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Christopher G, Eaton S, Herring M, McGhee H, Smedley B, Wenger MR. Heart of America Annual Survey: A Call for Unity and the Power of Racial Healing. Health Equity 2024; 8:46-65. [PMID: 38260722 PMCID: PMC10802218 DOI: 10.1089/heq.2023.29041.nche] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Affiliation(s)
- Gail Christopher
- Executive Director, National Collaborative for Health Equity, Washington, District of Columbia, USA
| | - Susan Eaton
- Professor of Practice and Director, Sillerman Center for the Advancement of Philanthropy, Brandeis University's Heller School for Social Policy, Waltham, Massachusetts, USA
| | | | | | - Brian Smedley
- Equity Scholar, Senior Fellow, Urban Institute, Washington, District of Columbia, USA
| | - Michael R Wenger
- Senior Fellow, American Association of Colleges & Universities, Washington, District of Columbia, USA
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2
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Kupelian V, Viscidi E, Hall S, Li L, Eaton S, Dilley A, Currier N, Ferguson T, Fanning L. Increased Risk of Venous Thromboembolism in Patients With Amyotrophic Lateral Sclerosis: Results From a US Insurance Claims Database Study. Neurol Clin Pract 2023; 13:e200110. [PMID: 36891280 PMCID: PMC9987205 DOI: 10.1212/cpj.0000000000200110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 10/10/2022] [Indexed: 01/20/2023]
Abstract
Background and Objectives Reduced mobility in patients with amyotrophic lateral sclerosis (ALS) is hypothesized to increase the risk of venous thromboembolism (VTE). A few small, single-center studies have investigated the risk of VTE in patients with ALS. Given the high morbidity and mortality associated with VTE, further understanding of the risk in patients with ALS may inform clinical care. The objective of this study was to investigate the incidence of VTE in patients with ALS compared with controls without ALS. Methods Patients were identified from a US health insurance claims database, Optum's deidentified Clinformatics Data Mart Database, between 2004 and 2019. ALS cases were defined as patients aged 18 years or older with (1) 2 or more ALS claims at least 27 days apart including at least 1 claim from a neurologist visit or (2) 1 or more ALS claims and a prescription for riluzole or edaravone. Each ALS case was matched on age and sex to 5 controls without ALS. VTE was defined as at least 1 claim for VTE and at least 1 anticoagulant prescription or VTE-related procedure within 7 days before and 30 days after a VTE claim date. Incidence rates were reported per 1,000 person-years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model. Results Among 4,205 ALS cases and 21,025 controls, incident VTE occurred in 132 ALS cases (3.1%) and 244 controls (1.2%). Incidence rates of VTE were 19.9 per 1,000 person-years (95% CI 16.7-23.6) in ALS cases compared with 6.0 per 1,000 person-years (95% CI 5.0-7.1) in controls. ALS cases were about 3 times more likely to develop VTE (HR 3.3, 95% CI 2.6-4.0), with similar results among men and women. The median time to first VTE was 10 months from the initial ALS claim in ALS cases. Discussion Consistent with previous smaller studies, a higher incidence rate of VTE was observed in a large sample of patients with ALS from across the United States, as compared to matched controls. The markedly increased risk underscores the importance of preventive efforts and careful monitoring for VTE in patients with ALS and may have implications for the management of ALS.
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3
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Viscidi E, Litvan I, Dam T, Juneja M, Li L, Krzywy H, Eaton S, Hall S, Kupferman J, Höglinger GU. Clinical Features of Patients With Progressive Supranuclear Palsy in an US Insurance Claims Database. Front Neurol 2021; 12:571800. [PMID: 34220661 PMCID: PMC8245849 DOI: 10.3389/fneur.2021.571800] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Progressive supranuclear palsy is a rare neurodegenerative movement disorder and little is known about its epidemiology. Objective: Estimate age-adjusted prevalence of progressive supranuclear palsy and describe antecedent diagnoses and progressive supranuclear palsy patient features in the 5 years before first diagnostic code. Methods: In a nested case-control study in the IBM MarketScan Commercial and Medicare Supplemental Databases, a large set of US insurance databases containing medical service and prescription drug claims from employer-based commercial and Medicare supplemental health insurance plans, progressive supranuclear palsy cases (identified via International Statistical Classification of Diseases 9th/10th revision codes) and controls were included if enrollment was ≥1 month in the study period (October 1, 2015–October 31, 2017). Two controls with no diagnosis codes for PSP were matched to cases on birth year, sex, enrollment time in the database, and pharmacy benefit eligibility. Controls were assigned a randomly selected index date from their eligibility period. Prevalence of progressive supranuclear palsy was estimated in 2016 among patients with ≥1 month of continuous enrollment in that year. Prevalence ratios for comorbidities (claim/diagnosis codes) were examined in the ≤ 5 years before index date (first progressive supranuclear palsy claim date). Results: Age-adjusted progressive supranuclear palsy prevalence was 2.95/100,000 in 2016. The most common diagnosis codes in cases vs. controls in the 5 years pre-index were gait abnormalities (79.3 vs. 21.8%), pain in joint (54.9 vs. 36.0%), Parkinson's disease (54.6 vs. 1.0%), fatigue (49.8 vs. 21.6%), and cerebrovascular disease (45.6 vs. 16.4%). Conclusions: In this large database analysis, based on preliminary analyses, the prevalence of diagnosed progressive supranuclear palsy was 2.95/100,000, which is lower than many prior studies. Typical symptoms suggestive of progressive supranuclear palsy were present before index date, indicating a potential delay in time to diagnosis. The identification of diagnostic codes for clinical features of progressive supranuclear palsy that occurred before index date may be used to develop predictive models to identify potential progressive supranuclear palsy patients earlier in their disease course.
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Affiliation(s)
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, University of California, San Diego, San Diego, CA, United States
| | - Tien Dam
- Biogen, Cambridge, MA, United States
| | - Maneesh Juneja
- MJ Analytics Ltd., Hemel Hempstead, Hertfordshire, United Kingdom
| | - Li Li
- Biogen, Cambridge, MA, United States
| | | | | | | | | | - Günter U Höglinger
- Department of Neurology, Technische Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Hanover Medical School, Hanover, Germany
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4
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Davidson JR, Kyrklund K, Eaton S, Pakarinen MP, Thompson DS, Cross K, Blackburn SC, De Coppi P, Curry J. Sexual function, quality of life, and fertility in women who had surgery for neonatal Hirschsprung's disease. Br J Surg 2021; 108:e79-e80. [PMID: 33711127 DOI: 10.1093/bjs/znaa108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 11/13/2022]
Abstract
The authors explore multi-domain outcomes in a cross-sectional cohort study of patients with Hirschsprung's Disease. They identify hitherto unrecognised issues affecting sexual function and fertility specifically in female patients.
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Affiliation(s)
- J R Davidson
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK.,Stem Cells and Regenerative Medicine Section, Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - K Kyrklund
- Department of Paediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Eaton
- Stem Cells and Regenerative Medicine Section, Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - M P Pakarinen
- Department of Paediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - D S Thompson
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
| | - K Cross
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
| | - S C Blackburn
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
| | - P De Coppi
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK.,Stem Cells and Regenerative Medicine Section, Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - J Curry
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
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5
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Maserejian N, Krzywy H, Eaton S, Galvin JE. Cognitive measures lacking in EHR prior to dementia or Alzheimer's disease diagnosis. Alzheimers Dement 2021; 17:1231-1243. [PMID: 33656251 PMCID: PMC8359414 DOI: 10.1002/alz.12280] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/22/2020] [Revised: 11/02/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
Introduction The extent that cognitive measures are documented in electronic health records (EHR) is important for quality care and addressing disparities in timely diagnosis of dementia or Alzheimer's disease (AD). Methods Analysis of U.S. EHR data to describe the frequency and factors associated with cognitive measures prior to diagnosis of dementia (N = 111,125) or AD (N = 30,203). Results Only 11% of dementia patients and 24% of AD patients had a cognitive measure documented in the 5 years prior to diagnosis. Black race, older age, non‐commercial health insurance, lower mean neighborhood income, greater in‐patient stays, and fewer out‐patient visits were associated with lacking cognitive measures. Discussion Extensive missing cognitive data and differences in the availability of cognitive measures by race, age, and socioeconomic factors hinder patient care and limit utility of EHR for dementia research. Structured fields and prompts for cognitive data inputs at the point of care may help address these gaps.
