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Baltgalvis KA, Lamb KN, Symons KT, Wu CC, Hoffman MA, Snead AN, Song X, Glaza T, Kikuchi S, Green JC, Rogness DC, Lam B, Rodriguez-Aguirre ME, Woody DR, Eissler CL, Rodiles S, Negron SM, Bernard SM, Tran E, Pollock J, Tabatabaei A, Contreras V, Williams HN, Pastuszka MK, Sigler JJ, Pettazzoni P, Rudolph MG, Classen M, Brugger D, Claiborne C, Plancher JM, Cuartas I, Seoane J, Burgess LE, Abraham RT, Weinstein DS, Simon GM, Patricelli MP, Kinsella TM. Chemoproteomic discovery of a covalent allosteric inhibitor of WRN helicase. Nature 2024; 629:435-442. [PMID: 38658751 DOI: 10.1038/s41586-024-07318-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/14/2024] [Indexed: 04/26/2024]
Abstract
WRN helicase is a promising target for treatment of cancers with microsatellite instability (MSI) due to its essential role in resolving deleterious non-canonical DNA structures that accumulate in cells with faulty mismatch repair mechanisms1-5. Currently there are no approved drugs directly targeting human DNA or RNA helicases, in part owing to the challenging nature of developing potent and selective compounds to this class of proteins. Here we describe the chemoproteomics-enabled discovery of a clinical-stage, covalent allosteric inhibitor of WRN, VVD-133214. This compound selectively engages a cysteine (C727) located in a region of the helicase domain subject to interdomain movement during DNA unwinding. VVD-133214 binds WRN protein cooperatively with nucleotide and stabilizes compact conformations lacking the dynamic flexibility necessary for proper helicase function, resulting in widespread double-stranded DNA breaks, nuclear swelling and cell death in MSI-high (MSI-H), but not in microsatellite-stable, cells. The compound was well tolerated in mice and led to robust tumour regression in multiple MSI-H colorectal cancer cell lines and patient-derived xenograft models. Our work shows an allosteric approach for inhibition of WRN function that circumvents competition from an endogenous ATP cofactor in cancer cells, and designates VVD-133214 as a promising drug candidate for patients with MSI-H cancers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Betty Lam
- Vividion Therapeutics, San Diego, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Piergiorgio Pettazzoni
- Pharma Research and Early Development pRED F. Hoffmann-La Roche, Ltd, Basel, Switzerland
| | - Markus G Rudolph
- Pharma Research and Early Development pRED F. Hoffmann-La Roche, Ltd, Basel, Switzerland
| | - Moritz Classen
- Pharma Research and Early Development pRED F. Hoffmann-La Roche, Ltd, Basel, Switzerland
| | - Doris Brugger
- Pharma Research and Early Development pRED F. Hoffmann-La Roche, Ltd, Basel, Switzerland
| | - Christopher Claiborne
- Pharma Research and Early Development pRED F. Hoffmann-La Roche, Ltd, Basel, Switzerland
| | - Jean-Marc Plancher
- Pharma Research and Early Development pRED F. Hoffmann-La Roche, Ltd, Basel, Switzerland
| | - Isabel Cuartas
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Joan Seoane
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | | | - Robert T Abraham
- Vividion Therapeutics, San Diego, CA, USA
- Odyssey Therapeutics, San Diego, CA, USA
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Dworaczyk DA, Hunt AL, Di Spirito M, Lor M, Dretchen KL, Lamson MJ, Pollock J, Ward T. A 13.2 mg epinephrine intranasal spray demonstrates comparable pharmacokinetics, pharmacodynamics, and safety to a 0.3 mg epinephrine autoinjector. J Allergy Clin Immunol Glob 2024; 3:100200. [PMID: 38328805 PMCID: PMC10847913 DOI: 10.1016/j.jacig.2023.100200] [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] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 02/09/2024]
Abstract
Background Recent acute anaphylaxis guideline updates have identified remaining unmet needs based on currently available therapeutic options as a critical focus. Objective We compared the pharmacokinetic, pharmacodynamic, safety, and tolerability profiles of intranasal epinephrine with intramuscular epinephrine administered by autoinjector and manual syringe. Methods An open-label, 3-period crossover study was conducted in 116 healthy adult volunteers to assess the bioavailability of a single 13.2 mg intranasal dose of epinephrine compared to a 0.3 mg intramuscular autoinjector and a 0.5 mg manual syringe. Patients with epinephrine concentrations of 50, 100, and 200 pg/mL at 10, 20, 30, and 60 minutes after dosing were also evaluated. Results Pharmacokinetic parameters for the 13.2 mg intranasal dose exceeded those of the 0.3 mg autoinjector with a rapid and higher maximum observed concentration (intranasal, 429.4 pg/mL; autoinjector, 328.6 pg/mL) and greater systemic exposure (AUC0-360; intranasal, 39,060 pg∙min/mL; autoinjector, 17,440 pg∙min/mL). Similar results were observed compared to the 0.5 mg manual syringe. Pharmacokinetic parameters for opposite-nostril and same-nostril dosing were higher than both intramuscular doses, except time to reach maximum observed concentration, which was bracketed between the 2 intramuscular doses (intranasal opposite and same nostril, 20 minutes; autoinjector, 14.9 minutes; manual syringe, 45 minutes). Similar effects on blood pressure and heart rate were observed for intranasal and autoinjector administration. Intranasal epinephrine was safe and well tolerated. No serious or unexpected adverse events were reported, confirming results from earlier clinical studies. Conclusions Bidose epinephrine spray addresses the unmet medical and patient needs for a needle-free, convenient, and effective dose-delivery system for self-administration of epinephrine that is as good as or better than the 0.3 mg autoinjector.
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Kerhoulas Z, Ojaghi R, Hayes E, Khoury J, Pollock J. What are the common factors that lead to the failure to achieve minimal clinically important difference after shoulder surgery? A scoping review. Eur J Orthop Surg Traumatol 2024; 34:1749-1755. [PMID: 38480530 DOI: 10.1007/s00590-024-03867-0] [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] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION The goal of this research is to identify the factors that negatively impact the achievement of the minimum clinically significant change (MCID) for the American Shoulder and Elbow Surgeons (ASES) score within the realm of various orthopedic shoulder procedures. METHODS We conducted a comprehensive review of studies published from 2002 to 2023, utilizing OvidMedline and PubMed databases. Our search criteria included terms such as "minimal clinically important difference" or "MCID" along with associated MeSH terms, in addition to "American shoulder and elbow surgeon" or "ASES." We selectively included primary investigations that assessed factors linked to the failure to achieve MCID for the ASES score subsequent to orthopedic shoulder procedures, while excluding papers addressing anatomical, surgical, or injury-related aspects. RESULTS Our analysis identified 149 full-text articles, leading to the inclusion of 12 studies for detailed analysis. The selected studies investigated outcomes following various orthopedic shoulder procedures, encompassing biceps tenodesis, total shoulder arthroplasty, and rotator cuff repair. Notably, factors, such as gender, body mass index, diabetes, smoking habits, opioid usage, depression, anxiety, workers' compensation, occupational satisfaction, and the preoperative ASES score, were all associated with the inability to attain MCID. CONCLUSION In summary, numerous factors exert a negative influence on the attainment of MCID following shoulder procedures, and these factors appear to be irrespective of the specific surgical technique employed. Patients presenting with these factors may perceive their surgical outcomes as less successful when compared to those without these factors. Identifying these factors can enable healthcare providers to provide more effective counseling to patients regarding their expected outcomes and rehabilitation course. Furthermore, these findings can aid in the development of a screening tool to better identify these risk factors and optimize them before surgery.
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Affiliation(s)
- Zoe Kerhoulas
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
| | - Reza Ojaghi
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada.
| | - Emmitt Hayes
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
| | - Jason Khoury
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
| | - J Pollock
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
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Pollock J, Awan M, Benjamin J, Harris L. The transition from cranial surgery to neurosurgery in East London, 1760-1960. J Hist Neurosci 2024; 33:220-240. [PMID: 38346221 DOI: 10.1080/0964704x.2023.2298907] [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] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The emergence of neurosurgery from the practice of cranial surgery between the eighteenth and the twentieth centuries in London, UK, is well documented, including the role of Sir Victor Horsley, the first neurosurgical appointee at the National Hospital Queen Square in 1886. The process of this transition elsewhere in London and the subsequent foundation of other neurosurgical units are less well described. In East London, the status of St. Bartholomew's Hospital (Barts) as the oldest London hospital still active on its original site and its comprehensive archives allow an unusually long history of surgical practice in the specialty to be studied. Using these archives and other primary and secondary sources, this article describes the transition of cranial surgery in East London from the general surgeons, limited to the treatment of brain and skull injury, to the specialized discipline of neurosurgery. We discuss the culmination of this process in the foundation of three neurosurgical units at London Hospital, Whitechapel, by Sir Hugh B. Cairns from 1927; at Barts Hospital, Smithfield, by John E. A. O'Connell from 1937; and at Oldchurch Hospital, Romford, by Leslie C. Oliver from 1945. Two modern neurosurgical units, in Whitechapel and Romford, have taken forward the work begun by this group.
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Affiliation(s)
- Jonathan Pollock
- Department of Neurosurgery, Essex Neurosciences Centre, Queens Hospital, Romford, London, UK
| | - Mariam Awan
- Department of Neurosurgery, Essex Neurosciences Centre, Queens Hospital, Romford, London, UK
| | - Jonathan Benjamin
- Department of Neurosurgery, Essex Neurosciences Centre, Queens Hospital, Romford, London, UK
| | - Lauren Harris
- Department of Neurosurgery, Essex Neurosciences Centre, Queens Hospital, Romford, London, UK
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Wong ZY, Wickham N, Bagirathan S, Leggate A, Smith SJ, Pollock J. Craniectomy with soft tissue reconstruction for locally advanced non-melanoma skin cancer of scalp with calvarial invasion: The Nottingham experience. J Plast Reconstr Aesthet Surg 2024; 90:175-182. [PMID: 38387413 DOI: 10.1016/j.bjps.2024.02.016] [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] [Received: 08/23/2023] [Revised: 11/09/2023] [Accepted: 02/01/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Locally advanced non-melanoma skin cancer (NMSC) involving the periosteum or calvarium poses a clinical challenge for patients who are unfit for immunotherapy due to medical comorbidities and/or frailty. This case series aims to investigate outcomes for patients undergoing craniectomy and soft tissue reconstruction. METHOD Patients who underwent craniectomy and soft tissue reconstruction for invasive NMSC with calvarium or periosteal invasion between 2016 and 2022 were included. Data, including demographics, operative details, and clinical outcomes, were gathered from Nottingham University Hospitals' digital health record and the histopathology electronic database. RESULT Eight patients (average age: 78.4 years, 3 females 5 males) with significant comorbidities and varying degrees of periosteal or bone invasion fulfilled the inclusion criteria. Diagnoses included four squamous cell carcinomas, two basal cell carcinomas, and two pleomorphic dermal sarcomas. Five patients had a history of prior incomplete deep margin excision. The median sizes for soft tissue defect, tumor and bone defect size were 51.83 cm2, 34.63 cm2 and 42.25 cm2, respectively. Intraoperative complications included one dural tear. Four patients underwent local flap reconstruction and with split-thickness skin grafting, four patients underwent free flap reconstruction. Adjuvant radiotherapy was administered to three patients. Complications comprised partial graft loss in two and complete graft loss in one. There was partial flap loss in one case. One patient required subsequent parotidectomy due to regional progression before achieving disease control. All patients achieved lasting locoregional disease control (average follow-up 29.7 months). CONCLUSION Craniectomy with soft tissue reconstruction proves to be a safe and effective treatment option in advanced NMSC of the scalp in patients unsuitable for immunotherapy due to frailty or medical co-morbidity.
