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Christie M, Love C, Hanna I, Thomas G, Greenspon A, Chen S, Sanders M, Bauer C, Christopherson M, Balaji V, Skulsky S, Sohail M. Pre-clinical evaluation of a third generation absorbable antibacterial envelope. Europace 2022. [DOI: 10.1093/europace/euac053.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic
Background
An absorbable antibacterial envelope (TYRX), which stabilizes cardiac implantable electronic devices (CIEDs) was shown to significantly reduce infections in a large randomized controlled trial (WRAP-IT). A 3rd generation envelope (T3) is being developed to improve the implanter experience and enable smoother device insertion with a redesigned, multifilament mesh, an enhanced form factor, and identical polymer coating and antibiotic concentrations as the currently available 2nd generation envelope (T2).
Purpose
To compare drug elution profiles of T3 vs T2 and evaluate the efficacy of T3 against bacteria commonly known to be associated with CIED infections.
Methods
The T3 drug elution profile was assessed in vitro by evaluating the amount of each drug, minocycline and rifampin, released at a given timepoint using an accelerated dissolution method. For comparative analysis with T2, elution curve equivalency was based on similarity factor values (f2) of ≥50 per FDA guidance. An in vivo elution study was also conducted (per the Principles of Laboratory Animal Care [NIH Publication no. 85-23 revised 1985]) to ensure drug concentrations met the minimal inhibitory concentration (MIC) through 7 days. Substantial equivalence was defined as rifampin and minocycline concentrations above MIC at 2hr post-implant and sustained through 7 days. In a further animal model, 12 pockets were created in 6 rabbits, for CIED insertion with and without T3 envelopes, to evaluate efficacy against gram+ and gram- bacteria. At day 7, implant sites were evaluated for signs of infection via macroscopic observations and microbial recovery procedures. A Fisher’s Exact Test was used for comparisons.
Results
The T3 envelope showed a similar elution profile to T2 in vitro (Figure) with f2 >50 (range 76-84). In the in vivo assessment, the T3 envelope eluted both antibiotics above the MIC at 2hr post-implant with sustained elution through 7 days, consistent with historical T2 performance. Further bacterial challenge studies in vivo showed a statistically significant reduction (p<0.05) in infections with 0/6 infected pockets in the CIED + T3 group vs 6/6 infected pockets in the CIED only group consistent with T2 performance (Table).
Conclusion
The 3rd generation absorbable antibacterial envelope demonstrated equivalent pre-clinical performance compared to the 2nd generation envelope as antibiotic elution curves were equivalent, elution was sustained at concentrations above MIC for 7 days, and infection rates were significantly reduced compared to no envelope. These results suggest equivalent clinical performance could be expected with the newly designed envelope.
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Affiliation(s)
- M Christie
- 1Medtronic Inc., Melissa Christie, United States of America
| | - C Love
- The Johns Hopkins Hospital, Baltimore, United States of America
| | - I Hanna
- Brookwood Baptist Health Centers, Birmingham, United States of America
| | - G Thomas
- Weill Cornell Medical College, Pelham, United States of America
| | - A Greenspon
- Thomas Jefferson University Hospital, Elkins Park, United States of America
| | - S Chen
- 1Medtronic Inc., Melissa Christie, United States of America
| | - M Sanders
- 1Medtronic Inc., Melissa Christie, United States of America
| | - C Bauer
- 1Medtronic Inc., Melissa Christie, United States of America
| | | | - V Balaji
- 1Medtronic Inc., Melissa Christie, United States of America
| | - S Skulsky
- 1Medtronic Inc., Melissa Christie, United States of America
| | - M Sohail
- Baylor College of Medicine, Houston, United States of America
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Christie M, Coyne E, Mitchell M. The educational experiences and needs of patients with an internal cardiac defibrillator: An interpretive phenomenological study. Collegian 2021. [DOI: 10.1016/j.colegn.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Sanderson L, da Silva M, Sekhar GN, Brown RC, Burrell-Saward H, Fidanboylu M, Liu B, Dailey LA, Dreiss CA, Lorenz C, Christie M, Persaud SJ, Yardley V, Croft SL, Valero M, Thomas SA. Drug reformulation for a neglected disease. The NANOHAT project to develop a safer more effective sleeping sickness drug. PLoS Negl Trop Dis 2021; 15:e0009276. [PMID: 33857146 PMCID: PMC8078842 DOI: 10.1371/journal.pntd.0009276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/27/2021] [Accepted: 02/26/2021] [Indexed: 01/16/2023] Open
Abstract
Background Human African trypanosomiasis (HAT or sleeping sickness) is caused by the
parasite Trypanosoma brucei sspp. The disease has two
stages, a haemolymphatic stage after the bite of an infected tsetse fly,
followed by a central nervous system stage where the parasite penetrates the
brain, causing death if untreated. Treatment is stage-specific, due to the
blood-brain barrier, with less toxic drugs such as pentamidine used to treat
stage 1. The objective of our research programme was to develop an
intravenous formulation of pentamidine which increases CNS exposure by some
10–100 fold, leading to efficacy against a model of stage 2 HAT. This target
candidate profile is in line with drugs for neglected diseases inititative
recommendations. Methodology To do this, we evaluated the physicochemical and structural characteristics
of formulations of pentamidine with Pluronic micelles (triblock-copolymers
of polyethylene-oxide and polypropylene oxide), selected candidates for
efficacy and toxicity evaluation in vitro, quantified
pentamidine CNS delivery of a sub-set of formulations in vitro and
in vivo, and progressed one pentamidine-Pluronic formulation
for further evaluation using an in vivo single dose brain
penetration study. Principal Findings Screening pentamidine against 40 CNS targets did not reveal any major
neurotoxicity concerns, however, pentamidine had a high affinity for the
imidazoline2 receptor. The reduction in insulin secretion in
MIN6 β-cells by pentamidine may be secondary to pentamidine-mediated
activation of β-cell imidazoline receptors and impairment of cell viability.
