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Lindeback R, Abdo R, Schnabel L, Le Jambre R, Kennedy SE, Katz T, Ooi CY, Lambert K. Does the Nutritional Intake and Diet Quality of Children With Chronic Kidney Disease Differ From Healthy Controls? A Comprehensive Evaluation. J Ren Nutr 2023:S1051-2276(23)00229-7. [PMID: 38128854 DOI: 10.1053/j.jrn.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/09/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Children with chronic kidney disease (CKD) experience many obstacles to achieving optimal dietary intake. Dietary intake patterns remain unexplored or poorly described. This study compares nutritional intake and diet quality of Australian children with CKD to controls. METHODS A food frequency questionnaire captured intake data and was compared to controls. Nutritional intake was determined using individualized nutrient reference values, and diet quality described using the Australian Guide to Healthy Eating and the Australian Child and Adolescent Recommended Food Score. RESULTS Children with CKD (n = 36) and controls (n = 82) were studied. Children with CKD had lower weight and height z scores, but higher body mass index (P < .0001 for all parameters). Children with CKD had adequate energy intake, and excessive protein and sodium intake (336% and 569%). They were significantly less likely to meet requirements for vitamin A (P < .001), thiamine (P = .006), folate (P = .01), vitamin C (P = .008), calcium (P < .0001), iron (P = .01), magnesium (P = .0009), and potassium (P = .002). No child met recommended vegetable intake; however, less than half of children with CKD met fruit (44%), grains (31%), and dairy serves (31%). They were also less likely to meet recommended fruit and dairy serves (P = .04 and P = .01, respectively). Non-core foods provided 36% of energy, and although comparable to controls, was contributed more by takeaway foods (P = .01). CONCLUSION Children with CKD have reduced nutritional intake of key nutrients and consume more takeaways than controls. Attention to increasing core foods, limiting sodium intake, and managing restrictions while promoting nutrient density appears necessary.
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Affiliation(s)
- Rachel Lindeback
- Department of Nutrition and Dietetics, St George Hospital, Sydney, New South Wales, Australia.
| | - Rasha Abdo
- Nutrition and Dietetics, University of Wollongong, School of Medical, Indigenous and Health Sciences, Wollongong, New South Wales, Australia
| | - Lyndal Schnabel
- Nutrition and Dietetics, University of Wollongong, School of Medical, Indigenous and Health Sciences, Wollongong, New South Wales, Australia
| | - Renee Le Jambre
- Department of Nutrition and Dietetics, Sydney Children's Hospital Network, Randwick, Sydney, New South Wales, Australia
| | - Sean E Kennedy
- Department of Nutrition and Dietetics, Sydney Children's Hospital Network, Randwick, Sydney, New South Wales, Australia
| | - Tamarah Katz
- Department of Nutrition and Dietetics, Sydney Children's Hospital Network, Randwick, Sydney, New South Wales, Australia
| | - Chee Y Ooi
- Discipline of Paediatrics and Child Health, University of New South Wales, School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Kelly Lambert
- Nutrition and Dietetics, University of Wollongong, School of Medical, Indigenous and Health Sciences, Wollongong, New South Wales, Australia
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Tran JK, Ooi CY, Blazek K, Katz T. Body composition and body mass index measures from 8 to 18 years old in children with cystic fibrosis. J Cyst Fibros 2023; 22:851-856. [PMID: 37365079 DOI: 10.1016/j.jcf.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/21/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Historically, body mass index (BMI) >50th percentile has represented optimal nutritional status in children with cystic fibrosis (CF) due to its positive association with lung function. Body composition parameters including fat-free mass index (FFMI) have been suggested as a more physiological nutrition benchmark. AIMS (1) describe changes in body composition with age and gender; (2) assess the correlation between measures of nutritional status (FFMI-z, FMI-z, BMI-z) and lung function (forced expiratory volume in one second predicted; FEV1pp). METHODS This retrospective, mixed cross-sectional and serial measures study consisted of children with CF (8 to 18 years) attending Sydney Children's Hospital (2007-2020). FFMI and fat mass index (FMI) were taken from biennial dual energy x-ray absorptiometry (DXA) scans. Z-scores were derived using Well's reference population [1]. Repeated measures correlation analyses assessed correlations between FFMI-z, FMI-z, and BMI-z with FEV1pp. RESULTS 339 DXA reports were analysed from 137 patients. There were slight downwards trends in BMI-z and FMI-z, and an upwards trend in FFMI-z with increasing age and across both genders. Females had higher FMI-z and FFMI-z than males from 12.5 years. There was a weak, positive correlation between FEV1pp and BMI-z (r = 0.14, p = 0.04), and FFMI-z (r = 0.25, p<0.001). FMI-z had no correlation with FEV1pp (r=-0.06, p = 0.41). CONCLUSION Deficits in FFMI exist despite increasing trends with age. FFMI-z and BMI-z had a weak, positive correlation with FEV1pp. In contemporary cohorts, nutritional status (reflected by surrogate markers such as FFMI and BMI) may be less influential upon lung function than in previous decades. [1]: Wells, J.C., et al. Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child. Am. J. Clin. Nutr.96, 1316-1326 (2012).
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Affiliation(s)
- Jade K Tran
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| | - Chee Y Ooi
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Gastroenterology, Sydney Children's Hospital Randwick, New South Wales, Australia
| | - Katrina Blazek
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Tamarah Katz
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Nutrition and Dietetics, Sydney Children's Hospital Randwick, New South Wales, Australia
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McKay I, van Dorst J, Katz T, Doumit M, Prentice B, Owens L, Belessis Y, Chuang S, Jaffe A, Thomas T, Coffey M, Ooi CY. Diet and the gut-lung axis in cystic fibrosis - direct & indirect links. Gut Microbes 2023; 15:2156254. [PMID: 36573804 PMCID: PMC9809969 DOI: 10.1080/19490976.2022.2156254] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cystic fibrosis (CF) is a multisystem, autosomal, recessive disease primarily affecting the lungs, pancreas, gastrointestinal tract, and liver. Whilst there is increasing evidence of a microbial 'gut-lung axis' in chronic respiratory conditions, there has been limited analysis of such a concept in CF. We performed a comprehensive dietary and microbiota analysis to explore the interactions between diet, gastrointestinal microbiota, respiratory microbiota, and clinical outcomes in children with CF. Our results demonstrate significant alterations in intestinal inflammation and respiratory and gastrointestinal microbiota when compared to age and gender matched children without CF. We identified correlations between the gastrointestinal and respiratory microbiota, lung function, CF pulmonary exacerbations and anthropometrics, supporting the concept of an altered gut-lung axis in children with CF. We also identified significant differences in dietary quality with CF children consuming greater relative proportions of total, saturated and trans fats, and less relative proportions of carbohydrates, wholegrains, fiber, insoluble fiber, starch, and resistant starch. Our findings position the CF diet as a potential modulator in gastrointestinal inflammation and the proposed gut-lung axial relationship in CF. The dietary intake of wholegrains, fiber and resistant starch may be protective against intestinal inflammation and should be explored as potential therapeutic adjuvants for children with CF.
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Affiliation(s)
- Isabelle McKay
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, Univeristy of New South Wales, Randwick, Australia
| | - Josie van Dorst
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, Univeristy of New South Wales, Randwick, Australia
| | - Tamarah Katz
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, Univeristy of New South Wales, Randwick, Australia,Department of Nutrition and Dietetics, Sydney Children’s Hospital Randwick, Randwick, Australia
| | - Michael Doumit
- Department of Physiotherapy, Sydney Children’s Hospital Randwick, Randwick, Australia
| | - Bernadette Prentice
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, Univeristy of New South Wales, Randwick, Australia,Molecular and Integrative Cystic Fibrosis (miCF) Research Centre, University of New South Wales, Randwick, Australia,Department of Respiratory Medicine, Sydney Childrens Hospital, Randwick, Australia
| | - Louisa Owens
- Department of Respiratory Medicine, Sydney Childrens Hospital, Randwick, Australia
| | - Yvonne Belessis
- Department of Respiratory Medicine, Sydney Childrens Hospital, Randwick, Australia
| | - Sandra Chuang
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, Univeristy of New South Wales, Randwick, Australia,Department of Respiratory Medicine, Sydney Childrens Hospital, Randwick, Australia
| | - Adam Jaffe
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, Univeristy of New South Wales, Randwick, Australia,Molecular and Integrative Cystic Fibrosis (miCF) Research Centre, University of New South Wales, Randwick, Australia,Department of Respiratory Medicine, Sydney Childrens Hospital, Randwick, Australia
| | - Torsten Thomas
- Biological, Earth and Environmental Sciences, University of New South Wales, Randwick, Australia,University of New South Wales, Centre for Marine Science and Innovation, Randwick, Australia
| | - Michael Coffey
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, Univeristy of New South Wales, Randwick, Australia,Department of Gastroenterology, Sydney Children’s Hospital, Randwick, Australia
| | - Chee Y. Ooi
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, Univeristy of New South Wales, Randwick, Australia,Molecular and Integrative Cystic Fibrosis (miCF) Research Centre, University of New South Wales, Randwick, Australia,Department of Gastroenterology, Sydney Children’s Hospital, Randwick, Australia,CONTACT Chee Y. Ooi Centre for Child Health Research and Innovation, Level 8, Bright Alliance Building, Cnr of Avoca and High Streets, Randwick, NSW2031, Australia
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Mathew NE, Mallitt KA, Masi A, Katz T, Walker AK, Morris MJ, Ooi CY. Dietary intake in children on the autism spectrum is altered and linked to differences in autistic traits and sensory processing styles. Autism Res 2022; 15:1824-1839. [PMID: 36054787 DOI: 10.1002/aur.2798] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 08/10/2022] [Indexed: 01/07/2023]
Abstract
Diets of children and adolescents on the autism spectrum often differ when compared to their non-autistic peers. Most dietary studies have been limited by small sample sizes and rarely assess the heterogeneity of autism. Addressing this gap, this study compared the anthropometrics, dietary composition, dietary quality, and food variety of 154 Australian children and adolescents on the spectrum and 213 non-autistic children (71 siblings and 142 unrelated controls). Beyond the case-control approach, within-group comparisons assessed the influence of autism clinical presentations and sensory processing styles on body mass index (BMI) and measures of dietary intake among those on the spectrum. In this word first study of diet that included between-group comparisons with non-autistic peers (siblings and an unrelated comparison group) and within-autism group comparisons, we found that children on the spectrum consumed limited variety and lower quality of food and non-autistic siblings also ate comparably higher levels of energy-dense, nutrient poor food, and less diary. This may be due to autistic traits influencing family's diets or shared sensory sensitivities driving dietary intake. Within the autism group, higher autistic traits were associated with lower BMIs and a specific dietary pattern higher in simple carbohydrates and lower in unprocessed protein. Contrastingly, greater sensitivity to sensory stimuli was associated with a healthier diet. Increased age was linked to more varied diets but also diets higher in saturated fats and energy-dense, nutrient poor foods. Overall, this research highlights that potential mediators of dietary intake, such as familial influences, autistic traits, sensory processing styles, age and sex, need to be considered when assessing diet in the autistic population. LAY SUMMARY: In this study of dietary differences linked to autism, children, and teenagers on the spectrum ate fewer different foods and were less likely to eat recommended amounts of fruits and vegetables when compared to non-autistic siblings and unrelated children and teenagers. There were also family differences, in that those on the spectrum and their siblings ate more unhealthy foods and less dairy. Among those on the spectrum, dietary differences were linked to age, sex, autistic traits and sensory processing styles.