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Affiliation(s)
| | | | | | - James E Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, Florida, USA
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6
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Sherratt FC, Allin BSR, Kirkham JJ, Walker E, Young B, Wood W, Beasant L, Eaton S, Hall NJ. Core outcome set for uncomplicated acute appendicitis in children and young people. Br J Surg 2020; 107:1013-1022. [PMID: 32181505 PMCID: PMC7317752 DOI: 10.1002/bjs.11508] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/05/2019] [Accepted: 12/13/2019] [Indexed: 12/24/2022]
Abstract
Background Research studies to inform clinical practice and policy in children and young people with appendicitis are hampered by inconsistent selection and reporting of outcomes. The aim of this study was to develop a core outcome set for reporting all studies of uncomplicated acute appendicitis in children and young people. Methods Systematic literature reviews, qualitative interviews with parents and patients treated for uncomplicated acute appendicitis, and a Study‐Specific Advisory Group informed a long list of outcomes. Outcomes were then prioritized by stakeholders based in the UK (patients, parents, and paediatric and general surgeons) in an online three‐round Delphi consensus process, followed by face‐to‐face consensus meetings. Results A long list of 40 items was scored by 147 key stakeholders in the first Delphi round, of whom 90 completed the two subsequent Delphi rounds. The final core outcome set comprises 14 outcomes: intra‐abdominal abscess, reoperation (including interventional radiology procedure), readmission to hospital, bowel obstruction, wound infection, antibiotic failure, wound complication, negative appendicectomy, recurrent appendicitis, death, patient stress/psychological distress, length of hospital stay, time away from full activity and child's quality of
life. Conclusion A core outcome set comprising 14 outcomes across five key domains has been developed for reporting studies in children and young people with uncomplicated acute appendicitis. Further work is required to determine how and when to measure these outcomes.
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Affiliation(s)
- F C Sherratt
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - B S R Allin
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - E Walker
- Centre for Outcomes and Experience Research in Children's Health Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - B Young
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - W Wood
- National Institute for Health Research (NIHR) Research Design Service South Central, University of Southampton, Southampton, UK
| | - L Beasant
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - S Eaton
- Developmental Biology and Cancer Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - N J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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7
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Geros H, Sizer H, Mifsud N, Reynolds S, Kim DJ, Eaton S, McGorry P, Nelson B, O'Donoghue B. Migrant status and identification as ultra-high risk for psychosis and transitioning to a psychotic disorder. Acta Psychiatr Scand 2020; 141:52-59. [PMID: 31520527 DOI: 10.1111/acps.13099] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Certain migrant groups are more likely to develop a psychotic disorder compared to the native-born populations, and a younger age at migration is associated with greater risk. However, it is not known at which stage migration has an effect on the development of psychotic disorders. We examined whether migrants were more likely to be identified as ultra-high risk for psychosis (UHR) compared to native-born young people and whether migrant status was associated with the risk of transition to a full-threshold psychotic disorder. METHODS The cohort included all young people aged 15-24 who were identified as UHR at a specialist clinic over a five-year period (2012-16). Australian census data were used to obtain the at-risk population. Poisson regression was used to calculate rate ratios and Cox regression analysis determined hazard ratios. RESULTS 467 young people were identified as UHR, of which 13.5% (n = 63) were born overseas. First-generation migrants were 2.6-fold less likely to be identified as UHR compared to Australian-born young people (IRR = 0.39, 95% CI [0.30, 0.51], P < 0.001). There was no difference between migrant and native-born young people in their risk of transitioning to a psychotic disorder (HR = 0.90, 95% CI [0.39, 2.08], P = 0.81). CONCLUSIONS UHR first-generation migrants may be under-accessing mental health services.
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Affiliation(s)
- H Geros
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - H Sizer
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - N Mifsud
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - S Reynolds
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - D J Kim
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - S Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - P McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - B Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - B O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia.,Orygen Youth Health, Parkville, Vic., Australia
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8
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Scoto M, Muntoni F, Hall S, Eaton S, Rashid A, Avendano J, Samsuddin S, Balashkina J, Finkel R, Mercuri E. P.399The international spinal muscular atrophy (SMA) registry: longitudinal collection and refinement of outcome measures for spinal muscular atrophy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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Maserejian NN, Krzywy H, Wang J, Juneja M, Eaton S. P1-296: SYMPTOMS OF ALZHEIMER'S DISEASE (AD) NOTED IN U.S. ELECTRONIC HEALTH RECORDS PRIOR TO THE DIAGNOSIS OF AD IN COMPARISON TO MATCHED NON-DEMENTED PATIENTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- S Eaton
- From the School of History Anthropology Politics and Philosophy, Queen's University Belfast, Belfast, UK
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11
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Thakkar HS, Hewitt R, Cross K, Hannon E, De Bie F, Blackburn S, Eaton S, McLaren CA, Roebuck DJ, Elliott MJ, Curry JI, Muthialu N, De Coppi P. The multi-disciplinary management of complex congenital and acquired tracheo-oesophageal fistulae. Pediatr Surg Int 2019; 35:97-105. [PMID: 30392126 PMCID: PMC6325990 DOI: 10.1007/s00383-018-4380-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 12/02/2022]
Abstract
AIM OF THE STUDY Complex tracheo-oesophageal fistulae (TOF) are rare congenital or acquired conditions in children. We discuss here a multidisciplinary (MDT) approach adopted over the past 5 years. METHODS We retrospectively collected data on all patients with recurrent or acquired TOF managed at a single institution. All cases were investigated with neck and thorax CT scan. Other investigations included flexible bronchoscopy and bronchogram (B&B), microlaryngobronchoscopy (MLB) and oesophagoscopy. All cases were subsequently discussed in an MDT meeting on an emergent basis if necessary. MAIN RESULTS 14 patients were referred during this study period of which half had a congenital aetiology and the other half were acquired. The latter included button battery ingestions (5/7) and iatrogenic injuries during oesophageal atresia (OA) repair. Surgical repair was performed on cardiac bypass in 3/7 cases of recurrent congenital fistulae and all cases of acquired fistulae. Post-operatively, 9/14 (64%) patients suffered complications including anastomotic leak (1), bilateral vocal cord paresis (1), further recurrence (1), and mortality (1). Ten patients continue to receive surgical input encompassing tracheal/oesophageal stents and dilatations. CONCLUSIONS MDT approach to complex cases is becoming increasingly common across all specialties and is important in making decisions in these difficult cases. The benefits include shared experience of rare cases and full access to multidisciplinary expertise.
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Affiliation(s)
- H. S. Thakkar
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - R. Hewitt
- Department of Otolaryngology, Great Ormond Street Hospital, London, UK ,Tracheal Team, Great Ormond Street Hospital, London, UK
| | - K. Cross
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - E. Hannon
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - F. De Bie
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK ,General Surgery Resident, KU Leuven, Leuven, Belgium
| | - S. Blackburn
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - S. Eaton
- Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK ,Department of Radiology, Great Ormond Street Children’s Hospital, London, UK
| | - C. A. McLaren
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK ,Department of Radiology, Great Ormond Street Children’s Hospital, London, UK
| | - D. J. Roebuck
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK ,Department of Radiology, Great Ormond Street Children’s Hospital, London, UK
| | - M. J. Elliott
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - J. I. Curry
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - N. Muthialu
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - P. De Coppi
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK ,Tracheal Team, Great Ormond Street Hospital, London, UK ,Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK
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12
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Fernandez HH, Boyd JT, Fung VSC, Lew MF, Rodriguez RL, Slevin JT, Standaert DG, Zadikoff C, Vanagunas AD, Chatamra K, Eaton S, Facheris MF, Hall C, Robieson WZ, Benesh J, Espay AJ. Long-term safety and efficacy of levodopa-carbidopa intestinal gel in advanced Parkinson's disease. Mov Disord 2018; 33:928-936. [DOI: 10.1002/mds.27338] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - James T. Boyd
- University of Vermont Larner College of Medicine, Burlington; Vermont USA
| | | | - Mark F. Lew
- Keck/University of Southern California School of Medicine; Los Angeles California USA
| | - Ramon L. Rodriguez
- University of Florida College of Medicine, Gainesville, Florida, USA, and Orlando Veterans Affairs Medical Center; Orlando Florida USA
| | - John T. Slevin
- University of Kentucky Medical Center; Lexington Kentucky USA
| | | | - Cindy Zadikoff
- Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
| | | | | | | | | | | | | | | | - Alberto J. Espay
- University of Cincinnati Academic Health Center; Cincinnati Ohio USA
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13
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Singh RR, Nah SA, Roebuck DJ, Eaton S, Pierro A, Curry JI, Barnacle A, Chippington S, Stuart S, Gibson C, Cross KMK, Stanwell J, Yardley IE, Kiely EM, De Coppi P. Double-blind randomized clinical trial of percutaneous endoscopic gastrostomy versus radiologically inserted gastrostomy in children. Br J Surg 2017; 104:1620-1627. [DOI: 10.1002/bjs.10687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/26/2017] [Accepted: 07/02/2017] [Indexed: 12/31/2022]
Abstract
Abstract
Background
The aim of this RCT was to determine whether radiologically inserted gastrostomy (RIG) in children is associated with more complications than percutaneous endoscopic gastrostomy (PEG).
Methods
Children at a single tertiary children's hospital requiring a primary gastrostomy were randomized to PEG or RIG. Patients were followed by assessors blinded to the insertion method. Complications were recorded, assigned a severity score, and analysed by zero-inflated Poisson regression analysis on an intention-to-treat basis, adjusting for length of follow-up.
Results
Over a 3-year period, 214 children were randomized (PEG, 107; RIG, 107), of whom 100 received PEG and 96 RIG. There was no significant difference in the number of complications between PEG and RIG groups (P = 0·875), or in the complication score: patients undergoing RIG had a 1·04 (95 per cent c.i. 0·89 to 1·21) times higher complication score than those who underwent PEG (P = 0·597). Only age had an independent significant effect on complication score, with older patients having a 0·97 (0·95 to 1·00) times lower complication score per year.
