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Yokoyama M, Peto L, Budgell EP, Jones N, Sheridan E, Liu J, Walker AS, Stoesser N, Gweon HS, Llewelyn MJ. Microbial diversity and antimicrobial resistance in faecal samples from acute medical patients assessed through metagenomic sequencing. PLoS One 2023; 18:e0282584. [PMID: 36928667 PMCID: PMC10019653 DOI: 10.1371/journal.pone.0282584] [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: 10/12/2022] [Accepted: 02/18/2023] [Indexed: 03/18/2023] Open
Abstract
Antimicrobial resistance (AMR) is a threat to global public health. However, unsatisfactory approaches to directly measuring the AMR burden carried by individuals has hampered efforts to assess interventions aimed at reducing selection for AMR. Metagenomics can provide accurate detection and quantification of AMR genes within an individual person's faecal flora (their gut "resistome"). Using this approach, we aimed to test the hypothesis that differences in antimicrobial use across different hospitals in the United Kingdom will result in observable differences in the resistome of individual patients. Three National Health Service acute Hospital Trusts with markedly different antibiotic use and Clostridioides difficile infection rates collected faecal samples from anonymous patients which were discarded after C. difficile testing over a period of 9 to 15 months. Metagenomic DNA was extracted from these samples and sequenced using an Illumina NovaSeq 6000 platform. The resulting sequencing reads were analysed for taxonomic composition and for the presence of AMR genes. Among 683 faecal metagenomes we found huge variation between individuals in terms of taxonomic diversity (Shannon Index range 0.10-3.99) and carriage of AMR genes (Median 1.50 genes/cell/sample overall). We found no statistically significant differences in diversity (median Shannon index 2.16 (IQR 1.71-2.56), 2.15 (IQR 1.62-2.50) and 2.26 (IQR 1.55-2.51)) or carriage of AMR genes (median 1.37 genes/cell/sample (IQR 0.70-3.24), 1.70 (IQR 0.70-4.52) and 1.43 (IQR 0.55-3.71)) at the three trusts respectively. This was also the case across the sample collection period within the trusts. While we have not demonstrated differences over place or time using metagenomic sequencing of faecal discards, other sampling frameworks may be more suitable to determine whether organisational level differences in antibiotic use are associated with individual-level differences in burden of AMR carriage.
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Affiliation(s)
- Maho Yokoyama
- Department of Global Health and Infectious Diseases, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Leon Peto
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Eric P Budgell
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicola Jones
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Elizabeth Sheridan
- Department of Microbiology, University Hospitals Dorset, Bournemouth, United Kingdom
| | - Jane Liu
- Department of Microbiology, Royal United Hospitals Bath, Bath, United Kingdom
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicole Stoesser
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hyun S Gweon
- School of Biological Sciences, University of Reading, Whiteknights, Reading, United Kingdom
- UK Centre for Ecology & Hydrology, Wallingford, Oxfordshire, United Kingdom
| | - Martin J Llewelyn
- Department of Global Health and Infectious Diseases, Brighton and Sussex Medical School, Brighton, United Kingdom
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Quatman CE, Wiseman JM, Sheridan E, Caterino JM, Weade M, Wisner D, Leyshon C, Quatman-Yates C. Automated referral to community paramedicine during 9-1-1 fall calls for resource activation. J Am Geriatr Soc 2022; 70:3578-3584. [PMID: 36039856 PMCID: PMC9771950 DOI: 10.1111/jgs.18011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 07/07/2022] [Accepted: 07/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND We sought to improve the referral process to a community paramedicine (CP) program following a 9-1-1 encounter. METHODS An electronic health record (EHR) for CP records with the ability to link to emergency EHR was identified and implemented with a single-click referral to the CP program. Referrals were tracked for 15 months before and after implementation. RESULTS Referral capacity increased from an average of 14.2 referrals per month to 44.9 referrals per month. CONCLUSION The results of this study suggest an EHR is a useful investment for CP programs and may be integral to efficient program operations.
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Affiliation(s)
- Carmen E Quatman
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jessica M Wiseman
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Elizabeth Sheridan
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Weade
- Upper Arlington Community Assistance, Referrals, and Education Services (UA CARES), Upper Arlington Fire Division, Upper Arlington, OH
| | - David Wisner
- Upper Arlington Community Assistance, Referrals, and Education Services (UA CARES), Upper Arlington Fire Division, Upper Arlington, OH
| | - Christine Leyshon
- Upper Arlington Community Assistance, Referrals, and Education Services (UA CARES), Upper Arlington Fire Division, Upper Arlington, OH
| | - Catherine Quatman-Yates
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA, Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA, Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA, The Ohio State University Sports Medicine Research Institute, Columbus, OH, USA
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Russell AR, Petridou C, Saeed K, Jeppessen C, Sheridan E, Okyere S, Lee M, Dryden M, Lovett J. Review of the clinical spectrum of typical and atypical Lyme neuroborreliosis in southwest England. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundLyme disease is endemic in the UK with a high incidence in southwest England. Neurological involvement occurs in approximately 5% of infected individuals. Previous reviews in southwest England have shown a consistent phenotype in most cases, however anecdotal review suggests a small number of atypical cases, with diverse presentations, which provide a diagnostic challenge, even to experienced neurologists.MethodsWe performed a retrospective, observational study of all identified cases (positive screening ELISA confirmed by immunoblot and neurological symptoms) of neuroborreliosis from six hospitals between January 2015 and December 2017. In addition, we reviewed atypical cases seen over the last decade in the regional neurosciences centre in depth.Results72 patients were included in the observational study. 83% had characteristics of Bannwarth’s syndrome (cranial neuropathy, radiculopathy and CSF pleocytosis). Unusual cases included mononeu- ritis multiplex.Central nervous system involvement was rare. We saw cases presenting with cerebrovascular events, meningitis and encephalitis. Complete resolution of symptoms was reported in 72% of patients. 28% of patients reported residual symptoms, most commonly fatigue and memory problems.ConclusionsThis is the largest UK review of neuroborreliosis. The presentation is usually typical, but atypical presentations vary and can be challenging. The majority of patients recover fully.amyrossrussell@gmail.com
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Fordham SME, Mantzouratou A, Sheridan E. Prevalence of insertion sequence elements in plasmids relating to mgrB gene disruption causing colistin resistance in Klebsiella pneumoniae. Microbiologyopen 2022; 11:e1262. [PMID: 35212479 PMCID: PMC8796155 DOI: 10.1002/mbo3.1262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/04/2022] [Indexed: 12/05/2022] Open
Abstract
Colistin is a last resort antibiotic for the treatment of carbapenemase producing Klebsiella pneumoniae. The disruption of the mgrB gene by insertion sequences (ISs) is a mechanism mediating colistin resistance. Plasmids encode mobilizable IS elements which integrate into the mgrB gene in K. pneumoniae causing gene inactivation and colistin resistance. The species prevalence of mgrB-gene disrupting insertion elements ISL3 (ISKpn25), IS5 (ISKpn26), ISKpn14, and IS903B present on plasmids were assessed. IS containing plasmids were also scanned for antimicrobial resistance genes, including carbapenem resistant genes. Plasmids encoding ISs are abundant in K. pneumoniae. IS903B was found in 28 unique Inc groups, while ISKpn25 was largely carried by IncFIB(pQil) plasmids. ISKpn26 and ISKpn14 were most often found associated with IncFII(pHN7A8) plasmids. Of the 34 unique countries which contained any of the IS elements, ISKpn25 was identified from 26. ISKpn26, ISKpn14, and IS903B ISs were identified from 89.3%, 44.9%, and 23.9% plasmid samples from China. Plasmids carrying ISKpn25, ISKpn14, and ISKpn26 IS have a 4.6-, 6.0-, and 6.6-fold higher carbapenemase gene count, respectively, relative to IS903B-carrying plasmids. IS903B bearing plasmids have a 20-, 5-, and 5-fold higher environmental source isolation count relative to ISKpn25, ISKpn14, and ISKpn26 bearing plasmids. ISKpn25 present on IncFIB(pQil) sourced from clinical settings is established across multiple countries, while ISKpn26, ISKpn14, and IS903B appear most often in China. Carbapenemase presence in tandem with IS elements may help promote an extensively drug resistant profile in K. pneumoniae limiting already narrow treatment options.
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Affiliation(s)
| | - Anna Mantzouratou
- Department of Life & Environmental SciencesBournemouth UniversityPooleUK
| | - Elizabeth Sheridan
- Department of Medical MicrobiologyUniversity Hospitals Dorset NHS Foundation Trust, Poole HospitalPooleUK
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Quatman-Yates CC, Wisner D, Weade M, Gabriel M, Wiseman JM, Sheridan E, Garvin JH, Bridges JFP, Santry HP, Panchal AR, Fernandez S, Quatman CE. Assessment of Fall-Related Emergency Medical Service Calls and Transports after a Community-Level Fall-Prevention Initiative. PREHOSP EMERG CARE 2021; 26:410-421. [PMID: 33909512 PMCID: PMC8626520 DOI: 10.1080/10903127.2021.1922556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Getting effective fall prevention into the homes of medically and physically vulnerable individuals is a critical public health challenge. Community paramedicine is emerging globally as a new model of care that allows emergency medical service units to evaluate and treat patients in non-emergency contexts for prevention efforts and chronic care management. The promise of community paramedicine as a delivery system for fall prevention that scales to community-level improvements in outcomes is compelling but untested.Objective: To study the impact of a community paramedic program's optimization of a fall prevention system entailing a clinical pathway and learning health system (called Community-FIT) on community-level fall-related emergency medical service utilization rates.Methods: We used an implementation science framework and quality improvement methods to design and optimize a fall prevention model of care that can be embedded within community paramedic operations. The model was implemented and optimized in an emergency medical service agency servicing a Midwestern city in the United States (∼35,000 residents). Primary outcome measures included relative risk reduction in the number of community-level fall-related 9-1-1 calls and fall-related hospital transports. Interrupted time series analysis was used to evaluate relative risk reduction from a 12-month baseline period (September 2016 - August 2017) to a 12-month post-implementation period (September 2018-August 2019).Results: Community paramedic home visits increased from 25 in 2017, to 236 in 2018, to 517 in 2019, indicating a large increase in the number of households that benefited from the efforts. A relative risk reduction of 0.66 (95% [CI] 0.53, 0.76) in the number of fall calls and 0.63 (95% [CI] 0.46, 0.75) in the number of fall-related calls resulting in transports to the hospital were observed.Conclusions: Community-FIT may offer a powerful mechanism for community paramedics to reduce fall-related 9-1-1 calls and transports to hospitals that can be implemented in emergency medical agencies across the country.
