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Alexander EC, Greaves W, Vaidya HJ, Burford C, Jain V, Samyn M. Social and Educational Outcomes in Patients With Biliary Atresia: A Systematic Review. J Pediatr Gastroenterol Nutr 2022; 74:104-109. [PMID: 34560722 DOI: 10.1097/mpg.0000000000003306] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/02/2023]
Abstract
OBJECTIVES To systematically review the social outcomes of patients with biliary atresia (BA), including educational, employment and family outcomes. METHODS We conducted a systematic review of Medline, EMBASE, Global Health, Maternity and Infant Care Database, supplemented by reference searching. National Heart, Lung and Blood Institute scoring was conducted for quality assessment. The PROSPERO registration ID was CRD42020178846. RESULTS Fifty-one studies were included (41 cohort, 10 cross-sectional), including 4631 participants across 16 countries. Cohorts were BA post-liver transplant (LT) (18 studies), native liver survivors (NLS) (16 studies), mixed (13 studies) and four other cohorts. Outcomes covered; education (n = 35), employment (n = 16), family outcomes (n = 22), and social functioning (n = 22). BA patients had lower school functioning scores than controls, with no difference between NLS versus post-LT. Between 2% and 48% of children required additional educational support. Between 60% and 100% of adult patients with BA were employed. Pregnancies were described in 17 studies, with small samples, and some noted complications. Social functioning scores were similar to healthy controls in 8 of 11 comparisons. CONCLUSIONS Despite BA being the primary indication for liver transplantation in childhood, social outcomes for children and adolescents are predominantly reported in non-controlled, single-centre survey-based studies. School functioning is lower compared to peer groups, with no evidence of a difference for those having a liver transplant. We recommend routine psychosocial assessment of these patients during follow-up, alongside multi-centre collaborations, to maximise the quality of evidence for future patients.
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Affiliation(s)
- Emma C Alexander
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, Kings College Hospital
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London
| | - William Greaves
- University College London Medical School, University College London
- Northwick Park Hospital, London North West University Healthcare NHS Trust, London
| | - Hrisheekesh J Vaidya
- Northwick Park Hospital, London North West University Healthcare NHS Trust, London
| | - Charlotte Burford
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, Kings College Hospital
- William Harvey Hospital, East Kent University Hospitals NHS Foundation Trust, Ashford, UK
| | - Vandana Jain
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, Kings College Hospital
| | - Marianne Samyn
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, Kings College Hospital
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Greaves W. A response to Dr Lakhani's commentary - what do we mean by optimism? J R Soc Med 2020; 113:421. [PMID: 33167767 PMCID: PMC7686516 DOI: 10.1177/0141076820952394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Prevo R, Pirovano G, Puliyadi R, Herbert KJ, Rodriguez-Berriguete G, O’Docherty A, Greaves W, McKenna WG, Higgins GS. CDK1 inhibition sensitizes normal cells to DNA damage in a cell cycle dependent manner. Cell Cycle 2018; 17:1513-1523. [PMID: 30045664 PMCID: PMC6132956 DOI: 10.1080/15384101.2018.1491236] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/01/2018] [Accepted: 06/13/2018] [Indexed: 12/15/2022] Open
Abstract
Cyclin-dependent kinase 1 (CDK1) orchestrates the transition from the G2 phase into mitosis and as cancer cells often display enhanced CDK1 activity, it has been proposed as a tumor specific anti-cancer target. Here we show that the effects of CDK1 inhibition are not restricted to tumor cells but can also reduce viability in non-cancer cells and sensitize them to radiation in a cell cycle dependent manner. Radiosensitization by the specific CDK1 inhibitor, RO-3306, was determined by colony formation assays in three tumor lines (HeLa, T24, SQ20B) and three non-cancer lines (HFL1, MRC-5, RPE). Initial results showed that CDK1 inhibition radiosensitized tumor cells, but did not sensitize normal fibroblasts and epithelial cells in colony formation assays despite effective inhibition of CDK1 signaling. Further investigation showed that normal cells were less sensitive to CDK1 inhibition because they remained predominantly in G1 for a prolonged period when plated in colony formation assays. In contrast, inhibiting CDK1 a day after plating, when the cells were going through G2/M phase, reduced their clonogenic survival both with and without radiation. Our finding that inhibition of CDK1 can damage normal cells in a cell cycle dependent manner indicates that targeting CDK1 in cancer patients may lead to toxicity in normal proliferating cells. Furthermore, our finding that cell cycle progression becomes easily stalled in non-cancer cells under normal culture conditions has general implications for testing anti-cancer agents in these cells.
