37.8%, n = 14) expressed uncertainty about how NF1 might affect them in the future. The remaining AYAs mostly expressed concerns regarding tumor growth, pain, or cancer. CONCLUSIONS In this small study, preliminary findings suggest that AYAs with NF1 express confidence in many areas of transition readiness but continue to require support, particularly with Self-Management skills. Given the gaps in understanding of future health risks, AYAs with NF1 would benefit from early assessment, psychoeducation, and support for transition readiness to adult care.
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Affiliation(s)
- Atara Siegel
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Robin Lockridge
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Kari L Struemph
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Mary Anne Toledo-Tamula
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Paige Little
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Anne Dufek
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Cecilia Tibery
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Melissa Baker
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Brigitte C Wideman
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
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6
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Siegel A, Toledo-Tamula MA, Martin S, Gillespie A, Goodwin A, Widemann B, Wolters PL. Written language achievement in children and adolescents with neurofibromatosis type 1 and Plexiform Neurofibromas. Child Neuropsychol 2024:1-21. [PMID: 38318699 DOI: 10.1080/09297049.2024.2307663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
Neurofibromatosis type 1 (NF1) is associated with below average writing achievement. However, little is known about specific aspects of written language impacted by NF1, changes in writing over time, and associations between cognitive aspects of the NF1 phenotype and writing. At three timepoints over six years, children with NF1 and plexiform neurofibromas (PNs) completed Woodcock-Johnson tests of writing mechanics (Spelling, Punctuation & Capitalization, handwriting), written expression of ideas (Writing Samples), writing speed (Writing Fluency), and tests of general cognitive ability, executive function, memory, and attention. Children (N = 76, mean age = 12.8 ± 3.4 years) completed at least one baseline writing subtest. Overall writing scores were in the Average range (M = 93.4, SD = 17.4), but lower than population norms (p = 0.002). Scores were highest on Writing Samples (M = 95.2, SD = 17.3), and lowest for Punctuation & Capitalization (M = 87.9, SD = 18.8, p = 0.034). Writing scores were mostly stable over time. Nonverbal reasoning was related to some tests of writing mechanics and written expression of ideas. Short-term memory and inattention explained additional variance in Writing Samples and Spelling. Poor handwriting was associated with writing content beyond the impact of cognitive factors. Children with NF1 and PNs may benefit from early screening and writing support. Interventions should address the contribution of both cognitive and handwriting difficulties in written language.
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Affiliation(s)
- Atara Siegel
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
- Kennedy Krieger Institute, Baltimore, MD
| | - Mary Anne Toledo-Tamula
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Andy Gillespie
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Anne Goodwin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Brigitte Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
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Wolters PL, Ghriwati NA, Baker M, Martin S, Berg D, Erickson G, Franklin B, Merker VL, Oberlander B, Reeve S, Rohl C, Rosser T, Vranceanu AM. Perspectives of adults with neurofibromatosis regarding the design of psychosocial trials: Results from an anonymous online survey. Clin Trials 2024; 21:73-84. [PMID: 37962219 PMCID: PMC10922214 DOI: 10.1177/17407745231209224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND/AIMS Individuals with neurofibromatosis, including neurofibromatosis 1 (NF1), neurofibromatosis 2 (NF2)-related schwannomatosis (SWN), and other forms of SWN, often experience disease manifestations and mental health difficulties for which psychosocial interventions may help. An anonymous online survey of adults with neurofibromatosis assessed their physical, social, and emotional well-being and preferences about psychosocial interventions to inform clinical trial design. METHODS Neurofibromatosis clinical researchers and patient representatives from the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration developed the survey. Eligibility criteria included age ≥ 18 years, self-reported diagnosis of NF1, NF2, or SWN, and ability to read and understand English. The online survey was distributed internationally by the Neurofibromatosis Registry and other neurofibromatosis foundations from June to August 2020. RESULTS Surveys were completed by 630 adults (18-81 years of age; M = 45.5) with NF1 (78%), NF2 (14%), and SWN (8%) who were mostly White, not Hispanic/Latino, female, and from the United States. The majority (91%) reported that their neurofibromatosis symptoms had at least some impact on daily life. In the total sample, 51% endorsed a mental health diagnosis, and 27% without a diagnosis believed they had an undiagnosed mental health condition. Participants indicated that neurofibromatosis affected their emotional (44%), physical (38%), and social (35%) functioning to a high degree. Few reported ever having participated in a drug (6%) or psychosocial (7%) clinical trial, yet 68% reported they "probably" or "definitely" would want to participate in a psychosocial trial if it targeted a relevant concern. Top treatment targets were anxiety, healthier lifestyle, and daily stress. Top barriers to participating in psychosocial trials were distance to clinic, costs, and time commitment. Respondents preferred interventions delivered by clinicians via individual sessions or a combination of group and individual sessions, with limited in-person and mostly remote participation. There were no significant group differences by neurofibromatosis type in willingness to participate in psychosocial trials (p = 0.27). Regarding interest in intervention targets, adults with SWN were more likely to prefer psychosocial trials for pain support compared to those with NF1 (p < 0.001) and NF2 (p < 0.001). CONCLUSION This study conducted the largest survey assessing physical symptoms, mental health needs, and preferences for psychosocial trials in adults with neurofibromatosis. Results indicate a high prevalence of disease manifestations, psychosocial difficulties, and untreated mental health problems in adults with neurofibromatosis and a high degree of willingness to participate in psychosocial clinical trials. Patient preferences should be considered when designing and implementing psychosocial interventions to develop the most feasible and meaningful studies.
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Affiliation(s)
- Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nour Al Ghriwati
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Melissa Baker
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dale Berg
- REiNS International Collaboration Patient Representative, Children's Tumor Foundation Volunteer Leadership Program, Minneapolis, MN, USA
| | - Gregg Erickson
- REiNS International Collaboration Patient Representative, NF Network, Wheaton, IL, USA
| | - Barbara Franklin
- REiNS International Collaboration Patient Representative, Morristown, NJ, USA
| | - Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Beverly Oberlander
- REiNS International Collaboration Patient Representative, NF Network, Wheaton, IL, USA
| | - Stephanie Reeve
- REiNS International Collaboration Patient Representative, Fishers, IN, USA
| | - Claas Rohl
- REiNS International Collaboration Patient Representative, NF Kinder, NF Patients United, Vienna, Austria
| | - Tena Rosser
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Merker VL, Thompson HL, Wolters PL, Buono FD, Hingtgen CM, Rosser T, Barton B, Barnett C, Smith T, Haberkamp D, McManus ML, Baldwin A, Moss IP, Röhl C, Martin S. Recommendations for assessing appearance concerns related to plexiform and cutaneous neurofibromas in neurofibromatosis 1 clinical trials. Clin Trials 2024; 21:6-17. [PMID: 38140900 PMCID: PMC10922038 DOI: 10.1177/17407745231205577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
BACKGROUND/AIMS Individuals with neurofibromatosis 1 may experience changes in their appearance due to physical manifestations of the disorders and/or treatment sequelae. Appearance concerns related to these physical changes can lead to psychological distress and poorer quality of life. While many neurofibromatosis 1 clinical trials focus on assessing changes in tumor volume, evaluating patients' perspectives on corresponding changes in symptoms such as physical appearance can be key secondary outcomes. We aimed to determine whether any existing patient-reported outcome measures are appropriate for evaluating changes in appearance concerns within neurofibromatosis 1 clinical trials. METHODS After updating our previously published systematic review process, we used it to identify and rate existing patient-reported outcome measures related to disfigurement and appearance. Using a systematic literature search and initial triage process, we focused on identifying patient-reported outcome measures that could be used to evaluate changes in appearance concerns in plexiform or cutaneous neurofibroma clinical trials in neurofibromatosis 1. Our revised Patient-Reported Outcome Rating and Acceptance Tool for Endpoints then was used to evaluate each published patient-reported outcome measures in five domains, including (1) respondent characteristics, (2) content validity, (3) scoring format and interpretability, (4) psychometric data, and (5) feasibility. The highest-rated patient-reported outcome measures were then re-reviewed in a side-by-side comparison to generate a final consensus recommendation. RESULTS Eleven measures assessing appearance concerns were reviewed and rated; no measures were explicitly designed to assess appearance concerns related to neurofibromatosis 1. The FACE-Q Craniofacial Module-Appearance Distress scale was the top-rated measure for potential use in neurofibromatosis 1 clinical trials. Strengths of the measure included that it was rigorously developed, included individuals with neurofibromatosis 1 in the validation sample, was applicable to children and adults, covered item topics deemed important by neurofibromatosis 1 patient representatives, exhibited good psychometric properties, and was feasible for use in neurofibromatosis 1 trials. Limitations included a lack of validation in older adults, no published information regarding sensitivity to change in clinical trials, and limited availability in languages other than English. CONCLUSION The Response Evaluation in Neurofibromatosis and Schwannomatosis patient-reported outcome working group currently recommends the FACE-Q Craniofacial Module Appearance Distress scale to evaluate patient-reported changes in appearance concerns in clinical trials for neurofibromatosis 1-related plexiform or cutaneous neurofibromas. Additional research is needed to validate this measure in people with neurofibromatosis 1, including older adults and those with tumors in various body locations, and explore the effects of nontumor manifestations on appearance concerns in people with neurofibromatosis 1 and schwannomatosis.
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Affiliation(s)
- Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Heather L Thompson
- Department of Communication Sciences and Disorders, California State University, Sacramento, Sacramento, CA, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Frank D Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Tena Rosser
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Belinda Barton
- Faculty of Health, Discipline of Psychology, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Taylor Smith
- Department of Psychology and Child Development, California Polytechnic State University, San Luis Obispo, CA, USA
| | | | | | - Andrea Baldwin
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | - Claas Röhl
- NF Kinder, NF Patients United, Vienna, Austria
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
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Kursumovic E, Cook TM, Lucas DN, Davies MT, Martin S, Kane AD, Armstrong RA, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Beecham E, Cordingley J, Dorey J, Finney SJ, Kunst G, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Smith JH, Varney L, Wain EC, Soar J. The 7th National Audit Project (NAP7) baseline survey of individual anaesthetists: preparedness for and experiences of peri-operative cardiac arrest. Anaesthesia 2023; 78:1453-1464. [PMID: 37920919 DOI: 10.1111/anae.16154] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 11/04/2023]
Abstract
The Royal College of Anaesthetists' 7th National Audit Project baseline survey assessed knowledge, attitudes, practices and experiences of peri-operative cardiac arrests among UK anaesthetists and Anaesthesia Associates. We received 10,746 responses, representing a 71% response rate. In-date training in adult and paediatric advanced life support was reported by 9646 (90%) and 7125 (66%) anaesthetists, respectively. There were 8994 (84%) respondents who were confident in leading a peri-operative cardiac arrest, with males more confident than females, but only 5985 (56%) were confident in leading a debrief and 7340 (68%) communicating with next of kin. In the previous two years, 4806 (46%) respondents had managed at least one peri-operative cardiac arrest, of which 321 (7%) and 189 (4%) of these events involved a child or an obstetric patient, respectively. Respondents estimated the most common causes of peri-operative cardiac arrest to be hypovolaemia, hypoxaemia and cardiac ischaemia, with haemorrhage coming fifth. However, the most common reported causes for the most recently attended peri-operative cardiac arrest were haemorrhage; (927, 20%); anaphylaxis (474, 10%); and cardiac ischaemia (397, 9%). Operating lists or shifts were paused or stopped after 1330 (39%) cardiac arrests and 1693 (38%) respondents attended a debrief, with 'hot' debriefs most common. Informal wellbeing support was relatively common (2458, 56%) and formal support was uncommon (472, 11%). An impact on future care delivery was reported by 196 (4%) anaesthetists, most commonly a negative psychological impact. Management of a peri-operative cardiac arrest during their career was reported by 8654 (85%) respondents. The overall impact on professional life was more often judged positive (2630, 30%) than negative (1961, 23%), but impact on personal life was more often negative.