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Affiliation(s)
- Catherine C Quatman-Yates
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - David Wisner
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Mark Weade
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Mindy Gabriel
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Jessica M Wiseman
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Elizabeth Sheridan
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Jennifer H Garvin
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - John F P Bridges
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Heena P Santry
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Ashish R Panchal
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Soledad Fernandez
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Carmen E Quatman
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
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O'Toole RV, Joshi M, Carlini AR, Murray CK, Allen LE, Huang Y, Scharfstein DO, O'Hara NN, Gary JL, Bosse MJ, Castillo RC, Bishop JA, Weaver MJ, Firoozabadi R, Hsu JR, Karunakar MA, Seymour RB, Sims SH, Churchill C, Brennan ML, Gonzales G, Reilly RM, Zura RD, Howes CR, Mir HR, Wagstrom EA, Westberg J, Gaski GE, Kempton LB, Natoli RM, Sorkin AT, Virkus WW, Hill LC, Hymes RA, Holzman M, Malekzadeh AS, Schulman JE, Ramsey L, Cuff JAN, Haaser S, Osgood GM, Shafiq B, Laljani V, Lee OC, Krause PC, Rowe CJ, Hilliard CL, Morandi MM, Mullins A, Achor TS, Choo AM, Munz JW, Boutte SJ, Vallier HA, Breslin MA, Frisch HM, Kaufman AM, Large TM, LeCroy CM, Riggsbee C, Smith CS, Crickard CV, Phieffer LS, Sheridan E, Jones CB, Sietsema DL, Reid JS, Ringenbach K, Hayda R, Evans AR, Crisco MJ, Rivera JC, Osborn PM, Kimmel J, Stawicki SP, Nwachuku CO, Wojda TR, Rehman S, Donnelly JM, Caroom C, Jenkins MD, Boulton CL, Costales TG, LeBrun CT, Manson TT, Mascarenhas DC, Nascone JW, Pollak AN, Sciadini MF, Slobogean GP, Berger PZ, Connelly DW, Degani Y, Howe AL, Marinos DP, Montalvo RN, Reahl GB, Schoonover CD, Schroder LK, Vang S, Bergin PF, Graves ML, Russell GV, Spitler CA, Hydrick JM, Teague D, Ertl W, Hickerson LE, Moloney GB, Weinlein JC, Zelle BA, Agarwal A, Karia RA, Sathy AK, Au B, Maroto M, Sanders D, Higgins TF, Haller JM, Rothberg DL, Weiss DB, Yarboro SR, McVey ED, Lester-Ballard V, Goodspeed D, Lang GJ, Whiting PS, Siy AB, Obremskey WT, Jahangir AA, Attum B, Burgos EJ, Molina CS, Rodriguez-Buitrago A, Gajari V, Trochez KM, Halvorson JJ, Miller AN, Goodman JB, Holden MB, McAndrew CM, Gardner MJ, Ricci WM, Spraggs-Hughes A, Collins SC, Taylor TJ, Zadnik M. Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial. JAMA Surg 2021; 156:e207259. [PMID: 33760010 DOI: 10.1001/jamasurg.2020.7259] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Importance Despite the widespread use of systemic antibiotics to prevent infections in surgically treated patients with fracture, high rates of surgical site infection persist. Objective To examine the effect of intrawound vancomycin powder in reducing deep surgical site infections. Design, Setting, and Participants This open-label randomized clinical trial enrolled adult patients with an operatively treated tibial plateau or pilon fracture who met the criteria for a high risk of infection from January 1, 2015, through June 30, 2017, with 12 months of follow-up (final follow-up assessments completed in April 2018) at 36 US trauma centers. Interventions A standard infection prevention protocol with (n = 481) or without (n = 499) 1000 mg of intrawound vancomycin powder. Main Outcomes and Measures The primary outcome was a deep surgical site infection within 182 days of definitive fracture fixation. A post hoc comparison assessed the treatment effect on gram-positive and gram-negative-only infections. Other secondary outcomes included superficial surgical site infection, nonunion, and wound dehiscence. Results The analysis included 980 patients (mean [SD] age, 45.7 [13.7] years; 617 [63.0%] male) with 91% of the expected person-time of follow-up for the primary outcome. Within 182 days, deep surgical site infection was observed in 29 of 481 patients in the treatment group and 46 of 499 patients in the control group. The time-to-event estimated probability of deep infection by 182 days was 6.4% in the treatment group and 9.8% in the control group (risk difference, -3.4%; 95% CI, -6.9% to 0.1%; P = .06). A post hoc analysis of the effect of treatment on gram-positive (risk difference, -3.7%; 95% CI, -6.7% to -0.8%; P = .02) and gram-negative-only (risk difference, 0.3%; 95% CI, -1.6% to 2.1%; P = .78) infections found that the effect of vancomycin powder was a result of its reduction in gram-positive infections. Conclusions and Relevance Among patients with operatively treated tibial articular fractures at a high risk of infection, intrawound vancomycin powder at the time of definitive fracture fixation reduced the risk of a gram-positive deep surgical site infection, consistent with the activity of vancomycin. Trial Registration ClinicalTrials.gov Identifier: NCT02227446.
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Affiliation(s)
| | - Robert V O'Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Manjari Joshi
- Department of Infectious Diseases, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Anthony R Carlini
- Major Extremity Trauma Research Consortium Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clinton K Murray
- Department of Medicine, San Antonio Military Medical Center, San Antonio, Texas
| | - Lauren E Allen
- Major Extremity Trauma Research Consortium Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yanjie Huang
- Major Extremity Trauma Research Consortium Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel O Scharfstein
- Major Extremity Trauma Research Consortium Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nathan N O'Hara
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Joshua L Gary
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
| | - Michael J Bosse
- Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Renan C Castillo
- Major Extremity Trauma Research Consortium Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Michael J Weaver
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Reza Firoozabadi
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center/University of Washington, Seattle
| | - Joseph R Hsu
- Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Madhav A Karunakar
- Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Rachel B Seymour
- Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Stephen H Sims
- Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Christine Churchill
- Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael L Brennan
- Department of Orthopaedic Surgery, Baylor Scott and White Memorial Center, Temple, Texas
| | - Gabriela Gonzales
- Department of Orthopaedic Surgery, Baylor Scott and White Memorial Center, Temple, Texas
| | - Rachel M Reilly
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Robert D Zura
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Cameron R Howes
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Hassan R Mir
- Florida Orthopaedic Institute/Tampa General Hospital, Tampa
| | - Emily A Wagstrom
- Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Jerald Westberg
- Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Greg E Gaski
- Department of Orthopaedic Surgery, Indiana University Methodist Hospital, Indianapolis
| | - Laurence B Kempton
- Department of Orthopaedic Surgery, Indiana University Methodist Hospital, Indianapolis
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University Methodist Hospital, Indianapolis
| | - Anthony T Sorkin
- Department of Orthopaedic Surgery, Indiana University Methodist Hospital, Indianapolis
| | - Walter W Virkus
- Department of Orthopaedic Surgery, Indiana University Methodist Hospital, Indianapolis
| | - Lauren C Hill
- Department of Orthopaedic Surgery, Indiana University Methodist Hospital, Indianapolis
| | - Robert A Hymes
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Fairfax, Virginia
| | - Michael Holzman
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Fairfax, Virginia
| | - A Stephen Malekzadeh
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Fairfax, Virginia
| | - Jeff E Schulman
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Fairfax, Virginia
| | - Lolita Ramsey
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Fairfax, Virginia
| | - Jaslynn A N Cuff
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Fairfax, Virginia
| | - Sharon Haaser
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Fairfax, Virginia
| | - Greg M Osgood
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Babar Shafiq
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Vaishali Laljani
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Olivia C Lee
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans
| | - Peter C Krause
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans
| | - Cara J Rowe
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans
| | - Colette L Hilliard
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans
| | - Massimo Max Morandi
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport
| | - Angela Mullins
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport
| | - Timothy S Achor
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
| | - Andrew M Choo
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
| | - John W Munz
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
| | - Sterling J Boutte
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
| | | | - Mary A Breslin
- Department of Orthopaedics, MetroHealth, Cleveland, Ohio
| | - H Michael Frisch
- Orthopaedic Trauma Service, Mission Health, Asheville, North Carolina
| | - Adam M Kaufman
- Orthopaedic Trauma Service, Mission Health, Asheville, North Carolina
| | - Thomas M Large
- Orthopaedic Trauma Service, Mission Health, Asheville, North Carolina
| | - C Michael LeCroy
- Orthopaedic Trauma Service, Mission Health, Asheville, North Carolina
| | | | - Christopher S Smith
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Colin V Crickard
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Laura S Phieffer
- Department of Orthopaedics, Ohio State University, Wexner Medical Center, Columbus
| | - Elizabeth Sheridan
- Department of Orthopaedics, Ohio State University, Wexner Medical Center, Columbus
| | | | | | - J Spence Reid
- Department of Orthopaedics and Rehabilitation, Penn State Health, Hershey, Pennsylvania
| | - Kathy Ringenbach
- Department of Orthopaedics and Rehabilitation, Penn State Health, Hershey, Pennsylvania
| | - Roman Hayda
- Department of Orthopedic Surgery, Brown University/Rhode Island Hospital, Providence
| | - Andrew R Evans
- Department of Orthopedic Surgery, Brown University/Rhode Island Hospital, Providence
| | - M J Crisco
- Department of Orthopedic Surgery, Brown University/Rhode Island Hospital, Providence
| | - Jessica C Rivera
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas
| | - Patrick M Osborn
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas
| | - Joseph Kimmel
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas
| | - Stanislaw P Stawicki
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Chinenye O Nwachuku
- Department of Orthopedic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Thomas R Wojda
- Department of Family Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Saqib Rehman
- Department of Orthopaedic Surgery and Sports Medicine, Temple University, Philadelphia, Pennsylvania
| | - Joanne M Donnelly
- Department of Orthopaedic Surgery and Sports Medicine, Temple University, Philadelphia, Pennsylvania
| | - Cyrus Caroom
- Department of Orthopaedics, Texas Tech University Health Sciences Center, Lubbock
| | - Mark D Jenkins
- Department of Orthopaedics, Texas Tech University Health Sciences Center, Lubbock
| | - Christina L Boulton
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Timothy G Costales
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Christopher T LeBrun
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Theodore T Manson
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Daniel C Mascarenhas
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Jason W Nascone
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Andrew N Pollak
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Marcus F Sciadini
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Gerard P Slobogean
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Peter Z Berger
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Daniel W Connelly
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Yasmin Degani
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Andrea L Howe
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Dimitrius P Marinos
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Ryan N Montalvo
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - G Bradley Reahl
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Carrie D Schoonover
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Lisa K Schroder
- Department of Orthopaedic Surgery, University of Minnesota-Regions Hospital, St Paul
| | - Sandy Vang
- Department of Orthopaedic Surgery, University of Minnesota-Regions Hospital, St Paul
| | - Patrick F Bergin
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson
| | - Matt L Graves
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson
| | - George V Russell
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson
| | - Josie M Hydrick
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson
| | - David Teague
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City
| | - William Ertl
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City
| | - Lindsay E Hickerson
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City
| | - Gele B Moloney
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John C Weinlein
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis
| | - Boris A Zelle
- Department of Orthopaedics, University of Texas Health at San Antonio, San Antonio
| | - Animesh Agarwal
- Department of Orthopaedics, University of Texas Health at San Antonio, San Antonio
| | - Ravi A Karia
- Department of Orthopaedics, University of Texas Health at San Antonio, San Antonio
| | - Ashoke K Sathy
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Brigham Au
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Medardo Maroto
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Drew Sanders
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas
| | | | - Justin M Haller
- Department of Orthopaedics, University of Utah, Salt Lake City
| | | | - David B Weiss
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville
| | - Seth R Yarboro
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville
| | - Eric D McVey
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville
| | - Veronica Lester-Ballard
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville
| | - David Goodspeed
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison
| | - Gerald J Lang
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison
| | - Paul S Whiting
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison
| | - Alexander B Siy
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison
| | - William T Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - A Alex Jahangir
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Basem Attum
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eduardo J Burgos
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cesar S Molina
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Vamshi Gajari
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen M Trochez
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason J Halvorson
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest Baptist University Medical Center, Winston-Salem, North Carolina
| | - Anna N Miller
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest Baptist University Medical Center, Winston-Salem, North Carolina
| | - James Brett Goodman
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest Baptist University Medical Center, Winston-Salem, North Carolina
| | - Martha B Holden
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest Baptist University Medical Center, Winston-Salem, North Carolina
| | - Christopher M McAndrew
- Department of Orthopedic Surgery, Washington University in St Louis/Barnes Jewish Hospital, St Louis, Missouri
| | - Michael J Gardner
- Department of Orthopedic Surgery, Washington University in St Louis/Barnes Jewish Hospital, St Louis, Missouri
| | - William M Ricci
- Department of Orthopedic Surgery, Washington University in St Louis/Barnes Jewish Hospital, St Louis, Missouri
| | - Amanda Spraggs-Hughes
- Department of Orthopedic Surgery, Washington University in St Louis/Barnes Jewish Hospital, St Louis, Missouri
| | - Susan C Collins
- Major Extremity Trauma Research Consortium Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tara J Taylor
- Major Extremity Trauma Research Consortium Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Zadnik
- Major Extremity Trauma Research Consortium Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Wiseman JM, Stamper DS, Sheridan E, Caterino JM, Quatman-Yates CC, Quatman CE. Barriers to the Initiation of Home Modifications for Older Adults for Fall Prevention. Geriatr Orthop Surg Rehabil 2021; 12:21514593211002161. [PMID: 33868764 PMCID: PMC8020400 DOI: 10.1177/21514593211002161] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Home modifications are associated with decreased risk for falls and facilitate safe aging in place. The purpose of this study was to identify barriers to procurement of home modifications for older adults. Materials and Methods: Cross-sectional interviews by 2 separate (1 male and 1 female) researchers in a Midwestern city of home repair (“handyman”) and construction businesses within 15 miles of the areas of interest (neighborhood with a high socioeconomic status and neighborhood with low socioeconomic status) with a publicly listed phone number (n = 98). Estimated cost, earliest date of installation, and duration for a home modification project (installation of 3 grab bars) were collected. Results: At least 1 response was attained only 43% of the time (n = 42), and residential grab bar installations were not provided by most businesses (n = 24). The average quote for materials and labor was $394.31 (range $125-$1300). Five of the 7 businesses that responded to both researchers with the same representative differed in cost estimates, generally offering a reduced quote for the low socioeconomic status neighborhood by as much as $300. Quotes provided to the female researcher were also higher than those obtained by the male researcher by about $30 regardless of socioeconomic status. The average wait for home modifications was 23 days and the average anticipated duration of the project was 2.6 hours. Discussion: There are financial and procedural barriers to accessing home modifications for older adults who independently attempt to acquire them. There is a need for pathways in clinical and community settings to reduce barriers to home modifications to reduce the risk of falls. Conclusion: Home modifications are a promising tool to reduce falls and fall-related injuries in older adults. However, further work to identify cost-effective and timely options to reduce acquisition barriers is necessary to leverage the preventive power of home modifications.