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Affiliation(s)
- Nisha E Mathew
- Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Kylie-Ann Mallitt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anne Masi
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tamarah Katz
- Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Nutrition and Dietetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Adam K Walker
- Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Margaret J Morris
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Chee Y Ooi
- Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Traini I, Chan SY, Menzies J, Hughes J, Coffey MJ, Katz T, McKay IR, Ooi CY, Leach ST, Krishnan U. Evaluating the Dietary Intake of Children With Esophageal Atresia: A Prospective, Controlled, Observational Study. J Pediatr Gastroenterol Nutr 2022; 75:221-226. [PMID: 35653431 DOI: 10.1097/mpg.0000000000003498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Children with esophageal atresia (EA) often have feeding difficulties and dysphagia, which may compromise their nutritional status. This study aimed to compare dietary intake between children with EA and matched healthy controls (HC) and to investigate the relationship between dietary factors, growth, dysphagia, and feeding difficulties in the EA cohort. METHODS This cross-sectional cohort study recruited children with EA and HC aged 2-17 years from a tertiary pediatric hospital in Australia. Growth parameters were measured. Dietary intake was assessed using the validated Australian Child and Adolescent Eating Survey. Dysphagia and feeding difficulties were assessed using objective questionnaires. RESULTS Twenty-one children with EA were matched for age and sex with 21 HC. Compared to HC, children with EA had lower mean z scores for height-for-age, but mean weight-for-age and body mass index-for-age z scores were similar. Energy intake was similar between the groups. The diet of children with EA consisted of a higher proportion of fats and lower proportion of carbohydrates compared to matched HC. Dysphagia severity in children with EA positively correlated with proportion of energy from fats and saturated fats. CONCLUSIONS Children with EA have similar energy intake and growth parameters to HC, but their diet consists of a higher proportion of fats and lower proportion of carbohydrates compared to HC. Targeted dietary interventions and parental education are necessary.
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Affiliation(s)
- Isabelle Traini
- From the School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Sin Yee Chan
- From the School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Jessica Menzies
- the Department of Nutrition and Dietetics, Sydney Children's Hospital, Randwick, NSW, Australiathe
| | - Jennifer Hughes
- the Department of Speech Pathology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Michael J Coffey
- From the School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Tamarah Katz
- the Department of Nutrition and Dietetics, Sydney Children's Hospital, Randwick, NSW, Australiathe
| | - Isabelle R McKay
- From the School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Chee Y Ooi
- From the School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
- the Department of Gastroenterology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Steven T Leach
- From the School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Usha Krishnan
- From the School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
- the Department of Gastroenterology, Sydney Children's Hospital, Randwick, NSW, Australia
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Abdelrahim M, Esmail A, Katz T, Sharma S, Kalashnikova E, Malhotra M, Olshan P, Billings P, Aleshin A. P-108 Circulating tumor DNA for early relapse detection and monitoring disease status in patients with early-stage pancreatic adenocarcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.163] [Citation(s) in RCA: 2] [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: 11/30/2022] Open
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Tzoran I, Katz T, Romano J, Brenner B. PO-112 Forthcoming study of a novel assay for the stratification of cancer patients' risk of thromboembolism. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Katz T, Oh R, Thomson A, Widger J. ePS4.10 The principles of the Toyota Production System (TPS) applied to an inpatient food service model can improve nutritional outcomes for children with cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Coffey MJ, McKay IR, Doumit M, Chuang S, Adams S, Stelzer-Braid S, Waters SA, Kasparian NA, Thomas T, Jaffe A, Katz T, Ooi CY. Evaluating the Alimentary and Respiratory Tracts in Health and disease (EARTH) research programme: a protocol for prospective, longitudinal, controlled, observational studies in children with chronic disease at an Australian tertiary paediatric hospital. BMJ Open 2020; 10:e033916. [PMID: 32295774 PMCID: PMC7200033 DOI: 10.1136/bmjopen-2019-033916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/08/2020] [Accepted: 03/24/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic gastrointestinal and respiratory conditions of childhood can have long-lasting physical, psychosocial and economic effects on children and their families. Alterations in diet and intestinal and respiratory microbiomes may have important implications for physical and psychosocial health. Diet influences the intestinal microbiome and should be considered when exploring disease-specific alterations. The concepts of gut-brain and gut-lung axes provide novel perspectives for examining chronic childhood disease(s). We established the 'Evaluating the Alimentary and Respiratory Tracts in Health and disease' (EARTH) research programme to provide a structured, holistic evaluation of children with chronic gastrointestinal and/or respiratory conditions. METHODS AND ANALYSIS The EARTH programme provides a framework for a series of prospective, longitudinal, controlled, observational studies (comprised of individual substudies), conducted at an Australian tertiary paediatric hospital (the methodology is applicable to other settings). Children with a chronic gastrointestinal and/or respiratory condition will be compared with age and gender matched healthy controls (HC) across a 12-month period. The following will be collected at baseline, 6 and 12 months: (i) stool, (ii) oropharyngeal swab/sputum, (iii) semi-quantitative food frequency questionnaire, (iv) details of disease symptomatology, (v) health-related quality of life and (vi) psychosocial factors. Data on the intestinal and respiratory microbiomes and diet will be compared between children with a condition and HC. Correlations between dietary intake (energy, macro-nutrients and micro-nutrients), intestinal and respiratory microbiomes within each group will be explored. Data on disease symptomatology, quality of life and psychosocial factors will be compared between condition and HC cohorts.Results will be hypothesis-generating and direct future focussed studies. There is future potential for direct translation into clinical care, as diet is a highly modifiable factor. ETHICS AND DISSEMINATION Ethics approval: Sydney Children's Hospitals Network Human Research Ethics Committee (HREC/18/SCHN/26). Results will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04071314.
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Affiliation(s)
- Michael J Coffey
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Isabelle R McKay
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Doumit
- Department of Physiotherapy, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Sandra Chuang
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Susan Adams
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Surgery, Sydney Children's Hospital Randwick & Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Sacha Stelzer-Braid
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Shafagh A Waters
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Molecular and Integrative Cystic Fibrosis (miCF) Research Centre®, Sydney, New South Wales, Australia
| | - Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Cincinnati Children's Center for Heart Disease and the Developing Mind, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center & Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Torsten Thomas
- Centre for Marine Science and Innovation, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Molecular and Integrative Cystic Fibrosis (miCF) Research Centre & Department of Respiratory, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Tamarah Katz
- Department of Nutrition and Dietetics, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Chee Y Ooi
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Molecular and Integrative Cystic Fibrosis (miCF) Research Centre & Department of Respiratory, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
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Katz T, Tham A, Sutherland R, Garg M, Liu V, Tong C, Brunner R, Justine Q, Collins C, Ooi C. P328 Are we achieving energy density at the expense of micronutrient density? J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30620-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Garg M, Leach ST, Pang T, Needham B, Coffey MJ, Katz T, Strachan R, Widger J, Field P, Belessis Y, Chuang S, Day AS, Jaffe A, Ooi CY. Age-related levels of fecal M2-pyruvate kinase in children with cystic fibrosis and healthy children 0 to 10years old. J Cyst Fibros 2017; 17:109-113. [PMID: 28754328 DOI: 10.1016/j.jcf.2017.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The pathogenesis of gut inflammation, bacterial dysbiosis and increased rates of malignancy in CF is unclear. Fecal M2-pyruvate kinase (M2-PK) is a biomarker indicative of cellular proliferation that may be raised in intestinal malignancy and inflammation. Biomarkers, including M2-PK, may be useful in assessing effects of novel therapies on the gastrointestinal tract. METHODS M2-PK was measured in stools collected from patients with CF and HC (0-10years). Linear mixed model analysis was used. RESULTS M2-PK levels did not significantly change in children with CF (36 patients, 77 samples) (P=0.998) or HC (45 patients, 45 samples) (P=0.21), over the age range 0-10years. Patients with CF had elevated M2-PK compared to HC (median [IQR; range]: 10.7 [5.7-28.6; 1.0-239.1] (n=77) vs. 1.0 [1.0-1.0; 1.0-50.0] (n=45) U/mL, respectively; P=0.001). CONCLUSIONS Fecal M2-PK was elevated in children with CF compared with HC during infancy and throughout childhood suggesting abnormalities in the CF gut exist in early life.