Pluronic F68 (0.01%w/v)-pentamidine formulation had a similar inhibitory
effect on insulin secretion as pentamidine alone and an additive
trypanocidal effect in vitro. However, all Pluronics tested
(P85, P105 and F68) did not significantly enhance brain exposure of
pentamidine. Significance These results are relevant to further developing block-copolymers as
nanocarriers, improving BBB drug penetration and understanding the side
effects of pentamidine. Sleeping sickness or human African Trypanosomiasis (HAT) is a disease caused by a
parasite, which is transferred to humans by the bite of an infected tsetse fly.
There are two disease stages: the first stage is the blood-based stage of the
disease and the second stage affects the brain. It is fatal if left untreated.
The blood-brain barrier (BBB) makes the brain stage difficult to treat because
it prevents 99% of all drugs from entering the brain from the blood. Those
anti-HAT drugs that do enter the brain are toxic and have serious side effects.
Pentamidine is a less toxic blood stage drug, which our research has shown has a
limited ability to cross the BBB due to its removal by proteins called
transporters. The objective of this study was to use Pluronic to improve
pentamidine delivery to target sites, whilst reducing its side effects. Pluronic
is a polymer, which can assemble into micelles and encapsulate the drug. Thus,
prolonging its circulation time and protecting it. Our study indicated that the
selected Pluronics did not increase the brain delivery of pentamidine. However.
Pluronic-pentamidine formulations were identified that harboured trypanocidal
activity and did not increase safety concerns compared to unformulated
pentamidine.
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Affiliation(s)
- Lisa Sanderson
- King’s College London, Institute of Pharmaceutical Science,
Franklin-Wilkins Building, Stamford Street, London, United
Kingdom
| | - Marcelo da Silva
- King’s College London, Institute of Pharmaceutical Science,
Franklin-Wilkins Building, Stamford Street, London, United
Kingdom
| | - Gayathri N. Sekhar
- King’s College London, Institute of Pharmaceutical Science,
Franklin-Wilkins Building, Stamford Street, London, United
Kingdom
| | - Rachel C. Brown
- King’s College London, Institute of Pharmaceutical Science,
Franklin-Wilkins Building, Stamford Street, London, United
Kingdom
| | - Hollie Burrell-Saward
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and
Tropical Medicine, London, United Kingdom
| | - Mehmet Fidanboylu
- King’s College London, Institute of Pharmaceutical Science,
Franklin-Wilkins Building, Stamford Street, London, United
Kingdom
| | - Bo Liu
- King’s College London, Department of Diabetes, School of Life Course
Sciences, Faculty of Life Sciences & Medicine, London, United
Kingdom
| | - Lea Ann Dailey
- King’s College London, Institute of Pharmaceutical Science,
Franklin-Wilkins Building, Stamford Street, London, United
Kingdom
| | - Cécile A. Dreiss
- King’s College London, Institute of Pharmaceutical Science,
Franklin-Wilkins Building, Stamford Street, London, United
Kingdom
| | - Chris Lorenz
- King’s College London, Theory & Simulation of Condensed Matter Group,
Department of Physics, Strand, London, United Kingdom
| | - Mark Christie
- King’s College London, Institute of Pharmaceutical Science,
Franklin-Wilkins Building, Stamford Street, London, United
Kingdom
| | - Shanta J. Persaud
- King’s College London, Department of Diabetes, School of Life Course
Sciences, Faculty of Life Sciences & Medicine, London, United
Kingdom
| | - Vanessa Yardley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and
Tropical Medicine, London, United Kingdom
| | - Simon L. Croft
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and
Tropical Medicine, London, United Kingdom
| | - Margarita Valero
- Physical Chemistry Department, Faculty of Pharmacy, University of
Salamanca, Salamanca, Spain
| | - Sarah A. Thomas
- King’s College London, Institute of Pharmaceutical Science,
Franklin-Wilkins Building, Stamford Street, London, United
Kingdom
- * E-mail:
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Trayner KMA, Hopps L, Nguyen M, Christie M, Bagg J, Roy K. Cross-sectional survey of a sample of UK primary care dental professionals' experiences of sharps injuries and perception of access to occupational health support. Br Dent J 2018; 225:sj.bdj.2018.1031. [PMID: 30499564 DOI: 10.1038/sj.bdj.2018.1031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 12/27/2022]
Affiliation(s)
- K M A Trayner
- NHS National Services Scotland, Health Protection Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom
| | - L Hopps
- University of Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - M Nguyen
- University of Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - M Christie
- NHS National Services Scotland, Health Protection Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom
| | - J Bagg
- University of Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - K Roy
- NHS National Services Scotland, Health Protection Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom