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Affiliation(s)
- Jessica M Wiseman
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Surgical Health Assessment, Research and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David S Stamper
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Elizabeth Sheridan
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Surgical Health Assessment, Research and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Catherine C Quatman-Yates
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA.,Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA.,The Ohio State University Sports Medicine Research Institute, Columbus, OH, USA
| | - Carmen E Quatman
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Surgical Health Assessment, Research and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Humeidan ML, Reyes JPC, Mavarez-Martinez A, Roeth C, Nguyen CM, Sheridan E, Zuleta-Alarcon A, Otey A, Abdel-Rasoul M, Bergese SD. Effect of Cognitive Prehabilitation on the Incidence of Postoperative Delirium Among Older Adults Undergoing Major Noncardiac Surgery: The Neurobics Randomized Clinical Trial. JAMA Surg 2021; 156:148-156. [PMID: 33175114 DOI: 10.1001/jamasurg.2020.4371] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Postoperative delirium in older adults is a common and costly complication after surgery. Cognitive reserve affects the risk of postoperative delirium, and thus preoperative augmentation of reserve as a preventive technique is of vital interest. Objective To determine whether cognitive prehabilitation reduces the incidence of postoperative delirium among older adults. Design, Setting, and Participants This was a prospective, single-blinded randomized clinical trial conducted from March 2015 to August 2019 at the Ohio State University Wexner Medical Center in Columbus. Patients 60 years and older undergoing major, noncardiac, nonneurological surgery under general anesthesia, with an expected hospital stay of at least 72 hours, were eligible for trial inclusion. Patients were excluded for preoperative cognitive dysfunction and active depression. Interventions Participation in electronic, tablet-based preoperative cognitive exercise targeting memory, speed, attention, flexibility, and problem-solving functions. Main Outcomes and Measures The primary outcome was incidence of delirium between postoperative day 0 to day 7 or discharge, as measured by a brief Confusion Assessment Method, Memorial Delirium Assessment Scale, or a structured medical record review. Secondary outcomes compared delirium characteristics between patients in the intervention and control groups. Results Of the 699 patients approached for trial participation, 322 completed consent and 268 were randomized. Subsequently, 17 patients were excluded, leaving 251 patients in the primary outcome analysis. A total of 125 patients in the intervention group and 126 control patients were included in the final analysis (median [interquartile range] age, 67 [63-71] years; 163 women [64.9%]). Ninety-seven percent of the patients in the intervention group completed some brain exercise (median, 4.6 [interquartile range, 1.31-7.4] hours). The delirium rate among control participants was 23.0% (29 of 126). With intention-to-treat analysis, the delirium rate in the intervention group was 14.4% (18 of 125; P = .08). Post hoc analysis removed 4 patients who did not attempt any cognitive exercise from the intervention group, yielding a delirium rate of 13.2% (16 of 121; P = .04). Secondary analyses among patients with delirium showed no differences in postoperative delirium onset day or duration or total delirium-positive days across study groups. Conclusions and Relevance The intervention lowered delirium risk in patients who were at least minimally compliant. The ideal activities, timing, and effective dosage for cognitive exercise-based interventions to decrease postoperative delirium risk and burden need further study. Trial Registration ClinicalTrials.gov Identifier: NCT02230605.
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Affiliation(s)
- Michelle L Humeidan
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus
| | - Joshua-Paolo C Reyes
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus
| | - Ana Mavarez-Martinez
- Renaissance School of Medicine, Department of Anesthesiology, Stony Brook University, Stony Brook, New York
| | - Cory Roeth
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Christopher M Nguyen
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - Elizabeth Sheridan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus
| | - Alix Zuleta-Alarcon
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus
| | - Andrew Otey
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus
| | - Mahmoud Abdel-Rasoul
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Sergio D Bergese
- Renaissance School of Medicine, Department of Anesthesiology, Stony Brook University, Stony Brook, New York
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Abstract
OBJECTIVE To estimate the economic burden to the health service of surgical site infection following caesarean section and to identify potential savings achievable through implementation of a surveillance programme. DESIGN Economic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers' perspective. SETTING England. PARTICIPANTS Women undergoing caesarean section in National Health Service hospitals. MAIN OUTCOME MEASURE Costs attributable to treatment and management of surgical site infection following caesarean section. RESULTS The costs (2010) for a hospital carrying out 800 caesarean sections a year based on infection risk of 9.6% were estimated at £18 914 (95% CI 11 521 to 29 499) with 28% accounted for by community care (£5370). With inflation to 2019 prices, this equates to an estimated cost of £5.0 m for all caesarean sections performed annually in England 2018-2019, approximately £1866 and £93 per infection managed in hospital and community, respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as £3747 (2010 costs). Modelling a decrease in risk of infection of 30%, 20% or 10% between successive surveillance periods indicated that a variable intermittent surveillance strategy achieved higher or similar net savings than continuous surveillance. Breakeven was reached sooner with the variable surveillance strategy than continuous surveillance when the baseline risk of infection was 10% or 15% and smaller loses with a baseline risk of 5%. CONCLUSION Surveillance of surgical site infections after caesarean section with feedback of data to surgical teams offers a potentially effective means to reduce infection risk, improve patient experience and save money for the health service.
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Affiliation(s)
- Catherine Wloch
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Albert Jan Van Hoek
- Immunisation, Hepatitis, and Blood Safety, Public Health England, London, UK
| | - Nathan Green
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Joanna Conneely
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Pauline Harrington
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Elizabeth Sheridan
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Jennie Wilson
- Richard Wells Research Centre, University of West London, London, UK
| | - Theresa Lamagni
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
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Carreras-Abad C, Cochet M, Hall T, Ramkhelawon L, Khalil A, Peregrine E, Vinayakarao L, Sivarajan S, Hamid R, Planche T, Sheridan E, Winchester S, Plumb J, Djennad A, Andrews N, Le Doare K, Heath P. Developing a serocorrelate of protection against invasive group B streptococcus disease in pregnant women: a feasibility study. Health Technol Assess 2019; 23:1-40. [PMID: 31855555 PMCID: PMC6936166 DOI: 10.3310/hta23670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Group B streptococcus is the leading cause of infection in infants. Currently, intrapartum antibiotic prophylaxis is the major strategy to prevent invasive group B streptococcus disease. However, intrapartum antibiotic prophylaxis does not prevent maternal sepsis, premature births, stillbirths or late-onset disease. Maternal vaccination may offer an alternative strategy. Multivalent polysaccharide protein conjugate vaccine development is under way and a serocorrelate of protection is needed to expedite vaccine licensure. OBJECTIVES The ultimate aim of this work is to determine the correlate of protection against the major group B streptococcus disease-causing serotypes in infants in the UK. The aim of this feasibility study is to test key operational aspects of the study design. DESIGN Prospective cohort study of pregnant women and their infants in a 6-month period (1 July to 31 December 2018). SETTING Five secondary and tertiary hospitals from London and South England. National iGBS disease surveillance was conducted in all trusts in England and Wales. PARTICIPANTS Pregnant women aged ≥ 18 years who were delivering at one of the selected hospitals and who provided consent during the study period. There were no exclusion criteria. INTERVENTIONS No interventions were performed. MAIN OUTCOME MEASURES (1) To test the feasibility of collecting serum at delivery from a large cohort of pregnant women. (2) To test the key operational aspects for a proposed large serocorrelates study. (3) To test the feasibility of collecting samples from those with invasive group B streptococcus. RESULTS A total of 1823 women were recruited during the study period. Overall, 85% of serum samples were collected at three sites collecting only cord blood. At the two sites collecting maternal, cord and infant blood samples, the collection rate was 60%. A total of 614 women were screened for group B streptococcus with a colonisation rate of 22% (serotype distribution: 30% III, 25% Ia, 16% II, 14% Ib, 14% V and 1% IV). A blood sample was collected from 34 infants who were born to colonised women. Maternal and infant blood and the bacterial isolates for 15 newborns who developed invasive group B streptococcal disease during the study period were collected (serotype distribution: 29% III, 29% II, 21% Ia, 7% Ib, 7% IV and 7% V). LIMITATIONS Recruitment and sample collection were dependent on the presence of research midwives rather than the whole clinical team. In addition, individualised consent limited the number of women who could be approached each day, and site set-up for the national surveillance study and the limited time period of this feasibility study limited recruitment of all eligible participants. CONCLUSIONS We have verified the feasibility of collecting and processing rectovaginal swabs and blood samples in pregnant women, as well as samples from those with invasive group B streptococcal disease. We have made recommendations for the recruitment of cases within the proposed GBS3 study and for controls both within GBS3 and as an extension of this feasibility study. FUTURE WORK A large case-control study comparing specific immunoglobulin G levels in mothers whose infants develop invasive group B streptococcal disease with those in colonised mothers whose infants do not develop invasive group B streptococcal disease is recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN49326091; IRAS project identification number 246149/REC reference number 18/WM/0147. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Clara Carreras-Abad
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Madeleine Cochet
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Tom Hall
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Laxmee Ramkhelawon
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Asma Khalil
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Elisabeth Peregrine
- Department of Obstetrics and Gynaecology, Kingston Hospital NHS Foundation Trust, London, UK
| | - Latha Vinayakarao
- Department of Obstetrics and Gynaecology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Sharmila Sivarajan
- Department of Obstetrics and Gynaecology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Rosol Hamid
- Department of Obstetrics and Gynaecology, Croydon Health Services NHS Trust, Croydon, UK
| | - Tim Planche
- Microbiology Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen Winchester
- Microbiology Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Jane Plumb
- Group B Strep Support Group, Haywards Heath, UK
| | - Abdelmajid Djennad
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Paul Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
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Malik AT, Khan SN, Phieffer L, Ly TV, Wiseman J, Sheridan E, Quatman CE. Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF for Ankle Fractures. Foot & Ankle Orthopaedics 2019. [PMCID: PMC8697182 DOI: 10.1177/2473011419s00288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Category: Ankle, Trauma Introduction/Purpose: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >=80 years). Past literature has shown octogenarians to be a potentially vulnerable population that have drastically different adverse outcomes and higher resource utilization as compared to individuals below the age of 80 years. Methods: The 2012-2017 American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) was queried using Current Procedural Terminology codes for patients undergoing open reduction internal fixation (ORIF) for isolated uni-malleolar (CPT-27766, CPT-27769, CPT-27792), bi-malleolar (CPT-27814) and tri-malleolar (CPT-27822, CPT-27823) ankle fractures. The study cohort was divided into three distinct groups for comparisons (Age <65 years, Age 65-79 years and Age=>80 years/octogenarians + nonagenarians). Multi-variate regression analyses were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for differences in baseline clinical characteristics (age, gender, sex, race, fracture type/severity, open vs. closed fracture, admission status, BMI, co-morbidities, functional health status, ASA group and operative time). For comparison purposes, Age<65 years was taken as reference group in multi-variate regression models. Results: A total of 19,585 patients were included – out of which 1,033 (5.3%) were octogenarians/nonagenarians (=>80 years). Following multivariate analysis, individuals aged =>80 years were at a significantly higher risk of 30-day wound complications (OR 1.84; p=0.019), pulmonary complications (OR 3.88; p<0.001), renal complications (OR 1.96; p=0.015), septic complications (OR 3.72; p=0.002), urinary tract infections (OR 2.24; p<0.001), bleeding requiring transfusion (OR 1.90; p=0.025), mortality (OR 7.44; p<0.001), readmissions (OR 1.65; p=0.004) and non-home discharge (OR 13.91; p<0.001). Individuals between the age of 65-79 years only had a higher risk of pulmonary complications (OR 2.30; p=0.004), urinary tract infections (OR 2.24; p<0.001), readmissions (OR 1.41; p=0.005) and non-home discharges (OR 3.55; p<0.001), with the effect sizes being small as compared to age >=80 years group. Conclusion: Based on the findings, it appears that octagenarians and nonagenarians (age =>80) are a fundamentally distinct and vulnerable age group that is at a higher risk of complications, readmissions, mortality and non-home discharges as compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Providers should understand the importance of pre-operative counselling and risk-stratification in this vulnerable patient population.
