1
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Stewart JA, Culverhouse E, Harrell M. Preterm infant with necrotizing enterocolitis and arteritis secondary to streptococcus gallolyticus subspecies pasteurianus. J Neonatal Perinatal Med 2024; 17:265-268. [PMID: 38669486 DOI: 10.3233/npm-230089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Streptococcus gallolyticus subspecies pasteurianus is a subtype of Streptococcus bovis (S. bovis) that has become increasingly recognized as a sepsis-causing pathogen in neonates. It is well documented that S. bovis species have a predilection to both cardiac and gastrointestinal tissue, and in adult populations, isolating these organisms in the bloodstream often triggers further evaluation for co-morbid complications such as colon cancer or endocarditis. However, no such guidance currently exists in neonatal literature. We present a case of a preterm infant with S. gallolyticus subsp. pasteurianus bacteremia presenting as necrotizing enterocolitis (NEC) not previously described in the literature. Furthermore, through a complete diagnostic evaluation, including an echocardiogram, our patient was found to have the rare complication of endocarditis.
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Affiliation(s)
- J A Stewart
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA
| | - E Culverhouse
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA
| | - Mathew Harrell
- Department of Neonatology, Tripler Army Medical Center, Honolulu, HI, USA
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2
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Stewart JA, Merritt EK, Lidstone DE, McBride JM, Zwetsloot KA. Prolonged cycling lowers subsequent running mechanical efficiency in collegiate triathletes. BMC Sports Sci Med Rehabil 2022; 14:149. [PMID: 35915467 PMCID: PMC9344700 DOI: 10.1186/s13102-022-00543-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022]
Abstract
Background A significant challenge that non-elite collegiate triathletes encounter during competition is the decline in running performance immediately after cycling. Therefore, the purpose of this study was to determine if performing a 40-km bout of cycling immediately before running would negatively influence running economy and mechanical efficiency of running during simulated race conditions in collegiate triathletes. Methods Eight competitive club-level collegiate triathletes randomly performed two trials: cycling for 40 km (Cycle-Run) or running for 5 km (Run–Run), immediately followed by a four-minute running economy and mechanical efficiency of running test at race pace on an instrumented treadmill. Blood lactate, respiratory exchange ratio, mechanical work, energy expenditure, and muscle glycogen were also measured during the four-minute running test. Results Mechanical efficiency of running, but not running economy, was significantly lower in Cycle-Run, compared to Run–Run (42.1 ± 2.5% vs. 48.1 ± 2.5%, respectively; p = 0.027). Anaerobic energy expenditure was significantly higher in the Cycle-Run trial, compared to the Run–Run trial (16.3 ± 2.4 vs. 7.6 ± 1.1 kJ; p = 0.004); while net (151.0 ± 12.3 vs. 136.6 ± 9.6 kJ; p = 0.204) and aerobic energy expenditure (134.7 ± 12.3 vs. 129.1 ± 10.5 kJ; p = 0.549) were not statistically different between trials. Analysis of blood lactate, respiratory exchange ratio, mechanical work, and changes in muscle glycogen revealed no statistically significant differences between trials. Conclusions These results suggest that mechanical efficiency of running, but not running economy, is decreased and anaerobic energy expenditure is increased when a 40-km bout of cycling is performed immediately before running in collegiate triathletes.
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Affiliation(s)
- J A Stewart
- Integrative Muscle Physiology Laboratory, Appalachian State University, ASU Box 32071, Boone, NC, USA.,Biomechanics and Neuromuscular Laboratory, Appalachian State University, ASU Box 32071, Boone, NC, USA
| | - E K Merritt
- Kinesiology Department, Southwestern University, 1001 E. University Ave., Georgetown, TX, USA
| | - D E Lidstone
- Biomechanics and Neuromuscular Laboratory, Appalachian State University, ASU Box 32071, Boone, NC, USA
| | - J M McBride
- Biomechanics and Neuromuscular Laboratory, Appalachian State University, ASU Box 32071, Boone, NC, USA.,Department of Health and Exercise Science, Appalachian State University, ASU Box 32071, Boone, NC, 28608, USA
| | - K A Zwetsloot
- Integrative Muscle Physiology Laboratory, Appalachian State University, ASU Box 32071, Boone, NC, USA. .,Department of Health and Exercise Science, Appalachian State University, ASU Box 32071, Boone, NC, 28608, USA.
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3
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Stewart JA, Särkelä MOK, Salmi T, Wennervirta J, Vakkuri AP, Vainikka TLS, Suojaranta R, Mäki K, Ilkka VH, Viertiö-Oja H, Salminen US. Noninvasive Neuromonitoring of Hypothermic Circulatory Arrest in Aortic Surgery. Scand J Surg 2019; 109:320-327. [PMID: 31315537 DOI: 10.1177/1457496919863942] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Circulatory arrest carries a high risk of neurological damage, but modern monitoring methods lack reliability, and is susceptible to the generalized effects of both anesthesia and hypothermia. The objective of this prospective, explorative study was to research promising, reliable, and noninvasive methods of neuromonitoring, capable of predicting neurological outcome after hypothermic circulatory arrest. MATERIALS AND METHODS Thirty patients undergoing hypothermic circulatory arrest during surgery of the thoracic aorta were recruited in a single center and over the course of 4 years. Neuromonitoring was performed with a four-channel electroencephalogram montage and a near-infrared spectroscopy monitor. All data were tested off-line against primary neurological outcome, which was poor if the patient suffered a significant neurological complication (stroke, operative death). RESULTS A poor primary neurological outcome seen in 10 (33%) patients. A majority (63%) of the cases were emergency surgery, and thus, no neurological baseline evaluation was possible. The frontal hemispheric asymmetry of electroencephalogram, as measured by the brain symmetry index, predicted primary neurological outcome with a sensitivity of 79 (interquartile range; 62%-88%) and specificity of 71 (interquartile range; 61%-84%) during the first 6 h after end of circulatory arrest. CONCLUSION The hemispheric asymmetry of frontal electroencephalogram is inherently resistant to generalized dampening effects and is predictive of primary neurological outcome. The brain symmetry index provides an easy-to-use, noninvasive neuromonitoring method for surgery of the thoracic aorta and postoperative intensive care.
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Affiliation(s)
- J A Stewart
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital (HUS) and University of Helsinki, Helsinki, Finland
| | | | - T Salmi
- Department of Clinical Neurophysiology, Helsinki University Hospital, Helsinki, Finland
| | - J Wennervirta
- Department of Anesthesiology and Intensive Care, Helsinki University Hospital, Helsinki, Finland
| | - A P Vakkuri
- Department of Anesthesiology and Intensive Care, Helsinki University Hospital, Helsinki, Finland
| | - T L S Vainikka
- Department of Cardiac Surgery, Helsinki University Hospital, Helsinki, Finland
| | - R Suojaranta
- Department of Anesthesiology and Intensive Care, Helsinki University Hospital, Helsinki, Finland
| | - K Mäki
- Department of Neuropsychology, Helsinki University Hospital, Helsinki, Finland
| | - V H Ilkka
- University of Helsinki, Helsinki, Finland
| | | | - U-S Salminen
- Department of Cardiac Surgery, Helsinki University Hospital, Helsinki, Finland
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4
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Rae JWB, Burke A, Robinson LF, Adkins JF, Chen T, Cole C, Greenop R, Li T, Littley EFM, Nita DC, Stewart JA, Taylor BJ. CO 2 storage and release in the deep Southern Ocean on millennial to centennial timescales. Nature 2018; 562:569-573. [PMID: 30356182 DOI: 10.1038/s41586-018-0614-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/29/2018] [Indexed: 11/09/2022]
Abstract
The cause of changes in atmospheric carbon dioxide (CO2) during the recent ice ages is yet to be fully explained. Most mechanisms for glacial-interglacial CO2 change have centred on carbon exchange with the deep ocean, owing to its large size and relatively rapid exchange with the atmosphere1. The Southern Ocean is thought to have a key role in this exchange, as much of the deep ocean is ventilated to the atmosphere in this region2. However, it is difficult to reconstruct changes in deep Southern Ocean carbon storage, so few direct tests of this hypothesis have been carried out. Here we present deep-sea coral boron isotope data that track the pH-and thus the CO2 chemistry-of the deep Southern Ocean over the past forty thousand years. At sites closest to the Antarctic continental margin, and most influenced by the deep southern waters that form the ocean's lower overturning cell, we find a close relationship between ocean pH and atmospheric CO2: during intervals of low CO2, ocean pH is low, reflecting enhanced ocean carbon storage; and during intervals of rising CO2, ocean pH rises, reflecting loss of carbon from the ocean to the atmosphere. Correspondingly, at shallower sites we find rapid (millennial- to centennial-scale) decreases in pH during abrupt increases in CO2, reflecting the rapid transfer of carbon from the deep ocean to the upper ocean and atmosphere. Our findings confirm the importance of the deep Southern Ocean in ice-age CO2 change, and show that deep-ocean CO2 release can occur as a dynamic feedback to rapid climate change on centennial timescales.