Conclusion
PEG and RIG are both safe methods of gastrostomy insertion with a low rate of major complications. Registration number: NCT01920438 (http://www.clinicaltrials.gov).
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Affiliation(s)
- R R Singh
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - S A Nah
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - D J Roebuck
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - S Eaton
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - A Pierro
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - J I Curry
- Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - A Barnacle
- Great Ormond Street Hospital for Children, London, UK
| | - S Chippington
- Great Ormond Street Hospital for Children, London, UK
| | - S Stuart
- Great Ormond Street Hospital for Children, London, UK
| | - C Gibson
- Great Ormond Street Hospital for Children, London, UK
| | - K M K Cross
- Great Ormond Street Hospital for Children, London, UK
| | - J Stanwell
- Great Ormond Street Hospital for Children, London, UK
| | - I E Yardley
- Great Ormond Street Hospital for Children, London, UK
| | - E M Kiely
- Great Ormond Street Hospital for Children, London, UK
| | - P De Coppi
- Great Ormond Street Hospital for Children, London, UK
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Standaert DG, Rodriguez RL, Slevin JT, Lobatz M, Eaton S, Chatamra K, Facheris MF, Hall C, Sail K, Jalundhwala YJ, Benesh J. Effect of Levodopa-carbidopa Intestinal Gel on Non-motor Symptoms in Patients with Advanced Parkinson's Disease. Mov Disord Clin Pract 2017; 4:829-837. [PMID: 29242809 PMCID: PMC5724683 DOI: 10.1002/mdc3.12526] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 03/27/2017] [Revised: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 11/18/2022] Open
Abstract
Background Levodopa‐carbidopa intestinal gel (LCIG; carbidopa‐levodopa enteral suspension in the United States), delivered via percutaneous gastrojejunostomy (PEG‐J) and titrated in the inpatient setting, is an established treatment option for advanced Parkinson's disease (PD) patients with motor fluctuations. However, long‐term prospective data on the efficacy of LCIG on non‐motor symptoms and the safety of outpatient titration are limited. Methods In this 60‐week, open‐label phase 3b study, LCIG titration was initiated in an outpatient setting following PEG‐J placement in PD patients. The efficacy of LCIG on motor and non‐motor symptoms, quality of life, and safety was assessed. Results Thirty‐nine patients were enrolled in the study and 28 patients completed the treatment. A majority of patients (54%) completed outpatient titration within the first week of LCIG infusion. LCIG led to significant reductions from baseline in Non‐Motor Symptom Scale (NMSS) total score (least squares mean ± SE = −17.6 ± 3.6, P < 0.001) and 6 of the NMSS domain scores (sleep/fatigue, attention/memory, gastrointestinal tract, urinary, sexual function, miscellaneous) at week 12. These reductions were maintained at week 60 with the exception of the urinary domain. “Off” time (−4.9 ± 0.5 hours/day, P < 0.001) and “On” time without troublesome dyskinesia (−4.3 ± 0.6 hours/day, P < 0.001) were improved at week 60. Adverse events (AEs) were reported in 37 (95%) patients. Conclusions LCIG treatment led to reductions in non‐motor symptom burden and motor fluctuations in advanced PD patients. The safety profile was consistent with previous studies that used inpatient titration and outpatient titration did not appear to pose additional risk.
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Affiliation(s)
| | | | - John T Slevin
- University of Kentucky Medical Center Lexington KY USA
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Maserejian NN, Eaton S, Krzywy H, Juneja M, Enayetallah A. [P2–275]: SIGNS AND SYMPTOMS OF ALZHEIMER's DISEASE NOTED IN HEALTH RECORDS UP TO 5 YEARS PRIOR TO DIAGNOSIS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.928] [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: 11/24/2022]
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16
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Urbani L, Camilli C, Crowley C, Phylactopoulos D, Natarajan D, Scottoni F, Pellegata A, McCann C, Urciuolo A, Baradez M, Hannon E, Deguchi K, Gjinovci A, Cossu G, Eaton S, Bonfanti P, De Coppi P. Development of a bioartificial oesophagus engineered with primary mesoangioblasts, neural and epithelial cells for preclinical studies. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Crowley C, De Santis M, Urbani L, Khedr M, Tedeschi A, Meran L, Lee S, Campinoti S, Li V, Bonfanti P, Burns A, Eaton S, Birchall M, De Coppi P. 3D-culture of intestinal stem cells using an extracellular matrix hydrogel derived from decellularised intestinal tissue. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.047] [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: 10/19/2022]
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Pal A, Park J, Gonzalez-Malerva L, Eaton S, LaBaer J. Abstract P1-08-05: Discovering drug targets for aggressive breast cancer with TP53 missense mutations by a genome-wide screen. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-08-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Breast cancer is a heterogeneous disease and has subtypes with distinct phenotypic and molecular characteristics. Genetically, 30% of all breast tumors and 80% of the basal-like breast cancer (BLBC) subtype harbor mutations in TP53 and numerous sporadic somatic mutations in other genes. This molecular heterogeneity has posed a challenge in developing safe and effective therapeutic regimens to treat a broad spectrum of breast cancer patients, and discovery of intra-subtype along with inter-subtype heterogeneity has added another layer of complexity for targeted therapies. Based on the analysis of somatic mutation profiles in the BLBC subtype, we identified a wide variety of TP53 missense mutations and thousands of co-existing mutations, which led us to hypothesize that intra-subtype heterogeneity is derived from combinatorial effects of neo-morphic (gain-of-function) activities of different types of missense mutant p53 proteins and complex interplay between specific driver mutations in TP53 and a distinct subset of functionally important co-mutations (or “co-drivers”). We ectopically overexpressed the ten most prevalent missense mutations in TP53 found in breast cancer tumors in non-transformed mammary epithelial cells and examined their cellular functions associated with the hallmarks of cancer. The results showed widely different spectrums of phenotypic changes in cell proliferation, resistance to apoptosis, cell invasion, anoikis resistance and cell polarity. As a proof of concept for the 'co-drivers', we knocked-out PTEN in a non-invasive TP53 mutant cell using the CRISPR and shRNA systems. Inactivation of PTEN in non-invasive TP53-mutant cell increased its invasiveness. TP53 mutations and PTEN deletions are frequent in BLBC patients, who have significantly higher rates of metastasis, recurrence and a lower survival rate than the other subtypes. The absence of three signaling hormone receptors, which can be targeted by specific inhibitors, significantly limits available therapies for the majority of BLBC patients to surgery and cytotoxic chemo/radiotherapies. Combination therapies targeting the driver and co-driver gene associated pathways could be quite promising solutions to treat aggressive breast cancer cases. To address this, we have developed a genome-wide CRISPR based gene knock-out screening approach to test the effect of loss-of-function of individual human genes in clinically important TP53 mutant backgrounds that can promote cancer-like behaviors and identify the combinations of 'TP53 mutation and co-driver pathways' that can be targeted by specific inhibitors.
Citation Format: Pal A, Park J, Gonzalez-Malerva L, Eaton S, LaBaer J. Discovering drug targets for aggressive breast cancer with TP53 missense mutations by a genome-wide screen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-08-05.
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Affiliation(s)
- A Pal
- The Biodesign Institute, ASU, Tempe, AZ
| | - J Park
- The Biodesign Institute, ASU, Tempe, AZ
| | | | - S Eaton
- The Biodesign Institute, ASU, Tempe, AZ
| | - J LaBaer
- The Biodesign Institute, ASU, Tempe, AZ
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Abstract
PURPOSE Macrolide antibiotics, erythromycin, in particular, have been linked to the development of infantile hypertrophic pyloric stenosis (IHPS). Our aim was to conduct a systematic review of the evidence of whether post-natal erythromycin exposure is associated with subsequent development of IHPS. METHODS A systematic review of postnatal erythromycin administration and IHPS was performed. Papers were included if data were available on development (yes/no) of IHPS in infants exposed/unexposed to erythromycin. Data were meta-analysed using Review Manager 5.3. A random effects model was decided on a priori due to heterogeneity of study design; data are odds ratio (OR) with 95 % CI. RESULTS Nine papers reported data suitable for analysis; two randomised controlled trials and seven retrospective studies. Overall, erythromycin exposure was significantly associated with development of IHPS [OR 2.45 (1.12-5.35), p = 0.02]. However, significant heterogeneity existed between the studies (I 2 = 84 %, p < 0.0001). Data on erythromycin exposure in the first 14 days of life was extracted from 4/9 studies and identified a strong association between erythromycin exposure and subsequent development IHPS [OR 12.89 (7.67-2167), p < 0.00001]. CONCLUSION This study demonstrates a significant association between post-natal erythromycin exposure and development of IHPS, which seems stronger when exposure occurs in the first 2 weeks of life.
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Affiliation(s)
- L Murchison
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children, London, UK
| | - P De Coppi
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children, London, UK
| | - S Eaton
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Great Ormond Street Hospital for Children, London, UK.