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Affiliation(s)
- Millie Garg
- School of Women and Children's Health, Medicine, The University of New South Wales, High Street, Sydney Children's Hospital, Randwick 2031, New South Wales, Australia
| | - Steven T Leach
- School of Women and Children's Health, Medicine, The University of New South Wales, High Street, Sydney Children's Hospital, Randwick 2031, New South Wales, Australia
| | - Tamara Pang
- School of Women and Children's Health, Medicine, The University of New South Wales, High Street, Sydney Children's Hospital, Randwick 2031, New South Wales, Australia
| | - Bronwen Needham
- Sydney Medical Program, The University of Sydney, Camperdown 2050, New South Wales, Australia
| | - Michael J Coffey
- School of Women and Children's Health, Medicine, The University of New South Wales, High Street, Sydney Children's Hospital, Randwick 2031, New South Wales, Australia
| | - Tamarah Katz
- Department of Nutrition and Dietetics, Sydney Children's Hospital, High Street, Randwick 2031, New South Wales, Australia
| | - Roxanne Strachan
- Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick 2031, New South Wales, Australia
| | - John Widger
- School of Women and Children's Health, Medicine, The University of New South Wales, High Street, Sydney Children's Hospital, Randwick 2031, New South Wales, Australia; Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick 2031, New South Wales, Australia
| | - Penelope Field
- School of Women and Children's Health, Medicine, The University of New South Wales, High Street, Sydney Children's Hospital, Randwick 2031, New South Wales, Australia; Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick 2031, New South Wales, Australia
| | - Yvonne Belessis
- School of Women and Children's Health, Medicine, The University of New South Wales, High Street, Sydney Children's Hospital, Randwick 2031, New South Wales, Australia; Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick 2031, New South Wales, Australia
| | - Sandra Chuang
- School of Women and Children's Health, Medicine, The University of New South Wales, High Street, Sydney Children's Hospital, Randwick 2031, New South Wales, Australia; Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick 2031, New South Wales, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Riccarton Ave, Christchurch 8011, Canterbury, New Zealand
| | - Adam Jaffe
- School of Women and Children's Health, Medicine, The University of New South Wales, High Street, Sydney Children's Hospital, Randwick 2031, New South Wales, Australia; Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick 2031, New South Wales, Australia
| | - Chee Y Ooi
- School of Women and Children's Health, Medicine, The University of New South Wales, High Street, Sydney Children's Hospital, Randwick 2031, New South Wales, Australia; Department of Gastroenterology, Sydney Children's Hospital, High Street, Randwick 2031, New South Wales, Australia.
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12
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Ortega-Usobiaga J, Llovet-Osuna F, Katz T, Djodeyre MR, Druchkiv V, Bilbao-Calabuig R, Baviera J. Comparison of 5468 retreatments after laser in situ keratomileusis by lifting the flap or performing photorefractive keratectomy on the flap. ACTA ACUST UNITED AC 2017; 93:60-68. [PMID: 28651810 DOI: 10.1016/j.oftal.2017.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess visual outcomes of retreatment after laser in situ keratomileusis (LASIK) by lifting the flap or performing photorefractive keratectomy (PRK) on the flap, as well as to establish whether there was an increased risk of epithelial ingrowth (EIG) when LASIK and lifting of the flap are separated by a long time interval and to determine the incidence of corneal haze after PRK. METHODS Retrospective study of 4077 patients (5468 eyes) who underwent LASIK and subsequent retreatment were reviewed in order to study their visual results and identify cases of EIG and corneal haze. RESULTS Enhancements included 5196 eyes from 3876 patients that were retreated by lifting the flap, and 272 eyes from 201 patients that were retreated by PRK on the flap. No statistically significant differences were found between the retreatments in terms of predictability, efficacy, and safety. A total of 704 cases of EIG were found after lifting the flap, for which surgical cleansing was necessary in 70. Surgical cleansing decreased the efficacy index when compared with patients with EIG who did not need cleansing (P=.01). Differences in terms of safety and predictability were not statistically significant. The incidence of corneal haze after ablation of the surface of the previous flap was 14.34%, although none of these cases were clinically relevant. CONCLUSIONS Visual outcomes were similar between patients who were retreated by lifting the flap and those who underwent PRK. The incidence of EIG when the flap was lifted was 13.55%. The incidence of EIG increases with the time elapsed between the primary procedure and retreatment.
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Affiliation(s)
- J Ortega-Usobiaga
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Bilbao, España.
| | - F Llovet-Osuna
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Madrid, España
| | - T Katz
- Departamento de Catarata y Cirugía Refractiva, Care Vision, Hamburgo, Alemania; Departamento de Oftalmología, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburgo, Alemania
| | - M R Djodeyre
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Zaragoza, España
| | - V Druchkiv
- Departamento de Investigación y Desarrollo, Clínica Baviera, Valencia, España
| | - R Bilbao-Calabuig
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Madrid, España
| | - J Baviera
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Valencia, España
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13
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Frings A, Steinberg J, Linke SJ, Druchkiv V, Katz T. [Multifocal intraocular lens (MIOL) surgery in young non-presbyopic ametropes : Reasonable and safe?]. Ophthalmologe 2016; 114:722-727. [PMID: 27913863 DOI: 10.1007/s00347-016-0401-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Refractive lens exchange and implantation of a multifocal intraocular lens (MIOL) is mainly advised for ametropes with presbyopia. Non-presbyopic young ametropes who wish spectacle-independence are usually treated with corneal refractive surgery or phakic lenses. OBJECTIVES This retrospective case series aimed to analyse the refractive and subjective satisfaction outcome after MIOL surgery in both eyes of non-presbyopic ametropes where other treatment options were not possible. MATERIALS AND METHODS This retrospective case series comprised consecutively treated 32 eyes of 16 patients (5 myopic, 11 hyperopic patients; mean age 31 ± 6 years) who wished spectacle-independence and thus received an aspheric bifocal biconvex refractive-diffractive single-piece MIOL (Acri.Lisa 366/809, Carl Zeiss Meditec AG). Refractive data prior to and after surgery as well as subjective satisfaction at the 1‑year follow-up examination were assessed. RESULTS Related to distance corrected near visual acuity myopic eyes had a median efficacy index (EI) of 0.92 (±0.20) and hyperopes of 0.91 (±0.12) (P = 0.415). For intermediate vision, in both groups a lower EI (<0.5; P = 0.188) resulted in lower subjective satisfaction, which was higher for near and distance vision. Some of hyperopic patients reported limitations in near and distance vision, only one hyperopic patient would not have chosen this surgery again. None had a related complication during the follow-up. CONCLUSIONS When neither laser refractive surgery nor implantation of a phakic lens is possible, young non-presbyopic ametropes do profit from MIOL surgery with an aspheric bifocal biconvex refractive-diffractive MIOL.
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Affiliation(s)
- A Frings
- Univ.-Klinik für Augenheilkunde, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - J Steinberg
- Univ.-Klinik für Augenheilkunde, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.,Care Vision GmbH, Hamburg, Deutschland.,zentrumsehstärke, Augenarztpraxis am UKE, Hamburg, Deutschland
| | - S J Linke
- Univ.-Klinik für Augenheilkunde, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.,Care Vision GmbH, Hamburg, Deutschland.,zentrumsehstärke, Augenarztpraxis am UKE, Hamburg, Deutschland
| | - V Druchkiv
- Univ.-Klinik für Augenheilkunde, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - T Katz
- Univ.-Klinik für Augenheilkunde, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland. .,Care Vision GmbH, Hamburg, Deutschland.