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Hou Y, Wu X, Allen T, Toledo-Tamula MA, Martin S, Gillespie A, Goodwin A, Widemann BC, Wolters PL. Longitudinal association between executive function and academic achievement in children with neurofibromatosis type 1 and plexiform neurofibromas. J Int Neuropsychol Soc 2023; 29:839-849. [PMID: 36750981 PMCID: PMC10695331 DOI: 10.1017/s1355617723000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To examine how executive functioning (EF) relates to academic achievement longitudinally in children with neurofibromatosis type 1 (NF1) and plexiform neurofibromas (PNs) and whether age at baseline moderates this relationship. METHOD Participants included 88 children with NF1 and PNs (ages 6-18 years old, M = 12.05, SD = 3.62, 50 males) enrolled in a natural history study. Neuropsychological assessments were administered three times over 6 years. EF (working memory, inhibitory control, cognitive flexibility, and attention) was assessed by performance-based (PB) and parent-reported (PR) measures. Multilevel growth modeling was used to examine how EF at baseline related to initial levels and changes in broad math, reading, and writing across time, controlling for demographic variables. RESULTS The relationship between EF and academic achievement varied across EF and academic domains. Cognitive flexibility (PB) uniquely explained more variances in initial math, reading, and writing scores; working memory (PB) uniquely explained more variances in initial levels of reading and writing. The associations between EF and academic achievement tended to remain consistent across age groups with one exception: Lower initial levels of inhibitory control (PR) were related to a greater decline in reading scores. This pattern was more evident among younger (versus older) children. CONCLUSIONS Findings emphasize the heterogeneous nature of academic development in NF1 and that EF skills could help explain the within-group variability in this population. Routine cognitive/academic monitoring via comprehensive assessments and early targeted treatments consisting of medication and/or systematic cognitive interventions are important to evaluate for improving academic performance in children with NF1 and PNs.
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Affiliation(s)
- Yang Hou
- Department of Behavioral Sciences and Social Medicine, Florida State University
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute
| | - Xian Wu
- Department of Behavioral Sciences and Social Medicine, Florida State University
| | - Taryn Allen
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute
| | | | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute
| | - Andy Gillespie
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute
| | - Anne Goodwin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute
| | - Brigitte C. Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute
| | - Pamela L. Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute
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11
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Gross AM, Dombi E, Wolters PL, Baldwin A, Dufek A, Herrera K, Martin S, Derdak J, Heisey KS, Whitcomb PM, Steinberg SM, Venzon DJ, Fisher MJ, Kim A, Bornhorst M, Weiss BD, Blakeley JO, Smith MA, Widemann BC. Long-term safety and efficacy of selumetinib in children with neurofibromatosis type 1 on a phase 1/2 trial for inoperable plexiform neurofibromas. Neuro Oncol 2023; 25:1883-1894. [PMID: 37115514 PMCID: PMC10547508 DOI: 10.1093/neuonc/noad086] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Selumetinib shrank inoperable symptomatic plexiform neurofibromas (PN) in children with neurofibromatosis type 1 (NF1) and provided clinical benefit for many in our previously published phase 1/2 clinical trials (SPRINT, NCT01362803). At the data cutoff (DCO) of the prior publications, 65% of participants were still receiving treatment. This report presents up to 5 years of additional safety and efficacy data from these studies. METHODS This manuscript includes data from the phase 1 and phase 2, stratum 1 study which included participants with clinically significant PN-related morbidity. Participants received continuous selumetinib dosing (1 cycle = 28 days). Safety and efficacy data through February 27, 2021 are included. PN response assessed by volumetric magnetic resonance imaging analysis: Confirmed partial response (cPR) ≥20% decrease from baseline on 2 consecutive evaluations. Phase 2 participants completed patient-reported outcome measures assessing tumor pain intensity (Numeric Rating Scale-11) and interference of pain in daily life (pain interference index). RESULTS For the 74 children (median age 10.3 years; range 3-18.5) enrolled, overall cPR rate was 70% (52/74); median duration of treatment was 57.5 cycles (range 1-100). Responses were generally sustained with 59% (44) lasting ≥ 12 cycles. Tumor pain intensity (n = 19, P = .015) and pain interference (n = 18, P = .0059) showed durable improvement from baseline to 48 cycles. No new safety signals were identified; however, some developed known selumetinib-related adverse events (AEs) for the first time after several years of treatment. CONCLUSIONS With up to 5 years of additional selumetinib treatment, most children with NF1-related PN had durable tumor shrinkage and sustained improvement in pain beyond that previously reported at 1 year. No new safety signals were identified; however, ongoing monitoring for known selumetinib-related AEs is needed while treatment continues.
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Affiliation(s)
- Andrea M Gross
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Eva Dombi
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Andrea Baldwin
- Leidos, Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Anne Dufek
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Kailey Herrera
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Joanne Derdak
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Kara S Heisey
- Leidos, Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Patricia M Whitcomb
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland 20892, USA
| | - David J Venzon
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland 20892, USA
| | - Michael J Fisher
- Children’s Hospital of Philadelphia, Section of Neuro-Oncology, Philadelphia, Pennsylvania, USA
| | - AeRang Kim
- Children’s National Hospital, Center for Cancer and Blood Disorders, Washington, District of Columbia, USA
| | - Miriam Bornhorst
- Children’s National Hospital, Center for Cancer and Blood Disorders, Washington, District of Columbia, USA
| | - Brian D Weiss
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jaishri O Blakeley
- Johns Hopkins University, Division of Neurology, Baltimore, Maryland, USA
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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12
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Bedford R, Smith G, Rothwell E, Martin S, Medhane R, Casentieri D, Daunt A, Freiberg G, Hollings M. A multi-organ, lung-derived inflammatory response following in vitro airway exposure to cigarette smoke and next-generation nicotine delivery products. Toxicol Lett 2023; 387:35-49. [PMID: 37774809 DOI: 10.1016/j.toxlet.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023]
Abstract
Despite increasing use of in vitro models that closely resemble in vivo human biology, their application in understanding downstream effects of airway toxicity, such as inflammation, are at an early stage. In this study, we used various assays to examine the inflammatory response induced in MucilAir™ tissues and A549 cells exposed to three products known to induce toxicity. Reduced barrier integrity was observed in tissues following exposure to each product, with reduced viability and increased cytotoxicity also shown. Similar changes in viability were also observed in A549 cells. Furthermore, whole cigarette smoke (CS) induced downstream phenotypic THP-1 changes and endothelial cell adhesion, an early marker of atherosclerosis. In contrast, exposure to next-generation delivery product (NGP) aerosol did not induce this response. Cytokine, histological and RNA analysis highlighted increased biomarkers linked to inflammatory pathways and immune cell differentiation following exposure to whole cigarette smoke, including GM-CSF, IL-1β, cleaved caspase-3 and cytochrome P450 enzymes. As a result of similar observations in human airway inflammation, we propose that our exposure platform could act as a representative model for studying such events in vitro. Furthermore, this model could be used to test the inflammatory or anti-inflammatory impact posed by inhaled compounds delivered to the lung.
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Affiliation(s)
- R Bedford
- Labcorp Early Development Laboratories Limited, Harrogate, UK.
| | - G Smith
- Labcorp Early Development Laboratories Limited, Harrogate, UK
| | - E Rothwell
- Labcorp Early Development Laboratories Limited, Harrogate, UK
| | - S Martin
- Labcorp Early Development Laboratories Limited, Harrogate, UK
| | - R Medhane
- Labcorp Early Development Laboratories Limited, Harrogate, UK
| | - D Casentieri
- Labcorp Early Development Laboratories Limited, Harrogate, UK
| | - A Daunt
- Labcorp Early Development Laboratories Limited, Harrogate, UK
| | - G Freiberg
- Labcorp Early Development Laboratories Limited, Eye, UK
| | - M Hollings
- Labcorp Early Development Laboratories Limited, Harrogate, UK.
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Carlson EJ, Al Ghriwati N, Wolters P, Anne Tamula M, Tisdale J, Fitzhugh C, Hsieh M, Martin S. Longitudinal neurocognitive effects of nonmyeloablative hematopoietic stem cell transplant among older adolescents and adults with sickle cell disease: A description and comparison with sibling donors. Neuropsychol Rehabil 2023:1-20. [PMID: 37540620 DOI: 10.1080/09602011.2023.2238948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/13/2023] [Indexed: 08/06/2023]
Abstract
Sickle cell disease (SCD) is associated with increased risk of neurocognitive deficits. However, whether functioning changes following nonmyeloablative hematopoietic stem cell transplant (HSCT) remains unclear. This study aimed to examine changes in neuropsychological functioning pre- to post-transplant among patients with SCD and compare patients and siblings. Adults with SCD (n = 47; Mage = 31.8 ± 8.9) and their sibling stem cell donors (n = 22; Mage = 30.5± 9.2) enrolled on a nonmyeloablative HCST protocol completed cognitive and patient-reported outcome assessments at baseline and 12 months post-transplant. Path analyses were used to assess associations between pre-transplant variables and sibling/patient group status and post-transplant function. Mean patient cognitive scores were average at both timepoints. Patient processing speed and somatic complaints improved from baseline to follow-up. Baseline performance predicted follow-up performance across cognitive variables; patient/sibling status predicted follow-up performance on some processing speed measures. Results suggest that patients with SCD demonstrate slower processing speed than siblings. Processing speed increased pre- to post-HSCT among patients and siblings, and on some measures patients demonstrated greater improvement. Thus, HSCT may improve processing speed in patients, although further confirmation is needed. Findings provide promising evidence that neurocognitive functioning remains stable without detrimental effects from pre- to 12-months post nonmyeloablative HSCT in individuals with SCD.
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Affiliation(s)
- Emily J Carlson
- Department of Psychology, American University, Washington, United States
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Nour Al Ghriwati
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Pam Wolters
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Mary Anne Tamula
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick , USA
| | - John Tisdale
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institute, Bethesda, United States
| | - Courtney Fitzhugh
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institute, Bethesda, United States
| | - Matt Hsieh
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institute, Bethesda, United States
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, United States
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Kiguli-Malwadde E, Forster M, Eliaz A, Celentano J, Chilembe E, Couper ID, Dassah ET, De Villiers MR, Gachuno O, Haruzivishe C, Khanyola J, Martin S, Motlhatlhedi K, Mubuuke R, Mteta KA, Moabi P, Rodrigues A, Sears D, Semitala F, von Zinkernagel D, Reid MJA, Suleman F. Comparing in-person, blended and virtual training interventions; a real-world evaluation of HIV capacity building programs in 16 countries in sub-Saharan Africa. PLOS Glob Public Health 2023; 3:e0001654. [PMID: 37486898 PMCID: PMC10365303 DOI: 10.1371/journal.pgph.0001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/05/2023] [Indexed: 07/26/2023]
Abstract
We sought to evaluate the impact of transitioning a multi-country HIV training program from in-person to online by comparing digital training approaches implemented during the pandemic with in-person approaches employed before COVID-19. We evaluated mean changes in pre-and post-course knowledge scores and self-reported confidence scores for learners who participated in (1) in-person workshops (between October 2019 and March 2020), (2) entirely asynchronous, Virtual Workshops [VW] (between May 2021 and January 2022), and (3) a blended Online Course [OC] (between May 2021 and January 2022) across 16 SSA countries. Learning objectives and evaluation tools were the same for all three groups. Across 16 SSA countries, 3023 participants enrolled in the in-person course, 2193 learners participated in the virtual workshop, and 527 in the online course. The proportions of women who participated in the VW and OC were greater than the proportion who participated in the in-person course (60.1% and 63.6%, p<0.001). Nursing and midwives constituted the largest learner group overall (1145 [37.9%] vs. 949 [43.3%] vs. 107 [20.5%]). Across all domains of HIV knowledge and self-perceived confidence, there was a mean increase between pre- and post-course assessments, regardless of how training was delivered. The greatest percent increase in knowledge scores was among those participating in the in-person course compared to VW or OC formats (13.6% increase vs. 6.0% and 7.6%, p<0.001). Gains in self-reported confidence were greater among learners who participated in the in-person course compared to VW or OC formats, regardless of training level (p<0.001) or professional cadre (p<0.001). In this multi-country capacity HIV training program, in-person, online synchronous, and blended synchronous/asynchronous strategies were effective means of training learners from diverse clinical settings. Online learning approaches facilitated participation from more women and more diverse cadres. However, gains in knowledge and clinical confidence were greater among those participating in in-person learning programs.