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Thompson A, Marshall M, Christie M, Kirchhof N, Paulin J, Mazzetti H, Martinez G, Guirguis M, Zamarripa N. P4862Chronic tissue encapsulation profile and extraction of extravascular versus transvenous leads. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4862] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Thompson
- Medtronic, Mounds View, United States of America
| | - M Marshall
- Medtronic, Mounds View, United States of America
| | - M Christie
- Medtronic, Mounds View, United States of America
| | - N Kirchhof
- Medtronic, Mounds View, United States of America
| | - J Paulin
- Medtronic, Mounds View, United States of America
| | | | - G Martinez
- Medtronic, Mounds View, United States of America
| | - M Guirguis
- Medtronic, Portsmouth, United States of America
| | - N Zamarripa
- Medtronic, Portsmouth, United States of America
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Mantamadiotis T, Daniel P, Filiz G, Christie M, Waring P, Zhang Y, Pouton C, Flanagan D, Vincan E, Phillips W. PO-202 PI3K activation in neural stem cells drives tumourigenesis which can be ameliorated by targeting the cAMP response element binding (CREB) protein. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.720] [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] Open
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Rohr UP, Herrmann P, Ilm K, Zhang H, Lohmann S, Reiser A, Muranyi A, Smith J, Burock S, Osterland M, Leith K, Singh S, Brunhoeber P, Bowermaster R, Tie J, Christie M, Wong HL, Waring P, Shanmugam K, Gibbs P, Stein U. Prognostic value of MACC1 and proficient mismatch repair status for recurrence risk prediction in stage II colon cancer patients: the BIOGRID studies. Ann Oncol 2017; 28:1869-1875. [DOI: 10.1093/annonc/mdx207] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Aziz D, Etemadmoghadam D, Au-Yeung G, Muranyi A, Gresshoff I, Christie M, Hutchinson R, Ferraro D, Stanislaw S, Henricksen L, Tubbs A, Shanmugam K, Bowtell D, Waring P. 298O The clinical significance of deregulated cyclin E1 in high grade serous ovarian cancer (HGSOC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw585.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aziz D, Etemadmoghadam D, Au-Yeung G, Muranyi A, Gresshoff I, Christie M, Hutchinson R, Ferraro D, Stanislaw S, Henricksen L, Tubbs, Shanmugam K, Bowtell D, Waring P. 298O The clinical significance of deregulated cyclin E1 in high grade serous ovarian cancer (HGSOC). Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00456-7] [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] Open
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Braga MS, Barnes H, Christie M, Watson F. CP-027 Development of a stroke pathway pharmacy team to support reablement and medication optimisation. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.27] [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] Open
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Massey AJ, Stokes S, Browne H, Foloppe N, Fiumana A, Scrace S, Fallowfield M, Bedford S, Webb P, Baker L, Christie M, Drysdale MJ, Wood M. Identification of novel, in vivo active Chk1 inhibitors utilizing structure guided drug design. Oncotarget 2015; 6:35797-812. [PMID: 26437226 PMCID: PMC4742142 DOI: 10.18632/oncotarget.5929] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/14/2015] [Indexed: 12/13/2022] Open
Abstract
Chk1 kinase is a critical component of the DNA damage response checkpoint especially in cancer cells and targeting Chk1 is a potential therapeutic opportunity for potentiating the anti-tumor activity of DNA damaging chemotherapy drugs. Fragment elaboration by structure guided design was utilized to identify and develop a novel series of Chk1 inhibitors culminating in the identification of V158411, a potent ATP-competitive inhibitor of the Chk1 and Chk2 kinases. V158411 abrogated gemcitabine and camptothecin induced cell cycle checkpoints, resulting in the expected modulation of cell cycle proteins and increased cell death in cancer cells. V158411 potentiated the cytotoxicity of gemcitabine, cisplatin, SN38 and camptothecin in a variety of p53 deficient human tumor cell lines in vitro, p53 proficient cells were unaffected. In nude mice, V158411 showed minimal toxicity as a single agent and in combination with irinotecan. In tumor bearing animals, V158411 was detected at high levels in the tumor with a long elimination half-life; no pharmacologically significant in vivo drug-drug interactions with irinotecan were identified through analysis of the pharmacokinetic profiles. V158411 potentiated the anti-tumor activity of irinotecan in a variety of human colon tumor xenograft models without additional systemic toxicity. These results demonstrate the opportunity for combining V158411 with standard of care chemotherapeutic agents to potentiate the therapeutic efficacy of these agents without increasing their toxicity to normal cells. Thus, V158411 would warrant further clinical evaluation.