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14
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Mehlan J, Steinberg J, Traber L, Katz T, Linke SJ. Recurrence rate and subjective symptoms after standardized (Hamburg protocol) phototherapeutic keratectomy on recurrent corneal erosions. Graefes Arch Clin Exp Ophthalmol 2016; 254:2005-2009. [DOI: 10.1007/s00417-016-3470-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 06/21/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022] Open
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Abstract
INTRODUCTION Multiple myeloma (MM) is an incurable, genetically heterogeneous malignancy of plasma cells that secrete non-functioning immunoglobulins and present high proteasome activity. MM is characterized by bone marrow infiltration leading to multiple lytic bone lesions, cytopenia and increased rate of thrombotic events. Microvesicles (MVs) include exosomes (30-100 nm) and microparticles (0.1-1 micron) shed from various cells and expressing antigens reflecting their cellular origin. MVs are involved in thrombosis, inflammation and cancer.However, the effect of MM-MVs on disease progression and their mechanism of action are unclear. We assume that MVs play a role in the interaction between malignant plasma cells and mesenchymal and endothelial cells (EC). AIM To characterize MM-MVs and investigate their effects on microenvironment cells. MATERIALS AND METHODS MVs were isolated from MM cell line RPMI 8226 untreated or treated with bortezomib and from peripheral blood (PB) and bone marrow (BM) of MM patients (n=13) and healthy controls (n=14). MM-MV size, concentration and cell origin were measured by Nanosite and FACS. Protein content was evaluated by protein arrays and ELISA. Coagulation and proteasome activity were assessed using chromogenic assays. Migratory capacity (migration assay), proliferative rate (XTT assay) and cell-signaling effects (Western blot analysis) of MVs on BM-mesenchymal and ECs were analyzed. RESULTS MM cells exhibited high MV shedding rate, which further increased with the exposure to bortezomib. Significant elevation in MV production was found in MM patients compared to controls. MM-MVs expressed membrane MM markers (syndecan-1/ CD138, CD38), coagulation factor (TF, TFPI, EPCR, TM) and angiogenic factors (VEGFR1, VEGFR2, and CD31). MM-MVs contained high levels of growth factors (Angiogenin, PDGF-BB and VEGF) and displayed procoagulant and proteasome activity. MM-MVs penetrated cells and affected their function. MVs of untreated cells and patient MVs increased EC and mesenchymal cell migration and EC proliferation, while MVs obtained from bortezomib-treated cells decreased these effects. MVs of untreated cells increased ERK1/2 and c-Jun phosphorylation in ECs (by 6.15 and 1.84 fold) but did not affect MAPKAPK-2. MVs of bortezomib-treated cells reduced c-Jun phosphorylation in ECs. CONCLUSIONS MM cells are characterized by high shedding rate of MVs. They are pro-coagulants and increase EC thrombogenicity, suggesting their involvement in MM-related thrombosis. MVs contain high levels of angiogenic factors that affect mesenchymal and EC, induce cell migration and proliferation via specific signal transductions. MVs exposed to bortezomib display lower levels of angiogenic factors, which limits proliferation and migration of MVs, reflecting the efficacy of therapy and MM dynamics.
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Affiliation(s)
- M Zarfati
- Bruce Rappaport Faculty of Medicine, Technion
| | - T Katz
- Bruce Rappaport Faculty of Medicine, Technion; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care; Haifa, Israel
| | - I Avivi
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care; Haifa, Israel
| | - B Brenner
- Bruce Rappaport Faculty of Medicine, Technion; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care; Haifa, Israel
| | - A Aharon
- Bruce Rappaport Faculty of Medicine, Technion; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care; Haifa, Israel
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Ooi CY, Jeyaruban C, Lau J, Katz T, Matson A, Bell SC, Adams SE, Krishnan U. High ambient temperature and risk of intestinal obstruction in cystic fibrosis. J Paediatr Child Health 2016; 52:430-5. [PMID: 27145507 DOI: 10.1111/jpc.13096] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/04/2015] [Accepted: 10/05/2015] [Indexed: 12/31/2022]
Abstract
AIMS Distal intestinal obstruction syndrome (DIOS) and constipation in cystic fibrosis (CF) are conditions associated with impaction and/or obstruction by abnormally viscid mucofaecal material within the intestinal lumen. Dehydration has been proposed as a risk factor for DIOS and constipation in CF. The study primarily aimed to determine whether warmer ambient temperature and lower rainfall are risk factors for DIOS and constipation in CF. METHODS Hospitalisations for DIOS (incomplete or complete) and/or constipation were retrospectively identified (2000-2012). Genotype, phenotype, temperatures and rainfall data (for the week preceding and season of hospitalisation) were collected. RESULTS Twenty-seven DIOS (59.3% incomplete; 40.7% complete) and 44 constipation admissions were identified. All admitted patients were pancreatic insufficient. Meconium ileus was significantly more likely in DIOS than constipation (64.7% vs. 33.3%; P = 0.038) and in complete than incomplete DIOS (100% vs. 57.1%; P = 0.04). The maximum temperature of the week before DIOS admission (mean (standard deviation) = 28.0 (5.8) °C) was significantly higher than the maximum temperature of the season of admission (25.2 (3.4) °C; P = 0.002). Similarly, the maximum temperature of the week before hospitalisation for constipation (mean (standard deviation) = 27.9 (6.3) °C) was significantly warmer compared with the season of admission (24.0 (4.1) °C; P < 0.0001). There were no significant differences between levels of rainfall during the week before hospitalisation and the season of admission for both DIOS and constipation. CONCLUSIONS Relatively high ambient temperature may play a role in the pathogenesis of DIOS and constipation in CF.
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Affiliation(s)
- Chee Y Ooi
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Gastroenterology, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Christina Jeyaruban
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine Lau
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Tamarah Katz
- Department of Nutrition and Dietetics, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Angela Matson
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Nutrition and Dietetics, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Scott C Bell
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Queensland Children's Medical Research Institute, Brisbane, Queensland, Australia
| | - Susan E Adams
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Paediatric Surgery, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Usha Krishnan
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Gastroenterology, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
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Smith RC, Smith SF, Wilson J, Pearce C, Wray N, Vo R, Chen J, Ooi CY, Oliver M, Katz T, Turner R, Nikfarjam M, Rayner C, Horowitz M, Holtmann G, Talley N, Windsor J, Pirola R, Neale R. Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency. Pancreatology 2016; 16:164-80. [PMID: 26775768 DOI: 10.1016/j.pan.2015.12.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/01/2015] [Accepted: 12/10/2015] [Indexed: 02/06/2023]
Abstract
AIM Because of increasing awareness of variations in the use of pancreatic exocrine replacement therapy, the Australasian Pancreatic Club decided it was timely to re-review the literature and create new Australasian guidelines for the management of pancreatic exocrine insufficiency (PEI). METHODS A working party of expert clinicians was convened and initially determined that by dividing the types of presentation into three categories for the likelihood of PEI (definite, possible and unlikely) they were able to consider the difficulties of diagnosing PEI and relate these to the value of treatment for each diagnostic category. RESULTS AND CONCLUSIONS Recent studies confirm that patients with chronic pancreatitis receive similar benefit from pancreatic exocrine replacement therapy (PERT) to that established in children with cystic fibrosis. Severe acute pancreatitis is frequently followed by PEI and PERT should be considered for these patients because of their nutritional requirements. Evidence is also becoming stronger for the benefits of PERT in patients with unresectable pancreatic cancer. However there is as yet no clear guide to help identify those patients in the 'unlikely' PEI group who would benefit from PERT. For example, patients with coeliac disease, diabetes mellitus, irritable bowel syndrome and weight loss in the elderly may occasionally be given a trial of PERT, but determining its effectiveness will be difficult. The starting dose of PERT should be from 25,000-40,000 IU lipase taken with food. This may need to be titrated up and there may be a need for proton pump inhibitors in some patients to improve efficacy.
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Affiliation(s)
| | - Ross C Smith
- Department of Surgery, University of Sydney, NSW, Australia; Australasian Pancreatic Club, Australia.
| | | | | | - Callum Pearce
- Institute for Immunology and Infectious Diseases, Murdoch University, WA, Australia; Fremantle Hospital, WA, Australia
| | - Nick Wray
- Nutrition & Dietetics, School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ruth Vo
- Liverpool Hospital, University of NSW, Australia
| | - John Chen
- South Australian Liver Transplant & HPB Unit, RAH & Flinders Medical Centre, SA, Australia
| | - Chee Y Ooi
- School of Women's and Children's Health, Dept. of Medicine, University of NSW, Australia; Department of Gastroenterology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Mark Oliver
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, VIC, Australia
| | - Tamarah Katz
- Sydney Children's Hospital, Randwick, NSW, Australia
| | - Richard Turner
- Hobart Clinical School and Dept. Surgery, University of Tasmania, Australia
| | - Mehrdad Nikfarjam
- Dept. Surgery, University of Melbourne, VIC, Australia; Australasian Pancreatic Club, Australia
| | - Christopher Rayner
- School of Medicine, University of Adelaide, SA, Australia; Centre for Digestive Diseases, Royal Adelaide Hospital, SA, Australia
| | - Michael Horowitz
- Endocrine and Metabolic Unit, University of Adelaide and Royal Adelaide Hospital, SA, Australia
| | - Gerald Holtmann
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia; Translational Research Institute, Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Qld, Australia
| | - Nick Talley
- Faculty of Health and Medicine, University of Newcastle, NSW, Australia; Royal Australasian College of Physicians, Australia
| | - John Windsor
- Dept. of Surgery, University of Auckland, New Zealand
| | - Ron Pirola
- Faculty of Medicine, SW Sydney Clinical School, University of NSW, Australia
| | - Rachel Neale
- Cancer Control Laboratory, Queensland Institute of Medical Research, Qld, Australia
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Ooi CY, Pang T, Leach ST, Katz T, Day AS, Jaffe A. Fecal Human β-Defensin 2 in Children with Cystic Fibrosis: Is There a Diminished Intestinal Innate Immune Response? Dig Dis Sci 2015; 60:2946-52. [PMID: 26271615 DOI: 10.1007/s10620-015-3842-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 08/02/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Defects in bacterial host defenses in the cystic fibrosis (CF) airways have been extensively investigated, but the role of the intestinal innate immune system in CF is unknown. Human β-defensin 2 (HBD-2) is an antimicrobial protein produced by epithelial surfaces and upregulated by inflammation. Its expression in the CF intestine is unknown. AIM To determine whether HBD-2 was present in the feces of patients with CF, and to compare fecal HBD-2 levels between CF and healthy controls (HC). To compare fecal HBD-2 levels in inflamed and noninflamed states, as measured by fecal calprotectin, as a secondary aim. METHODS Feces from children with CF and HC were collected for analysis. RESULTS Thirty-three CF patients and 33 HC were recruited. All CF patients had detectable fecal HBD-2. There was no difference between fecal HBD-2 in CF and HC (median (IQR) 49.1 (19.7-77.2) versus 43.4 (26.5-71.9) ng/g; P = 0.7). Fecal calprotectin was significantly higher in the CF cohort than in HC (median (IQR) 61.3 (43.8-143.8) versus 19.5 (19.5-35.1) mg/kg; P < 0.0001). There was no difference in fecal HBD-2 levels between CF subjects with fecal calprotectin ≥50 mg/kg and <50 mg/kg (50.5 (19.6-80.2) versus 43.0 (19.0-70.4); P = 0.7). There was no correlation between fecal HBD-2 and calprotectin in CF (r = 0.14; P = 0.4). CONCLUSION Fecal HBD-2 levels were not increased in children with CF, in inflamed or noninflamed states. The lack of HBD-2 induction and upregulation under inflammatory conditions may suggest a diminished intestinal innate immune response in CF.