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Affiliation(s)
- Zhen Y Wong
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, England, UK; Department of Neurosurgery, Queens Medical Centre, Nottingham, England, UK
| | - Neil Wickham
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, England, UK
| | - Shenbana Bagirathan
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, England, UK
| | - Alex Leggate
- Department of Neurosurgery, Queens Medical Centre, Nottingham, England, UK
| | - Stuart J Smith
- Department of Neurosurgery, Queens Medical Centre, Nottingham, England, UK
| | - Jonathan Pollock
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, England, UK.
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Harris L, Parwez R, Baig A, Rahman S, Vaqas B, Pollock J, Shoakazemi A. Aberrant Arterial Anatomy at the Floor of the Third Ventricle: Video Case Report. World Neurosurg 2023; 180:13. [PMID: 37659752 DOI: 10.1016/j.wneu.2023.08.108] [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] [Received: 06/19/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023]
Abstract
A 65-year-old woman presented with a 2-month progressive history of forgetfulness, headaches, and decline in mobility. Imaging showed a large, enhancing pineal region tumor with triventricular hydrocephalus. She underwent an endoscopic third ventriculostomy and biopsy after appropriate consent was gained. Video 1 demonstrates the endoscopic procedure during which 2 aberrant arteries were identified at the floor of the third ventricle. The endoscopic third ventriculostomy was performed between these 2 arteries with great care to preserve them. The patient improved postoperatively with resolution of the hydrocephalus. Histology showed a metastatic malignant melanoma. To the best of our knowledge, no similar anatomy has been shown in an endoscopic procedure. We speculate that these are perforating arteries from the posterior communicating artery (premamillary artery) or a branch from the first part of the posterior cerebral artery P1 (thalamoperforators). Other options include perforators from the ophthalmic segment of the internal carotid artery, the communicating segment of the internal carotid artery, the superior hypophyseal artery, or a branch of the medial posterior choroidal arteries. We look at each in turn.
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Affiliation(s)
- Lauren Harris
- Department of Neurosurgery, Queen's Hospital Romford, London, United Kingdom
| | - Rabeeia Parwez
- Department of Neurosurgery, Queen's Hospital Romford, London, United Kingdom.
| | - Arsalan Baig
- Department of Neurosurgery, Queen's Hospital Romford, London, United Kingdom
| | - Shahinur Rahman
- Department of Urology, Nottingham General Hospital NHS Trust, Nottingham, United Kingdom
| | - Babar Vaqas
- Department of Neurosurgery, Queen's Hospital Romford, London, United Kingdom
| | - Jonathan Pollock
- Department of Neurosurgery, Queen's Hospital Romford, London, United Kingdom
| | - Alireza Shoakazemi
- Department of Neurosurgery, Queen's Hospital Romford, London, United Kingdom
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Fairhead R, Harris L, Shoakazemi A, Pollock J. Hydrocephalus in patients with vestibular schwannoma. Acta Neurochir (Wien) 2023; 165:4169-4174. [PMID: 37935949 DOI: 10.1007/s00701-023-05866-2] [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] [Received: 08/14/2023] [Accepted: 10/20/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Hydrocephalus (HC) is common in patients with vestibular schwannoma (VS). This can be managed with a cerebrospinal fluid (CSF) diversion procedure prior to VS resection or with VS resection, keeping CSF diversion in reserve unless required postoperatively. No clear consensus exists as to which approach is superior. This study identifies factors predictive of the development of HC, and analyses outcomes for those managed with primary CSF resection versus tumour resection. METHODS Single-centre retrospective cohort study of 204 consecutive adult patients with a unilateral VS from May 2009 to June 2021. Data was collected on patient and tumour demographics, management, and outcome. RESULTS 204 patients, with a mean age at presentation of 59.5 (21-83), with 50% female, and a mean follow-up of 7.5 years (1.8-13.9) were included. 119 were managed conservatively, 36 with stereotactic radiosurgery only, and 49 with surgery. 30 (15%) patients had radiological HC, of which 23 (77%) were obstructive, and 7 (23%) were communicating. Maximum intracranial tumour diameter and Koos grade were higher in patients with HC. Of the patients with HC the majority (20, 67%) were managed initially with CSF diversion, with 12 patients undergoing subsequent tumour resection, and three patients avoiding primary resection. Nine (30%) were managed with primary surgical resection, of whom three required subsequent CSF diversion. Complication rates and Modified Rankin Scale (MRS) were comparable or lower in the CSF diversion group (8%, MRS ≤2 = 83%), versus the primary resection group (67%, MRS ≤2 = 67%), and the primary surgical resection without HC group (25%, MRS ≤2 = 86%). CONCLUSIONS CSF diversion prior to tumour resection is a safe and acceptable strategy compared to primary VS resection, with improved outcomes and reduced surgical complications. Randomized studies and national databases are needed to determine the long-term outcomes of patients treated with CSF diversion versus primary resection.
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Bal J, Fairhead RJ, Matloob S, Shapey J, Romani R, Gavin C, Shoakazemi A, Pollock J. The Use of the Suboccipital Transtentorial Approach to the Posterior Inferior Incisural Space. Cureus 2023; 15:e47705. [PMID: 38021782 PMCID: PMC10674890 DOI: 10.7759/cureus.47705] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To describe our experience with the microsurgical technique of the suboccipital transtentorial (SOTT) approach in the removal of posterior fossa lesions located in the posterior incisural space. Method Between 2002 and 2020 we reviewed all patients who underwent microsurgical resection of lesions of the posterior incisural space at the Department of Neurosurgery, Essex Neuroscience Centre, London, England (eight patients, male to female 3:5, mean age: 51, range 35-69). We describe the preoperative symptoms, radiological findings, surgical techniques, histology and postoperative outcomes in this cohort of patients. Results Eight patients with tumours located in the posterior incisural space underwent surgery during the study period including four meningiomas (50%), two haemangioblastomas (25%), one metastasis (13%) and one giant prolactinoma (13%). Gross or near total resection was achieved in six patients (75%): the giant prolactinoma could not be radically removed and one of the meningiomas required a small fragment to be left in place to protect the Vein of Galen. No patient developed a visual field deficit due to occipital lobe retraction. One patient developed a temporary trochlear nerve palsy (13%). Five patients had mild disability (Glasgow Outcome Scale (GOS) = 5), and four had moderate disability (GOS = 4). Conclusion In our series, the SOTT approach provided excellent access for all cases of tumours in the posterior incisural space. The tumour's size and relationship to the deep venous system contributed to the choice of approach and in one patient who had previously undergone surgery via the supracerebellar route, the SOTT approach enabled the avoidance of gliotic scar tissue. Success is dependent on careful case selection, though from our series of 8 patients, we conclude that this approach allows safe access to the posterior incisural space, with acceptable outcomes with regard to postoperative disability and cranial nerve palsy. As such, the approach should be in the armamentarium of any neurosurgeon who regularly deals with posterior fossa pathology.
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Affiliation(s)
- Jarnail Bal
- Neurosurgery, Royal London Hospital, London, GBR
| | | | | | | | - Rossana Romani
- Neurosurgery, Southampton General Hospital National Health Service (NHS) Foundation Trust, London, GBR
| | - Cormac Gavin
- Neurosurgery, The Royal Hallamshire Hospital, Sheffield, GBR
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Harris L, Bal JS, Drosos E, Matloob S, Roberts NY, Hammerbeck-Ward C, Pathmanaban O, Evans G, King AT, Rutherford SA, Pollock J, Shoakazemi A. The management of symptomatic hyperostotic bilateral spheno-orbital meningiomas: patient series. J Neurosurg Case Lessons 2023; 6:CASE23179. [PMID: 37773763 PMCID: PMC10555579 DOI: 10.3171/case23179] [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] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/16/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The occurrence of hyperostotic bilateral spheno-orbital meningiomas (BSOMs) is very rare. Patients present with bilateral symptoms and require bilateral treatment. This series describes 6 patients presenting to 2 UK neurosurgical units and includes a literature review. To the best of the authors' knowledge, this is the largest series documented. OBSERVATIONS This is a retrospective review of patients with BSOMs presenting between 2006 and 2023. Six females, whose mean age was 43 (range: 36-64) years, presented with features of visual disturbance. Bilateral sphen-oorbital meningiomas were identified. All patients underwent bilateral staged resections. The patients had an initial improvement in their symptoms. Extensive genetic testing was performed in 4 patients, with no variants in the NF2, LZTR1, SMARCB1, SMARCE1, and SMARCA4 genes or other variants detected. The mean follow-up was 100.3 (range: 64-186) months. Sixty-seven percent of patients had good long-term visual acuity. The progression rate was 75% and was particularly aggressive in 1 patient. Four patients required radiation therapy, and 2 needed further surgery. LESSONS Hyperostotic BSOMs are extensive, challenging tumors causing significant disability. They can recur, with significant patient impact. Multidisciplinary management and indefinite long-term follow-up are essential. The biology of these tumors remains unclear. As molecular testing expands, the understanding of BSOM oncogenesis and potential therapeutic targets is likely to improve.
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Affiliation(s)
- Lauren Harris
- Department of Neurosurgery, Essex Neuroscience Centre, Queens Hospital, Romford, United Kingdom
| | - Jarnail S Bal
- Department of Neurosurgery, Essex Neuroscience Centre, Queens Hospital, Romford, United Kingdom
| | - Evangelos Drosos
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance Foundation Trust, Manchester, United Kingdom
| | - Samir Matloob
- Department of Neurosurgery, Essex Neuroscience Centre, Queens Hospital, Romford, United Kingdom
| | - Nicola Y Roberts
- North West Genomic Laboratory Hub (Manchester), Genomic Diagnostics Laboratory, Manchester Centre for Genomic Medicine, Manchester, United Kingdom
| | - Charlotte Hammerbeck-Ward
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance Foundation Trust, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Centre, Manchester, United Kingdom; and
| | - Omar Pathmanaban
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance Foundation Trust, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Centre, Manchester, United Kingdom; and
| | - Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution Infection and Genomic Medicine, University of Manchester, St Mary’s Hospital, Manchester Universities NHS Foundation Trust, Manchester, United Kingdom
| | - Andrew T King
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance Foundation Trust, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Centre, Manchester, United Kingdom; and
| | - Scott A Rutherford
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance Foundation Trust, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Centre, Manchester, United Kingdom; and
| | - Jonathan Pollock
- Department of Neurosurgery, Essex Neuroscience Centre, Queens Hospital, Romford, United Kingdom
| | - Alireza Shoakazemi
- Department of Neurosurgery, Essex Neuroscience Centre, Queens Hospital, Romford, United Kingdom
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Varela F, Symowski C, Pollock J, Wirtz S, Voehringer D. IL-4/IL-13-producing ILC2s are required for timely control of intestinal helminth infection in mice. Eur J Immunol 2022; 52:1925-1933. [PMID: 36116042 DOI: 10.1002/eji.202249892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/10/2022] [Accepted: 09/16/2022] [Indexed: 12/13/2022]
Abstract
Infection of mice with Nippostrongylus brasiliensis (Nb) serves as a model for human hookworm infection affecting about 600 million people world-wide. Expulsion of Nb from the intestine requires IL-13-mediated mucus secretion from goblet cells and activation of smooth muscles cells. Type 2 innate lymphoid cells (ILC2s) are a major cellular source of IL-13 but it remains unclear whether IL-13 secretion from ILC2s is required for Nb expulsion. Here, we compared the immune response to Nb infection in mixed bone marrow chimeras with wild-type or IL-4/IL-13-deficient ILC2s. ILC2-derived IL-4/IL-13 was required for recruitment of eosinophils to the lung but had no influence of systemic eosinophil levels. In the small intestine, goblet cell hyperplasia and tuft cell accumulation was largely dependent on IL-4/IL-13 secretion from ILC2s. This further translated to higher eggs counts and impaired worm expulsion in mice with IL-4/IL-13-deficient ILC2s. Overall, we demonstrate that ILC2s constitute a non-redundant source of IL-4/IL-13 required for protective immunity against primary Nb infection.