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Affiliation(s)
| | | | | | | | | | - Simon Scrace
- Vernalis Research, Granta Park, Cambridge, UK
- Horizon Discovery, Cambridge Research Park, Waterbeach, Cambridge, UK
| | | | | | - Paul Webb
- Vernalis Research, Granta Park, Cambridge, UK
| | - Lisa Baker
- Vernalis Research, Granta Park, Cambridge, UK
| | | | - Martin J. Drysdale
- Vernalis Research, Granta Park, Cambridge, UK
- Cancer Research UK Beatson Institute, Garscube Estate, Bearsden, Glasgow, UK
| | - Mike Wood
- Vernalis Research, Granta Park, Cambridge, UK
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Masters N, Christie M, Katouli M, Stratton H. A combination of PhP typing and β-d-glucuronidase gene sequence variation analysis for differentiation of Escherichia coli from humans and animals. Can J Microbiol 2015; 61:409-16. [PMID: 25950195 DOI: 10.1139/cjm-2015-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We investigated the usefulness of the β-d-glucuronidase gene variance in Escherichia coli as a microbial source tracking tool using a novel algorithm for comparison of sequences from a prescreened set of host-specific isolates using a high-resolution PhP typing method. A total of 65 common biochemical phenotypes belonging to 318 E. coli strains isolated from humans and domestic and wild animals were analysed for nucleotide variations at 10 loci along a 518 bp fragment of the 1812 bp β-d-glucuronidase gene. Neighbour-joining analysis of loci variations revealed 86 (76.8%) human isolates and 91.2% of animal isolates were correctly identified. Pairwise hierarchical clustering improved assignment; where 92 (82.1%) human and 204 (99%) animal strains were assigned to their respective cluster. Our data show that initial typing of isolates and selection of common types from different hosts prior to analysis of the β-d-glucuronidase gene sequence improves source identification. We also concluded that numerical profiling of the nucleotide variations can be used as a valuable approach to differentiate human from animal E. coli. This study signifies the usefulness of the β-d-glucuronidase gene as a marker for differentiating human faecal pollution from animal sources.
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Affiliation(s)
- N Masters
- Genecology Research Centre, School of Health and Sports Science, University of the Sunshine Coast, Maroochydore, Queensland, Australia
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13
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Masters N, Christie M, Stratton H, Katouli M. Viability and stability of Escherichia coli and enterococci populations in fecal samples upon freezing. Can J Microbiol 2015; 61:495-501. [PMID: 26053765 DOI: 10.1139/cjm-2015-0020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We studied the survival of Escherichia coli and enterococci populations in fecal samples of 7 host species after storage at -20 and -80 °C for 30 days. Composite fecal samples were collected from cows, chickens, horses, pigs, dogs, birds, and humans, and bacteria were enumerated before and after storage. Twenty-eight colonies of each bacterial species were typed before and after storage and the strains were assigned to different biochemical phenotypes (BPTs). A significant reduction in the number of E. coli was observed in all samples stored at -20 °C but in only 3 of those samples stored at -80 °C. However, the numbers of enterococci were similar in most stored samples (except cow and birds). The number and the distribution of E. coli and enterococci BPTs in fresh samples did not vary significantly from those stored at either temperature. Furthermore, the population structure of E. coli and enterococci did not change significantly after storage at -80 °C, this was always the case for those samples stored at -20 °C. We conclude that for those studies investigating E. coli or enterococci population structure, short-term storage (≤ 30 days) of fecal samples in a glycerol broth at -80 °C is a preferable option.