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Affiliation(s)
- Chee Y Ooi
- Discipline of Paediatrics, School of Women's and Children's Health, Medicine, Sydney Children's Hospital, University of New South Wales, High Street, Randwick, Sydney, NSW, 2031, Australia. .,Department of Paediatric Gastroenterology, Sydney Children's Hospital, High Street, Randwick, Sydney, NSW, 2031, Australia.
| | - Tamara Pang
- Discipline of Paediatrics, School of Women's and Children's Health, Medicine, Sydney Children's Hospital, University of New South Wales, High Street, Randwick, Sydney, NSW, 2031, Australia.
| | - Steven T Leach
- Discipline of Paediatrics, School of Women's and Children's Health, Medicine, Sydney Children's Hospital, University of New South Wales, High Street, Randwick, Sydney, NSW, 2031, Australia.
| | - Tamarah Katz
- Department of Nutrition and Dietetics, Sydney Children's Hospital, High Street, Randwick, Sydney, NSW, 2031, Australia.
| | - Andrew S Day
- Department of Paediatrics, Christchurch Hospital, University of Otago, Christchurch, 4710, New Zealand.
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, Medicine, Sydney Children's Hospital, University of New South Wales, High Street, Randwick, Sydney, NSW, 2031, Australia. .,Department of Paediatric Respiratory, Sydney Children's Hospital, High Street, Randwick, Sydney, NSW, 2031, Australia.
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Pang T, Leach ST, Katz T, Jaffe A, Day AS, Ooi CY. Elevated fecal M2-pyruvate kinase in children with cystic fibrosis: a clue to the increased risk of intestinal malignancy in adulthood? J Gastroenterol Hepatol 2015; 30:866-71. [PMID: 25376228 DOI: 10.1111/jgh.12842] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 10/28/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Adult patients with cystic fibrosis (CF) have an increased risk of gastrointestinal malignancies. We hypothesized that increased intestinal cell turnover beginning in childhood may explain the increased risk of malignancy in early adulthood. Therefore, we aimed to measure fecal M2-pyruvate kinase (M2-PK), a biomarker of intestinal cell turnover, in children with CF. To assess whether the increased cell turnover is secondary to intestinal inflammation, the secondary aims were to measure fecal calprotectin and evaluate its association with fecal M2-PK. METHODS Fecal samples, for M2-PK and calprotectin measurements, were prospectively collected from children with CF and healthy controls (HC). RESULTS Thirty-three children with CF (mean [standard deviation] 7.3 [3.8] years old; 29 pancreatic insufficient [PI]) were enrolled and compared with 33 age-matched HC. Fecal M2-PK in CF patients (median [interquartile range, IQR]: 4.7 [1.5-9.7]) was greater than HC (1.0 [1.0-1.0] U/mL; P < 0.0001), and higher in PI (median [IQR]: 5.1 [1.8-13.7]) than pancreatic sufficient patients (1.0 [1.0-1.0] U/mL; P = 0.002). Fecal calprotectin was significantly elevated in CF than HC (median [IQR] 61.3 [43.8-143.8] vs 19.5 [19.5-35.1] mg/kg; P < 0.0001). However, there was no correlation between fecal M2-PK and fecal calprotectin levels among subjects with CF (r = 0.29; P = 0.1). CONCLUSION Increased intestinal cell turnover is present in children with PI CF. The lack of relationship between fecal M2-PK and calprotectin suggests that contributing factor(s) other than inflammation may be present.
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Affiliation(s)
- Tamara Pang
- Discipline of Paediatrics, School of Women's and Children's Health, Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Linke SJ, Ren L, Frings A, Steinberg J, Wöllmer W, Katz T, Reimer R, Hansen NO, Jowett N, Richard G, Dwayne Miller RJ. [Perspectives of laser-assisted keratoplasty: current overview and first preliminary results with the picosecond infrared laser (λ = 3 µm)]. Ophthalmologe 2015; 111:523-30. [PMID: 24942118 DOI: 10.1007/s00347-013-2995-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND This article provides a review of the current state of laser-assisted keratoplasty and describes a first proof of concept study to test the feasibility of a new mid-infrared (MIR) picosecond laser to perform applanation-free corneal trephination. METHODS The procedure is based on a specially adapted laser system (PIRL-HP2-1064 OPA-3000, Attodyne, Canada) which works with a wavelength of 3,000 ± 90 nm, a pulse duration of 300 ps and a repetition rate of 1 kHz. The picosecond infrared laser (PIRL) beam is delivered to the sample by a custom-made optics system with an implemented scanning mechanism. Corneal specimens were mounted on an artificial anterior chamber and subsequent trephination was performed with the PIRL under stable intraocular pressure conditions. RESULTS A defined corneal ablation pattern, e.g. circular, linear, rectangular or disc-shaped, can be selected and its specific dimensions are defined by the user. Circular and linear ablation patterns were employed for the incisions in this study. Linear and circular penetrating PIRL incisions were examined by macroscopic inspection, histology, confocal microscopy and environmental scanning electron microscopy (ESEM) for characterization of the incisional quality. Using PIRL reproducible and stable incisions could be made in human and porcine corneal samples with minimal damage to the surrounding tissue. CONCLUSION The PIRL laser radiation in the mid-infrared spectrum with a wavelength of 3 µm is exactly tuned to one of the dominant vibrational excitation bands of the water molecule, serves as an effective tool for applanation-free corneal incision and might broaden the armamentarium of corneal transplant surgery.
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Affiliation(s)
- S J Linke
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland,
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Rana M, Wong-See D, Katz T, Gaskin K, Whitehead B, Jaffe A, Coakley J, Lochhead A. Fat-soluble vitamin deficiency in children and adolescents with cystic fibrosis. J Clin Pathol 2014; 67:605-8. [PMID: 24711511 DOI: 10.1136/jclinpath-2013-201787] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS Determine the prevalence of fat-soluble vitamin deficiency in children with cystic fibrosis (CF) aged ≤18 years in New South Wales (NSW), Australia, from 2007 to 2010. METHODS A retrospective analysis of fat-soluble vitamin levels in children aged ≤18 years who lived in NSW and attended any of the three paediatric CF centres from 2007 to 2010. An audit of demographic and clinical data during the first vitamin level measurement of the study period was performed. RESULTS Deficiency of one or more fat-soluble vitamins was present in 240/530 children (45%) on their first vitamin level test in the study period. The prevalence of vitamins D and E deficiency fell from 22.11% in 2007 to 15.54% in 2010, and 20.22% to 13.89%, respectively. The prevalence of vitamin A deficiency increased from 11.17% to 13.13%. Low vitamin K was present in 29% in 2007, and prevalence of prolonged prothrombin time increased from 19.21% to 22.62%. Fat-soluble vitamin deficiency is present in 10%-35% of children with pancreatic insufficiency, but only a very small proportion of children who are pancreatic-sufficient. CONCLUSIONS This is one of few studies of fat-soluble vitamin deficiency in children with CF in Australia. Fat-soluble vitamin testing is essential to identify deficiency in pancreatic-insufficient children who may be non-compliant to supplementation or require a higher supplement dose, and pancreatic-sufficient children who may be progressing to insufficiency. Testing of vitamin K-dependent factors needs consideration. Further studies are needed to monitor rates of vitamin deficiency in the CF community.
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Affiliation(s)
- Malay Rana
- Southern IML Pathology, Wollongong, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Denise Wong-See
- Department of Nutrition and Dietetics, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Tamarah Katz
- Department of Nutrition and Dietetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Kevin Gaskin
- Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Bruce Whitehead
- Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Adam Jaffe
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - John Coakley
- Department of Clinical Biochemistry, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Abstract
The identification of various fecal biomarkers has provided insight into the intestinal milieu. Most of these markers are associated with the innate immune system of the gut, apart from the more novel M2-pyruvate kinase. The innate immunity of the gut plays a role in maintaining a fine balance between tolerance to commensal bacteria and immune response to potential pathogens. It is a complex system, which comprises of multiple elements, including antimicrobial peptides (e.g., defensins, cathelicidins, lactoferrin, and osteoprotegerin), inflammatory proteins (e.g., calprotectin and S100A12), and microbial products (e.g., short-chain fatty acids). Dysfunction of any component can lead to the development of intestinal disease, and different diseases have been associated with different fecal levels of these biomarkers. Each fecal biomarker provides information on specific biological and disease processes. Therefore, stool quantification of these biomarkers provides a non-invasive method to define potential pathways behind the pathogenesis of diseases and can assist in the assessment and diagnosis of various gastrointestinal conditions. The abovementioned fecal biomarkers and their role in intestinal health and disease will be reviewed in this paper with a pediatric focus.