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Affiliation(s)
- Filipa Varela
- Department of Infection Biology, University Hospital Erlangen and Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, 91054, Germany
| | - Cornelia Symowski
- Department of Infection Biology, University Hospital Erlangen and Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, 91054, Germany
| | - Jonathan Pollock
- Department of Infection Biology, University Hospital Erlangen and Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, 91054, Germany
| | - Stefan Wirtz
- Department of Medicine 1, University Hospital Erlangen and Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, 91054, Germany
| | - David Voehringer
- Department of Infection Biology, University Hospital Erlangen and Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, 91054, Germany
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Krane NA, Loyo M, Pollock J, Hill M, Johnson CZ, Stevens AA. Exploratory Study of the Brain Response in Facial Synkinesis after Bell Palsy with Systematic Review and Meta-analysis of the Literature. AJNR Am J Neuroradiol 2022; 43:1470-1475. [PMID: 36574328 PMCID: PMC9575525 DOI: 10.3174/ajnr.a7619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Facial synkinesis, characterized by unintentional facial movements paired with intentional movements, is a debilitating sequela of Bell palsy. PURPOSE Our aim was to determine whether persistent peripheral nerve changes arising from Bell palsy result in persistent altered brain function in motor pathways in synkinesis. DATA SOURCES A literature search using terms related to facial paralysis, Bell palsy, synkinesis, and fMRI through May 2021 was conducted in MEDLINE and EMBASE. Additionally, an fMRI study examined lip and eyeblink movements in 2 groups: individuals who fully recovered following Bell palsy and individuals who developed synkinesis. STUDY SELECTION Task-based data of the whole brain that required lip movements in healthy controls were extracted from 7 publications. Three studies contributed similar whole-brain analyses in acute Bell palsy. DATA ANALYSIS The meta-analysis of fMRI in healthy control and Bell palsy groups determined common clusters of activation within each group using activation likelihood estimates. A separate fMRI study used multivariate general linear modeling to identify changes associated with synkinesis in smiling and blinking tasks. DATA SYNTHESIS A region of the precentral gyrus contralateral to the paretic side of the face was hypoactive in synkinesis during lip movements compared with controls. This region was centered in a cluster of activation identified in the meta-analysis of the healthy controls but absent from individuals with Bell palsy. LIMITATIONS The meta-analysis relied on a small set of studies. The small sample of subjects with synkinesis limited the power of the fMRI analysis. CONCLUSIONS Premotor pathways show persistent functional changes in synkinesis first identifiable in acute Bell palsy.
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Affiliation(s)
- N A Krane
- From the Division of Facial Plastic and Reconstructive Surgery (N.A.K., M.L., C.Z.J.), Department of Otolaryngology-Head and Neck Surgery
| | - M Loyo
- From the Division of Facial Plastic and Reconstructive Surgery (N.A.K., M.L., C.Z.J.), Department of Otolaryngology-Head and Neck Surgery
| | - J Pollock
- Division of Neuroradiology (J.P.), Department of Diagnostic Radiology
| | - M Hill
- Department of Otolaryngology-Head and Neck Surgery (M.H.), University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - C Z Johnson
- From the Division of Facial Plastic and Reconstructive Surgery (N.A.K., M.L., C.Z.J.), Department of Otolaryngology-Head and Neck Surgery
| | - A A Stevens
- Advanced Imaging Research Center (A.A.S.), Oregon Health & Science University, Portland, Oregon
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12
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Zhang C, Harris L, Itum H, Chawda S, Coker J, Pollock J, Sadek AR, Shoakazemi A. Potential Surgical Implications of Internal Jugular Stenosis in a Craniocervical Junction Meningioma. Cureus 2022; 14:e26403. [PMID: 35915693 PMCID: PMC9337779 DOI: 10.7759/cureus.26403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/05/2022] Open
Abstract
We report a case of a 61-year-old lady presenting with several weeks of progressive left-sided weakness, and found to have a foramen magnum meningioma. She was counselled on surgical resection of the tumour, and a preoperative computed tomography angiogram (CTA) was obtained for operative planning purposes. CTA demonstrated incidental bilateral internal jugular vein (IJV) stenosis, with enlarged extracranial collateral vessels and elongated styloid processes. The main surgical concern was potential injury of the extracranial collateral vessels during operative exposure, which may compromise her intracranial venous outflow in light of the IJV stenosis. A doppler ultrasound scan of the IJVs was performed, which demonstrated that blood flow was still present through both vessels. Through careful soft tissue dissection during surgery, potential complications and injury to the extracranial collaterals were avoided. We performed a literature review of the incidence of IJV stenosis, its associated conditions, and potential surgical implications. Complications from injury to vital collateral extracranial vessels should be considered during preoperative planning in patients with anatomical variants or risk factors for IJV stenosis, as seen in this case.
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13
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Anderson S, Pollock J, Hogan J, Hammond J, Jain V, Madura J. Is there strength in numbers? Current trends in U.S. general surgery practice consolidation. Am J Surg 2022; 223:481. [DOI: 10.1016/j.amjsurg.2022.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Thomas RJ, Whittaker J, Pollock J. Discerning a smile - The intricacies of analysis of post-neck dissection asymmetry. Am J Otolaryngol 2022; 43:103271. [PMID: 34800862 DOI: 10.1016/j.amjoto.2021.103271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Iatrogenic facial nerve palsy is distressing to the patient and clinician. The deformity is aesthetically displeasing, and can be functionality problematic for oral competence, dental lip trauma and speech. Furthermore such injuries have litigation implications. Marginal mandibular nerve (MMN) palsy causes an obvious asymmetrical smile. MMN is at particular risk during procedures such as rhytidoplasties, mandibular fracture, tumour resection and neck dissections. Cited causes for the high incidence are large anatomical variations, unreliable landmarks, an exposed neural course and tumour grade or nodal involvement dictating requisite nerve sacrifice. An alternative cause for post-operative asymmetry is damage to the cervical branch of the facial nerve or platysmal dysfunction due to its division. The later tends to have a transient course and recovers. Distinction between MMN palsy and palsy of the cervical branch of the facial nerve or platysma division should therefore be made. In 1979 Ellenbogen differentiated between MMN palsy and "Pseudo-paralysis of the mandibular branch of the facial nerve". Despite this, there is paucity in the literature & confusion amongst clinicians in distinguishing between these palsies, and there is little regarding these post-operative sequelae and neck dissections. METHOD This article reflects on the surgical anatomy of the MMN and cervical nerve in relation to danger zones during lymphadenectomy. The authors review the anatomy of the smile. Finally, case studies are utilised to evaluate the differences between MMN palsy and its pseudo-palsy to allow clinical differentiation. CONCLUSION Here we present a simple method for clinical differentiation between these two prognostically different injuries, allowing appropriate reassurance, ongoing therapy & management.
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Affiliation(s)
- R J Thomas
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, United Kingdom of Great Britain and Northern Ireland.
| | | | - J Pollock
- Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom of Great Britain and Northern Ireland.
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Sierra A, Bollig T, Pollock J, Lindor R, Joseph A. 370 Trends in Emergency Department Patients’ Payment Method by Ethnicity from 2014-2018. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Jerrom R, Lam M, Pollock J, Varma S. Response to: Intraoral Basal Cell Carcinoma Discovered During Mohs Micrographic Surgery. Dermatol Surg 2021; 47:1398-1399. [PMID: 34148993 DOI: 10.1097/dss.0000000000003136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Minh Lam
- Sheffield Teaching Hospitals NHS Foundation Trust
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Bandyopadhyay S, Khan DZ, Marcus HJ, Schroeder BE, Patel V, O'Donnell A, Ahmed S, Alalade AF, Ali AM, Allison C, Al-Barazi S, Al-Mahfoudh R, Amarouche M, Bahl A, Bennett D, Bhalla R, Bhatt P, Boukas A, Cabrilo I, Chadwick A, Chowdhury YA, Choi D, Cudlip SA, Donnelly N, Dorward NL, Dow G, Fountain DM, Grieve J, Giamouriadis A, Gilkes C, Gnanalingham K, Halliday J, Hanna B, Hayhurst C, Hempenstall J, Henderson D, Hossain-Ibrahim K, Hirst T, Hughes M, Javadpour M, Jenkins A, Kamel M, Mannion RJ, Kolias AG, Khan MH, Khan MS, Lacy P, Mahmood S, Maratos E, Martin A, Mathad N, McAleavey P, Mendoza N, Millward CP, Mirza S, Muquit S, Murray D, Naik PP, Nair R, Nicholson C, Paluzzi A, Pathmanaban O, Paraskevopoulos D, Pollock J, Phillips N, Piper RJ, Ram B, Robertson I, Roman E, Ross P, Santarius T, Sayal P, Shapey J, Sharma R, Shaw S, Shoakazemi A, Shumon S, Sinha S, Solomou G, Soon WC, Stapleton S, Statham P, Stew B, Thomas N, Tsermoulas G, Tysome JR, Varma A, Weir P, Williams A, Youssef M, Veljanoski D. CSF Rhinorrhea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 2: Impact of COVID-19. World Neurosurg 2021; 149:e1090-e1097. [PMID: 33444833 PMCID: PMC7965443 DOI: 10.1016/j.wneu.2020.12.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been raised regarding the increased risk of perioperative mortality for patients with COVID-19, and the transmission risk to healthcare workers, especially during endonasal neurosurgical operations. The Pituitary Society has produced recommendations to guide management during this era. We sought to assess contemporary neurosurgical practice and the effects of COVID-19. METHODS A multicenter prospective observational cohort study was conducted at 12 tertiary neurosurgical units (United Kingdom and Ireland). Data were collected from March 23 to July 31, 2020, inclusive. The data points collected included patient demographics, preoperative COVID-19 test results, operative modifications, and 30-day COVID-19 infection rates. RESULTS A total of 124 patients were included. Of the 124 patients, 116 (94%) had undergone COVID-19 testing preoperatively (transsphenoidal approach, 97 of 105 [92%]; expanded endoscopic endonasal approach, 19 of 19 [100%]). One patient (1 of 116 [0.9%]) had tested positive for COVID-19 preoperatively, requiring a delay in surgery until the infection had been confirmed as resolved. Other than transient diabetes insipidus, no other complications were reported for this patient. All operating room staff had worn at least level 2 personal protective equipment. Adaptations to surgical techniques included minimizing drilling, draping modifications, and the use of a nasal iodine wash. At 30 days postoperatively, no evidence of COVID-19 infection (symptoms or positive formal testing results) were found in our cohort and no mortality had occurred. CONCLUSIONS Preoperative screening protocols and operative modifications have facilitated endonasal neurosurgery during the COVID-19 pandemic, with the Pituitary Society guidelines followed for most of these operations. We found no evidence of COVID-19 infection in our cohort and no mortality, supporting the use of risk mitigation strategies to continue endonasal neurosurgery in subsequent pandemic waves.
