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Hindi N, Razak A, Rosenbaum E, Jonczak E, Hamacher R, Rutkowski P, Bhadri VA, Skryd A, Brahmi M, Alshibany A, Jagodzinska-Mucha P, Bauer S, Connolly E, Gelderblom H, Boye K, Henon C, Bae S, Bogefors K, Vincenzi B, Martinez-Trufero J, Lopez-Martin JA, Redondo A, Valverde C, Blay JY, Moura DS, Gutierrez A, Tap W, Martin-Broto J. Efficacy of immune checkpoint inhibitors in alveolar soft-part sarcoma: results from a retrospective worldwide registry. ESMO Open 2023; 8:102045. [PMID: 38016251 PMCID: PMC10698259 DOI: 10.1016/j.esmoop.2023.102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Conventional cytotoxic drugs are not effective in alveolar soft-part sarcoma (ASPS). Immune checkpoint (programmed cell death protein 1/programmed death-ligand 1) inhibitors (ICIs) are promising drugs in ASPS. A worldwide registry explored the efficacy of ICI in ASPS. MATERIALS AND METHODS Data from adult patients diagnosed with ASPS and treated with ICI for advanced disease in expert sarcoma centers from Europe, Australia and North America were retrospectively collected, including demographics and data related to treatments and outcome. RESULTS Seventy-six ASPS patients, with a median age at diagnosis of 25 years (range 3-61 years), were registered. All patients received ICI for metastatic disease. Immunotherapy regimens consisted of monotherapy in 38 patients (50%) and combination in 38 (50%) (23 with a tyrosine kinase inhibitor). Among the 68 assessable patients, there were 3 complete responses and 34 partial responses, translating into an overall response rate of 54.4%. After a median follow-up of 36 months [95% confidence interval (CI) 32-40 months] since the start of immunotherapy, 45 (59%) patients have progressed on ICI, with a median progression-free survival (PFS) of 16.3 months (95% CI 8-25 months). Receiving ICI in first line (P = 0.042) and achieving an objective response (P = 0.043) correlated with a better PFS. Median estimated overall survival (OS) from ICI initiation has not been reached. The 12-month and 24-month OS rates were 94% and 81%, respectively. CONCLUSIONS This registry constitutes the largest available series of ASPS treated with ICI. Our results suggest that the ICI treatment provides long-lasting disease control and prolonged OS in patients with advanced ASPS, an ultra-rare entity with limited active therapeutic options.
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Affiliation(s)
- N Hindi
- Medical Oncology Department, Fundacion Jimenez Diaz University Hospital and Hospital General de Villalba, Madrid; Instituto de Investigación Sanitaria-Fundación Jimenez Díaz-UAM (IIS-FJD-UAM), Madrid, Spain.
| | - A Razak
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - E Rosenbaum
- Memorial Sloan Kettering Cancer Center, New York
| | - E Jonczak
- Department of Hematology Oncology, Miami University, Miami, USA
| | - R Hamacher
- Medical Oncology Department, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - P Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - V A Bhadri
- Medical Oncology Department, Chris O Brien Lifehouse, Sydney, Australia
| | - A Skryd
- Miller School of Medicine, University of Miami, Miami, USA
| | - M Brahmi
- Centre Leon Berard & University Claude Bernard Lyon 1, Lyon, France
| | - A Alshibany
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - P Jagodzinska-Mucha
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - S Bauer
- Medical Oncology Department, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - E Connolly
- Medical Oncology Department, Chris O Brien Lifehouse, Sydney, Australia
| | - H Gelderblom
- Medical Oncology Department, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Institute for Cancer Research, Oslo University Hospital, Oslo; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - C Henon
- Medical Oncology Department, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - S Bae
- Medical Oncology Department, Peter Mac Callum Center, Melbourne, Australia
| | - K Bogefors
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
| | - B Vincenzi
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
| | - J Martinez-Trufero
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza
| | - J A Lopez-Martin
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Translational Oncology Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid
| | - A Redondo
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, Madrid
| | - C Valverde
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Barcelona
| | - J-Y Blay
- Centre Leon Berard & University Claude Bernard Lyon 1, Lyon, France
| | - D S Moura
- Instituto de Investigación Sanitaria-Fundación Jimenez Díaz-UAM (IIS-FJD-UAM), Madrid, Spain
| | - A Gutierrez
- Hematology Department, Hospital Universitario Son Espases, Palma, Spain
| | - W Tap
- Memorial Sloan Kettering Cancer Center, New York
| | - J Martin-Broto
- Medical Oncology Department, Fundacion Jimenez Diaz University Hospital and Hospital General de Villalba, Madrid; Instituto de Investigación Sanitaria-Fundación Jimenez Díaz-UAM (IIS-FJD-UAM), Madrid, Spain
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Rangaswamy G, Nicholson J, Wallace N, Connolly E, Houlihan O, Monaghan O, Trousdell J, Skourou C, Rohan C, Foley D, Duane FK, O'Neill BD, Thirion P, Cunningham M, Brennan SM, McArdle O. Enhancing Specialist Training in Radiation Oncology through the Implementation of Structured Radiotherapy Contouring Workshops. Int J Radiat Oncol Biol Phys 2023; 117:e538-e539. [PMID: 37785664 DOI: 10.1016/j.ijrobp.2023.06.1829] [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) Contouring tumor volumes and organs at risk is a key component of Radiation Oncology specialist training. As trainees rotate through different tumor sites, they are expected to develop proficiency in contouring skills relevant to their year of training. These skills have historically been acquired in an unstructured manner during supervised clinical work. However, trainees often struggle to learn these skills due to variability in practice and approach amongst senior colleagues. Research has shown that contouring workshops improve the standardization of contouring and can be an effective way of enhancing the learning experience through interaction, instant feedback and reflection. We present our experience of implementing structured contouring workshops and the feedback received from the trainees. MATERIALS/METHODS Eight contouring workshops were held in our institution over a period of 3 years between 2019 and 2022. These included Head & Neck (3), Prostate (1), SABR Lung (2), Breast (1), and Esophagus (1). Six were held in-person pre-COVID and two in a virtual format during the pandemic. Each workshop was 2 hours long and attended by trainees with varying levels of contouring experience. All the workshops were facilitated by a consultant radiation oncologist and a clinical tutor and followed a similar format consisting of a brief tutorial on the tumor site, followed by a contouring demonstration on an anonymized case on an Eclipse planning platform referencing published contouring atlases. Each of the trainees had access to a copy of the same case throughout the workshop and their contours were then reviewed both individually and collectively. A key component of the workshops was instant feedback, as trainees could compare their contours to that of the tutors and discuss any differences. Feedback on the contouring workshop was then collected through a post workshop questionnaire. RESULTS The workshops were attended by an average of 12 trainees (range 10 to 14). Regardless of their year of training, all trainees rated the content and format of the workshops highly and stated they were relevant to their daily practice. Their subjective level of confidence in contouring in that specific tumor site improved significantly, going from an average of 5.6 out of 10 (range of 4 to 7) before the workshop to 8.7 (range of 8 to 9) after the 8 workshops. All the workshops were conducted at no extra cost as they were held using our existing planning software. CONCLUSION The trainees indicated that the workshops were of definite educational benefit and strongly supported incorporating this approach to teaching contouring skills into the curriculum. Based on this feedback, these contouring workshops have been integrated into the recently revised higher specialist training curriculum on a more structured basis. This will ensure that trainees will continue to develop progressive expertise in contouring skills in keeping with best international practice as they advance through their training scheme.
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Affiliation(s)
- G Rangaswamy
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland
| | - J Nicholson
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland
| | - N Wallace
- Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland; Cork University Hospital, Cork, Ireland
| | - E Connolly
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - O Houlihan
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - O Monaghan
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - J Trousdell
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - C Skourou
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - C Rohan
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - D Foley
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - F K Duane
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland
| | - B D O'Neill
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - P Thirion
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland
| | - M Cunningham
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland
| | - S M Brennan
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland
| | - O McArdle
- St.Luke's Radiation Oncology Network, Dublin, Ireland; Faculty of Radiologists and Radiation Oncologists, RCSI, Dublin, Ireland
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Ruderman T, Ferrari G, Valeta F, Boti M, Kumwenda K, Park PH, Ngoga G, Ndarama E, Connolly E, Bukhman G, Adler A. Implementation of self-monitoring of blood glucose for patients with insulin-dependent diabetes at a rural non-communicable disease clinic in Neno, Malawi. S Afr Med J 2023; 113:84-90. [PMID: 36757071 DOI: 10.7196/samj.2023.v113i2.16643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is a widely accepted standard of practice for management of insulin-dependentdiabetes, yet is largely unavailable in rural sub-Saharan Africa (SSA). This prospective cohort study is the first known report ofimplementation of SMBG in a rural, low-income country setting. OBJECTIVES To evaluate adherence and change in clinical outcomes with SMBG implementation at two rural hospitals in Neno, Malawi. METHODS Forty-eight patients with type 1 and insulin-dependent type 2 diabetes were trained to use glucometers and logbooks. Participantsmonitored preprandial glucose daily at rotating times and overnight glucose once a week. Healthcare providers were trained to evaluateglucose trends, and adjusted insulin regimens based on results. Adherence was measured as the frequency with which patients checked anddocumented blood glucose at prescribed times, while clinical changes were measured by change in glycated haemoglobin (HbA1c) over a6-month period. RESULTS Participants brought their glucometers and logbooks to the clinic 95 - 100% of the time. Adherence with measuring glucose valuesand recording them in logbooks eight times a week was high (mean (standard deviation) 69.4% (15.7) and 69.0% (16.6), respectively). MeanHbA1c decreased from 9.0% (75 mmol/mol) at enrolment to 7.8% (62 mmol/mol) at 6 months (mean difference 1.2% (95% confidenceinterval (CI) 0.6 - 2.0; p=0.0005). The difference was greater for type 1 diabetes (1.6%; 95% CI 0.6 - 2.7; p=0.0031) than for type 2 diabetes(0.9%; 95% CI 0.1 - 1.9; p=0.0630). There was no documented increase in hypoglycaemic events, and no hospitalisations or deaths occurred. CONCLUSION SMBG is feasible for patients with insulin-dependent diabetes in a rural SSA population, and may be associated with improvedHbA1c levels. Despite common misconceptions, all patients, regardless of education level, can benefit from SMBG. Further research onlong-term retention of SMBG activities and the benefits of increasing frequency of monitoring is warranted.
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Affiliation(s)
| | - G Ferrari
- NCD Synergies project, Partners in Health, Boston, Mass., USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Mass., USA.
| | - F Valeta
- Partners in Health, Neno, Malawi.
| | - M Boti
- Partners in Health, Neno, Malawi.
| | | | - P H Park
- NCD Synergies project, Partners in Health, Boston, Mass., USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Mass., USA; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Mass., USA.
| | - G Ngoga
- NCD Synergies project, Partners in Health, Boston, Mass., USA; Noncommunicable Disease Program, Partners in Health, Rwanda; Non-Communicable Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.
| | - E Ndarama
- Ministry of Health and Populations, Neno, Malawi.
| | - E Connolly
- Partners in Health, Neno, Malawi; Division of Pediatrics, University of Cincinnati College of Medicine, Ohio, USA; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio, USA.
| | - G Bukhman
- NCD Synergies project, Partners in Health, Boston, Mass., USA; ivision of Global Health Equity, Brigham and Women's Hospital, Boston, Mass., USA; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Mass., USA.
| | - A Adler
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Mass., USA.
