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Gonzalo-Nadal V, Kohl A, Rocchi M, Brennan B, Hughes J, Nichols J, Da Silva Filipe A, Dunlop JI, Fares M, Clark JJ, Tandavanitj R, Patel AH, Cloquell-Miro A, Bongers J, Deacon J, Kaczmarska A, Stalin C, Liatis T, Irving J, Gutierrez-Quintana R. Suspected tick-borne flavivirus meningoencephalomyelitis in dogs from the UK: six cases (2021). J Small Anim Pract 2024; 65:132-143. [PMID: 37956993 DOI: 10.1111/jsap.13682] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/30/2023] [Accepted: 10/01/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Tick-borne encephalitis virus and louping ill virus are neurotropic flaviviruses transmitted by ticks. Epidemiologically, tick-borne encephalitis is endemic in Europe whereas louping ill's predominant geographical distribution is the UK. Rarely, these flaviviruses affect dogs causing neurological signs. This case series aimed to describe the clinical, clinicopathological, and imaging findings, as well as the outcomes in six dogs with meningoencephalitis and/or meningomyelitis caused by a flavivirus in the UK in 2021. MATERIALS AND METHODS Observational retrospective case-series study. Clinical data were retrieved from medical records of dogs with positive serological or immunohistochemical results from three different institutions from spring to winter 2021. RESULTS Six dogs were included in the study. All dogs presented an initial phase of pyrexia and/or lethargy followed by progressive signs of spinal cord and/or intracranial disease. Magnetic resonance imaging showed bilateral and symmetrical lesions affecting the grey matter of the thalamus, pons, medulla oblongata, and thoracic or lumbar intumescences with none or mild parenchymal and meningeal contrast enhancement. Serology for tick-borne encephalitis virus was positive in five dogs with the presence of seroconversion in two dogs. The viral distinction between flaviviruses was not achieved. One dog with negative serology presented positive immunohistochemistry at post-mortem examination. Three dogs survived but presented neurological sequelae. Three dogs were euthanased due to the rapid progression of the clinical signs or static neurological signs. CLINICAL SIGNIFICANCE These cases raise awareness of the presence of tick-borne encephalitis as an emergent disease or the increased prevalence of louping ill virus affecting dogs in the UK.
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Affiliation(s)
- V Gonzalo-Nadal
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - A Kohl
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - M Rocchi
- Moredun Research Institute, Midlothian, UK
| | - B Brennan
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - J Hughes
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - J Nichols
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | | | - J I Dunlop
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - M Fares
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - J J Clark
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - R Tandavanitj
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - A H Patel
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - A Cloquell-Miro
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - J Bongers
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Moorview Vets, Cramlington, UK
| | | | - A Kaczmarska
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - C Stalin
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Moorview Vets, Cramlington, UK
| | - T Liatis
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, London, UK
| | - J Irving
- Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, Hertfordshire, UK
- Harper & Keele Veterinary School, Newport, Shropshire, UK
| | - R Gutierrez-Quintana
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Gaffney J, Rieu R, France AK, Glynn AM, Brown K, Rooney C, Swan A, Kapacee Z, Brennan B, Dyker K, Noble D, Dixon L, Houghton F, Mandeville HC, Brennan SM, Gains J, Lim P, Thomson DD, McPartlin A, Pan S. Evaluation of Radiotherapy Dose and Survival Outcomes for Teenagers, and Young Adults with Nasopharyngeal Carcinoma in UK and Ireland. Int J Radiat Oncol Biol Phys 2023; 117:e582. [PMID: 37785767 DOI: 10.1016/j.ijrobp.2023.06.1924] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Nasopharyngeal carcinoma (NPC) follows a bimodal distribution with a smaller incidence peak in teenagers and young adults (TYAs). In TYAs, an over-whelming proportion are associated with Epstein-Barr virus (EBV). We have evaluated the variation in TYA NPC practice patterns across the UK and Ireland, along with survival outcomes. MATERIALS/METHODS We performed a multicenter, observational cohort study, of patients aged 13-25 years, with histologically confirmed NPC, treated between the years 2002-2022. An initial expression of interest was sent to selected centers treating H&N patients in the UK and Ireland. For analysis, patients were assessed based on total prescribed dose, with a cut off for low dose (LD) (≤61.2Gy) versus a high dose (HD)(>61.2Gy). RESULTS Ninety-five patients, from 9 centers, were eligible for inclusion. Patient demographics are shown in table1. At a median follow up of 45 months (IQR 23-111), 3-year overall survival (OS) was 98% (95% CI 93%-100%) with LD versus 91% (95% CI 83%-99%) with HD (Hazard ratio (HR) = 3.0; 95% CI 0.3-27, p = 0.3). 3-year progression free survival (PFS) was 84% (95% CI 71%-97%) with LD versus 83% (95% CI 72%-94%) with HD (HR 1.3; 95% CI 0.4-4.0, p = 0.6), and 5-year PFS was 84% (95% CI 71%-97%) with LD versus 83% (95% CI 72%-94%) with HD (HR 1.3; 95% CI 0.4-4.0, p = 0.6). Incidence of distant metastasis (DM) was 9.9%. 2 patients (6%) with T3-T4 tumors, treated with LD, had locoregional failure (LRF) compared to 1 patient (3%) treated with HD. CONCLUSION We have demonstrated excellent survival outcomes for the UK & Ireland TYA NPC patients. As the majority of cases in this age group have EBV+ NPC, with survival similar between LD and HD protocols, we propose that pediatric protocols, with lower radiotherapy doses should be considered for all TYA NPC, with the aim of reducing late effects. Additional analysis to better understand the impact of heterogeneity between both groups, including choice of protocol, induction and adjuvant treatment will follow this study. Prospective evaluation, as part of an international collaboration, is required to optimize the management strategy for this rare cohort of patients.
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Affiliation(s)
- J Gaffney
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R Rieu
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A K France
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, United Kingdom
| | - A M Glynn
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - K Brown
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - C Rooney
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - Z Kapacee
- Leeds Teaching Hospital NHS Trust, Leeds, UK, Leeds, United Kingdom
| | - B Brennan
- Royal Manchester Children's Hospital, Manchester, UK, Manchester, United Kingdom
| | - K Dyker
- Leeds Teaching Hospital NHS Trust, Leeds, UK, Leeds, United Kingdom
| | - D Noble
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - L Dixon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, Sheffield, United Kingdom
| | - F Houghton
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - H C Mandeville
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - S M Brennan
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - J Gains
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Lim
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - D D Thomson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A McPartlin
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - S Pan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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3
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Soden D, Meyer JE, Briskin SM, Dundr JM, Brennan B, Smith PM, Bailey CM. A-43 Effects of Subthreshold Exercise on Post-concussive Symptom Endorsement and Cognition: A Pilot Randomized Clinical Trial. Arch Clin Neuropsychol 2022. [DOI: 10.1093/arclin/acac32.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose: The current study examined the effects of subthreshold exercise on symptom endorsement and neurocognitive functioning in adolescents with persisting concussion symptoms (>1 month). Methods: Sixteen participants (age M = 16.2, SD = 1.4) with persisting concussion symptoms were randomly assigned to control or subthreshold exercise intervention groups (Leddy et al., 2019). Participants engaged in concussion education before assignment to 6 weeks (3x weekly) of intervention: control (stretching) or subthreshold exercise. Both groups completed evaluations at baseline, midpoint, and follow-up, including a hybrid battery of assessments (yielding composites of processing speed and memory), a concussion symptom scale (PCS-R), and psychological inventories. Results: Both the intervention group and control group reported significant reduction in concussive symptom severity during the study period (PCS-R Change M = -21.29, SD = 13.54). Baseline endorsement of anxiety significantly differed across groups (p < 0.05); when controlling for anxiety, the intervention group demonstrated greater reduction in symptom endorsement compared to controls (F(1,13) = 7.30, p < 0.05, partial eta2 = 0.40). In contrast, after controlling for performance validity and the baseline anxiety difference, there was no significant difference (p > 0.05) in processing speed performance (partial eta2 = 0.14) or memory performance (partial eta2 = 0.11) by intervention group. Both groups remained generally intact normatively from the baseline to the follow-up evaluation across measures. Conclusions: Current results support the use of subthreshold exercise to reduce persisting symptoms of concussion post-acutely; additionally, results suggest that anxiety significantly impacted response to intervention. Lastly, there was no effect on cognitive indices by the intervention, suggesting that subthreshold exercise may have less impact on cognition than symptom endorsement in the post-acute phase of recovery.