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Buzzell N, Blash S, Miner K, Pollock J, Hawkins N, Gavin W. 128 Comparison of multiple maturation times on juvenile invitro embryo transfer (JIVET)-derived oocytes and embryo development in the goat. Reprod Fertil Dev 2021. [DOI: 10.1071/rdv33n2ab128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Juvenile invitro embryo transfer (JIVET) is an assisted reproductive technology (ART) with the potential to produce numerous offspring from a single young female goat at 4 to 8 weeks of age. It has been reported in small ruminants that there can be a marked variable response to the administration of exogenous hormones for superovulation, the subsequent number of oocytes generated, and subsequent embryo developmental potential. The industry standard (as well as the recommendation of commercial media suppliers) invitro maturation time is 21 to 24h for conventionally derived oocytes. This study investigated multiple maturation times for JIVET-derived oocytes: 16, 22, and 28h. Oocytes were collected from four JIVET animals at 6 to 8 weeks of age. The hormonal superovulation regimen used on the juvenile animals consisted of 4×40-mg FSH injections at ∼12h apart and a 400IU of PMSG injection given with the first FSH injection. Surgical recovery of the oocytes via a midline laparotomy was performed the day following the last FSH injection. All of the oocytes were collected via aspirating follicles that were 4mm and larger. Oocytes with compact cumulus cells subsequently underwent IVM, IVF, and invitro culture (IVC) utilising IVF Bioscience media and methods. A single straw of identical cryopreserved/thawed semen from the same buck was utilised for each of the IVF procedures. The results were (37/88) 42%, (37/85) 44%, and (39/91) 43% cleaved and (23/88) 26%, (24/85) 28%, and (28/91) 31% blastocyst rate based on respective maturation times for JIVET-derived ova. Development rate during the cleavage stage and blastocyst stage was analysed using a repeated-measures logistic regression model utilising generalized estimating equations (GEE), with maturation time as fixed effect and a compound symmetry within subject (juvenile goat) covariance structure. The main effect of maturation time on the odds of development during the cleavage stage (P=0.8727) and blastocyst stage (P=0.3857) was not significant. These results indicate that the time in maturation media does not have as profound an effect on development to blastocysts as a factor in the variability reported by other laboratories. The development rate of embryos from one juvenile goat produced very high blastocyst rates of (5/12) 42%, (11/12) 92%, and (11/15) 73%, respectively. Additional logistic regression analysis showed that the odds of development in this juvenile donor was significantly different compared with the other donors (pooled) during the cleavage stage at 16h (P=0.0083) and 28h (P=0.0021) maturation times. Likewise, the odds of development in this donor was significantly different than that of the other donors (pooled) during the blastocyst stage at 22h (P=0.0002) and 28h (P=0.0003) maturation times. This further indicates the wide variation of oocyte quality from JIVET-derived oocytes and indicates potential for higher development rates at 22 and 28h in this specific goat.
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19
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Pollock J, Low AS, McHugh RE, Muwonge A, Stevens MP, Corbishley A, Gally DL. Alternatives to antibiotics in a One Health context and the role genomics can play in reducing antimicrobial use. Clin Microbiol Infect 2020; 26:1617-1621. [PMID: 32220638 DOI: 10.1016/j.cmi.2020.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND This review follows on from the International Conference on One Health Antimicrobial Resistance (ICOHAR 2019), where strategies to improve the fundamental understanding and management of antimicrobial resistance at the interface between humans, animals and the environment were discussed. OBJECTIVE This review identifies alternatives to antimicrobials in a One Health context, noting how advances in genomic technologies are assisting their development and enabling more targeted use of antimicrobials. SOURCES Key articles on the use of microbiota modulation, livestock breeding and gene editing, vaccination, antivirulence strategies and bacteriophage therapy are discussed. CONTENT Antimicrobials are central for disease control, but reducing their use is paramount as a result of the rise of transmissible antimicrobial resistance. This review discusses antimicrobial alternatives in the context of improved understanding of fundamental host-pathogen and microbiota interactions using genomic tools. IMPLICATIONS Host and microbial genomics and other novel technologies play an important role in devising disease control strategies for healthier animals and humans that in turn reduce our reliance on antimicrobials.
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Affiliation(s)
- J Pollock
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - A S Low
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - R E McHugh
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, Scotland, UK; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
| | - A Muwonge
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - M P Stevens
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - A Corbishley
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - D L Gally
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Edinburgh, UK.
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20
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Hewlett S, Almeida C, Ambler N, Blair PS, Choy E, Dures E, Hammond A, Hollingworth W, Kadir B, Kirwan J, Plummer Z, Rooke C, Thorn J, Turner N, Pollock J. Group cognitive-behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations. Health Technol Assess 2020; 23:1-130. [PMID: 31601357 DOI: 10.3310/hta23570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fatigue is a major problem in rheumatoid arthritis (RA). There is evidence for the clinical effectiveness of cognitive-behavioural therapy (CBT) delivered by clinical psychologists, but few rheumatology units have psychologists. OBJECTIVES To compare the clinical effectiveness and cost-effectiveness of a group CBT programme for RA fatigue [named RAFT, i.e. Reducing Arthritis Fatigue by clinical Teams using cognitive-behavioural (CB) approaches], delivered by the rheumatology team in addition to usual care (intervention), with usual care alone (control); and to evaluate tutors' experiences of the RAFT programme. DESIGN A randomised controlled trial. Central trials unit computerised randomisation in four consecutive cohorts within each of the seven centres. A nested qualitative evaluation was undertaken. SETTING Seven hospital rheumatology units in England and Wales. PARTICIPANTS Adults with RA and fatigue severity of ≥ 6 [out of 10, as measured by the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS)] who had no recent changes in major RA medication/glucocorticoids. INTERVENTIONS RAFT - group CBT programme delivered by rheumatology tutor pairs (nurses/occupational therapists). Usual care - brief discussion of a RA fatigue self-management booklet with the research nurse. MAIN OUTCOME MEASURES Primary - fatigue impact (as measured by the BRAF-NRS) at 26 weeks. Secondary - fatigue severity/coping (as measured by the BRAF-NRS); broader fatigue impact [as measured by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ)]; self-reported clinical status; quality of life; mood; self-efficacy; and satisfaction. All data were collected at weeks 0, 6, 26, 52, 78 and 104. In addition, fatigue data were collected at weeks 10 and 18. The intention-to-treat analysis conducted was blind to treatment allocation, and adjusted for baseline scores and centre. Cost-effectiveness was explored through the intervention and RA-related health and social care costs, allowing the calculation of quality-adjusted life-years (QALYs) with the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). Tutor and focus group interviews were analysed using inductive thematic analysis. RESULTS A total of 308 out of 333 patients completed 26 weeks (RAFT, n/N = 156/175; control, n/N = 152/158). At 26 weeks, the mean BRAF-NRS impact was reduced for the RAFT programme (-1.36 units; p < 0.001) and the control interventions (-0.88 units; p < 0.004). Regression analysis showed a difference between treatment arms in favour of the RAFT programme [adjusted mean difference -0.59 units, 95% confidence interval (CI) -1.11 to -0.06 units; p = 0.03, effect size 0.36], and this was sustained over 2 years (-0.49 units, 95% CI -0.83 to -0.14 units; p = 0.01). At 26 weeks, further fatigue differences favoured the RAFT programme (BRAF-MDQ fatigue impact: adjusted mean difference -3.42 units, 95% CI -6.44 to - 0.39 units, p = 0.03; living with fatigue: adjusted mean difference -1.19 units, 95% CI -2.17 to -0.21 units, p = 0.02; and emotional fatigue: adjusted mean difference -0.91 units, 95% CI -1.58 to -0.23 units, p = 0.01), and these fatigue differences were sustained over 2 years. Self-efficacy favoured the RAFT programme at 26 weeks (Rheumatoid Arthritis Self-Efficacy Scale: adjusted mean difference 3.05 units, 95% CI 0.43 to 5.6 units; p = 0.02), as did BRAF-NRS coping over 2 years (adjusted mean difference 0.42 units, 95% CI 0.08 to 0.77 units; p = 0.02). Fatigue severity and other clinical outcomes were not different between trial arms and no harms were reported. Satisfaction with the RAFT programme was high, with 89% of patients scoring ≥ 8 out of 10, compared with 54% of patients in the control arm rating the booklet (p < 0.0001); and 96% of patients and 68% of patients recommending the RAFT programme and the booklet, respectively, to others (p < 0.001). There was no significant difference between arms for total societal costs including the RAFT programme training and delivery (mean difference £434, 95% CI -£389 to £1258), nor QALYs gained (mean difference 0.008, 95% CI -0.008 to 0.023). The probability of the RAFT programme being cost-effective was 28-35% at the National Institute for Health and Care Excellence's thresholds of £20,000-30,000 per QALY. Tutors felt that the RAFT programme's CB approaches challenged their usual problem-solving style, helped patients make life changes and improved tutors' wider clinical practice. LIMITATIONS Primary outcome data were missing for 25 patients; the EQ-5D-5L might not capture fatigue change; and 30% of the 2-year economic data were missing. CONCLUSIONS The RAFT programme improves RA fatigue impact beyond usual care alone; this was sustained for 2 years with high patient satisfaction, enhanced team skills and no harms. The RAFT programme is < 50% likely to be cost-effective; however, NHS costs were similar between treatment arms. FUTURE WORK Given the paucity of RA fatigue interventions, rheumatology teams might investigate the pragmatic implementation of the RAFT programme, which is low cost. TRIAL REGISTRATION Current Controlled Trials ISRCTN52709998. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 57. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Hewlett
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - Celia Almeida
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | | | - Peter S Blair
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Ernest Choy
- Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Emma Dures
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - Alison Hammond
- Centre for Health Sciences Research, School of Health Sciences, University of Salford, Salford, UK
| | | | - Bryar Kadir
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - John Kirwan
- Academic Rheumatology, Department of Translational Health Sciences, University of Bristol, Bristol, UK
| | - Zoe Plummer
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - Clive Rooke
- Patient Research Partner, Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Joanna Thorn
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicholas Turner
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Jonathan Pollock
- Department of Health and Social Sciences, University of the West of England Bristol, Bristol, UK
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21
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Khan DZ, Bandyopadhyay S, Patel V, Schroeder BE, Cabrilo I, Choi D, Cudlip SA, Donnelly N, Dorward NL, Fountain DM, Grieve J, Halliday J, Kolias AG, Mannion RJ, O'Donnell A, Phillips N, Piper RJ, Ramachandran B, Santarius T, Sayal P, Sharma R, Solomou G, Tysome JR, Marcus HJ, Alalade AF, Ahmed S, Al-Barazi S, Al-Mahfoudh R, Bahl A, Bennett D, Bhalla R, Bhatt P, Dow G, Giamouriadis A, Gilkes C, Gnanalingham K, Hanna B, Hayhurst C, Hempenstall J, Hossain-Ibrahim K, Hughes M, Javadpour M, Jenkins A, Kamel M, Habibullah Khan M, Lacy P, Maratos E, Martin A, Mathad N, Mendoza N, Mirza S, Muquit S, Nair R, Nicholson C, Paluzzi A, Paraskevopoulos D, Pathmanaban O, Pollock J, Ram B, Robertson I, Ross P, Shaw S, Shoakazemi A, Sinha S, Stapleton S, Statham P, Stew B, Thomas N, Tsermoulas G, Weir P, Williams A. CSF rhinorrhoea after endonasal intervention to the anterior skull base (CRANIAL): proposal for a prospective multicentre observational cohort study. Br J Neurosurg 2020; 35:408-417. [PMID: 32909855 DOI: 10.1080/02688697.2020.1795622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/23/2022]
Abstract
BACKGROUND The endonasal transsphenoidal approach (TSA) has emerged as the preferred approach in order to treat pituitary adenoma and related sellar pathologies. The recently adopted expanded endonasal approach (EEA) has improved access to the ventral skull base whilst retaining the principles of minimally invasive surgery. Despite the advantages these approaches offer, cerebrospinal fluid (CSF) rhinorrhoea remains a common complication. There is currently a lack of comparative evidence to guide the best choice of skull base reconstruction, resulting in considerable heterogeneity of current practice. This study aims to determine: (1) the scope of the methods of skull base repair; and (2) the corresponding rates of postoperative CSF rhinorrhoea in contemporary neurosurgical practice in the UK and Ireland. METHODS We will adopt a multicentre, prospective, observational cohort design. All neurosurgical units in the UK and Ireland performing the relevant surgeries (TSA and EEA) will be eligible to participate. Eligible cases will be prospectively recruited over 6 months with 6 months of postoperative follow-up. Data points collected will include: demographics, tumour characteristics, operative data), and postoperative outcomes. Primary outcomes include skull base repair technique and CSF rhinorrhoea (biochemically confirmed and/or requiring intervention) rates. Pooled data will be analysed using descriptive statistics. All skull base repair methods used and CSF leak rates for TSA and EEA will be compared against rates listed in the literature. ETHICS AND DISSEMINATION Formal institutional ethical board review was not required owing to the nature of the study - this was confirmed with the Health Research Authority, UK. CONCLUSIONS The need for this multicentre, prospective, observational study is highlighted by the relative paucity of literature and the resultant lack of consensus on the topic. It is hoped that the results will give insight into contemporary practice in the UK and Ireland and will inform future studies.