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Affiliation(s)
- N Masters
- a GeneCology Research Centre, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - M Christie
- b School of Biomolecular and Physical Sciences, Griffith University, Nathan, Queensland, Australia
| | - H Stratton
- b School of Biomolecular and Physical Sciences, Griffith University, Nathan, Queensland, Australia.,c Smart Water Research Centre, Griffith University, Gold Coast, Queensland, Australia
| | - M Katouli
- a GeneCology Research Centre, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.,c Smart Water Research Centre, Griffith University, Gold Coast, Queensland, Australia
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Tie J, Kinde I, Wang Y, Wong HL, Roebert J, Christie M, Tacey M, Wong R, Singh M, Karapetis CS, Desai J, Tran B, Strausberg RL, Diaz LA, Papadopoulos N, Kinzler KW, Vogelstein B, Gibbs P. Circulating tumor DNA as an early marker of therapeutic response in patients with metastatic colorectal cancer. Ann Oncol 2015; 26:1715-22. [PMID: 25851626 DOI: 10.1093/annonc/mdv177] [Citation(s) in RCA: 459] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/20/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Early indicators of treatment response in metastatic colorectal cancer (mCRC) could conceivably be used to optimize treatment. We explored early changes in circulating tumor DNA (ctDNA) levels as a marker of therapeutic efficacy. PATIENTS AND METHODS This prospective study involved 53 mCRC patients receiving standard first-line chemotherapy. Both ctDNA and CEA were assessed in plasma collected before treatment, 3 days after treatment and before cycle 2. Computed tomography (CT) scans were carried out at baseline and 8-10 weeks and were centrally assessed using RECIST v1.1 criteria. Tumors were sequenced using a panel of 15 genes frequently mutated in mCRC to identify candidate mutations for ctDNA analysis. For each patient, one tumor mutation was selected to assess the presence and the level of ctDNA in plasma samples using a digital genomic assay termed Safe-SeqS. RESULTS Candidate mutations for ctDNA analysis were identified in 52 (98.1%) of the tumors. These patient-specific candidate tissue mutations were detectable in the cell-free DNA from the plasma of 48 of these 52 patients (concordance 92.3%). Significant reductions in ctDNA (median 5.7-fold; P < 0.001) levels were observed before cycle 2, which correlated with CT responses at 8-10 weeks (odds ratio = 5.25 with a 10-fold ctDNA reduction; P = 0.016). Major reductions (≥10-fold) versus lesser reductions in ctDNA precycle 2 were associated with a trend for increased progression-free survival (median 14.7 versus 8.1 months; HR = 1.87; P = 0.266). CONCLUSIONS ctDNA is detectable in a high proportion of treatment naïve mCRC patients. Early changes in ctDNA during first-line chemotherapy predict the later radiologic response.
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Affiliation(s)
- J Tie
- Division of Systems Biology and Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne Department of Medical Oncology, Western Hospital, Melbourne Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - I Kinde
- Ludwig Center for Cancer Genetics and Therapeutics, Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, USA
| | - Y Wang
- Ludwig Center for Cancer Genetics and Therapeutics, Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, USA
| | - H L Wong
- Division of Systems Biology and Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia Faculty of Medicine, Nursing and Health Sciences, Monash University, Eastern Health Clinical School, Melbourne
| | | | - M Christie
- Division of Systems Biology and Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - M Tacey
- Melbourne EpiCentre, Department of Medicine, The University of Melbourne, Melbourne
| | - R Wong
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Eastern Health Clinical School, Melbourne
| | - M Singh
- Andrew Love Cancer Centre, Barwon Health, Geelong
| | - C S Karapetis
- Department of Medical Oncology, Flinders University, Adelaide, Australia
| | - J Desai
- Division of Systems Biology and Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - B Tran
- Division of Systems Biology and Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne Department of Medical Oncology, Western Hospital, Melbourne Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | | | - L A Diaz
- Ludwig Center for Cancer Genetics and Therapeutics, Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, USA
| | - N Papadopoulos
- Ludwig Center for Cancer Genetics and Therapeutics, Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, USA
| | - K W Kinzler
- Ludwig Center for Cancer Genetics and Therapeutics, Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, USA
| | - B Vogelstein
- Ludwig Center for Cancer Genetics and Therapeutics, Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, USA
| | - P Gibbs
- Division of Systems Biology and Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne Department of Medical Oncology, Western Hospital, Melbourne Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia Ludwig Institute for Cancer Research, New York, USA Ludwig Institute for Cancer Research, Melbourne, Australia
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Preece P, Mees B, Norris B, Christie M, Wagner T, Dundee P. Surgical management of haemorrhaging renal angiomyolipoma in pregnancy. Int J Surg Case Rep 2015; 7C:89-92. [PMID: 25598402 PMCID: PMC4336430 DOI: 10.1016/j.ijscr.2015.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/03/2015] [Accepted: 01/03/2015] [Indexed: 12/30/2022] Open
Abstract
We report the case of a 25-week pregnant woman that had a ruptured AML. This is the first case of nephrectomy in late second trimester with the foetus left in-utero. We present a literature review of the management of bleeding AML in pregnancy.