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Affiliation(s)
- E Kiguli-Malwadde
- African Center for Global Health and Social Transformation, Kampala, Uganda
| | - M Forster
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - A Eliaz
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - J Celentano
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - E Chilembe
- Kamuzu College of Nursing, University of Malawi, Kamuzu, Malawi
| | - I D Couper
- Department of Global Health, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - E T Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - M R De Villiers
- Department of Global Health, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - O Gachuno
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - C Haruzivishe
- Faculty of Health Sciences, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - J Khanyola
- University of Global Health Equity, Kigali, Rwanda
| | - S Martin
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - K Motlhatlhedi
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Botswana
| | - R Mubuuke
- School of Medicine, Makerere University, Kampala, Uganda
| | - K A Mteta
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - P Moabi
- Scott College of Nursing, Morija, Lesotho
| | - A Rodrigues
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - D Sears
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, United States of America
| | - F Semitala
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Botswana
| | - D von Zinkernagel
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - M J A Reid
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, United States of America
| | - F Suleman
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Barrallier M, Rageul E, Nesseler C, Martin S, Thibault R. Is Diabetes Associated With A Specific Phenotype Of Malnutrition And Mortality? An Observational Study In Hospitalized Patients Managed By The Nutritional Support Team Of An University Hospital. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Martin S, Saur D, Hartwigsen G. FV 9 Facilitatory stimulation of the pre-SMA has distinct effects on task-based activity and connectivity networks in healthy aging. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Rageul E, Barrallier M, Nesseler C, Martin S, Thibault R. Insufficient Food Intake At Hospital Is Associated With Higher Risk Of Hospital Readmission. An Observational Study Of Patients Managed By The Nutrition Support Team Of An University Hospital. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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El Asmar K, Annan NB, Khoury R, Colle R, Martin S, Ghoul TE, Trabado S, Chanson P, Feve B, Verstuyft C, Becquemont L, Corruble E. Non-overweight depressed patients who respond to antidepressant treatment have a higher risk of later metabolic syndrome: findings from the METADAP cohort. Psychol Med 2023; 53:1-10. [PMID: 36628576 PMCID: PMC10600935 DOI: 10.1017/s0033291722003919] [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] [Received: 03/10/2022] [Revised: 11/08/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is a complex disorder with a significant public health burden. Depression remission is often associated with weight gain, a major risk factor for metabolic syndrome (MetS). The primary objective of our study was to assess prospectively the impact of response to antidepressant treatment on developing MetS in a sample of MDD patients with a current major depressive episode (MDE) and who are newly initiating their treatment. METHODS In the 6-month prospective METADAP cohort, non-overweight patients, body mass index <25 kg/m2, with MDD and a current MDE were assessed for treatment response after 3 months of treatment, and incidence of MetS after 3 and 6 months of treatment. Outcome variables were MetS, number of MetS criteria, and each MetS criterion (high waist circumference, high blood pressure, high triglyceridemia, low high-density lipoprotein-cholesterolemia, and high fasting plasma glucose). RESULTS In total, 98/169 patients (58%) responded to treatment after 3 months. A total of 2.7% (1/38) developed MetS out of which 12.7% (10/79) (p value < 0.001) had responded to treatment after 3 months. The fixed-effect regression models showed that those who responded to treatment after 3 months of follow-up had an 8.6 times higher odds of developing MetS (odds ratio = 8.58, 95% confidence interval 3.89-18.93, p value < 0.001). CONCLUSION Compared to non-responders, non-overweight patients who responded to treatment after 3 months of antidepressant treatment had a significantly higher risk of developing MetS during the 6 months of treatment. Psychiatrists and nurses should closely monitor the metabolic profile of their patients, especially those who respond to treatment.
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Affiliation(s)
- K. El Asmar
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ. Paris-Saclay, Le Kremlin Bicêtre F-94275, France
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - N. B. Annan
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - R. Khoury
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - R. Colle
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ. Paris-Saclay, Le Kremlin Bicêtre F-94275, France
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - S. Martin
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ. Paris-Saclay, Le Kremlin Bicêtre F-94275, France
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - T. E. Ghoul
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - S. Trabado
- INSERM UMR-S U1185, Faculté de Médecine, Univ. Paris-Saclay, Le Kremlin Bicêtre F-94275, France
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - P. Chanson
- INSERM UMR-S U1185, Faculté de Médecine, Univ. Paris-Saclay, Le Kremlin Bicêtre F-94275, France
- Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - B. Feve
- Sorbonne Université-INSERM, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire ICAN, Service d'Endocrinologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris F-75012, France
| | - C. Verstuyft
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ. Paris-Saclay, Le Kremlin Bicêtre F-94275, France
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - L. Becquemont
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ. Paris-Saclay, Le Kremlin Bicêtre F-94275, France
- Centre de recherche clinique, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - E. Corruble
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ. Paris-Saclay, Le Kremlin Bicêtre F-94275, France
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
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Kane AD, Armstrong RA, Kursumovic E, Cook TM, Oglesby FC, Cortes L, Moppett IK, Moonesinghe SR, Agarwal S, Bouch DC, Cordingley J, Davies MT, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Samuel K, Scholefield BR, Smith JH, Varney L, Vindrola‐Padros C, Martin S, Wain EC, Kendall SW, Ward S, Drake S, Lourtie J, Taylor C, Soar J. Methods of the 7 th National Audit Project (NAP7) of the Royal College of Anaesthetists: peri-operative cardiac arrest. Anaesthesia 2022; 77:1376-1385. [PMID: 36111390 PMCID: PMC9826156 DOI: 10.1111/anae.15856] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 01/11/2023]
Abstract
Cardiac arrest in the peri-operative period is rare but associated with significant morbidity and mortality. Current reporting systems do not capture many such events, so there is an incomplete understanding of incidence and outcomes. As peri-operative cardiac arrest is rare, many hospitals may only see a small number of cases over long periods, and anaesthetists may not be involved in such cases for years. Therefore, a large-scale prospective cohort is needed to gain a deep understanding of events leading up to cardiac arrest, management of the arrest itself and patient outcomes. Consequently, the Royal College of Anaesthetists chose peri-operative cardiac arrest as the 7th National Audit Project topic. The study was open to all UK hospitals offering anaesthetic services and had a three-part design. First, baseline surveys of all anaesthetic departments and anaesthetists in the UK, examining respondents' prior peri-operative cardiac arrest experience, resuscitation training and local departmental preparedness. Second, an activity survey to record anonymised details of all anaesthetic activity in each site over 4 days, enabling national estimates of annual anaesthetic activity, complexity and complication rates. Third, a case registry of all instances of peri-operative cardiac arrest in the UK, reported confidentially and anonymously, over 1 year starting 16 June 2021, followed by expert review using a structured process to minimise bias. The definition of peri-operative cardiac arrest was the delivery of five or more chest compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist. The peri-operative period began with the World Health Organization 'sign-in' checklist or first hands-on contact with the patient and ended either 24 h after the patient handover (e.g. to the recovery room or intensive care unit) or at discharge if this occured earlier than 24 h. These components described the epidemiology of peri-operative cardiac arrest in the UK and provide a basis for developing guidelines and interventional studies.
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Martin S, Rashidifard C, Norris D, Goncalves A, Vercollone C, Brezinski M. Minimally Invasive Polarization Sensitive Optical Coherence Tomography (PS-OCT) for assessing Pre-OA, a pilot study on technical feasibility. Osteoarthritis and Cartilage Open 2022; 4. [DOI: 10.1016/j.ocarto.2022.100313] [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] Open
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21
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Rhodes A, Martin S, Toledo-Tamula MA, Loucas C, Glod J, Warren KE, Wolters PL. The neuropsychological profile of children with Diffuse Intrinsic Pontine Glioma (DIPG) before and after radiation therapy: A prospective longitudinal study. Child Neuropsychol 2022:1-25. [DOI: 10.1080/09297049.2022.2144189] [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: 11/15/2022]
Affiliation(s)
- Amanda Rhodes
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Caitlyn Loucas
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - John Glod
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Katherine E. Warren
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
- Department of Pediatric Neuro-Oncology, Dana Farber Cancer Institute/Boston Children’s Hospital, Boston, MA, USA
| | - Pamela L. Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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22
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de Blank PMK, Gross AM, Akshintala S, Blakeley JO, Bollag G, Cannon A, Dombi E, Fangusaro J, Gelb BD, Hargrave D, Kim A, Klesse LJ, Loh M, Martin S, Moertel C, Packer R, Payne JM, Rauen KA, Rios JJ, Robison N, Schorry EK, Shannon K, Stevenson DA, Stieglitz E, Ullrich NJ, Walsh KS, Weiss BD, Wolters PL, Yohay K, Yohe ME, Widemann BC, Fisher MJ. MEK inhibitors for neurofibromatosis type 1 manifestations: Clinical evidence and consensus. Neuro Oncol 2022; 24:1845-1856. [PMID: 35788692 PMCID: PMC9629420 DOI: 10.1093/neuonc/noac165] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The wide variety of clinical manifestations of the genetic syndrome neurofibromatosis type 1 (NF1) are driven by overactivation of the RAS pathway. Mitogen-activated protein kinase kinase inhibitors (MEKi) block downstream targets of RAS. The recent regulatory approvals of the MEKi selumetinib for inoperable symptomatic plexiform neurofibromas in children with NF1 have made it the first medical therapy approved for this indication in the United States, the European Union, and elsewhere. Several recently published and ongoing clinical trials have demonstrated that MEKi may have potential benefits for a variety of other NF1 manifestations, and there is broad interest in the field regarding the appropriate clinical use of these agents. In this review, we present the current evidence regarding the use of existing MEKi for a variety of NF1-related manifestations, including tumor (neurofibromas, malignant peripheral nerve sheath tumors, low-grade glioma, and juvenile myelomonocytic leukemia) and non-tumor (bone, pain, and neurocognitive) manifestations. We discuss the potential utility of MEKi in related genetic conditions characterized by overactivation of the RAS pathway (RASopathies). In addition, we review practical treatment considerations for the use of MEKi as well as provide consensus recommendations regarding their clinical use from a panel of experts.
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Affiliation(s)
- Peter M K de Blank
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrea M Gross
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Jaishri O Blakeley
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Ashley Cannon
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eva Dombi
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Jason Fangusaro
- Children's Hospital of Atlanta, Emory University and the Aflac Cancer Center, Atlanta, Georgia, USA
| | - Bruce D Gelb
- Department of Pediatrics and Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Darren Hargrave
- Department of Oncology, Great Ormond Street Hospital for Children, London, UK
| | - AeRang Kim
- Center for Neuroscience and Behavioral Medicine and Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, USA
| | - Laura J Klesse
- Department of Pediatrics, Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mignon Loh
- Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Christopher Moertel
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roger Packer
- Center for Neuroscience and Behavioral Medicine and Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, USA
| | - Jonathan M Payne
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Katherine A Rauen
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Jonathan J Rios
- Center for Pediatric Bone Biology and Translational Research, Scottish Rite for Children, Dallas, Texas, USA
| | - Nathan Robison
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Elizabeth K Schorry
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kevin Shannon
- Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - David A Stevenson
- Department of Pediatrics, Division of Medical Genetics, Stanford University, Stanford, California, USA
| | - Elliot Stieglitz
- Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Karin S Walsh
- Center for Neuroscience and Behavioral Medicine and Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, USA
| | - Brian D Weiss
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Kaleb Yohay
- Department of Neurology and Pediatrics, New York University Grossman School of Medicine, New York, New York, USA
| | - Marielle E Yohe
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Michael J Fisher
- Division of Oncology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Fisher MJ, Blakeley JO, Weiss BD, Dombi E, Ahlawat S, Akshintala S, Belzberg AJ, Bornhorst M, Bredella MA, Cai W, Ferner RE, Gross AM, Harris GJ, Listernick R, Ly I, Martin S, Mautner VF, Salamon JM, Salerno KE, Spinner RJ, Staedtke V, Ullrich NJ, Upadhyaya M, Wolters PL, Yohay K, Widemann BC. Management of neurofibromatosis type 1-associated plexiform neurofibromas. Neuro Oncol 2022; 24:1827-1844. [PMID: 35657359 PMCID: PMC9629437 DOI: 10.1093/neuonc/noac146] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Plexiform Neurofibromas (PN) are a common manifestation of the genetic disorder neurofibromatosis type 1 (NF1). These benign nerve sheath tumors often cause significant morbidity, with treatment options limited historically to surgery. There have been tremendous advances over the past two decades in our understanding of PN, and the recent regulatory approvals of the MEK inhibitor selumetinib are reshaping the landscape for PN management. At present, there is no agreed upon PN definition, diagnostic evaluation, surveillance strategy, or clear indications for when to initiate treatment and selection of treatment modality. In this review, we address these questions via consensus recommendations from a panel of multidisciplinary NF1 experts.