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Affiliation(s)
- J W B Rae
- School of Earth and Environmental Sciences, University of St Andrews, St Andrews, UK.
| | - A Burke
- School of Earth and Environmental Sciences, University of St Andrews, St Andrews, UK
| | - L F Robinson
- School of Earth Sciences, University of Bristol, Bristol, UK
| | - J F Adkins
- Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena, CA, USA
| | - T Chen
- School of Earth Sciences, University of Bristol, Bristol, UK.,School of Earth Sciences and Engineering, Nanjing University, Nanjing, China
| | - C Cole
- School of Earth and Environmental Sciences, University of St Andrews, St Andrews, UK
| | - R Greenop
- School of Earth and Environmental Sciences, University of St Andrews, St Andrews, UK
| | - T Li
- School of Earth Sciences, University of Bristol, Bristol, UK.,School of Earth Sciences and Engineering, Nanjing University, Nanjing, China
| | - E F M Littley
- School of Earth and Environmental Sciences, University of St Andrews, St Andrews, UK
| | - D C Nita
- School of Earth and Environmental Sciences, University of St Andrews, St Andrews, UK.,Faculty of Environmental Science and Engineering, Babes-Bolyai University, Cluj-Napoca, Romania
| | - J A Stewart
- School of Earth and Environmental Sciences, University of St Andrews, St Andrews, UK.,School of Earth Sciences, University of Bristol, Bristol, UK
| | - B J Taylor
- School of Earth and Environmental Sciences, University of St Andrews, St Andrews, UK
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Stewart JA, Ilkka VH, Jokinen JJ, Vakkuri AP, Suojaranta RT, Wennervirta J, Salminen US. Long-Term Survival and Quality of Life After Hypothermic Circulatory Arrest in Aortic Surgery. Scand J Surg 2018; 107:322-328. [PMID: 29628011 DOI: 10.1177/1457496918766719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS: Hypothermic circulatory arrest carries a high risk of mortality and neurological complications. An important part of assessing surgical treatment is the evaluation of long-term survival and postoperative health-related quality of life. MATERIAL AND METHODS: In this prospective study, 30 patients undergoing hypothermic circulatory arrest during surgery of the thoracic aorta, and 31 comparison patients undergoing elective coronary artery surgery without hypothermic circulatory arrest were evaluated for long-term survival and health-related quality of life, using the RAND 36-Item Health Survey questionnaire. The results were compared to national age- and sex-matched reference populations of the chronically ill and healthy adults. RESULTS: After 4.6-8.0 years, available study (88%) and comparison (59%) patients were interviewed. The life expectancy was similar with 4- and 8-year survival of 90%, and 87% for the study group, and 94%, and 94% for the comparison group, respectively (log rank test, p = 0.62). The RAND-36 scores for study and comparison groups were congruent in all dimensions, describing physical, mental, and social domains. The study patients' health-related quality of life results were similar to the national reference population with chronic illnesses. CONCLUSION: After hypothermic circulatory arrest, patients undergoing surgery of the thoracic aorta achieve a similar long-term life expectancy and health-related quality of life as do patients undergoing coronary surgery without hypothermic circulatory arrest, and a health-related quality of life similar to the national reference population with chronic illnesses. These results justify operative treatment in this high-risk patient population.
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Affiliation(s)
- J A Stewart
- 1 Department of Cardiology, Helsinki University Hospital, Helsinki, Finland.,2 University of Helsinki, Helsinki, Finland
| | - V H Ilkka
- 2 University of Helsinki, Helsinki, Finland
| | - J J Jokinen
- 3 Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - A P Vakkuri
- 4 Department of Anesthesiology and Intensive Care, Helsinki University Hospital, Helsinki, Finland
| | - R T Suojaranta
- 4 Department of Anesthesiology and Intensive Care, Helsinki University Hospital, Helsinki, Finland
| | - J Wennervirta
- 4 Department of Anesthesiology and Intensive Care, Helsinki University Hospital, Helsinki, Finland
| | - U-S Salminen
- 5 Department of Cardiac Surgery, Helsinki University Hospital, Helsinki, Finland
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Grolimund J, Studer M, Stewart JA, Egloff N, grosse Holtforth M. Typen der Schmerzverarbeitung bei Patienten mit chronischen Schmerzen. Schmerz 2017; 32:39-47. [DOI: 10.1007/s00482-017-0261-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Yao S, Sucheston LE, Zhao H, Barlow WE, Zirpoli G, Liu S, Moore HCF, Thomas Budd G, Hershman DL, Davis W, Ciupak GL, Stewart JA, Isaacs C, Hobday TJ, Salim M, Hortobagyi GN, Gralow JR, Livingston RB, Albain KS, Hayes DF, Ambrosone CB. Germline genetic variants in ABCB1, ABCC1 and ALDH1A1, and risk of hematological and gastrointestinal toxicities in a SWOG Phase III trial S0221 for breast cancer. Pharmacogenomics J 2013; 14:241-7. [PMID: 23999597 PMCID: PMC3940691 DOI: 10.1038/tpj.2013.32] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/25/2013] [Accepted: 07/31/2013] [Indexed: 01/29/2023]
Abstract
Hematological and gastrointestinal toxicities are common among patients treated with cyclophosphamide and doxorubicin for breast cancer. To examine whether single-nucleotide polymorphisms (SNPs) in key pharmacokinetic genes were associated with risk of hematological or gastrointestinal toxicity, we analyzed 78 SNPs in ABCB1, ABCC1 and ALDH1A1 in 882 breast cancer patients enrolled in the SWOG trial S0221 and treated with cyclophosphamide and doxorubicin. A two-SNP haplotype in ALDH1A1 was associated with an increased risk of grade 3 and 4 hematological toxicity (odds ratio=1.44, 95% confidence interval=1.16-1.78), which remained significant after correction for multiple comparisons. In addition, four SNPs in ABCC1 were associated with gastrointestinal toxicity. Our findings provide evidence that SNPs in pharmacokinetic genes may have an impact on the development of chemotherapy-related toxicities. This is a necessary first step toward building a clinical tool that will help assess risk of adverse outcomes before undergoing chemotherapy.
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Affiliation(s)
- S Yao
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - L E Sucheston
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - H Zhao
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W E Barlow
- SWOG Statistical Center, Seattle, WA, USA
| | - G Zirpoli
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - S Liu
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - H C F Moore
- Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - G Thomas Budd
- Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - D L Hershman
- Columbia University Medical Center, Columbia University, New York, NY, USA
| | - W Davis
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - G L Ciupak
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - J A Stewart
- Department of medicine, Baystate Medical Center, Springfield, MA, USA
| | - C Isaacs
- Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | - M Salim
- Allan Blair Cancer Centre, Regina, SK, Canada
| | - G N Hortobagyi
- Department of Breast Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - J R Gralow
- Seattle Cancer Care Alliance, Seattle, WA, USA
| | - R B Livingston
- College of Medicine, Arizona Cancer Center, Tucson, AZ, USA
| | - K S Albain
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL, USA
| | - D F Hayes
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - C B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
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8
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Byun J, Bak CW, Lee JH, Ju YJ, Han S, Seok HH, Lyu SW, Yoon TK, Gudipati M, Hemingway V, Nowak L, Pearce S, Stewart JA, McEleny K, Lee J, Byun JS, Bak CW, Ju YJ, Cha E, Han S, Hamilton CJCM, Braam SC, Brandes M, Smeenk JMJ, de Bruin JP, Nelen WLDM, Kremer JAM, Borges E, Setti AS, Braga DPAF, Vingris L, Figueira RCS, Iaconelli A, Witzke J, Kocent J, Neri QV, Rosenwaks Z, Palermo GD. SESSION 33: MALE INFERTILITY - CLINICAL AND LABORATORY ASPECTS. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Stewart JA, Saiani A, Bayly A, Tiddy GJT. Phase Behavior of Lyotropic Liquid Crystals in Linear Alkylbenzene Sulphonate (LAS) Systems in the Presence of Dilute and Concentrated Electrolyte. J DISPER SCI TECHNOL 2011. [DOI: 10.1080/01932691.2011.616120] [Citation(s) in RCA: 10] [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: 10/15/2022]
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10
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Budd GT, Barlow WE, Moore HCF, Hobday TJ, Stewart JA, Isaacs C, Salim M, Cho JK, Rinn K, Albain KS, Chew HK, Burton GV, Moore TD, Srkalovic G, McGregor BA, Flaherty LE, Livingston RB, Lew D, Gralow J, Hortobagyi GN. First analysis of SWOG S0221: A phase III trial comparing chemotherapy schedules in high-risk early breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Stewart WC, Konstas AGP, Quaranta L, Rossetti L, Garcia-Feijoo J, O'Brien C, Nasr MB, Fogagnolo P, Demos CM, Stewart JA. Response to Weinreb et al. Eye (Lond) 2010. [DOI: 10.1038/eye.2010.79] [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] Open
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12
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Quaranta L, Konstas AGP, Rossetti L, Garcia-Feijoo J, O'Brien C, Nasr MB, Fogagnolo P, Demos CM, Stewart JA, Stewart WC. Untreated 24-h intraocular pressures measured with Goldmann applanation tonometry vs nighttime supine pressures with Perkins applanation tonometry. Eye (Lond) 2009; 24:1252-8. [DOI: 10.1038/eye.2009.300] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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13
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Stewart WC, Stewart JA, Mychaskiw MA. Response to Anderson et al. Eye (Lond) 2009. [DOI: 10.1038/eye.2009.71] [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] Open
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14
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Jayaprakasan K, Herbert M, Moody E, Stewart JA, Murdoch AP. Estimating the risks of ovarian hyperstimulation syndrome (OHSS): implications for egg donation for research. HUM FERTIL 2009; 10:183-7. [PMID: 17786651 DOI: 10.1080/14647270601021743] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aims to provide an estimate of women's risk of ovarian hyperstimulation syndrome (OHSS) when undergoing superovulation to donate eggs for research. This is an essential prerequisite for appropriate informed consent. In the absence of sufficiently large numbers of egg donors to assess the risk, comparative data was obtained from women undergoing the same superovulation protocol for in vitro fertilization (IVF) treatment. In this prospective study 339 women, who developed >/=20 follicles after superovulation in their first treatment cycle (total number of treatment cycles during the same period - 2417), were intensively monitored on five occasions, between human chorionic gonadotrophin and pregnancy test, according to our routine clinical protocol. Hospital admission was needed for 49 (14.5%) women, 13 (3.8%) needed intravenous fluids and 9 (2.7%) needed paracentesis. The admission rates were similar in pregnant and non-pregnant women (13.5% vs. 15%); the need for intravenous fluids and paracentesis were 3.2% vs. 2.3% and 6.3% vs. 2.3%, respectively. The peak increase in haematocrit occurred on Day 4 after hCG, and the mean day of hospital admission was Day 5. If an egg donor develops <20 follicles, she can be reassured that the risk of OHSS is very small (<0.1%). If >/=20 follicles develop, her risk of hospital admission due to OHSS is <15%. The absence of pregnancy in egg donors does not eliminate the risk of OHSS. Given the timescale of development of the haematological and biochemical abnormalities, egg donors who develop >/=20 follicles should be actively monitored for the first week after egg collection.
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Affiliation(s)
- K Jayaprakasan
- Newcastle Fertility Centre at Life, International Centre for Life, Newcastle upon Tyne, UK.