Introduction Renal angiomyolipoma (AML) is a benign mesenchymal tumour of the kidney with a tendency of aneurysm formation at risk of rupturing. Due to increased maternal circulation and hormonal influences, rupture risk is greater in pregnancy, often leading to a vascular emergency and premature delivery or termination. Presentation of case A 24-weeks pregnant woman (45 years old, G6P1) presented with haematuria and flank pain. CT showed AML with acute haemorrhage. The patient became haemodynamically unstable and underwent urgent embolisation and follow-on total radical nephrectomy with the foetus being left in-utero. This involved a multidisciplinary team (urologist, vascular surgeon, interventional radiologist and obstetrician). The procedure was uncomplicated and the pregnancy went to term with a healthy girl delivered at 38 weeks. Discussion The incidence of AML is 0.13% in the general population. 21 reports of haemorrhaging AML in pregnancy have been published in the last 35 years. Mean gestational age was 29.6 weeks. Eight were treated conservatively to term, one underwent exploratory laparotomy with evacuation of haematoma only, five were embolised, and seven were managed with nephrectomy. Of the nephrectomy subgroup, one was preceded by vaginal delivery and five underwent concurrent caesarean section (one with pre-op embolisation). There were two associated foetal deaths. Conclusion This case demonstrates that with a multidisciplinary approach, it is possible to successfully leave a foetus undelivered whilst performing a radical nephrectomy for a large bleeding AML in a woman carrying a late second trimester pregnancy.
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Affiliation(s)
- P Preece
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.
| | - B Mees
- Department of Vascular Surgery, MUMC+, Maastricht, The Netherlands; Department of Vascular Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - B Norris
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - M Christie
- Department of Anatomical Pathology, Royal Melbourne Hospital, Melbourne, Australia
| | - T Wagner
- Department of Vascular Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - P Dundee
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
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Dubey R, Martini LG, Christie M. Duel-acting subcutaneous microemulsion formulation for improved migraine treatment with zolmitriptan and diclofenac: formulation and in vitro-in vivo characterization. AAPS J 2013; 16:214-20. [PMID: 24363199 DOI: 10.1208/s12248-013-9557-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/09/2013] [Indexed: 11/30/2022]
Abstract
Subcutaneous triptan provides immediate analgesia in migraine and cluster headache but is limited by high pain recurrence due to rapid drug elimination. A dual-acting subcutaneous formulation providing immediate release of a triptan and slow but sustained release of a nonsteroidal anti-inflammatory drug may provide a longer duration of relief. A microemulsion-based technology has various advantages over other technically complex dosage forms. Oil-in-water microemulsions of zolmitriptan and diclofenac acid using Labrafac Lipophile, Tween 80, Capryol 90 and water were prepared. One formulation was characterised in vitro and found to have uniformly dispersed nanosized globules. The formulation provided differential release of zolmitriptan and diclofenac acid both in vitro as well as in vivo that may be potentially beneficial to migraine patients.
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Affiliation(s)
- R Dubey
- King's College London, Waterloo Campus, 150 Stamford Street, SE1 9NH, London, UK,
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Lindeman GJ, Vaillant F, Merino D, Lee L, Breslin K, Pal B, Ritchie ME, Smyth GK, Christie M, Phillipson LJ, Burns CJ, Mann GB, Visvader JE. Abstract P2-09-01: Targeting BCL-2 with the BH3 mimetic ABT-199 in ER-positive breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-09-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Impairment of apoptosis is a hallmark of cancer and can result in resistance to therapy. Over-expression of the pro-survival protein BCL-2 is common in breast cancer, with elevated levels found in approximately 85% of luminal tumors. Although BCL-2 has been shown to be an important prognostic marker, its role as a therapeutic target has yet to be fully explored. Small molecule inhibitors termed ‘BH3 mimetics’ that mimic the action of pro-apoptotic BH3-only proteins have recently been developed. These bind and neutralize BCL-2 pro-survival proteins. We have previously shown that the BH3 mimetic ABT-737 (which neutralizes BCL-2, BCL-XL and BCL-W) synergizes with docetaxel in BCL-2-positive patient-derived xenograft (PDX) models. Recently, a potent BCL-2-specific inhibitor, ABT-199, has been developed that is showing considerable promise in early phase studies of lymphoid malignancies. Since BCL-2 expression is prominent in the luminal B tumors, we sought to determine whether it might be feasible to target luminal B tumors with combination therapy comprising endocrine therapy (tamoxifen) and a BH3 mimetic (ABT-737 or ABT-199), using novel PDX models of luminal B breast cancer.
Methods and Results: A panel of 36 primary breast tumor xenografts (including 15 luminal tumors) was generated in immunocompromised (NOG) mice. Three BCL-2-positive luminal B models (23T, 315T, 50T), as determined by Ki-67 immunostaining and gene expression profiling, and a control BCL-2-positive, ER-negative model (838T) were selected for further study. Cohorts of mice bearing tumor xenografts were treated with either ABT-737 (50 mg/kg i.p. d1-10), tamoxifen or both agents in q21d cycles. Tumor response and overall survival were significantly improved by combination therapy in all three ER-positive xenograft models, when compared to tamoxifen alone (p<0.005). Despite abundant BCL-XL expression in tumors, similar efficacy was observed with the selective BCL-2 inhibitor ABT-199 (50 mg/kg o.g. d1-5 and 8-12 q21d) and tamoxifen (p<0.005), revealing that BCL-2 is a crucial target. Unexpectedly, both BH3 mimetics were found to counteract the side effect of tamoxifen-induced endometrial hyperplasia. In addition, we observed that BH3 mimetics synergized with dual PI3K/mTOR inhibitors in the induction of apoptosis. In the 315T model, where AKT was found to be activated, triple therapy with ABT-737, a PI3K/mTOR inhibitor (PKI-587) and tamoxifen further augmented tumor response in vivo, when compared to ABT-737 and tamoxifen (p<0.004).