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Murphy C, Duggan E, Knight S, Davis J, Zuniga RG, Connolly E, Kenny RA, McCarthy S, Romero-Ortuno R. 34 RELATIONSHIP BETWEEN SERUM CAROTENOID CONCENTRATIONS AND FRAILTY, PROBABLE SARCOPENIA, AND PHYSICAL FUNCTION IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA). Age Ageing 2022. [DOI: 10.1093/ageing/afac218.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Lutein and zeaxanthin are antioxidant and anti-inflammatory carotenoids derived from foods such as fruit and vegetables. Serum concentrations of Lutein (Ls) and Zeaxanthin (Zs) reflect habitual dietary intake. This study examined the cross-sectional and longitudinal relationships between Ls and Zs and frailty, probable sarcopenia, and indices of physical function in TILDA.
Methods
The cross-sectional analysis included n=4672 community-dwelling adults aged ≥50 years with Ls and Zs at Wave 1 (2010). For the longitudinal analyses, changes in usual gait speed (at Wave 3, 2014), grip strength (Wave 4, 2016) and Timed Up-and-Go (TUG; Wave 5, 2018), incident probable sarcopenia (defined as grip strength <27 kg in men, <16 kg in women, at Wave 4) and incident frailty (Fried, at Wave 5) were determined. Multivariable linear and logistic regression analyses were adjusted for age, sex, waist circumference, education, malnutrition, smoking, chronic disease, alcohol intake and physical activity.
Results
Cross-sectionally, Ls and Zs were positively associated with gait speed (B [95% CI] per 100-nmol/L higher concentration: Ls 0.67 [0.22, 1.12], Zs 1.3 [0.21, 2.48] cm/s) and inversely associated with TUG time (Ls –0.07 [-0.11, –0.02], Zs –0.14 [-0.25, –0.03] s) and with frailty (OR: Ls 0.61 [0.42, 0.87], Zs 0.23 [0.08, 0.68]), all p <0.05), but not with grip strength or probable sarcopenia. Longitudinally, Ls was inversely associated incident frailty (OR 0.85 [0.04, 0.84], p=0.03), whereas Zs was not (0.83 [0.56, 1.23], p=0.36). Neither Ls or Zs were related to changes in physical function measures or incident probable sarcopenia (p>0.05).
Conclusion
Cross-sectionally, lower Ls and Zs were independently associated with frailty, slower gait speed and worse TUG performance. However, Wave 1 Ls and Zs were not predictive of changes in these outcomes over 4-8 years of follow up, with the exception of Ls which was inversely associated with incident frailty after 8 years.
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Affiliation(s)
- C Murphy
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Teagasc Food Research Centre , Dublin, Ireland
| | - E Duggan
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - S Knight
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - J Davis
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - RG Zuniga
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - E Connolly
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - RA Kenny
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - S McCarthy
- Teagasc Food Research Centre , Dublin, Ireland
| | - R Romero-Ortuno
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
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Dyer A, Noonan C, Reddy C, Garcia L, Batten I, McElheron M, Roche N, Connolly E, Boran G, White M, Pelleau S, Leonard A, O'Neill D, Fallon A, O'Farrelly C, Bourke N, Kennelly S. 16 SARS-COV-2 INFECTION AND VACCINATION PATTERNS DETERMINE LONG-TERM ANTIBODY RESPONSES IN NURSING HOME RESIDENTS: DATA FROM NH-COVAIR. Age Ageing 2022. [PMCID: PMC9620582 DOI: 10.1093/ageing/afac218.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Older Nursing Home Residents (NHRs) are at greatest risk of morbidity and mortality from SARS-CoV-2, particularly in the context of both waning vaccine efficacy and the emergence of Variants-of-Concern (VOCs). However, the determinants of long-term vaccine-induced protective antibody responses are yet to be determined in this group. Methods NH-COVAIR recruited older NHRs for comprehensive clinical and frailty (NH-FRAIL) assessment. Blood samples were obtained pre-vaccination, at 6-weeks and 6-months following primary vaccination and 6-months following booster vaccination. Antibody titres were measured using both an electrochemiluminescence assay and a custom bead-based array (Luminex™) to measure antibody titre and avidity for Wuhan strain/major VOC antigens. Stepwise adjusted linear regression (log-transformed) assessed longitudinal determinants of vaccine-induced antibody responses. Results Of 86 participants (81.1 ± 10.8 years; 65% female), just under half (45.4%) had evidence of previous SARS-CoV-2 infection. All NHRs mounted a significant antibody-response to vaccination at 5 weeks followed by a significant decrease in antibody titre by 6 months. Previous SARS-CoV-2 infection was the strongest predictor of antibody waning at all timepoints (β: 3.59; 2.89, 4.28; P < 0.001 for 6-months). Independent of infection history, both age (β: –0.05; –0.08, –0.02; p<0.001) and frailty (β: –0.22; –0.33, –0.11; p<0.001) were associated with faster antibody waning at 6-months. Cross-reactivity and avidity were significantly lower for Beta (B.1.351) and Gamma (P.1) VOC strains (all p<0.001). Additionally, there was faster antibody waning and significantly reduced antibody avidity to Beta and Gamma VOCs in SARS-CoV-2 naïve NHRs. Conclusion Older NHRs are capable of mounting protective antibody responses to SARS-CoV-2 vaccination. Responses were more durable, with a greater cross-reactivity to and avidity for VOCs in those with previous SARS-CoV-2 infection. Increasing age and greater frailty in NHRs was associated with faster antibody waning. Our findings support ongoing serological surveillance and use of additional vaccine doses in older NHRs, particularly in those without previous SARS-CoV-2 exposure.
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Affiliation(s)
- A Dyer
- Tallaght University Hospital Age-Related Healthcare, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - C Noonan
- Tallaght University Hospital Age-Related Healthcare, , Dublin, Ireland
| | - C Reddy
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - L Garcia
- Infectious Diseases Epidemiology and Analytics Unit, Institut Pastuer , Paris, France
| | - I Batten
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - M McElheron
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - N Roche
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - E Connolly
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - G Boran
- Tallaght University Hospital Department of Clinical Biochemistry, , Dublin, Ireland
| | - M White
- Infectious Diseases Epidemiology and Analytics Unit, Institut Pastuer , Paris, France
| | - S Pelleau
- Infectious Diseases Epidemiology and Analytics Unit, Institut Pastuer , Paris, France
| | - A Leonard
- Tallaght University Hospital Department of Clinical Biochemistry, , Dublin, Ireland
| | - D O'Neill
- Tallaght University Hospital Age-Related Healthcare, , Dublin, Ireland
| | - A Fallon
- Tallaght University Hospital Age-Related Healthcare, , Dublin, Ireland
| | - C O'Farrelly
- Trinity College Dublin Comparative Immunology, , Dublin, Ireland
| | - N Bourke
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - S Kennelly
- Tallaght University Hospital Age-Related Healthcare, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
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Connolly E, Reidy C, Murphy A, Pope G, Cooke J, Bambrick P, O'Regan N, Mulcahy R. 298 AN AUDIT OF HEALTH PROFESSIONALS’ KNOWLEDGE OF PARKINSON’S DISEASE AND ITS MEDICATION MANAGEMENT FOR HOSPITALISED PATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Studies have shown that patients with Parkinson’s Disease (PD) have a higher rate of hospitalisation and longer lengths of stay than their age matched controls. Good inpatient management is key to maintaining functional ability and preventing complications, but many PD patients deteriorate while in hospital. Patients with PD are often on multiple time sensitive medications. This study aims to assess healthcare workers knowledge of PD, medications used to treat it and how they should be prescribed and administered.
Methods
A convenience sample survey was distributed to doctors, nurses and other health care professionals over a five-week period. This survey included multiple choice questions and open-ended short answer questions. Results were collated and analysed on Microsoft Excel.
Results
71 surveys were returned - 34 from doctors, 23 from nurses and the 14 others included pharmacists, physios and dieticians. Only 11 (15%) participants correctly identified all PD medications listed in the survey with Sinemet being the most recognised drug (n= 68). Non motor symptoms of PD correctly identified by participants included constipation (n=54, 76%), hallucinations (n=48, 68%) and anosmia (n=18, 25%). 32 participants (45%) were unable to correctly identify when to administer PD medications in relation to mealtimes. 29 participants surveyed (41%) would consider inserting a nasogastric tube for a patient who was fasting and unable to take oral medications. 12 participants (17%) did not know that Sinemet could be given via nasogastric tube.
Conclusion
This survey highlights a gap in knowledge of Parkinson’s Disease and its management. Participants displayed poor knowledge regarding optimum timing of medication administration and management of patients who are fasting. These findings suggest that education sessions and hospital specific guidelines regarding the management and administration of PD medications would assist healthcare professionals with a view to improving patient outcomes and preventing complications.
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Affiliation(s)
- E Connolly
- University Hospital Waterford , Waterford, Ireland
| | - C Reidy
- University Hospital Waterford , Waterford, Ireland
| | - A Murphy
- University Hospital Waterford , Waterford, Ireland
| | - G Pope
- University Hospital Waterford , Waterford, Ireland
| | - J Cooke
- University Hospital Waterford , Waterford, Ireland
| | - P Bambrick
- University Hospital Waterford , Waterford, Ireland
| | - N O'Regan
- University Hospital Waterford , Waterford, Ireland
| | - R Mulcahy
- University Hospital Waterford , Waterford, Ireland
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Davey N, Connolly E, McFeely A, Bambrick P, Pope G, Mulcahy R, Cooke J, O'Regan N. 286 PERCEPTIONS OF RESEARCH AMONGST OLDER ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Older adults are often excluded from healthcare research, particularly those with cognitive impairment. It is crucial that study participants have given informed consent and partake in research of their own free will. People with cognitive impairment are not always able to engage in the informed consent process. This can lead to under-representation of this cohort in studies. Understanding older people’s perceptions of research is important to better design policies and research studies that are inclusive of older adults. This pilot study aimed to gain a better understanding of older adults’ views about healthcare research and what they imagine their wishes would be if they were unable to consent themselves due to memory problems.
Methods
In this prospective observational study, participants were recruited from outpatient clinics. Consenting participants were surveyed over the phone to ascertain their perceptions of healthcare research.
Results
Twenty-five interviews were conducted. Median age was 76.24 years (range 68-85 years). Most respondents reached at least second level education (80%), and most volunteered knowing very little about healthcare research. All participants had a nominated next of kin. Of 23 participants who had not previously been involved in healthcare research, none had been asked to do so.