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15
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Affiliation(s)
- M R Teutsch
- Department of Animal Sciences, University of Illinois, Urbana 61801
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16
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Warren RC, Tevaarwerk AJ, Attia S, Grade D, Stewart JA. ASCO Quality Oncology Practice Initiative (QOPI): Lessons in clinical quality improvement (QI) for hematology/oncology fellows. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6609] [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: 11/20/2022] Open
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17
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Tevaarwerk AJ, Attia S, Campbell B, Warren RC, Lentz SD, Stewart JA. Barriers to creating uniform chemotherapy practice at a university hospital: the Chemotherapy Council (CC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6614] [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: 11/20/2022] Open
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18
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Stewart WC, Stewart JA, Mychaskiw MA. Cost-effectiveness of latanoprost and timolol maleate for the treatment of glaucoma in Scandinavia and the United Kingdom, using a decision-analytic health economic model. Eye (Lond) 2007; 23:132-40. [PMID: 17721497 DOI: 10.1038/sj.eye.6702964] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the cost-effectiveness of latanoprost or timolol in glaucoma treatment in Norway, Sweden, Denmark (Scandinavia) and the United Kingdom (UK). METHODS A Markov model was constructed to perform a cost-effectiveness analysis. Health states were 'stable' and 'progressed' glaucoma, and transition probabilities for both primary open-angle and exfoliation glaucoma were derived from the medical literature. Practice patterns were obtained from surveys completed by 54 ophthalmologists geographically dispersed throughout each country. Country specific unit costs were used for medications, patient visits, diagnostics, and therapeutic procedures. RESULTS Over the life of the model latanoprost was less expensive than timolol by 5.3-7.6% (Scandinavia) and 2.1% (UK). Following adjustments, therapy in the original timolol-treated cohort was slightly more effective in each country with a difference in 0.003-0.015 years to progression of glaucoma existing between latanoprost. This may have resulted from the model design, which reflected that physicians ultimately control most patients' glaucoma over 5 years by adding or changing therapy. The associated incremental cost-effectiveness ratios for latanoprost vs timolol generated by the Scandinavian and the UK models, respectively, were: Norway 351,396 NOK; Sweden 988,985 SEK; Denmark 351,641; and the UK 4751 GBP. CONCLUSIONS Over 5 years, in the UK timolol is the cost-effective option, whereas in Scandinavia latanoprost may be the cost-effective alternative to timolol.
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Affiliation(s)
- W C Stewart
- PRN Pharmaceutical Research Network, LLC, Charleston, SC, USA.
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19
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Tevaarwerk A, Stewart JA, Love R, Binkley NC, Black S, Eickhoff J, Mulkerin DL. Randomized trial to assess bone mineral density (BMD) effects of zoledronic acid (ZA) in postmenopausal women (PmW) with breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19558 Introduction: Osteoporotic fracture represents a major source of morbidity in PmW. Breast cancer patients can be at additional risk because of treatment related estrogen deprivation. The favorable effects of bisphosphonates in osteoporosis and potential reduction of metastases warrant evaluation of ZA in PmW at high risk for breast cancer relapse. We assessed whether ZA 4 mg IV every 12 weeks x 4 doses was associated with an increase in BMD. Secondary objectives included defining ZA’s toxicity profile in this setting, and assessing for differences in overall cancer relapse. Methods: PmW with node positive or stage III breast cancer diagnosed less than 5 years earlier were randomized to ZA or observation. BMD was assessed by dual energy xray absorptiometry (DXA) for all subjects at 0 and 12 months. A toxicity evaluation was performed pre- and post-treatment for patients receiving ZA. Study endpoint occurred when subjects completed the DXAs, had disease progression or declined further treatment. We calculated change in BMD between 0 and 12 months at the L1–4 spine and femur neck. Results: 66 women have enrolled since 2000; 49 women have completed DXAs at 0 and 12 months (observation 23, ZA 26). Median age was 52 (range 40–81 yr), median ECOG performance status was 0 (range 0–1), and most women received concurrent tamoxifen (observation 74%, ZA 61%). Over 12 months, L1–4 spine BMD decreased in the observation arm (-0.006 ± 0.034 g/cm2) and increased in the ZA arm (p<0.001; 0.050 ± 0.042 g/cm2). No significant BMD change occurred at the femur neck. Only three grade 3 events occurred (2 arthralgia, 1 myalgia). Side effects were mild and transient, but as frequent as 87% following dose 1. The most common side effects were fatigue, myalgia and arthralgia. No clinically significant changes in creatinine or calcium occurred. Osteonecrosis of the jaw was not observed. Of the 66 women enrolled, 7 have relapsed (observation 4, ZA 3) but time since diagnosis is less than 10 years for most patients. Conclusions: ZA administered every 12 weeks for 4 doses leads to a statistically and clinically significant change in BMD at the lumbar spine. Toxicity was mild but common. There are as yet no significant differences in cancer relapse. No significant financial relationships to disclose.
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Affiliation(s)
- A. Tevaarwerk
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - J. A. Stewart
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - R. Love
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - N. C. Binkley
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - S. Black
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - J. Eickhoff
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - D. L. Mulkerin
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
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20
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Krishnamachary MK, Swain-Eng RJ, Barnet J, Maloney J, Stewart JA, Asthana S. Wisconsin Comorbidity Assessment Scale (WCAS): A novel, comprehensive, performance-based assessment scale of geriatric syndromes and medical comorbidities in older cancer patients. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19619] [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
19619 Background: Elderly patients with cancer have potential for multiple geriatric syndromes that influence treatment and outcomes. No single clinical assessment tool has targeted all the major geriatric syndromes and their interaction on cancer management and outcomes. We developed WCAS to evaluate cognitive and physical function, risk of falls and gait disorders, polypharmacy, and medical comorbidities. Methods: Eighteen newly diagnosed patients with breast cancer (age 55–82), were enrolled prior to cancer treatment. Cognitive function was evaluated with a comprehensive battery of neuropsychological tests targeting the domains of memory, executive function, attention, language, and praxis. Physical function skills were assessed with novel performance-based tasks (e.g., bed-making) and computerized assessments of balance, gait and risk of falls. Cancer treatment included surgery in all patients with variable use of adjuvant radiation and medical therapy. WCAS was administered at baseline and at month 6. Results: Ten subjects have completed both baseline and month 6 visits. Surgical treatment occurred at a mean of ten days after baseline assessment (SD 6.7). The mean (SD) of the age, years of education and baseline Mini Mental Status Exam (MMSE) was 66 years (7.3), 15.2 years (3.7) and 29.3 (1.1). From baseline to month six assessment performance on the WAIS Digit Symbol test, a measure of working memory and processing speed, declined (mean change −11.7, p<0.01). Likewise, the performance on the WAIS letter number sequence test (mean change −1.3, p=0.09) and the MMSE (mean change −1.1, p=0.12) declined. Interestingly, four subjects with pre-existing hypothyroidism on replacement treatment showed a greater decline (p<0.01) in memory than those without this common condition. Conclusions: Findings indicate that breast cancer diagnosis and therapy can be associated with significant decline in aspects of cognition in older adults with cancer. These changes can last at least 6 months and are more pronounced in those with hypothyroidism. Larger, longer term prospective studies utilizing WCAS are necessary to confirm our preliminary findings. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - J. Barnet
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
| | - J. Maloney
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
| | - J. A. Stewart
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
| | - S. Asthana
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
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21
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Day DG, Sharpe ED, Atkinson MJ, Stewart JA, Stewart WC. The clinical validity of the treatment satisfaction survey for intraocular pressure in ocular hypertensive and glaucoma patients. Eye (Lond) 2006; 20:583-90. [PMID: 15933751 DOI: 10.1038/sj.eye.6701932] [Citation(s) in RCA: 41] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To provide initial validation of the Treatment Satisfaction Survey-Intraocular Pressure (TSS-IOP) quality-of-life survey that analyses specific issues related to side effects, patient satisfaction, and compliance. METHODS A prospective, observational cohort of 250 consecutive patients with primary open-angle glaucoma or ocular hypertension was administered the TSS-IOP survey. RESULTS Factors that correlated with patient satisfaction included perceived effectiveness of the medicine (F=7.47, P<0.001), ocular irritation (F=6.06, P<0.001), conjunctival hyperaemia (F=4.40, P<0.001), ease of use (F=8.52, P<0.001), and convenience of use (F=6.90, P<0.001). Patient compliance, acceptance of their illness, and knowledge of glaucoma were also related to perceived effectiveness of the medicine (P<0.001), ease of use (P<0.05) and convenience (P<0.001). Physician ratings of patient pressure control, side effects, and instillation problems also were significantly correlated to patient satisfaction (R=0.13-0.26, P=0.05-0.001). The physician ratings of patient compliance, however, were not significantly related to any dimension of patient satisfaction (P>0.05). Among monotherapy prostaglandin treatments, latanoprost demonstrated statistically greater satisfaction than bimatoprost or travoprost regarding conjunctival hyperaemia (P<0.05) and eye irritation (P<0.01). CONCLUSIONS This study provides initial evidence that patient satisfaction may be related to compliance, perceived effectiveness of treatment, adverse side effects, ease and convenience of use, acceptance of illness, and knowledge of glaucoma.
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Affiliation(s)
- D G Day
- Atlanta Research Company, Atlanta, GA, USA
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22
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Abstract
AIMS To determine carriage rates and densities of methanogens and sulfate-reducing bacteria in adults and children using molecular methods, and to also determine if a reciprocal relationship exists between these organisms. METHODS AND RESULTS Real-time PCR was used to detect and quantify methanogens and sulfate-reducing bacteria. Real-time PCR was more sensitive than breath methane measurements. Real-time PCR assays were applied to faecal DNA samples collected from 40 children and 12 adults. Methanogens were present in 25% of the children and 42% of the adults studied, and sulfate-reducing bacteria were detected in 15% of the children and 58% of the adults. High levels of sulfate-reducing bacteria were found in two methanogenic adults. CONCLUSIONS Carriage rates and densities of methanogens and sulfate-reducing bacteria are greater in adults than in children. Competition does not necessarily lead to the predominance of one group in the faecal microflora. SIGNIFICANCE AND IMPACT OF THE STUDY This study describes sensitive, molecular assays that could be used to monitor these organisms in gastrointestinal disease. Therapeutic exclusion of one group from the bowel would not necessarily lead to the expansion of the other, as there does not appear to be a reciprocal relationship between these groups.
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Affiliation(s)
- J A Stewart
- Wakefield Gastroenterology Research Institute, Newtown, Wellington, New Zealand.