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12
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Sheridan E, Wiseman JM, Malik AT, Pan X, Quatman CE, Santry HP, Phieffer LS. The role of sociodemographics in the occurrence of orthopaedic trauma. Injury 2019; 50:1288-1292. [PMID: 31160037 PMCID: PMC6613982 DOI: 10.1016/j.injury.2019.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/29/2019] [Accepted: 05/18/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We sought to determine the effects of sociodemographic factors on the occurrence of orthopaedic injuries in an adult population presenting to a level 1 trauma center. MATERIALS AND METHODS We conducted a retrospective chart review of patients who received orthopaedic trauma care at a level 1 academic trauma center. RESULTS 20,919 orthopaedic trauma injury cases were treated at an academic level 1 trauma center between 01 January 1993 and 27 August 2017. Following application of inclusion/exclusion criteria, a total of 14,654 patients were retrieved for analysis. Out of 14,654 patients, 4602 (31.4%) belonged to low socioeconomic status (SES), 4961 (32.0%) to middle SES and 5361 (36.6%) to high SES. Following adjustment for age, sex, race, insurance status and injury severity score (ISS), patients belonging to middle SES vs. low SES (OR 0.77 [95% CI 0.63-0.94]; p = 0.009) or high SES vs. low SES (OR 0.77 [95% CI 0.62-0.95]; p = 0.016) had lower odds of receiving a penetrating injury as compared to a blunt injury. CONCLUSION The results from this study indicate that a link exists between sociodemographic factors and the occurrence of orthopaedic injuries presenting to a level 1 trauma center. The most common cause of injury varied within age groups, by sex, and within the different socioeconomic groups.
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Affiliation(s)
- Elizabeth Sheridan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - Jessica M Wiseman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - Azeem Tariq Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - Xueliang Pan
- Department of Biomedical Informatics, The Ohio State University, United States
| | - Carmen E Quatman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States; Center for Surgical Health Assessment, Research and Policy (SHARP), The Ohio State University Wexner Medical Center, United States.
| | - Heena P Santry
- Department of Surgery, The Ohio State University Wexner Medical Center, United States; Center for Surgical Health Assessment, Research and Policy (SHARP), The Ohio State University Wexner Medical Center, United States
| | - Laura S Phieffer
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
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13
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Vijayakrishnan J, Kumar R, Henrion MYR, Moorman AV, Rachakonda PS, Hosen I, da Silva Filho MI, Holroyd A, Dobbins SE, Koehler R, Thomsen H, Irving JA, Allan JM, Lightfoot T, Roman E, Kinsey SE, Sheridan E, Thompson PD, Hoffmann P, Nöthen MM, Heilmann-Heimbach S, Jöckel KH, Greaves M, Harrison CJ, Bartram CR, Schrappe M, Stanulla M, Hemminki K, Houlston RS. A genome-wide association study identifies risk loci for childhood acute lymphoblastic leukemia at 10q26.13 and 12q23.1. Leukemia 2017; 31:573-579. [PMID: 27694927 PMCID: PMC5336191 DOI: 10.1038/leu.2016.271] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/26/2016] [Accepted: 09/06/2016] [Indexed: 02/08/2023]
Abstract
Genome-wide association studies (GWASs) have shown that common genetic variation contributes to the heritable risk of childhood acute lymphoblastic leukemia (ALL). To identify new susceptibility loci for the largest subtype of ALL, B-cell precursor ALL (BCP-ALL), we conducted a meta-analysis of two GWASs with imputation using 1000 Genomes and UK10K Project data as reference (totaling 1658 cases and 7224 controls). After genotyping an additional 2525 cases and 3575 controls, we identify new susceptibility loci for BCP-ALL mapping to 10q26.13 (rs35837782, LHPP, P=1.38 × 10-11) and 12q23.1 (rs4762284, ELK3, P=8.41 × 10-9). We also provide confirmatory evidence for the existence of independent risk loci at 9p21.3, but show that the association marked by rs77728904 can be accounted for by linkage disequilibrium with the rare high-impact CDKN2A p.Ala148Thr variant rs3731249. Our data provide further insights into genetic susceptibility to ALL and its biology.
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Affiliation(s)
- J Vijayakrishnan
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - R Kumar
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - M Y R Henrion
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - A V Moorman
- Leukemia Research Group, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - P S Rachakonda
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - I Hosen
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - M I da Silva Filho
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - A Holroyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - S E Dobbins
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - R Koehler
- Department of Human Genetics, Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - H Thomsen
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - J A Irving
- Leukemia Research Group, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - J M Allan
- Leukemia Research Group, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - T Lightfoot
- Department of Health Sciences, Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - E Roman
- Department of Health Sciences, Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - S E Kinsey
- Department of Paediatric and Adolescent Haematology and Oncology, Leeds General Infirmary, Leeds, UK
| | - E Sheridan
- Medical Genetics Research Group, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, UK
| | - P D Thompson
- Paediatric and Familial Cancer Research Group, Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - P Hoffmann
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Biomedicine, Human Genomics Research Group, University Hospital Basel, Basel, Switzerland
| | - M M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | | | - K H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - M Greaves
- Haemato-Oncology Research Unit, Division of Molecular Pathology, Institute of Cancer Research, Sutton, UK
| | - C J Harrison
- Leukemia Research Group, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - C R Bartram
- Department of Human Genetics, Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - M Schrappe
- General Paediatrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Stanulla
- Department of Paediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany
| | - K Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - R S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
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14
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Lorente D, Omlin A, Zafeiriou Z, Nava-Rodrigues D, Pérez-López R, Pezaro C, Mehra N, Sheridan E, Figueiredo I, Riisnaes R, Miranda S, Crespo M, Flohr P, Mateo J, Altavilla A, Ferraldeschi R, Bianchini D, Attard G, Tunariu N, de Bono J. Castration-Resistant Prostate Cancer Tissue Acquisition From Bone Metastases for Molecular Analyses. Clin Genitourin Cancer 2016; 14:485-493. [PMID: 27246360 PMCID: PMC5132155 DOI: 10.1016/j.clgc.2016.04.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/18/2016] [Accepted: 04/22/2016] [Indexed: 11/18/2022]
Abstract
Background The urgent need for castration-resistant prostate cancer molecular characterization to guide treatment has been constrained by the disease's predilection to metastasize primarily to bone. We hypothesized that the use of clinical and imaging criteria could maximize tissue acquisition from bone marrow biopsies (BMBs). We aimed to develop a score for the selection of patients undergoing BMB. Materials and Methods A total of 115 BMBs were performed in 101 patients: 57 were included in a derivation set and 58 were used as the validation set. The clinical and laboratory data and prebiopsy computed tomography parameters (Hounsfield units [HUs]) were determined. A score for the prediction of biopsy positivity was developed from logistic regression analysis of the derivation set and tested in the validation set. Results Of the 115 biopsy specimens, 75 (62.5%) were positive; 35 (61.4%) in the test set and 40 (69%) in the validation set. On univariable analysis, hemoglobin (P = .019), lactate dehydrogenase (P = .003), prostate-specific antigen (P = .005), and mean HUs (P = .004) were selected. A score based on the LDH level (≥ 225 IU/L) and mean HUs (≥ 125) was developed in multivariate analysis and was associated with BMB positivity in the validation set (odds ratio, 5.1; 95% confidence interval, 1.9%-13.4%; P = .001). The area under the curve of the score was 0.79 in the test set and 0.77 in the validation set. Conclusion BMB of the iliac crest is a feasible technique for obtaining tumor tissue for genomic analysis in patients with castration-resistant prostate cancer metastatic to the bone. A signature based on the mean HUs and LDH level can predict a positive yield with acceptable internal validity. Prospective studies of independent cohorts are needed to establish the external validity of the score.
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Affiliation(s)
- David Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Aurelius Omlin
- Oncohematology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Zafeiris Zafeiriou
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Daniel Nava-Rodrigues
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Raquel Pérez-López
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Carmel Pezaro
- Eastern Health Medicine School, Monash University, Box Hill, VC, Australia
| | - Niven Mehra
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Elizabeth Sheridan
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Ines Figueiredo
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Ruth Riisnaes
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Susana Miranda
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Mateus Crespo
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Penny Flohr
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Joaquín Mateo
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Amelia Altavilla
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Roberta Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Diletta Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Gerhardt Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Nina Tunariu
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Johann de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden National Health Services Foundation Trust and The Institute of Cancer Research, Sutton, UK.