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4
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Strauss SJ, Frezza AM, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Blay JY, Bolle S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brennan B, Brodowicz T, Buonadonna A, de Álava E, Dei Tos AP, Garcia Del Muro X, Dufresne A, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Gaspar N, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Gronchi A, Haas R, Hassan AB, Hecker-Nolting S, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kager L, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, López Pousa A, Martin-Broto J, Merimsky O, Messiou C, Miah AB, Mir O, Montemurro M, Morland B, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Sundby Hall K, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Ladenstein R, Casali PG, Stacchiotti S. Bone sarcomas: ESMO-EURACAN-GENTURIS-ERN PaedCan Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2021; 32:1520-1536. [PMID: 34500044 DOI: 10.1016/j.annonc.2021.08.1995] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- S J Strauss
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - A M Frezza
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - J Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Bauer
- Department of Medical Oncology, Interdisciplinary Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - J Y Blay
- Centre Leon Berard and UCBL1, Lyon, France
| | - S Bolle
- Radiation Oncology Department, Gustave Roussy, Villejuif, France
| | - S Bonvalot
- Department of Surgery, Institut Curie, Paris, France
| | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - B Brennan
- Paediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - E de Álava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital, CSIC, University of Sevilla, CIBERONC, Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | - A P Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | | | - A Dufresne
- Département d'Oncologie Médicale Centre Leon Berard, Lyon, France
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - F Fagioli
- Paediatric Onco-Haematology Department, Regina Margherita Children's Hospital, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A Fedenko
- P.A. Herzen Cancer Research Institute, Moscow, Russian Federation
| | - V Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - N Gaspar
- Department of Oncology for Child and Adolescents, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
| | - S Gasperoni
- Department of Oncology and Robotic Surgery, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Gouin
- Centre Leon-Berard Lyon, Lyon, France
| | - G Grignani
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - R Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - A B Hassan
- Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
| | | | - N Hindi
- Department of Medical Oncology, Fundación Jimenez Diaz, University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - P Hohenberger
- Mannheim University Medical Center, Mannheim, Germany
| | - H Joensuu
- Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - R L Jones
- Sarcoma Unit, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - C Jungels
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | - L Kager
- St. Anna Children's Hospital and Children's Cancer Research Institute (CCRI), Department of Pediatrics and Medical University Vienna Children's Cancer Research Institute, Vienna, Austria
| | - B Kasper
- Mannheim University Medical Center, Mannheim, Germany
| | - A Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - K Kopeckova
- University Hospital Motol, Prague, Czech Republic
| | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - F Le Grange
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - E Legius
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - A López Pousa
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - J Martin-Broto
- Department of Medical Oncology, Fundación Jimenez Diaz, University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - A B Miah
- Department of Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - O Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - M Montemurro
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - B Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Morosi
- Department of Radiology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - E Palmerini
- Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Pantaleo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria, di Bologna, Bologna, Italy
| | - R Piana
- Azienda Ospedaliero, Universitaria Cita della Salute e della Scienza di Torino, Turin, Italy
| | | | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Denmark
| | - C Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | - S Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D Strauss
- Department of Surgery, Royal Marsden Hospital, London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - A Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - M A J van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W T A van der Graaf
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T Frebourg
- Department of Genetics, Normandy Center for Genomic and Personalized Medicine, Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | - R Ladenstein
- University Medical Center Groningen, Groningen, The Netherlands
| | - P G Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Oncology and Hemato-oncology University of Milan, Milan, Italy
| | - S Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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5
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Gronchi A, Miah AB, Dei Tos AP, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Blay JY, Bolle S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brennan B, Brodowicz T, Buonadonna A, De Álava E, Del Muro XG, Dufresne A, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Frezza AM, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Haas R, Hassan AB, Hecker-Nolting S, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kager L, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, Lopez-Pousa A, Martin-Broto J, Merimsky O, Messiou C, Mir O, Montemurro M, Morland B, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Strauss S, Sundby Hall K, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Casali PG, Stacchiotti S. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up ☆. Ann Oncol 2021; 32:1348-1365. [PMID: 34303806 DOI: 10.1016/j.annonc.2021.07.006] [Citation(s) in RCA: 345] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
- A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - A B Miah
- Department of Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - A P Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - J Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Bauer
- Department of Medical Oncology, Interdisciplinary Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - J Y Blay
- Centre Leon Berard and UCBL1, Lyon, France
| | - S Bolle
- Radiation Oncology Department, Gustave Roussy, Villejuif, France
| | - S Bonvalot
- Department of Surgery, Institut Curie, Paris, France
| | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - B Brennan
- Paediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - E De Álava
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - A Dufresne
- Département d'Oncologie Médicale, Centre Leon Berard, Lyon, France
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - F Fagioli
- Paediatric Onco-Haematology Department, Regina Margherita Children's Hospital, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A Fedenko
- P. A. Herzen Cancer Research Institute, Moscow, Russian Federation
| | - V Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A M Frezza
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Gouin
- Centre Leon-Berard Lyon, Lyon, France
| | - G Grignani
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - R Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - A B Hassan
- Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
| | | | - N Hindi
- Department of Medical Oncology, Fundación Jimenez Diaz University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - P Hohenberger
- Mannheim University Medical Center, Mannheim, Germany
| | - H Joensuu
- Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - R L Jones
- Sarcoma Unit, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - C Jungels
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | - L Kager
- St. Anna Children's Hospital, Department of Pediatrics and Medical University Vienna Children's Cancer Research Institute, Vienna, Austria
| | - B Kasper
- Mannheim University Medical Center, Mannheim, Germany
| | - A Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - K Kopeckova
- University Hospital Motol, Prague, Czech Republic
| | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - F Le Grange
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - E Legius
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - A Lopez-Pousa
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - J Martin-Broto
- Department of Medical Oncology, Fundación Jimenez Diaz University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - O Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - M Montemurro
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - B Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Morosi
- Department of Radiology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - E Palmerini
- Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Pantaleo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria, di Bologna, Bologna, Italy
| | - R Piana
- Azienda Ospedaliero, Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Denmark
| | - C Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | - S Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D Strauss
- Department of Surgery, Royal Marsden Hospital, London, UK
| | - S Strauss
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - A Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - M A J van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W T A van der Graaf
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T Frebourg
- Department of Genetics, Normandy Center for Genomic and Personalized Medicine, Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | - P G Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Oncology and Hemato-oncology University of Milan, Milan, Italy
| | - S Stacchiotti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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6
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Meyer J, Briskin S, Tangen C, Hoffer S, Dundr J, Brennan B, Smith P, Lissemore F, Bailey C. B-48 Effects of Anxiety on Response to a Subsymptom Threshold Exercise Program for Treatment of Persistent Post-Concussive Symptoms: A Pilot Randomized Clinical Trial. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
There is a growing literature to support the use of subsymptom threshold exercise for treatment of both acute and chronic post-concussion symptoms. The present study aimed to explore the influence of anxiety on response to exercise intervention for patients with persistent post-concussive symptoms.
Methods
Sixteen adolescents (ages 14-18) with persistent (>1 month) concussion symptoms were randomized into a light, home exercise group and a subsymptom threshold exercise group performed by PT’s (modeled after Leddy et al.,2019). Participants underwent intervention for 6 weeks and completed evaluations at Baseline, Mid-Point, and Follow-up after treatment; evaluations included State-Trait Anxiety Inventory (STAI), the Post-Concussive Scale-Revised (PCS-R), as well as additional measures of emotional functioning, balance disturbance, and neuropsychological functioning.
Results
Average PCS-R endorsement improved by 21 points from Baseline to Follow-up across treatment groups (PCS-R Total Change M = -21.29,SD = 13.54). There were meaningful Baseline differences between intervention groups in STAI state anxiety (p < .05) and STAI trait anxiety (p = 0.51); STAI variables were used as covariates in an ANOVA comparing mean PCS-R Percent Change between treatment and control groups. After removing the influence of anxiety, the intervention groups significantly differed and showed large effect (F(3,13) = 6.94,p < .05,partial eta2 = .41), with the intervention group improving (PCS-R Percent Change M = -63.3,SD = 17.4) more than the control group (PCS-R Percent Change M = -56.8,SD = 27.8).
Conclusion
Exercise intervention appears to be more effective than standard-of-care light activity in the treatment of persistent symptoms in adolescents; however, anxiety may alter response to intervention. Complimentary mental health treatment may augment response to exercise intervention and optimize concussion recovery trajectory in patients with persisting symptoms.