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23
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Gerstein HC, Yale JF, Harris SB, Issa M, Stewart JA, Dempsey E. A randomized trial of adding insulin glargine vs. avoidance of insulin in people with Type 2 diabetes on either no oral glucose-lowering agents or submaximal doses of metformin and/or sulphonylureas. The Canadian INSIGHT (Implementing New Strategies with Insulin Glargine for Hyperglycaemia Treatment) Study. Diabet Med 2006; 23:736-42. [PMID: 16842477 DOI: 10.1111/j.1464-5491.2006.01881.x] [Citation(s) in RCA: 170] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIMS Insulin is generally withheld until people with Type 2 diabetes are unresponsive to other therapies. However, its potential advantages suggest that it could be added earlier to achieve glycaemic goals; this possibility was tested in a clinical trial. METHODS Consenting adults aged 18-80 years with Type 2 diabetes for at least 6 months, HbA1c of 7.5-11%, and on 0, 1 or 2 oral agents, were randomized to one of two therapeutic approaches for 24 weeks: evening insulin glargine plus self-titration by 1 unit/day if the fasting plasma glucose (FPG) was > 5.5 mmol/l; or conventional therapy with physician adjustment of oral glucose-lowering agents if capillary FPG levels were > 5.5 mmol/l. The primary outcome was the first achievement of two consecutive HbA1c levels <or= 6.5%. RESULTS Two hundred and six participants were allocated to glargine and 199 to oral agents. Compared with control subjects, participants receiving glargine: (i) were 1.68 times more likely to achieve two consecutive HbA1c levels <or= 6.5% (95% CI 1.00-2.83; P = 0.049); (ii) reduced their HbA1c by 1.55 vs. 1.25% (P = 0.005), achieving adjusted means of 7.0 vs. 7.2% (P = 0.0007); (iii) had lower FPG (P = 0.0001), non-high-density lipoprotein (HDL) cholesterol (P = 0.02) and triglycerides (P = 0.02); (iv) had greater increases in treatment satisfaction (P = 0.045); and (v) had a 1.9-kg greater increase in weight (P < 0.0001). No differences in hypoglycaemia were noted. CONCLUSIONS Adding insulin glargine is more likely to achieve a lower HbA(1c) level than conventional therapy with oral agents.
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Affiliation(s)
- H C Gerstein
- Division of Endocrinology and Metabolism and the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada.
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24
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Stewart JA, Runde D, Rovick K, Cleary J, Grossman J. End-of-life care resource utilization: A single provider perspective. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.16022] [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
16022 Background: Most cancer physicians are aware that significant resources are spent in the last year of life but they are provided little feedback on cost or yield of care. Awareness of resource allocation for patients near the end of life may influence physician conversation with patients and families, treatment recommendations, and hospice referral. Methods: UWHealth cancer registry data were used to identify 90 patients who had died in a recent three year period and were cared for at least in part by the medical oncologist being evaluated. Health services utilization within UWHealth (hospital and hospital based clinic sites) was assessed for the last 6 months of life in 66 patients where a clear date of death could be identified. Data included in- and out-patient, pharmacy, laboratory, radiation and imaging services. Hospice charges are not included. Results: In the last 6 months of life, radiology, radiation therapy and pharmacy charges made up 52% of the total. Use of CT, MRI and palliative radiation increased near the end of life. In the last two months of life, 47% of the entire pharmacy charges were spent. In-patient services were greatly increased in the last month of life. Overall charges and more expensive services were highest in the last month of life. Conclusions: Care near the end of life is expensive. This review targeting patients affiliated with one medical oncologist at a large academic health center showed that radiology, radiotherapy, and pharmacy charges involved more than half the total accrued in the last 6 months of life. Feedback such as this if routinely provided to individual oncologists and disease oriented teams may generate strategies for improving end of life care. Even if expensive, some services may be helpful and necessary, others may not. Discussion regarding accountability for resource allocation within the multidisciplinary setting of cancer care may aid in developing improved end of life approaches for patients. No significant financial relationships to disclose.
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Affiliation(s)
| | - D. Runde
- University of Wisconsin, Madison, WI
| | - K. Rovick
- University of Wisconsin, Madison, WI
| | - J. Cleary
- University of Wisconsin, Madison, WI
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25
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O'Connor PW, Li D, Freedman MS, Bar-Or A, Rice GPA, Confavreux C, Paty DW, Stewart JA, Scheyer R. A Phase II study of the safety and efficacy of teriflunomide in multiple sclerosis with relapses. Neurology 2006; 66:894-900. [PMID: 16567708 DOI: 10.1212/01.wnl.0000203121.04509.31] [Citation(s) in RCA: 275] [Impact Index Per Article: 15.3] [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: 11/15/2022] Open
Abstract
BACKGROUND Teriflunomide, a dihydro-orotate dehydrogenase inhibitor, has immunomodulatory effects, including the ability to suppress experimental allergic encephalomyelitis. In this randomized, double-blind, placebo-controlled Phase II study, the authors examined the safety and efficacy of oral teriflunomide in multiple sclerosis (MS) with relapses. METHODS Patients (n = 179) with relapsing-remitting MS (n = 157) or secondary progressive MS with relapses (n = 22) were randomized to receive placebo, teriflunomide 7 mg/day, or teriflunomide 14 mg/day for 36 weeks. MRI brain scans were performed every 6 weeks. The primary endpoint was the number of combined unique active lesions per MRI scan. Secondary endpoints included MRI-defined disease burden, relapse frequency, and disability increase. RESULTS The median number of combined unique active lesions per scan was 0.5, 0.2, and 0.3 in the placebo, teriflunomide 7 mg/day (p < 0.03 vs placebo), and teriflunomide 14 mg/day (p < 0.01 vs placebo) groups during the 36-week double-blind treatment phase. Teriflunomide-treated patients also had significantly fewer T1 enhancing lesions per scan, new or enlarging T2 lesions per scan, and new T2 lesions. Patients receiving teriflunomide 14 mg/day had significantly reduced T2 disease burden. Teriflunomide treatment resulted in trends toward a lower annualized relapse rate and fewer relapsing patients (14 mg/day only) vs placebo. Significantly fewer patients receiving teriflunomide 14 mg/day vs placebo demonstrated disability increase. Treatment was well tolerated; numbers of adverse events and serious adverse events were similar in all treatment groups. CONCLUSION Oral teriflunomide was effective in reducing MRI lesions and was well tolerated in patients with relapsing multiple sclerosis.
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Abstract
BACKGROUND The demand for sperm donors has continued despite the introduction of ICSI. This study was undertaken in the light of impending changes in donor anonymity laws to evaluate the recruitment process of sperm donors. METHODS Retrospective analysis of 1101 potential sperm donors in a tertiary referral centre between January 1994 and August 2003. The main outcome measures were to determine the demographic details, recruitment rate and reasons for rejection of donors. RESULTS The majority of the applicants were aged <36 years (88.07%), students (54.88%), without a partner (53.47%), unmarried (85.38%) and without proven fecundity (78.67%). Only 3.63% of the applicants were released as donors, 30.79% defaulted, whilst 64.48% were rejected. The most common reason for rejection was suboptimal semen quality (85.07%). Over the years, the numbers of the applicants and released donors have declined significantly. The overall clinical pregnancy rate from donor sperm during this period was 23.52%. CONCLUSIONS In this successful anonymous sperm donor programme only a small proportion of the applicants are released as donors. The significant decline in released sperm donors coupled with the potential effects of loss of donor anonymity means that new strategies for sperm donor recruitment are urgently required.
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Affiliation(s)
- S Paul
- Newcastle Fertility Centre at Life, Bioscience Centre, International Centre for Life, Times Square, Newcastle-upon-Tyne NE1 4EP, UK
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27
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Day DG, Sharpe ED, Beischel CJ, Jenkins JN, Stewart JA, Stewart WC. Safety and efficacy of bimatoprost 0.03% versus timolol maleate 0.5%/dorzolamide 2% fixed combination. Eur J Ophthalmol 2005; 15:336-42. [PMID: 15945001 DOI: 10.1177/112067210501500304] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the efficacy and safety of bimatoprost given every evening versus the dorzolamide/timolol fixed combination (DTFC) given twice daily in open-angle glaucoma and ocular hypertensive patients. METHODS A double-masked, three-center, prospective, randomized, crossover comparison with two 8-week treatment periods following a 4-week medicine free washout period. Diurnal curve intraocular pressures (IOPs) were taken at 08:00 (trough) and 10:00 and 16:00 hours. RESULTS A total of 35 patients were enrolled and 32 completed all evaluations. The diurnal untreated baseline intraocular pressures was 24.8 +/- 2.4 mmHg. On the last day of treatment the mean diurnal intraocular pressures was 17.4 +/- 2.9 for bimatoprost and 18.1 +/- 2.8 mmHg for DTFC (p = 0.35). The individual time points for intraocular pressures were not statistically different between groups. Both groups statistically reduced the intraocular pressures from baseline for each time point and for the diurnal curve (p < 0.05). Regarding ocular safety and tolerability, there was more conjunctival hyperemia with bimatoprost (n = 15) than with DTFC (n = 7, p = 0.013) and more burning and stinging with DTFC (n = 12) than with bimatoprost (n = 0, p = 0.0005). Few systemic adverse events were recorded and there was no statistical difference between groups for any individual event (p > 0.05). CONCLUSIONS This study indicates that the intraocular pressures are lowered to a statistically similar amount with DTFC compared to bimatoprost in open-angle glaucoma and ocular hypertensive patients.