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Affiliation(s)
- Michael J Fisher
- Division of Oncology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jaishri O Blakeley
- Division of Neuro-Oncology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian D Weiss
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eva Dombi
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Shivani Ahlawat
- Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Allan J Belzberg
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Miriam Bornhorst
- Family Neurofibromatosis Institute, Center for Neuroscience and Behavioral Medicine,Children's National Hospital, Washington, District of Columbia, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Wenli Cai
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rosalie E Ferner
- Neurofibromatosis Service, Department of Neurology, Guy's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Andrea M Gross
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Gordon J Harris
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Listernick
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ina Ly
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes M Salamon
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kilian E Salerno
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Verena Staedtke
- Division of Neuro-Oncology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Meena Upadhyaya
- Division of Cancer and Genetics, Cardiff University, Wales, UK
| | - Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Kaleb Yohay
- Grossman School of Medicine, Department of Neurology, New York, New York, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
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Fekom M, Bonello K, Gomajee R, Ibanez G, Martin S, Keyes K, Nakamura A, Lepeule J, Strandberg-Larsen K, Melchior M. Smoking during pregnancy and children’s emotional and behavioural trajectories. Eur J Public Health 2022. [PMCID: PMC9593937 DOI: 10.1093/eurpub/ckac129.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The nature of the relationship between maternal tobacco smoking during pregnancy and the occurrence of children's behavioural problems is still a matter of controversy. We tested this association using data collected among a sample of children followed from pregnancy to early adolescence (age 11.5 years), accounting for multiple parents’, children's and family characteristics. Methods Data come from 1424 mother-child pairs participating in the EDEN mother-child cohort set up in France. Using repeated measures (3, 5.5, 8 and 11.5 years) of the mother-reported Strengths and Difficulties Questionnaire, we estimated trajectories of children's emotional and behavioural difficulties. Two aspects of maternal smoking were studied: the timing and the level of use (cigarettes/day) during the first trimester of pregnancy. Multinomial regression models controlled for confounding factors including maternal mental health and socioeconomic characteristics using propensity scores with the overlap weighting technique. Results Contrary to bivariate analyses, in propensity score-controlled regression models, maternal smoking throughout pregnancy was no longer significantly associated with offspring emotional or behavioural difficulties. Maternal heavy smoking (≥10cigarettes/day) remained significantly associated with intermediate levels of overall emotional and behavioural difficulties (OR 1.64, 95%CI 1.04-2.58) and conduct problems (OR 3.05 95%CI 1.22-7.61), as well as with high levels of conduct problems symptoms (OR 2.82 95%CI 0.88-9.06) - although the latter did not reach statistical significance. Conclusions The association between maternal smoking in pregnancy and offspring emotional and behavioural difficulties appears to be largely explained by women's other characteristics. However, maternal heavy smoking appears to be related to offspring behavioural difficulties beyond the role of confounding characteristics. Key messages • The association between maternal smoking in pregnancy and offspring emotional and behavioural difficulties seem largely explained by the family's socio-demographic and behavioural characteristics. • Maternal heavy smoking appears to be related to offspring behavioural difficulties beyond the role of confounding characteristics.
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Affiliation(s)
- M Fekom
- Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre , Paris, France
| | - K Bonello
- General Practice, Sorbonne University, School of Medicine , Paris, France
- Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre , Paris, France
| | - R Gomajee
- Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre , Paris, France
| | - G Ibanez
- General Practice, Sorbonne University, School of Medicine , Paris, France
- Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre , Paris, France
| | - S Martin
- Epidemiology, Mailman School of Public Health, Columbia University , New York, USA
| | - K Keyes
- Epidemiology, Mailman School of Public Health, Columbia University , New York, USA
| | - A Nakamura
- Institute for Advanced Biosciences, Université Grenoble Alpes, INSERM, CNRS , Grenoble, France
| | - J Lepeule
- Institute for Advanced Biosciences, Université Grenoble Alpes, INSERM, CNRS , Grenoble, France
| | | | - M Melchior
- Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre , Paris, France
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Martin S, Ditmarsch M, Simmons M, Alp N, Turner T, Davidson M, Kastelein JJP. Comparison of low-density lipoprotein cholesterol equations in patients with dyslipidaemia receiving cholesterol ester transfer protein inhibition. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Low-density lipoprotein (LDL-C) lowering is imperative in cardiovascular disease prevention. Effectively translating the evidence for LDL-C lowering to maximize clinical and public health benefits depends on the availability of accurate LDL-C results from clinical laboratories to guide therapy. Furthermore, prior work has raised the possibility that cholesterol esterase transfer protein (CETP) inhibition could interfere with accurate assessment of LDL-C.
Purpose
We aimed to compare accuracy of three clinically implemented LDL-C equations in a clinical trial of CETP inhibition.
Methods
Men and women aged 18–75 years with dyslipidaemia were recruited from 17 sites in the Netherlands and Denmark. Patients were randomly assigned to one of nine groups using various combinations of the CETP inhibitor TA-8995, statin therapy, and placebo. In pooled measurements over 12 weeks, we calculated LDL-C by the Friedewald, Martin/Hopkins, and Sampson equations, and compared values with preparative ultracentrifugation (PUC) LDL-C as the reference measure (also known as “beta quantification”). Based on prior literature and dyslipidaemia guidelines, we examined correct classifications across the LDL-C 1.81 mmol/L cutpoint in the subgroup of patients with triglycerides of 1.69–4.51 mmol/L.
Results
The analysis included 242 patients contributing 921 observations. The full distributions of differences between LDL-C estimates and PUC are shown in Figure 1. Overall median LDL-C differences between estimates and PUC were small: Friedewald, 0.00 (25th, 75th: −0.10, 0.08) mmol/L; Martin/Hopkins, 0.02 (−0.08, 0.10) mmol/L; and Sampson, 0.05 (−0.03, 0.15) mmol/L. In the subgroup with estimated LDL-C <1.81 mmol/L and triglycerides 1.69–4.51 mmol/L, the Friedewald equation underestimated LDL-C with a median difference versus PUC of −0.25 (−0.33, −0.10) mmol/L, whereas the Martin/Hopkins equation corrected this issue with a median difference of 0.00 (−0.08, 0.10) mmol/L and the Sampson equation showed tendency towards underestimation with a median difference of −0.06 (−0.13, 0.00) mmol/L. In patients with triglyceride levels of 1.69–4.51 mmol/L, Figure 2 shows the proportion of LDL-C levels classified by the equations as < or ≥1.81 mmol/L that were correctly classified when compared with PUC. All three equations showed >95% accuracy when estimated LDL-C levels were ≥1.81 mmol/L. However, the proportion of LDL-C observations <1.81 mmol/L that were correctly classified compared with PUC was 71.4% by Friedewald versus 100.0% by Martin/Hopkins and 93.1% by Sampson.
Conclusion
In Europeans with dyslipidaemia, our analysis shows improved accuracy in LDL-C when using contemporary LDL-C equations over the Friedewald equation, particularly when using the Martin/Hopkins equation. High levels of accuracy with the Martin/Hopkins equation were seen in individuals treated with CETP inhibition and even in the context of low LDL-C and high triglyceride levels.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Dezima and NewAmsterdam Pharma
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Affiliation(s)
- S Martin
- Johns Hopkins , Baltimore , United States of America
| | - M Ditmarsch
- NewAmsterdam Pharma B.V., Naarden , Noord-Holland , The Netherlands
| | - M Simmons
- Medpace and Medpace Reference Laboratories , Cincinnati , United States of America
| | - N Alp
- Medpace and Medpace Reference Laboratories , Cincinnati , United States of America
| | - T Turner
- Medpace and Medpace Reference Laboratories , Cincinnati , United States of America
| | - M Davidson
- NewAmsterdam Pharma B.V., Naarden , Noord-Holland , The Netherlands
| | - J J P Kastelein
- NewAmsterdam Pharma B.V., Naarden , Noord-Holland , The Netherlands
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Martin S, Rhodes AC, Brill CD, Sandoz EK. Diversity-related Factors in Research Mentorship and Publishing in the ACBS Community and the Journal of Contextual Behavioral Science. J Contextual Behav Sci 2022; 26:56-62. [PMID: 36275125 PMCID: PMC9586200 DOI: 10.1016/j.jcbs.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Gender, racial, and ethnic disparities persist in the scientific community despite increasing attention to research-related equity. Men publish in biomedical, scientific journals more frequently than women researchers and have more leadership roles (e.g., first authorship) in these submissions. Similar differences in scientific publishing appear among under-represented minority (URM) authors compared to White counterparts. These findings of authorship disparities are not consistent across all journals and may relate to mentorship variables. This study aimed to investigate gender and racial patterns of publishing and research mentorship within the Association for Contextual Behavioral Science (ACBS) community, including in the Journal of Contextual Behavioral Science (JCBS). Two hundred and eighty-two ACT for Professionals listserv members responded to the anonymous 31-item survey. Men reported significantly more publications and more first author manuscripts than women, both in scientific journals generally and in JCBS specifically. White versus URM respondents more frequently reported publishing in JCBS, but not in other scientific journals. There were no differences in the total number of barriers noted between men and women or between White respondents and URM respondents. The top barriers to publishing among all respondents were lack of time, institutional support, and funding. Women more frequently reported lack of adequate research mentorship or collaboration as a barrier to publishing in scientific journals, as well as in JCBS specifically; men more frequently reported experiencing publishing barriers related to embargos and not having research that was appropriate for JCBS. Identifying as the same gender as one's primary research mentor did not relate to any areas of training. However, participants whose race differed from their mentor were significantly more likely to report training in running a study and receiving positive encouragement. Being matched in terms of gender or race with one's mentor did not relate to publishing variables. Findings highlight the continued gender and racial disparities in publishing within the ACBS community and in JCBS. Recommendations for decreasing these differences through research mentorship and structured training efforts are provided.
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Affiliation(s)
- Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Amanda C. Rhodes
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | | | - Emily K. Sandoz
- Department of Psychology, University of Louisiana at Lafayette, Lafayette LA
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Shalabi H, Qin H, Su A, Yates B, Wolters PL, Steinberg SM, Ligon JA, Silbert S, DéDé K, Benzaoui M, Goldberg S, Achar S, Schneider D, Shahani SA, Little L, Foley T, Molina JC, Panch S, Mackall CL, Lee DW, Chien CD, Pouzolles M, Ahlman M, Yuan CM, Wang HW, Wang Y, Inglefield J, Toledo-Tamula MA, Martin S, Highfill SL, Altan-Bonnet G, Stroncek D, Fry TJ, Taylor N, Shah NN. CD19/22 CAR T cells in children and young adults with B-ALL: phase 1 results and development of a novel bicistronic CAR. Blood 2022; 140:451-463. [PMID: 35605184 PMCID: PMC9353146 DOI: 10.1182/blood.2022015795] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/03/2022] [Indexed: 11/20/2022] Open
Abstract
Remission durability following single-antigen targeted chimeric antigen receptor (CAR) T-cells is limited by antigen modulation, which may be overcome with combinatorial targeting. Building upon our experiences targeting CD19 and CD22 in B-cell acute lymphoblastic leukemia (B-ALL), we report on our phase 1 dose-escalation study of a novel murine stem cell virus (MSCV)-CD19/CD22-4-1BB bivalent CAR T-cell (CD19.22.BBζ) for children and young adults (CAYA) with B-cell malignancies. Primary objectives included toxicity and dose finding. Secondary objectives included response rates and relapse-free survival (RFS). Biologic correlatives included laboratory investigations, CAR T-cell expansion and cytokine profiling. Twenty patients, ages 5.4 to 34.6 years, with B-ALL received CD19.22.BBζ. The complete response (CR) rate was 60% (12 of 20) in the full cohort and 71.4% (10 of 14) in CAR-naïve patients. Ten (50%) developed cytokine release syndrome (CRS), with 3 (15%) having ≥ grade 3 CRS and only 1 experiencing neurotoxicity (grade 3). The 6- and 12-month RFS in those achieving CR was 80.8% (95% confidence interval [CI]: 42.4%-94.9%) and 57.7% (95% CI: 22.1%-81.9%), respectively. Limited CAR T-cell expansion and persistence of MSCV-CD19.22.BBζ compared with EF1α-CD22.BBζ prompted laboratory investigations comparing EF1α vs MSCV promoters, which did not reveal major differences. Limited CD22 targeting with CD19.22.BBζ, as evaluated by ex vivo cytokine secretion and leukemia eradication in humanized mice, led to development of a novel bicistronic CD19.28ζ/CD22.BBζ construct with enhanced cytokine production against CD22. With demonstrated safety and efficacy of CD19.22.BBζ in a heavily pretreated CAYA B-ALL cohort, further optimization of combinatorial antigen targeting serves to overcome identified limitations (www.clinicaltrials.gov #NCT03448393).