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Affiliation(s)
- Tamara Pang
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales , Sydney, NSW , Australia
| | - Steven T Leach
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales , Sydney, NSW , Australia ; Department of Gastroenterology, Sydney Children's Hospital Randwick , Sydney, NSW , Australia
| | - Tamarah Katz
- Department of Nutrition and Dietetics, Sydney Children's Hospital , Sydney, NSW , Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago , Christchurch , New Zealand
| | - Chee Y Ooi
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales , Sydney, NSW , Australia ; Department of Gastroenterology, Sydney Children's Hospital Randwick , Sydney, NSW , Australia
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Katz T, Wasiak J, Cleland H, Padiglione A. Incidence of non-candidal fungal infections in severe burn injury: an Australian perspective. Burns 2013; 40:881-6. [PMID: 24380706 DOI: 10.1016/j.burns.2013.11.025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/25/2013] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Infection remains the primary cause of morbidity and mortality in the burns patient population. While candidal infection in burns patients is well described, there is dearth of information regarding non-candidal fungal infections in this setting. METHOD All adult burns patients who developed non-candidal fungal infections over a period of 10 years (between January 2001 and June 2011) were included. Retrospective data analyzed included patient demographics, organisms cultured, antibiotic susceptibility patterns, treatment, length of stay and overall mortality. RESULTS The incidence of non-candidal fungal infections at our centre over the time period studied was 0.04%. A total of 12 patients had a fungus other than Candida isolated. Of these 12 patients, seven were thought to have clinically significant fungal infections and were treated with targeted anti-fungal therapy. Between them, seven species of fungus were isolated: Aspergillus fumigatus (n=7), Scedosporium prolificans (n=2), Fusarium solani (n=2), Mucor spp. (n=2), Absydia corymbifera (n=1), Penicillium (n=1) and Alternaria spp. (n=1). Of those definitively treated, two died, although fungal infection was not believed to be a contributing factor to these deaths. CONCLUSION We demonstrate a low incidence and attributable mortality of non-candidal fungal infections in the setting of early antifungal therapy and extensive surgical debridement at our state-wide Burns Service.
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Affiliation(s)
- T Katz
- Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
| | - J Wasiak
- Victorian Adult Burns Service and School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
| | - H Cleland
- Victorian Adult Burns Service and Department of Surgery, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
| | - A Padiglione
- Department of Infectious Diseases, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
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Middleton PG, Wagenaar M, Matson AG, Craig ME, Holmes-Walker DJ, Katz T, Hameed S. Australian standards of care for cystic fibrosis-related diabetes. Respirology 2013; 19:185-192. [DOI: 10.1111/resp.12227] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/08/2013] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Maria E. Craig
- Sydney Children's Hospital Network (Westmead); Sydney New South Wales Australia
| | | | - Tamarah Katz
- Sydney Children's Hospital Network; Sydney New South Wales Australia
| | - Shihab Hameed
- Sydney Children's Hospital Network; Sydney New South Wales Australia
- School of Women's and Children's Health; Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
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Steinberg J, Kohl C, Katz T, Richard G, Linke SJ. [Difference and distance between the central and thinnest points of the cornea: impact of refractive state, age and ocular side]. Ophthalmologe 2013; 111:339-47. [PMID: 23921813 DOI: 10.1007/s00347-013-2892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the study was to quantify the difference in corneal thickness between the central and thinnest points (∆PachyZ-PachyD), the distance between the center of the cornea and its thinnest point (vector length PachyD) and to explore the impact of refractive state, age and ocular side. PATIENTS AND METHODS This was a multicenter, retrospective, cross-sectional study and medical records of 16,872 eyes were reviewed. The Orbscan® (Bausch and Lomb) procedure was used for pachymetry and keratometry. RESULTS The results showed that ∆PachyZ-PachyD and vector length PachyD were higher in hyperopic eyes (∆PachyZ-PachyD: 11.99 ± 12.08 µm, vector length PachyD: 0.85 ± 0.44 mm) compared to myopic eyes (∆PachyZ-PachyD: 9.2 ± 7.86 µm, vector length PachyD: 0.7 ± 0.37 mm; p < 0.001). Refractive state, age and ocular side demonstrated an independent, statistically significant impact on ∆PachyZ-PachyD and vector length PachyD. CONCLUSIONS As a result of the significant impact of refractive state, age and ocular side on ∆PachyZ-PachyD and vector length PachyD, these variables should be considered in a normative data collection.
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Affiliation(s)
- J Steinberg
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland,
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Linke SJ, Steinberg J, Katz T. [Therapeutic excimer laser treatment of the cornea]. Klin Monbl Augenheilkd 2013; 230:595-603. [PMID: 23794429 DOI: 10.1055/s-0032-1328507] [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: 10/26/2022]
Abstract
Concomitant with new innovations in the field of refractive surgery, therapeutic excimer laser applications like phototherapeutic keratectomy (PTK) and topography-guided customised ablation treatment are gaining high importance and undergoing rapid evolution. Nowadays, PTK is an effective treatment modality for superficial corneal pathologies. Primary indications are decreased epithelial adherence, superficial opacifications and an irregular corneal surface. For the right indication and successful treatment of corneal pathologies with PTK, a knowledge of the size, depth and nature of the pathology, as well as the refractive status of both eyes is important. Next to slit-lamp examination, objective measuring systems like the topography, confocal microscopy and the anterior segment OCT facilitate presurgical planning. Regarding the treatment procedure the surgeon can choose between a variety of methods. PTK can be combined with manual epithelial debridement or done by only using the excimer laser. In the case of an irregular corneal surface, depending on the pathology, masking fluids or topography-guided custom ablation protocols can increase the visual outcome. To avoid recurrence of the underlying pathology (e.g., corneal dystrophy, haze), the topical application of 0.02% mitomycin C for 20-60 seconds has proved to be a safe and effective procedure. If the surgeon considers all the patient-related factors carefully and manages to combine the available treatment options correctly, PTK embodies an effective and minimally invasive alternative to lamellar or penetrating keratoplasty.
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Affiliation(s)
- S J Linke
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg.
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Shepherd D, Belessis Y, Katz T, Morton J, Field P, Jaffe A. Single high-dose oral vitamin D3 (stoss) therapy — A solution to vitamin D deficiency in children with cystic fibrosis? J Cyst Fibros 2013; 12:177-82. [DOI: 10.1016/j.jcf.2012.08.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/05/2012] [Accepted: 08/14/2012] [Indexed: 11/15/2022]
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Ooi C, Lee J, Leach S, Katz T, Day A, Jaffe A. 226 Intestinal inflammation in CF: stool markers and correlation with pancreatic enzymes. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hameed S, Morton JR, Field PI, Belessis Y, Yoong T, Katz T, Woodhead HJ, Walker JL, Neville KA, Campbell TA, Jaffé A, Verge CF. Once daily insulin detemir in cystic fibrosis with insulin deficiency. Arch Dis Child 2012; 97:464-7. [PMID: 21493664 DOI: 10.1136/adc.2010.204636] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [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: 11/04/2022]
Abstract
The aim of this study was to determine if once daily insulin detemir reverses decline in weight and lung function in patients with cystic fibrosis (CF). 12 patients with early insulin deficiency and six with CF related diabetes (aged 7.2-18.1 years) were treated for a median of 0.8 years. Changes in weight and lung function following treatment were compared to pretreatment changes. Before treatment, the change in weight SD score (ΔWtSDS), percentage of predicted forced expiratory volume in 1 s (Δ%FEV(1)) and percentage of predicted forced vital capacity (Δ%FVC) declined in the whole study population (-0.45±0.38, -7.9±12.8%, -5.8±14.3%) and in the subgroup with early insulin deficiency (-0.41±0.43, -9.8±9.3%, -6.8±10.3%). Following treatment with insulin ΔWtSDS, Δ%FEV(1) and Δ%FVC significantly improved in the whole study population (+0.18±0.29 SDS, p=0.0001; +3.7±10.6%, p=0.007; +5.2±12.7%, p=0.013) and in patients with early insulin deficiency (+0.22±0.31 SDS, p=0.003; +5.3±11.5%, p=0.004; +5.8±13.4%, p=0.024). Randomised controlled trials are now needed.
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Affiliation(s)
- Shihab Hameed
- Department of Endocrinology, Sydney Children’s Hospital, Randwick, New South Wales, Australia.