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Affiliation(s)
- D G Day
- Omni Eye Services, Atlanta, GA, USA
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28
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Affiliation(s)
- J. D. Patel
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Inst, Boston, MA; Univ of Wisconsin Cancer Ctr, Madison, WI
| | - R. G. Gray
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Inst, Boston, MA; Univ of Wisconsin Cancer Ctr, Madison, WI
| | - J. A. Stewart
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Inst, Boston, MA; Univ of Wisconsin Cancer Ctr, Madison, WI
| | - H. G. Skinner
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Inst, Boston, MA; Univ of Wisconsin Cancer Ctr, Madison, WI
| | - J. H. Schiller
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Inst, Boston, MA; Univ of Wisconsin Cancer Ctr, Madison, WI
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29
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Hollen PJ, Gralla RJ, Stewart JA, Chin C, Bizette GA, Leighl NB, Kuruvilla PG, Meharchand JM, Solow H. A prospective comparison of Karnofsky (KPS) with ECOG performance status in patients with non-small cell lung cancer (NSCLC): A COMET group study investigating sensitivity and specificity issues important in clinical decision making. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. J. Hollen
- Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY; Aventis Pharma, Laval, PQ, Canada; Ochsner Clinic Fdn, Covington, LA; Princess Margaret Hosp, Toronto, ON, Canada; Grey Bruce Health Services (GBHS), Owen Sound, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada
| | - R. J. Gralla
- Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY; Aventis Pharma, Laval, PQ, Canada; Ochsner Clinic Fdn, Covington, LA; Princess Margaret Hosp, Toronto, ON, Canada; Grey Bruce Health Services (GBHS), Owen Sound, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada
| | - J. A. Stewart
- Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY; Aventis Pharma, Laval, PQ, Canada; Ochsner Clinic Fdn, Covington, LA; Princess Margaret Hosp, Toronto, ON, Canada; Grey Bruce Health Services (GBHS), Owen Sound, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada
| | - C. Chin
- Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY; Aventis Pharma, Laval, PQ, Canada; Ochsner Clinic Fdn, Covington, LA; Princess Margaret Hosp, Toronto, ON, Canada; Grey Bruce Health Services (GBHS), Owen Sound, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada
| | - G. A. Bizette
- Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY; Aventis Pharma, Laval, PQ, Canada; Ochsner Clinic Fdn, Covington, LA; Princess Margaret Hosp, Toronto, ON, Canada; Grey Bruce Health Services (GBHS), Owen Sound, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada
| | - N. B. Leighl
- Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY; Aventis Pharma, Laval, PQ, Canada; Ochsner Clinic Fdn, Covington, LA; Princess Margaret Hosp, Toronto, ON, Canada; Grey Bruce Health Services (GBHS), Owen Sound, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada
| | - P. G. Kuruvilla
- Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY; Aventis Pharma, Laval, PQ, Canada; Ochsner Clinic Fdn, Covington, LA; Princess Margaret Hosp, Toronto, ON, Canada; Grey Bruce Health Services (GBHS), Owen Sound, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada
| | - J. M. Meharchand
- Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY; Aventis Pharma, Laval, PQ, Canada; Ochsner Clinic Fdn, Covington, LA; Princess Margaret Hosp, Toronto, ON, Canada; Grey Bruce Health Services (GBHS), Owen Sound, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada
| | - H. Solow
- Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY; Aventis Pharma, Laval, PQ, Canada; Ochsner Clinic Fdn, Covington, LA; Princess Margaret Hosp, Toronto, ON, Canada; Grey Bruce Health Services (GBHS), Owen Sound, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada
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30
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Kuruvilla PG, Krieger H, Zibdawi L, Meharchand J, Solow H, Leighl N, Chin C, Stewart JA, Hollen PJ, Gralla RJ. Assessing quality of life (QL) and patient reported outcomes (PROs) in clinical trials and clinical practice: A study using a hand-held computerized form of the validated LCSS instrument in patients with non-small cell lung cancer (NSCLC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. G. Kuruvilla
- Grey Bruce Hlth Svcs Owen Sound Site, Owen Sound, ON, Canada; Scarborough Gen Hosp, Scarborough, ON, Canada; Southlake Regional Health Ctr, Newmarket, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada; Aventis Pharma, Laval, PQ, Canada; Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY
| | - H. Krieger
- Grey Bruce Hlth Svcs Owen Sound Site, Owen Sound, ON, Canada; Scarborough Gen Hosp, Scarborough, ON, Canada; Southlake Regional Health Ctr, Newmarket, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada; Aventis Pharma, Laval, PQ, Canada; Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY
| | - L. Zibdawi
- Grey Bruce Hlth Svcs Owen Sound Site, Owen Sound, ON, Canada; Scarborough Gen Hosp, Scarborough, ON, Canada; Southlake Regional Health Ctr, Newmarket, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada; Aventis Pharma, Laval, PQ, Canada; Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY
| | - J. Meharchand
- Grey Bruce Hlth Svcs Owen Sound Site, Owen Sound, ON, Canada; Scarborough Gen Hosp, Scarborough, ON, Canada; Southlake Regional Health Ctr, Newmarket, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada; Aventis Pharma, Laval, PQ, Canada; Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY
| | - H. Solow
- Grey Bruce Hlth Svcs Owen Sound Site, Owen Sound, ON, Canada; Scarborough Gen Hosp, Scarborough, ON, Canada; Southlake Regional Health Ctr, Newmarket, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada; Aventis Pharma, Laval, PQ, Canada; Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY
| | - N. Leighl
- Grey Bruce Hlth Svcs Owen Sound Site, Owen Sound, ON, Canada; Scarborough Gen Hosp, Scarborough, ON, Canada; Southlake Regional Health Ctr, Newmarket, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada; Aventis Pharma, Laval, PQ, Canada; Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY
| | - C. Chin
- Grey Bruce Hlth Svcs Owen Sound Site, Owen Sound, ON, Canada; Scarborough Gen Hosp, Scarborough, ON, Canada; Southlake Regional Health Ctr, Newmarket, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada; Aventis Pharma, Laval, PQ, Canada; Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY
| | - J. A. Stewart
- Grey Bruce Hlth Svcs Owen Sound Site, Owen Sound, ON, Canada; Scarborough Gen Hosp, Scarborough, ON, Canada; Southlake Regional Health Ctr, Newmarket, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada; Aventis Pharma, Laval, PQ, Canada; Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY
| | - P. J. Hollen
- Grey Bruce Hlth Svcs Owen Sound Site, Owen Sound, ON, Canada; Scarborough Gen Hosp, Scarborough, ON, Canada; Southlake Regional Health Ctr, Newmarket, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada; Aventis Pharma, Laval, PQ, Canada; Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY
| | - R. J. Gralla
- Grey Bruce Hlth Svcs Owen Sound Site, Owen Sound, ON, Canada; Scarborough Gen Hosp, Scarborough, ON, Canada; Southlake Regional Health Ctr, Newmarket, ON, Canada; Toronto East Gen Hosp, Toronto, ON, Canada; Markham Stouffville Health Ctr, Markham, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada; Aventis Pharma, Laval, PQ, Canada; Univ of Virginia, Charlottesville, VA; New York Lung Cancer Alliance, New York, NY
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Stewart WC, Day DG, Stewart JA, Holmes KT, Jenkins JN. Short-term ocular tolerability of dorzolamide 2% and brinzolamide 1% vs placebo in primary open-angle glaucoma and ocular hypertension subjects. Eye (Lond) 2004; 18:905-10. [PMID: 15002017 DOI: 10.1038/sj.eye.6701353] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [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: 11/10/2022] Open
Abstract
PURPOSE To compare ocular tolerability of dorzolamide 2%, brinzolamide 1%, and placebo given three times daily. METHODS A prospective, double-masked, three-centre, crossover comparison in which 25 ocular hypertensive or primary-open angle glaucoma subjects were randomized to receive dorzolamide, brinzolamide, or placebo three times daily for 3 days. Intraocular pressure, visual acuity, a visual analogue scale, and ocular and systemic symptom queries were completed at the end of each period. RESULTS After chronic dosing, there was a significant difference in ocular pain on the visual analogue scale among the groups at the 10-s postinstillation time point with dorzolamide having the highest level (22.5+/-28.9) compared to brinzolamide (5.0+/-8.7) or placebo (3.2+/-10.4) (P=0.0006). No differences between groups were observed preinstillation nor following dosing at 3 or 10-min postinstillation. On the initial instillation, the 10-s postinstillation pain was rated as 43.3+/-77.1, which was significantly higher than after chronic dosing (P=0.017). On the ocular symptom query, dorzolamide had the highest incidence of burning/stinging and redness compared to the other groups, but was generally characterized as mild. There were no significant differences in the visual acuity at any time point. CONCLUSIONS This study suggests that subjects treated with dorzolamide suffer more ocular pain upon instillation compared to brinzolamide or placebo. However, pain symptoms are fewer following chronic dosing and are generally characterized as mild.
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Affiliation(s)
- W C Stewart
- Pharmaceutical Research Network, LLC, Charleston, SC 29412-2464, USA.
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Sharpe ED, Day DG, Beischel CJ, Rhodes JS, Stewart JA, Stewart WC. Brimonidine purite 0.15% versus dorzolamide 2% each given twice daily to reduce intraocular pressure in subjects with open angle glaucoma or ocular hypertension. Br J Ophthalmol 2004; 88:953-6. [PMID: 15205246 PMCID: PMC1772220 DOI: 10.1136/bjo.2003.032979] [Citation(s) in RCA: 16] [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: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate the efficacy of brimonidine purite versus dorzolamide given twice daily in primary open angle glaucoma or ocular hypertensive subjects. METHODS In this double masked, multicentre, prospective, crossover comparison 33 subjects were randomised to brimonidine purite or dorzolamide for the first 4 week treatment period after a 4 week washout. Subjects began the opposite treatment for the second 4 week period after another 4 week washout. Intraocular pressure (IOP) was measured at 08:00 (trough) and 10:00, 18:00, and 20:00 hours after dosing at each baseline and at the end of each treatment period. RESULTS The baseline diurnal IOP was 22.9 (SD 2.8) for brimonidine purite and 22.2 (SD 2.4) mm Hg for dorzolamide. The trough IOP following 4 weeks of therapy was 21.0 (SD 3.7) for brimonidine purite and 21.0 (SD 3.1) mm Hg for dorzolamide (p = 0.90). The mean diurnal IOP was 19.3 (SD 3.1) for brimonidine purite and 19.8 (SD 2.4) mm Hg for dorzolamide (p = 0.46). Dorzolamide caused more ocular stinging upon instillation (n = 8) than brimonidine purite (n = 1) (p = 0.02). No statistical differences existed between groups for systemic adverse events. CONCLUSIONS This study suggests that brimonidine purite and dorzolamide each given twice daily have similar efficacy in primary open angle glaucoma or ocular hypertensive subjects. However, a trend was observed at 10:00 of greater brimonidine purite efficacy compared with dorzolamide.