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Affiliation(s)
- Danyal Z Khan
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK
| | | | - Vikesh Patel
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Ivan Cabrilo
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - David Choi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Simon A Cudlip
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neil Donnelly
- Department of ENT Surgery, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Joan Grieve
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jane Halliday
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK
| | - Richard J Mannion
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK
| | - Alice O'Donnell
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Nick Phillips
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Clinical lead for Cranial Neurosurgery, Getting it Right First Time, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Bhavna Ramachandran
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK
| | - Thomas Santarius
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK
| | - Parag Sayal
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Rishi Sharma
- Department of ENT Surgery, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
| | | | - James R Tysome
- Department of ENT Surgery, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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Buzzell N, Blash S, Miner K, Schofield M, Pollock J, Hawkins N, Hevy M, Gavin W. 154 A method of oviductal semen deposition for use in the goat. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to investigate a method of oviducal semen deposition as a strategy for producing offspring from poor-quality cryopreserved goat sperm. Invitro fertilisation (IVF) and AI are common assisted reproductive technologies used in small ruminants, but they have varied results in the goat. The use of poor-quality cryopreserved-thawed sperm (<50% live/dead ratio at post-thaw) can decrease the rate of success. These procedures were performed in the month of November in Central Massachusetts in the United States (42° N). Seven 10-year-old dairy goats (Saanen, Toggenburg, and Alpine breeds) were synchronised and superovulated using a progesterone implant on Day 0, a prostaglandin injection at Day 7, two daily injections of 36mg of FSH ~12h apart on Days 12-15, and progesterone implant removal on Day 14 followed by an injection of 50µg of gonadotrophin-releasing hormone. Sperm deposition was performed on Day 17 (72 h after implant removal). The animals were anaesthetised using a standardised protocol, intubated, and maintained using isoflurane, and sterile prep was performed before a midline laparotomy procedure. Straws from a single ejaculate from a transgenic founder that was cryopreserved using a commercial two-step glycerol-egg yolk-based extender were used. A straw from this collection was post-thawed 30 days after collection and, using a commercial live/dead stain, 67% live sperm was determined. The optimal type of sperm prep and sperm concentration is unknown and may be dependent on sperm quality. Therefore, different gradient preps using Vitrolife SpermGrad at three volumes (1.5 (used on two animals), 1.0, and 0.5mL) as well as two volumes of IVF Bioscience Bovine BO-SemenPrep (4.0mL (used on two animals) and 2.0mL) were used. All five pellets were diluted in 1.0mL of IVF Bioscience Bovine BO-IVF media. Sperm concentrations ranging from 75×106 to 27×106 spermmL−1 were deposited into one oviduct; then, a 10:1 dilution was performed and 7.5×106 to 2.7×10 spermmL−1 were deposited into the contralateral oviduct. The depositions were performed just proximal to the uterotubal junction in a volume of 0.1mL of diluent via a tuberculin syringe attached to a 20-gauge needle. Two days following the procedure, oviducts were flushed postmortem from three of the seven randomly selected goats. All three had fertilised embryos, and nineteen 8-cell embryos were retrieved. Three of these embryos were surgically transferred to the distal uterine horn of a suitable recipient. The recipient became pregnant and produced a single offspring. The remaining four of seven goats were killed 41 days post-surgery. Two of the four goats were pregnant, with one carrying one fetus and the other carrying five fetuses. Further studies are needed to optimise this method, but these initial results indicate that oviducal semen deposition directly into the oviduct proximal to the uterotubal junction may be a suitable alternative for producing offspring from suboptimal cryopreserved-thawed goat sperm.
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Abstract
Background: Cavernous sinus tumours comprise 0.1-0.2% of all intracranial tumours, and are most commonly meningiomas or schwannomas. Central nervous system and cranial nerve granular cell tumours (GCTs) are extremely rare. We report the tenth case of a GCT arising from a cranial nerve, and the second case reported in a cavernous sinus location, and review the literature. Clinical presentation: A 67-year-old man presented with right sided trigeminal neuralgia. Imaging findings suggested a trigeminal schwannoma and he was treated with CyberKnife radiosurgery. Over a period of 41 months follow up, there was a progression in both symptoms and imaging findings, requiring debulking surgery. Histopathology identified a GCT. Conclusions: This is the first case of a cranial nerve GCT treated with stereotactic radiosurgery. Trigeminal nerve GCTs are a rare differential in cases of presumed schwannomas.
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Affiliation(s)
- Lauren Harris
- Department of Neurosurgery, Queen's Hospital , Romford , UK
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24
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Jumabhoy I, Collins M, Pollock J. Sentinel lymph node biopsy in malignant melanoma; the East Midlands experience. J Plast Reconstr Aesthet Surg 2019; 72:1576-1606. [PMID: 31153811 DOI: 10.1016/j.bjps.2019.05.025] [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] [Received: 02/25/2019] [Revised: 03/20/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Irfan Jumabhoy
- Department of Burns, Plastics and Reconstructive Surgery, Nottingham City Hospital, Nottingham University Hospitals NHS Trust.
| | - Michelle Collins
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, UK
| | - Jonathan Pollock
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, UK
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Mills SJ, Radon MR, Baird RD, Hanemann CO, Keatley D, Lewis J, Pollock J, Sanghera P, Santarius T, Whitfield G, Zakaria R, Michael D. J. Utilization of volumetric magnetic resonance imaging for baseline and surveillance imaging in Neuro-oncology. Br J Radiol 2019; 92:20190059. [PMID: 30924680 PMCID: PMC6592091 DOI: 10.1259/bjr.20190059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 12/14/2022] Open
Abstract
The acquisition of volumetric post-contrast MRI has clear advantages in the interpretation of neuro-oncology studies but has yet to find its way into routine clinical practice beyond planning scans for surgery and radiotherapy. This commentary briefly highlights the benefits of these techniques whilst dispelling some of the perceived disadvantages.
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Affiliation(s)
| | - Mark R. Radon
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | | | - Debbie Keatley
- National Cancer Research Institute Metastases and Meningioma subgroup of the Brain Clinical Studies Group, London, United Kingdom
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Madan Paramasivan A, Marouf S, Raghunathan S, Shoakazemi A, Pollock J, Chawda S, Stojanovic N, Drincic A. SAT-474 Giant Prolactinoma Case Series Assessing Response on Initial Dose of Cabergoline. J Endocr Soc 2019. [PMCID: PMC6552231 DOI: 10.1210/js.2019-sat-474] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Giant prolactinomas (GPs) are rare representing 2-3% of prolactinomas and only ~ 0.5% of all pituitary tumors. Various definitions have been proposed for GP but commonly accepted criteria is tumor dimension of ≥4 cm. GP is often associated with very high prolactin (PRL) ranging 1,000 -100,000 ng/ml, significant extrasellar extension and no concomitant growth hormone or ACTH secretion. Patients predominantly present with neurological symptoms rather than endocrine dysfunction, and so the primary goal of treatment is amelioration of neurological symptoms. The literature search reveals approximately 190 papers on this topic and most are single case reports or series describing only unusual clinical manifestations. Hence, evidence based recommendations for treatment are lacking. Dopamine agonist (DA) is considered first line of therapy, as these tumors are highly sensitive to medical therapy. Surgery and radiation may be warranted in special situations. Low starting doses of cabergoline (CAB) are generally recommended due to concern for complications of apoplexy and cerebrospinal fluid (CSF) leak from rapid tumor shrinkage. However, no recommendations for a specific starting dose exist. Objective: Individual tumor and hormonal response were assessed on 15 patients (pts) with GP on low dose CAB; 0.25-0.5 mg weekly to determine the effectiveness of DA therapy. Methods: 15 GP pts from two tertiary care centers, meeting the diagnostic criteria mentioned above, were reviewed. Reduction in tumor volume and maximal tumor diameter along with PRL, after initiation of CAB, at or before 6 months and 1 year post diagnosis, was calculated. Results: Presenting symptom: visual disturbance (56%), headache (20%), apoplexy (13%) and incidental finding (6%). Mean age at diagnosis: 61 years. Male to Female: 4: 1. Basal prolactin concentration: >2000 ng/dl (12/15pts), and > 900 ng/ml (2/15). Initial total CAB dose/week: 0.25-0.5 mg (13/15) and 1-2 mg (2/15). Cranial surgery: 4/15. Complications: CSF leak (1/15). Tumor volume assessed at 6 months (11/15) and 1 year (4/15) along with decrease in maximum tumor diameter in the same period of time. PRL assessed at or before 6 months (13/15) and at 1 year (2/15). Improvement in tumor size occurred promptly even with low dose CAB (0.25-0.5mg/week). 100% of patients initiated on low dose CAB responded to therapy. Mean reduction in tumor volume at or before 6 months was 47% in 11/15, and 52% at 1 year (10/15). Mean decrease in maximal tumor dimension was calculated as 0.95 cm at 6 months (12/15) and 1.4 cm at 1 year (9/15). The overall prolactin response rate at or before 6 months was > 90% in 7/15 patients (53%) and >50% in 11/15 patients (73%). Conclusion: Our data confirms excellent tumor response to low dose cabergoline therapy. Dose as low at 0.25 mg twice weekly is proven to be effective, leading to decrease in both tumor volume and PRL levels.