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Murata M, Mihara M, Hasegawa K, Jeon B, Tsai CH, Nishikawa N, Oeda T, Yokoyama M, Robieson WZ, Ryman D, Eaton S, Chatamra K, Benesh J. Efficacy and safety of levodopa-carbidopa intestinal gel from a study in Japanese, Taiwanese, and Korean advanced Parkinson's disease patients. NPJ Parkinsons Dis 2016; 2:16020. [PMID: 28725701 PMCID: PMC5516619 DOI: 10.1038/npjparkd.2016.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/01/2016] [Accepted: 08/23/2016] [Indexed: 01/12/2023]
Abstract
In a previous multinational, randomized, double-blind, double-dummy study, levodopa–carbidopa intestinal gel (LCIG) was tolerable and significantly improved ‘off’ time in advanced Parkinson’s disease (PD) patients. However, efficacy and safety in the Asian population has not yet been demonstrated. In this open-label study, efficacy and safety of LCIG were assessed in Japanese, Korean, and Taiwanese advanced PD patients with motor complications not adequately controlled by available PD medication. The patients were treated with LCIG monotherapy for 12 weeks. The primary end point was the mean change from baseline to week 12 in ‘off’ time, as reported in the PD Symptom Diary, normalized to a 16 h waking day and analyzed by a mixed-model repeated-measures analysis. Adverse events (AEs) were recorded. Thirty-one patients were enrolled (23 Japanese, 4 Taiwanese, 4 Korean) and 28 (90%) completed the study. For those who completed the study, the mean (s.d.) total daily levodopa dose from LCIG was 1,206.3 (493.6) mg/day at final visit (n=28); last observation carried forward (n=30) was 1,227.6 (482.8) mg/day. There was a significant mean change (s.d.) of −4.6 (3.0) hours of ‘off’ time from baseline (mean (s.d.)=7.4 (2.3)) to week 12 (n=29), P<0.001. All the patients had an AE, with the most frequently reported being incision site pain (42%); 1 (3.2%) discontinued treatment because of an AE and later died because of sepsis, which the investigator considered unrelated to LCIG treatment. These results suggest that LCIG is efficacious and tolerable in Japanese, Taiwanese, and Korean advanced PD patients.
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Affiliation(s)
- Miho Murata
- National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Kazuko Hasegawa
- National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | | | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital and Medical College, China Medical University, Taichung, Taiwan
| | | | - Tomoko Oeda
- National Hospital Organization Utano Hospital, Kyoto, Japan
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Epstein M, Johnson DA, Hawes R, Schmulewitz N, Vanagunas AD, Gossen ER, Robieson WZ, Eaton S, Dubow J, Chatamra K, Benesh J. Long-Term PEG-J Tube Safety in Patients With Advanced Parkinson's Disease. Clin Transl Gastroenterol 2016; 7:e159. [PMID: 27030949 PMCID: PMC4822096 DOI: 10.1038/ctg.2016.19] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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] [Received: 12/14/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES: The objectives of this study were to present procedure- and device-associated adverse events (AEs) identified with long-term drug delivery via percutaneous endoscopic gastrojejunostomy (PEG-J). Levodopa-carbidopa intestinal gel (LCIG, also known in US as carbidopa-levodopa enteral suspension, CLES) is continuously infused directly to the proximal small intestine via PEG-J in patients with advanced Parkinson's disease (PD) to overcome slow and erratic gastric emptying and treat motor fluctuations that are not adequately controlled by oral or other pharmacological therapy. METHODS: An independent adjudication committee of three experienced (>25 years each) gastroenterologists reviewed gastrointestinal procedure- and device-associated AEs reported for PD patients (total n=395) enrolled in phase 3 LCIG studies. The rate, clinical significance, and causality of the procedure/device events were determined. RESULTS: The patient median exposure to PEG-J at the data cutoff was 480 days. Procedure- and device-associated serious AEs (SAEs) occurred in 67 (17%) patients. A total of 42% of SAEs occurred during the first 4 weeks following PEG-J placement. SAEs of major clinical significance with the highest procedural incidence were peritonitis (1.5%), pneumonia (1.5%), and abdominal pain (1.3%). The most common non-serious procedure- and device-associated AEs were abdominal pain (31%), post-operative wound infection (20%), and procedural pain (23%). In all, 17 (4.3%) patients discontinued treatment owing to an AE. CONCLUSIONS: In conclusion, incidences of PEG-J AEs with the LCIG delivery system and PEG-J longevity were compared favorably with ranges described in the PEG/PEG-J literature. A low discontinuation rate in this study suggests acceptable procedural outcomes and AE rates in PD patients treated with this PEG-J drug delivery system.
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Affiliation(s)
| | - David A Johnson
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Robert Hawes
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Nathan Schmulewitz
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Arvydas D Vanagunas
- Department of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Susan Eaton
- Department of Pharmaceutical Development, AbbVie Inc., North Chicago, Illinois, USA
| | - Jordan Dubow
- Department of Pharmaceutical Development, AbbVie Inc., North Chicago, Illinois, USA
| | - Krai Chatamra
- Department of Pharmaceutical Development, AbbVie Inc., North Chicago, Illinois, USA
| | - Janet Benesh
- Department of Pharmaceutical Development, AbbVie Inc., North Chicago, Illinois, USA
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22
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Antonini A, Fung VSC, Boyd JT, Slevin JT, Hall C, Chatamra K, Eaton S, Benesh JA. Effect of levodopa-carbidopa intestinal gel on dyskinesia in advanced Parkinson's disease patients. Mov Disord 2016; 31:530-7. [PMID: 26817533 PMCID: PMC5066747 DOI: 10.1002/mds.26528] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [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: 06/30/2015] [Revised: 12/02/2015] [Accepted: 12/13/2015] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the effect of levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension) in advanced Parkinson's disease patients with troublesome dyskinesia. METHODS Post hoc analyses of patient data from a 12-week, randomized, double-blind study and a 54-week open-label study were performed. Efficacy was assessed in the subgroup of patients defined by ≥1 hour of "on" time with troublesome dyskinesia at baseline as recorded in Parkinson's disease symptom diaries (double blind: n = 11 levodopa-carbidopa intestinal gel, n = 12 oral levodopa-carbidopa; open label: n = 144 levodopa-carbidopa intestinal gel). The changes in "off" time, "on" time with and without troublesome dyskinesia, and the overall safety and tolerability of levodopa-carbidopa intestinal gel were analyzed. RESULTS Although not significantly different from oral levodopa treatment (P > .05) in the double-blind study, levodopa-carbidopa intestinal gel treatment resulted in a reduction from baseline in "on" time with troublesome dyskinesia (mean [standard deviation] hours: baseline = 3.1 [1.7], change from baseline to final = -1.8 [1.8], P = .014), increase in "on" time without troublesome dyskinesia (baseline = 7.4 [2.2], change = 4.4 [3.6], P = .004), and decrease in "off" time (baseline = 5.5 [1.3], change = -2.7 [2.8], P = .015). Similar trends were found in the open-label study. An increase in levodopa-carbidopa intestinal gel dose was not significantly correlated with increased "on" time with troublesome dyskinesia in either study (double blind: r = -.073, P = .842; open label: r = -0.001, P = .992). Adverse events were usually mild to moderate in severity and related to the gastrointestinal procedure. CONCLUSION Our exploratory analyses suggest that optimizing levodopa delivery with levodopa-carbidopa intestinal gel may reduce troublesome dyskinesia in advanced Parkinson's disease.
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Affiliation(s)
- Angelo Antonini
- Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy
| | - Victor S C Fung
- Movement Disorders Unit, Westmead Hospital and Sydney Medical School, Sydney, Australia
| | - James T Boyd
- Department of Neurology, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - John T Slevin
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Standaert D, Slevin J, Hall C, Dubow J, Eaton S, Chatamra K, Benesh J. Effects of levodopa-carbidopa intestinal gel on non-motor symptoms and safety of outpatient titration: A new phase 3 study in patients with advanced Parkinson's disease. Parkinsonism Relat Disord 2016. [DOI: 10.1016/j.parkreldis.2015.10.204] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rodriguez R, Lobatz M, Dubow J, Eaton S, Hall C, Chatamra K, Benesh J. Outpatient levodopa-carbidopa intestinal gel titration in patients with advanced Parkinson's disease. Parkinsonism Relat Disord 2016. [DOI: 10.1016/j.parkreldis.2015.10.201] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lang AE, Rodriguez RL, Boyd JT, Chouinard S, Zadikoff C, Espay AJ, Slevin JT, Fernandez HH, Lew MF, Stein DA, Odin P, Fung VS, Klostermann F, Fasano A, Draganov PV, Schmulewitz N, Robieson WZ, Eaton S, Chatamra K, Benesh JA, Dubow J. Integrated safety of levodopa-carbidopa intestinal gel from prospective clinical trials. Mov Disord 2015; 31:538-46. [PMID: 26695437 PMCID: PMC5064722 DOI: 10.1002/mds.26485] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Continuous administration of levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension) through a percutaneous endoscopic gastrojejunostomy is a treatment option for advanced Parkinson disease (PD) patients with motor fluctuations resistant to standard oral medications. Safety data from 4 prospective studies were integrated to assess the safety of this therapy. METHODS Safety data from 4 studies were summarized using 2 overlapping data sets, permitting the separation of procedure/device-associated (n = 395) from non-procedure/device adverse events (n = 412). RESULTS At the data cutoff, median exposure to levodopa-carbidopa intestinal gel was 911 days (range, 1-1980 days) with 963 total patient-years of exposure. Procedure/device adverse events occurred in 300 patients (76%), and serious adverse events occurred in 68 (17%); most frequently reported procedure/device adverse events and serious adverse events were complications of device insertion (41% and 8%, respectively) and abdominal pain (36% and 4%, respectively). Non-procedure/device adverse events occurred in 92% (379), with most frequently reported being insomnia (23%) and falls (23%); 42% (171) had non-procedure/device serious adverse events, with most frequently reported being pneumonia (5%) and PD symptoms (2%). Adverse events led to discontinuation in 17% (72), most frequently because of complication of device insertion (2.4%). There were 34 treatment-emergent deaths (8.3%) in the overlapping data sets, 2 of which (0.5%) were considered "possibly related" to the treatment system. CONCLUSION In the largest collection of levodopa-carbidopa intestinal gel safety data from prospective clinical studies, procedure/device events were frequently reported and occasionally life threatening. Most non-procedure/device events were typical for levodopa treatment and an elderly population. These factors combined with high treatment efficacy led to a relatively low discontinuation rate in advanced PD patients.