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Affiliation(s)
- Remko Prevo
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - Giacomo Pirovano
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - Rathi Puliyadi
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - Katharine J. Herbert
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - Gonzalo Rodriguez-Berriguete
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - Alice O’Docherty
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - William Greaves
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - W. Gillies McKenna
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - Geoff S. Higgins
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
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Elbasha E, Greaves W, Roth D, Nwankwo C. Cost-effectiveness of elbasvir/grazoprevir use in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and chronic kidney disease in the United States. J Viral Hepat 2017; 24:268-279. [PMID: 27966249 DOI: 10.1111/jvh.12639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/18/2016] [Indexed: 12/14/2022]
Abstract
Among patients with chronic kidney disease (CKD) in the United States, HCV infection causes significant morbidity and mortality and results in substantial healthcare costs. A once-daily oral regimen of elbasvir/grazoprevir (EBR/GZR) for 12 weeks was found to be a safe and efficacious treatment for HCV in patients with CKD. We evaluated the cost-effectiveness of EBR/GZR in treatment-naïve and treatment-experienced CKD patients compared with no treatment (NoTx) and pegylated interferon plus ribavirin (peg-IFN/RBV) using a computer-based model of the natural history of chronic HCV genotype 1 infection, CKD and liver disease. Data on baseline characteristics of the simulated patients were obtained from NHANES, 2000-2010. Model inputs were estimated from published studies. Cost of treatment with EBR/GZR and peg-INF/RBV were based on wholesale acquisition cost. All costs were from a third-party payer perspective and were expressed in 2015 U.S. dollars. We estimated lifetime incidence of liver-related complications, liver transplantation, kidney transplantation, end-stage live disease mortality and end-stage renal disease mortality; lifetime quality-adjusted life years (QALY); and incremental cost-utility ratios (ICUR). The model predicted that EBR/GZR will significantly reduce the incidence of liver-related complications and prolong life in patients with chronic HCV genotype 1 infection and CKD compared with NoTx or use of peg-IFN/RBV. EBR/GZR-based regimens resulted in higher average remaining QALYs and higher costs (11.5716, $191 242) compared with NoTx (8.9199, $156 236) or peg-INF/RBV (10.2857, $186 701). Peg-IFN/RBV is not cost-effective, and the ICUR of EBR/GZR compared with NoTx was $13 200/QALY. Treatment of a patient on haemodialysis with EBR/GZR resulted in a higher ICUR ($217 000/QALY). Assuming a threshold of $100 000 per QALY gained for cost-effectiveness, use of elbasvir/grazoprevir to treat an average patient with CKD can be considered cost-effective in the United States.
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Affiliation(s)
- E Elbasha
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - W Greaves
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - D Roth
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - C Nwankwo
- Merck & Co., Inc., Kenilworth, NJ, USA
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Pol S, Roth D, Greaves W. C-SURFER : grazoprevir plus elbasvir chez des patients infectés par le VHC de génotype 1 et une insuffisance rénale chronique naïfs de traitement et pré-traités. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.185] [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: 11/27/2022]
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Angel JB, Jacobson MA, Skolnik PR, Giordano M, Shapiro L, LeBeaut A, Greaves W, Fuchs AC. A multicenter, randomized, double-blind, placebo-controlled trial of recombinant human interleukin-10 in HIV-infected subjects. AIDS 2000; 14:2503-8. [PMID: 11101061 DOI: 10.1097/00002030-200011100-00012] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the effect of multiple subcutaneous doses of recombinant human interleukin (rhuIL)-10 on plasma HIV RNA levels and CD4 T-cell counts, and to evaluate its safety and tolerability in HIV-infected subjects. DESIGN Prospective, randomized, double-blind, placebo-controlled, multicenter trial. SUBJECTS Thirty-nine HIV-infected subjects with CD4 T-cell counts > 200 x 10(6)/l, plasma HIV RNA concentrations > or = 3.18 log10 copies/ml and on stable antiretroviral therapy were recruited from six centers. INTERVENTION Subjects received (subcutaneously) rhuIL-10 1 microg/kg daily, 4 microg/kg daily, 8 microg/kg three times per week, placebo daily or placebo three times per week for 4 weeks. MAIN OUTCOME MEASURES Prospectively defined outcomes included safety and tolerability, plasma HIV RNA levels and CD4 T-cell counts. Outcomes were assessed at baseline, weeks 1, 2, 3 and 4 during treatment and weeks 2 and 4 following completion of therapy. RESULTS Baseline characteristics were similar in all groups. Compared to baseline, no significant change in plasma HIV RNA concentrations or CD4 T-cell counts was observed in any of the groups. RhuIL-10 was generally well tolerated. Two patients receiving rhuIL-10 4 microg/kg required discontinuation due to thrombocytopenia. One patient receiving rhuIL-10 4 microg/kg who had chronic hepatitis B and C infections discontinued drug because of elevated liver function tests. One patient receiving placebo discontinued study drug because of depression. CONCLUSION The lack of a demonstrable virological benefit, as assessed by plasma viral load, with 4 weeks of rhuIL-10 does not support the development of this immune-based therapy for treatment of HIV infection.