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Affiliation(s)
| | | | | | | | | | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - John A Ligon
- Pediatric Oncology Branch and
- Division of Hematology/Oncology, Department of Pediatrics, University of Florida, Gainesville, FL
| | - Sara Silbert
- Pediatric Oncology Branch and
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC
| | | | - Mehdi Benzaoui
- Pediatric Oncology Branch and
- Université Montpellier, Institut de Génétique Moléculaire de Montpellier, CNRS, Montpellier, France
| | | | - Sooraj Achar
- Laboratory of Integrative Cancer Immunology, CCR, NCI, NIH, Bethesda, MD
| | | | - Shilpa A Shahani
- Pediatric Oncology Branch and
- Department of Pediatrics, City of Hope, Duarte, CA
| | | | | | | | - Sandhya Panch
- Center for Cellular Engineering, Department of Transfusion Medicine, NIH Clinical Center, Bethesda, MD
- Department of Hematology, Seattle Cancer Care Alliance, University of Washington, Seattle, WA
| | - Crystal L Mackall
- Pediatric Oncology Branch and
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, CA
- Department of Pediatrics and
- Department of Medicine, Stanford University, Stanford, CA
| | - Daniel W Lee
- Pediatric Oncology Branch and
- Department of Pediatric Hematology/Oncology, Department of Pediatrics, University of Virginia, Charlottesville, VA
- University of Virginia Cancer Center, Charlottesville, VA
| | | | | | - Mark Ahlman
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD
| | | | - Hao-Wei Wang
- Laboratory of Pathology, CCR, NCI, NIH, Bethesda, MD
| | - Yanyu Wang
- Applied Developmental Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Jon Inglefield
- Applied Developmental Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, NCI, Frederick MD; and
| | | | - Steven L Highfill
- Center for Cellular Engineering, Department of Transfusion Medicine, NIH Clinical Center, Bethesda, MD
| | | | - David Stroncek
- Center for Cellular Engineering, Department of Transfusion Medicine, NIH Clinical Center, Bethesda, MD
| | - Terry J Fry
- Pediatric Oncology Branch and
- University of Colorado Anschutz Medical Campus and Center for Cancer and Blood Disorders, Children's Hospital of Colorado, Aurora, CO
| | - Naomi Taylor
- Pediatric Oncology Branch and
- Université Montpellier, Institut de Génétique Moléculaire de Montpellier, CNRS, Montpellier, France
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Hailey L, Bundy C, Howells L, Kirtley S, Martin S, O’sullivan D, Steinkoenig I, Stepney M, Coates L. POS1052 DEVELOPING EVIDENCE-BASED PATIENT FOCUSED LEARNING MATERIALS TO SUPPORT HEALTH BEHAVIOUR CHANGE FOR PEOPLE LIVING WITH PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPsoriatic arthritis (PsA) is a complex condition that requires high levels of self-management from those living with the condition. It is associated with many comorbidities, including depression, metabolic syndrome, and increased cardiovascular disease risk and can adversely affect quality of life. There is growing evidence that people living with psoriatic arthritis (PsA) are more likely to be overweight, consume alcohol above recommended levels, smoke, be affected by poor sleep, fatigue, anxiety, and take insufficient exercise for healthy living. These modifiable health behaviours further increase the already known risk of cardiovascular morbidity and mortality. These issues are not systematically addressed in routine clinical care due to low confidence in effective delivery and time constraints.ObjectivesTo co-develop evidence-based patient-focused learning materials to support healthy lifestyle changes for people living with PsA.MethodsThe development of the materials was overseen by a steering group of people living with PsA, psychologists, rheumatologists, and researchers. The COM-B model was used in the development of the materials, and they are designed around motivational interviewing principles. Firstly, a systematic literature review was performed to establish the evidence for the current burden and potential interventions aimed at these issues in PsA. These included diet, weight, alcohol, smoking, exercise, anxiety, depression, and stress. An initial focus group of people living with PsA was used to identify priority behaviours and ideas for content.The steering group developed draft materials, and we partnered with a design agency to create engaging materials. They developed a website and downloadable postcards. A second focus made up of people living with PsA was held for people to give their views on the draft content for the materials and initial design ideas. A third focus group was held with people living with PsA and a fourth with clinicians to refine the design materials and ensure they were accessible, interesting, and helpful to initiate and maintain change. A final evaluation survey was performed to review the draft website before launching the final materials. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) approved the final materials.ResultsFollowing the steering and focus groups’ input, 15 candidate topics were prioritised (Table 1). A website and downloadable postcards summarising each of the topics were developed by the design team and refined following feedback from the patient focus groups. An example of the postcard for ‘keeping active’ can be found in Figure 1. The resources are free to use and can be accessed at https://www.informatree.org.Table 1.Topics1Pain2Fatigue3Healthcare appointments4Tobacco5Different treatments6Alcohol7Work8Social support9Food and weight10Sleep11Keeping active12Mood13Intimacy14Travel15Using treatmentsFigure 1.During the development of the website and downloadable postcards, particular attention was paid to making the material as accessible and as friendly as possible for patients.ConclusionThis project created patient-focused information to support behaviour change in clinical practice. It addresses common concerns of people living with PsA about how they may optimise their health by providing practical and brief interventions to challenge and support them to make personal changes. Future research is needed to test the impact of the resource.AcknowledgementsThis research project was funded by a Medical Education Grant from Pfizer. SK was funded by Cancer Research UK (grant C49297/A27294).Disclosure of InterestsLouise Hailey: None declared, Christine Bundy Consultant of: Over the last 3 years, I have received funds for consultancy from the following pharmaceutical companies: Abbvie, Almirall, Amgen (was Celgene), Beiersdorf, Janssen, Novartis, Pfizer, UCB., Grant/research support from: Over the last 3 years, I have received funds for research and honoraria from the following pharmaceutical companies: Abbvie, Almirall, Amgen (was Celgene), Beiersdorf, Janssen, Novartis, Pfizer, UCB., Laura Howells: None declared, Shona Kirtley: None declared, Sam Martin: None declared, Denis O’Sullivan: None declared, Ingrid Steinkoenig: None declared, Melissa Stepney: None declared, Laura Coates Speakers bureau: LCC has been paid as a speaker for AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer and UCB., Consultant of: LCC has worked as a paid consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB., Grant/research support from: LCC has received grants/research support from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB.
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Martin S, Searl T, Ohlander S, Harrington D, Stupp S, McVary K, Podlasek C. Sonic hedgehog signaling in corpora cavernosal cells from prostatectomy, diabetic, hypertension and Peyronie's patients with erectile dysfunction. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Loucas C, Wolters P, Toledo-Tamula MA, Rhodes A, Baldwin A, Goodwin A, Widemann B, Martin S. Verbal learning and memory in youth with neurofibromatosis type 1 and plexiform neurofibromas: Relationships with disease severity. Eur J Paediatr Neurol 2022; 38:7-12. [PMID: 35334353 PMCID: PMC10575344 DOI: 10.1016/j.ejpn.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/08/2022] [Accepted: 03/11/2022] [Indexed: 11/18/2022]
Abstract
AIM To provide a comprehensive characterization of verbal learning and memory (VLM) abilities in youth with neurofibromatosis type 1 (NF1) and plexiform neurofibromas (PNs) and to evaluate disease severity as a predictor of VLM functioning over time. METHOD As part of a longitudinal natural history study, youth with NF1 and PNs were administered repeat neuropsychological assessments, including measures of VLM and ratings of NF1 disease severity completed by a medical professional. This sub-study analyzed data from 89 patients (M age baseline = 13.1, SD = 4.3 years, range 6-24 years) who had completed tests of VLM abilities and verbal attention at either baseline and/or 36 months. RESULTS VLM scores across the sample fell predominantly within the average range of functioning at both time points. However, relative to peers with mild NF1 disease severity, youth with moderate/severe NF1 disease showed lower functioning across multiple VLM domains at 36 months, even after controlling for the effects of verbal attention. INTERPRETATION Exclusive use of overall domain scores does not fully characterize VLM functioning in youth with NF1 and PNs. Additionally, children and adolescents with more severe NF1 disease should be monitored more closely for verbal memory challenges and targeted for interventions.
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Affiliation(s)
- Caitlyn Loucas
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, United States
| | - Pamela Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, United States
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, United States
| | - Amanda Rhodes
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, United States
| | - Andrea Baldwin
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, United States
| | - Anne Goodwin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, United States
| | - Brigitte Widemann
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, United States
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, United States.
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Allen T, Reda S, Martin S, Long P, Franklin A, Bedoya SZ, Wiener L, Wolters PL. The Needs of Adolescents and Young Adults with Chronic Illness: Results of a Quality Improvement Survey. Children 2022; 9:children9040500. [PMID: 35455544 PMCID: PMC9025253 DOI: 10.3390/children9040500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022]
Abstract
Adolescent and young adults (AYAs) with chronic illnesses cope with complex issues that require unique psychological support and healthcare services to reduce psychosocial difficulties, improve disease management, and facilitate positive transitions to adult care. Engaging patients and caregivers can help providers understand the specific needs of this population and identify the perceived areas of support. The purpose of this quality improvement initiative is to assess the needs of AYAs with chronic medical conditions at a large government research hospital. Eighty-nine AYA patients (age = 23.5 years; range 13–34) with neurofibromatosis type 1, cancer, primary immunodeficiencies, or sickle cell disease, and a sample of caregivers (n = 37, age = 52 years; range: 41–65), completed an anonymized survey that assessed their preferences for a wide range of informational and service-related needs. The results indicate an overwhelming desire for information about general health and wellbeing and disease-specific medical knowledge. The most endorsed item was the need for more information about an individual’s medical condition (72%), which was a primary concern across disease, racial, and gender groups. Demographic and disease-specific needs were also identified. Thus, providing information to AYA patients and caregivers is a critical and largely unmet component of care, which requires the development and implementation of targeted educational and psychosocial interventions.
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Greenwood D, Steinke D, Martin S, Norton G, Tully MP. With a new role comes new responsibilities: interviews to explore what Emergency Department Pharmacist Practitioners know and understand about patient safeguarding. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac021.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
In the UK, pharmacists with additional clinical skills now work in emergency departments (1). Known as Emergency Department Pharmacist Practitioners (EDPPs), the role was developed in response to a shortage of doctors and nurses. EDPPs carry out activities typical of traditional hospital pharmacists, but also novel ‘practitioner’ activities such as examining patients. They also may act as designated care providers with overall responsibility for patients, which includes a responsibility to safeguard patients (children and vulnerable adults) from harm – as is required of other healthcare professionals who take on that role. The initial safeguarding process comprises four stages: recognition, ensuring safety, documentation and escalation. Professional competence, i.e. to safeguard patients, is underpinned by knowledge of the subject, but also the ability to apply that knowledge (2).
Aim
To investigate what EDPPs know and understand about safeguarding vulnerable children and adults.
Methods
Past and current students of an ‘Advanced Specialist Training in Emergency Medicine’ programme, which delivers additional clinical skills to pharmacists, were interviewed to explore their knowledge and understanding of safeguarding. Interview questions were developed from review of relevant literature, as were four vignettes which were used to further explore participants’ understanding i.e. apply their knowledge of safeguarding to realistic scenarios. Vignettes concerned victims of: theft, sexual abuse, physical abuse and a medication error. A Social Worker reviewed the vignettes for plausibility, suggesting changes e.g. to victim characteristics. The interview schedule and vignettes were then piloted by two acute medicine pharmacists. For analysis, interview transcripts were reviewed with template analysis used to code data to four a priori themes (stages of the initial safeguarding process), and new themes that emerged throughout the process.