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Affiliation(s)
- Anthony E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | | | - James T. Boyd
- University of Vermont College of MedicineBurlingtonVermontUSA
| | | | - Cindy Zadikoff
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Alberto J. Espay
- University of Cincinnati Academic Health CenterCincinnatiOhioUSA
| | - John T. Slevin
- University of Kentucky Medical CenterLexingtonKentuckyUSA
| | | | - Mark F. Lew
- Keck/University of Southern California School of MedicineLos AngelesCaliforniaUSA
| | | | - Per Odin
- Klinikim‐BremerhavenGermany and Skane University HospitalLundSweden
| | | | | | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
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Estcourt CS, Gibbs J, Sutcliffe LJ, Gkatzidou V, Tickle L, Hone K, Aicken C, Lowndes C, Harding-Esch E, Eaton S, Oakeshott P, Szczepura A, Ashcroft R, Hogan G, Nettleship A, Pinson D, Sadiq ST, Sonnenberg P. O14.1 Is an automated online clinical care pathway for people with genital chlamydia (chlamydia-occp) within an esexual health clinic feasible and acceptable? proof of concept study. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.153] [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: 11/04/2022]
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Wells JCK, Haroun D, Williams JE, Nicholls D, Darch T, Eaton S, Fewtrell MS. Body composition in young female eating-disorder patients with severe weight loss and controls: evidence from the four-component model and evaluation of DXA. Eur J Clin Nutr 2015; 69:1330-5. [PMID: 26173868 PMCID: PMC4672328 DOI: 10.1038/ejcn.2015.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/04/2015] [Accepted: 03/21/2015] [Indexed: 11/26/2022]
Abstract
Background/Objectives: Whether fat-free mass (FFM) and its components are depleted in eating-disorder (ED) patients is uncertain. Dual energy X-ray absorptiometry (DXA) is widely used to assess body composition in pediatric ED patients; however, its accuracy in underweight populations remains unknown. We aimed (1) to assess body composition of young females with ED involving substantial weight loss, relative to healthy controls using the four-component (4C) model, and (2) to explore the validity of DXA body composition assessment in ED patients. Subjects/Methods: Body composition of 13 females with ED and 117 controls, aged 10–18 years, was investigated using the 4C model. Accuracy of DXA for estimation of FFM and fat mass (FM) was tested using the approach of Bland and Altman. Results: Adjusting for age, height and pubertal stage, ED patients had significantly lower whole-body FM, FFM, protein mass (PM) and mineral mass (MM) compared with controls. Trunk and limb FM and limb lean soft tissue were significantly lower in ED patients. However, no significant difference in the hydration of FFM was detected. Compared with the 4C model, DXA overestimated FM by 5±36% and underestimated FFM by 1±9% in ED patients. Conclusion: Our study confirms that ED patients are depleted not only in FM but also in FFM, PM and MM. DXA has limitations for estimating body composition in individual young female ED patients.
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Affiliation(s)
- J C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - D Haroun
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - J E Williams
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - D Nicholls
- Department of Psychological Medicine, Child and Adolescent Mental Health, Great Ormond Street Hospital, London, UK
| | - T Darch
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - S Eaton
- Developmental Biology and Cancer Programme, UCL Institute of Child Health, London, UK
| | - M S Fewtrell
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
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Pachl M, Eaton S, Kiely EM, Drake D, Cross K, Curry JI, Pierro A, DeCoppi P. Esophageal atresia and malrotation: what association? Pediatr Surg Int 2015; 31:181-5. [PMID: 25403487 DOI: 10.1007/s00383-014-3641-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Esophageal atresia/tracheo-esophageal fistula (EA/TEF) has an incidence of approximately 1:3,500. The incidence of malrotation is thought to be 1:200-500. We attempted to define the incidence of a combination and discuss the implications. METHODS This was a retrospective review of all patients admitted to a single institution with a diagnosis of EA or EA/TEF or TEF between April 1981 and January 2013. Patients were included if the position of the duodeno-jejunal flexure (DJF) was determined by upper GI contrast study (UGIS), surgery or post-mortem. RESULTS Case notes were reviewed for 235 patients. In the EA type A group, 3/28 (11 %; 95 % CI 3.7-27.2 %) had malrotation, significantly higher than the reported incidence of malrotation in the general population (p = 0.0008). All three patients in this group were symptomatic with one patient found to have a volvulus at emergency surgery. In the type C group, 6/196 (3 %, 95 % CI 1.4-6.5 %) had malrotation, significantly higher than the incidence reported for the general population (p = 0.0033) but not significantly different to that of the type A group (p = 0.0878). There were no patients with malrotation identified in any other EA/TEF type. In total, 9/235 (3.8 %; 95 % CI 2.0-7.2 %) patients with EA had malrotation, significantly higher than the 5/1,050 (0.48 %) reported for the general population (p = 0.0002). CONCLUSION There is a high incidence of malrotation in patients with pure EA. In the type A group an attempt to identify the DJF position at gastrostomy siting and/or performance of UGIS in the neonatal period should be undertaken. There should also be a low threshold for UGIS in all EA/TEF patients.
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Affiliation(s)
- M Pachl
- Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital, London, UK,
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Eaton S, Wang Q, Menahem S. Quality of life of adults with congenital heart disease, a Melbourne cohort analysis. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Slevin JT, Fernandez HH, Zadikoff C, Hall C, Eaton S, Dubow J, Chatamra K, Benesh J. Long-Term Safety and Maintenance of Efficacy of Levodopa-Carbidopa Intestinal Gel: An Open-Label Extension of the Double-Blind Pivotal Study in Advanced Parkinson's Disease Patients. Journal of Parkinson's Disease 2015; 5:165-74. [DOI: 10.3233/jpd-140456] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John T. Slevin
- University of Kentucky Medical Center, Lexington, KY, USA
| | | | - Cindy Zadikoff
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Williams T, van Staa T, Puri S, Eaton S. Recent advances in the utility and use of the General Practice Research Database as an example of a UK Primary Care Data resource. Ther Adv Drug Saf 2014; 3:89-99. [PMID: 25083228 DOI: 10.1177/2042098611435911] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Since its inception in the mid-1980s, the General Practice Research Database (GPRD) has undergone many changes but remains the largest validated and most utilised primary care database in the UK. Its use in pharmacoepidemiology stretches back many years with now over 800 original research papers. Administered by the Medicines and Healthcare products Regulatory Agency since 2001, the last 5 years have seen a rebuild of the database processing system enhancing access to the data, and a concomitant push towards broadening the applications of the database. New methodologies including real-world harm-benefit assessment, pharmacogenetic studies and pragmatic randomised controlled trials within the database are being implemented. A substantive and unique linkage program (using a trusted third party) has enabled access to secondary care data and disease-specific registry data as well as socio-economic data and death registration data. The utility of anonymised free text accessed in a safe and appropriate manner is being explored using simple and more complex techniques such as natural language processing.