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Affiliation(s)
- J B Angel
- The Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ontario, Canada
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Alston B, Ellenberg JH, Standiford HC, Muth K, Martinez A, Greaves W, Kumi J. A multicenter, randomized, controlled trial of three preparations of low-dose oral alpha-interferon in HIV-infected patients with CD4+ counts between 50 and 350 cells/mm(3). Division of AIDS Treatment Research Initiative (DATRI) 022 Study Group. J Acquir Immune Defic Syndr 1999; 22:348-57. [PMID: 10634196 DOI: 10.1097/00126334-199912010-00005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To evaluate the effectiveness of low-dose oral alpha-interferon (alpha-IFN), 247 HIV-infected study subjects received placebo, Alferon LDO, Veldona, or Ferimmune in a randomized, double-blind trial. Subjects had CD4+ counts between 50 and 350 cells/mm3 and HIV-related symptoms at entry. Study subjects rated the severity of eight symptoms using a symptom burden index (SBI). Study endpoints included changes in SBI, weight, CD4+ count, and Karnofsky score between baseline and the 24-week visit. The SBI outcome and weight were measured in 99 and 106 study subjects, respectively, at both the baseline and 24-week visits. Baseline SBI scores ranged from 5.4 to 7.9 in the four arms. No clinically important or statistically significant differences were found among the four arms with regard to SBI or weight change over the 24-week period. There were also no significant differences among the arms for CD4+ cell count and Karnofsky score. Few adverse reactions were noted in any arm, and there were no significant differences between arms. Although the trial was designed to enroll 560 study subjects and was prematurely terminated because of slow accrual and discontinuations of participants, the small differences among the arms in the primary and secondary endpoints do not support claims of efficacy for the measures studied.
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Affiliation(s)
- B Alston
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-7624, USA.
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McCunney RJ, Greaves W. Addressing the shortage of occupational physicians. J Occup Med 1990; 32:1247-8. [PMID: 2095772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Lowery RC, Greaves W. Acquired immune deficiency syndrome--to operate or not to operate? J Natl Med Assoc 1987; 79:807-8. [PMID: 3508214 PMCID: PMC2625579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Greaves W. AIDS: no time for apathy. J Natl Med Assoc 1986; 78:97-8. [PMID: 3005600 PMCID: PMC2571235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Rom WN, Moshell A, Greaves W, Bang KM, Holthouser M, Campbell D, Bernstein R. A study of dermatitis in trona miners and millers. J Occup Med 1983; 25:295-9. [PMID: 6854418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Trona (sodium sesquicarbonate) is mined from an underground deposit in Wyoming and processed for use in the manufacture of glass, paper, and detergents, and in chemical applications. Trona dust is alkaline (pH 10.5) and may have an irritant effect on the respiratory airways, mucous membranes, and the skin. One hundred forty-two underground miners and 88 surface workers from one trona facility participated voluntarily in an epidemiologic and clinical study. Their mean age was 37.6 and their mean working period, 10.0 years. One half of the study participants complained of skin symptoms; dermatologic symptoms increased from twofold to fifteenfold after the subjects began trona mining. Trona dermatitis consists of pruritic, erythematous, raised, dry, and fissured lesions commonly affecting the hands, arms, and legs. A dose-response relationship was observed among underground workers. Patch testing with 10% aqueous trona and sodium carbonate was negative, suggesting that the dermatitis was primarily irritant in nature.
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Rom WN, Greaves W, Bang KM, Holthouser M, Campbell D, Bernstein R. An epidemiologic study of the respiratory effects of trona dust. Arch Environ Health 1983; 38:86-92. [PMID: 6221702 DOI: 10.1080/00039896.1983.10543986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Trona (sodium sesquicarbonate) is mined from an underground deposit in Wyoming and processed for use in glass, paper, detergent, and chemical applications. Trona dust is alkaline (pH 10.5) and can have an irritant effect on respiratory airways, mucous membranes, and the skin. A study population of 142 underground miners and 88 surface workers from one facility volunteered for an epidemiologic study. Their mean age was 37.6 yr and mean duration of employment was 10.0 yr. The percentage with chronic cough and phlegm was 23%; both symptoms were more common among smokers than nonsmokers. Thirty-three percent of the workers complained of dyspnea when hurrying on level ground or walking up a slight hill. Half of the workers complained of upper respiratory tract symptoms and eye irritation. Both smokers and exsmokers had significant declines of forced expiratory volume in 1 sec (FEV1.0) with age; exsmokers also had declines with work-years when compared to a nonsmoking comparison population. Nonsmokers with personal dust measurements had a significant decline of FEV1.0 related to respirable dust exposure. A shift study of 104 workers revealed a significant fall in FEV1.0 among nonsmokers and surface workers. Significance was approached in the high dust exposure group. An increase in the mean percent predicted forced vital capacity and FEV1.0 was shown for the 125 workers who had a 5-yr follow-up of pulmonary function. There was no correlation between the shift study decrements and the longitudinal 5-yr follow-up. Industrial hygiene dust sampling found elevated levels of total dust but lower respirable dust, with no detectable free silica.
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