Results
Thirteen EDPPs were interviewed (four in 2016, and then a further nine in 2019 following delays due to competing research commitments). In addition to the four a priori themes, a further six themes were identified: scope of safeguarding; responsibility to safeguard; resources and setting; education, training and experiential learning; multidisciplinary working and communication; and culture. Overall, participants had a broad and often detailed knowledge of safeguarding. All four stages were frequently described which demonstrates EDPPs awareness of how safeguarding concerns are both recognised and responded to. Somewhat unsurprisingly, participants were generally more comfortable when responding to medicines related concerns although whether these should be reported via safeguarding or error systems is currently unclear. Several participants were more involved with the formal escalation of issues, and one participant had safeguarding issues escalated to them and had given evidence in court.
Conclusion
Although interview phases were three years apart, no thematic differences were identified between these phases and thematic saturation was also achieved. EDPPs interviewed were aware of the different types of maltreatment and the safeguarding process. Safeguarding training for pharmacists should include a focus on the importance of good inter-professional communication. Training should also include information about the types of medication error (e.g. type and severity) that require escalation via safeguarding, but these first need to be confirmed through future research.
References
(1) Greenwood D, Tully MP, Martin S, Steinke D. The description and definition of Emergency Department Pharmacist Practitioners in the United Kingdom (the ENDPAPER study). International journal of clinical pharmacy. 2019 Apr;41(2):434-44.
(2) James KL, Davies JG, Kinchin I, Patel JP, Whittlesea C. Understanding vs. competency: the case of accuracy checking dispensed medicines in pharmacy. Advances in health sciences education. 2010 Dec;15(5):735-47.
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Affiliation(s)
- D Greenwood
- School of Medicine, Anglia Ruskin University, Chelmsford, United Kingdom
- Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
| | - D Steinke
- Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
| | - S Martin
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom
| | - G Norton
- Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
| | - M P Tully
- Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
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Martin S, Searl T, Ohlander S, Harrington D, Stupp S, McVary K, Podlasek C. Sonic Hedgehog Signaling in Corpora Cavernosal Cells from Prostatectomy, Diabetic, Hypertension and Peyronie's Patients with Erectile Dysfunction. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shalabi H, Martin S, Yates B, Wolters PL, Kaplan C, Smith H, Sesi CR, Jess J, Toledo-Tamula MA, Struemph K, Delbrook CP, Khan OI, Mackall CL, Lee DW, Shah NN. Neurotoxicity following CD19/CD28ζ CAR T-cells in children and young adults with B-cell malignancies. Neuro Oncol 2022; 24:1584-1597. [PMID: 35148417 PMCID: PMC9435493 DOI: 10.1093/neuonc/noac034] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Neurotoxicity is an established toxicity of CD19 CAR T-cell therapy; however, there is little information on neurotoxicity in children, adolescents, and young adults (CAYA) receiving CD19/CD28ζ CAR T-cells for B-cell malignancies. METHODS We analyzed neurotoxicity of CD19/CD28ζ CAR T-cells in CAYA treated on a phase I study (NCT01593696). Assessments included daily inpatient monitoring, caregiver-based neuro-symptom checklist (NSC), exploratory neurocognitive assessments, clinically-indicated imaging, CSF analysis, and systematic cytokine profiling, outcomes of which were associated with cytokine release syndrome (CRS) and treatment response postinfusion. Patients with active CNS leukemia were included. RESULTS Amongst 52 patients treated, 13 patients had active CNS leukemia at infusion. Neurotoxicity was seen in 11/52 (21.2%) patients, with an incidence of 29.7% (11/37) in patients with CRS. Neurotoxicity was associated with the presence and severity of CRS. Those with neurotoxicity had higher levels of peak serum IL-6, IFNγ, and IL-15. Additionally, CNS leukemia was effectively eradicated in most patients with CRS. Pilot neurocognitive testing demonstrated stable-to-improved neurocognitive test scores in most patients, albeit limited by small patient numbers. The NSC enabled caregiver input into the patient experience. CONCLUSIONS This is the first systematic analysis of neurotoxicity utilizing a CD19/CD28ζ CAR construct in CAYA, including in those with active CNS involvement. The experience demonstrates that the neurotoxicity profile was acceptable and reversible, with evidence of anti-leukemia response and CNS trafficking of CAR T-cells. Additionally, neurocognitive testing, while exploratory, provides an opportunity for future studies to employ systematic evaluations into neurotoxicity assessments and validation is needed in future studies.
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Affiliation(s)
- Haneen Shalabi
- Corresponding Author: Haneen Shalabi, DO, Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Building 10, Room 1W-5750, 9000 Rockville Pike, Bethesda, MD 20892-1104, USA ()
| | | | - Bonnie Yates
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Claire Kaplan
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Hannah Smith
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Christopher R Sesi
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Jennifer Jess
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Kari Struemph
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Cindy P Delbrook
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Omar I Khan
- National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Mackall
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA,Center for Cancer Cell Therapy, Stanford Cancer Institute, Palo Alto, California, USA,Department of Pediatrics, Stanford University, Palo Alto, California, USA,Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Daniel W Lee
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA,Department of Pediatric Hematology/Oncology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA,University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
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Gross AM, Glassberg B, Wolters PL, Dombi E, Baldwin A, Fisher MJ, Kim A, Bornhorst M, Weiss BD, Blakeley JO, Whitcomb P, Paul SM, Steinberg SM, Venzon DJ, Martin S, Carbonell A, Heisey K, Therrien J, Kapustina O, Dufek A, Derdak J, Smith MA, Widemann BC. OUP accepted manuscript. Neuro Oncol 2022; 24:1978-1988. [PMID: 35467749 PMCID: PMC9629448 DOI: 10.1093/neuonc/noac109] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Selumetinib was recently approved for the treatment of inoperable symptomatic plexiform neurofibromas (PNs) in children with neurofibromatosis type 1 (NF1). This parallel phase II study determined the response rate to selumetinib in children with NF1 PN without clinically significant morbidity. METHODS Children with NF1 and inoperable PNs, which were not yet causing clinically significant morbidity but had the potential to cause symptoms, received selumetinib at 25 mg/m2 orally twice daily (1 cycle = 28 days). Volumetric magnetic resonance imaging analysis and outcome assessments, including patient-reported (PRO), observer-reported, and functional outcome measures were performed every 4 cycles for 2 years, with changes assessed over time. A confirmed partial response (cPR) was defined as PN volume decrease of ≥20% on at least 2 consecutive scans ≥3 months apart. RESULTS 72% of subjects experienced a cPR on selumetinib. Participants received selumetinib for a median of 41 cycles (min 2, max 67) at data cutoff. Approximately half of the children rated having some target tumor pain at baseline, which significantly decreased by pre-cycle 13. Most objectively measured baseline functions, including visual, motor, bowel/bladder, or airway function were within normal limits and did not clinically or statistically worsen during treatment. CONCLUSIONS Selumetinib resulted in PN shrinkage in most subjects with NF1 PN without clinically significant morbidity. No new PN-related symptoms developed while on selumetinib, and PRO measures indicated declines in tumor-related pain intensity. This supports that selumetinib treatment may prevent the development of PN-related morbidities, though future prospective studies are needed to confirm these results. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01362803.
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Affiliation(s)
- Andrea M Gross
- Corresponding Authors: Andrea M. Gross, MD, NIH Clinical Center (Building 10), 10 Center Drive, Room 1-5742, Bethesda, MD 20852, USA ()
| | | | - Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Eva Dombi
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Andrea Baldwin
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Michael J Fisher
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - AeRang Kim
- Center for Cancer and Blood Disorders, Children’s National Hospital, Washington, DC, USA
| | - Miriam Bornhorst
- Center for Cancer and Blood Disorders, Children’s National Hospital, Washington, DC, USA
| | - Brian D Weiss
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jaishri O Blakeley
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patricia Whitcomb
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Scott M Paul
- Rehabilitation Medicine Department, NIH Clinical Center, Baltimore, Maryland, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Baltimore, Maryland, USA
| | - David J Venzon
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Baltimore, Maryland, USA
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Amanda Carbonell
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Kara Heisey
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Janet Therrien
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Oxana Kapustina
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Anne Dufek
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Joanne Derdak
- Pediatric Oncology Branch, Center for Cancer research, National Cancer Institute, Bethesda, Maryland, USA
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA (M.A.S.)
| | - Brigitte C Widemann
- Brigitte C. Widemann, MD, NIH Clinical Center (Building 10), 10 Center Drive, Room 1-3752, Bethesda, MD 20852, USA ()
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Loeb E, El Asmar K, Trabado S, Gressier F, Colle R, Rigal A, Martin S, Verstuyft C, Fève B, Chanson P, Becquemont L, Corruble E. Nitric Oxide Synthase activity in major depressive episodes before and after antidepressant treatment: Results of a large case-control treatment study. Psychol Med 2022; 52:80-89. [PMID: 32524920 DOI: 10.1017/s0033291720001749] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nitric oxide synthase (NOS) activity, an enzyme potentially involved in the major depressive episodes (MDE), could be indirectly measured by the L-Citrulline/L-Arginine ratio (L-Cit/L-Arg). The aim of this study was: (1) to compare the NOS activity of patients with a MDE to that of healthy controls (HC); (2) to assess its change after antidepressant treatment. METHODS A total of 460 patients with a current MDE in a context of major depressive disorder (MDD) were compared to 895 HC for NOS activity (L-Cit/L-Arg plasma ratio). L-Arg and L-Cit plasma levels were measured using a MS-based liquid chromatography method. Depressed patients were assessed at baseline, and after 3 and 6 months of antidepressant treatment for depression severity and clinical response. RESULTS Depressed patients had a lower NOS activity than HC at baseline [0.31 ± 0.09 v. 0.38 ± 0.12; 95% confidence interval (CI) -0.084 to -0.062, p < 0.0001]. Lower NOS activity at baseline predicted a higher response rate [odds ratio (OR) = 29.20; 95% CI 1.58-536.37; p = 0.023]. NOS activity in depressed patients increased significantly up to 0.34 ± 0.08 after antidepressant treatment (Est = 0.0034; 95% CI 0.0002-0.0067; p = 0.03). CONCLUSIONS Depressed patients have a decreased NOS activity that improves after antidepressant treatment and predicts drug response. NOS activity may be a promising biomarker for MDE in a context of MDD.