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Affiliation(s)
- E D Sharpe
- Opthalmology Consultants, Mt Pleasant, SC, USA
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Stewart JA, Fehrenbacher L, Blanchard RA, Rodriguez GI, Vogel CL, Anavekar P. Phase II trial of trastuzumab and paclitaxel or docetaxel administered every 3 weeks to patients receiving a first treatment for HER2+ metastatic breast cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. A. Stewart
- University of Wisconsin, Madison, WI; Kaiser Permanente, Vallejo, CA; Boston Medical Center, Boston, MA; South Texas Oncology and Hematology, San Antonio, TX; Cancer Research Network, Inc, Plantation, FL; Brigham and Women's Hospital, Boston, MS
| | - L. Fehrenbacher
- University of Wisconsin, Madison, WI; Kaiser Permanente, Vallejo, CA; Boston Medical Center, Boston, MA; South Texas Oncology and Hematology, San Antonio, TX; Cancer Research Network, Inc, Plantation, FL; Brigham and Women's Hospital, Boston, MS
| | - R. A. Blanchard
- University of Wisconsin, Madison, WI; Kaiser Permanente, Vallejo, CA; Boston Medical Center, Boston, MA; South Texas Oncology and Hematology, San Antonio, TX; Cancer Research Network, Inc, Plantation, FL; Brigham and Women's Hospital, Boston, MS
| | - G. I. Rodriguez
- University of Wisconsin, Madison, WI; Kaiser Permanente, Vallejo, CA; Boston Medical Center, Boston, MA; South Texas Oncology and Hematology, San Antonio, TX; Cancer Research Network, Inc, Plantation, FL; Brigham and Women's Hospital, Boston, MS
| | - C. L. Vogel
- University of Wisconsin, Madison, WI; Kaiser Permanente, Vallejo, CA; Boston Medical Center, Boston, MA; South Texas Oncology and Hematology, San Antonio, TX; Cancer Research Network, Inc, Plantation, FL; Brigham and Women's Hospital, Boston, MS
| | - P. Anavekar
- University of Wisconsin, Madison, WI; Kaiser Permanente, Vallejo, CA; Boston Medical Center, Boston, MA; South Texas Oncology and Hematology, San Antonio, TX; Cancer Research Network, Inc, Plantation, FL; Brigham and Women's Hospital, Boston, MS
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Konstas AGP, Kozobolis VP, Lallos N, Christodoulakis E, Stewart JA, Stewart WC. Daytime diurnal curve comparison between the fixed combinations of latanoprost 0.005%/timolol maleate 0.5% and dorzolamide 2%/timolol maleate 0.5%. Eye (Lond) 2004; 18:1264-9. [PMID: 15218522 DOI: 10.1038/sj.eye.6701446] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The diurnal efficacy and safety of the fixed combinations of latanoprost/timolol given once daily vs dorzolamide/timolol given twice daily in primary open-angle glaucoma or ocular hypertensive patients. DESIGN A double-masked, two-centre, crossover comparison. RESULTS In 33 patients, the mean diurnal IOP (0800-2000, measured every 2 h) for latanoprost/timolol fixed combination was 17.3+/-2.2 mmHg and for dorzolamide/timolol, the fixed combination was 17.0+/-2.0 mmHg (P = 0.36). Additionally, there was no statistical difference for individual time points following a Bonferroni correction. A bitter taste was found more frequently with the dorzolamide/timolol fixed combination (n = 6) than the latanoprost/timolol fixed combination (n = 0) (P = 0.040), while the latanoprost/timolol fixed combination demonstrated more conjunctival hyperaemia (n = 9) than the dorzolamide/timolol fixed combination (n = 2) (P = 0.045). One patient was discontinued early from the dorzolamide/timolol fixed combination due to elevated IOP. CONCLUSION This study suggests that the daytime diurnal IOP is not statistically different between the dorzolamide/timolol fixed combination and latanoprost/timolol fixed combination in primary open-angle glaucoma and ocular hypertensive patients.
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Affiliation(s)
- A G P Konstas
- University Department of Ophthalmology, AHEPA Hospital, Thessaloniki, Greece
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Sharpe ED, Henry CJ, Mundorf TK, Day DG, Stewart JA, Jenkins JN, Stewart WC. Brimonidine 0.2% vs unoprostone 0.15% both added to timolol maleate 0.5% given twice daily to patients with primary open-angle glaucoma or ocular hypertension. Eye (Lond) 2004; 19:35-40. [PMID: 15094733 DOI: 10.1038/sj.eye.6701392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare the efficacy and safety of brimonidine 0.2% vs unoprostone 0.15%, both added to timolol maleate 0.5% each given twice daily. METHODS In this prospective, multi-centred, double-masked, crossover comparison, patients were randomized to one treatment group for a 6-week treatment period, and then crossed over to the opposite treatment. Measurements were performed at 0800, 1000, 1600, 1800, and 2000 h at baseline and at the end of each treatment period. RESULTS In all, 33 patients entered this trial and 29 completed. The baseline trough intraocular pressure (IOP) was 23.3+/-2.4 and the diurnal curve IOP was 22.0+/-1.3 mmHg. For the brimonidine and timolol maleate treatment group, the trough IOP was 21.6+/-3.3 and the diurnal curve IOP was 19.8+/-2.1 mmHg, while the timolol and unoprostone treatment showed a trough IOP of 20.9+/-3.8 and a diurnal curve IOP of 19.3+/-2.4 mmHg. There was no significant difference between treatment groups at any time point for the diurnal curve, or in the reduction from baseline (P>0.05). Both treatments failed to statistically reduce the IOP from baseline at 1800 h. There was no difference between treatment groups regarding ocular and systemic unsolicited adverse events, but patients admitted to more dryness (P=0.02) and burning upon instillation (P<0.0001) with unoprostone by survey. CONCLUSION Brimonidine 0.2% or unoprostone 0.15% added to timolol maleate 0.5% provide similar efficacy and safety throughout the daytime diurnal curve.
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Affiliation(s)
- E D Sharpe
- Center for Eye Research, Mt. Pleasant, SC, USA
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Stewart WC, Stewart JA, Day DG, Sharpe ED, Jenkins JN. Efficacy and safety of the latanoprost/timolol maleate fixed combination vs concomitant brimonidine and latanoprost therapy. Eye (Lond) 2004; 18:990-5. [PMID: 15037890 DOI: 10.1038/sj.eye.6701375] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS To evaluate the efficacy and safety of latanoprost/timolol maleate fixed combination (LTFC) given once daily vs the concomitant therapy of brimonidine twice daily and latanoprost once daily in primary open-angle glaucoma or ocular hypertensive subjects. METHODS A prospective, double-masked, active-controlled comparison in which qualified subjects had all glaucoma medicines discontinued for 1 month and then were randomized to either LTFC or brimonidine and latanoprost concomitant therapy for 6 weeks. They were then switched to the other treatment regimen. The intraocular pressure (IOP) was measured at 0800, 1200, and 1600 h at baseline and at the end of Periods 1 and Period 2. RESULTS In 32 subjects, the diurnal curve of the untreated IOP of 26.0+/-3.4 decreased to 17.8+/-2.5 on LTFC and 17.2+/-2.8 mmHg on brimonidine and latanoprost (P=0.31). At 0800 and 1600 h, the IOPs were statistically similar between the groups (P>0.05). At 1200 h the latanoprost and brimonidine treatment IOP was statistically lower (16.2+/-3.2) than LTFC (18.0+/-2.8 mmHg). However, the reduced IOP from untreated baseline was not statistically different at each time point and for the diurnal curve for each therapy (P<0.05). Safety was similar between groups for both solicited and unsolicited side effects (P>0.05). CONCLUSION This study suggests that LTFC and concomitant therapy of brimonidine and latanoprost provide statistically similar diurnal IOP reduction from an untreated baseline.
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Affiliation(s)
- W C Stewart
- Pharmaceutical Research Network LLC, Charleston, SC 29412, USA.
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Martro E, Bulterys M, Stewart JA, Spira TJ, Cannon MJ, Thacher TD, Bruns R, Pellett PE, Dollard SC. Comparison of human herpesvirus 8 and Epstein-Barr virus seropositivity among children in areas endemic and non-endemic for Kaposi's sarcoma. J Med Virol 2004; 72:126-31. [PMID: 14635020 DOI: 10.1002/jmv.10548] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Human herpesvirus 8 (HHV-8) is the etiologic agent of Kaposi's sarcoma (KS). Several studies indicate horizontal HHV-8 transmission among children in areas where KS is endemic, but few studies have assessed acquisition of HHV-8 by children in low seroprevalence areas. Antibody screening was carried out for HHV-8 and Epstein-Barr virus (EBV) on 787 serum specimens from children living in two areas where HHV-8 is not endemic, the United States (US) and Germany, and on 184 specimens from children living in a KS-endemic area (Nigeria). For children in the US and Germany, the results showed low HHV-8 seroprevalence rates (3-4%). However, US children aged 6 months to 5 years had higher HHV-8 antibody titers than did 6-17-year-old children (P < 0.01), a finding consistent with more recent infections being detected in the younger children. Compared with seroprevalence rates and antibody titers in US and German children, those in Nigerian children were significantly higher, and seroprevalence increased with age. There was no evidence of cross-reactivity between assays for HHV-8 and EBV, despite the genetic similarity of these two herpesviruses. The data indicate that HHV-8 transmission among children where HHV-8 is not endemic occurs, but is uncommon. The findings also suggest that HHV-8 antibodies, as measured by current tests, may not persist for long periods in populations at low risk for KS and that vertical transmission is rare, although longitudinal studies are necessary to address directly these issues.
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Affiliation(s)
- E Martro
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Tyler-McMahon BM, Stewart JA, Jackson J, Bitner MD, Fauq A, McCormick DJ, Richelson E. Altering behavioral responses and dopamine transporter protein with antisense peptide nucleic acids. Biochem Pharmacol 2001; 62:929-32. [PMID: 11543728 DOI: 10.1016/s0006-2952(01)00698-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 10/17/2022]
Abstract
The dopamine transporter (DAT) plays a role in locomotion and is an obligatory target for amphetamines. We designed and synthesized an antisense peptide nucleic acid (PNA) to rat DAT to examine the effect of this antisense molecule on locomotion and on responsiveness to amphetamines. Rats were injected intraperitoneally daily for 9 days with either saline, an antisense DAT PNA, a scrambled DAT PNA, or a mismatch DAT PNA. On days 7 and 9 after initial motility measurements were taken, the animals were challenged with 10 mg/kg of amphetamine and scored for motility. On day 7, there was no significant difference between the baseline levels of activity of any of the groups or their responses to amphetamine. On day 9, the antisense PNA-treated rats showed a statistically significant increase in their resting motility (P < 0.01). When these rats were challenged with amphetamine, motility of the saline-, scrambled PNA-, and mismatch PNA-treated animals showed increases of 31-, 36-, and 20-fold, respectively, while the antisense PNA-treated animals showed increases of only 3.4-fold (P < 0.01). ELISA results revealed a 32% decrease in striatal DAT in antisense PNA-treated rats compared with the saline, scrambled PNA, and mismatch PNA controls (P < 0.001). These results extend our previous findings that brain proteins can be knocked down in a specific manner by antisense molecules administered extracranially. Additionally, these results suggest some novel approaches for the treatment of diseases dependent upon the function of the dopamine transporter.