Most participants would be interested or very interested in participating in research if the study involved either survey questions (64%), chart review (88%), or additional investigations (68%), however only a minority were interested or very interested in partaking in research involving a trial drug (16%). Most participants (88%) would be happy or very happy for their next of kin to ‘consent’ on their behalf (if they themselves were unable to do so).
Conclusion
In this study, older adults had clear views about healthcare research and a keenness to participate. This group of older adults expressed trust in their next of kin to make decisions on their behalf regarding research participation. More research is required to explore this area further.
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Affiliation(s)
- N Davey
- University Hospital Waterford , Waterford, Ireland
| | - E Connolly
- University Hospital Waterford , Waterford, Ireland
| | - A McFeely
- Tallaght University Hospital , Dublin, Ireland
| | - P Bambrick
- University Hospital Waterford , Waterford, Ireland
| | - G Pope
- University Hospital Waterford , Waterford, Ireland
| | - R Mulcahy
- University Hospital Waterford , Waterford, Ireland
| | - J Cooke
- University Hospital Waterford , Waterford, Ireland
| | - N O'Regan
- University Hospital Waterford , Waterford, Ireland
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8
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Connolly E, Doyle SL, Kenny RA, Romero-Ortuno R. 27 ASSOCIATIONS BETWEEN ORTHOSTATIC BLOOD PRESSURE BEHAVIOUR AND PROGRESSION OF AGE-RELATED MACULAR DEGENERATION IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA). Age Ageing 2022. [DOI: 10.1093/ageing/afac218.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Age-Related Macular Degeneration (AMD) is a progressive disease and the leading cause of vision loss in over 50’s in developed countries. Age-related changes in the neuro-cardiovascular system, at times manifesting as exaggerated blood pressure drops on standing (orthostatic hypotension) may be associated with end-organ damage. The aim of this study was to examine if the pattern of recovery of blood pressure upon standing from a supine position (orthostatic blood pressure behaviour), was associated with progression of AMD.
Methods
We utilised data from TILDA participants who had AMD at the wave 1 health assessment and returned for retinal image grading during the wave 3 health assessment, four years later. Beat-to-beat BP data was measured non-invasively by digital photoplethysmography (Finometer® MIDI) during the wave 1 Active Stand (AS) test. Measures recorded during AS included Systolic (SBP) and Diastolic (DBP) blood pressure. Associations between systolic and diastolic orthostatic BP behaviour and AMD progression were examined using generalised linear models (GLM). Baseline characteristics were compared between progression groups with the 2-samples Mann-Whitney U test and the Chi-squared test.
Results
Of the 191 included participants, 46 (24%) were found to have progression of AMD, while 145 (76%) had no change or regression of the disease. GLMs revealed no significant differences in SBP orthostatic behaviour across groups. However, those with AMD progression had lower orthostatic DBP values (tests of between-subjects effects p=0.005), particularly between 30-60 seconds post-stand (AMD progression: 72±10mmHg vs. No AMD progression: 79±12mmHg; p<0.001). Of the baseline participant characteristics considered, only age was associated with AMD progression (AMD progression: 66±8yrs vs. No AMD progression: 62±9yrs; p=0.005).
Conclusion
In this sample of TILDA participants with AMD, lower orthostatic DBP values were associated with AMD progression over four years. Reduced orthostatic diastolic perfusion may be a novel modifiable risk factor for AMD progression.
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Affiliation(s)
- E Connolly
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - SL Doyle
- Trinity College Dublin Department of Clinical Medicine, School of Medicine, , Dublin, Ireland
| | - RA Kenny
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - R Romero-Ortuno
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
- Trinity College Dublin Global Brain Health Institute, , Dublin, Ireland
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9
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Smrke A, Frezza AM, Giani C, Somaiah N, Brahmi M, Czarnecka AM, Rutkowski P, Van der Graaf W, Baldi GG, Connolly E, Duffaud F, Huang PH, Gelderblom H, Bhadri V, Grimison P, Mahar A, Stacchiotti S, Jones RL. Systemic treatment of advanced clear cell sarcoma: results from a retrospective international series from the World Sarcoma Network. ESMO Open 2022; 7:100522. [PMID: 35717681 PMCID: PMC9271493 DOI: 10.1016/j.esmoop.2022.100522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Clear cell sarcoma (CCS) is a translocated aggressive malignancy with a high incidence of metastases and poor prognosis. There are few studies describing the activity of systemic therapy in CCS. We report a multi-institutional retrospective study of the outcomes of patients with advanced CCS treated with systemic therapy within the World Sarcoma Network (WSN). Materials and methods Patients with molecularly confirmed locally advanced or metastatic CCS treated with systemic therapy from June 1985 to May 2021 were included. Baseline demographic and treatment information, including response by Response Evaluation Criteria in Solid Tumours (RECIST) 1.1, was retrospectively collected by local investigators. Descriptive statistics were carried out. Results Fifty-five patients from 10 institutions were included. At diagnosis, the median age was 30 (15-73) years and 24% (n = 13/55) had metastatic disease. The median age at diagnosis was 30 (15-73) years. Most primary tumours were at aponeurosis (n = 9/55, 16%) or non-aponeurosis limb sites (n = 17/55, 31%). The most common fusion was EWSR1–ATF1 (n = 24/55, 44%). The median number of systemic therapies was 1 (range 1-7). The best response rate was seen for patients treated with sunitinib (30%, n = 3/10), with a median progression-free survival of 4 [95% confidence interval (CI) 1-7] months. The median overall survival for patients with advanced/metastatic disease was 15 months (95% CI 3-27 months). Conclusions Soft tissue sarcoma-type systemic therapies have limited benefit in advanced CCS and response rate was poor. International, multicentre prospective translational studies are required to identify new treatments for this ultra-rare subtype, and access to early clinical trial enrolment remains key for patients with CCS. This is the largest reported series of advanced CCS patients treated with systemic therapy. The activity of sarcoma-type systemic therapy is poor and modest responses were seen only with sunitinib. Effective therapies are needed to improve outcomes for patients with this ultra-rare sarcoma type.
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Affiliation(s)
- A Smrke
- The Royal Marsden Hospital NHS Foundation Trust, London, UK; BC Cancer, Vancouver, Canada
| | - A M Frezza
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Giani
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - N Somaiah
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Brahmi
- Centre Leon Berard, Lyon, France
| | - A M Czarnecka
- Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - P Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | | | - G G Baldi
- Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - E Connolly
- Chris O'Brien Lifehouse, Camperdown, Australia
| | - F Duffaud
- La Timone Hospital and Aix-Marseille University (AMU), Marseilles, France
| | - P H Huang
- Institute of Cancer Research, London, UK
| | - H Gelderblom
- Leiden University Medical Center, Leiden, The Netherlands
| | - V Bhadri
- Chris O'Brien Lifehouse, Camperdown, Australia
| | - P Grimison
- Chris O'Brien Lifehouse, Camperdown, Australia
| | - A Mahar
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - S Stacchiotti
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - R L Jones
- The Royal Marsden Hospital NHS Foundation Trust, London, UK.
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10
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Breslin L, Connolly E, Lavan A, Kenny RA, Briggs R. 165 WHAT FACTORS ARE ASSOCIATED WITH ADVANCED CARE PLANNING IN COMMUNITY-DWELLING OLDER PEOPLE? Age Ageing 2021. [DOI: 10.1093/ageing/afab219.165] [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: 02/25/2023] Open
Abstract
Abstract
Background
Advance Care Planning (ACP) involves expressing wishes regarding your future medical care and/or preferences about your end-of-life in the event of serious illness.
The aim of this study was to clarify the proportion of community-dwelling older people who engage in ACP and what factors are independently associated with ACP.
Methods
Participants aged ≥60 years (n = 4,831, mean age 71 years) at Wave 4 of the Irish Longitudinal Study on Ageing were asked: Have you made your wishes/preferences known about the kind of care that you would like to receive in the event of serious illness? If yes, they were asked if this had been documented informally (family/carers or medical professionals) or formally (by written advanced care plan).
Logistic regression models assessed the association of covariates of interest with ACP.
Results
One quarter of the study sample (1,153/4,831) had an ACP. Only 10% (119/1,153) had ACP documented in writing, while only 2% (27/1,153) had discussed ACP with a healthcare professional.
Age ≥ 80 years (OR 1.63 (1.31–2.02)), female sex (OR 1.58 (1.37–1.83)), higher educational attainment (OR 1.42 (1.18–1.71), poorer self-rated health (OR 1.58 (1.04–2.39) and lower levels of religiosity (OR 1.50 (1.03–2.19) were independently associated with ACP.
Conclusion
While ACP may have benefits in extending autonomy and facilitating decision-making, only 1 in 4 of this population-representative sample of older people had engaged in ACP, with only 1 in 50 having their ACP documented in writing.
Further work is therefore required to educate the public and healthcare professionals regarding the benefits of ACP.
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Affiliation(s)
- L Breslin
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
| | - E Connolly
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
| | - A Lavan
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
| | - R A Kenny
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
- The Irish Longitudinal Study on Ageing , Dublin, Ireland
| | - R Briggs
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
- The Irish Longitudinal Study on Ageing , Dublin, Ireland
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11
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Polus M, Hanhauser Y, McGarrigle S, Spillane C, Byrne N, Prizeman G, Drury A, Connolly E, Brady AM. CN19 BRCA mutation carriers’ and stakeholders’ perspectives on cancer risk management and decision-making: A qualitative study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Hare D, Coates C, Kelly M, Cottrell E, Connolly E, Muldoon EG, O' Connell B, Rogers TR, Talento AF. Antifungal stewardship in critical care: Implementing a diagnostics-driven care pathway in the management of invasive candidiasis. Infect Prev Pract 2020; 2:100047. [PMID: 34368697 PMCID: PMC8336030 DOI: 10.1016/j.infpip.2020.100047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/08/2020] [Indexed: 12/01/2022] Open
Abstract
Background Invasive candidiasis (IC) is the most common invasive fungal disease in patients admitted to critical care and is associated with high mortality rates. Diagnosis can be delayed by the poor sensitivity of culture-based methods, leading to unnecessary use of empirical antifungal therapy (EAFT). The fungal biomarker (1–3)-β-d-glucan (BDG) has been shown to aid in the diagnosis of IC in critical care and has been incorporated into antifungal stewardship (AFS) programmes. Aim To describe our experience using a diagnostics-driven AFS programme incorporating the fungal biomarker BDG, analyse its impact on antifungal therapy (AFT), and gain an improved understanding of the epidemiology of IC in our critical care unit (CrCU). Methods An AFS care pathway incorporating BDG was introduced in the CrCU in St James's Hospital, Dublin. Following an educational programme, compliance with the pathway was prospectively audited between December 1st, 2017 and July 31st, 2018. Results and Conclusion One hundred and nine AFT episodes were included, of which 95 (87%) had a BDG sent. Of those with BDG results available at the time of decision-making, 38 (63%) were managed in accordance with the care pathway. In compliant episodes without IC, median EAFT duration was 5.5 days [IQR 4–7] and no increase in mortality or subsequent IC was observed. Although adopting a diagnostics-driven approach was found to be useful in the cohort of patients with BDG results available, the use of once-weekly BDG testing did not result in an observed reduction in the consumption of anidulafungin, highlighting an important limitation of this approach.