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15
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Hartill V, Logan C, Parry DA, Szymanska K, Ashcroft K, English K, Prescott K, Dobbie A, Barwick S, Bennett C, Goodship J, Sheridan E, Johnson C. Investigation into the Importance of genes encoding ciliary proteins in congenital heart disease using whole exome sequencing. Cilia 2015. [PMCID: PMC4518900 DOI: 10.1186/2046-2530-4-s1-p9] [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: 11/17/2022] Open
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16
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Kelmemi W, Teeuw ME, Bochdanovits Z, Ouburg S, Jonker MA, Alkuraya F, Hashem M, Kayserili H, van Haeringen A, Sheridan E, Masri A, Cobben JM, Rizzu P, Kostense PJ, Dommering CJ, Henneman L, Bouhamed-Chaabouni H, Heutink P, Ten Kate LP, Cornel MC. Determining the genome-wide kinship coefficient seems unhelpful in distinguishing consanguineous couples with a high versus low risk for adverse reproductive outcome. BMC Med Genet 2015; 16:50. [PMID: 26188928 PMCID: PMC4557855 DOI: 10.1186/s12881-015-0191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 06/17/2015] [Indexed: 11/25/2022]
Abstract
Background Offspring of consanguineous couples are at increased risk of congenital disorders. The risk increases as parents are more closely related. Individuals that have the same degree of relatedness according to their pedigree, show variable genomic kinship coefficients. To investigate whether we can differentiate between couples with high- and low risk for offspring with congenital disorders, we have compared the genomic kinship coefficient of consanguineous parents with a child affected with an autosomal recessive disorder with that of consanguineous parents with only healthy children, corrected for the degree of pedigree relatedness. Methods 151 consanguineous couples (73 cases and 78 controls) from 10 different ethnic backgrounds were genotyped on the Affymetrix platform and passed quality control checks. After pruning SNPs in linkage disequilibrium, 57,358 SNPs remained. Kinship coefficients were calculated using three different toolsets: PLINK, King and IBDelphi, yielding five different estimates (IBDelphi, PLINK (all), PLINK (by population), King robust (all) and King homo (by population)). We performed a one-sided Mann Whitney test to investigate whether the median relative difference regarding observed and expected kinship coefficients is bigger for cases than for controls. Furthermore, we fitted a mixed effects linear model to correct for a possible population effect. Results Although the estimated degrees of genomic relatedness with the different toolsets show substantial variability, correlation measures between the different estimators demonstrated moderate to strong correlations. Controls have higher point estimates for genomic kinship coefficients. The one-sided Mann Whitney test did not show any evidence for a higher median relative difference for cases compared to controls. Neither did the regression analysis exhibit a positive association between case–control status and genomic kinship coefficient. Conclusions In this case–control setting, in which we compared consanguineous couples corrected for degree of pedigree relatedness, a higher degree of genomic relatedness was not significantly associated with a higher likelihood of having an affected child. Further translational research should focus on which parts of the genome and which pathogenic mutations couples are sharing. Looking at relatedness coefficients by determining genome-wide SNPs does not seem to be an effective measure for prospective risk assessment in consanguineous parents. Electronic supplementary material The online version of this article (doi:10.1186/s12881-015-0191-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- W Kelmemi
- Laboratory of Human Genetics, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - M E Teeuw
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Z Bochdanovits
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Medical Microbiology and Infection Control, Research School V-ICI, VU University Medical Center, Amsterdam, The Netherlands
| | - M A Jonker
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - F Alkuraya
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M Hashem
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - H Kayserili
- Medical Genetics Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - A van Haeringen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.,Juliana Children's Hospital, Hague, The Netherlands
| | - E Sheridan
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.,Department of Genetics, Wellcome Trust Brenner Building, St James's University Hospital, Leeds, UK
| | - A Masri
- Division of Child Neurology, Department of Pediatrics, University of Jordan, Amman, Jordan
| | - J M Cobben
- Department of Pediatric Genetics, AMC University Hospital, Amsterdam, The Netherlands
| | - P Rizzu
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,Genome Biology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - P J Kostense
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - C J Dommering
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - L Henneman
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - H Bouhamed-Chaabouni
- Laboratory of Human Genetics, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - P Heutink
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,Genome Biology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - L P Ten Kate
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - M C Cornel
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,EMGO Institute for Health and Care Research, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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17
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Onoufriadis A, Hjeij R, Watson CM, Slagle CE, Klena NT, Dougherty GW, Kurkowiak M, Loges NT, Diggle CP, Morante NF, Gabriel GC, Lemke KL, Li Y, Pennekamp P, Menchen T, Marthin JK, Mans D, Letteboer SJ, Werner C, Burgoyne T, Westermann C, Rutman A, Carr IM, O'Callaghan C, Moya E, Chung EMK, Sheridan E, Nielsen KG, Roepman R, Burdine RD, Lo CW, Omran H, Mitchison H. Gene discovery for motile cilia disorders: mutation spectrum in primary ciliary dyskinesia and discovery of mutations in CCDC151. Cilia 2015. [PMCID: PMC4518893 DOI: 10.1186/2046-2530-4-s1-p30] [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: 11/25/2022] Open
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18
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Robson E, Moya E, Burgoyne T, Chetcuti P, Dixon M, Hirst R, Hogg C, Mitchison H, O'Callaghan C, Onoufriadis A, Patel M, Rutman A, Sheridan E, Shoemark A. Phenotypic variability of CCDC103 mutation in British Pakistani children with Primary Ciliary Dyskinesia (PCD). Cilia 2015. [PMCID: PMC4518667 DOI: 10.1186/2046-2530-4-s1-p61] [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: 11/15/2022] Open
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19
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Cohen K, Tzika A, Wood H, Berri S, Roberts P, Mason G, Sheridan E. Diagnosis of fetal submicroscopic chromosomal abnormalities in failed array CGH samples: copy number by sequencing as an alternative to microarrays for invasive fetal testing. Ultrasound Obstet Gynecol 2015; 45:394-401. [PMID: 25510919 DOI: 10.1002/uog.14767] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 11/11/2014] [Accepted: 12/10/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Array comparative genomic hybridization (CGH) has become the technology of choice for high-resolution prenatal whole genome analysis. Limitations of microarrays are mainly related to the analog nature of the analysis, and poor-quality DNA can result in failed quality metrics with these platforms. We examined a cohort of abnormal fetuses with failed array CGH results using a next-generation sequencing algorithm, CNV-Seq. We assessed the ability of the platform to handle suboptimal prenatal samples and generate interpretable molecular karyotypes. METHODS Nine samples obtained from abnormal fetuses and one from a normal control fetus were sequenced using an Illumina GAIIx. A segmentation algorithm for sequencing data was used to determine regional copy number data on the sequencing datasets. RESULTS Phred quality scores were satisfactory for analysis of all samples. CNV-Seq identified both large- and small-scale abnormalities in the cohort, and normal results were obtained for fetuses for which microarray data were previously uninterpretable. No variants of uncertain significance were detected. Analysis of the digital sequencing datasets offered some advantages over array CGH output. CONCLUSIONS Using next-generation sequencing for the detection of genomic copy number variants may be advantageous for poor-quality, invasively-acquired prenatal samples. CNV-Seq could become a potential alternative to array CGH in this setting.
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Affiliation(s)
- K Cohen
- Department of Fetal Medicine, Leeds General Infirmary, Leeds, UK; Leeds Institute of Cancer and Pathology, Leeds, UK
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Jafri H, Hewison J, Sheridan E, Ahmed S. Acceptability of prenatal testing and termination of pregnancy in Pakistan. J Community Genet 2014; 6:29-37. [PMID: 25081227 DOI: 10.1007/s12687-014-0198-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/21/2014] [Indexed: 02/06/2023] Open
Abstract
This study aimed to assess acceptability of prenatal testing (PNT) and termination of pregnancy (TOP) for a range of conditions in Pakistani parents with and without a child with a genetic condition. A structured questionnaire assessing acceptability of PNT and TOP for 30 conditions was completed by 400 Pakistani participants: 200 parents with a child with a genetic condition (100 fathers and 100 mothers) and 200 parents without an affected child (100 fathers and 100 mothers). There was a high level of interest in PNT, where over 80 % of parents in all four study groups would want PNT for the majority of the conditions. There was comparatively less interest in TOP for the same conditions (ranging from 5 to 70 % of parents, with mothers of an affected child being most interested). Parents were most likely to be interested in TOP for conditions at the serious end of the continuum. More than half of the participants in each group would consider TOP for anencephaly and quadriplegia. The interest in PNT and TOP for a range of conditions suggests that rapidly developing PNT technologies are likely to be acceptable in Pakistan, a low-middle income level and Muslim country. The comparatively lower level of interest in TOP for the same conditions highlights ethical dilemmas that such technologies are likely to raise.
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Affiliation(s)
- H Jafri
- Genetech Laboratory, 146/1 Shadman Jail Road, Lahore, Pakistan
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Sheridan E. Cyril Sheridan. Assoc Med J 2014. [DOI: 10.1136/bmj.g1884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharpe J, Logan C, Szabadkai G, Parry D, Torelli S, Childs AM, Kriek M, Phadke R, Johnson C, Roberts N, Bonthron D, Pysden K, Whyte T, Munteanu I, Foley A, Wheway G, Szymanska K, Natarajan S, Abdelhamed Z, Morgan J, Roper H, Santen G, Niks E, van der Pol W, Lindhout D, Raffaello A, De Stefani D, den Dunnen J, Sun Y, Ginjaar I, Sewry C, Hurles M, Rizzuto R, Duchen M, Muntoni F, Sheridan E. P24 Loss-of-function mutations in MICU1 cause a brain and muscle disorder linked to primary alterations in mitochondrial calcium signalling. Neuromuscul Disord 2014. [DOI: 10.1016/s0960-8966(14)70040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lorente D, Omlin AG, Pezaro CJ, Tunariu N, Ferraldeschi R, Riisnaes R, Mateo J, Sheridan E, Perez Lopez R, Nava Rodrigues D, Crespo M, Figueiredo I, Zafeirou Z, Altavilla A, Attard G, De Bono JS. Predicting positive bone marrow biopsies (BMBs) in patients (PTS) with advanced prostate cancer (APC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.180] [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: 11/20/2022] Open
Abstract
180 Background: Advanced prostate cancer (APC) is a molecularly heterogeneous disease, with evidence of clonal evolution that could be responsible for resistance to treatment. About 90% of patients (pts) with APC have bone metastases. The acquisition of a bone marrow biopsies (BMBs) is a safe and feasible technique for obtaining tissue, with a low rate of complications. We hypothesized that pre-biopsy clinical variables may increase the success rate of BMBs in APC. Methods: Standard BMBs of the iliac crest were performed in APC pts between October 2011 and June 2013. All pts signed ethics approved consent. In the control cohort (n=10) BMBs were collected in pts with normal CT and bone scan appearance. Minimum, maximum, and mean Hounsfield Units (HU) of the iliac crest on pre-biopsy CTs were determined. Clinical and laboratory variables were collected from the electronic record system. Biopsies were defined as containing 50 or more or 1 to 50 malignant cells or none (negative). Univariate analysis was performed to determine variables associated with biopsy positivity with 50 or more cells. For variables with p value<0.1, the optimal cut-off point was determined by ROC curve analysis. A multivariate analysis with optimal cut-off points was then performed. Results: A total of 71 BMBs were performed in 57 pts. None of the control biopsies in pts with normal CT and bone scan (10 of 10) contained tumor. A total of 46 of 61 BMBs (75.4%) were positive. 38 of 61 (62.3%) contained 50 or more cells. Prior treatments were docetaxel in 57 (79.2%) and abiraterone in 42 (58%) pts. Bisphosphonates had been used in 21 (28.8%) pts. The significant variables on univariate analysis were ALP more than or equal to 200 IU/L (p=0.059), prostate-specific antigen (PSA) more than or equal to 225 ng/mL (p=0.008), lactate dehydrogenase (LDH) more than or equal to 200 IU/L (p=0.09), mean HU more than or equal to 125 (p=0.000) and maximum HU more than or equal to 550 (p=0.001). These factors were tested in multivariate analysis. Only PSA and mean HU were significant in multivariate analysis. The combined PSA and mean HU score had an ROC AUC of 0.79. Conclusions: A combination of PSA and mean HU on CT could assist physicians in selecting APC patients/ iliac crest site more likely to have a positive BMB. Prospective evaluation is ongoing in a validation set.
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Affiliation(s)
- David Lorente
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Aurelius Gabriel Omlin
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Carmel Jo Pezaro
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Nina Tunariu
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Roberta Ferraldeschi
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Ruth Riisnaes
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Joaquin Mateo
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Elizabeth Sheridan
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Raquel Perez Lopez
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Daniel Nava Rodrigues
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Mateus Crespo
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Ines Figueiredo
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Zafeiris Zafeirou
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Amelia Altavilla
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Gerhardt Attard
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Lamagni TL, Keshishian C, Efstratiou A, Guy R, Henderson KL, Broughton K, Sheridan E. Emerging Trends in the Epidemiology of Invasive Group B Streptococcal Disease in England and Wales, 1991–2010. Clin Infect Dis 2013; 57:682-8. [DOI: 10.1093/cid/cit337] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Birgand G, Lepelletier D, Baron G, Barrett S, Breier AC, Buke C, Markovic-Denic L, Gastmeier P, Kluytmans J, Lyytikainen O, Sheridan E, Szilagyi E, Tacconelli E, Troillet N, Ravaud P, Lucet JC. Agreement among healthcare professionals in ten European countries in diagnosing case-vignettes of surgical-site infections. PLoS One 2013; 8:e68618. [PMID: 23874690 PMCID: PMC3706413 DOI: 10.1371/journal.pone.0068618] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 05/30/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Although surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe. METHODS Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale. RESULTS Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00-0.35) to 0.65 (0.45-0.82). Inter-specialty agreement varied from 0.04 (0.00-0.62) in to 0.55 (0.37-0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14-0.42) and good for ICPs (0.41, 0.28-0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00-0.10) to 0.50 (0.45-0.55) and was not improved by reading SSI definition. CONCLUSION Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries.