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Dickinson M, Briones Mejjide J, Herrera A, González Barca E, Ghosh N, Cordoba R, Rutherford S, Advani R, Bournazou E, Labriola-Tompkins E, Friess T, Chesne E, Brouwer-Visser J, Lechner K, Brennan B, Nueesch E, De Mario M, Hutchings M. BET INHIBITOR RG6146, VENETOCLAX, AND RITUXIMAB IS A HIGHLY ACTIVE REGIMEN IN RELAPSED/REFRACTORY (R/R) DLBCL: INITIAL REPORT OF PHASE 1B SAFETY, BIOMARKER, AND RESPONSE DATA. Hematol Oncol 2019. [DOI: 10.1002/hon.131_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Dickinson
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Australia
| | - J. Briones Mejjide
- Hematology Department; Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes; Barcelona Spain
| | - A.F. Herrera
- Department of Hematology and Hematopoietic Cell Transplantation; City of Hope National Medical Center; Duarte United States
| | - E. González Barca
- Haematology; Institut Català d'Oncologia, L'Hospitalet de Llobregat; Barcelona Spain
| | - N. Ghosh
- Department of Hematologic Oncology and Blood Disorders; Levine Cancer Institute-Morehead; Charlotte United States
| | - R. Cordoba
- Department of Haematology; Fundacion Jimenez Diaz University Hospital; Madrid Spain
| | - S.C. Rutherford
- Meyer Cancer Center, Division of Hematology and Medical Oncology; New York Presbyterian Hospital/Weill Cornell Medicine; New York United States
| | - R. Advani
- Blood and Marrow Transplant Program; Stanford Cancer Center; Palo Alto United States
| | - E. Bournazou
- Roche Pharma Research and Early Development; Roche Innovation Center New York; New York United States
| | - E. Labriola-Tompkins
- Roche Pharma Research and Early Development; Roche Innovation Center New York; New York United States
| | - T. Friess
- Roche Pharma Research and Early Development; Roche Innovation Center Munich; Penzberg Germany
| | - E. Chesne
- Roche Pharma Research and Early Development; Roche Innovation Center Basel; Basel Switzerland
| | - J. Brouwer-Visser
- Roche Pharma Research and Early Development; Roche Innovation Center New York; New York United States
| | - K. Lechner
- Roche Pharma Research and Early Development; Roche Innovation Center Munich; Penzberg Germany
| | - B. Brennan
- Roche Pharma Research and Early Development; Roche Innovation Center New York; New York United States
| | - E. Nueesch
- Roche Pharma Research and Early Development; Roche Innovation Center Basel; Basel Switzerland
| | - M. De Mario
- Roche Pharma Research and Early Development; Roche Innovation Center New York; New York United States
| | - M. Hutchings
- Department of Haematology and Phase 1 Unit, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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8
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Casali PG, Bielack S, Abecassis N, Aro HT, Bauer S, Biagini R, Bonvalot S, Boukovinas I, Bovee JVMG, Brennan B, Brodowicz T, Broto JM, Brugières L, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Dhooge C, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gaspar N, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hecker-Nolting S, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kager L, Kasper B, Kopeckova K, Krákorová DA, Ladenstein R, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Morland B, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Strauss SJ, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Bone sarcomas: ESMO-PaedCan-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv79-iv95. [PMID: 30285218 DOI: 10.1093/annonc/mdy310] [Citation(s) in RCA: 315] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan and University of Milan, Milan, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - H T Aro
- Turku University Hospital (Turun Yliopistollinen Keskussairaala), Turlu, Finland
| | - S Bauer
- University Hospital Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Brennan
- Royal Manchester Children's Hospital, Manchester, UK
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - J M Broto
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - L Brugières
- Gustave Roussy Cancer Campus, Villejuif, France
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano
| | - E De Álava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital /CSIC/University of Sevilla/CIBERONC, Seville, Spain
| | - A P Dei Tos
- Ospedale Regionale di Treviso "S.Maria di Cà Foncello", Treviso, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - P Dileo
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - C Dhooge
- Ghent University Hospital (Pediatric Hematology-Oncology & Stem Cell Transplantation), Ghent, Belgium
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - F Fagioli
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - A Fedenko
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - V Ferraresi
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Ferrari
- Istituto Ortopedico Rizzoli, Bologna
| | - A M Frezza
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - N Gaspar
- Gustave Roussy Cancer Campus, Villejuif, France
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | - G Grignani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan and University of Milan, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - R Issels
- Department of Medicine III, University Hospital Ludwig-Maximilians-University Munich, Munich, Germany
| | - H Joensuu
- Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | | | - I Judson
- The Institute of Cancer Research, London, UK
| | - P Jutte
- University Medical Center Groningen, Groningen
| | - S Kaal
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Kager
- St. Anna Children's Hospital & Children's Cancer Research Institute, Medical University Vienna, Vienna, Austria
| | - B Kasper
- Mannheim University Medical Center, Mannheim
| | | | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - R Ladenstein
- St. Anna Children's Hospital & Children's Cancer Research Institute, Medical University Vienna, Vienna, Austria
| | - A Le Cesne
- Gustave Roussy Cancer Campus, Villejuif, France
| | - I Lugowska
- Maria Sklodowska Curie Institute-Oncology Centre, Warsaw, Poland
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - M Montemurro
- Medical Oncology University Hospital of Lausanne, Lausanne, Switzerland
| | - B Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - M A Pantaleo
- Azienda Ospedaliera, Universitaria, Policlinico S Orsola-Malpighi Università di Bologna, Bologna, Italy
| | - R Piana
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - P Picci
- Istituto Ortopedico Rizzoli, Bologna
| | | | - A L Pousa
- Fundacio de Gestio Sanitaria de L'Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - M H Robinson
- YCRC Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
| | - P Rutkowski
- Maria Sklodowska Curie Institute-Oncology Centre, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Finland
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Stacchiotti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - S J Strauss
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - F Van Coevorden
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - W T A van der Graaf
- Royal Marsden Hospital, London
- Radboud University Medical Center, Nijmegen, The Netherlands
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - J Whelan
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - O Zaikova
- Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - J Y Blay
- Centre Leon Bernard and UCBL1, Lyon, France
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Young E, Johnston M, Robertson C, Naguit I, Stevens P, Galashan D, Oskamp M, Brennan B, Ginsberg J, Chunilal S. The APTT Response of Pregnant Plasma to Unfractionated Heparin. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1612949] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryPregnancy is associated with a physiological increase in coagulation factors and heparin binding proteins; both can affect the activated partial thromboplastin time (APTT) in response to unfractionated heparin (UFH) invalidating the use of a non-pregnant APTT therapeutic range. We compared the anticoagulant response of UFH added in vitro to the plasma of 13 pregnant (third trimester) and 15 nonpregnant women to determine whether the measured APTT and antifactor Xa activities are lower in pregnancy. Increasing concentrations of UFH were added to platelet-poor plasma from each subject and the APTT and anti-factor Xa activity were measured. The amount of UFH which was reversibly bound and neutralised by plasma heparin binding proteins was assessed by comparing the anti-factor Xa activity before and after addition of low affinity heparin (LAH). Fibrinogen, von Willebrand factor antigen (vWF Ag) and factor VIII levels, were also measured. The APTT response, assessed by the slope of the regression line of log APTT versus added heparin concentration, was attenuated in pregnant plasma (0.76 s/U/mL versus 1.2 s/U/mL, p = 0.005) and was highly correlated to increased non-specific plasma protein binding (47% versus 35% p <0.01) and increased fibrinogen (5.1g/L versus 2.8 g/L, p <0.01) and factor VIII activity (2.7 U/mL versus 1.2 U/mL, p <0.01). Thus, to achieve the same heparin level, pregnant women require higher daily doses of UFH than non-pregnant women. However, if UFH dose adjustments during the third trimester are based upon a non-pregnant APTT therapeutic range, systematic overdosing of pregnant women will result, possibly increasing the risk of bleeding and osteoporosis.