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Affiliation(s)
- D Hare
- Department of Microbiology, St James's Hospital, Dublin, Ireland
| | - C Coates
- Department of Microbiology, St James's Hospital, Dublin, Ireland
| | - M Kelly
- Pharmacy Department, St James's Hospital, Dublin, Ireland
| | - E Cottrell
- Pharmacy Department, St James's Hospital, Dublin, Ireland
| | - E Connolly
- Department of Critical Care and Anaesthesia, St James's Hospital, Dublin, Ireland
| | - E G Muldoon
- Department of Infectious Disease, Mater Misericordiae University Hospital, Dublin, Eccles St, Dublin, Ireland
| | - B O' Connell
- Department of Microbiology, St James's Hospital, Dublin, Ireland
| | - T R Rogers
- Department of Microbiology, St James's Hospital, Dublin, Ireland.,Department of Clinical Microbiology, Trinity College Dublin, Ireland
| | - A F Talento
- Department of Microbiology, St James's Hospital, Dublin, Ireland
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13
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Jones DJ, Baldwin C, Lal S, Stanmore E, Farrer K, Connolly E, Weekes CE, Anderson L, Murphy J, Gillespie L, Welsh N, Ogden M, McDevitt M, Day R, Lynne S, Paulden P, Gronlund T, Burden ST. Priority setting for adult malnutrition and nutritional screening in healthcare: a James Lind Alliance. J Hum Nutr Diet 2019; 33:274-283. [DOI: 10.1111/jhn.12722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- D. J. Jones
- Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - C. Baldwin
- Department of Nutritional Sciences Kings College London London UK
| | - S. Lal
- Salford Royal Foundation Trust Salford UK
| | - E. Stanmore
- Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - K. Farrer
- NHS Salford CCG St James House Salford UK
| | | | - C. E. Weekes
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - L. Anderson
- Buckinghamshire Healthcare NHS Trust Stoke Mandeville Hospital Aylesbury Bucks UK
| | - J. Murphy
- Bournemouth University Bournemouth UK
| | | | - N. Welsh
- Manchester University NHS Foundation Trust Manchester UK
| | - M. Ogden
- Patient and Carer Involvement/Representatives Manchester UK
| | - M. McDevitt
- Patient and Carer Involvement/Representatives Manchester UK
| | - R. Day
- Patient and Carer Involvement/Representatives Manchester UK
| | - S. Lynne
- Patient and Carer Involvement/Representatives Manchester UK
| | - P. Paulden
- Patient and Carer Involvement/Representatives Manchester UK
| | | | - S. T. Burden
- Faculty of Biology, Medicine and Health University of Manchester Manchester UK
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14
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Connolly E, Rangaswamy G, Boychek O, Gillham C, McArdle O. EP-1500 Squamous Cell Carcinoma of unknown primary (CUP) in the Pelvis:A case series and review of literature. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31920-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Marks DK, Gartrell RD, Pan Q, El Asmar M, Hart TD, Esancy CL, Lu Y, Yu J, Hibshoosh H, Connolly E, Kalinsky K, Saenger YM. Abstract P2-03-01: Akt inhibition associated with change in immunophenotype of tumor microenvironment (TME) in breast cancer (BC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-03-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The PI3K/Akt/mTOR pathway is a known oncogenic pathway in BC. In addition, this pathway has demonstrated capacity to modulate host immune activity and may indirectly affect tumorigenesis. Clinicopathologic studies have demonstrated that lymphocyte density within the TME is predictive of chemosensitivity and improved prognosis in BC, while myeloid infiltration may play a deleterious role. To define the impact of Akt inhibition on the TME, we analyzed tumor tissue from patients (pts) with early-stage BC treated with single agent MK-2206, an Akt inhibitor, enrolled on a presurgical trial (NCT01319539).
Methods: Quantitative immunofluorescence (qmIF) was performed for CD3, CD8, CD4, FOXP3, CD68, Pancytokeratin on 4uM sections from biopsy and surgical specimens of MK-2206 (n=5) and control (n=5) pts. Images were analyzed using Vectra/inForm software (PerkinElmer), allowing for multiparameter phenotyping. Transcriptomic analysis was performed on surgical specimens to assess if differences exist in mRNA expression of tumor-associated and immune genes between pts treated with MK-2206 (n=5) and untreated matched controls (n=5) (nanoString). Statistical analysis was performed using t-Test, NetBID, and multiple comparison analysis by Benjamini-Hochberg. Gene set enrichment analysis (GSEA) was performed within R with gene sets from Molecular Signatures Database (Hallmark, Reactome, GO).
Results: On qmIF analysis, MK-2206 treated pts exhibited a significant increase in median cytotoxic T-cell (CD3+CD8+, CTL) density between pretreatment biopsy and surgical excision specimens, as compared to the control pts (87% vs.0.2%, p < 0.05). Mean macrophage density (CD68+) was numerically lower in surgical specimens of pts who received MK-2206 vs. control pts, although CD68+ infiltration was overall low (p=ns). mRNA expression supports in vivo activity of MK-2206 with lower expression levels of cell cycle, proliferation and anti-apoptotic genes (e.g. CTNNB1, CCND2, BAX) and greater expression of pro-apoptotic genes (e.g. BAD) associated with MK-2206 treatment (raw p-value <0.05). Additionally, greater mRNA copy number of IGF1R, a receptor tyrosine kinase (RTK) previously identified as upregulated in BC in the context of Akt inhibition, was found in post-MK-2206 surgical specimens as compared to control, non-MK-2206 specimens (raw p-value <0.05). MK-2206 was also associated with reduced expression of myeloid markers (e.g. CSF1R, CD163) (raw p-value <0.05). By GSEA, canonical gene sets related to interferon signaling were increased in post-MK-2206 specimens as compared to non-MK-2206 specimens, whereas monocyte chemotaxis genes were decreased in treated pts (adj p-value <0.05). RT-PCR is currently underway to compare biopsy and surgical specimens for a subset of RTK, immune and apoptosis related genes identified above.
Conclusion: mRNA and qmIF analysis suggest that Akt inhibition, may increase interferon signaling, CTL density, and decrease myeloid infiltration. Thus, Akt inhibition may promote a favorable TME. At present, there are both FDA approved and investigational agents that target the PI3K/mTOR pathway. Further investigation is warranted to understand the impact of Akt inhibition on the TME and potential therapeutic implications.
Citation Format: Marks DK, Gartrell RD, Pan Q, El Asmar M, Hart TD, Esancy CL, Lu Y, Yu J, Hibshoosh H, Connolly E, Kalinsky K, Saenger YM. Akt inhibition associated with change in immunophenotype of tumor microenvironment (TME) in breast cancer (BC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-03-01.
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Affiliation(s)
- DK Marks
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - RD Gartrell
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - Q Pan
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - M El Asmar
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - TD Hart
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - CL Esancy
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - Y Lu
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - J Yu
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - H Hibshoosh
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - E Connolly
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - K Kalinsky
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
| | - YM Saenger
- Columbia University Irving Medical Center, New York, NY; Columbia University, New York, NY; St. Jude Children's Research Hospital, Memphis, TN
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16
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Connolly E, Nordman I, Mallesara G. P3.01-20 Advanced NSCLC Treatment and Outcomes After Nivolumab. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Kalinsky K, Sparano JA, Zhong X, Andreopoulou E, Taback B, Wiechmann L, Feldman SM, Ananthakrishnan P, Ahmad A, Cremers S, Sireci AN, Cross JR, Marks DK, Mundi P, Connolly E, Crew KD, Maurer MA, Hibshoosh H, Lee S, Hershman DL. Pre-surgical trial of the AKT inhibitor MK-2206 in patients with operable invasive breast cancer: a New York Cancer Consortium trial. Clin Transl Oncol 2018; 20:1474-1483. [PMID: 29736694 DOI: 10.1007/s12094-018-1888-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/26/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The PI3K/AKT/mTOR pathway is an oncogenic driver in breast cancer (BC). In this multi-center, pre-surgical study, we evaluated the tissue effects of the AKT inhibitor MK-2206 in women with stage I-III BC. MATERIALS AND METHODS Two doses of weekly oral MK2206 were administered at days - 9 and - 2 before surgery. The primary endpoint was reduction of pAktSer473 in breast tumor tissue from diagnostic biopsy to surgery. Secondary endpoints included changes in PI3K/AKT pathway tumor markers, tumor proliferation (ki-67), insulin growth factor pathway blood markers, pharmacokinetics (PK), genomics, and MK-2206 tolerability. Paired t tests were used to compare biomarker changes in pre- and post-MK-2206, and two-sample t tests to compare with prospectively accrued untreated controls. RESULTS Despite dose reductions, the trial was discontinued after 12 patients due to grade III rash, mucositis, and pruritus. While there was a trend to reduction in pAKT after MK-2206 (p = 0.06), there was no significant change compared to controls (n = 5, p = 0.65). After MK-2206, no significant changes in ki-67, pS6, PTEN, or stathmin were observed. There was no significant association between dose level and PK (p = 0.11). Compared to controls, MK-2206 significantly increased serum glucose (p = 0.02), insulin (p < 0.01), C-peptide (p < 0.01), and a trend in IGFBP-3 (p = 0.06). CONCLUSION While a trend to pAKT reduction after MK-2206 was observed, there was no significant change compared to controls. However, the accrued population was limited, due to toxicity being greater than expected. Pre-surgical trials can identify in vivo activity in the early drug development, but side effects must be considered in this healthy population.