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Rosenblatt J, Stone R, Avivi I, Uhl L, Neuberg D, Joyce R, Tzachanis D, Levine J, Boussiotis V, Zwicker J, Arnason J, Luptakova K, Steesma D, DeAngelo D, Galinsky I, Vasir B, Somaiya P, Mills H, Yuan E, Bonhoff J, Delaney C, Drummy N, Nicholson L, Stroopinsky D, Held V, Katz T, Rowe J, Kufe D, Avigan D. Clinical Trial Evaluating DC/AML Fusion Cell Vaccination Alone and in Conjunction with PD-1 Blockade in AML Patients Who Achieve a Chemotherapy-Induced Remission. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.504] [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: 11/16/2022]
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Higgins J, Hodges N, Olliff C, Katz T, Phillips A. The Use of Electrical Conductivity to Assess the Potential Activity of Cryoprotectives. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1985.tb14193.x] [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: 11/29/2022]
Affiliation(s)
- J Higgins
- Pharmacy Department, Brighton Polytechnic BN2 4GJ
| | - N Hodges
- Pharmacy Department, Brighton Polytechnic BN2 4GJ
| | - C Olliff
- Pharmacy Department, Brighton Polytechnic BN2 4GJ
| | - T Katz
- Pharmacy Department, Brighton Polytechnic BN2 4GJ
| | - A Phillips
- Merck Sharp & Dohme, Hoddesdon, Herts. EN11 9BU
- Pharmacy Department, Brighton Polytechnic BN2 4GJ
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Abstract
LASIK has become the preferred surgical procedure for the correction of refractive errors. Microbial keratitis is a rare but severe complication. The incidence of post-LASIK keratitis, (uni- and bilateral) is difficult to estimate. The risk of bilateral infection could until now only be approximated by calculating it from the risk of unilateral infection. Due to the fortunately low incidence of post-LASIK keratitis, large-scale studies are necessary to obtain valid statistical data. The American Society of Cataract and Refractive surgery (ASCRS) developed a post-LASIK infectious keratitis survey in 2001. 116 post-LASIK infections were reported by the members of the society. The calculated incidence was 0.035 % or 1 infection in every 2919 procedures. Llovet et al. found 9 patients (18 eyes) with bilateral post-LASIK keratitis out of 204 586 procedures (incidence 0.0084 %). Gram-positive bacteria and atypical mycobacteria are the most common causes for microbial post-LASIK keratitis. There is an increasing literature of post-LASIK case reports caused by rare or atypical species. Severe cases of keratitis are more often correlated with a prolonged onset of infection and caused by atypical species. An overview of the current literature and our own data regarding post-LASIK keratitis (uni-, and bilateral) are presented.
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Affiliation(s)
- S J Linke
- Universitätsklinikum Eppendorf, Klinik und Poliklinik für Augenheilkunde, Martinistrasse 52, Hamburg.
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Abstract
OBJECTIVE Progressive beta-cell loss causes catabolism in cystic fibrosis. Existing diagnostic criteria for diabetes were based on microvascular complications rather than on cystic fibrosis-specific outcomes. We aimed to relate glycemic status in cystic fibrosis to weight and lung function changes. RESEARCH DESIGN AND METHODS We determined peak blood glucose (BG(max)) during oral glucose tolerance tests (OGTTs) with samples every 30 min for 33 consecutive children (aged 10.2-18 years). Twenty-five also agreed to undergo continuous glucose monitoring (CGM) (Medtronic). Outcome measures were change in weight standard deviation score (wtSDS), percent forced expiratory volume in 1 s (%FEV1), and percent forced vital capacity (%FVC) in the year preceding the OGTT. RESULTS Declining wtSDS and %FVC were associated with higher BG(max) (both P = 0.02) and with CGM time >7.8 mmol/l (P = 0.006 and P = 0.02, respectively) but not with BG(120 min). A decline in %FEV1 was related to CGM time >7.8 mmol/l (P = 0.02). Using receiver operating characteristic (ROC) analysis to determine optimal glycemic cutoffs, CGM time above 7.8 mmol/l > or =4.5% detected declining wtSDS with 89% sensitivity and 86% specificity (area under the ROC curve 0.89, P = 0.003). BG(max) > or =8.2 mmol/l gave 87% sensitivity and 70% specificity (0.76, P = 0.02). BG(120 min) did not detect declining wtSDS (0.59, P = 0.41). After exclusion of two patients with BG(120 min) > or =11.1 mmol/l, the decline in wtSDS was worse if BG(max) was > or =8.2 mmol/l (-0.3 +/- 0.4 vs. 0.0 +/- 0.4 for BG(max) <8.2 mmol/l, P = 0.04) or if CGM time above 7.8 mmol/l was > or =4.5% (-0.3 +/- 0.4 vs. 0.1 +/- 0.2 for time <4.5%, P = 0.01). CONCLUSIONS BG(max) > or =8.2 mmol/l on an OGTT and CGM time above 7.8 mmol/l > or =4.5% are associated with declining wtSDS and lung function in the preceding 12 months.
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Affiliation(s)
- Shihab Hameed
- Endocrinology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia.
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Rosenblatt J, Avivi I, Vasir B, Katz T, Uhl L, Wu Z, Somaiya P, Mills H, Joyce R, Levine J, Tzachanis D, Boussiotis V, Glotzbecker B, Francoeur K, Dombagoda D, Tsumer M, Bisharat L, Giallombardo N, Conway K, Fitzgerald D, Barhad R, Richardson P, Anderson K, Munshi N, Rowe J, Kufe D, Avigan D. Dendritic Cell Tumor Fusion Vaccination In Conjunction With Autologous Transplantation For Multiple Myeloma. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.087] [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: 11/30/2022]
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Higano C, Alumkal J, Ryan CJ, Yu EY, Beer TM, Chandrawansa K, Katz T, Youssoufian H, Schwartz J. A phase II study evaluating the efficacy and safety of single agent IMC A12, a monoclonal antibody (MAb), against the insulin-like growth factor-1 receptor (IGF-IR), as monotherapy in patients with metastastic, asymptomatic castration-resistant prostate cancer (CRPC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5142] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5142 Background: IGF-IR-mediated signaling contributes to prostate cancer carcinogenesis and pathogenesis and may be associated with hormone resistance. IMC-A12 is a fully human IgG1 MAb that specifically targets the IGF-IR and inhibits ligand binding and signaling. In xenografts, IMC-A12 inhibits growth of both androgen-dependent and -independent prostate cancer. This phase 2, multicenter study was designed to assess the safety and antitumor activity of IMC-A12 in asymptomatic pts with metastatic CRPC who were chemotherapy-naive. Methods: Pts received IMC-A12 10 mg/kg IV every 2 wks; until evidence of progressive disease (PD), intolerable toxicity, or other withdrawal criteria were met. Radiologic evaluation was performed every 8 wks. PD by bone scan required at least 2 new lesions with confirmation at subsequent imaging per PCWG2. Results: 19 of 31 pts treated have discontinued IMC-A12, 12 due to PD. 9 of 31 pts experienced disease stabilization for ≥6 mos (range: 7.4–12.5 mos), 5 pts (3 with PSA reduction) continue on IMC-A12. The most common AEs possibly or probably related to IMC-A12, were fatigue (25.8%) and hyperglycemia (19.4%). In 4 pts cases of Grade 3 hyperglycemia was treatment related none requiring discontinuation of IMC-A12; 1 pt required insulin but continued on study. Approximately 70% of pts experienced at least transient elevation of nonfasting glucose to above normal range. Other AEs grade ≥3 at least possibly related to IMC-A12 were one case each of thrombocytopenia (requiring IMC-A12 discontinuation), hyperkalemia, fatigue, pneumonia (resulting in death), and Grade 4 pharmacokinetic and pharmacodynamic analayses are pending leukoencephalopathy (probably related; requiring IMC-A12 discontinuation). Pharmakinetic and pharmacodynamic analyses are pending. Conclusions: IMC-A12 monotherapy appears well tolerated in pts with metastatic asymptomatic CRPC. As in phase I, hyperglycemia was largely asymptomatic and manageable. Disease stabilization for > 6 months in 9 of 31 pts suggests that IMC- A12 may have modest antitumor activity. Additional studies of IMC-A12 in CRPC are planned. [Table: see text]
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Affiliation(s)
- C. Higano
- University of Washington, Seattle, WA; Oregon Health and Science University, Portland, OR; University of California, San Francisco, San Franciscso, CA; ImClone Systems Incorporated, New York, NY
| | - J. Alumkal
- University of Washington, Seattle, WA; Oregon Health and Science University, Portland, OR; University of California, San Francisco, San Franciscso, CA; ImClone Systems Incorporated, New York, NY
| | - C. J. Ryan
- University of Washington, Seattle, WA; Oregon Health and Science University, Portland, OR; University of California, San Francisco, San Franciscso, CA; ImClone Systems Incorporated, New York, NY
| | - E. Y. Yu
- University of Washington, Seattle, WA; Oregon Health and Science University, Portland, OR; University of California, San Francisco, San Franciscso, CA; ImClone Systems Incorporated, New York, NY
| | - T. M. Beer
- University of Washington, Seattle, WA; Oregon Health and Science University, Portland, OR; University of California, San Francisco, San Franciscso, CA; ImClone Systems Incorporated, New York, NY
| | - K. Chandrawansa
- University of Washington, Seattle, WA; Oregon Health and Science University, Portland, OR; University of California, San Francisco, San Franciscso, CA; ImClone Systems Incorporated, New York, NY
| | - T. Katz
- University of Washington, Seattle, WA; Oregon Health and Science University, Portland, OR; University of California, San Francisco, San Franciscso, CA; ImClone Systems Incorporated, New York, NY
| | - H. Youssoufian
- University of Washington, Seattle, WA; Oregon Health and Science University, Portland, OR; University of California, San Francisco, San Franciscso, CA; ImClone Systems Incorporated, New York, NY
| | - J. Schwartz
- University of Washington, Seattle, WA; Oregon Health and Science University, Portland, OR; University of California, San Francisco, San Franciscso, CA; ImClone Systems Incorporated, New York, NY