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Pope H, Kanayama G, Jane's A, Hudson J, Brennan B, Jensen E, Kaufman M. Long-term anabolic-androgenic steroid (AAS) Use: A possible new risk factor for early dementia. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pretorius T, Brennan B, Thomas J. Staphylococcus aureus bacteraemia in children: a formidable foe. Southern African Journal of Anaesthesia and Analgesia 2015. [DOI: 10.1080/22201181.2015.1122151] [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: 10/22/2022]
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12
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Ferrari A, De Salvo GL, Brennan B, van Noesel MM, De Paoli A, Casanova M, Francotte N, Kelsey A, Alaggio R, Oberlin O, Carli M, Ben-Arush M, Bergeron C, Merks JHM, Jenney M, Stevens MC, Bisogno G, Orbach D. Synovial sarcoma in children and adolescents: the European Pediatric Soft Tissue Sarcoma Study Group prospective trial (EpSSG NRSTS 2005). Ann Oncol 2014; 26:567-72. [PMID: 25488687 DOI: 10.1093/annonc/mdu562] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To report the results of the first European prospective nonrandomized trial dedicated to pediatric synovial sarcoma. PATIENTS AND METHODS From August 2005 to August 2012, 138 patients <21 years old with nonmetastatic synovial sarcoma were registered in 9 different countries (and 60 centers). Patients were treated with a multimodal therapy including ifosfamide-doxorubicin chemotherapy and radiotherapy, according to a risk stratification based on surgical stage, tumor size and site, and nodal involvement. RESULTS With a median follow-up of 52.1 months (range 13.8-104.4 months), event-free survival (EFS) was 81.9% and 80.7%, and overall survival (OS) was 97.2% and 90.7%, at 3 and 5 years, respectively. The only significant prognostic variable at univariate analysis was the risk group: 3-year EFS was 91.7% for low-risk, 91.2% for intermediate-risk, and 74.4% for high-risk cases. In 24 low-risk patients (completely resected tumor ≤5 cm in size) treated with surgery alone, there were two local relapses and no metastatic recurrences. Among 67 high-risk patients (unresected, or axial tumor or nodal involvement), 66 underwent surgery after neoadjuvant chemotherapy. Response to chemotherapy was 55.2%, including 22.4% cases with complete or major partial remissions, and 32.8% with minor partial remissions. CONCLUSION This study demonstrates that collaborative prospective studies on rare pediatric sarcomas are feasible even on a European scale, with excellent treatment compliance. The overall results of treatment were satisfactory, with higher survival rates than those previously published by pediatric groups. Nonetheless, larger, international projects are needed, based on a cooperative effort of pediatric and adult oncologists. CLINICAL TRIALS NUMBER European Union Drug Regulating Authorities Clinical Trials No. 2005-001139-31.
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Affiliation(s)
- A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - G L De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - B Brennan
- Department of Pediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - M M van Noesel
- Department of Pediatric Oncology-Hematology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A De Paoli
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - M Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - N Francotte
- Department of Pediatrics, CHC-Clin Espérance, Montegnée, Belgium
| | - A Kelsey
- Department of Diagnostic Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester, UK
| | - R Alaggio
- Department of Pathology, Padova University, Padova, Italy
| | - O Oberlin
- Department of Pediatrics, Institut Gustave Roussy, Villejuif, France
| | - M Carli
- Division of Pediatric Hematology and Oncology, Padova University, Padova, Italy
| | - M Ben-Arush
- Department of Pediatric Hematology Oncology, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - C Bergeron
- Department of Pediatric Oncology, Institut D'Hematologie et D'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - J H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital-Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M Jenney
- Department of Pediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff
| | - M C Stevens
- Department of Pediatric Oncology, Royal Hospital for Children, University of Bristol, Bristol, UK
| | - G Bisogno
- Division of Pediatric Hematology and Oncology, Padova University, Padova, Italy
| | - D Orbach
- Department of Pediatric, Adolescent and Young Adult Oncology, Institut Curie, Paris, France
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O'Shea B, Martin D, Brennan B, Bailey O, McElwee O, O'Leary F, Darker C. Are we ready to "think ahead"? Acceptability study using an innovative end of life planning tool. Ir Med J 2014; 107:138-140. [PMID: 24908856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This is a cross sectional study in 5 GP Training Practices, sample size 100 clinically stable patients, attending for routine care. Purpose of the study was explained and informed written consent was sought. Participants were provided with 'Think Ahead,' an innovative end of life planning tool, devised by The Forum on The End of Life, based on best international practice, presented in a questionnaire format, detailing main decision centres relevant in end of life planning. Participants completed telephone surveys at 1 and 3 weeks, ascertaining their experience with 'Think Ahead;' 92/100 completed both surveys. Results indicate high levels of acceptability and positive experience for most participants. A majority (63%) indicated 'no difficulty' in completing 'Think Ahead;' 74% indicated reported they did not find completing the folder to cause upset; 87% indicated they felt the folder should be more widely available, and 68% indicated they felt 'Think Ahead' would be of general interest. The study was effective in encouraging discussion on end of life issues with family (83%) with 49% indicating they had done so in detail, and 34% indicating having 'done so somewhat,' having read 'Think Ahead; 27% indicated aspects of it were upsetting. Results will be used to inform further development of the tool. General Practice consulting is a suitable context in which to systematically present 'Think Ahead.'
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Orbach D, Brennan B, Casanova M, Bergeron C, Mosseri V, Francotte N, Van Noesel M, Rey A, Bisogno G, Pierron G, Ferrari A. Paediatric and adolescent alveolar soft part sarcoma: A joint series from European cooperative groups. Pediatr Blood Cancer 2013; 60:1826-32. [PMID: 23857870 DOI: 10.1002/pbc.24683] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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: 05/07/2013] [Accepted: 06/12/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Alveolar soft part sarcomas (ASPS) are generally chemo- and radio-resistant mesenchymal tumours, with no standardized treatment guidelines. We describe the clinical behaviour of paediatric ASPS and compare these features to previously reported adult series. PATIENTS AND METHODS The clinical data of 51 children and adolescents with ASPS, prospectively enrolled in or treated according to seven European Paediatric trials were analysed. RESULTS Median age was 13 years [range: 2-21]. Primary sites included mostly limbs (63%). IRS post-surgical staging was: IRS-I (complete resection) 35%, II (microscopic residual disease) 20%, III (gross residual disease) 18% and IV (metastases) 27%. Only 3 of the 18 evaluable patients (17%) obtained a response to conventional chemotherapy. After a median follow-up of 126 months (range: 9-240), 14/18 patients with IRS-I tumour, 10/10 IRS-II, 7/9 IRS-III and 2/14 IRS-IV were alive in remission. Sunitinib treatment achieved two very good partial responses in four patients. Ten-year overall survival (OS) and event free survival (EFS) was 78.0 ± 7% and 62.8 ± 7% respectively. Stage IV, size >5 cm and T2 tumours had a poorer outcome, but only IRS staging was an independent prognostic factor. CONCLUSIONS ASPS is a very rare tumour frequently arising in adolescents and in the extremities, and chemo resistant. Local surgical control is critical. ASPS is a poorly chemo sensitive tumour. For IRS-III/IV tumours, delayed radical local therapies including surgery are essential. Metastatic patients had a poor prognosis but targeted therapies showed promising results.