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Affiliation(s)
- K Kalinsky
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.
| | - J A Sparano
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA
| | - X Zhong
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | | | - B Taback
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, USA
| | - L Wiechmann
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, USA
| | - S M Feldman
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA
| | | | - A Ahmad
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - S Cremers
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - A N Sireci
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - J R Cross
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - D K Marks
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
| | - P Mundi
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
| | - E Connolly
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - K D Crew
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - M A Maurer
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
| | - H Hibshoosh
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - S Lee
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - D L Hershman
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
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Yu D, Daddacha W, Koyen A, Bastien A, Head P, Dhere V, Nabeta G, Connolly E, Werner E, Madden M, Daly M, Minten E, Whelan D, Zhang H, Anand R, Shepard C, Sundaram R, Deng X, Dynan W, Wang Y, Bindra R, Cejka P, Rothenberg E, Doetsch P, Kim B. OC-0377: Targeting a Novel Function for SAMHD1 in DNA Repair for Radiation Therapy and PARP Inhibition. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Connolly E, Beausang A, Faul C. EP-1230: Molecular Markers as a predictor of Long-term survival in patients with Glioblastoma Multiforme. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31540-8] [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: 11/13/2022]
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Kawonga R, Connolly E, Fisher A, Dunbar E, McMeel L, Kapira S, Wroe E. Does a One Size Fit All Approach Work for Community Management of Acute
Malnutrition in Rural Malawi? Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Mhango J, Fisher A, Connolly E, Uladi B, Gunya D, Nkula G, Mwale N, Maulidi C, Mhango M, Wroe E, Nazimera L. Lessons Learned in Creating a Neonatal Nursery at a District Hospital in
Rural Malawi. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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22
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Connolly E, Mallesara G, Nordman I. Immune related adverse events (irAE) and disease response with nivolumab in pre-treated advanced non-small cell lung cancer (NSCLC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx091.035] [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: 11/14/2022] Open
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McCulloch L, Hébert J, Tcholakov Y, Ashorn M, Blair K, Byrne M, Connolly E, Evert J, Goodman L, Liu T, LoPiccolo M, Perez W, Rhee J, Shen J, Tran T, Wiley E. CUGH Trainee Advisory Committee (TAC) survey: the trainee perspectives in
global health. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kalinsky K, Zheng T, Hibshoosh H, Du X, Mundi P, Yang J, Refice S, Feldman SM, Taback B, Connolly E, Crew KD, Maurer MA, Hershman DL. Proteomic modulation in breast tumors after metformin exposure: results from a "window of opportunity" trial. Clin Transl Oncol 2016; 19:180-188. [PMID: 27305912 DOI: 10.1007/s12094-016-1521-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/19/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE Reverse Phase Protein Array (RPPA) is a high-throughput antibody-based technique to assess cellular protein activity. The goal of this study was to assess protein marker changes by RPPA in tumor tissue from a pre-surgical metformin trial in women with operable breast cancer (BC). METHODS In an open-label trial, metformin 1500-mg PO daily was administered prior to resection in 35 non-diabetic patients with stage 0-III BC, body mass index ≥25 kg/m2. For RPPA, formalin-fixed paraffin-embedded (FFPE) samples were probed with 160 antibodies. Paired and two-sample t-tests were performed (p ≤ 0.05). Multiple comparisons were adjusted for by fixing the false discovery rate at 25 %. We evaluated whether pre- and post-metformin changes of select markers by RPPA were identified by immunohistochemistry (IHC) in these samples. We also assessed for these changes by western blot in metformin-treated BC cell lines. RESULTS After adjusting for multiple comparisons in the 32 tumors from metformin-treated patients vs. 34 untreated historical controls, 11 proteins were significantly different between cases vs. CONTROLS increases in Raptor, C-Raf, Cyclin B1, Cyclin D1, TRFC, and Syk; and reductions in pMAPKpT202,Y204, JNKpT183,pT185, BadpS112, PKC.alphapS657, and SrcpY416. Cyclin D1 change after metformin by IHC was not observed. In cell lines, reductions in JNKpT183 and BadpS112 were seen, with no change in Cyclin D1 or Raptor. CONCLUSIONS These results suggest that metformin modulates apoptosis/cell cycle, cell signaling, and invasion/motility. These findings should be assessed in larger metformin trials. If confirmed, associations between these changes and BC clinical outcome should be evaluated. CLINICALTRIALS. GOV IDENTIFIER NCT00930579.
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Affiliation(s)
- K Kalinsky
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, USA.
| | - T Zheng
- Department of Statistics, Columbia University, New York, USA
| | - H Hibshoosh
- Herbert Irving Comprehensive Cancer Center, Columbia University, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, USA.,Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA
| | - X Du
- Herbert Irving Comprehensive Cancer Center, Columbia University, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, USA
| | - P Mundi
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA
| | - J Yang
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA
| | - S Refice
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA
| | - S M Feldman
- Herbert Irving Comprehensive Cancer Center, Columbia University, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, USA.,Department of Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA
| | - B Taback
- Herbert Irving Comprehensive Cancer Center, Columbia University, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, USA.,Department of Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA
| | - E Connolly
- Herbert Irving Comprehensive Cancer Center, Columbia University, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, USA.,Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA
| | - K D Crew
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, USA.,Department of Epidemiology and Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - M A Maurer
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, USA
| | - D L Hershman
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, USA.,Department of Epidemiology and Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
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Mundi PS, Chen E, Sparano J, Andreopoulou E, Taback B, Wiechmann L, Feldman S, Ananthakrishnan P, Hibshoosh H, Connolly E, Crew K, Maurer M, Hershman DL, Kalinsky K. Abstract P3-07-52: Identification of serum biomarkers associated with Akt inhibitor MK-2206-induced toxicity in a pre-surgical breast cancer (BC) trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The PI3K/Akt/mTOR pathway is an important oncogenic driver in BC. A major hurdle in clinical Akt inhibitor development has been dose-limiting toxicities, such as rash. To facilitate the risk assessment of Akt inhibitor associated toxicity, we hypothesize that circulating biomarkers can be identified in proteins secreted by the tumor or tumor microenvironment and systemic response after treatment. Exosomes are small membrane bound vesicles containing proteins, mRNA, miRNA, and lipids that are secreted from host cells and remain viable after long-term storage of blood. In this study, we focused on identifying biomarkers associated with drug rash from serum exosomes in BC patients treated with the Akt inhibitor MK-2206.
Methods: In an open-label pre-surgical trial, 2 doses of weekly MK2206 were administered to patients (pts) with stage I-III invasive BC: first at day -9 and second at day -2 from surgery. Sera were collected before and after MK2206. 200 μL of serum was used to isolate total exosomes by precipitation and centrifugation, followed by trypsin digestion and multiplexing labeling analysis. The Orbitrap mass spectrometer was used to acquire LC-MS/MS data. 1,053 unique proteins were identified from the uniProt database. Maximum false discovery rate level (FDR) for predictive biomarkers was controlled at 26% (q<0.26). Analysis was conducted on pre-MK-2206 and post-MK-2206 treated sera from pts to develop a protein signature associated with rash and identify candidate biomarkers of MK-2206-associated rash.
Results: The study was discontinued after 12 pts were enrolled due to toxicity. Notably, an acneiform/maculopapular rash was observed in 5 pts. Unsupervised principal component analysis on the pre-MK-2206 specimens and the entire set of 1,053 proteins demonstrated that 4 of the 5 pts with rash formed a distinct cluster. 30 proteins were differentially expressed in pre-MK-2206 samples from pts who developed rash vs. no rash (q<0.26), with ≥1.5 fold difference in expression level in those with rash after MK-2206. Ingenuity pathway analysis revealed statistically significant over-representation of pathways involved in lipid metabolism (including MALRD1, AWAT2), nucleic acid synthesis (PPAT, ADSLL1), and protein synthesis (PPIB). 45 proteins were significantly different in post-MK-2206 samples (q<0.285). Lipid metabolism was the most significantly over-represented pathway in post-MK-2206 samples.
Conclusions: We demonstrated that mass spectrometry-based proteomic analysis of patient-derived serum exosomes is a promising approach to study drug-induced toxicity. We found significant changes of circulating proteins before and after MK-2206. Increased expression of different proteins involved in lipid metabolism appears to predict skin toxicity, commonly seen with PI3K/Akt pathway inhibitors. Since the PI3K/Akt signaling pathway plays a role in physiological regulation of lipid metabolism, lipid metabolic profiles of BC patients might be important for predicting the risk and controlling toxicity induced by Akt inhibitors. These toxicity-associated biomarkers should be validated and then assessed prospectively in clinical trials.
Citation Format: Mundi PS, Chen E, Sparano J, Andreopoulou E, Taback B, Wiechmann L, Feldman S, Ananthakrishnan P, Hibshoosh H, Connolly E, Crew K, Maurer M, Hershman DL, Kalinsky K. Identification of serum biomarkers associated with Akt inhibitor MK-2206-induced toxicity in a pre-surgical breast cancer (BC) trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-52.
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Affiliation(s)
- PS Mundi
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - E Chen
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - J Sparano
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - E Andreopoulou
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - B Taback
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - L Wiechmann
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - S Feldman
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - P Ananthakrishnan
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - H Hibshoosh
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - E Connolly
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - K Crew
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - M Maurer
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - DL Hershman
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - K Kalinsky
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
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Connolly E, Millhouse E, Doyle R, Culshaw S, Ramage G, Moran GP. The Porphyromonas gingivalis hemagglutinins HagB and HagC are major mediators of adhesion and biofilm formation. Mol Oral Microbiol 2016; 32:35-47. [PMID: 28051836 DOI: 10.1111/omi.12151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 11/28/2022]
Abstract
Porphyromonas gingivalis is a bacterium associated with chronic periodontitis that possesses a family of genes encoding hemagglutinins required for heme acquisition. In this study we generated ΔhagB and ΔhagC mutants in strain W83 and demonstrate that both hagB and hagC are required for adherence to oral epithelial cells. Unexpectedly, a double ΔhagB/ΔhagC mutant had less severe adherence defects than either of the single mutants, but was found to exhibit increased expression of the gingipain-encoding genes rgpA and kgp, suggesting that a ΔhagB/ΔhagC mutant is only viable in populations of cells that exhibit increased expression of genes involved in heme acquisition. Disruption of hagB in the fimbriated strain ATCC33277 demonstrated that HagB is also required for stable attachment of fimbriated bacteria to oral epithelial cells. Mutants of hagC were also found to form defective single and multi-species biofilms that had reduced biomass relative to biofilms formed by the wild-type strain. This study highlights the hitherto unappreciated importance of these genes in oral colonization and biofilm formation.