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Affiliation(s)
- B M Tyler-McMahon
- Neuropsychopharmacology, Mayo Clinic, Birdsall Medical Research Building, 4500 San Pablo Rd., Jacksonville, FL 32224, USA.
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McMahon BM, Stewart JA, Jackson J, Fauq A, McCormick DJ, Richelson E. Intraperitoneal injection of antisense peptide nucleic acids targeted to the mu receptor decreases response to morphine and receptor protein levels in rat brain. Brain Res 2001; 904:345-9. [PMID: 11406133 DOI: 10.1016/s0006-8993(01)02511-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 11/22/2022]
Abstract
To determine the effectiveness of peptide nucleic acids (PNAs) in vivo, we designed and synthesized PNAs antisense to the mu receptor, the molecular target of morphine for inducing antinociception. Responsiveness of rats to morphine and the levels of mu receptor expression after treatment was measured. We delivered intraperitoneal injections of antisense PNAs targeted to the mu receptor (AS-MOR), mismatch PNAs (AS-MOR MM), antisense PNAs targeted to the neurotensin receptor subtype 1 (AS-NTR1), or saline and then challenged the rats with 5 mg/kg morphine (intraperitonally) or neurotensin directly into the periaqueductal gray region of the brain. To avoid tolerance, separate groups of animals were tested at 24, 48, and 72 h post-PNA treatment. Only animals treated with the AS-MOR showed a reduction in their antinociceptive response to morphine. The lack of effect of morphine on the AS-MOR rats was profound at 24 and 48 h, but animals tested at 72 h were similar to control groups. At 24 h the AS-MOR rats had a significant 55% decrease in the levels of mu receptor in their periaqueductal gray region, while AS-MOR MM rats showed no significant change. Lastly, the AS-MOR rats continued to show a normal antinociceptive response to neurotensin. This study, therefore, provides additional support for the use of PNAs to target proteins within brain by systemically administered PNAs.
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Affiliation(s)
- B M McMahon
- Neuropsychopharmacology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA.
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Abstract
PURPOSE To evaluate the effect of timolol maleate solution or gel forming solution versus placebo on pulmonary function in patients with primary open-angle glaucoma or ocular hypertension without reactive airway disease. METHODS After a screening visit, each patient was randomized by a Latin square technique to receive placebo twice daily, 0.5% timolol solution twice daily, or 0.5% timolol gel once a day (placebo given as second dose) to each eye for 2 weeks. Subjects then were crossed over to the two other treatments for 2-week treatment intervals. At each visit, patients were received a dose 15 minutes before pulmonary function testing. RESULTS This study began with 25 patients, and 20 finished the trial. There was no difference between treatment groups for the forced expiratory volume at one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio (P > 0.1). The mean FEV1 for timolol solution, timolol gel, and placebo was 2.42 L, 2.45 L, and 2.50 L, respectively. The mean FVC for timolol solution, timolol gel, and placebo was 3.33 L, 3.38 L, and 3.44 L, respectively. No difference in intraocular pressure was observed between the timolol solution (17.1 +/- 3.3 mm Hg) and timolol gel (17.1 +/- 3.6 mm Hg) between the treatment periods (P > 0.1). No difference in side effects was observed between treatment groups (P > 0.05). CONCLUSIONS In older patients with primary open-angle glaucoma or ocular hypertension without reactive airway disease, nonselective beta-blockers should not worsen pulmonary function.
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Affiliation(s)
- W C Stewart
- Pharmaceutical Research Corporation, Charleston, South Carolina 29412-2464, USA
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Stewart WC, Day DG, Stewart JA, Schuhr J, Latham KE. The efficacy and safety of latanoprost 0.005% once daily versus brimonidine 0.2% twice daily in open-angle glaucoma or ocular hypertension. Am J Ophthalmol 2001; 131:631-5. [PMID: 11336939 DOI: 10.1016/s0002-9394(00)00902-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [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: 11/23/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of latanoprost 0.005% given topically every evening versus brimonidine 0.2% given topically twice daily in primary open-angle glaucoma or ocular hypertensive patients. METHODS This was a multicenter, crossover, double-masked comparison. After a 28-day treatment-free period, patients with primary open-angle glaucoma or ocular hypertension were randomized for 6 weeks to brimonidine or latanoprost and then crossed over to the opposite treatment. At baseline and after each treatment period, patients underwent intraocular pressure measurements every 2 hours from 08:00 to 20:00. RESULTS In 33 patients the mean baseline trough (08:00) was 23.2 +/- 2.1 mm Hg and the diurnal curve pressure was 19.8 +/- 2.7 mm Hg. The trough and diurnal intraocular pressures for brimonidine were 19.6 +/- 3.4 mm Hg and 17.6 +/- 2.2 mm Hg, respectively. Brimonidine statistically reduced the pressure from baseline at each time point except hours 10 and 12 (P =.14 and P =.21, respectively). For latanoprost, the trough and diurnal pressures were 16.2 +/- 2.9 mm Hg and 15.4 +/- 2.5 mm Hg, respectively, and the pressure was statistically reduced at each time point (P <.001) and for the diurnal curve (P <.001). When compared directly, the intraocular pressure level for latanoprost was lower than brimonidine for the diurnal pressure and at each time point (P <.05). One patient was discontinued early from latanoprost treatment because of eyelid swelling; also, latanoprost caused more hyperemia than brimonidine (P =.04). CONCLUSION This study suggests latanoprost dosed daily in the evening statistically reduces intraocular pressure more during daytime and evening hours than brimonidine dosed twice daily. Brimonidine may not consistently decrease the pressure 10 and 12 hours past dosing from nontreated levels.
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Affiliation(s)
- W C Stewart
- Pharmaceutical Research Corporation, Charleston, South Carolina 29412-2464, USA.
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Stewart JA, Heo G, Glover KE, Williamson PC, Lam EW, Major PW. Factors that relate to treatment duration for patients with palatally impacted maxillary canines. Am J Orthod Dentofacial Orthop 2001; 119:216-25. [PMID: 11244415 DOI: 10.1067/mod.2001.110989] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objectives of this study were to determine the relationship between the initial position of a palatally impacted maxillary canine (as seen on a panoramic radiograph) and the duration of orthodontic treatment and to determine whether a difference in treatment duration existed between patients with bilateral palatally impacted canines and patients with unilateral impaction. A total of 47 adolescent subjects were chosen (9 subjects with unilateral impactions and 18 subjects with bilateral impactions). All subjects had full fixed orthodontic appliances placed. The treatment duration of this group was compared with that of a control group with similar characteristics but without the impacted canine. The results showed that the average duration of treatment was 22.4 months for the control group, 25.8 months for the unilateral-impacted group, and 32.3 months for the bilateral-impacted canine group. The length of treatment for the impacted canine sample was related to the age of the patient at the start of treatment; younger patients required a longer treatment. The younger the patient, the more severely impacted the canine. The bilateral-impacted canine group had at least 1 canine that was more severely impacted than the impacted canine in the unilateral-impacted group. If the canine was impacted less than 14 mm from the occlusal plane, treatment duration averaged 23.8 months; if the canine was impacted more than 14 mm from the occlusal plane, treatment duration averaged 31.1 months.
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Affiliation(s)
- J A Stewart
- Division of Orthodontics, Department of Dentistry, Dentistry/Pharmacy Building, University of Alberta, Edmonton, Alberta, Canada T6G 2N8
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Abstract
PURPOSE To evaluate the safety and efficacy of adding unoprostone isopropyl 0.12% vs placebo both given twice daily to latanoprost 0.005% given every evening. METHODS We treated 41 patients with primary open-angle glaucoma or ocular hypertension with latanoprost 0.005% for 1 month and then randomized each to either placebo or unoprostone isopropyl 0.12% for 8 weeks. Diurnal intraocular pressures were measured at 08:00, 10:00, 12:00, 18:00, and 20:00 hours, both at baseline (time of randomization) and after 8 weeks of treatment. RESULTS Twenty patients were treated in the placebo group and 21 in the unoprostone isopropyl group. After 8 weeks of treatment in the placebo group, the trough intraocular pressure at 08:00 and the diurnal pressure were 20.4 +/- 3.2 and 19.1 +/- 2.2 mm Hg, respectively. In the unoprostone isopropyl group the pressures were 19.4 +/- 3.3 and 18.0 +/- 1.7 mm Hg (P =.22 and P =.042), respectively. However, eyes with a baseline pressure of 22 mm Hg or greater on latanoprost had an average 3.3 mm Hg greater reduction at trough (P <.01) and a 2.1 mm Hg greater decrease in diurnal pressure (P =.030) after adding unoprostone isopropyl (n = 14 eyes) compared with placebo (n = 16 eyes; P <.001). In addition, the range of the pressures throughout the diurnal curve was reduced from 2.7 mm Hg on latanoprost alone to 1.4 mm Hg after adding unoprostone isopropyl. Adverse events were similar between groups, and no patients were discontinued because of safety reasons. CONCLUSIONS This study suggests that unoprostone isopropyl can safely improve the diurnal curve characteristics in patients who continue to have an elevated pressure on latanoprost 0.005% alone.
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Affiliation(s)
- W C Stewart
- Pharmaceutical Research Corporation, 1639 Tatum St., Charleston, SC 29412-2464, USA
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Hajat C, Dundas R, Stewart JA, Lawrence E, Rudd AG, Howard R, Wolfe CD. Cerebrovascular risk factors and stroke subtypes: differences between ethnic groups. Stroke 2001; 32:37-42. [PMID: 11136911 DOI: 10.1161/01.str.32.1.37] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The excess risk of stroke seen in the black population has not been explained by differences in age, sex, and social class, although differences in the frequency of cerebrovascular risk factors may be partly responsible. Data on risk factor profiles for the UK black stroke population are sparse. Previous studies have contrasted the association of cerebrovascular risk factors between hemorrhagic and ischemic stroke and between etiologic subtypes of infarct. The relationship of cerebrovascular risk factors to clinical classifications of stroke, however, has been little examined. The aim of this study was to establish the frequency of cerebrovascular risk factors in patients with first-ever strokes in the South London, UK, population and to examine the relationship of these risk factors to both ethnicity and Bamford stroke subtype. METHODS The study included 1254 first-ever stroke patients registered in the South London Community Stroke Register between 1995 and 1998; 995 patients (79.3%) were white, 203 (16.2%) were black, 52 (4.1%) were of other ethnic origin, and 4 (0. 3%) were of unknown ethnic origin. RESULTS In multivariate analysis, increasing age (P:<0.001) and previous cerebrovascular disease (P:=0.007) were independently associated with infarct rather than hemorrhage. Atrial fibrillation was associated with all nonlacunar (P:=0.02), total anterior circulation (P:=0.007), and partial anterior circulation infarcts (P:=0.02) compared with the lacunar group. All other risk factors were similar between infarct subtypes. Risk factors for hemorrhage subtypes were similar in multivariate analysis; increasing age was the only factor associated with primary intracerebral hemorrhage over subarachnoid hemorrhage (P:<0.001). The black stroke population suffered significantly less atrial fibrillation (P:=0.001) and engaged in less alcohol excess (P:<0. 001) and were less likely to have ever smoked (P:<0.001). Hypertension (P:<0.001) and diabetes mellitus (P:<0.001) were more prevalent in the black population. CONCLUSIONS Physiological cerebrovascular risk factors for the UK black population are similar to those of the US black population, but behavioral risk factors differ. Risk factors differ between ethnic groups in the United Kingdom, and future measures for secondary prevention should take this into consideration. Bamford clinical subtypes bear little association with cerebrovascular risk factors. Other classification systems, such as those that classify stroke by etiology, may be more useful in explaining the excess risk of stroke and the scope for its prevention.