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Affiliation(s)
- D Orbach
- Department of Paediatric Oncology, Institut Curie, Paris, France
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Bisogno G, Ferrari A, Bien E, Brecht I, Brennan B, Cecchetto G, Godzinski J, Orbach D, Reguerre Y, Stachowicz-Stencel T, Schneider D. Rare Cancers in Children – The EXPeRT Initiative: A Report from the European Cooperative Study Group on Pediatric Rare Tumors. Klin Padiatr 2012; 224:416-20. [DOI: 10.1055/s-0032-1327608] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- G. Bisogno
- Clinic of Pediatric Oncology, University of Padova, Padova, Italy
| | - A. Ferrari
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - E. Bien
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - I. Brecht
- Pediatric Hematology and Oncology, University Children’s Hospital Erlangen, Erlangen, Germany
| | - B. Brennan
- Pediatric Oncology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - G. Cecchetto
- Pediatric Surgery, University of Padova, Padova, Italy
| | - J. Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland
| | - D. Orbach
- Pediatric Hematology and Oncology, Institute Gustave Curie, Paris, France
| | - Y. Reguerre
- Pediatric Hematology and Oncology, University Hospital Angers, Angers, France
| | - T. Stachowicz-Stencel
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - D. Schneider
- Klinik für Kinder- und Jugendmedizin, Klinikum Dortmund gGmbH, Dortmund, Germany
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Oberlin O, Le Deley M, Dirksen U, Lewis IJ, Ranft A, Michon JM, Paulussen M, Whelan J, Ladenstein RL, Brennan B, Marec Bérard P, Laurence V, Van Den Berg H, Hjorth L, Douglas C, Wheatley K, Van Glabbeke MM, Judson IR, Craft AW, Juergens H. Randomized comparison of VAC versus VAI chemotherapy (CT) as consolidation for standard risk (SR) Ewing sarcoma tumor (ES): Results of the Euro-EWING.99-R1 trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9517] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Morschhauser F, Marlton P, Vitolo U, Lindén O, Seymour J, Crump M, Coiffier B, Foà R, Wassner E, Burger HU, Brennan B, Mendila M. Results of a phase I/II study of ocrelizumab, a fully humanized anti-CD20 mAb, in patients with relapsed/refractory follicular lymphoma. Ann Oncol 2010; 21:1870-1876. [DOI: 10.1093/annonc/mdq027] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Gibbs L, Alonzo G, Bon C, Brennan B, Calvarese B, Chaudhuri B, Chavdarian C, Wagner G. Systemic exposure to butenafine is low after topical administration of Mentax®. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639709160528] [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: 11/13/2022]
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Brennan B, McDonnell S, Hughes G. Photoemission studies of the interface formation of ultrathin MgO dielectric layers on the oxidised Si(111) surface. ACTA ACUST UNITED AC 2008. [DOI: 10.1088/1742-6596/100/4/042047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Brennan B, Siu L, Dhesy-Thind B, Cripps C, Gandhi A, Abt M, Smith K, Rittweger K, Hussain S, Choudhury S. Pharmacokinetic (PK) interactions between capecitabine (X), oxaliplatin (O) and bevacizumab (A) when used in combination for first-line treatment of metastatic colorectal cancer (MCRC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.2554] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
Abstract
2554 Background: X + O in combination (XELOX) has similar efficacy to FOLFOX-4 in untreated MCRC patients (pts) [1]. The addition of A to irinotecan/5-FU/LV improves progression-free survival (PFS) and overall survival [2], and the potential improvement of adding A to XELOX in MCRC is currently being investigated. Here we present the first PK evaluation of the effects of X on O, O on X, X+A on O, and O+A on X in a multicenter open-label study of pts with untreated MCRC. Methods: Pts received treatment for up to 16 cycles with blood samples for PK analysis taken during cycles 1–3. Treatment: cycle 1: X 1000 mg/m2 orally on morning of d1, O 130 mg/m2 i.v. infusion d2, X 1000 mg/m2 bid orally d5–14, rest d15–21; cycle 2: O 130 mg/m2 i.v. infusion d1 + X 1000 mg/m2 bid orally d1–14, rest d15–21; cycle 3 (XOA): A 7.5 mg/kg i.v. infusion d1 + O 130 mg/m2 i.v. infusion d1 + X 1000 mg/m2 bid orally d1–14, q3w. Treatment with the XOA regimen continued for a further 13 cycles. Safety was evaluated throughout. Results: 36 pts were enrolled; 26 pts completed cycles 1–3 and were evaluable for PK analysis; all pts were evaluable for safety. Baseline characteristics were: M/F 42%/58%; median age 60 years (range 22–74). The primary parameter for PK analysis of X, AUC0-8 of 5’-DFUR, was slightly lower in cycle 2 d1 (XO) and cycle 3 d1 (XOA) vs. cycle 1 d1 (X) (10% and 13% lower, respectively, with CV 27–33%); a decrease in the Cmax of 5’-DFUR was also observed (26% and 36% lower, respectively, with CV 48–54%). However these differences were not considered clinically important. The primary parameter for PK analysis of O, AUC0-8 of free platinum, was very similar among cycle 2 d1 (XO), cycle 3 d1(XOA), and cycle 1 d2 (O), with geometric mean ratios very close to 1. Treatment with X, O and A in combination was generally well tolerated. Conclusions: No large differences in exposure of X or its metabolites, free platinum or total platinum occur when X, O and A are administered in combination. This provides further support for the development of the above dosing regimen in MCRC. References: 1. Cassidy J et al. J Clin Oncol 2004;22:2084–91. 2. Hurwitz H et al. N Eng J Med 2004;350:2335–42. No significant financial relationships to disclose.
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Affiliation(s)
- B. Brennan
- Hoffmann-La Roche, Nutley, NJ; Princess Margaret Hospital, Toronto, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; The Ottawa Hospital Regional Cancer Center, Ottawa, ON, Canada; Hoffmann-La Roche, Basel, Switzerland; Hoffmann-La Roche, Welwyn, United Kingdom
| | - L. Siu
- Hoffmann-La Roche, Nutley, NJ; Princess Margaret Hospital, Toronto, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; The Ottawa Hospital Regional Cancer Center, Ottawa, ON, Canada; Hoffmann-La Roche, Basel, Switzerland; Hoffmann-La Roche, Welwyn, United Kingdom
| | - B. Dhesy-Thind
- Hoffmann-La Roche, Nutley, NJ; Princess Margaret Hospital, Toronto, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; The Ottawa Hospital Regional Cancer Center, Ottawa, ON, Canada; Hoffmann-La Roche, Basel, Switzerland; Hoffmann-La Roche, Welwyn, United Kingdom
| | - C. Cripps
- Hoffmann-La Roche, Nutley, NJ; Princess Margaret Hospital, Toronto, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; The Ottawa Hospital Regional Cancer Center, Ottawa, ON, Canada; Hoffmann-La Roche, Basel, Switzerland; Hoffmann-La Roche, Welwyn, United Kingdom
| | - A. Gandhi
- Hoffmann-La Roche, Nutley, NJ; Princess Margaret Hospital, Toronto, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; The Ottawa Hospital Regional Cancer Center, Ottawa, ON, Canada; Hoffmann-La Roche, Basel, Switzerland; Hoffmann-La Roche, Welwyn, United Kingdom
| | - M. Abt
- Hoffmann-La Roche, Nutley, NJ; Princess Margaret Hospital, Toronto, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; The Ottawa Hospital Regional Cancer Center, Ottawa, ON, Canada; Hoffmann-La Roche, Basel, Switzerland; Hoffmann-La Roche, Welwyn, United Kingdom
| | - K. Smith
- Hoffmann-La Roche, Nutley, NJ; Princess Margaret Hospital, Toronto, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; The Ottawa Hospital Regional Cancer Center, Ottawa, ON, Canada; Hoffmann-La Roche, Basel, Switzerland; Hoffmann-La Roche, Welwyn, United Kingdom
| | - K. Rittweger
- Hoffmann-La Roche, Nutley, NJ; Princess Margaret Hospital, Toronto, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; The Ottawa Hospital Regional Cancer Center, Ottawa, ON, Canada; Hoffmann-La Roche, Basel, Switzerland; Hoffmann-La Roche, Welwyn, United Kingdom
| | - S. Hussain
- Hoffmann-La Roche, Nutley, NJ; Princess Margaret Hospital, Toronto, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; The Ottawa Hospital Regional Cancer Center, Ottawa, ON, Canada; Hoffmann-La Roche, Basel, Switzerland; Hoffmann-La Roche, Welwyn, United Kingdom
| | - S. Choudhury
- Hoffmann-La Roche, Nutley, NJ; Princess Margaret Hospital, Toronto, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; The Ottawa Hospital Regional Cancer Center, Ottawa, ON, Canada; Hoffmann-La Roche, Basel, Switzerland; Hoffmann-La Roche, Welwyn, United Kingdom
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Brennan B, Chiu Y, Berthelon L, Kolis S, Davies B. Effect of age and gender on the pharmacokinetics of R667, a novel agent for the treatment of emphysema, in healthy volunteers. J Pharm Pharm Sci 2007; 10:9-16. [PMID: 17498389] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The purpose of the present study was to assess the impact of age and gender on the pharmacokinetics (PK) of R667. Thirty six healthy male and female volunteers (12 m 18-45 years; 12 m and 12 f > or = 65 years) received a single 1 mg oral dose of R667. Serial blood samples were collected for determination of plasma R667 and metabolite concentrations. The PK parameters of R667 were similar between elderly males and young males (Cmax = 9.8 vs 9.8 ng/mL; AUC(0-last) = 50.9 vs 47.3 ng x h/mL, respectively). Exposure of R667 increased in elderly females compared to elderly males (Cmax = 13.1 vs 9.8 ng/mL; AUC(0-last) = 60.8 vs 47.3 ng x h/mL, respectively). When the CL/F was corrected for BSA and V/F corrected for weight these differences were no longer evident. In conclusion these exposure differences are not considered clinically relevant, and no dose adjustment of R667 is required based on gender or age.