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Avigan D, Rosenblatt J, Vasir B, Wu Z, Bissonnette A, Somaiya P, MacNamara C, Uhl L, Avivi I, Katz T, Zarwan C, Joyce R, Levine J, Lowe K, Dombagoda D, Tzachanis D, Boussiotis V, Giallombardo N, Mortellite J, Conway K, Fitzgerald D, Richardson P, Anderson K, Munshi N, Rowe J, Tsumer M, Bishart L, Kufe D. Fusion Cell Vaccination In Conjunction With Stem Cell Transplantation Is Well Tolerated, Induces Anti-Tumor Immunity and Is Associated With Responses In Patients With Multiple Myeloma. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.202] [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: 11/30/2022]
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Linke S, Haberland P, Richard G, Katz T. Sicherheit und Effektivität nach Implantation phaker Intraokularlinsen (Artisan). Klin Monbl Augenheilkd 2009. [DOI: 10.1055/s-0029-1213660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chiorean E, Sweeney C, Youssoufian H, Fox F, Katz T, Rowinsky E, Amato R. 511 POSTER Phase I study of IMC-3G3, an IgG1 monoclonal antibody targeting platelet-derived growth factor alpha (PDGFRa) in patients with advanced solid malignancies. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72445-5] [Citation(s) in RCA: 2] [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: 10/21/2022] Open
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Youssoufian H, Amato RJ, Sweeney CJ, Chiorean EG, Fox F, Katz T, Rowinsky EK. Phase 1 study of IMC-3G3, an IgG1 monoclonal antibody targeting PDGFRα in patients with advanced solid malignancies. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.14617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wierzbicki R, Jonker DJ, Moore MJ, Berry SR, Loehrer PJ, Fox F, Katz T, Rowinsky EK, Youssoufian H. A phase II multicenter study of cetuximab monotherapy in patients with EGFR-undetectable refractory metastatic colorectal carcinoma (mCRC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4065] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
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Zuckerman T, Haddad N, Katz T, Gidoni O, Faibish T, Rowe J. 328: Allogeneic Transplantation in Rapid Succession from Two Donors: Immunologic Lesson for Stem Cell Engraftment. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Katz T. Weight Matters for Children, a Complete Guide to Weight, Eating and Fitness. Nutr Diet 2007. [DOI: 10.1111/j.1747-0080.2007.00103.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Katz T, Richard G, Linke SJ. Subjektive Entwicklung der Schmerzsymptomatik und Funktion nach LASEK – bzw. PTK-PRK: eine intraindividuelle, prospektive und vergleichende Studie. Klin Monbl Augenheilkd 2007. [DOI: 10.1055/s-2007-976282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Higano C, Gordon M, LoRusso P, Fox F, Katz T, Roecker J, Rowinsky E, Youssoufian H. 648 POSTER A phase I dose-escalation study of weekly IMC-A12, a fully human insulin like growth factor-I receptor (IGF-IR) IgG1 monoclonal antibody (Mab), in patients (pts) with advanced cancer. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70653-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Camidge DR, Eckhardt SG, Diab S, Gore L, Chow L, O’Bryant C, Temmer E, Ervin-Haynes A, Katz T, Fox F, Cohen RB. A phase I dose-escalation study of weekly IMC-1121B, a fully human anti-vascular endothelial growth factor receptor 2 (VEGFR2) IgG1 monoclonal antibody (Mab), in patients (pts) with advanced cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3032 Background: Anti-VEGFR2 antibodies are effective in a variety of preclinical leukemia and solid tumor models. IMC-1121B is a fully human anti-VEGFR2 IgG1 Mab. Methods: Cohorts of 3–6 pts (ECOG PS ≤ 2) with advanced cancer and no significant cardiovascular, thrombotic or bleeding disorders received escalating doses of IMC-1121B. A single initial dose with extended PK sampling was followed by 4 x weekly infusions per treatment cycle starting at 2mg/kg. 7 dose levels up to a maximum of 16 mg/kg are planned. Human anti-human antibodies (HAHA) directed against IMC-1121B were assessed at baseline and before each Week 4 dose. Tumor response was assessed every 2 cycles. PD analyses include DCE-MRI, serum VEGF and sVEGFR1/2 levels, and peripheral blood mononucleocyte gene expression profiling at baseline and post-dosing. Results: 12 pts (8 M; 4 F), median age 58 years (range: 36–76), have entered the study: cohort 1 (2mg/kg) n=6, cohort 2 (4mg/kg) n=4 and cohort 3 (6mg/kg) n=2. No toxicities ≥ grade 2, considered definitely or probably related to study drug, have occurred. Toxicities ≥ grade 2 possibly drug-related include anorexia, vomiting, anemia, depression, fatigue, and insomnia. To date, there has been one unconfirmed partial response (melanoma) and 5 pts with stable disease for >3 months (colon: 2, breast, gastric, thyroid). Preliminary non-compartmental PK analysis reveals dose-dependent elimination and non-linear exposure, consistent with saturable clearance mechanism(s): mean t1/2 = 63.62, 93.46, 99.63 hrs, mean Cmax = 43.67, 80.25, 264 ug/mL, and AUC0-Inf = 3860, 9242, 27437 hr*ug/mL, at the 2, 4, and 6 mg/kg dose levels, respectively. Conclusions: Weekly administration of IMC-1121B is well tolerated at doses up to 6mg/kg/week. There is early evidence of a non-linear dose-PK relationship. Dose escalation continues. Updated safety, PK, PD, HAHA, and efficacy data will be presented. [Table: see text]
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Affiliation(s)
- D. R. Camidge
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
| | - S. G. Eckhardt
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
| | - S. Diab
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
| | - L. Gore
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
| | - L. Chow
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
| | - C. O’Bryant
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
| | - E. Temmer
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
| | - A. Ervin-Haynes
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
| | - T. Katz
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
| | - F. Fox
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
| | - R. B. Cohen
- University of Colorado Cancer Center, Denver, CO; Fox Chase Cancer Center, Philadelphia, PA; ImClone Systems Incorporated, Branchburg, NJ
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Webb K, Rutishauser I, Katz T, Knezevic N, Lahti-Koski M, Peat J, Mihrshahi S. Meat consumption among 18-month-old children participating in the Childhood Asthma Prevention Study. Nutr Diet 2005. [DOI: 10.1111/j.1747-0080.2005.tb00004.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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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Katz T, Fisher P, Katz A, Davidson J, Feder G. The feasibility of a randomised, placebo-controlled clinical trial of homeopathic treatment of depression in general practice. HOMEOPATHY 2005; 94:145-52. [PMID: 16060200 DOI: 10.1016/j.homp.2005.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Depression is common in general practice and lack of concordance is an important problem in its treatment. Homeopathy has few side effects and is generally associated with good compliance. We report a study investigating the feasibility of a trial to compare the effectiveness of homeopathy with a conventional antidepressant and placebo. OBJECTIVES To assess the feasibility of a general practice-based clinical trial comparing the effectiveness of individualised homeopathic treatment vs Fluoxetine (Prozac) vs placebo in the treatment of major depressive episodes of moderate severity. DESIGN Randomised, double-dummy, double-blind parallel group clinical trial. SETTING Lower Clapton Group Practice, East London. METHOD Patients were recruited through their general practitioners as they presented during a 9 month period. Recruitment target was 30 patients. Eligibility was confirmed by a consultant psychiatrist using standard criteria (DSM-IV) and instruments Hamilton Depression Scale (HAMD). Suicidal and psychotic patients were excluded, additional precautions against suicide were incorporated. There was a 1 week run-in period and patients showing spontaneous improvement were excluded. Homeopathic treatment was prescribed by a GP qualified in homeopathy, from a 'limited list' of 30 homeopathic medicines, with the help of decision support software. Patients were randomised to receive verum Fluoxetine and placebo homeopathy, or verum homeopathy and placebo Fluoxetine, or placebo homeopathy and placebo Fluoxetine. Treatment duration was 12 weeks. The outcomes were: adverse drug reactions, clinical global impression (CGI); HAMD; mini international psychiatric Interview; Pittsburgh sleep quality index; Side-effects checklist; Short Form 12; treatment credibility questionnaire; work and social disability scale. The primary outcome measures were HAMD and CGI. RESULTS A recruitment calculation indicated that over 230 suitable patients would be expected to attend the practice during the recruitment phase. Thirty one patients were referred for possible inclusion in the trial by their GPs. Twenty three met the entry criteria, 11 were randomised and 6 completed the study. Of the completers, one received homeopathy, 2 placebo and 3 Fluoxetine. CONCLUSIONS A trial of this design in general practice is not feasible, because of recruitment difficulties, many of them linked to patient preference. Different approaches are required to recruit adequate patient numbers to trials of this sort.
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Affiliation(s)
- T Katz
- Lower Clapton Group Practice.
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Hoffmann FW, Simmons TC, Beck RB, Holler HV, Katz T, Koshar RJ, Larsen ER, Mulvaney JE, Rogers FE, Singleton B, Sparks RS. Fluorocarbon Derivatives. I. Derivatives of Sulfur Hexafluoride. J Am Chem Soc 2002. [DOI: 10.1021/ja01570a029] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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