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Quint JK, Müllerova H, DiSantostefano RL, Forbes H, Eaton S, Hurst JR, Davis K, Smeeth L. Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD). BMJ Open 2014; 4:e005540. [PMID: 25056980 PMCID: PMC4120321 DOI: 10.1136/bmjopen-2014-005540] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The optimal method of identifying people with chronic obstructive pulmonary disease (COPD) from electronic primary care records is not known. We assessed the accuracy of different approaches using the Clinical Practice Research Datalink, a UK electronic health record database. SETTING 951 participants registered with a CPRD practice in the UK between 1 January 2004 and 31 December 2012. Individuals were selected for ≥1 of 8 algorithms to identify people with COPD. General practitioners were sent a brief questionnaire and additional evidence to support a COPD diagnosis was requested. All information received was reviewed independently by two respiratory physicians whose opinion was taken as the gold standard. PRIMARY OUTCOME MEASURE The primary measure of accuracy was the positive predictive value (PPV), the proportion of people identified by each algorithm for whom COPD was confirmed. RESULTS 951 questionnaires were sent and 738 (78%) returned. After quality control, 696 (73.2%) patients were included in the final analysis. All four algorithms including a specific COPD diagnostic code performed well. Using a diagnostic code alone, the PPV was 86.5% (77.5-92.3%) while requiring a diagnosis plus spirometry plus specific medication; the PPV was slightly higher at 89.4% (80.7-94.5%) but reduced case numbers by 10%. Algorithms without specific diagnostic codes had low PPVs (range 12.2-44.4%). CONCLUSIONS Patients with COPD can be accurately identified from UK primary care records using specific diagnostic codes. Requiring spirometry or COPD medications only marginally improved accuracy. The high accuracy applies since the introduction of an incentivised disease register for COPD as part of Quality and Outcomes Framework in 2004.
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Affiliation(s)
- Jennifer K Quint
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Hana Müllerova
- Department of Respiratory Epidemiology, GlaxoSmithKline R&D, Uxbridge, UK
| | - Rachael L DiSantostefano
- Department of Respiratory Epidemiology, GlaxoSmithKline R&D, ResearchTriangle Park, North Carolina, USA
| | - Harriet Forbes
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Susan Eaton
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - John R Hurst
- Department of UCL Respiratory Medicine, Royal Free Campus, University College London Medical School, London, UK
| | - Kourtney Davis
- Department of Respiratory Epidemiology, GlaxoSmithKline R&D, Uxbridge, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Arnaud A, Capito C, de Castro L, Aldeiri B, Rex D, Eaton S, Iardly I, Pierro A, Kiely E, Curry J, Cross K, de Coppi P. SFCP CO-04 - Procédure de Ladd coelioscopique pour malrotation intestinale, une approche controversée. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Seelig DM, Nalls AV, Flasik M, Frank V, Eaton S, Mathiason CK, Hoover EA. Lesion profiling and subcellular prion localization of cervid chronic wasting disease in domestic cats. Vet Pathol 2014; 52:107-19. [PMID: 24577721 DOI: 10.1177/0300985814524798] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic wasting disease (CWD) is an efficiently transmitted, fatal, and progressive prion disease of cervids with an as yet to be fully clarified host range. While outbred domestic cats (Felis catus) have recently been shown to be susceptible to experimental CWD infection, the neuropathologic features of the infection are lacking. Such information is vital to provide diagnostic power in the event of natural interspecies transmission and insights into host and strain interactions in interspecies prion infection. Using light microscopy and immunohistochemistry, we detail the topographic pattern of neural spongiosis (the "lesion profile") and the distribution of misfolded prion protein in the primary and secondary passage of feline CWD (Fel(CWD)). We also evaluated cellular and subcellular associations between misfolded prion protein (PrP(D)) and central nervous system neurons and glial cell populations. From these studies, we (1) describe the novel neuropathologic profile of Fel(CWD), which is distinct from either cervid CWD or feline spongiform encephalopathy (FSE), and (2) provide evidence of serial passage-associated interspecies prion adaptation. In addition, we demonstrate through confocal analysis the successful co-localization of PrP(D) with neurons, astrocytes, microglia, lysosomes, and synaptophysin, which, in part, implicates each of these in the neuropathology of Fel(CWD). In conclusion, this work illustrates the simultaneous role of both host and strain in the development of a unique Fel(CWD) neuropathologic profile and that such a profile can be used to discriminate between Fel(CWD) and FSE.
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Affiliation(s)
- D M Seelig
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA
| | - A V Nalls
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA
| | - M Flasik
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - V Frank
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA
| | - S Eaton
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - C K Mathiason
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA
| | - E A Hoover
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA
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Botta Gordon-Smith S, Eaton S, Ursu S, Moncrieffe H, Wedderburn LR. PReS-FINAL-1001: Lymphocytes from the inflamed joint of juvenile idiopathic arthritis patients express reduced levels of cd73 and have a functional defect in adenosine production. Pediatr Rheumatol Online J 2013. [PMCID: PMC4045819 DOI: 10.1186/1546-0096-11-s2-o1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mushtaq I, Garriboli M, Smeulders N, Cherian A, Desai D, Eaton S, Duffy P, Cuckow P. Primary bladder exstrophy closure in neonates: challenging the traditions. J Urol 2013; 191:193-7. [PMID: 23871929 DOI: 10.1016/j.juro.2013.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [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] [Accepted: 07/15/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE We describe a novel approach to neonatal bladder exstrophy closure that challenges the role of postoperative immobilization and pelvic osteotomy. MATERIALS AND METHODS We reviewed the primary management of bladder exstrophy at our institutions between 2007 and 2011. In particular we compared postoperative management in the surgical ward using epidural analgesia to muscle paralysis and ventilation in the intensive care unit. Clinical outcome measures were time to full feed, length of stay, postoperative complications and redo closure. Cost-effectiveness was also evaluated using hospital financial data. Data are expressed as median (range). Significance was explored by Fisher exact test and unpaired t-test. RESULTS A total of 74 patients underwent primary closure without osteotomy. Successful closure was achieved in 70 patients (95%). A total of 48 cases (65%) were managed on the ward (group A) and 26 (35%) were transferred to the intensive care unit (group B). The 2 groups were homogeneous for gestational age (median 39 weeks, range 27 to 41) and age at closure (3 days, 1 to 152). Complications requiring surgical treatment were noted in 4 patients (8.3%) in group A and 3 (11.5%) in group B (p = 0.609). Length of stay was significantly shorter for the group managed on the ward (11 vs 18 days, p <0.0001). Median costs were $42,732 for patients admitted to the intensive care unit and $16,214 for those admitted directly to the surgical ward (p <0.0001). CONCLUSIONS Primary closure of bladder exstrophy without lower limb immobilization and osteotomy is feasible. Postoperative care on the surgical ward using epidural analgesia results in shorter hospitalization.
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Affiliation(s)
- I Mushtaq
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - M Garriboli
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; Department of Pediatric Surgery, UCL Institute of Child Health, London, United Kingdom
| | - N Smeulders
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - A Cherian
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - D Desai
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - S Eaton
- Department of Pediatric Surgery, UCL Institute of Child Health, London, United Kingdom
| | - P Duffy
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - P Cuckow
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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Boggon R, Hubbard R, Smeeth L, Gulliford M, Cassell J, Eaton S, Pirmohamed M, van Staa TP. Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study. BMC Pulm Med 2013; 13:32. [PMID: 23724907 PMCID: PMC3679783 DOI: 10.1186/1471-2466-13-32] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 05/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of antibiotics in treating mild or moderate exacerbations in patients with acute chronic obstructive pulmonary disease (COPD) is unclear. The aims were to: (i) describe patient characteristics associated with acute exacerbations amongst a representative COPD population, (ii) explore the relationship between COPD severity and outcomes amongst patients with exacerbations, and (iii) quantify variability by general practice in prescribing of antibiotics for COPD exacerbations. METHOD A cohort of 62,747 patients with COPD was identified from primary care general practices (GP) in England, and linked to hospital admission and death certificate data. Exacerbation cases were matched to three controls and characteristics compared using conditional logistic regression. Outcomes were compared using incidence rates and Cox regression, stratified by disease severity. Variability of prescribing at the GP level was evaluated graphically and by using multilevel models. RESULTS COPD severity was found to be associated with exacerbation and subsequent mortality (very severe vs. mild, odds ratio for exacerbation 2.12 [95%CI 19.5-2.32]), hazard ratio for mortality 2.14 [95%CI 1.59-2.88]). Whilst 61% of exacerbation cases were prescribed antibiotics, this proportion varied considerably between GP practices (interquartile range, 48-73%). This variation is greater than can be explained by patient characteristics alone. CONCLUSIONS There is significant variability between GP practices in the prescribing of antibiotics to COPD patients experiencing exacerbations. Combined with a lack of evidence on the effects of treatment, this supports the need and opportunity for a large scale pragmatic randomised trial of the prescribing of antibiotics for COPD patients with exacerbations, in order to clarify their effectiveness and long term outcomes whilst ensuring the representativeness of subjects.