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Affiliation(s)
| | - Sarah Marouf
- Barking, Havering and Redbridge University Hospitals NHS Trust, London, , United Kingdom
| | | | - Alireza Shoakazemi
- Barking, Havering and Redbridge University Hospitals NHS Trust, London, , United Kingdom
| | - Jonathan Pollock
- Barking, Havering and Redbridge University Hospitals NHS Trust, London, , United Kingdom
| | - Sanjiv Chawda
- Barking, Havering and Redbridge University Hospitals NHS Trust, London, , United Kingdom
| | - Nemanja Stojanovic
- Barking, Havering and Redbridge University Hospitals NHS Trust, London, , United Kingdom
| | - Andjela Drincic
- Int Med: Diab Endo & Meta, University of Nebraska Med Ctr, Omaha, NE, United States
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Ghanbari R, Pathmasiri W, McRitchie S, Stewart D, Etemadi A, Abnet C, Pollock J, Malekzadeh R, Sumner S. Metabolomics Analysis of Opiate Abusers from Golestan Cohort Study (GCS). FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.lb235] [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: 11/11/2022]
Affiliation(s)
- Reza Ghanbari
- Nutrition Research InstituteUniversity of North Carolina at Chapel HillKannapolisNC
| | - Wimal Pathmasiri
- Nutrition Research InstituteUniversity of North Carolina at Chapel HillKannapolisNC
| | - Susan McRitchie
- Nutrition Research InstituteUniversity of North Carolina at Chapel HillKannapolisNC
| | - Delisha Stewart
- Nutrition Research InstituteUniversity of North Carolina at Chapel HillKannapolisNC
| | - Arash Etemadi
- Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaMD
| | - Christian Abnet
- Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaMD
| | - Jonathan Pollock
- Genetics, Epigenetics and Developmental Neuroscience BranchNational Institute on Drug AbuseRockvilleMD
| | - Reza Malekzadeh
- Digestive Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Susan Sumner
- Nutrition Research InstituteUniversity of North Carolina at Chapel HillKannapolisNC
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Buzzell N, Blash S, Miner K, Schofield M, Pollock J, Hawkins N, Hevy M, Gavin W. 194 Superovulation response does not affect embryo development of pronuclear microinjected embryos in the goat. Reprod Fertil Dev 2019. [DOI: 10.1071/rdv31n1ab194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Superovulation of donor animals is essential in the production of transgenic founder goats generated through microinjection. There can be a marked variable response to the exogenous hormones used for superovulation. The objective of this study was to examine how the superovulatory response of individual goats affected the ability of the fertilized, microinjected embryos to develop into offspring. The donors were superovulated using a progesterone implant on Day 0, a prostaglandin injection at Day 7, 2 injections ~12h apart of 32 to 36mg of FSH on Day 12 to 15, progesterone implant removal on Day 14, bred by intact bucks several times starting on Day 15 to 16, an injection of 50μg of gonadotropin-releasing hormone, and surgical collection of 1- to 2-cell embryos from retrograde flushing of the oviduct on Day 17 (~24-48 h, 1-2 days after breeding). Surgical collection allows for an accurate ovulation point (OP) count before the oviduct being retrograde flushed and ova collected and counted. Data from donor animals were grouped by superovulatory response based on OP counts of 1-10, 11-20, 21-30, or >30. The number of donors that contributed per group were 130, 280, 175, and 52, respectively. The recovery rate was 76, 72, 68, and 62%, respectively. After collection, ova were viewed under a dissecting microscope and assessed for fertilization by identifying pronuclei, and 1 pronucleus was microinjected. The fertilization rate was 47, 52, 51, and 56%, respectively. The survivability rate after microinjection was 80, 76, 75, and 76%, respectively. Surviving embryos were transferred (3-5) into recipient goats following a 2- to 6-h in vitro culture (as 1- to 2-cell embryos), allowing for a suitable period to assess viability post-injection. Further in vitro development rates were not assessed because of the short timeframe the embryos stayed in culture. The conception rates were 71, 56, 65, and 53%, respectively, and abortion rates were 23, 10, 14, and 9%, respectively. As some recipients received embryos from multiple donors, this data could not be included in the analysis as identifying which offspring were from the corresponding embryo group could not be confirmed. Data were analysed using SAS software (version 9.4, SAS Institute Inc., Cary, NC, USA). The Wald chi square test under linear regression was used to analyse the number of offspring produced per embryo transferred. No significant differences were found between groups (all P-values were>0.05). This analysis indicated that the range of superovulation response does not affect the developmental competence of the pronuclear microinjected embryo or the ability to produce viable offspring.
Table 1.Comparison of the donor ovulation counts, number of embryos transferred, offspring produced and overall efficiency
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Buzzell N, Blash S, Miner K, Schofield M, Pollock J, Hawkins N, Hevy M, Gavin W. 94 Impact of number of embryos transferred on the number of offspring produced in a commercial transgenic founder production operation. Reprod Fertil Dev 2019. [DOI: 10.1071/rdv31n1ab94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The production of transgenic founder dairy goats (cross-bred Saanens, Alpines, Toggenburgs, and Nubians) involves the collection, microinjection, and transfer of numerous embryos into suitable recipient goats to ultimately produce a transgenic founder(s). The objective of this study was to determine the most efficient number of microinjection embryos to transfer to suitable recipients for transgenic founder generation. This is critically important in a commercial production program, as it impacts the goal for the number of embryos collected from donors, number of recipients utilised, and, hence, the overall number of surgical procedures being performed. The entire embryo collection, transfer, and founder-generation process is continuously being evaluated for ways to become more efficient in producing transgenic animals. During LFB USA’s commercial founder-production campaigns over the years (1997-2017), pronuclear microinjection was performed and 3, 4, or 5 embryos were transferred to female goat recipients. The recipients were synchronized using a progesterone implant on Day 0, a prostaglandin injection at Day 7, an injection of 300-500IU of pregnant mare serum gonadotropin on Day 13, progesterone implant removal on Day 14, and surgical transfer of pronuclear microinjected 1- or 2-cell embryos into the oviduct on Day 17. The individual totals and calculation for offspring per embryos transferred was compared for 3, 4, and 5 embryos transferred per recipient and was determined to be (1659/8637) 0.19, (912/4548) 0.20, and (112/675) 0.17, respectively. These embryo efficacy ratios were not significantly different (P>0.05) using the Wald Chi-squared test under logistic regression, and suggests that the number of offspring born is not impacted by number of embryos transferred. Seasonality was also evaluated in this production environment located in North America, with in-season being considered September to December and out-of-season being January to July. Nulliparous recipients during in-season (September to December) embryo transfer operations produced a significant difference, with totals and calculation for (offspring per embryo transferred) of (470/2346) 0.20, (260/1088) 0.24, and (23/190) 0.12 for 3, 4, and 5 embryo transfers, respectively (Table 1). This data indicates that when using nulliparous recipients during the in-season, transferring 4 embryos is optimal for offspring produced.
Table 1.Comparison of the individual totals and the calculation of (offspring/embryo) by parity and season
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di Bonaventura R, Young A, Zakaria R, Champeaux C, Foo A, Tonn JC, McMurran C, Yeo TT, Kirsch M, Afshari F, Florian S, Rossi M, Biczok A, Dedeciusová M, Benes V, Pollock J, Magill S, Allinson K, Hanemann O, McDermott M, Bhatt K, Bello L, Jenkinson M, Kirollos R, Guilfoyle M, Santarius T. MNGI-07. THE ANAPLASTIC MENINGIOMA INTERNATIONAL CONSORTIUM (AMICo) RETROSPECTIVE STUDY OF TREATMENT AND OUTCOME OF PATIENTS WITH ANAPLASTIC MENINGIOMAS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Adam Young
- Cambridge University Hospitals, Cambridge, England, United Kingdom
| | | | | | | | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | | | | | | | | | | | - Annamaria Biczok
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | | | | | - Stephen Magill
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Kieren Allinson
- Department of Pathology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England, United Kingdom
| | | | | | - Kush Bhatt
- U Plymouth, Plymouth, England, United Kingdom
| | - Lorenzo Bello
- Department of Neurosurgery, University of Milan and Clinical Institute Humanitas, Rozzano, Italy
| | | | - Ramez Kirollos
- Cambridge University Hospitals, Cambridge, England, United Kingdom
| | - Mathew Guilfoyle
- Cambridge University Hospitals, Cambridge, England, United Kingdom
| | - Thomas Santarius
- Cambridge University Hospitals, Cambridge, England, United Kingdom
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Howard L, Berdusco R, Momoli F, Pollock J, Liew A, Papp S, Lalonde KA, Gofton W, Ruggiero S, Lapner P. Open reduction internal fixation vs non-operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol. BMC Musculoskelet Disord 2018; 19:299. [PMID: 30121091 PMCID: PMC6098830 DOI: 10.1186/s12891-018-2223-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Proximal humerus fractures are the third most common fracture in the elderly population and are expected to increase due to the aging population. Surgical fixation with locking plate technology has increased over the last decade despite a lack of proven superiority in the literature. Three previous randomized controlled trials have not shown a difference in patient-centered outcomes when comparing non-operative treatment with open reduction and internal fixation. Low patient enrollment and other methodological concerns however limit the generalizability of these conclusions and as a result, management of these fractures remains a controversy. By comparing the functional outcomes of locked plate surgical fixation versus non-operative treatment of displaced three and four-part proximal humerus fractures in the elderly population with a large scale, prospective, multi-centered randomized controlled trial, the optimal management strategy for this common injury may be determined. METHODS We will conduct a prospective, single blind randomized controlled parallel arm trial to compare non-operative management of proximal humerus fractures with open reduction and internal fixation using locked plating technology. One-hundred and sixty patients > age 60 with acute 3- or 4- part proximal humerus fractures will be randomized to either open reduction and internal fixation with locked plating technology or non-operative management treatment arms. The primary outcome measure is the Constant Score at 24 months post-operative. Secondary outcome measures include the American Shoulder and Elbow Surgeon's Score (ASES), EuroQol EQ-5D-5 L Health Questionnaire Score, short form PROMIS upper extremity score and IPAQ for the elderly score. Further outcome measures include assessment of the initial classification, displacement and angulation and the quality of surgical reduction via a standard computed tomography (CT) scan; rates of non-union, malunion, arthrosis, osteopenia or other complications including infection, nerve injury, intra-articular screw penetration, reoperation rates and hospital re-admission rates. DISCUSSION The results of this trial will provide Level 1 evidence to guide decision-making in the treatment of proximal humerus fractures in the elderly population. TRIAL REGISTRATION ClinicalTrials.gov NCT02362100 . Registered 5 Feb 2015.
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Affiliation(s)
- Lisa Howard
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Randa Berdusco
- Orthopaedic Sports Medicine & Upper Extremity Reconstruction, Fellowship, University of Manitoba, Winnipeg, MB Canada
| | - Franco Momoli
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - J. Pollock
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Allan Liew
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Steve Papp
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Karl-Andre Lalonde
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Wade Gofton
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Sara Ruggiero
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Lapner
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Romani R, Ryan G, Benner C, Pollock J. Non-operative meningiomas: long-term follow-up of 136 patients. Acta Neurochir (Wien) 2018; 160:1547-1553. [PMID: 29876678 DOI: 10.1007/s00701-018-3554-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Received: 11/06/2017] [Accepted: 04/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Improving access to neuroradiology investigations has led to an increased rate of diagnosis of incidental meningiomas. METHOD A cohort of 136 incidental meningioma patients collected by a single neurosurgeon in a single neurosurgical centre is retrospectively analysed between 2002 and 2016. Demographic data, imaging and clinical features are presented. The radiological factors associated with meningiomas progression are also presented. RESULTS The mean age at diagnosis was 65 (range, 33-94) years. Univariate analysis showed oedema was most strongly correlated with progression (p = 0.010) followed by hyperintensity in T2-weighted (T2W) MRI (p = 0.029) and in Flair-T2W MRI (p = 0.017). Isointensity in Flair-T2W MRI (0.004) was most strongly correlated with non-progression of the meningioma followed by calcification (p = 0.007), older age (p = 0.087), hypointensity in Flair-T2W MRI (p = 0.014) sequences and in T2W MRI (p = 0.096). In multivariate analysis, the strongest radiological factor predictive of progression was peritumoural oedema (p = 0.016) and that of non-progression was calcification (p = 0.002). At the end of the median follow-up (FU) of 43 (range, 4-150) months, 109 (80%) patients remained clinically stable, 13 (10%) became symptomatic and 14 (10%) showed clinical and radiological progression. CONCLUSIONS One hundred and nine (80%) patients remained stable at the end of FU. Peritumoural oedema was predictive of meningiomas progression. Further prospective study is needed to identify the combination of factors which can predict the meningioma progression for an early surgery or early discharge.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Charing Cross Hospital, Imperial College NHS Trust, Fulham Palace Rd, London, W6 8RF, UK.
| | - George Ryan
- Department of Neurosurgery, Essex Neuroscience Centre, Queen's Hospital, Romford, RM7 0AG, UK
| | - Christian Benner
- Department of Mathematics and Statistics, University of Helsinki, 2b, P.O. Box 68, FI-00014, Helsinki, Finland
| | - Jonathan Pollock
- Department of Neurosurgery, Essex Neuroscience Centre, Queen's Hospital, Romford, RM7 0AG, UK
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Borkin D, Klossowski S, Pollock J, Miao H, Linhares BM, Kempinska K, Jin Z, Purohit T, Wen B, He M, Sun D, Cierpicki T, Grembecka J. Complexity of Blocking Bivalent Protein-Protein Interactions: Development of a Highly Potent Inhibitor of the Menin-Mixed-Lineage Leukemia Interaction. J Med Chem 2018; 61:4832-4850. [PMID: 29738674 PMCID: PMC7029623 DOI: 10.1021/acs.jmedchem.8b00071] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The protein-protein interaction between menin and mixed-lineage leukemia 1 (MLL1) plays an important role in development of acute leukemia with translocations of the MLL1 gene and in solid tumors. Here, we report the development of a new generation of menin-MLL1 inhibitors identified by structure-based optimization of the thienopyrimidine class of compounds. This work resulted in compound 28 (MI-1481), which showed very potent inhibition of the menin-MLL1 interaction (IC50 = 3.6 nM), representing the most potent reversible menin-MLL1 inhibitor reported to date. The crystal structure of the menin-28 complex revealed a hydrogen bond with Glu366 and hydrophobic interactions, which contributed to strong inhibitory activity of 28. Compound 28 also demonstrates pronounced activity in MLL leukemia cells and in vivo in MLL leukemia models. Thus, 28 is a valuable menin-MLL1 inhibitor that can be used for potential therapeutic applications and in further studies regarding the role of menin in cancer.