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Affiliation(s)
- E Connolly
- Division of Oral Biosciences, Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - E Millhouse
- Infection and Immunity Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, School of Dental Science, University of Glasgow, Glasgow, UK
| | - R Doyle
- Division of Oral Biosciences, Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - S Culshaw
- Infection and Immunity Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, School of Dental Science, University of Glasgow, Glasgow, UK
| | - G Ramage
- Infection and Immunity Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, School of Dental Science, University of Glasgow, Glasgow, UK
| | - G P Moran
- Division of Oral Biosciences, Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, University of Dublin, Dublin, Ireland
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Gahan JM, Byrne MM, Connolly E, Gray SG, Anney RJL, Murphy RT, Ryan AW. 39 Allelic expression imbalance at interleukin 18 and chemokine cxcl 16 in patients with acute coronary syndromes. Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Manning N, Meyers E, Schmidt J, Claassen J, Connolly E, Lavine S, Meyers P. E-138 early treatment of ruptured aneurysms is associated with improved functional outcomes independent of aneurysm rebleeding. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.212] [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: 11/03/2022]
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Loughman J, Nolan JM, Howard AN, Connolly E, Meagher K, Beatty S. The Impact of Macular Pigment Augmentation on Visual Performance Using Different Carotenoid Formulations. Invest Ophthalmol Vis Sci 2012; 53:7871-80. [DOI: 10.1167/iovs.12-10690] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Min C, Connolly E, Chen T, Pope S, Jozsef G, Formenti S. Whole Breast Hypofractionated Radiation Therapy: Outcomes, Toxicities, and Cost-benefit Analysis. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li KKW, Pang JCS, Ng HK, Massimino M, Gandola L, Biassoni V, Spreafico F, Schiavello E, Poggi G, Casanova M, Pecori E, De Pava MV, Ferrari A, Meazza C, Terenziani M, Polastri D, Luksch R, Podda M, Modena P, Antonelli M, Giangaspero F, Ahmed S, Zaghloul MS, Mousa AG, Eldebawy E, Elbeltagy M, Awaad M, Massimino M, Gandola L, Biassoni V, Antonelli M, Schiavello E, Buttarelli F, Spreafico F, Collini P, Pollo B, Patriarca C, Giangaspero F, MacDonald T, Liu J, Munson J, Park J, Wang K, Fei B, Bellamkonda R, Arbiser J, Gomi A, Yamaguchi T, Mashiko T, Oguro K, Somasundaram A, Neuberg R, Grant G, Fuchs H, Driscoll T, Becher O, McLendon R, Cummings T, Gururangan S, Bourdeaut F, Grison C, Doz F, Pierron G, Delattre O, Couturier J, Cho YJ, Pugh T, Weeraratne SD, Archer T, Krummel DP, Auclair D, Cibulkis K, Lawrence M, Greulich H, McKenna A, Ramos A, Shefler E, Sivachenko A, Amani V, Pierre-Francois J, Teider N, Northcott P, Taylor M, Meyerson M, Pomeroy S, Potts C, Cline H, Rotenberry R, Guldal C, Bhatia B, Nahle Z, Kenney A, Fan YN, Pizer B, See V, Makino K, Nakamura H, Kuratsu JI, Grahlert J, Ma M, Fiaschetti G, Shalaby T, Grotzer M, Baumgartner M, Clifford S, Gustafsson G, Ellison D, Figarella-Branger D, Doz F, Rutkowski S, Lannering B, Pietsch T, Fiaschetti G, Shalaby T, Baumgartner M, Grotzer M, Fleischhack G, Siegler N, Zimmermann M, Rutkowski S, Warmuth-Metz M, Kortmann RD, Pietsch T, Faldum A, Bode U, Yoon JH, Kang HJ, Park KD, Park SH, Phi JH, Kim SK, Wang KC, Kim IH, Shin HY, Ahn HS, Faria C, Golbourn B, Smith C, Rutka J, Greene BD, Whitton A, Singh S, Scheinemann K, Hill R, Lindsey J, Howell C, Ryan S, Shiels K, Shrimpton E, Bailey S, Clifford S, Schwalbe E, Lindsey J, Williamson D, Hamilton D, Northcott P, O'Toole K, Nicholson SL, Lusher M, Gilbertson R, Hauser P, Taylor M, Taylor R, Ellison D, Bailey S, Clifford S, Kool M, Jones DTW, Jager N, Hovestadt V, Schuller U, Jabado N, Perry A, Cowdrey C, Croul S, Collins VP, Cho YJ, Pomeroy S, Eils R, Korshunov A, Lichter P, Pfister S, Northcott P, Shih D, Taylor M, Darabi A, Sanden E, Visse E, Siesjo P, Harris P, Venkataraman S, Alimova I, Birks D, Cristiano B, Donson A, Foreman N, Vibhakar R, Bertin D, Vallero S, Basso ME, Romano E, Peretta P, Morra I, Mussano A, Fagioli F, Kunkele A, De Preter K, Heukamp L, Thor T, Pajtler K, Hartmann W, Mittelbronn M, Grotzer M, Deubzer H, Speleman F, Schramm A, Eggert A, Schulte J, Bandopadhayay P, Kieran M, Manley P, Robison N, Chi S, Thor T, Mestdagh P, Vandesomple J, Fuchs H, Durner VG, de Angelis MH, Heukamp L, Kunkele A, Pajtler K, Eggert A, Schramm A, Schulte JH, Ohe N, Yano H, Nakayama N, Iwama T, Lastowska M, Perek-Polnik M, Grajkowska W, Malczyk K, Cukrowska B, Dembowska-Baginska B, Perek D, Othman RT, Storer L, Grundy R, Kerr I, Coyle B, Hulleman E, Lagerweij T, Biesmans D, Crommentuijn MHW, Cloos J, Tannous BA, Vandertop WP, Noske DP, Kaspers GJL, Wurdinger T, Bergthold G, El Kababri M, Varlet P, Dhermain F, Sainte-Rose C, Raquin MA, Valteau-Couanet D, Grill J, Dufour C, Burchill C, Hii H, Dallas P, Cole C, Endersby R, Gottardo N, Gevorgian A, Morozova E, Kazantsev I, Youhta T, Safonova S, Kozlov A, Punanov Y, Afanasyev B, Zheludkova O, Packer R, Gajjar A, Michalski J, Jakacki R, Gottardo N, Tarbell N, Vezina G, Olson J, Friedrich C, von Bueren AO, von Hoff K, Gerber NU, Benesch M, Faldum A, Pietsch T, Warmuth-Metz M, Kuehl J, Kortmann RD, Rutkowski S, Malbari F, Atlas M, Friedman G, Kelly V, Bray A, Cassady K, Markert J, Gillespie Y, Taylor R, Howman A, Brogden E, Robinson K, Jones D, Gibson M, Bujkiewicz S, Mitra D, Saran F, Michalski A, Pizer B, Jones DTW, Jager N, Kool M, Zichner T, Hutter B, Sultan M, Cho YJ, Pugh TJ, Warnatz HJ, Reifenberger G, Northcott PA, Taylor MD, Meyerson M, Pomeroy SL, Yaspo ML, Korbel JO, Korshunov A, Eils R, Pfister SM, Lichter P, Pajtler KW, Weingarten C, Thor T, Kuenkele A, Fleischhack G, Heukamp LC, Buettner R, Kirfel J, Eggert A, Schramm A, Schulte JH, Friedrich C, von Bueren AO, von Hoff K, Gerber NU, Benesch M, Kwiecien R, Pietsch T, Warmuth-Metz M, Faldum A, Kuehl J, Kortmann RD, Rutkowski S, Lupo P, Scheurer M, Martin A, Nirschl C, Polanczyk M, Cohen KJ, Pardoll DM, Drake CG, Lim M, Manoranjan B, Hallett R, Wang X, Venugopal C, McFarlane N, Sheinemann K, Hassell J, Singh S, Venugopal C, Manoranjan B, McFarlane N, Whitton A, Delaney K, Scheinemann K, Singh S, Manoranjan B, Hallett R, Venugopal C, McFarlane N, Hassell J, Scheinemann K, Dunn S, Singh S, Garcia I, Crowther AJ, Gama V, Miller CR, Deshmukh M, Gershon TR, Garcia I, Crowther AJ, Gershon TR, Gerber NU, von Hoff K, Friedrich C, von Bueren AO, Treulieb W, Benesch M, Faldum A, Pietsch T, Warmuth-Metz M, Rutkowski S, Kortmann RD, Zin A, De Bortoli M, Bonvini P, Viscardi E, Perilongo G, Rosolen A, Connolly E, Zhang C, Anderson R, Feldstein N, Stark E, Garvin J, Shing MMK, Lee V, Cheng FWT, Leung AWK, Zhu XL, Wong HT, Kam M, Li CK, Ward S, Sengupta R, Kroll K, Rubin J, Dallas P, Milech N, Longville B, Hopkins R, Vergiliana JVD, Endersby R, Gottardo N, von Bueren AO, Gerss J, Hagel C, Cai H, Remke M, Hasselblatt M, Feuerstein BG, Pernet S, Delattre O, Korshunov A, Rutkowski S, Pfister SM, Baudis M, Lee C, Fotovati A, Triscott J, Dunn S, Valdora F, Freier F, Seyler C, Brady N, Bender S, Northcott P, Kool M, Jones D, Coco S, Tonini GP, Scheurlen W, Boutros M, Taylor M, Katus H, Kulozik A, Zitron E, Korshunov A, Lichter P, Pfister S, Remke M, Shih DJH, Northcott PA, Van Meter T, Pollack IF, Van Meir E, Eberhart CG, Fan X, Dellatre O, Collins VP, Jones DTW, Clifford SC, Pfister SM, Taylor MD, Pompe R, von Bueren AO, von Hoff K, Friedrich C, Treulieb W, Lindow C, Deinlein F, Kuehl J, Rutkowski S, Gupta T, Krishnatry R, Shirsat N, Epari S, Kunder R, Kurkure P, Vora T, Moiyadi A, Jalali R, Cohen K, Perek D, Perek-Polnik M, Dembowska-Baginska B, Drogosiewicz M, Grajkowska W, Lastowska M, Chojnacka M, Filipek I, Tarasinska M, Roszkowski M, Hauser P, Jakab Z, Bognar L, Markia B, Gyorsok Z, Ottoffy G, Nagy K, Cservenyak J, Masat P, Turanyi E, Vizkeleti J, Krivan G, Kallay K, Schuler D, Garami M, Lacroix J, Schlund F, Adolph K, Leuchs B, Bender S, Hielscher T, Pfister S, Witt O, Schlehofer JR, Rommelaere J, Witt H, Leskov K, Ma N, Eberhart C, Stearns D, Dagri JN, Torkildson J, Evans A, Ashby LS, Zakotnik B, Brown RJ, Dhall G, Portnow J, Finlay JL, McCabe M, Pizer B, Marino AM, Baryawno N, Ekstrom TP, Ostman A, Johnsen JI, Robinson G, Parker M, Kranenburg T, Lu C, Pheonix T, Huether R, Easton J, Onar A, Lau C, Bouffet E, Gururangan S, Hassall T, Cohn R, Gajjar A, Ellison D, Mardis E, Wilson R, Downing J, Zhang J, Gilbertson R, Robinson G, Dalton J, O'Neill T, Yong W, Chingtagumpala M, Bouffet E, Bowers D, Kellie S, Gururangan S, Fisher P, Bendel A, Fisher M, Hassall T, Wetmore C, Broniscer A, Clifford S, Gilbertson R, Gajjar A, Ellison D, Zhukova N, Martin D, Lipman T, Castelo-Branco P, Zhang C, Fraser M, Baskin B, Ray P, Bouffet E, Alman B, Ramaswamy V, Dirks P, Clifford S, Rutkowski S, Pfister S, Bristow R, Taylor M, Malkin D, Hawkins C, Tabori U, Dhall G, Ji L, Haley K, Gardner S, Sposto R, Finlay J, Leary S, Strand A, Ditzler S, Heinicke G, Conrad L, Richards A, Pedro K, Knoblaugh S, Cole B, Olson J, Yankelevich M, Budarin M, Konski A, Mentkevich G, Stefanits H, Ebetsberger-Dachs G, Weis S, Haberler C, Milosevic J, Baryawno N, Sveinbjornsson B, Martinsson T, Grotzer M, Johnsen JI, Kogner P, Garzia L, Morrisy S, Jelveh S, Lindsay P, Hill R, Taylor M, Marks A, Zhang H, Rood B, Williamson D, Clifford S, Aurtenetxe O, Gaffar A, Lopez JI, Urberuaga A, Navajas A, O'Halloran K, Hukin J, Singhal A, Dunham C, Goddard K, Rassekh SR, Davidson TB, Fangusaro JR, Ji L, Sposto R, Gardner SL, Allen JC, Dunkel IJ, Dhall G, Finlay JL, Trivedi M, Tyagi A, Goodden J, Chumas P, O'kane R, Crimmins D, Elliott M, Picton S, Silva DS, Viana-Pereira M, Stavale JN, Malheiro S, Almeida GC, Clara C, Jones C, Reis RM, Spence T, Sin-Chan P, Picard D, Ho KC, Lu M, Huang A, Bochare S, Khatua S, Gopalakrishnan V, Chan TSY, Picard D, Pfister S, Hawkins C, Huang A, Chan TSY, Picard D, Ho KC, Huang A, Picard D, Millar S, Hawkins C, Rogers H, Kim SK, Ra YS, Fangusaro J, Toledano H, Nakamura H, Van Meter T, Pomeroy S, Ng HK, Jones C, Gajjar A, Clifford S, Pfister S, Eberhart C, Bouffet E, Grundy R, Huang A, Sengupta S, Weeraratne SD, Phallen J, Sun H, Rallapalli S, Amani V, Pierre-Francois J, Teider N, Cook J, Jensen F, Lim M, Pomeroy S, Cho YJ. MEDULLOBLASTOMA. Neuro Oncol 2012; 14:i82-i105. [PMCID: PMC3483339 DOI: 10.1093/neuonc/nos093] [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: 08/15/2023] Open