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Affiliation(s)
- Gabriel Birgand
- Infection control unit, Bichat-Claude Bernard Hospital, Paris, France.
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Hope R, Blackburn RM, Verlander NQ, Johnson AP, Kearns A, Hill R, Hopkins S, Sheridan E, Livermore DM, Scarborough M, Majumdar S, Cunniffe J, Farrington M, Gouliouris T, Marodi C, Godwin P, Tuck A, Warren R, Coe P, Hassan I, Mannion P, Loudon K, Youngs E, Johnson A, Lee M, Weston V, Guleri A, Howe R, Matthew D, Cotterill S, Todd N, Patel B, Mlangeni D, Stockley JM, Spencer R, Gardner J, Thwaites G, Kirby A, Hopkins S, Crook D, Llewellyn M, Price J, Scarborough M, Morris Jones S, Tilley R. Vancomycin MIC as a predictor of outcome in MRSA bacteraemia in the UK context. J Antimicrob Chemother 2013; 68:2641-7. [DOI: 10.1093/jac/dkt234] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, Lamagni T, Elgohari S, Sheridan E. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect 2013; 84:44-51. [PMID: 23507051 DOI: 10.1016/j.jhin.2013.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/20/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Short postoperative stays following caesarean section delivery make it difficult to assess accurately the risk of surgical site infection (SSI). Methods of case-finding that minimize variation are required to support effective surveillance systems, especially where used for benchmarking. AIM To evaluate the efficacy of case-finding methods for SSI following caesarean delivery and their utility in establishing benchmark rates of SSI. METHODS Hospitals conducted surveillance over one or two 13-week periods. Patients were reviewed during their inpatient stay, post partum by community midwives and via patient questionnaire at 30 days post delivery. To estimate the reliability of case-finding methods, case-note reviews were undertaken in a random sample of four hospitals. FINDINGS A total of 404 SSIs were detected in 4107 caesarean deliveries from 14 hospitals. The median time to SSI was 10 days, 66% were detected in-hospital or by community midwives, and an additional 34% were patient-reported. The rate of SSI was 9.8% but the proportion of patients followed up varied significantly between centres. The estimated sensitivity and specificity of case-finding was 91.4% [95% confidence interval (CI): 53.4-98.4] and 98.6% (95% CI: 98.4-98.8), the positive predictive value 91.0% (95% CI: 82.4-96.1) and negative predictive value 98.6% (95% CI: 93.9-99.5). CONCLUSIONS Combined case ascertainment methods are a feasible way to achieve active post-discharge surveillance and had high negative and positive predictive values. Additional SSIs can be detected by patient questionnaires but rates of SSI were strongly influenced by variation in intensity of both healthcare worker- and patient-based case-finding. This factor must be taken into account when comparing or benchmarking rates of SSI.
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Affiliation(s)
- J Wilson
- Department of Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency, London, UK.
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Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England. Authors' reply. BJOG 2013; 120:509-10. [PMID: 23398835 DOI: 10.1111/1471-0528.12110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2012] [Indexed: 11/26/2022]
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Mezynski J, Pezaro C, Bianchini D, Zivi A, Sandhu S, Thompson E, Hunt J, Sheridan E, Baikady B, Sarvadikar A, Maier G, Reid AHM, Mulick Cassidy A, Olmos D, Attard G, de Bono J. Antitumour activity of docetaxel following treatment with the CYP17A1 inhibitor abiraterone: clinical evidence for cross-resistance? Ann Oncol 2012; 23:2943-2947. [PMID: 22771826 DOI: 10.1093/annonc/mds119] [Citation(s) in RCA: 210] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Abiraterone and docetaxel are both approved treatments for men with metastatic castration-resistant prostate cancer (mCRPC). Abiraterone pre-docetaxel is currently undergoing evaluation in a phase III study. In vitro studies indicate that taxanes may act by disrupting androgen receptor signalling. We hypothesised that prior abiraterone exposure would adversely impact docetaxel efficacy. PATIENTS AND METHODS We retrospectively evaluated activity of docetaxel in mCRPC patients previously treated with abiraterone, using Prostate Cancer Working Group and radiological criteria. RESULTS Of the 54 patients treated with abiraterone, 35 subsequently received docetaxel. Docetaxel resulted in a prostate-specific antigen (PSA) decline of ≥50% in nine patients [26%, 95% confidence interval (CI) 13% to 43%], with a median time to PSA progression of 4.6 months (95% CI 4.2% to 5.9%). PSA declines ≥30% were achieved by 13 patients (37%, 95% CI 22% to 55%). The median overall survival was 12.5 months (95% CI 10.6-19.4). All patients who failed to achieve a PSA fall on abiraterone and were deemed abiraterone-refractory were also docetaxel-refractory (N = 8). In the 24 patients with radiologically evaluable disease, partial responses were reported in four patients (11%), none of whom were abiraterone-refractory. CONCLUSION The activity of docetaxel post-abiraterone appears lower than anticipated and no responses to docetaxel were observed in abiraterone-refractory patients.
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Affiliation(s)
- J Mezynski
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - C Pezaro
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - D Bianchini
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - A Zivi
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - S Sandhu
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - E Thompson
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - J Hunt
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - E Sheridan
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - B Baikady
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - A Sarvadikar
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - G Maier
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - A H M Reid
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - A Mulick Cassidy
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - D Olmos
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - G Attard
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK.
| | - J de Bono
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
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Jafri H, Ahmed S, Ahmed M, Hewison J, Raashid Y, Sheridan E. Islam and termination of pregnancy for genetic conditions in Pakistan: implications for Pakistani health care providers. Prenat Diagn 2012; 32:1218-20. [PMID: 23080051 DOI: 10.1002/pd.3987] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG 2012; 119:1324-33. [DOI: 10.1111/j.1471-0528.2012.03452.x] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Ahmed S, Ahmed M, Sharif SM, Sheridan E, Taylor GR. Attitudes towards prenatal testing and termination of pregnancy in British Pakistani parents and relatives of children with recessive conditions in the UK. Prenat Diagn 2012; 32:954-9. [DOI: 10.1002/pd.3940] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 06/12/2012] [Accepted: 06/20/2012] [Indexed: 11/08/2022]
Affiliation(s)
- S. Ahmed
- Leeds Institute of Health Sciences, School of Medicine; University of Leeds; 101 Clarendon Road Leeds LS2 9LJ UK
| | - M. Ahmed
- Yorkshire Regional Genetics Service; Leeds NHS Teaching Hospitals Trust; UK
| | - S. M. Sharif
- Yorkshire Regional Genetics Service; Leeds NHS Teaching Hospitals Trust; UK
| | - E. Sheridan
- Yorkshire Regional Genetics Service; Leeds NHS Teaching Hospitals Trust; UK
| | - G. R. Taylor
- Translational Genomics; Leeds University and Leeds Teaching Hospital; UK
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Bianchini D, Sandhu SK, Mulick Cassidy A, Zivi A, Mezynski J, Mukherji D, Pezaro CJ, Reid AH, Oommen NB, Olmos D, Omlin AG, Sarvadikar A, Thompson E, Hunt J, Sheridan E, Attard G, De Bono JS. Durable radiologic and clinical disease stability beyond PSA progression in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate (AA). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4553 Background: AA, a potent oral CYP17A1 inhibitor is approved for treatment of mCRPC with a survival advantage of 4.9 months. In clinical practice, response evaluation remains challenging for pts with mCRPC. CTC conversion from CTC ≥ 5 to CTC < 5 with treatment predicts for improved overall survival in mCRPC. We hypothesized that pts continue to have durable disease stability beyond PSA progression on AA. Methods: Prostate Specific Antigen (PSA) responses, radiological responses and CTC conversion rates were retrospectively analysed in pts treated on AA at our institution. CTCs, PSA and imaging were obtained at predefined time points during these studies. Radiological and PSA progression were defined by standard Prostate Cancer Working Group Criteria II. Clinical progression consisted of worsening disease related pain, skeletal events or declining performance status.Pearson’s chi-squared test and the Kaplan-Meier method were used for this analysis. Results: 141 patients [ECOG Performance Status 0-2; Median Age: 69.7 (range 44.7-87.1); 85 post-docetaxel, 56 pre-docetaxel] received AA. The median duration of clinical and radiological stable disease (SD) was 16.8 months (n=55) and 5.6 months (n=75) in patients with a baseline CTCs count of ≤ 5 cells/7.5mls and ≥ 5 cells/7.5 mls respectively. In the 105 patients with documented PSA progression on AA there was a median 5.7-month delay in detecting radiological and/or clinical progression (95% CI: 4.2, 8.4; range 0.3, 35.6 months). Radiological and clinical SD of ≥ 1 year, ≥ 2 years and ≥ 3 years on AA was observed in 43/141 (30.5%), 21/141 (14.9%) and 12/141 (8.5%) respectively. Conclusions: Radiological and clinical disease stabilization beyond PSA progression is maintained in a high proportion of mCRPC patients treated with AA. Future studies should evaluate whether continued AA treatment beyond PSA and radiological progression can impact outcome.
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Affiliation(s)
- Diletta Bianchini
- The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Shahneen Kaur Sandhu
- The Institute of Cancer Research and Royal Marsden Foundation Trust, Sutton, United Kingdom
| | | | - Andrea Zivi
- The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom
| | | | - Deborah Mukherji
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Carmel Jo Pezaro
- The Institute of Cancer Research and Royal Marsden Foundation Trust, Sutton, United Kingdom
| | - Alison Helen Reid
- The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | | | - David Olmos
- Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Aurelius Gabriel Omlin
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | | | - Joanne Hunt
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Gerhardt Attard
- The Institute for Cancer Research and Royal Marsden Foundation Trust, Sutton, United Kingdom
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Enciso-Mora V, Hosking FJ, Sheridan E, Kinsey SE, Lightfoot T, Roman E, Irving JAE, Tomlinson IPM, Allan JM, Taylor M, Greaves M, Houlston RS. Common genetic variation contributes significantly to the risk of childhood B-cell precursor acute lymphoblastic leukemia. Leukemia 2012; 26:2212-5. [PMID: 22456626 DOI: 10.1038/leu.2012.89] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Recent genome-wide association studies (GWAS) have provided the first unambiguous evidence that common genetic variation influences the risk of childhood B-cell precursor acute lymphoblastic leukemia (BCP-ALL), identifying risk single-nucleotide polymorphisms (SNPs) localizing to 7p12.2, 9p21.3, 10q21.2 and 14q11.2. The testing of SNPs individually for an association in GWA studies necessitates the imposition of a very stringent P-value to address the issue of multiple testing. While this reduces false positives, real associations may be missed and therefore any estimate of the total heritability will be negatively biased. Using GWAS data on 823 BCP-ALL cases by considering all typed SNPs simultaneously, we have calculated that 24% of the total variation in BCP-ALL risk is accounted for common genetic variation (95% confidence interval 6-42%). Our findings provide support for a polygenic basis for susceptibility to BCP-ALL and have wider implications for future searches for novel disease-causing risk variants.