Discussion: Patient derived xenograft models of luminal B breast cancer have been derived that recapitulate the phenotype of the primary tumor. Here we have demonstrated that concomitant targeting of BCL-2 confers marked benefit above tamoxifen alone. Moreover, synergy between BH3 mimetics and PI3K/mTOR inhibitors could be exploited by targeting of both survival pathways, a strategy that appeared both safe and effective. Collectively, our findings provide a rationale for clinical evaluation of BH3 mimetics in early phase studies in breast cancer. Here, BCL-2 protein or mRNA expression (as determined by immunohistochemistry or RT-PCR, respectively) could provide a suitable companion biomarker for patient selection.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-09-01.
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Affiliation(s)
- GJ Lindeman
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - F Vaillant
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - D Merino
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - L Lee
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - K Breslin
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - B Pal
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - ME Ritchie
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - GK Smyth
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - M Christie
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - LJ Phillipson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - CJ Burns
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - GB Mann
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
| | - JE Visvader
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia
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Christie M, Jorissen RN, Mouradov D, Sakthianandeswaren A, Li S, Day F, Tsui C, Lipton L, Desai J, Jones IT, McLaughlin S, Ward RL, Hawkins NJ, Ruszkiewicz AR, Moore J, Burgess AW, Busam D, Zhao Q, Strausberg RL, Simpson AJ, Tomlinson IPM, Gibbs P, Sieber OM. Different APC genotypes in proximal and distal sporadic colorectal cancers suggest distinct WNT/β-catenin signalling thresholds for tumourigenesis. Oncogene 2013; 32:4675-82. [PMID: 23085758 PMCID: PMC3787794 DOI: 10.1038/onc.2012.486] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/20/2012] [Accepted: 09/04/2012] [Indexed: 01/05/2023]
Abstract
Biallelic protein-truncating mutations in the adenomatous polyposis coli (APC) gene are prevalent in sporadic colorectal cancer (CRC). Mutations may not be fully inactivating, instead producing WNT/β-catenin signalling levels 'just-right' for tumourigenesis. However, the spectrum of optimal APC genotypes accounting for both hits, and the influence of clinicopathological features on genotype selection remain undefined. We analysed 630 sporadic CRCs for APC mutations and loss of heterozygosity (LOH) using sequencing and single-nucleotide polymorphism microarrays, respectively. Truncating APC mutations and/or LOH were detected in 75% of CRCs. Most truncating mutations occurred within a mutation cluster region (MCR; codons 1282-1581) leaving 1-3 intact 20 amino-acid repeats (20AARs) and abolishing all Ser-Ala-Met-Pro (SAMP) repeats. Cancers commonly had one MCR mutation plus either LOH or another mutation 5' to the MCR. LOH was associated with mutations leaving 1 intact 20AAR. MCR mutations leaving 1 vs 2-3 intact 20AARs were associated with 5' mutations disrupting or leaving intact the armadillo-repeat domain, respectively. Cancers with three hits had an over-representation of mutations upstream of codon 184, in the alternatively spliced region of exon 9, and 3' to the MCR. Microsatellite unstable cancers showed hyper-mutation at MCR mono- and di-nucleotide repeats, leaving 2-3 intact 20AARs. Proximal and distal cancers exhibited different preferred APC genotypes, leaving a total of 2 or 3 and 0 to 2 intact 20AARs, respectively. In conclusion, APC genotypes in sporadic CRCs demonstrate 'fine-tuned' interdependence of hits by type and location, consistent with selection for particular residual levels of WNT/β-catenin signalling, with different 'optimal' thresholds for proximal and distal cancers.