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Affiliation(s)
- E Loeb
- INSERM CESP - Equipe 'Moods'- Univ Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Service de Psychiatrie- Hôpital Bicêtre- GH Paris Saclay- APHP, 94275 Le Kremlin Bicêtre, France
- Faculté de Médecine Paris-Saclay, 94275 Le Kremlin Bicêtre, France
| | - K El Asmar
- INSERM CESP - Equipe 'Moods'- Univ Paris-Saclay, 94275 Le Kremlin Bicêtre, France
| | - S Trabado
- Faculté de Médecine Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Inserm U1185 - Univ Paris-Sud, 94275 Le Kremlin Bicêtre, France
- Service de Génétique moléculaire, Pharmacogénétique et Hormonologie- CHU de Bicêtre- APHP, 94275 Le Kremlin Bicêtre, France
| | - F Gressier
- INSERM CESP - Equipe 'Moods'- Univ Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Service de Psychiatrie- Hôpital Bicêtre- GH Paris Saclay- APHP, 94275 Le Kremlin Bicêtre, France
- Faculté de Médecine Paris-Saclay, 94275 Le Kremlin Bicêtre, France
| | - R Colle
- INSERM CESP - Equipe 'Moods'- Univ Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Service de Psychiatrie- Hôpital Bicêtre- GH Paris Saclay- APHP, 94275 Le Kremlin Bicêtre, France
- Faculté de Médecine Paris-Saclay, 94275 Le Kremlin Bicêtre, France
| | - A Rigal
- INSERM CESP - Equipe 'Moods'- Univ Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Service de Psychiatrie- Hôpital Bicêtre- GH Paris Saclay- APHP, 94275 Le Kremlin Bicêtre, France
- Faculté de Médecine Paris-Saclay, 94275 Le Kremlin Bicêtre, France
| | - S Martin
- INSERM CESP - Equipe 'Moods'- Univ Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Service de Psychiatrie- Hôpital Bicêtre- GH Paris Saclay- APHP, 94275 Le Kremlin Bicêtre, France
- Faculté de Médecine Paris-Saclay, 94275 Le Kremlin Bicêtre, France
| | - C Verstuyft
- INSERM CESP - Equipe 'Moods'- Univ Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Faculté de Médecine Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Service de Génétique moléculaire, Pharmacogénétique et Hormonologie- CHU de Bicêtre- APHP, 94275 Le Kremlin Bicêtre, France
| | - B Fève
- Sorbonne Université-INSERM UMR S_938, Centre de Recherche Saint-Antoine, 75012Paris, France
- Service d'Endocrinologie- Hôpital Saint-Antoine- APHP, 75012Paris, France
- Institut Hospitalo-Universitaire ICAN, 75012Paris, France
| | - P Chanson
- Faculté de Médecine Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Inserm U1185 - Univ Paris-Sud, 94275 Le Kremlin Bicêtre, France
- Service d'Endocrinologie et des Maladies de la Reproduction- CHU de Bicêtre- APHP, 94275 Le Kremlin Bicêtre, France
| | - L Becquemont
- INSERM CESP - Equipe 'Moods'- Univ Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Faculté de Médecine Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Service de Génétique moléculaire, Pharmacogénétique et Hormonologie- CHU de Bicêtre- APHP, 94275 Le Kremlin Bicêtre, France
| | - E Corruble
- INSERM CESP - Equipe 'Moods'- Univ Paris-Saclay, 94275 Le Kremlin Bicêtre, France
- Service de Psychiatrie- Hôpital Bicêtre- GH Paris Saclay- APHP, 94275 Le Kremlin Bicêtre, France
- Faculté de Médecine Paris-Saclay, 94275 Le Kremlin Bicêtre, France
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Greenwood D, Tully MP, Martin S, Steinke D. Development of the Manchester framework for the evaluation of emergency department pharmacy services. Int J Clin Pharm 2022; 44:930-938. [PMID: 35449350 PMCID: PMC9393142 DOI: 10.1007/s11096-022-01403-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many countries, including the United Kingdom, have established Emergency Department (ED) pharmacy services where some ED pharmacists now work as practitioners. They provide both traditional pharmaceutical care and novel practitioner care i.e. clinical examination, yet their impact on quality of care is unknown. AIM To develop a framework of structures, processes and potential outcome indicators to support evaluation of the quality of ED pharmacy services in future studies. METHOD Framework components (structures, processes and potential outcome indicators) were identified in three ways: from a narrative review of relevant international literature, and separate panel meetings with ED pharmacists and then other ED healthcare professionals. Structures and processes were collated into categories developed iteratively throughout data collection, with outcome indicators collated into six domains of quality as proposed by the Institute of Medicine. These raw data were then processed e.g. outcome indicators screened for clarity i.e. those which explicitly stated what would be measured were included in the framework. RESULTS A total of 190 structures, 533 processes, and 503 outcome indicators were identified. Through data processing a total of 153 outcome indicators were included in the final framework divided into the domains safe (32), effective (50), patient centred (18), timely (24), efficient (20) and equitable (9). CONCLUSION The first framework specific to the quality evaluation ED pharmacy services, service evaluators should validate potential outcome indicators prior to their use. The minimum expected of a high-quality service should also be defined to enable interpretation of relevant measurements.
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Affiliation(s)
- D Greenwood
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, M13 9PT, Manchester, UK. .,School of Medicine, Anglia Ruskin University, Bishop Hall Lane, CM1 1SQ, Chelmsford, UK.
| | - MP Tully
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, M13 9PT Manchester, UK
| | - S Martin
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, M13 9PT Manchester, UK ,School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, BD7 1DP Bradford, UK
| | - D Steinke
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, M13 9PT Manchester, UK
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Alépée N, Grandidier M, Teluob S, Amaral F, Caviola E, De Servi B, Martin S, Meloni M, Nardelli L, Pasdelou C, Tagliati V, Viricel A, Adriaens E, Michaut V. Validation of the SkinEthic HCE time-to-toxicity test method for eye hazard classification of chemicals according to UN GHS. Toxicol In Vitro 2022; 80:105319. [DOI: 10.1016/j.tiv.2022.105319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Struemph KL, Watts ATM, Wolters PL, Tamula MA, Baldwin A, Widemann B, Martin S. Adolescents and young adults with neurofibromatosis type 1: A descriptive study of adaptive functioning. Am J Med Genet A 2021; 188:488-497. [PMID: 34731530 DOI: 10.1002/ajmg.a.62544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/09/2021] [Accepted: 09/25/2021] [Indexed: 11/10/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a genetic syndrome affecting about 1 in 3500 individuals; many of those affected have plexiform neurofibroma (pNF) tumors and associated symptoms and complications. Furthermore, learning and attention problems, as well as deficits in adaptive functioning, are common, often beginning in early childhood. This study aimed to describe adaptive functioning and to examine relationships between adaptive functioning and cognitive and academic variables and level of independence among adolescents and young adults (AYA) with NF1 and pNF tumors. Fifty-five AYA aged 16-31 years participated in a series of neuropsychological evaluations while parents completed the Vineland Adaptive Behavior Scales (VABS-II) as part of a larger natural history study. Over one-third (35%) of AYA were neither in school nor employed. Mean VABS-II daily living and socialization scores were low average while mean Verbal and Performance IQ scores were average. VABS-II scores were positively correlated with processing speed, executive functioning, and working memory scores. Verbal IQ was the only significant predictor of work/school status. Identification of the correlates and predictors of adaptive functioning and life achievement can help guide healthcare providers with the early identification of risk factors and possible areas for intervention.
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Affiliation(s)
- Kari L Struemph
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Adreanna T M Watts
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Mary Anne Tamula
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Andrea Baldwin
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Brigitte Widemann
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
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Martin S, Schwab J, Lopez PC, Benke E, Reitelshofer S, Franke J. Mechanical modifications of soft actuators for the use as a dynamic iris implant. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:4709-4712. [PMID: 34892263 DOI: 10.1109/embc46164.2021.9629906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aniridia is a condition characterized by defects or absence of the iris. Since the eyes are a central point of attention in the human face, these deformities are often covered with cosmetic implants. However, patients suffer from the static pupil diameter of these implants, resulting in high light sensitivity or inadequate night vision. Therefore, we present a functional iris implant based on dielectric elastomer actuators. These electric drives are characterized by a silent and continuous adaptation as well as a small construction volume and a low heat emission. Since they normally exhibit in-plane uniaxial motion, this displacement must be focused to operate similarly to the iris sphincter. Therefore, we investigated possible mechanical modifications of the setups to generate a directional motion. The results of the study are presented and discussed.Clinical Relevance- The proposed system design enables the functional treatment of aniridia and other accidental iris defects. In addition, the system serves as a basis for later developments of e.g. functional lenses that allow focus adjustment.
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Benke E, Stoinski RT, Preis A, Reitelshofer S, Martin S, Franke J. Intraurethral Energy Harvesting from Urine Flow as an Approach to Power Urologic Implants. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:7215-7218. [PMID: 34892764 DOI: 10.1109/embc46164.2021.9630116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Active urologic implants, such as bladder stimulators or artificial sphincters, are a widely-used approach for therapy of urinary incontinence. At present these devices are powered by primary batteries or conventional wireless power transferring techniques. As these methods are associated with several limitations, human body energy harvesting can be a promising alternative or complement for power supply. This paper introduces an approach to harvest energy from the urine flow inside the urethra with a mechatronic harvesting system based on a hubless flow turbine. Using a test bench approximating the flow conditions of the lower urinary tract, the feasibility of the harvesting principle is shown in-vitro.
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Fulton J, Koons M, Torres H, Gray A, Martin S, Hoppe J. 344: Initiating food insecurity screening during a pandemic: Identifying and overcoming barriers. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01768-9] [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: 11/16/2022]
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Douglas L, Reihill J, Ho M, Axten J, Campobasso N, Wilcoxen K, Martin S. 391: Highly selective, first-in-class furin inhibitor BOS-318 inhibits ENaC and restores airway hydration in cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sabri A, Cavalieri S, Ahmad F, Martin S, Abushattal A. Bacillus cereus Bacteremia: An Unusual Case Following Food Poisoning. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Bacillus cereus is a spore-forming, gram-positive rod, well known for causing food poisoning. In addition, this bacterium often presents as a contaminant of blood cultures. Differentiating true bacteremia from contamination of blood samples is important as it has treatment implications. Early recognition is necessary, as it can cause septic shock if untreated. We present a challenging case of food poisoning with concomitant bacteremia in a young patient with a history of diabetes mellitus (DM), celiac disease, and new-onset chronic kidney disease (CKD).
Methods/Case Report
A 23-year-old adult male with a history of DM, new-onset CKD, and celiac disease presented with nausea, intermittent vomiting, and lower abdominal pain for 2 weeks. On initial evaluation, he had normal blood pressure but tachypnea and tachycardia. Physical examination was significant for left lower quadrant and flank tenderness. The symptoms were persistent and progressed to point that he could not tolerate meals due to vomiting. Two weeks earlier, he presented with similar complaints along with dysuria and was treated for suspected urinary tract infection with Co-trimoxazole. This time, further workup revealed normal white blood cell count (11.8 k/µL) with 81% neutrophils, elevated creatinine (3.56 mg/dL), blood urea nitrogen (49 mg/dL), and procalcitonin (0.39 ng/mL), with abnormal urinalysis showing increased turbidity, pyuria, and nitrituria. He was started on ceftriaxone, fluids, antiemetics and was admitted to the hospital for further management. The urine culture had no bacterial growth. Two sets of peripheral blood cultures (different sites at different times) had gram-positive rods which eventually turned out to be B. cereus, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Levofloxacin was started, and he reported improvement in nausea and vomiting by the next day of admission and was discharged.
Results (if a Case Study enter NA)
NA
Conclusion
Differentiating true B. cereus bacteremia from blood sample contamination is important. Additionally, no symptoms are specific for B. cereus-associated food poisoning, and the presence of risk factors doesn’t always favor this entity over other entities, hence adding difficulty to the diagnosis. A high index of suspicion is needed, as early intervention can prevent the development of life-threatening complications.
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Affiliation(s)
- A Sabri
- Department of Pathology, Creighton University - School of Medicine, Omaha, Nebraska, UNITED STATES
| | - S Cavalieri
- Department of Pathology, Creighton University - School of Medicine, Omaha, Nebraska, UNITED STATES
| | - F Ahmad
- Division of Infectious Diseases, Department of Internal Medicine, Creighton University - School of Medicine, Omaha, Nebraska, UNITED STATES
| | - S Martin
- Department of Internal Medicine, Creighton University - School of Medicine, Omaha, Nebraska, UNITED STATES
| | - A Abushattal
- University of Jordan - School of Medicine, Amman, JORDAN
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Gao Y, Diab A, Sharma A, Khoury S, Huynh P, Spaulding E, Martin S, Marvel F. Adopting digital health interventions for secondary prevention of cardiovascular disease: clinician perspectives. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiovascular disease (CVD) remains the leading cause of death globally, taking an estimated 18 million lives each year. Digital health interventions (DHI), such as wearables and smartphone applications, have shown promise in CVD detection, prevention, and management. However, there are scarce data regarding clinician perspectives on the utility of DHI and identification of key elements to support adoption in clinical practice.
Method
In this cross-sectional study, a web-based survey was administered to 107 clinicians directly involved in the care of cardiac inpatients across multiple academic health care systems in the United States, between January 2020 and March 2021. Participants (1) reported their perceptions of DHI impact on their ability to care for patients with CVD, (2) rated the importance of factors related to DHI adoption, and (3) shared perspectives on using DHI for secondary CVD prevention to support guideline-directed medical therapy in patients after acute myocardial infarction. Descriptive statistics were analyzed and summarized as frequencies with percentages.
Results
Among survey respondents, 41% were women; 22% specialized in cardiovascular medicine; and 31% were practicing attendings (Table). Overall, 92% (86/94) of respondents believed that DHI would be important in offering advantages in cardiovascular patient care (Figure). Increasing patient adherence was reported as the most important benefit of DHI adoption by 39% of clinicians, followed by improvement in the patient-clinician relationship (29%), enabling remote care (18%), and improving patient experience (14%). Clinicians under age 40 years old, cardiologists, and internists were the groups more likely to consider DHI important in remote patient care, disease monitoring, and tele-visits, as compared to clinicians over age 40 years old or in other clinical specialties.