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Affiliation(s)
- V Enciso-Mora
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
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Johnson AP, Davies J, Guy R, Abernethy J, Sheridan E, Pearson A, Duckworth G. Mandatory surveillance of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in England: the first 10 years. J Antimicrob Chemother 2012; 67:802-9. [DOI: 10.1093/jac/dkr561] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wilson J, Elgohari S, Livermore DM, Cookson B, Johnson A, Lamagni T, Chronias A, Sheridan E. Trends among pathogens reported as causing bacteraemia in England, 2004-2008. Clin Microbiol Infect 2011; 17:451-8. [PMID: 20491834 DOI: 10.1111/j.1469-0691.2010.03262.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Health Protection Agency in England operates a voluntary surveillance system that collects data on bacteraemias reported by over 90% of laboratories in England. Trends in causative microorganisms reported between 2004 and 2008 were analyzed using a generalized linear model with a log link function for Poisson distribution. In 2008, 101,276 episodes of bacteraemia were reported; a rate of 189 per 100,000 population. More than one-half occurred in those aged over 65 years and males. The most common organisms reported were Escherichia coli (23%), coagulase-negative staphylococci (CNS) (16.9%) and Staphylococcus aureus (11.4%). Between 2004 and 2008, E. coli bacteraemia increased by 33% (p < 0.001); the species now accounts for more than 30% of bacteraemia in those aged over 75 years. There also were significant increases in bacteraemia caused by other Gram-negative pathogens and marked seasonal variation. Bacteraemia caused by S. aureus increased until 2005, with a decline after 2006 (p < 0.001) entirely due to methicillin-resistant strains. CNS bacteraemia have declined significantly since 2007. The renewed dominance of Gram-negative pathogens as major causes of bacteraemia in England is of particular concern because they are associated with a high morbidity and increasing resistance to antibiotics. Further investigation of the underlying causes and prevention strategies is a public health priority. Recent declines in methicillin-resistant S. aureus bacteraemia have not been reflected in other pathogens, including methicillin-susceptible S. aureus.
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Affiliation(s)
- J Wilson
- Health Protection Agency, Centre for Infections, London, UK.
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Blackburn RM, Henderson KL, Lillie M, Sheridan E, George RC, Deas AHB, Johnson AP. Empirical treatment of influenza-associated pneumonia in primary care: a descriptive study of the antimicrobial susceptibility of lower respiratory tract bacteria (England, Wales and Northern Ireland, January 2007-March 2010). Thorax 2011; 66:389-95. [PMID: 21357586 DOI: 10.1136/thx.2010.134643] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the susceptibility of lower respiratory tract (LRT) isolates of Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae to antimicrobial agents recommended by UK guidelines for treatment of pneumonia associated with influenza-like illness. METHODS Analysis of antimicrobial susceptibility data from sentinel microbiology laboratories in England, Wales and Northern Ireland was carried out. Subjects comprised patients who had an LRT specimen taken in a general practitioner surgery or hospital outpatient setting between January 2007 and March 2010. The main outcome measurements were antimicrobial susceptibility trends of LRT isolates over time, between patient age groups and in different geographical regions. RESULTS Susceptibility to tetracyclines or co-amoxiclav was high. Of the 70,288 and 45,288 isolates with susceptibility results for tetracyclines or co-amoxiclav, 96% and 92%, respectively, were susceptible. Overall susceptibility to ciprofloxacin, ampicillin/amoxicillin and macrolides was lower than for tetracyclines or co-amoxiclav and varied markedly by organism. There were few clinically relevant variations in susceptibility to doxycycline or co-amoxiclav over time, geographically or between age groups. CONCLUSIONS The data support the use of doxycycline or co-amoxiclav as appropriate empiric treatment for LRT infection caused by the pathogens investigated, for patients in primary care.
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Affiliation(s)
- Ruth M Blackburn
- Healthcare Associated Infections and Antimicrobial Resistance Department, Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK.
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Abstract
1. A study was made of the electrolyte changes which occur when frog muscles are immersed in a Ringer solution with 1/5 of the Na replaced by NH4Cl. Analyses were made in the solution and in the muscles for K and NH3, and the muscles were also analyzed for Cl, HCO3, and Na. Control muscles were immersed in normal Ringer's solution and similarly analyzed. 2. The amount of ammonia taken up was about equal to the K and Na lost. There was also a small increase in chloride content. The bicarbonate content was the same in both experimental and control muscles, indicating no change in the muscle pH due to the NH3 which penetrated. An increased loss of K due to the penetration of NH3 was also demonstrated by the use of radioactive K. 3. After 5 hours, the concentration of ammonia per gram of muscle is about the same as the concentration in the solution. After 4 or 5 days, the concentration in the muscle is about 1.5 times that in the solution. The inside to outside NH3 ratio is about equal to the corresponding H ion ratio, but is much less than the K ratio. 4. The rate of penetration of the NH3 is increased by a rise of temperature, by stirring the solution, and by decrease in the concentration of Na, K, Ca, or Mg in the solution; it is decreased by increasing the size of the muscles or by killing them with chloroform or boiling. 5. Liver, smooth muscle, skin, and kidney, in a few experiments, behaved much like muscle except that there was a formation of urea in the case of liver. 6. The injection of NH4Cl into anesthetized cats causes an increase in the level of K in the blood plasma.
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Affiliation(s)
- W O Fenn
- Department of Physiology, The University of Rochester School of Medicine and Dentistry, Rochester, New York
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Travaglini L, Brancati F, Attie-Bitach T, Audollent S, Bertini E, Kaplan J, Perrault I, Iannicelli M, Mancuso B, Rigoli L, Rozet JM, Swistun D, Tolentino J, Dallapiccola B, Gleeson JG, Valente EM, Zankl A, Leventer R, Grattan-Smith P, Janecke A, D'Hooghe M, Sznajer Y, Van Coster R, Demerleir L, Dias K, Moco C, Moreira A, Kim CA, Maegawa G, Petkovic D, Abdel-Salam GMH, Abdel-Aleem A, Zaki MS, Marti I, Quijano-Roy S, Sigaudy S, de Lonlay P, Romano S, Touraine R, Koenig M, Lagier-Tourenne C, Messer J, Collignon P, Wolf N, Philippi H, Kitsiou Tzeli S, Halldorsson S, Johannsdottir J, Ludvigsson P, Phadke SR, Udani V, Stuart B, Magee A, Lev D, Michelson M, Ben-Zeev B, Fischetto R, Benedicenti F, Stanzial F, Borgatti R, Accorsi P, Battaglia S, Fazzi E, Giordano L, Pinelli L, Boccone L, Bigoni S, Ferlini A, Donati MA, Caridi G, Divizia MT, Faravelli F, Ghiggeri G, Pessagno A, Briguglio M, Briuglia S, Salpietro CD, Tortorella G, Adami A, Castorina P, Lalatta F, Marra G, Riva D, Scelsa B, Spaccini L, Uziel G, Del Giudice E, Laverda AM, Ludwig K, Permunian A, Suppiej A, Signorini S, Uggetti C, Battini R, Di Giacomo M, Cilio MR, Di Sabato ML, Leuzzi V, Parisi P, Pollazzon M, Silengo M, De Vescovi R, Greco D, Romano C, Cazzagon M, Simonati A, Al-Tawari AA, Bastaki L, Mégarbané A, Sabolic Avramovska V, de Jong MM, Stromme P, Koul R, Rajab A, Azam M, Barbot C, Martorell Sampol L, Rodriguez B, Pascual-Castroviejo I, Teber S, Anlar B, Comu S, Karaca E, Kayserili H, Yüksel A, Akcakus M, Al Gazali L, Sztriha L, Nicholl D, Woods CG, Bennett C, Hurst J, Sheridan E, Barnicoat A, Hennekam R, Lees M, Blair E, Bernes S, Sanchez H, Clark AE, DeMarco E, Donahue C, Sherr E, Hahn J, Sanger TD, Gallager TE, Dobyns WB, Daugherty C, Krishnamoorthy KS, Sarco D, Walsh CA, McKanna T, Milisa J, Chung WK, De Vivo DC, Raynes H, Schubert R, Seward A, Brooks DG, Goldstein A, Caldwell J, Finsecke E, Maria BL, Holden K, Cruse RP, Swoboda KJ, Viskochil D. Expanding CEP290 mutational spectrum in ciliopathies. Am J Med Genet A 2009; 149A:2173-80. [PMID: 19764032 DOI: 10.1002/ajmg.a.33025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ciliopathies are an expanding group of rare conditions characterized by multiorgan involvement, that are caused by mutations in genes encoding for proteins of the primary cilium or its apparatus. Among these genes, CEP290 bears an intriguing allelic spectrum, being commonly mutated in Joubert syndrome and related disorders (JSRD), Meckel syndrome (MKS), Senior-Loken syndrome and isolated Leber congenital amaurosis (LCA). Although these conditions are recessively inherited, in a subset of patients only one CEP290 mutation could be detected. To assess whether genomic rearrangements involving the CEP290 gene could represent a possible mutational mechanism in these cases, exon dosage analysis on genomic DNA was performed in two groups of CEP290 heterozygous patients, including five JSRD/MKS cases and four LCA, respectively. In one JSRD patient, we identified a large heterozygous deletion encompassing CEP290 C-terminus that resulted in marked reduction of mRNA expression. No copy number alterations were identified in the remaining probands. The present work expands the CEP290 genotypic spectrum to include multiexon deletions. Although this mechanism does not appear to be frequent, screening for genomic rearrangements should be considered in patients in whom a single CEP290 mutated allele was identified.
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Affiliation(s)
- Lorena Travaglini
- CSS-Mendel Institute, Casa Sollievo della Sofferenza Hospital, Rome, Italy
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Grünfeld JP, Scholl UI, Bockenhauer D, Glaudemans B, van Bommel EF, Scheel PJ, Delvaeye M, Choi M, Liu T, Ramaekers VT, Häusler MG, Grimmer J, Tobe SW, Farhi A, Nelson-Williams C, Lifton RP, Feather S, Stanescu HC, Bandulik S, Zdebik AA, Reichold M, Tobin J, Lieberer E, Sterner C, Landoure G, Arora R, Sirimanna T, Thompson D, Cross JH, van't Hoff W, Al Masri O, Tullus K, Yeung S, Anikster Y, Klootwijk E, Hubank M, Dillon MJ, Heitzmann D, Arcos-Burgos M, Knepper MA, Dobbie A, Gahl WA, Warth R, Sheridan E, Kleta R, van der Wijst J, Scola R, Lorenzoni PJ, Heister A, van der Kemp A, Knoers NV, Hoenderop JG, Bindels RJ, Jansen I, Hendriksz TR, Aarnoudse AL, Feeley N, Noris M, De Vriese A, Esmon CT, Esmon NL, Ferrell G, Del-Favero J, Plaisance S, Claes B, Lambrechts D, Remuzzi G, Conway EM. Rare but Relevant Kidney DisordersSeizures, sensorineural deafness, ataxia, mental retardation, and electrolyte imbalance (SeSAME syndrome) caused by mutations in KCNJ10. Proc Natl Acad Sci U S A 106: 5842–5847, 2009Epilepsy, ataxia, sensorineural deafness, tubulopathy, and KCNJ10 mutations. N Engl J Med 360: 1960–1970, 2009A missense mutation in the Kv1.1 voltage-gated potassium channel-encoding gene KCNA1 is linked to human autosomal dominant hypomagnesemia. J Clin Invest 119: 936–942, 2009Idiopathic retroperitoneal fibrosis: Prospective evaluation of incidence and clinicoradiologic presentation. Medicine 88: 193–201, 2009Retroperitoneal fibrosis: The clinical, laboratory, and radiographic presentation. Medicine 88: 202–207, 2009Thrombomodulin mutations in atypical hemolytic-uremic syndrome. N Engl J Med 361: 345–357, 2009. Clin J Am Soc Nephrol 2009. [DOI: 10.2215/cjn.06710909] [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: 11/23/2022]
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Bockenhauer D, Feather S, Stanescu HC, Bandulik S, Zdebik AA, Reichold M, Tobin J, Lieberer E, Sterner C, Landoure G, Arora R, Sirimanna T, Thompson D, Cross JH, van't Hoff W, Al Masri O, Tullus K, Yeung S, Anikster Y, Klootwijk E, Hubank M, Dillon MJ, Heitzmann D, Arcos-Burgos M, Knepper MA, Dobbie A, Gahl WA, Warth R, Sheridan E, Kleta R. Rare but Relevant Kidney Disorders. Clin J Am Soc Nephrol 2009. [DOI: 10.2215/01.cjn.0000927052.57897.21] [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: 03/29/2023]
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Reddy S, Manuel R, Sheridan E, Sadler G, Patel S, Riley P. Brucellosis in the UK: a risk to laboratory workers? Recommendations for prevention and management of laboratory exposure. J Clin Pathol 2008; 63:90-2. [DOI: 10.1136/jcp.2007.053108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wood NJ, Munot S, Sheridan E, Duffy SR. Does a “one-stop” gynecology screening clinic for women in hereditary nonpolyposis colorectal cancer families have an impact on their psychological morbidity and perception of health? Int J Gynecol Cancer 2008; 18:279-84. [PMID: 17587321 DOI: 10.1111/j.1525-1438.2007.01009.x] [Citation(s) in RCA: 9] [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: 11/28/2022] Open
Abstract
Screening programs can reduce the burden of disease, however, they can be associated with raised levels of anxiety. The risk of endometrial and ovarian cancer is increased in hereditary nonpolyposis colorectal cancer (HNPCC). There is no prospective evidence to support screening for gynecological disease in HNPCC, however, current recommendations include the use of ultrasound and endometrial biopsy. This study assesses the impact of screening for gynecological cancer on self-reported symptoms of anxiety, depression, and perceptions of health. Women from HNPCC families attending gynecological screening (n= 26) completed the Hospital Anxiety and Depression Scale and the ShortForm36v2 questionnaires prior to screening with transvaginal ultrasound, outpatient/office hysteroscopy, endometrial biopsy, and ovarian tumor marker assessment (CA125). The same questionnaires were completed at 3 and 6 months following screening (15/26). Women in HNPCC families attending for gynecological screening did not have excess symptoms of anxiety or depression at baseline in subjective comparison to other populations. The process of screening and false positive screening results had no significant impact on symptoms of anxiety and depression or perceptions of health. We conclude that within the limitations of analysis in this small study group, screening for gynecological disease in HNPCC does not appear to be associated with any psychological morbidity.