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Affiliation(s)
- Rachael Boggon
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, 151 Buckingham Palace Road, London SW1W 9SZ, UK
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Eaton S, Klein N, Ong E, Pierro A. Authors' reply: Randomized clinical trial of glutamine-supplemented versus standard parenteral nutrition in infants with surgical gastrointestinal disease (Br J Surg 2012; 99: 929-938). Br J Surg 2013; 100:841-2. [PMID: 23553761 DOI: 10.1002/bjs.9126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Bishay M, Lakshminarayanan B, Arnaud A, Garriboli M, Cross KM, Curry JI, Drake D, Kiely EM, De Coppi P, Pierro A, Eaton S. The role of parenteral nutrition following surgery for duodenal atresia or stenosis. Pediatr Surg Int 2013. [PMID: 23187894 DOI: 10.1007/s00383-012-3200-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE In our institution, some children routinely receive parenteral nutrition (PN) following surgery for duodenal atresia/stenosis, while others do not. Our aim was to compare growth and infection rate between these two treatment strategies. METHODS This was a retrospective study of all children undergoing surgery for duodenal atresia/stenosis over 7 years. RESULTS Of the 54 children, 19 commenced PN soon after surgery (the 'Initial PN' group). Of the remaining 35 children, 13 (37 %) subsequently required PN (the 'Delayed PN' group). The remaining 22 never received PN (the 'Never PN' group). The proportion of patients experiencing clinically suspected sepsis was higher in those receiving PN ('Initial' plus 'Delayed'; 41 %) compared with those who never received PN (14 %; p = 0.04). The 'Initial PN' and 'Never PN' groups did not show a significant change in weight Z score over time. However, the 'Delayed PN' group showed a significant decrease in weight Z scores from the time of operation to the time of achieving full enteral feeds, and failed to catch up by the time of last follow-up. CONCLUSION Children with duodenal atresia/stenosis can be managed without PN. However, a third of these children subsequently require PN, lose weight centiles, and have a high rate of sepsis.
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Affiliation(s)
- M Bishay
- Surgery Unit, Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children, 30 Guilford Street, London, WC1N 1EH, UK
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Abstract
Appendicitis is a common condition in the pediatric population and appendectomy has been the traditional treatment. Both the urgency of the operation and the need for the appendectomy have recently been challenged. In children, this controversy focuses on operative management of perforated appendicitis and appendix abscesses. In adults, the debate has extended to management of nonperforated appendicitis. This review describes the evidence behind these challenges and updates a per-protocol meta-analysis of randomized controlled trials in adults. In the per-protocol meta-analysis, there was no difference between operative versus nonoperative management in failure of treatment. The complication rate was significantly lower in patients treated nonoperatively. However, in the nonoperative group, 10% of patients needed immediate surgery and 17% developed a recurrence during the 1-year follow-up. Overall, 73% of adults with suspected acute appendicitis may not need operative treatment. There are no data in the literature to support nonoperative treatment of acute appendicitis in children.
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Affiliation(s)
- J F Svensson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Ong EGP, Eaton S, Wade AM, Horn V, Losty PD, Curry JI, Sugarman ID, Klein NJ, Pierro A. Randomized clinical trial of glutamine-supplemented versus standard parenteral nutrition in infants with surgical gastrointestinal disease. Br J Surg 2012; 99:929-38. [PMID: 22513659 DOI: 10.1002/bjs.8750] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Addition of glutamine to parenteral nutrition in surgical infants remains controversial. The aim of this trial was to determine whether glutamine supplementation of parenteral nutrition in infants requiring surgery would reduce the time to full enteral feeding and/or decrease the incidence of sepsis and septicaemia. METHODS A prospective double-blind multicentre randomized clinical trial was performed in surgical infants less than 3 months old who required parenteral nutrition. Patients were allocated to treatment or control groups by means of minimization. Infants received either 0·6 g per kg per day alanyl-glutamine (treatment group) or isonitrogenous isocaloric parenteral nutrition (control group) until full enteral feeding was achieved. Primary outcomes were time to full enteral feeding and incidence of sepsis. Cox regression analysis was used to compare time to full enteral feeding, and to calculate risk of sepsis/septicaemia. RESULTS A total of 174 patients were randomized, of whom 164 completed the trial and were analysed (82 in each group). There was no difference in time to full enteral feeding or time to first enteral feeding between groups, and supplementation with glutamine had no effect on the overall incidence of sepsis or septicaemia. However, during total parenteral nutrition (before the first enteral feed), glutamine administration was associated with a significantly decreased risk of developing sepsis (hazard ratio 0·33, 95 per cent confidence interval 0·15 to 0·72; P = 0·005). CONCLUSION Glutamine supplementation during parenteral nutrition did not reduce the incidence of sepsis in surgical infants with gastrointestinal disease. REGISTRATION NUMBER ISRCTN83168963 (http://www.controlled-trials.com).
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Affiliation(s)
- E G P Ong
- Department of Paediatric Surgery, University College London Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
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Thyoka M, Eaton S, Hall NJ, Drake D, Kiely E, Curry J, Cross K, de Coppi P, Pierro A. Advanced necrotizing enterocolitis part 2: recurrence of necrotizing enterocolitis. Eur J Pediatr Surg 2012; 22:13-6. [PMID: 22434228 DOI: 10.1055/s-0032-1306264] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM OF THE STUDY The aim of this study was to report incidence and clinical outcomes of recurrent necrotizing enterocolitis (NEC). METHODS Review of infants treated for recurrent episode(s) of NEC at a tertiary Neonatal Surgical Intensive Care Unit over 8 years (January 2002 to February 2011). Demographic, clinical, radiological, and operative data were analyzed and compared using Mann-Whitney or Fisher's exact tests. Data are reported as median (range). RESULTS A total of 212 consecutive infants were referred for surgical evaluation and treatment of NEC (Bell stage II or III). Of these patients, 22 (10%) had suspected recurrent NEC: in 11 of these the primary episode was Bell stage I successfully treated before coming to our institution (suspected recurrent NEC); in the remaining 11, the primary episode was confirmed (Bell stage II or III) NEC successfully treated in our hospital. Birth weight, gestational age at birth, corrected gestational age, weight on admission, gender, need for surgery, stricture, and mortality rates were similar between infants with recurrent NEC and those with a single episode. Long-term parenteral nutrition (PN) dependency (>28 days) was significantly more common following recurrent NEC compared with a single episode. Among the infants with recurrent NEC, medical therapy alone was not successful in the majority (82%) of cases during the first episode and all required surgery during the recurrent episode. CONCLUSION Infants (10%) referred for surgical treatment of NEC develop recurrence of the disease. Surprisingly, these infants have similar mortality and stricture rates to those with a single episode. However, the incidence of long-term PN dependency was significantly increased in those with recurrent episodes of NEC.
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Affiliation(s)
- M Thyoka
- Department of Surgery, Great Ormond Street Hospital and UCL Institute of Child Health, London, UK
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Macharia EW, Eaton S, de Coppi P, Curry J, Drake D, Cross K, Kiely E, Pierro A. Fundoplication in ventilator-dependent infants with gastro-oesophageal reflux. Eur J Pediatr Surg 2012; 22:91-6. [PMID: 22434231 DOI: 10.1055/s-0032-1306265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM In ventilator-dependent infants with complex comorbidities, severe gastro-oesophageal reflux (GOR) may contribute to prolonging the period of ventilation. It is often difficult to predict whether antireflux surgery will improve the respiratory status of an infant and assist with weaning off the ventilator. The aim of this study was to review the outcomes in a cohort of ventilator-dependent infants who underwent fundoplication to help wean them off ventilation. METHODS Between January 2006 and December 2010, out of 596 infants who underwent fundoplication for symptoms of GOR, 26 were ventilator dependent before surgery; 13 patients had an emergency fundoplication following an acute life-threatening event (n = 5, 19%) or an acute deterioration of respiratory status (n = 8, 31%). Fundoplication was planned in the rest of the group (n = 13, 50%) with the aim of improving respiratory status and weaning from ventilation. The median age at surgery was 5.8 months (range: 0.8 to 19.4 months). The median weight at surgery was 6.3 kg (range: 4 to 15.1 kg). Data were collected for each infant on comorbidities, pre- and postoperative ventilation status, pre- and postoperative GOR symptoms, and survival. RESULTS All infants underwent a Nissen fundoplication with no intraoperative morbidity or mortality. Of these, 12 infants had a laparoscopic fundoplication; 14 infants had an open fundoplication. Postoperatively, all infants received invasive positive pressure ventilation in the intensive care unit (ICU). All infants were successfully weaned from ventilation. The median time to extubation was 4 days (range: 2 to 18 days). The median postoperative ICU stay was 9 days (range: 3 to 52 days). Of the patients, 9 (34%) had a recurrence of symptoms following fundoplication; 5 (19%) subsequently underwent revision of fundoplication and 1 (3.8%) underwent oesophago-gastric dissociation; and 10 (38%) died within the study period. CONCLUSION In infants with severe GOR, ventilator dependence, and complex comorbidities, fundoplication may be a useful procedure to assist weaning off ventilator dependence. Rates of symptom recurrence, of revision of fundoplication, and of mortality within this cohort were higher than expected. These data reflect the challenges of patient selection in high-risk groups.