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Affiliation(s)
- Dmitry Borkin
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Szymon Klossowski
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jonathan Pollock
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Hongzhi Miao
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Brian M. Linhares
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | | | - Zhuang Jin
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Trupta Purohit
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Bo Wen
- College of Pharmacy, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Miao He
- College of Pharmacy, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Duxin Sun
- College of Pharmacy, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Tomasz Cierpicki
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jolanta Grembecka
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Corresponding author; Jolanta Grembecka, PhD, Associate Professor, Department of Pathology, University of Michigan, 1150 West Medical Center Dr, MSRB I, Room 4510D, Ann Arbor, MI, 48108, , Tel. 734-615-9319
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Agarwal A, Patel A, Pollock J, Roberto S, Aung T, Markert R. LONG TERM MORTALITY RATES OF U.S. VETERANS WITH BUNDLE BRANCH BLOCKS PRESENTING FOR CORONARY ANGIOGRAPHY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33526-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Patel A, Pollock J, Roberto ES, Aung TT, Markert R, Agarwal A. Abstract 250: Role of First Degree Atrioventricular Block and Long Term Mortality in U.S. Veterans With Atherothrombotic Risk Factors. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/circoutcomes.10.suppl_3.250] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
First-degree atrioventricular (AV) block [PR interval exceeding 200 milliseconds (ms)] on a 12-lead electrocardiogram is a common finding. Previous studies suggested that first-degree AVB has a benign prognosis, but more recent reports suggest that first-degree AVB may be associated with adverse outcomes. We investigated the relationship between PR interval and long term morality in U.S. Veterans with atherothrombotic risk factors.
Methods:
We retrospectively collected and analyzed data from a Veterans Affairs (VA) medical center for consecutive patients (October 2001 to January 2005) who presented for coronary angiography.
Results:
Of 1193 charts, 1082 had a PR interval reading recorded (mean = 172.5±30.5 ms; median = 168 ms [range 59-334]). Mean follow-up period was 103±52 months. Mean age was 63.2±10.8 years with 98% male. Mean body mass index was 30.0±5.9. The prevalence of selected comorbidities was: hypertension (88%), hyperlipidemia (79%), obstructive coronary artery disease (73%), diabetes mellitus (45%), smoker (39%), history of peripheral vascular disease (17%), and history of cerebrovascular accident (8%). Mean left ventricular ejection fraction was 47%±13%. Eighty-two percent were on beta-blockers (BB), and 25% were on calcium channel blockers (CCB) while intraventricular conduction delay was seen in 6%. In a comparison of patients with PR interval ≤200 ms (n=936) vs. >200 ms (n=146), long term mortality was higher with PR interval >200 ms (58.2% vs. 44.4%, p=0.002). Mortality rate was also higher with patients on BB or CCB vs. not on either (49.8% vs 39.7%, p=0.024). While PR interval was a significant univariate predictor of mortality, it was not significant when adjusted for the covariates listed above [not including BB and CCB] (odds ratio = 1.08 [95% Cl = 0.70 to 1.66], p = 0.73).
Conclusion:
In this study of US Veterans with atherothrombotic risk factors, the long term mortality rate was higher with first-degree AV block. PR interval has prognostic value within this specific cohort.
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Affiliation(s)
- Amish Patel
- Wright State Univ/Dayton VA Med Cntr, Dayton, OH
| | | | | | | | | | - Ajay Agarwal
- Wright State Univ/Dayton VA Med Cntr, Dayton, OH
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Patel A, Pollock J, Roberto ES, Aung TT, Markert R, Agarwal A. Abstract 114: Relationship Between Duration of QRS Complex and Long Term Mortality in U.S. Veterans With Atherothrombotic Risk Factors. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/circoutcomes.10.suppl_3.114] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The 12-lead electrocardiogram (ECG) remains a cost-effective diagnostic tool in risk stratification for cardiovascular disease. Little is known of the prognostic value of QRS duration but recent reports suggest that a prolonged QRS duration may be associated with adverse outcomes. We investigated the relationship between QRS duration and long term mortality in Veterans with atherothrombotic risk factors.
Methods:
We retrospectively collected data from a Veterans Affairs (VA) medical center for consecutive patients (October 2001 to January 2005) to determine the long term mortality rates associated with different intervals of QRS duration in patients who presented for coronary angiography.
Results:
Of the 1193 charts reviewed, 1186 had a QRS duration reading recorded. For these 1186 patients the mean follow-up period was 103±52 months. Mean age was 63.2±10.8 years with 98% male. Mean body mass index was 30.0±5.9. The prevalence of comorbidities was: hypertension (88%), hyperlipidemia (79%), obstructive coronary artery disease (73%), left ventricular hypertrophy (50.4%), diabetes mellitus (45%), peripheral vascular disease (17%), and cerebrovascular accident (8%). Mean left ventricular ejection fraction (LVEF) was 47±13%, and mean PR interval was 172.5±30.5 milliseconds (ms). Most patients were on beta-blocker (82%). Among patients with bundle branch blocks (BBB), left BBB was present in 4.6% and right BBB was present in 6.9%. Mean QRS duration was 102.2±23.6 ms. As the QRS duration increased by intervals of 10-milliseconds, the mortality rate (%) increased [QRS ≤100 (40.7%), 101 to 110 (51.3%), 111 to 120 (66.3%), >120 (71.2%), p<0.001]. Among patients with QRS duration >120, mortality was higher in those >150 vs. 121 to 150 (79.7% vs 65.7, p=0.045). While QRS duration was a significant univariate predictor of morality, QRS duration is not significant when adjusted for 10 covariates listed above (odds ratio = 1.00 [95% Cl = 0.98 to 1.01], p = 0.72).
Conclusion:
Long term mortality was higher as QRS duration increased. QRS duration had utility in predicting mortality within this cohort of US Veterans with atherothrombotic risk factors.
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Affiliation(s)
- Amish Patel
- Wright State Univ/Dayton VA Med Cntr, Dayton, OH
| | | | | | | | | | - Ajay Agarwal
- Wright State Univ/Dayton VA Med Cntr, Dayton, OH
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Roberto S, Pollock J, Patel A, Aung T, Markert R, Agarwal A. LONG TERM MORTALITY RATES OF PREMATURE CORONARY ARTERY DISEASE IN YOUNG U.S. VETERAN POPULATION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35936-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kachnic L, Moughan J, Suntharalingam M, Ilson D, Konski A, Burrows W, Anker C, Ad VB, Thakrar H, Hayes J, Gore E, Kavadi V, Komaki R, Raben A, Giguere J, Pollock J, Greenberger J, Videtic G, Roof K, Watkins Bruner D. Patient-Reported Outcomes (PROs) in NRG Oncology/RTOG 0436: A Phase 3 Trial Evaluating the Addition of Cetuximab to Paclitaxel, Cisplatin, and Radiation for Esophageal Cancer Treated Without Surgery. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bonfield M, Cramp F, Pollock J. Deep vein thrombosis resolution, recurrence and post-thrombotic syndrome: a prospective observational study protocol. BMC Hematol 2016; 16:24. [PMID: 27651905 PMCID: PMC5025593 DOI: 10.1186/s12878-016-0063-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 09/05/2016] [Indexed: 11/12/2022]
Abstract
Background Reasons for the variation in response of deep vein thrombosis (DVT) to anticoagulation treatment are not known. Some patients develop complications such as post-thrombotic syndrome or recurrent DVT but others make a full recovery. The aim of the study is to identify the level of variation in response to anticoagulation treatment and provide more precise and quantitative disease characterisation in response to treatment. Methods A prospective observational study using duplex ultrasound to examine changes in thrombus characterisation, evolution and resolution over a 2 year period in patients with a confirmed DVT. Logistic regression analysis will be used to seek associations between characteristics present at baseline and the outcomes of DVT resolution, recurrence and the development of post-thrombotic syndrome (PTS). Discussion This research into the response to treatment of lower limb DVT and predictive factors for DVT resolution, recurrence and PTS could inform a more tailored approach to anticoagulation therapy for the future management of DVT. UKCRN ID: 16016. Registered on 20 January 2014.
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Affiliation(s)
- M Bonfield
- Vascular Studies Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK ; University of the West of England, Bristol, UK
| | - F Cramp
- University of the West of England, Bristol, UK
| | - J Pollock
- University of the West of England, Bristol, UK
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Pollock J, Bedenice D, Jennings SH, Papich MG. Pharmacokinetics of an extended-release formulation of eprinomectin in healthy adult alpacas and its use in alpacas confirmed with mange. J Vet Pharmacol Ther 2016; 40:192-199. [DOI: 10.1111/jvp.12341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/27/2016] [Indexed: 11/26/2022]
Affiliation(s)
- J. Pollock
- Cummings School of Veterinary Medicine at Tufts Universtity; North Grafton MA USA
| | - D. Bedenice
- Cummings School of Veterinary Medicine at Tufts Universtity; North Grafton MA USA
| | - S. H. Jennings
- Cummings School of Veterinary Medicine at Tufts Universtity; North Grafton MA USA
| | - M. G. Papich
- Department of Molecular Biomedical Sciences; College of Veterinary Medicine; North Carolina State University; St Raleigh NC USA
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Abstract
Background: “Watch, wait, and rescan” (WWR) has an established place as a successful management option for a significant proportion of vestibular schwannomas (VS) as an alternative to microsurgical removal or stereotactic radiotherapy. VS may grow slowly and continuously, followed by stagnation or even shrinkage. We present two case reports of spontaneous shrinkage of VS along with a review of the literature. Case Description: A 29-year-old female presented with a progressive history of visual blurring and intermittent diplopia over 2 months. A 29 mm of maximum intracranial diameter (ICD) VS with secondary obstructive hydrocephalus was diagnosed. The patient underwent a ventriculo-peritoneal shunt with resolution of her symptoms and opted for initial WWR management. Interval scanning between 2007 and 2014 showed progressive reduction in the maximum ICD together with reduction in the degree of central tumor enhancement. Maximum ICD at most recent follow up was 22 mm. A 28-year-old female was referred with right sensorineural deafness. A right VS of maximum ICD of 27 mm was diagnosed. Initial WWR management was planned after discussion. Serial imaging showed an initial increase in the size of the tumor followed by progressive reduction in size. The most recent follow up showed a maximum ICD of 20 mm. Conclusion: Early WWR management can be associated with spontaneous shrinkage of VS over time. Prospective clinical study of larger numbers of such cases using the UK VS database may help to identify predictive factors for the spontaneous regression of VS.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Queen's Hospital, Essex Neuroscience Centre, Romford, London, UK
| | - Jonathan Pollock
- Department of Neurosurgery, Queen's Hospital, Essex Neuroscience Centre, Romford, London, UK
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Halls S, Dures E, Kirwan J, Pollock J, Baker G, Edmunds A, Hewlett S. AB1128-HPR Developing A New Rheumatoid Arthritis (RA) Stiffness Patient Reported Outcome Measure (PROM). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Halls S, Dures E, Kirwan J, Pollock J, Baker G, Edmunds A, Hewlett S. AB1127-HPR Construct Validity Testing of Rast, A New RA Stiffness Patient Reported Outcome Measure (PROM). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Plummer Z, Almeida C, Ambler N, Blair P, Choy E, Dures E, Hammond A, Hollingworth W, Kirwan J, Pollock J, Rooke C, Thorn J, Tomkinson K, Hewlett S. AB1130-HPR Cognitive Therapy for Reducing The Impact of Rheumatoid Arthritis Fatigue: Sucessful Strategies for Meeting Targets in A Complex Health Care Intervention. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Borkin D, Pollock J, Kempinska K, Purohit T, Li X, Wen B, Zhao T, Miao H, Shukla S, He M, Sun D, Cierpicki T, Grembecka J. Property Focused Structure-Based Optimization of Small Molecule Inhibitors of the Protein-Protein Interaction between Menin and Mixed Lineage Leukemia (MLL). J Med Chem 2016; 59:892-913. [PMID: 26744767 PMCID: PMC5092235 DOI: 10.1021/acs.jmedchem.5b01305] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Development of potent small molecule inhibitors of protein-protein interactions with optimized druglike properties represents a challenging task in lead optimization process. Here, we report synthesis and structure-based optimization of new thienopyrimidine class of compounds, which block the protein-protein interaction between menin and MLL fusion proteins that plays an important role in acute leukemias with MLL translocations. We performed simultaneous optimization of both activity and druglike properties through systematic exploration of substituents introduced to the indole ring of lead compound 1 (MI-136) to identify compounds suitable for in vivo studies in mice. This work resulted in the identification of compound 27 (MI-538), which showed significantly increased activity, selectivity, polarity, and pharmacokinetic profile over 1 and demonstrated a pronounced effect in a mouse model of MLL leukemia. This study, which reports detailed structure-activity and structure-property relationships for the menin-MLL inhibitors, demonstrates challenges in optimizing inhibitors of protein-protein interactions for potential therapeutic applications.