Conclusion
Our results highlight clinician perspectives on the advantages of DHI and the potential for its adoption for secondary prevention of CVD.
Funding Acknowledgement
Type of funding sources: None. Table 1. Characteristics of RespondentsFigure 1. Clinician Survey
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Affiliation(s)
- Y Gao
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - A Diab
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - A Sharma
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - S Khoury
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - P Huynh
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - E Spaulding
- Johns Hopkins University School of Nursing, Baltimore, United States of America
| | - S Martin
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - F Marvel
- Johns Hopkins University School of Medicine, Baltimore, United States of America
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Puntmann V, Martin S, Vanchin B, Holm N, Giokoglu E, Hoffmann J, Karyou A, Arendt C, Khodamoradi Y, Vehreschild M, Braner A, Rohde G, Zeiher A, Vogl T, Nagel E. Patterns of cardiac involvement in patients with long COVID syndrome using cardiovascular magnetic resonance. Eur Heart J 2021. [PMCID: PMC8767595 DOI: 10.1093/eurheartj/ehab724.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Long COVID (LC) is an increasingly recognized late complication of COVID-19 infection. Cardiovascular involvement has also been implicated, however, the type and extent of the underlying cardiovascular injury remains unknown. Purpose To evaluate the association between ongoing symptoms and findings with cardiovascular magnetic resonance (CMR) in consecutive patients recently recovered from COVID-19 illness. Methods Prospective observational cohort study of patients recently recovered from COVID-19 illness and no previously known cardiovascular disease were included between April 2020 and April 2021. Demographic characteristics, cardiac blood markers, and CMR imaging a minimum of 4 weeks from the diagnosis were obtained. Results Of the 389 included patients, 192 (49%) were male, the mean (±standard deviation) age was 44 (±13) years and 61 (16%) required hospitalization during the acute illness. The median (IQR) time interval between COVID-19 diagnosis and CMR was 94 (71–165) days. 298 (77%) of patients continued to experience ongoing cardiovascular symptoms (long COVID, LC), including dyspnea, palpitations, atypical chest pain and fatigue at the time of CMR at least 4 weeks after the infection. In most patients, the symptoms were only effort related 137 (46%), whereas in 98 (33%) the symptoms affected the activities of daily life; 10 (3%) had severe and debilitating symptoms at rest. Compared to those with no LC (NLC, n=91), LC patients were more commonly hospitalized, had significantly higher native T1, native T2, and showed pericardial enhancement and effusion (Figure 1). There were no differences in cardiac biomarkers, left ventricular (LV) and right ventricular ejection fraction and mass. Proportionally, men and women were similarly affected (n=144 (73%) vs. n=157 (80%), p=0.18). Previous hospitalization was associated with hypertension and ongoing detectable troponin. LC status was associated with previous hospitalization and CMR findings of raised native T1 and native T2, and in females also pericardial enhancement. Severity of symptoms were associated with increased native T1 and T2 and decreased end-diastolic volume, whereas cardiac function showed no significant difference. Conclusions In this cohort of patients recently recovered from COVID-19 infection, ongoing cardiovascular symptoms were common. The LC status was related to previous hospitalization and CMR imaging findings of myopericardial inflammation. The extent and type of cardiovascular findings was associated with the severity of symptoms. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The German Heart Foundation (Deutsche Herzstiftung) and Bayer AG, Leverkusen, Germany
Figure 1 ![]()
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Affiliation(s)
- V Puntmann
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - S Martin
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - B Vanchin
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - N Holm
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - E Giokoglu
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - J Hoffmann
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - A Karyou
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - C Arendt
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Y Khodamoradi
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Vehreschild
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - A Braner
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - G Rohde
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - A Zeiher
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - T Vogl
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - E Nagel
- Wolfgang Goethe University, Frankfurt am Main, Germany
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Puntmann V, Carr-White G, Rolf A, Zainal H, Vasquez M, Zhou H, Arcari L, Valbuena S, Hinojar R, Vidalakis E, Kolentinis M, Martin S, Zeiher A, Marber M, Nagel E. Clinical risk score for individualized risk stratification of patients with clinically suspected myocardial inflammation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
To develop a clinical risk score for individualized risk stratification of patients with clinically suspected myocardial inflammation.
Background
Myocardial inflammation is a prominent cause of non-ischaemic dilated cardiomyopathy, heart failure (HF) and sudden cardiac death.
Methods
This is a prospective multicentre longitudinal study of consecutive patients referred to cardiac magnetic resonance (CMR) with clinically suspected myocardial inflammation between October 2011 and December 2019 as a part of standard diagnostic pathway. Patients were followed up from the date of CMR. The outcome endpoints included major adverse cardiovascular event (MACE, cardiovascular mortality, sudden cardiac death, appropriate device discharge); or death or hospitalisation due to HF). A prognostic model was developed using Cox proportional hazards analysis and validated internally and externally.
Results
The final dataset included 722 subjects (50 years (40–61); males 422 (58%)). During a follow-up period of median 19 (15–23) months, there were 64 (9%) MACE and 130 (18%) HF events. Ten predictor variables qualified for entry into the prognostic model: age, sex, hematocrit, C-reactive protein, high-sensitive troponin-T (TNT), left and right ventricular ejection fraction, native T1 and T2, and late gadolinium enhancement (LGE). The final multivariable Cox regression model included native T2 (Figure 1A), TNT and LGE (Figure 1B) for the primary (Chi-square: 102.0, p<0.001) and secondary endpoint (Chi-square: 166.9, p<0.001), respectively. Cross-validation as well as external validation of the secondary models revealed good performance and no healthcare system effect. Based on the MyoRISK Score, patients were classified into three risk groups with respective event rates for MACE of 0%, 6.3% and 25.1%, and HF endpoint of 1.8%, 17.3% and 44.2%. TNT≥7 pg/ml allowed to efficiently preselect patients prior to CMR.
Conclusions
This is the first systematic assessment of outcomes in patients with clinically suspected myocardial inflammation, providing a non-invasive estimation of the probability of adverse events based on a score using readily available clinical parameters.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): DZHK
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Affiliation(s)
- V Puntmann
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | | | - A Rolf
- Kerckhoff Heart and Thorax Center, Cardiology, Bad Nauheim, Germany
| | - H Zainal
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Vasquez
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - H Zhou
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - L Arcari
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - S Valbuena
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - R Hinojar
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - E Vidalakis
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Kolentinis
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - S Martin
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - A Zeiher
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Marber
- King's College Hospital, London, United Kingdom
| | - E Nagel
- Wolfgang Goethe University, Frankfurt am Main, Germany
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Thorpe C, Liokati I, Boyle E, Mohan H, Bates N, Martin S, Kennelly R, Hanly A, Winter D, Carrington EV. 935 Identification and Management of Electrolyte Abnormalities in Surgical Patients Requiring Total Parenteral Nutrition: An Audit of Current Practice at A University Hospital. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Electrolyte abnormalities are a common and serious consequence of nutritional deficiencies when patients are nil-by-mouth. Timely intervention with a multidisciplinary approach is known to improve outcome. This audit aimed to assess adequacy of initial electrolyte management and timing of dietetics referral in acute surgical patients requiring total parenteral nutrition in a university hospital.
Method
A retrospective audit of all general surgery patients referred to dietetics for total parenteral nutrition between January-December 2019 was performed. The following audit standards (from the time following admission) were applied: monitoring of electrolytes every 48-hours, treatment of electrolyte abnormalities within 24-hours of discovery; and referral to the dietetics service within 48-hours of nil-by-mouth being commenced.
Results
Data from 52 patients (27 females, median age 66) were analysed. Fifty-one (98%) had electrolytes measured every 48-hours, however magnesium, phosphate and/or calcium were not measured prior to dietetics input in 9 (17%). Forty electrolyte abnormalities requiring treatment were found in 28 patients (54%), though only 18 (64%) commenced treatment within 24-hours. The most common electrolyte abnormalities not corrected within 24-hours were phosphate and calcium (50%). 46% of patients were referred to dietetics after 48-hours of nil-by-mouth status.
Conclusions
In our unit, we found that basic electrolytes were frequently monitored in patients placed nil-by-mouth, however calcium, phosphate and magnesium were often omitted prior to dietetics input, and correction of abnormalities was sometimes delayed. Introduction of a local protocol-based approach for electrolyte monitoring with streamlined dietetics referrals is likely to improve adherence to best practice.
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Affiliation(s)
- C Thorpe
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - I Liokati
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - E Boyle
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - H Mohan
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - N Bates
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - S Martin
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - R Kennelly
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - A Hanly
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - D Winter
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - E V Carrington
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
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Glynn N, Martin S, Lewis H. 779 An Unusual Manifestation of Tophaceous Gout in The Flexor Digitorum Superficialis Tendon of An Immunocompromised Patient: A Case Report and Literature Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
This case report showcases an unusual presentation of tophaceous gout, in an immunocompromised patient. Furthermore, through a literature review, we highlight challenges posed by immunocompromised patients, the clinical manifestations of gout in the hand and principles of management.
Method
We report the case of a 62-year-old lady with previous liver transplant on immunosuppressants. She was admitted with a left palmar abscess, pyogenic tenosynovitis of the index finger and was taken to theatre for debridement and washout. Superimposed infection was apparent. This originated from an exophytic mass extending from the palm to FDS tendon insertion. This was debulked and histologically confirmed as gout. A review of the literature was performed using key search terms on PubMed relating to manifestations of gout in the tendons of the hand, and in patients on immunosuppression.
Results
Reports in the literature describe cases of gouty tendinopathy in both flexor and extensor tendons. Reported symptoms include triggering, tendon rupture and tenosynovitis. Gout occurs in a higher frequency in transplant patients. This can be attributed to medications such as cyclosporine which predispose to hyperuricaemia. Management of this condition involves medical optimisation. Despite concurrent problems with wound healing in the immunocompromised with gout, surgical intervention may be required. Indications include superimposed infection, attenuated tendon glide, joint movement, and neuropathy. Perioperative antibiotics are recommended in all immunocompromised patients.
Conclusions
This case highlights an unusual presentation of gout and the challenges of managing patients on immunosuppressant therapy. A greater awareness of this condition will allow for appropriate management in this high-risk patient cohort.
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Affiliation(s)
- N Glynn
- Ulster Hospital, Belfast, United Kingdom
| | - S Martin
- Ulster Hospital, Belfast, United Kingdom
| | - H Lewis
- Ulster Hospital, Belfast, United Kingdom
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50
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McCrossan S, Martin S, Hill C. 1488 Cosmetic Tourism in Aesthetic Breast Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Introduction
Medical tourism is expanding on a global basis, with patients seeking cosmetic surgery in countries abroad. Little information is known regarding the risks and outcomes of cosmetic tourism, in particular, for aesthetic breast surgery.
Method
A systematic-review was conducted using the PRISMA (Preferred Reporting Items for Systematic-reviews and Meta-analyses) guidelines. Fifty-seven titles were screened, 42 abstracts were reviewed leaving 30 full texts. Twenty-one of these met the inclusion criteria.
Results
One-hundred and fifty patients partook in cosmetic tourism for aesthetic breast surgery. Forty-two percent of patients had an implant-based procedure. Other procedures included mastopexy (n = 4), bilateral breast reduction (n = 10) and silicone injections (n = 2). One-hundred and sixty complications were recorded, common complications included wound infection 31% (n = 46), breast abscess/ collection 14% (n = 21), wound dehiscence 12% (n = 18) and ruptured implant 9% (n = 13). Clavien-Dindo classification of complications includes 67 (45%) IIIb-complications with 78 returns-to-theatre, 2 class-IV complications (ICU stay) and one class-V-death of a patient. Explanation occurred in 38% (n = 24) of implant-based augmentation patients.
Conclusions
Aesthetic breast surgery tourism is popular within the cosmetic tourism industry. However, with infective complications (31%) and return-to-theatre rates (45%) significantly higher than expected, it is clear that having these procedures abroad significantly increases the risks involved. Professional bodies for cosmetic surgery in each country must highlight and educate patients how to lower this risk if they do choose to have cosmetic surgery abroad. In this current era of an intra-pandemic world where healthcare is already stretched, the burden from cosmetic tourism complications must be minimised.
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Affiliation(s)
| | - S Martin
- Ulster Hospital, Dundonald, United Kingdom
| | - C Hill
- Ulster Hospital, Dundonald, United Kingdom
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