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Affiliation(s)
- N J Wood
- Department of Obstetrics and Gynaecology, St James' University Hospital, Leeds, West Yorkshire, United Kingdom
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Borchert DH, Sheridan E, Papatsoris A, Zaman F, Barua J, Junaid I, Pati J, Buchholz N, Chinegwundoh F. THE CASE FOR PROBIOTICS IN UROLOGY. BJU Int 2007; 101:413-4. [DOI: 10.1111/j.1464-410x.2007.07316.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: 11/30/2022]
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Hewitt MJ, Wood N, Quinton ND, Charlton R, Taylor G, Sheridan E, Duffy SR. The detection of microsatellite instability in blind endometrial samples--a potential novel screening tool for endometrial cancer in women from hereditary nonpolyposis colorectal cancer families? Int J Gynecol Cancer 2007; 16:1393-400. [PMID: 16803536 DOI: 10.1111/j.1525-1438.2006.00604.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/28/2022] Open
Abstract
Microsatellite instability (MSI) is the phenotypic molecular characteristic of the majority of tumors associated with the hereditary nonpolyposis colorectal cancer syndrome (HNPCC). Women in this group have an increased risk of endometrial cancer (EC). This study aimed to determine whether MSI could be demonstrated in blind endometrial samples from women with EC, HNPCC kindreds undergoing screening for EC, and women with normal endometrium. Twenty-four women with EC, 20 women from HNPCC kindreds, and 20 women undergoing gynecological surgery for benign indications underwent blind sampling. MSI analysis was performed by conventional polymerase chain reaction using fluorescent-labeled primers and automated analysis. Twelve microsatellites were studied with MSI defined as evident when novel alleles were seen in endometrial biopsy samples compared to genomic DNA. Of the 24 EC samples obtained, sufficient DNA for analysis was extracted in 17 cases. Three cases had evidence of MSI in at least 7/12 loci. None of the endometrium from the two other study groups revealed evidence of MSI. This is the first demonstration of MSI in blind endometrial biopsies. The ability to demonstrate MSI in heterogeneous endometrial samples suggests potential for the development of a novel EC screening tool for women in HNPCC kindreds.
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Affiliation(s)
- M J Hewitt
- Division of Obstetrics & Gynaecology, Academic Unit of Oncology and Haematology, University of Leeds, St. James's University Hospital, Beckett Street, Leeds, UK.
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Wood NJ, Quinton NA, Burdall S, Sheridan E, Duffy SR. Exploring the potential chemopreventative effect of aspirin and rofecoxib on hereditary nonpolyposis colorectal cancer-like endometrial cancer cells in vitro through mechanisms involving apoptosis, the cell cycle, and mismatch repair gene expression. Int J Gynecol Cancer 2007; 17:447-54. [PMID: 17316360 DOI: 10.1111/j.1525-1438.2007.00867.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Women in hereditary nonpolyposis colorectal cancer (HNPCC) families have up to a 71% lifetime risk for developing endometrial cancer (EC). This compares to the female lifetime risk for colorectal cancer (CRC) in HNPCC of 60%. The basis of HNPCC is an inherited mutation in a mismatch repair gene (MMR). Aspirin and COX2 inhibitors seem to have a chemoprotective effect on CRC in the general population and are the subject of prospective clinical studies in patients at high risk for CRC including HNPCC. There is no evidence that these agents have any protective effect against EC in the general population. This study investigated the effect of aspirin and a COX2 inhibitor (rofecoxib) on an HNPCC EC cell line model (Ishikawa) by assessing the effect on proliferation, apoptosis, the cell cycle, and MMR gene expression. Aspirin inhibits EC cell proliferation by inducing apoptosis and changes in the cell cycle. This effect is not mediated by changes in MMR gene (hMSH2) expression as assessed by quantitative reverse transcription-polymerase chain reaction. Rofecoxib inhibits EC cell proliferation; this did not appear to be mediated by induction of apoptosis, by alterations of the cell cycle, or by changes in MMR gene expression.
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Affiliation(s)
- N J Wood
- Department of Obstetrics and Gynaecology, St James' University Hospital, Leeds, United Kingdom
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Gregory SG, Barlow KF, McLay KE, Kaul R, Swarbreck D, Dunham A, Scott CE, Howe KL, Woodfine K, Spencer CCA, Jones MC, Gillson C, Searle S, Zhou Y, Kokocinski F, McDonald L, Evans R, Phillips K, Atkinson A, Cooper R, Jones C, Hall RE, Andrews TD, Lloyd C, Ainscough R, Almeida JP, Ambrose KD, Anderson F, Andrew RW, Ashwell RIS, Aubin K, Babbage AK, Bagguley CL, Bailey J, Banerjee R, Beasley H, Bethel G, Bird CP, Bray-Allen S, Brown JY, Brown AJ, Bryant SP, Buckley D, Burford DC, Burrill WDH, Burton J, Bye J, Carder C, Chapman JC, Clark SY, Clarke G, Clee C, Clegg SM, Cobley V, Collier RE, Corby N, Coville GJ, Davies J, Deadman R, Dhami P, Dovey O, Dunn M, Earthrowl M, Ellington AG, Errington H, Faulkner LM, Frankish A, Frankland J, French L, Garner P, Garnett J, Gay L, Ghori MRJ, Gibson R, Gilby LM, Gillett W, Glithero RJ, Grafham DV, Gribble SM, Griffiths C, Griffiths-Jones S, Grocock R, Hammond S, Harrison ESI, Hart E, Haugen E, Heath PD, Holmes S, Holt K, Howden PJ, Hunt AR, Hunt SE, Hunter G, Isherwood J, James R, Johnson C, Johnson D, Joy A, Kay M, Kershaw JK, Kibukawa M, Kimberley AM, King A, Knights AJ, Lad H, Laird G, Langford CF, Lawlor S, Leongamornlert DA, Lloyd DM, Loveland J, Lovell J, Lush MJ, Lyne R, Martin S, Mashreghi-Mohammadi M, Matthews L, Matthews NSW, McLaren S, Milne S, Mistry S, oore MJFM, Nickerson T, O'Dell CN, Oliver K, Palmeiri A, Palmer SA, Pandian RD, Parker A, Patel D, Pearce AV, Peck AI, Pelan S, Phelps K, Phillimore BJ, Plumb R, Porter KM, Prigmore E, Rajan J, Raymond C, Rouse G, Saenphimmachak C, Sehra HK, Sheridan E, Shownkeen R, Sims S, Skuce CD, Smith M, Steward C, Subramanian S, Sycamore N, Tracey A, Tromans A, Van Helmond Z, Wall J. M. Wallis M, White S, Whitehead SL, Wilkinson JE, Willey DL, Williams H, Wilming L, Wray PW, Wu Z, Coulson A, Vaudin M, Sulston JE, Durbin R, Hubbard T, Wooster R, Dunham I, Carter NP, McVean G, Ross MT, Harrow J, Olson MV, Beck S, Rogers J, Bentley DR. Erratum: The DNA sequence and biological annotation of human chromosome 1. Nature 2006. [DOI: 10.1038/nature05152] [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: 11/09/2022]
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Downey LM, Bottomley HM, Sheridan E, Ahmed M, Gilmour DF, Inglehearn CF, Reddy A, Agrawal A, Bradbury J, Toomes C. Reduced bone mineral density and hyaloid vasculature remnants in a consanguineous recessive FEVR family with a mutation in LRP5. Br J Ophthalmol 2006; 90:1163-7. [PMID: 16929062 PMCID: PMC1857417 DOI: 10.1136/bjo.2006.092114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Familial exudative vitreoretinopathy (FEVR) is an inherited blinding condition characterised by abnormal development of the retinal vasculature. FEVR has multiple modes of inheritance, and homozygous mutations in LRP5 have recently been reported as underlying the recessive form of this disease. The aim of this study was to examine LRP5 in a consanguineous recessive FEVR family and to clarify the eye and bone phenotype associated with recessive FEVR. METHODS All family members were examined by slit lamp biomicroscopy and indirect ophthalmoscopy. Linkage to LRP5 was determined by genotyping microsatellite markers, constructing haplotypes and calculating lod scores. Mutation screening of LRP5 was performed by polymerase chain reaction amplification of genomic DNA followed by direct sequencing. Bone mineral density (BMD) was evaluated in all family members using dual energy x ray absorptiometry (DEXA). RESULTS The clinical features observed in this family were consistent with a diagnosis of recessive FEVR. A homozygous LRP5 missense mutation, G550R, was identified in all affected individuals and all unaffected family members screened were heterozygous carriers of this mutation. Reduced BMD, hyaloid vasculature remnants, and nystagmus were features of the phenotype. CONCLUSION Recessive mutations in LRP5 can cause FEVR with reduced BMD and hyaloid vasculature remnants. Assessment of a patient with a provisional diagnosis of FEVR should therefore include investigation of BMD, with reduced levels suggestive of an underlying LRP5 mutation.
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Affiliation(s)
- L M Downey
- Department of Opthalmology, Leeds General Infirmary, Leeds, UK
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Richardson RJ, Joss S, Tomkin S, Ahmed M, Sheridan E, Dixon MJ. A nonsense mutation in the first transmembrane domain of connexin 43 underlies autosomal recessive oculodentodigital syndrome. J Med Genet 2006; 43:e37. [PMID: 16816024 PMCID: PMC2564566 DOI: 10.1136/jmg.2005.037655] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Oculodentodigital syndrome (ODD) is a pleiotropic congenital disorder characterised by abnormalities of the face, eyes, dentition, and limbs. ODD, which is inherited as an autosomal dominant trait, results from missense mutations in the gap junction protein connexin 43. OBJECTIVE To analyse a family with a history of ODD which is inherited in an autosomal recessive manner RESULTS ODD in this family resulted from the homozygous mutation R33X in the first transmembrane domain of connexin 43. CONCLUSIONS The findings provide clear genetic evidence that ODD can be inherited in an autosomal recessive manner and that a dominant negative mechanism underlies autosomal dominant ODD.
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Affiliation(s)
- R J Richardson
- Faculty of Life Sciences and Dental School, Michael Smith Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
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