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Affiliation(s)
- C Hajat
- Public Health Sciences, London, UK.
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Abstract
PURPOSE We evaluated the anterior segment surface reaction findings between timolol hemihydrate and timolol maleate. The only known difference between these preparations is the maleate salt. METHODS After a baseline examination, we randomized 28 healthy subjects (26 completed) to timolol hemihydrate or timolol maleate given in both eyes twice daily, in a double masked fashion, for 1 week. Subjects then were evaluated at the morning trough (hour 0 examination), dosed, and re-evaluated in 1 hour (hour 1 examination). Subjects were left untreated for 1 week and then switched to the opposite medication for the second study period. RESULTS Corneal staining (graded 0 to 4) for timolol maleate was worse between baseline (0.9) and hour 0 (1.4; P =.009) and baseline and hour 1 (1.4; P =.011). Also, mean punctate corneal staining for timolol maleate was increased from baseline (22.6) to hour 0 (31.7; P =.033) and showed borderline significance to hour 1 (33.4; P =.058), and for timolol hemihydrate there was a borderline significant elevation from baseline (24.2) to hour 1 (29.8; P =.060). When treatment groups were compared, there was a greater change in corneal staining with timolol maleate than timolol hemihydrate from baseline to hour 0 (P =.020) and greater staining with timolol maleate than timolol hemihydrate at hour 0 (P =.032). Nasal conjunctiva showed increased mean staining with timolol maleate from baseline (23.6, P =.035) to hour 0 (29.5, P =.035) and to hour 1 (31.9 P =.038) but not with timolol hemihydrate. There were increased symptoms of ocular dryness from baseline to hour 0 with timolol maleate (P =.012) but not with timolol hemihydrate. CONCLUSIONS The study suggests that timolol maleate potentially may have more of an irritant effect than timolol hemihydrate on the corneal and nasal conjunctival epithelium.
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Affiliation(s)
- W C Stewart
- Pharmaceutical Research Corporation, Charleston, South Carolina 29412-2464, USA
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Stewart WC, Day DG, Stewart JA, Holmes KT, Leech JN, Rowan CT, Schwartz GF. Therapeutic success of latanoprost 0.005% compared to brimonidine 0.2% in patients with open-angle glaucoma or ocular hypertension. J Ocul Pharmacol Ther 2000; 16:557-64. [PMID: 11132902 DOI: 10.1089/jop.2000.16.557] [Citation(s) in RCA: 18] [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: 11/12/2022] Open
Abstract
The purpose of this study was to evaluate the success rate ofmonotherapy with latanoprost 0.005% once daily versus brimonidine 0.2% twice daily in patients with open-angle glaucoma or ocular hypertension. Patients who were prescribed latanoprost or brimonidine as monotherapy were included in this study, and their consecutive charts were retrospectively reviewed. The primary efficacy variable was success of therapy, defined as a reduction in intraocular pressure > or =3 mm Hg without an adverse event leading to discontinuation over a potential of six months of therapy. We included 157 patients in this study. In the latanoprost group, 64 of 92 (70%) were considered successes; 26 of 65 (40%) were successful with brimonidine (P < 0.001). Nine failed brimonidine therapy, and one latanoprost, because of an adverse event, and the rest failed because of inadequate intraocular pressure response. The change from baseline in intraocular pressure was significantly greater with latanoprost (mean +/- S.D., 21.6 +/- 5.1 to 17.1 +/- 3.3 mm Hg) than brimonidine (23.7 +/- 5.6 to 21.9 +/- 5.7 mm Hg) (P = 0.001). Overall, 52 (80%) brimonidine- and 41 (45%) latanoprost-treated patients required additional visit(s) to adjust therapy to further lower intraocular pressure or to assess an adverse event (P < 0.001). In conclusion, latanoprost more likely provides a successful response to therapy than brimonidine when used as monotherapy in primary open-angle glaucoma or ocular hypertensive patients.
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Affiliation(s)
- W C Stewart
- Pharmaceutical Research Corporation, Charleston, South Carolina 29412-2464, USA.
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LaCroix S, Stewart JA, Thouless ME, Black JB. An immunoblot assay for detection of immunoglobulin M antibody to human herpesvirus 6. Clin Diagn Lab Immunol 2000; 7:823-7. [PMID: 10973462 PMCID: PMC95963 DOI: 10.1128/cdli.7.5.823-827.2000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2000] [Accepted: 07/12/2000] [Indexed: 11/20/2022]
Abstract
We identified the human herpesvirus 6 (HHV-6)-dominant immunoglobulin M (IgM)-reactive virion protein as being the same 101-kDa protein (101K) previously identified as the major IgG immunoreactive protein and a specific serologic marker of HHV-6 infection. An immunoblot assay (IB) to detect HHV-6-specific IgM antibodies against the 101K protein in human serum samples was developed. The assay was validated by using acute- and convalescent-phase serum collected from children under 2 years of age in which we previously detected IgG seroconversion to the HHV-6 101K protein. Of 32 serum pairs which previously demonstrated IgG seroconversion to the 101K protein, 29 had IgM reactivity to the same protein in the acute-phase sample and the remaining 3 had reactivity in the convalescent-phase sample. We also detected HHV-6 IgM activity in sera collected from individuals > or =4 years of age who were also IgM seropositive to measles or rubella. Results of cross-adsorption studies using measles virus-, rubella virus-, and HHV-6-infected cells as the adsorbing antigen indicated no cross-reactivity between measles or rubella IgM and HHV-6 IgM in human serum samples. The IgM IB detected HHV-6-specific IgM antibody to the 101K protein in 78% (63 of 81) of tested acute-phase serum collected from young children with an undifferentiated rash illness by using a single serum dilution.
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Affiliation(s)
- S LaCroix
- State of Washington Public Health Laboratory, Seattle, Washington, USA
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Reeves WC, Stamey FR, Black JB, Mawle AC, Stewart JA, Pellett PE. Human herpesviruses 6 and 7 in chronic fatigue syndrome: a case-control study. Clin Infect Dis 2000; 31:48-52. [PMID: 10913395 DOI: 10.1086/313908] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/1999] [Revised: 12/10/1999] [Indexed: 11/03/2022] Open
Abstract
We conducted this study to determine whether infection with human herpesvirus (HHV) 6A, HHV-6B, or HHV-7 differed between patients with chronic fatigue syndrome and control subjects. We recruited 26 patients and 52 nonfatigued matched control subjects from Atlanta. Serum samples were tested by enzyme immunoassay for seroreactivity to HHV-6, and all were seropositive. Lymphocyte specimens were cocultivated with cord blood lymphocytes and assayed for HHV-6 and HHV-7; neither virus was isolated. Finally, lymphocytes were tested by use of 3 polymerase chain reaction methods for HHV-6A, HHV-6B, and HHV-7 DNA. HHV-6A or HHV-6B DNA was detected in 17 (22.4%) of 76 samples, and there were no significant differences (by matched analyses) between patients (3 [11.5%] of 26) and control subjects (14 [28%] of 50). HHV-7 DNA was detected in 14 subjects, and although control subjects (12 [24%]) were more likely than patients (2 [7.7%]) to be positive, the difference was not statistically significant. We found no evidence that active or latent infection with HHV-6A, HHV-6B, HHV-7, or any combination these 3 HHVs is associated with chronic fatigue syndrome.
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Affiliation(s)
- W C Reeves
- Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
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Stewart WC, Sharpe ED, Harbin TS, Pastor SA, Day DG, Holmes KT, Stewart JA. Brimonidine 0.2% versus dorzolamide 2% each given three times daily to reduce intraocular pressure. Am J Ophthalmol 2000; 129:723-7. [PMID: 10926979 DOI: 10.1016/s0002-9394(00)00381-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [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: 11/17/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of brimonidine compared with dorzolamide given three times daily as monotherapy in patients with primary open-angle glaucoma or ocular hypertension. METHODS In a double-masked, multicenter, crossover comparison in 40 patients, qualified patients were washed out from their previous medication and randomized to dorzolamide 2% or brimonidine 0.2% for the first 6-week treatment period. Patients then were washed out for 2 weeks and started on the opposite medication for the second 6-week period. RESULTS Baseline intraocular pressure for all 40 subjects (76 eyes) was 24.1 +/- 2.0 mm Hg. This study found that the 8:00 AM trough intraocular pressure after 6 weeks of therapy for dorzolamide was 20. 7 +/- 3.1 mm Hg and for brimonidine 20.8 +/- 3.2 mm Hg (P =.99). The peak intraocular pressure (2 hours after dosing) for dorzolamide was 18.6 +/- 3.4 mm Hg and for brimonidine 17.8 +/- 2.7 mm Hg (P =.10 ). Dorzolamide caused more stinging upon instillation (P <.01) and brimonidine more itching (P =.01). No statistical differences existed between groups for systemic adverse events. Six patients, all on brimonidine, were discontinued from a treatment period early. Of these, two were discontinued for inadequate pressure control, two with dizziness and fatigue, one with ocular pain, and one for lifestyle reasons (P =.07). CONCLUSIONS This study found similar efficacy and safety between monotherapy treatment with dorzolamide or brimonidine when each was given three times daily to patients with ocular hypertension or primary open-angle glaucoma.
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Affiliation(s)
- W C Stewart
- Pharmaceutical Research Corporation, Charleston, South Carolina 29412-2464, USA
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