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Gurau I, Bobelu A, Brennan B, Gonzales M, Shah V, Narva A, Paine S, Stidley C, Zager P. 324 HEAVY METAL EXPOSURE IS ASSOCIATED WITH HIGH LEVELS OF TRANSFORMING GROWTH FACTOR-β IN ZUNI INDIANS. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brennan B. Vaccines: the wave of the future. Perspect Health 2002; 3:17-21. [PMID: 12322198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Chunilal SD, Young E, Johnston MA, Robertson C, Naguit I, Stevens P, Galashan D, Oskamp ML, Brennan B, Ginsberg JS. The APTT response of pregnant plasma to unfractionated heparin. Thromb Haemost 2002; 87:92-7. [PMID: 11848463] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Pregnancy is associated with a physiological increase in coagulation factors and heparin binding proteins; both can affect the activated partial thromboplastin time (APTT) in response to unfractionated heparin (UFH) invalidating the use of a non-pregnant APTT therapeutic range. We compared the anticoagulant response of UFH added in vitro to the plasma of 13 pregnant (third trimester) and 15 nonpregnant women to determine whether the measured APTT and antifactor Xa activities are lower in pregnancy. Increasing concentrations of UFH were added to platelet-poor plasma from each subject and the APTT and anti-factor Xa activity were measured. The amount of UFH which was reversibly bound and neutralised by plasma heparin binding proteins was assessed by comparing the anti-factor Xa activity before and after addition of low affinity heparin (LAH). Fibrinogen, von Willebrand factor antigen (vWF Ag) and factor VIII levels, were also measured. The APTT response, assessed by the slope of the regression line of log APTT versus added heparin concentration, was attenuated in pregnant plasma (0.76 s/U/mL versus 1.2 s/U/mL, p = 0.005) and was highly correlated to increased non-specific plasma protein binding (47% versus 35% p <0.01) and increased fibrinogen (5.1 g/L versus 2.8 g/L, p < 0.01) and factor VIII activity (2.7 U/mL versus 1.2 U/mL, p <0.01). Thus, to achieve the same heparin level, pregnant women require higher daily doses of UFH than non-pregnant women. However, if UFH dose adjustments during the third trimester are based upon a non-pregnant APTT therapeutic range, systematic overdosing of pregnant women will result, possibly increasing the risk of bleeding and osteoporosis.
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Affiliation(s)
- S D Chunilal
- Department of Medicine, McMaster University, Hamilton, Canada.
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Brennan B. The registered nurse as a first assistant: the "downunder" experience. Semin Perioper Nurs 2001; 10:108-14. [PMID: 15129519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
In 1996, Bernadette Brennan, RN, was awarded a fellowship from the Australian Confederation of Operating Room Nurses (now known as the Australian College of Operating Room Nurses Ltd.) to travel to the United States to study the role of the Advanced Nurse Practitioner, with an emphasis on the role of the registered nurse first assistant (RNFA). As part of this study, she undertook an RNFA course at Delaware County Community College. This article provides a description of her work to develop an educational program for RNFAs in Australia. Because of the size of the country and the many rural areas needing to be served, her challenge was to devise an accessible program that was also academically rigorous. Her trials as well as her triumphs are presented here.
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Peng B, Andrews J, Nestorov I, Brennan B, Nicklin P, Rowland M. Tissue distribution and physiologically based pharmacokinetics of antisense phosphorothioate oligonucleotide ISIS 1082 in rat. Antisense Nucleic Acid Drug Dev 2001; 11:15-27. [PMID: 11258618 DOI: 10.1089/108729001750072092] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to develop a whole body physiologically based model of the pharmacokinetics (PBPK) of the phosphorothioate oligonucleotide (PS-ODN) ISIS 1082 in vivo. Rats were administered an intravenous (i.v.) bolus dose of ISIS 1082 (10 mg/kg plus 3H tracer), and arterial blood and tissues were taken at specific times up to 72 hours. Radioactivity was measured in all samples. The parent compound was determined specifically in blood and tissues at 90 minutes and in liver and kidney also at 24 hours, using capillary gel electrophoresis (CGE). A whole body PBPK model was fitted to the combined blood and tissue radioactivity data using nonlinear regression analysis. CGE analysis indicated that the predominant species in plasma and all tissues is ISIS 1082, together with some n-1 and n-2 metabolites. Total radioactivity primarily reflects these species. The whole body model successfully described temporal events in all tissues. However, to adequately model the experimental data, all tissues had to be partitioned into vascular and extravascular spaces to accommodate the relatively slow distribution of ISIS 1082 out of blood because of a permeability rate limitation. ISIS 1082 distributes extensively into tissues, but the relative affinity varies enormously, being highest for kidney and liver and lowest for muscle and brain. A whole body PBPK model with a permeability rate limited tissue distribution was developed that adequately described events in both blood and tissue for an oligonucleotide. This model has the potential not only to characterize the events in individual tissues throughout the body for such compounds but also to scale across animal species, including human.
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Affiliation(s)
- B Peng
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, UK
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Brennan B. What's new in the world of the perioperative nurse surgeon's assistant. Aust Nurs J 2000; 8:35. [PMID: 11894245] [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: 04/18/2023]
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Abstract
Canine heartworm or Dirofilaria immitis can occasionally infect man. We present the case of a 36-year-old Balkan woman referred to us for a thoracoscopic biopsy of a well defined pulmonary mass. The latter was thoracoscopically resected and proved to be due to Dirofilaria immitis on histopathological examination. To our knowledge this is the second reported case in Western Australia, the first being that reported by Brine et al. The prevalence of the disease in Australia was recognized in 1969 in one study in the state of Queensland, where 12% of 761 dogs at one veterinary clinic and 20% of 296 dogs at another were shown to be infected. Dirofilaria immitis resides in the right ventricle and pulmonary arteries of dogs. The microfilariae are released into the blood stream and are transmitted to secondary hosts by mosquitoes.
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Affiliation(s)
- K Narine
- Department of Cardiothoracic Surgery, Fremantle Hospital, Perth, Australia.
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Hall TN, Brennan B, Leahy MF, Woodroffe AJ. Henoch-Schönlein purpura associated with human immunodeficiency virus infection. Nephrol Dial Transplant 1998; 13:988-90. [PMID: 9568864 DOI: 10.1093/ndt/13.4.988] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- T N Hall
- Renal Unit, Fremantle Hospital, Western Australia, Australia
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Brennan B. Erosion of the OR nurse's role. Aust Nurs J 1997; 5:26. [PMID: 9444134] [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: 02/05/2023]
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Abstract
BACKGROUND Fine needle biopsy (FNB) in children has been slow to gain acceptance compared with the use of the technique in adults where it is regarded as standard clinical practice in screening significant lymphadenopathy and suspicious masses. We report our early experience with FNB in the paediatric population. METHODS Fifty-two biopsies were performed between June 1991 and June 1993. The age of the children ranged from 6 months to 14 years (median 2 years, mean 5 years). RESULTS A definite diagnosis on cytology alone was obtained in 67%. The pathologist was certain of malignant or nonmalignant potential in 79% (67% benign and 12% malignant) and unsure in 21% (17% benign and 4% malignant). There were no false positive or false negative diagnoses of malignancy. Surgical excision or biopsy was performed in 33%. Fine needle biopsy assisted in planning surgery in 12%. Surgery was necessary for a definite diagnosis in 21% and FNB assisted 42% of the patients to avoid surgery altogether. CONCLUSIONS Fine needle biopsy is simple, minimally invasive and useful in the evaluation of children with suspicious lymph nodes and masses.
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Affiliation(s)
- J E Orford
- Division of Surgery, Princess Margaret Hospital for Children, Perth, Western Australia
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Abstract
Until recently the treatment options for superficial fungal infections have been limited mainly to the use of fungistatic drugs of the imidazole class, discovered in the 1960s. The recent development of allylamine and benzylamine compounds provides antifungal agents with fungicidal mechanisms of action. Both imidazole and allylamine/benzylamine drugs interfere with the production of ergosterol, an essential component of the fungal cell membrane; however, the newer drugs act at an earlier stage of the metabolic pathway than the azoles and cause an accumulation of squalene in the fungal cell, which leads to cell death. In vitro test results show that allylamine/benzylamine minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) are lower than the MICs and MFCs of azoles tested by the same methods. In studies using animal models of dermatophytosis, results have shown the efficacy of the allylamine/benzylamine drugs to be superior to that of azole drugs. Clinical trials have also shown significant differences favoring allylamine/benzylamine drugs over imidazoles in the treatment of dermatophytosis. The fungicidal drugs provide earlier evidence of efficacy, higher cure rates with shorter treatment periods, and lower relapse rates than imidazoles in direct-comparison studies. The allylamine/benzylamine drugs have also shown high cure rates in patients with candidiasis.