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Lamouille S, Connolly E, Smyth JW, Akhurst RJ, Derynck R. TGF-β-induced activation of mTOR complex 2 drives epithelial–mesenchymal transition and cell invasion. Development 2012. [DOI: 10.1242/dev.082628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Claassen J, Perotte A, Albers D, Schmidt J, Tu B, Badjatia N, Lee K, Mayer S, Connolly E, Hirsch L, Hripcsak G. Electrographic seizures after subarachnoid hemorrhage lead to derangement of brain homeostasis in humans. Crit Care 2011. [PMCID: PMC3067005 DOI: 10.1186/cc9751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Connolly E, Burt P. 65 Are we achieving lung cancer waiting time guidelines? Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Healy L, Ryan A, Carroll P, Ennis D, Boyle T, Kennedy M, Connolly E, Reynolds J. Is Metabolic Syndrome and Central Obesity Relevent to Biology and Progression of Postmenopausal Breast Cancer? Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-1051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Obesity isassociated with both an increased risk of postmenopausal breast cancer and increased mortality rates. The mechanism is unclear, and central (visceral) obesity, insulin resistance, altered sex steroids, and altered adipokines, are mooted as possible factors. These features may cluster in the so-called Metabolic Syndrome (MetS), and the focus of this study was to systematically relate MetS to standard clinicopathological indices of breast cancer.Methods: Postmenopausal women with newly diagnosed breast cancer (n=105) were prospectively recruited. A detailed clinical and dietary history was performed, as well as body composition analysis, metabolic screen, and plasma measurement of adipokines and inflammatory markers. MetS was defined according to the International Diabetes Federation definition.Results: One hundred and five patients were recruited, the median age was 68 years (40-94) and the mean BMI was 28.3 ± 5.2 kg/m2, with 87% of patients centrally obese. MetS was diagnosed in 39% of patients, and was significantly (p<0.005) associated with 13cm greater waist circumference, higher total and trunk fat mass and increased inflammation with CRP levels almost double for MetS patietns compared to non MetS (10.3 ± 2.7 V's 5.8 ± 1.0 mg/L; p=0.084).Patients with later pathological stage (II- IV) were significantly more likely to be obese (BMI) (45% Vs 16%; p=0.007), centrally obese (waist circumference) (94% Vs 72%; p=0.009), hyperglycaemic (31% Vs 12%; p=0.047), hyperinsulinaemia (19% Vs 0; p=0.026) and 51% had MetS compared to 12% for early stage disease (Path stage 0-I). Patients with node positive disease were significantly more likely to be hyperinsulaemic (22% V's 5%; p=0.030) and have MetS (50% V's 30%; p=0.028) than node negative disease.MetS was not associated with hormone receptor status or serum levels of oestradiol, progesterone, testosterone, or SHBG levels. However, SHBG levels decreased with obesity (p=0.002) and as the number of features of MetS increased (0 features: 87 ± 15.8 compared to 5 features: 32 ±2.7; p=0.003). Insulin levels increased with obesity (p=0.006), and with increasing number of features of MetS.Discussion: MetS and central obesity are common in Irish postmenopausal breast cancer patients. MetS appears to be associated with aggressive tumour biology, and this may have significance in preventive and novel treatment approaches.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1051.
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Affiliation(s)
| | - A. Ryan
- 1St James's Hospital, Ireland
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Babar M, Garvin J, Quinn L, Dunne B, Griffin M, Kennedy J, Boyle T, Connolly E. Adverse Clinico-Pathological Features in Breast Cancer Patients under the Age of 35. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-3043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
IntroductionBreast cancer in younger patients is a unique disease entity, associated with aggressive biologic phenotype and poorer prognosis. The aim of this study was to analyse age as a prognostic factor in pre-menopausal breast cancer specifically in regards to pre-menopausal patients under the age of 35.MethodsA 7 year prospective audit of pre-menopausal patients presenting to the symptomatic breast clinic in St. James's Hospital between 2001 and 2008 was conducted. The Clinico-pathological features of pre-menopausal patients presenting under the age of 35 versus over 35 where compared. All cancer diagnoses were discussed at the breast multidisciplinary conference, and all clinico-pathological treatment details and follow-up information were entered by a full-time data manager.ResultsPre-menopausal patients under the age of 35 (n=55) were more likely to present with higher grade (p<0.05), oestrogen receptor negative (p<0.05), HER-2 receptor negative (p<0.05) and stage IV disease (p<0.05) relative to the older premenopausal group (n=250). This group also had a non-significant increased rate of lymphovascular invasion and negative progesterone receptor status compared to the older premenopausal group (p> 0.05). Pre-menopausal patients over the age of 35 were twice as likely to have lobular carcinoma as opposed to their younger counterparts. Tumour size, nodal status and axillary node burden was not significantly different between groups. Patients under-35 with breast cancer were more likely to be nulliparous.ConclusionThis data demonstrates that breast cancer in pre-menopausal patients under the age of 35 is associated with adverse clinicopathological features relative to the older pre-menopausal patients. Further studies should be aimed at assessing the prognosis, disease recurrence, disease free survival and distinct genetic profile in age related breast cancer.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3043.
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Connolly E. State of the art on research of Lactobacillus reuteri. Minerva Pediatr 2009; 61:634-636. [PMID: 19935515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Carroll P, Kennedy J, Boyle T, Connolly E. A cohort of BRCA carriers: An Irish perspective. Eur J Surg Oncol 2008. [DOI: 10.1016/j.ejso.2008.06.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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O'Mahony D, Quinn L, Wilson G, McDermott R, Boyle T, Connolly E. The value of preoperative axillary ultrasound in the managment of early breast cancer. Eur J Surg Oncol 2008. [DOI: 10.1016/j.ejso.2008.06.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Silva DS, Gibson JL, Sibbald R, Connolly E, Singer PA. Clinical ethicists' perspectives on organisational ethics in healthcare organisations. J Med Ethics 2008; 34:320-323. [PMID: 18448706 DOI: 10.1136/jme.2007.020891] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. OBJECTIVE To describe clinical ethicists' perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. DESIGN AND SETTING Qualitative case study involving semi-structured interviews with 18 clinical ethicists across 13 health organisations in Toronto, Canada. RESULTS From the clinical ethicists' perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation's moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. CONCLUSION Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education.
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Affiliation(s)
- D S Silva
- University of Toronto Joint Centre for Bioethics, 88 College St, Toronto, Ontario M5G1L4, Canada
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Seder D, Schmidt M, Badjatia N, Rincon F, Claassen J, Gordon E, Carrera E, Oddo M, Fernandez L, Lesch C, Lee K, Connolly E, Mayer S. Transdermal nicotine replacement is associated with lower mortality among active smokers admitted with spontaneous subarachnoid hemorrhage. Crit Care 2008. [PMCID: PMC4088482 DOI: 10.1186/cc6332] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chidwick P, Connolly E, Frolic A, Hardingham L, MacDonald C, Murphy P, Rodney P, Webster GC. Commentary on the Olivieri symposium. J Med Ethics 2004; 30:231. [PMID: 15082825 PMCID: PMC1733836 DOI: 10.1136/jme.2004.007815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- P Chidwick
- William Osler Health Centre, Brampton Memorial Hospital Campus, Brampton, Ontario and University of Toronto Joint Centre for Bioethics/Trillium Health Centre, Toronto, Ontario, Canada
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Abstract
A case of gastric perforation 2 months following insertion of a gastric balloon is reported. The literature is reviewed regarding the complications and success rates inherent in such balloon devices. This is the first case report of an intra-gastric balloon causing gastric perforation.
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Affiliation(s)
- G Roche-Nagle
- Department of Surgery, Beaumont Hospital, Dublin, Ireland.
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Blue L, Lang E, McMurray JJ, Davie AP, McDonagh TA, Murdoch DR, Petrie MC, Connolly E, Norrie J, Round CE, Ford I, Morrison CE. Randomised controlled trial of specialist nurse intervention in heart failure. BMJ 2001; 323:715-8. [PMID: 11576977 PMCID: PMC56888 DOI: 10.1136/bmj.323.7315.715] [Citation(s) in RCA: 374] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure. DESIGN Randomised controlled trial. SETTING Acute medical admissions unit in a teaching hospital. PARTICIPANTS 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year. MAIN OUTCOME MEASURES Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure. RESULTS 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio=0.61, 95% confidence interval 0.33 to 0.96). Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 v 114, P=0.018), fewer admissions for heart failure (19 v 45, P<0.001) and spent fewer days in hospital for heart failure (mean 3.43 v 7.46 days, P=0.0051). CONCLUSIONS Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure.