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MESH Headings
- Animals
- Caco-2 Cells
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Female
- Histone-Lysine N-Methyltransferase/chemistry
- Histone-Lysine N-Methyltransferase/metabolism
- Humans
- Injections, Intraventricular
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/metabolism
- Mice
- Mice, Inbred C57BL
- Mice, SCID
- Models, Molecular
- Molecular Structure
- Myeloid-Lymphoid Leukemia Protein/chemistry
- Myeloid-Lymphoid Leukemia Protein/metabolism
- Protein Binding/drug effects
- Proto-Oncogene Proteins/chemistry
- Proto-Oncogene Proteins/metabolism
- Pyrimidines/administration & dosage
- Pyrimidines/chemistry
- Pyrimidines/pharmacology
- Small Molecule Libraries/administration & dosage
- Small Molecule Libraries/chemistry
- Small Molecule Libraries/pharmacology
- Structure-Activity Relationship
- Thiophenes/administration & dosage
- Thiophenes/chemistry
- Thiophenes/pharmacology
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Affiliation(s)
- Dmitry Borkin
- Department of Pathology, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Jonathan Pollock
- Department of Pathology, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Katarzyna Kempinska
- Department of Pathology, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Trupta Purohit
- Department of Pathology, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Xiaoqin Li
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Bo Wen
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Ting Zhao
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Hongzhi Miao
- Department of Pathology, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Shirish Shukla
- Department of Pathology, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Miao He
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Duxin Sun
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Tomasz Cierpicki
- Department of Pathology, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Jolanta Grembecka
- Department of Pathology, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109, United States
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Margari N, Pollock J, Stojanovic N. A novel surgical approach for the management of giant invasive prolactinoma compressing the brainstem. Endocrinol Diabetes Metab Case Rep 2016; 2016:150103. [PMID: 26734468 PMCID: PMC4700283 DOI: 10.1530/edm-15-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/02/2015] [Indexed: 11/08/2022] Open
Abstract
Prolactinomas constitute the largest subsection of all secretory pituitary adenomas. Most are microprolactinomas and are satisfactorily treated by medical management alone. Giant prolactinomas, measuring more than 4 cm in diameter, are rare and usually occur more commonly in men. Macroprolatinomas tend to present with symptoms of mass effect rather than those of hyperprolactinaemia. Dopamine agonists (DA) are the treatment of choice for all prolactinomas. Surgery is usually reserved for DA resistance or if vision is threatened by the mass effects of the tumour. We describe the case of a 52 year-old woman with a giant invasive prolactinoma who required multiple surgical procedures as well as medical management with DA. One of the surgical interventions required a posterior approach via the trans cranial sub occipital transtentorial approach, a surgical technique that has not been previously described in the medical literature for this indication. The giant prolactinoma was reduced significantly with the above approach and patient symptoms from the compressing effects of the tumour were resolved. This case highlights the importance of a multidisciplinary approach to the management of such patients who present with florid neurological sequelae secondary to pressure effects. Although this presentation is uncommon, surgery via a sub occipital transtentorial approach may be considered the treatment of choice in suitable patients with giant invasive prolactinomas compressing the brainstem.
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Affiliation(s)
- Niki Margari
- Department of Endocrinology and Diabetes, Royal London Hospital, Barts Health NHS Trust , London , UK
| | - Jonathan Pollock
- Department of Neurosurgery, Queens Hospital, Barking Havering and Redbridge University Hospitals NHS Trust , Romford, Essex , UK
| | - Nemanja Stojanovic
- Department of Endocrinology and Diabetes, Queens Hospital, Barking Havering and Redbridge University Hospitals NHS Trust , Romford, Essex , UK
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Krommyda M, Pollock J, Misbahuddin A. Secondary normal pressure hydrocephalus post gamma knife radiosurgery for treatment of vestibular schwannoma. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pollock J, Borkin D, Lund G, Purohit T, Dyguda-Kazimierowicz E, Grembecka J, Cierpicki T. Rational Design of Orthogonal Multipolar Interactions with Fluorine in Protein-Ligand Complexes. J Med Chem 2015; 58:7465-74. [PMID: 26288158 PMCID: PMC4584387 DOI: 10.1021/acs.jmedchem.5b00975] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
![]()
Multipolar interactions involving
fluorine and the protein backbone
have been frequently observed in protein–ligand complexes.
Such fluorine–backbone interactions may substantially contribute
to the high affinity of small molecule inhibitors. Here we found that
introduction of trifluoromethyl groups into two different sites in
the thienopyrimidine class of menin–MLL inhibitors considerably
improved their inhibitory activity. In both cases, trifluoromethyl
groups are engaged in short interactions with the backbone of menin.
In order to understand the effect of fluorine, we synthesized a series
of analogues by systematically changing the number of fluorine atoms,
and we determined high-resolution crystal structures of the complexes
with menin. We found that introduction of fluorine at favorable geometry
for interactions with backbone carbonyls may improve the activity
of menin–MLL inhibitors as much as 5- to 10-fold. In order
to facilitate the design of multipolar fluorine–backbone interactions
in protein–ligand complexes, we developed a computational algorithm
named FMAP, which calculates fluorophilic sites in proximity to the
protein backbone. We demonstrated that FMAP could be used to rationalize
improvement in the activity of known protein inhibitors upon introduction
of fluorine. Furthermore, FMAP may also represent a valuable tool
for designing new fluorine substitutions and support ligand optimization
in drug discovery projects. Analysis of the menin–MLL inhibitor
complexes revealed that the backbone in secondary structures is particularly
accessible to the interactions with fluorine. Considering that secondary
structure elements are frequently exposed at protein interfaces, we
postulate that multipolar fluorine–backbone interactions may
represent a particularly attractive approach to improve inhibitors
of protein–protein interactions.
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Affiliation(s)
- Jonathan Pollock
- Department of Pathology, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Dmitry Borkin
- Department of Pathology, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - George Lund
- Department of Pathology, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Trupta Purohit
- Department of Pathology, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Edyta Dyguda-Kazimierowicz
- Molecular Modeling and Quantum Chemistry Group, Department of Chemistry, Wrocław University of Technology , Wyb. Wyspiańskiego 27, 50-370 Wrocław, Poland
| | - Jolanta Grembecka
- Department of Pathology, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Tomasz Cierpicki
- Department of Pathology, University of Michigan , Ann Arbor, Michigan 48109, United States
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Hewlett S, Ambler N, Almeida C, Blair PS, Choy E, Dures E, Hammond A, Hollingworth W, Kirwan J, Plummer Z, Rooke C, Thorn J, Tomkinson K, Pollock J. Protocol for a randomised controlled trial for Reducing Arthritis Fatigue by clinical Teams (RAFT) using cognitive-behavioural approaches. BMJ Open 2015; 5:e009061. [PMID: 26251413 PMCID: PMC4538284 DOI: 10.1136/bmjopen-2015-009061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) fatigue is distressing, leading to unmanageable physical and cognitive exhaustion impacting on health, leisure and work. Group cognitive-behavioural (CB) therapy delivered by a clinical psychologist demonstrated large improvements in fatigue impact. However, few rheumatology teams include a clinical psychologist, therefore, this study aims to examine whether conventional rheumatology teams can reproduce similar results, potentially widening intervention availability. METHODS AND ANALYSIS This is a multicentre, randomised, controlled trial of a group CB intervention for RA fatigue self-management, delivered by local rheumatology clinical teams. 7 centres will each recruit 4 consecutive cohorts of 10-16 patients with RA (fatigue severity ≥ 6/10). After consenting, patients will have baseline assessments, then usual care (fatigue self-management booklet, discussed for 5-6 min), then be randomised into control (no action) or intervention arms. The intervention, Reducing Arthritis Fatigue by clinical Teams (RAFT) will be cofacilitated by two local rheumatology clinicians (eg, nurse/occupational therapist), who will have had brief training in CB approaches, a RAFT manual and materials, and delivered an observed practice course. Groups of 5-8 patients will attend 6 × 2 h sessions (weeks 1-6) and a 1 hr consolidation session (week 14) addressing different self-management topics and behaviours. The primary outcome is fatigue impact (26 weeks); secondary outcomes are fatigue severity, coping and multidimensional impact, quality of life, clinical and mood status (to week 104). Statistical and health economic analyses will follow a predetermined plan to establish whether the intervention is clinically and cost-effective. Effects of teaching CB skills to clinicians will be evaluated qualitatively. ETHICS AND DISSEMINATION Approval was given by an NHS Research Ethics Committee, and participants will provide written informed consent. The copyrighted RAFT package will be freely available. Findings will be submitted to the National Institute for Health and Care Excellence, Clinical Commissioning Groups and all UK rheumatology departments. ISRCTN 52709998; Protocol v3 09.02.2015.
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Affiliation(s)
- S Hewlett
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - N Ambler
- Pain Management Centre, Southmead Hospital, Bristol, UK
| | - C Almeida
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - P S Blair
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - E Choy
- Section of Rheumatology, Institute of Infection and Immunity, Cardiff University, Cardiff, UK
| | - E Dures
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - A Hammond
- Centre for Health Sciences Research, School of Health Sciences, University of Salford, Salford, UK
| | - W Hollingworth
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Kirwan
- Academic Rheumatology, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Z Plummer
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - C Rooke
- Patient research partner, Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - J Thorn
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - K Tomkinson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Pollock
- Department of Health and Social Sciences, University of the West of England Bristol, Bristol, UK
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