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Affiliation(s)
- E W Macharia
- Department of Surgery, Great Ormond Street Hospital and UCL Institute of Child Health, London, UK
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Carnaghan H, Johnson H, Eaton S, de Coppi P, Curry J, Morova M, Cross K, Drake D, Kiely E, Pierro A. Effectiveness of the antegrade colonic enema stopper at preventing stomal stenosis: long-term follow-up. Eur J Pediatr Surg 2012; 22:26-8. [PMID: 22270962 DOI: 10.1055/s-0031-1285874] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 10/14/2022]
Abstract
AIM OF THE STUDY Stomal stenosis is the commonest complication of the antegrade colonic enema (ACE) procedure, reportedly occurring in 25-55% of patients. As such, a simple ACE stopper device (a small silicone plug sited in the ACE conduit between catheterisations) was designed to prevent stenosis. We performed a long-term follow-up study to determine the effectiveness of the stopper device. METHODS A retrospective case note review was performed of all patients who successfully underwent a primary ACE procedure over an 8.5-year period (January 2002 to June 2010). The inclusion criteria were (i) a minimum of 6 months follow-up, (ii) simple appendicostomy, (iii) caecal/colonic flap. In all patients an ACE stopper was sited in the conduit for at least 4 months and removed only for catheterisation. Data are mean±SEM. MAIN RESULTS 38 children were included in our study. Mean age at surgery was 9.6±0.5 years. Surgery was performed in 22 patients for incontinence and in 16 for chronic constipation. 31 underwent an appendicostomy and 7 had a caecal/colonic flap; all received an ACE stopper. The mean follow-up was 2.6±0.3 years. Only 3 patients (8%) developed stomal stenosis. The first occurred 6 months postoperatively, resulting from an ACE stopper which was too small and consequently persistently fell out. This conduit required dilatation. The second occurred at 27 months secondary to a stomal infection and required surgical revision. The third occurred 8 months postoperatively for no obvious cause, and was treated with dilation. 1 patient experienced stomal leakage. CONCLUSION The ACE stopper is a simple yet highly effective method of preventing stomal stenosis. We recommend using the stopper in all ACE patients.
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Affiliation(s)
- H Carnaghan
- UCL Institute of Child Health, Paediatric Surgery Unit, London, UK
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Bishay M, Retrosi G, Horn V, Cloutman-Green E, Harris K, de Coppi P, Klein N, Eaton S, Pierro A. Septicaemia due to enteric organisms is a later event in surgical infants requiring parenteral nutrition. Eur J Pediatr Surg 2012; 22:50-3. [PMID: 22270963 DOI: 10.1055/s-0031-1287853] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 10/14/2022]
Abstract
INTRODUCTION The purpose of this study was to determine whether, in surgical infants requiring parenteral nutrition (PN), septicaemia due to enterococci or Gram-negative bacilli occurs later than septicaemia due to coagulase-negative staphylococci (CNS). PATIENTS/MATERIAL AND METHODS We retrospectively studied 112 consecutive surgical infants (corrected gestational age up to 3 months) receiving PN for at least 5 days for congenital or acquired intestinal anomalies over a 2-year period (July 2007-June 2009). Data collected included diagnosis, duration of PN, episodes of septicaemia (defined as growth of bacteria from blood culture), and organisms cultured. We compared the time to first occurrence of septicaemia due to CNS with the times to first occurrence of septicaemia due to enterococci, Gram-negative bacilli, or other micro-organisms, using Kruskal-Wallis nonparametric ANOVA test and Dunn's multiple comparisons test. Data are given as median (range). RESULTS 31 patients (28%) had a total of 65 episodes of septicaemia. Septicaemia due to CNS was most common, occurring in 22% of patients, after 17 days (1-239) of PN. Septicaemia due to enteric organisms was less common and occurred significantly later, at 59 (24-103) days for enterococci (p<0.01), and at 55 (30-106) days for Gram-negative bacilli (p<0.05). CONCLUSIONS Septicaemia due to enterococci or Gram-negative bacilli occurs later in the course of PN than septicaemia due to CNS, in surgical infants. This suggests that these infants become more vulnerable to the translocation of enteric micro-organisms after a longer period of parenteral nutrition.
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Affiliation(s)
- M Bishay
- UCL Institute of Child Health, Department of Paediatric Surgery, London, UK
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Abstract
AIM OF THE STUDY Intraoperative hypothermia may have a detrimental clinical effect. Preterm infants undergoing laparotomy for necrotizing enterocolitis (NEC) are particularly at risk. We investigated the relationship between intraoperative temperature and morbidity and outcome in infants with NEC. METHODS A review of all laparotomies for NEC (n = 82, 69 infants) performed between Jan 2008 and Jan 2011 in our institution was done. Relationships between intraoperative temperature and intra- and postoperative fluid and blood product requirements, postoperative clinical status (sequential organ failure assessment [SOFA] score) and outcome were determined. Data (mean [range]) were compared using paired t-test and regression analysis. RESULTS Data were available for 52 laparotomies (49 infants). The lowest intraoperative core temperature was significantly lower than the preoperative temperature (peri-op 34.9 °C [31.5-37.0] vs. pre-op 37.0 °C [35.8-38.0]; p < 0.0001). There was a statistically significant inverse relationship between mean intraoperative temperature and intraoperative blood transfusion requirement (p = 0.01). There were no statistically significant relationships between intraoperative temperature and other blood product or volume requirements, postoperative infective complications, change in SOFA score following surgery, length of stay, or mortality. CONCLUSIONS During laparotomy for NEC, there is a significant and profound drop in core temperature. The effect of this on short-term morbidity and long-term outcome (e.g., neurodevelopment) warrants further investigation.
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Affiliation(s)
- R Sim
- Institute of Child Health, Surgery Unit, London, UK
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Abstract
AIM OF THE STUDY The aim of this study was to investigate the factors associated with mortality in infants referred for the surgical treatment of advanced necrotizing enterocolitis (NEC). METHODS Retrospective review of all infants with confirmed (Bell stage II or III) NEC treated in our unit during the past 8 years (January 2002 to December 2010). Data for survivors and nonsurvivors were compared using Mann-Whitney test and Fisher's exact test and are reported as median (range). RESULTS Of the 205 infants with NEC, 35 (17%) were medically managed; 170 (83%) had surgery; 66 (32%) infants died; all had received surgery. Survivors and nonsurvivors were comparable for gestational age, birth weight, and gender distribution. Overall mortality was 32%, the highest mortality was in infants with pan-intestinal disease (86%) but remained significant in those with less severe disease (multifocal 39%; focal disease 21%). The commonest cause of mortality was multiple organ dysfunction syndrome and nearly half of the nonsurvivors had care withdrawn. CONCLUSION Despite improvement in neonatal care, overall mortality (32%) for advanced NEC has not changed in 10 years. Mortality is significant even with minimal bowel involvement.
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Affiliation(s)
- M Thyoka
- Department of Surgery, Great Ormond Street Hospital and UCL Institute of Child Health, London, UK
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Wells JCK, Haroun D, Williams JE, Darch T, Eaton S, Viner R, Fewtrell MS. Evaluation of lean tissue density for use in air displacement plethysmography in obese children and adolescents. Eur J Clin Nutr 2011; 65:1094-101. [DOI: 10.1038/ejcn.2011.76] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hall NJ, Eaton S, Pierro A. Editorial on "Open versus laparoscopic pyloromyotomy for pyloric stenosis: a meta-analysis of randomized controlled trials" by Jia et al. Eur J Pediatr Surg 2011; 21:75-6. [PMID: 21494993 DOI: 10.1055/s-0031-1275323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nah SA, Giacomello L, Eaton S, de Coppi P, Curry JI, Drake DP, Kiely EM, Pierro A. Surgical repair of incarcerated inguinal hernia in children: laparoscopic or open? Eur J Pediatr Surg 2011; 21:8-11. [PMID: 20938898 DOI: 10.1055/s-0030-1262793] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 10/19/2022]
Abstract
PURPOSE The management of Incarcerated Inguinal Hernia (IIH) in children is challenging and may be associated with complications. We aimed to compare the outcomes of laparoscopic vs. open repair of IIH. METHODS With institutional ethical approval (09SG13), we reviewed the notes of 63 consecutive children who were admitted to a single hospital with the diagnosis of IIH between 2000 and 2008. Data are reported as median (range). Groups were compared by chi-squared or t-tests as appropriate. RESULTS · Open repair (n=35): There were 21 children with right and 14 with left IIH. 2 patients also had contralateral reducible inguinal hernia. Small bowel resection was required in 2 children. · Laparoscopic repair (n=28): All children had unilateral IIH (19 right sided, 9 left sided). 15 children (54%) with no clinical evidence of contralateral hernia, had contralateral patent processus vaginalis at laparoscopy, which was also repaired. The groups were similar with regard to gender, age at surgery, history of prematurity, interval between admission and surgery, and proportion of patients with successful preoperative manual reduction. However, the duration of operation was longer in the laparoscopy group (p=0.01). Time to full feeds and length of hospital stay were similar in both groups. Postoperative follow-up was 3.5 months (1-36), which was similar in both groups. 5 patients in the group undergoing open repair had serious complications: 1 vas transaction, 1 acquired undescended testis, 2 testicular atrophy and 1 recurrence. The laparoscopic group had a single recurrence. CONCLUSION Open repair of incarcerated inguinal hernia is associated with serious complications. The laparoscopic technique appears safe, avoids the difficult dissection of an oedematous sac in the groin, allows inspection of the reduced hernia content and permits the repair of a contralateral patent processus vaginalis if present.
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Affiliation(s)
- S A Nah
- UCL Institute of Child Health & Great Ormond Street Hospital for Children, Unit of Paediatric Surgery, London, United Kingdom
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