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Affiliation(s)
- L Blue
- Department of Cardiology, Western Infirmary, Dumbarton Road, Glasgow G12 6NT
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Connolly E, Worthley LI. Induced and accidental hypothermia. CRIT CARE RESUSC 2000; 2:22-9. [PMID: 16597280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2000] [Accepted: 02/25/2000] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To review human thermoregulation and the pathophysiology and management of induced and accidental hypothermia. DATA SOURCES A review of studies reported over ten years from 1990 to 2000 and identified through a MEDLINE search of the English-language literature on thermoregulation and induced and accidental hypothermia. SUMMARY OF REVIEW Hypothermia is defined as a core temperature less than 35 degrees C, and may be therapeutic (i.e. induced for clinical benefit) or accidental. Hypothermia induced prior to cardiovascular or neurosurgical procedures (i.e. therapeutic hypothermia) allows for a greater hypotensive operative period with less risk of cerebral or cardiac ischaemic injury. Hypothermia induced following tissue injury (e.g. closed head injury, cerebrovascular accident, adult respiratory distress syndrome) has also been used to reduce ischaemic tissue injury, although significant clinical benefits have not yet been demonstrated. Inadvertent hypothermia (i.e. accidental hypothermia) is classed as mild from 33 degrees C-35 degrees C, moderate from 30 degrees C-33 degrees C and severe if less than 30 degrees C. Treatment includes surface and core warming methods, all of which have a valid basis from experimental studies. However, no prospective, randomised controlled clinical trials exist that have compared the various rewarming methods. Currently, passive rewarming methods (e.g. reflective metalloplastic sheets, blankets) are recommended for patients with mild hypothermia (> 33 degrees C), active surface rewarming (e.g. heated blankets, hot air circulators) for moderate hypothermia (> 30 degrees C), active core rewarming (e.g. heated haemodialysis, haemodiafiltration or peritoneal dialysis) for severe hypothermia (< 30 degrees C), and heated cardiopulmonary bypass for severe hypothermia with cardiopulmonary arrest. CONCLUSIONS Operative hypothermia reduces ischaemic injury during cardiac and neurosurgical procedures. Hypothermia induced following tissue injury has not yet been shown to be of benefit. Management of accidental hypothermia requires passive and active warming methods, the indication of each depending on the availability of the method and severity of hypothermia.
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Affiliation(s)
- E Connolly
- Department of Critical Care Medicine, Flinders Medical Centre, Adelaide, South Australia
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Tolentino MJ, Husain D, Theodosiadis P, Gragoudas ES, Connolly E, Kahn J, Cleland J, Adamis AP, Cuthbertson A, Miller JW. Angiography of fluoresceinated anti-vascular endothelial growth factor antibody and dextrans in experimental choroidal neovascularization. Arch Ophthalmol 2000; 118:78-84. [PMID: 10636419 DOI: 10.1001/archopht.118.1.78] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine if anti-vascular endothelial growth factor antibody and a range of dextrans with varying diffusion radii and molecular weights are permeable through experimental choroidal neovascularization (CNV). METHODS Choroidal neovascularization was induced in 10 cynomolgus monkey retinas by means of argon laser injury. Digital fundus fluorescein angiograms were performed with fluorescein sodium, fluoresceinated IgG antibodies (anti-vascular endothelial growth factor and a control antibody), and fluoresceinated dextrans with molecular weights of 4, 20, 40, 70 and 150 kd. The 40- and 70-kd dextrans straddle the effective diffusion radius of IgG. For each reagent, early and late angiograms were performed in a standardized fashion, with follow-up images obtained to monitor residual fluorescence. RESULTS Perfusion of retinal vessels and choroidal vasculature was seen with all reagents. Fluorescein and 4- and 20-kd dextran leaked rapidly from the CNV within the first minute. Angiography with the use of 40-kd dextran and fluoresceinated antibody, either anti-vascular endothelial growth factor or control IgG, showed fluorescence within the CNV that increased during the first 1 to 5 hours, with mild leakage from the CNV. By 24 hours, fluorescence in the CNV was minimal, although in some cases persistent fluorescence in the surrounding tissue was evident up to 2 weeks. The 70-kd dextran showed fluorescence within the CNV and leakage in 1 of 3 eyes. The 150-kd dextran showed fluorescence within the CNV but did not demonstrate leakage. CONCLUSIONS Fluoresceinated antibodies and dextran with smaller effective diffusion radii showed CNV perfusion and leakage. Dextrans with larger effective diffusion radii (70 kd and 150 kd) perfused into CNV but did not show leakage consistently. CLINICAL RELEVANCE Determining the permeablity of antibodies and molecules of similar size through CNV can help ascertain the feasibility of using intravenously administered antibodies against angiogenic growth factors as a future treatment for choroidal neovascularization.
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Affiliation(s)
- M J Tolentino
- Retina Service, Massachusetts Eye and Ear Infirmary, Boston 02114, USA
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Connolly E, O'Callaghan G. MDMA toxicity presenting with severe hyperpyrexia: a case report. CRIT CARE RESUSC 1999; 1:368-70. [PMID: 16599881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/1999] [Accepted: 11/20/1999] [Indexed: 05/08/2023]
Abstract
Ingestion of even small amounts of MDMA ('ecstasy') by a small subset of the population may result in a potentially fatal clinical syndrome of severe hyperpyrexia, cardiovascular collapse, coagulopathy, rhabdomyolysis and multiple organ failure. Rapid and aggressive temperature control is of utmost importance in the management of these patients. We report a case of MDMA toxicity presenting with severe hyperpyrexia (43 degrees C) who survived after a rapid reduction in temperature to 36 degrees C within 60 minutes following active surface cooling, cooled (approximately 4 degrees C) intravenous solutions, urinary and gastric lavage solutions and replacement fluids for continuous veno-venous diafiltration.
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Affiliation(s)
- E Connolly
- Department of Critical Care Medicine, Flinders Medical Centre, Adelaide, South Australia
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Abstract
Using a computer database, we conducted a retrospective review of all ankle fractures treated at our institution from March 1985 to October 1996. Twenty-one patients with diabetes mellitus and isolated ankle fractures that were treated operatively met all inclusion criteria. Seven had insulin-dependent diabetes, and 14 had non-insulin-dependent diabetes. A randomly selected control group of 46 patients without diabetes who also underwent operative treatment of ankle fractures during this same time period were matched for age, sex, and fracture severity. The complication rate was 43% with 13 complications in nine patients with diabetes. There were seven (15.5%) complications in the control group. Complications in the diabetic group included seven infections (five deep, two superficial) and three losses of fixation. The complications were more severe in our diabetic population, requiring seven additional procedures including two below-knee amputations; a third patient refused an amputation. No additional procedures were required in our control group. All complications in our control group resolved with treatment. The relative risk for postoperative complications in patients with diabetes who sustained ankle fractures that were treated operatively was 2.76 times greater than the control group's (95% confidence interval, 1.57-3.97).
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Affiliation(s)
- R H Blotter
- Department of Orthopaedic Surgery, U.S. Naval Hospital, Yokosuka, Japan
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Connolly E, Worthley LI. Intravenous magnesium. CRIT CARE RESUSC 1999; 1:162-72. [PMID: 16602999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/1998] [Accepted: 11/10/1998] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To review the function and use of intravenous magnesium in magnesium depleted and non-magnesium depleted patients. DATA SOURCES A review of studies reported from 1966 to 1998 and identified through a MEDLINE search of the English-language literature on the use of intravenous magnesium. SUMMARY OF REVIEW Magnesium is a metalo-coenzyme that participates in numerous enzymatic reactions including all reactions that involve the formation and utilization of ATP. The cardiovascular, neurological and metabolic disorders caused by magnesium deficiency are associated with an increase in morbidity and mortality and can be rapidly corrected by magnesium therapy. There is also evidence that intravenous magnesium alters ion channels, NMDA receptors, and calcium metabolism, causing effects that are beneficial in a range of cardiovascular, respiratory and metabolic disorders, in the absence of magnesium deficiency. In these disorders intravenous magnesium sulphate is usually administered as an initial bolus varying between 8 - 16 mmol over 5 min, followed by an infusion of 2 - 4 mmol/h, to keep the plasma magnesium between 1.5 - 3 mmol/L. CONCLUSIONS Magnesium is required in patients who are magnesium depleted and is also of benefit in non-magnesium depleted patients with pre-eclampsia. It may also be of benefit in non-magnesium depleted patients with acute coronary syndromes, arrhythmias, acute asthma, stroke, seizures and spinal cord injury.
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Affiliation(s)
- E Connolly
- Department of Critical Care Medicine, Flinders Medical Centre, Adelaide, SA Australia
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Kelleher C, Newell J, MacDonagh-White C, MacHale E, Egan E, Connolly E, Gough H, Delaney B, Shryane E. Incidence and occupational pattern of leukaemias, lymphomas, and testicular tumours in western Ireland over an 11 year period. J Epidemiol Community Health 1998; 52:651-6. [PMID: 10023465 PMCID: PMC1756621 DOI: 10.1136/jech.52.10.651] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE To determine incidence of the following malignancies, testicular tumours, all leukaemias and all lymphomas in the West of Ireland in an 11 year period. Secondly, to examine the relation between disease patterns and available occupational data in male subjects of working age. DESIGN A census survey of all cases occurring in the three counties in the Western Health Board (WHB) area, Galway, Mayo and Roscommon, for the 11 year period 1980 to 1990 inclusive. Average annual age standardised incidence rates for the period were calculated using the 1986 census data. Rates for the area are compared with rates from the southern region of Ireland, which had a tumour registry. Trends over the time period are evaluated. All male subjects for whom occupational data were available were categorised using the Irish socioeconomic group classification and incidence rates by occupation were compared using the standardised incidence ratio method. In one of the counties, Galway, a detailed occupational history of selected cases and an age matched control group was also elicited through patients' general practitioners. SETTING All available case records in the West of Ireland. RESULTS There are no national incidence records for the period. Compared with data from the Southern Tumour Registry, the number of cases of women with myeloid leukaemias was significantly lower. Male leukaemia rates were significantly lower as a group (SIR 84 (95% CI 74, 95) but not when considered as individual categories. Regression analysis revealed an increasing trend in the number of new cases of non-Hodgkin's lymphoma among both men (r = 0.47, p = 0.02) and women (r = 0.90, p = 0.0001) and of chronic lymphocytic leukaemia in men (r = 0.77, p = 0.005) and women (r = 0.68 p = 0.02) in the WHB region over the last decade. Four hundred and fifty six male cases over the age of 15 years were identified and adequate occupational information was available for 74% of these. Standardised incidence ratios of testicular tumours 100, 938) and agriworkers other than farmers (SIR 377, 95% CI 103, 967). There were also significantly increased incidence ratios for both non-Hodgkin's lymphoma (SIR 169, 95% CI 124, 266) and three categories of leukaemias among farmers. Hodgkin's disease and acute myeloid leukaemias were significantly increased among semi-skilled people. Interview data with 90 cases and 54 controls of both sexes revealed that among farmers, cases (n = 31) were significantly less likely than controls (n = 20) to use tractor mounted spraying techniques (OR = 0.19 (95% CI 0.04, 0.80)) and less likely to wear protective masks (OR 0.22 (95% CI 0.05, 0.84)). CONCLUSIONS Trends of increase in non-Hodgkin's lymphoma and some leukaemias are consistent with studies elsewhere. The study provides further evidence of the relation between agricultural work and certain lymphoproliferative cancers. The possible carcinogenic role of chemicals used in agricultural industries must be considered as an explanation.
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Affiliation(s)
- C Kelleher
- Department of Health Promotion, National University of Ireland, Galway
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