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Affiliation(s)
- B Brennan
- Penederm Incorporated, Foster City, California, USA
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Worboys PD, Brennan B, Bradbury A, Houston JB. Metabolite kinetics of ondansetron in rat. Comparison of hepatic microsomes, isolated hepatocytes and liver slices, with in vivo disposition. Xenobiotica 1996; 26:897-907. [PMID: 8893037 DOI: 10.3109/00498259609052492] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [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: 02/02/2023]
Abstract
1. The kinetics of hydroxylation and N-demethylation of ondansetron have been determined in freshly isolated hepatocytes, hepatic microsomes and precision-cut liver slices from the male Sprague-Dawley rat. In vivo studies have also been carried out to characterize the pharmacokinetics of ondansetron and in vitro data have been assessed for their value as predictors of hepatic clearance. 2. In the three in vitro systems, the formation of hydroxylated and demethylated metabolites were characterized as a function of substrate concentration by a high-affinity, low-capacity site and a low-affinity, high-capacity site which was not saturated over the concentration range studied (2.5-500 microM). Slices gave consistently higher Km's (20 and 30 microM for hydroxylation and demethylation respectively) than hepatocytes (3 and 13 microM respectively) and microsomes (2 and 5 microM respectively.) The rank order of Vmax and CL(int) was the same for each system; hydroxylation rates exceeding demethylation rates. Although two hydroxylations (7- and 8-hydroxy metabolites) occurred exclusively in microsomes, these are believed to originate from a common precursor. 3. The high CL(int) of ondansetron (150 ml/min/SRW, where SRW is a standard rat weight of 250g) is well predicted by scaling either microsomal clearance for microsomal protein recovery or hepatocyte clearance for hepatocellularity (212 and 135 ml/min/SRW respectively). In contrast, the use of liver slice data scaled to a whole liver substantially underestimates CL(int) (9 ml/min/SRW).
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Affiliation(s)
- P D Worboys
- Department of Pharmacy, University of Manchester, UK
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Abstract
Subcutaneous inoculation of dogs with Ehrlichia canis was investigated as a more appropriate model of canine ehrlichiosis, which is naturally transmitted by arthropod vectors. A dose-dependent response occurred following subcutaneous inoculation of seven groups of dogs with log concentrations of E. canis-infected canine-origin cells. Ehrlichial infection in dogs was defined as concurrence of an increased titer of anti-E. canis immunoglobulin G (IgG) antibody in serum, a decreased platelet concentration, and isolation of E. canis by blood culture. In dogs administered the two lowest doses, no changes were detected. In seven of nine dogs administered three intermediate doses, the only change detected was a transient and mild increase in the anti-E. canis IgG antibody titer in serum. Only two of nine dogs inoculated with the intermediate doses developed an ehrlichial infection. Five of six dogs administered the two highest dose of E. canis developed an ehrlichial infection. These dogs had the highest IgG antibody titers in serum and the earliest isolation of E. canis from blood. In dogs that developed an ehrlichial infection, thrombocytopenia occurred by 28 days after inoculation, while increased IgG antibody titers in serum and blood cultures positive for E. canis occurred as early as 14 days postinoculation. Thrombocytopenia and seroconversion occurred later in the course of infection than previously reported for ehrlichial infections induced by intravenous inoculation. The route of administration and E. canis inoculum size can influence the course of ehrlichial infection and should be regarded as important variables in experimentally induced canine ehrlichiosis.
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Affiliation(s)
- S D Gaunt
- Department of Veterinary Pathology, School of Veterinary Medicine, Louisiana State University, Baton Rouge 70803, USA
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Ervine CM, Matthew DE, Brennan B, Houston JB. Comparison of ketoconazole and fluconazole as cytochrome P450 inhibitors. Use of steady-state infusion approach to achieve plasma concentration-response relationships. Drug Metab Dispos 1996; 24:211-5. [PMID: 8742233] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The ability of two azole antifungal agents, ketoconazole and fluconazole, to inhibit hepatic cytochrome P450 activity in vivo in the rat has been determined. To make a valid comparison, differences in pharmacokinetic properties between the azoles were accounted for by using an infusion approach to maintain steady-state plasma concentrations over a range of 1-48 mg/liter. Both compounds showed a maximum inhibitory effect, assessed by a reduction in antipyrine clearance, of approximately 75%. The relationship between steady-state plasma concentration and the degree of inhibition of antipyrine clearance was nonlinear for both azoles. However, the inhibitory effect resulted at lower concentrations for ketoconazole than for fluconazole. Analysis of these data provided Ki values of 3 and 10 microM, for ketoconazole and fluconazole, respectively, based on plasma concentration of azole. This difference in activity is 2 orders of magnitude greater when Ki values are expressed in terms of unbound concentration in the blood, which may be more representative of hepatic tissue concentrations. Ki values based on unbound drug concentration are 0.07 and 8.7 microM for ketoconazole and fluconazole, respectively. These data confirm the conclusions based on in vitro findings that ketoconazole is a more inhibitory of mammalian cytochrome P450 isoenzymes than fluconazole.
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Affiliation(s)
- C M Ervine
- Department of Pharmacy, University of Manchester, UK
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Hayes KA, Brennan B, Chenery R, Houston JB. In vivo disposition of caffeine predicted from hepatic microsomal and hepatocyte data. Drug Metab Dispos 1995; 23:349-53. [PMID: 7628300] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The kinetics of caffeine metabolism has been investigated in freshly isolated hepatocytes, hepatic microsomes, and in vivo in male Sprague-Dawley rats. A simple Michaelis-Menten model provides an adequate description of each of the three sets of data. There is reasonable agreement between the KM values for the three systems (56-200 microM). Vmax values for hepatocytes and microsomes show good agreement when expressed in the same units using scaling factors for hepatic cellularity and microsomal protein yield [315 and 420 nmol/min/standard rat weight (SRW), respectively]. Both values slightly exceed the in vivo-determined Vmax (190 nmol/min/SRW). Taking the Vmax/KM ratio (intrinsic clearance) as the basis for scaling, the in vitro data from both the hepatocyte (2.6 ml/min/SRW) and microsomal (2.7 ml/min/SRW) studies provide a good prediction of the in vivo total body clearance (3.4 ml/min/SRW).
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Affiliation(s)
- K A Hayes
- Department of Pharmacy, University of Manchester, UK
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Brennan B. Greening the OR: an Australian perspective. Todays OR Nurse 1994; 16:25-32. [PMID: 7974646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
1. Many hospitals in Australia have become proactive about environmental issues, including use of plastics, disposable drapes, and glutaraldehyde; laundering of linen; and disposal of waste. 2. Although some standards are not mandated (as in the United States), timely, comprehensive guidelines are being published. 3. Environmental advocacy demonstrates the resourcefulness and creativity of perioperative nurses, as well as a commitment to preserving the environment for future generations.
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Lazaar AL, Albelda SM, Pilewski JM, Brennan B, Puré E, Panettieri RA. T lymphocytes adhere to airway smooth muscle cells via integrins and CD44 and induce smooth muscle cell DNA synthesis. J Exp Med 1994; 180:807-16. [PMID: 7520473 PMCID: PMC2191657 DOI: 10.1084/jem.180.3.807] [Citation(s) in RCA: 179] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Asthma is a disease of airway inflammation and hyperreactivity that is associated with a lymphocytic infiltrate in the bronchial submucosa. The interactions between infiltrating T lymphocytes with cellular and extracellular matrix components of the airway and the consequences of these interactions have not been defined. We demonstrate the constitutive expression of CD44 on human airway smooth muscle (ASM) cells in culture as well as in human bronchial tissue transplanted into severe combined immunodeficient mice. In contrast, basal levels of intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) expression are minimal but are induced on ASM by inflammatory mediators such as tumor necrosis factor alpha (TNF-alpha). Activated, but not resting T cells, adhere to cultured ASM; stimulation of the ASM with TNF-alpha enhanced this adhesion. Adhesion was partially blocked by monoclonal antibodies (mAb) specific for lymphocyte function-associated antigen 1 (LFA-1) and very late antigen 4 (VLA-4) on T cells and ICAM-1 and VCAM-1 on ASM cells. The observed integrin-independent adhesion was mediated by CD44/hyaluronate interactions as it was inhibited by anti-CD44 mAb 5F12 and by hyaluronidase. Furthermore, the adhesion of activated T lymphocytes induced DNA synthesis in growth-arrested ASM cells. Thus, the interaction between T cells and ASM may provide insight into the mechanisms that induce bronchial inflammation and possibly ASM cell hyperplasia seen in asthma.
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Affiliation(s)
- A L Lazaar
- Department of Medicine, University of Pennsylvania Medical Center, Philadelphia
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Abstract
Fetal goiter is a rare disorder, usually associated with maternal thyroid disease. Antenatal diagnosis of fetal goiter is crucial for the immediate postpartum management of these neonates. A case report is presented of an antenatally diagnosed fetal goiter induced by antithyroid medications. Color Doppler was used to demonstrate a high flow pattern that, unlike in the adult goiter, was associated with hypothyroidism in the neonate. A scan of fetal neck region is recommended in patients with current or previous history of thyroid disease, or if neck extension is noted on routine examination of fetal spine.
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Affiliation(s)
- S Soliman
- Department of Obstetrics and Gynecology, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Khaw KT, Compston JE, Murphy S, Lawlor R, McGee C, Hegarty V, Scott T, MacMahon M, Healy M, O’Moore RR, Keane CT, Mulvihill E, Taggart H, Crawford VLS, Tracey F, Crawford V, O’Mahory D, Coffey J, Hamilton D, Freyne P, Keane EM, Wilson H, Maher A, McGrane D, Walsh JB, Coakley D, Coen RF, O’Mahony D, O’Boyle CA, Browne J, Joyce CRB, O’Neill D, Wilcock GK, Crossin J, Mills JOM, Collins JC, Gilmore DH, Beringer TRO, Miller M, Hyland CM, Twomey C, Corcoran EM, Guerandel A, Wrigley M, Lee H, Walsh PJ, Hickey G, Tyrrell J, McCabe C, Kelly E, Swanwick G, Ward F, Lawlor BA, Moraes D, McCormack PME, Feely J, Jassal SV, Coulshed SC, Douglas JF, Stout RW, Kane N, Keane N, Brennan B, Denholm S, Fox J, Herlihey E, O’Keeffe S, Noel J, Lavan J, Mclntosh S, Kenny RA, Lawson J, da Costa D, Ford G, Mulkerin E, Rice K, Freeman EA, Keyes CB, Hickey A, Clinch D, Liston R, Passmore AP, Passmore CM, Copeland S, tout RW, Johnston GD. Irish gerontological society. Ir J Med Sci 1993. [DOI: 10.1007/bf02957576] [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: 11/24/2022]
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Matthew D, Brennan B, Zomorodi K, Houston JB. Disposition of azole antifungal agents. I. Nonlinearities in ketoconazole clearance and binding in rat liver. Pharm Res 1993; 10:418-22. [PMID: 8464816 DOI: 10.1023/a:1018996524141] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [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: 01/30/2023]
Abstract
The disposition of ketoconazole was characterized in the rat over a wide dose/concentration range. Bolus dose (0.03-10 mg/kg) studies indicate that plasma concentration-time profiles for ketoconazole are not superimposable when dose normalized because of nonlinearities occurring in both volume of distribution and clearance. The volume of distribution decreases from 3 to less than 1 L/kg, while the plasma clearance decreases 10-fold from 25 mL/min/kg as the dose is escalated. From these results, infusion rates were calculated to maintain the plasma concentrations achieved with particular bolus doses. The curvilinear relationship between steady-state plasma concentration (0.015-8.3 mg/L) and ketoconazole infusion rate (0.021-2.45 mg/hr/kg) was analyzed in terms of Michaelis-Menten kinetics. A Vmax of 3.2 mg/hr/kg and Km of 2.1 mg/L were obtained by nonlinear regression analysis. At the end of the ketoconazole infusion, liver, adrenals and kidneys were removed and assayed for ketoconazole. Tissue-to-plasma partition coefficients for the liver and adrenals showed a marked dependence upon steady-state plasma concentration. Both parameters (liver, 22; and adrenals, 53) showed a decrease of approximately 10-fold as the plasma concentrations were increased. In contrast, the kidney:plasma partition coefficient (1.8), blood:plasma concentration ratio (0.6), and plasma binding (96%) of ketoconazole did not show a concentration dependence over the range studied. It is concluded that the liver is an important determinant of ketoconazole's volume of distribution and that saturation of this process accounts largely for the reduction in volume of distribution with increasing dose.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Matthew
- Department of Pharmacy, University of Manchester, UK
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Abstract
Embryologically, cloacal exstrophy is thought to result from persistence and subsequent rupture of the infraumbilical cloacal membrane during the fifth embryonic week. We report a case of cloacal exstrophy in which a prenatal diagnosis was made prior to rupture of the cloacal membrane. A routine ultrasound at 17 weeks' gestation demonstrated monoamniotic twins. One twin was normal, but the other was found to have a sacral myelomeningocele, "rocker-bottom" feet, splaying of the pubic rami, and a large cystic mass protruding from the infraumbilical anterior abdominal wall. A repeat ultrasound was performed at 22 weeks, with the same findings. At 26 weeks, further examination showed disappearance of the abdominal cyst, a small omphalocele, no demonstrable bladder, and the suggestion of prolapsed bowel inferior to the umbilical cord insertion. After delivery at 34 weeks, the abnormal twin was found to have the typical findings of cloacal exstrophy, myelomeningocele, bilateral lower limb anomalies, and extremely foreshortened small bowel. Rupture of the presumed cloacal membrane after 22 weeks in this case is inconsistent with our current understanding of the embryology of this anomaly, and should stimulate a reexamination of the current concepts. If the characteristic features are recognized, cloacal exstrophy can be diagnosed by prenatal ultrasound, permitting prenatal counseling and appropriate perinatal management.
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Affiliation(s)
- J C Langer
- Department of Surgery, McMaster University, Hamilton, Ontario
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Grubbe RE, Hopp R, Dave NK, Brennan B, Bewtra A, Townley R. Effect of inhaled furosemide on the bronchial response to methacholine and cold-air hyperventilation challenges. J Allergy Clin Immunol 1990; 85:881-4. [PMID: 2332565 DOI: 10.1016/0091-6749(90)90072-c] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [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: 12/31/2022]
Abstract
Inhaled furosemide has been recently demonstrated to inhibit the bronchoconstrictive effects of exercise, ultrasonically nebulized distilled water, and antigen challenge. The presumed mechanism of action of these challenges is through mast cell degranulation. We report on the effect of inhaled furosemide on cold-air hyperventilation challenge (CAHC) and methacholine challenge. We studied 10 subjects with mild to moderate asthma in a double-blind, placebo-controlled, crossover study. Inhaled furosemide did not affect FEV1 in the hour after inhalation, and there was no significant difference between placebo or furosemide on the dose of methacholine causing a 20% fall in FEV1. Our results demonstrated inhaled furosemide significantly attenuated the bronchoconstrictive effect at 6 and 9 minutes after CAHC (p less than 0.05 and 0.029, respectively) when furosemide was compared to placebo and approached significance at 12 and 15 minutes after CAHC (p = 0.052 and 0.56, respectively). Inhaled furosemide attenuates CAHC but does not effect methacholine-induced bronchoconstriction.
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Affiliation(s)
- R E Grubbe
- Allergic Disease Center, Creighton University, Omaha, NE 68178
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O'Neill B, Brennan B, Zahra M. National derivation and blood transfusion in the Illawarra region of New South Wales. Med J Aust 1987; 147:159-60. [PMID: 3600486 DOI: 10.5694/j.1326-5377.1987.tb133340.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Alder H, diMonda R, Brennan B. Guideline report. Purchasing a satellite receiving earth terminal. AHA Hosp Technol Ser 1983; 2:1-33. [PMID: 10267882] [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: 02/12/2023]
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Abstract
The patterns of reflection of solar radiation from cloud, water, and land surfaces were measured with an aircraft-borne medium resolution radiometer. Reflectances in the 0.2-4.0-micro and 0.55-0.85-micro portions of the electromagnetic spectrum were investigated. Results indicate that the reflectance characteristics of most of the surface types measured are anisotropic. The anisotropy is dependent on the type of surface and the angles of incidence and reflection. In general, the anisotropy increases with increasing solar zenith angle. Clouds and forests show similar reflectance patterns, with forward and backward scattering peaks. Ocean surfaces yield a pattern similar to those of the clouds and forests but with an additional peak which is associated with sun glitter. Reflectances measured in the 0.2-4.0-micro band are generally lower than those in the 0.55-0.85-micro band under cloudy conditions. Anisotropy and spectral bandwidth should be accounted for when computing the albedo of the earth from narrow field-of-view measurements from satellites; otherwise, large errors may be expected to occur.
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