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Affiliation(s)
- M Christie
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - R N Jorissen
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - D Mouradov
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - A Sakthianandeswaren
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - S Li
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - F Day
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - C Tsui
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - L Lipton
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - J Desai
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - I T Jones
- Department of Colorectal Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - S McLaughlin
- Department of Colorectal Surgery, Western Hospital, Footscray, Victoria, Australia
| | - R L Ward
- Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - N J Hawkins
- Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - A R Ruszkiewicz
- Pathology Department, Institute of Medical and Veterinary Science, Adelaide, South Australia, Australia
| | - J Moore
- Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A W Burgess
- Epithelial Biology Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - D Busam
- J Craig Venter Institute, Rockville, MD, USA
| | - Q Zhao
- J Craig Venter Institute, Rockville, MD, USA
| | - R L Strausberg
- Department of Neurosurgery, Ludwig Collaborative Laboratory for Cancer Biology and Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Ludwig Institute for Cancer Research Ltd, New York, NY, USA
| | - A J Simpson
- Department of Neurosurgery, Ludwig Collaborative Laboratory for Cancer Biology and Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Ludwig Institute for Cancer Research Ltd, New York, NY, USA
| | - I P M Tomlinson
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Oxford, OX, UK
| | - P Gibbs
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - O M Sieber
- Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Danieau F, Lecuyer A, Guillotel P, Fleureau J, Mollet N, Christie M. Enhancing audiovisual experience with haptic feedback: a survey on HAV. IEEE Trans Haptics 2013; 6:193-205. [PMID: 24808303 DOI: 10.1109/toh.2012.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Haptic technology has been widely employed in applications ranging from teleoperation and medical simulation to art and design, including entertainment, flight simulation, and virtual reality. Today there is a growing interest among researchers in integrating haptic feedback into audiovisual systems. A new medium emerges from this effort: haptic-audiovisual (HAV) content. This paper presents the techniques, formalisms, and key results pertinent to this medium. We first review the three main stages of the HAV workflow: the production, distribution, and rendering of haptic effects. We then highlight the pressing necessity for evaluation techniques in this context and discuss the key challenges in the field. By building on existing technologies and tackling the specific challenges of the enhancement of audiovisual experience with haptics, we believe the field presents exciting research perspectives whose financial and societal stakes are significant.
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Mathew P, Gibbons AJ, Christie M, Eisenburg MF. Operative treatment of paediatric penetrating head injuries in southern Afghanistan. Br J Neurosurg 2013; 27:489-96. [DOI: 10.3109/02688697.2013.767314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Christie M. The economics of sport, health and happiness: The promotion of well-being through sporting activities. J Interprof Care 2012. [DOI: 10.3109/13561820.2012.715528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lipton L, Kentwell M, Li M, Williams D, Christie M, Landgren A, Dow C, Jones I, McLaughlin S, Delatycki M, Macrae F, Lynch E. Audit of routine immunohistochemistry testing for mismatch repair proteins at diagnosis of colorectal cancer under the age of 50. Hered Cancer Clin Pract 2012. [PMCID: PMC3326819 DOI: 10.1186/1897-4287-10-s2-a78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Christie M, Prakash S, Jorissen RN, Sakthianandeswaren A, Gibbs P, Lipton LR, Desai J, Tie J, Kerr DJ, Sieber O. Prognostic value of chronic inflammatory cell infiltrates in Duke's stage B and C colorectal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Powell C, Bankart J, Christie M, Bamber D, Arrindell T. Drug testing in the Criminal Justice System: Solutions to a costly commodity. Journal of Substance Use 2009. [DOI: 10.3109/14659890902963858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hu SH, Christie M, Latham C, James D, Martin J. Structural insights into the SM protein–syntaxin interactions. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308092477] [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: 11/10/2022] Open
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26
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Walters I, Austin C, Austin R, Bonnert R, Cage P, Christie M, Ebden M, Gardiner S, Grahames C, Hill S, Hunt F, Jewell R, Lewis S, Martin I, Nicholls D, Robinson D. Evaluation of a series of bicyclic CXCR2 antagonists. Bioorg Med Chem Lett 2008; 18:798-803. [DOI: 10.1016/j.bmcl.2007.11.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [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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Brosnan CA, Mitter N, Christie M, Smith NA, Waterhouse PM, Carroll BJ. Nuclear gene silencing directs reception of long-distance mRNA silencing in Arabidopsis. Proc Natl Acad Sci U S A 2007; 104:14741-6. [PMID: 17785412 PMCID: PMC1964546 DOI: 10.1073/pnas.0706701104] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.0] [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: 06/09/2007] [Indexed: 11/18/2022] Open
Abstract
In plants, silencing of mRNA can be transmitted from cell to cell and also over longer distances from roots to shoots. To investigate the long-distance mechanism, WT and mutant shoots were grafted onto roots silenced for an mRNA. We show that three genes involved in a chromatin silencing pathway, NRPD1a encoding RNA polymerase IVa, RNA-dependent RNA polymerase 2 (RDR2), and DICER-like 3 (DCL3), are required for reception of long-distance mRNA silencing in the shoot. A mutant representing a fourth gene in the pathway, argonaute4 (ago4), was also partially compromised in the reception of silencing. This pathway produces 24-nt siRNAs and resulted in decapped RNA, a known substrate for amplification of dsRNA by RDR6. Activation of silencing in grafted shoots depended on RDR6, but no 24-nt siRNAs were detected in mutant rdr6 shoots, indicating that RDR6 also plays a role in initial signal perception. After amplification of decapped transcripts, DCL4 and DCL2 act hierarchically as they do in antiviral resistance to produce 21- and 22-nt siRNAs, respectively, and these guide mRNA degradation. Several dcl genotypes were also tested for their capacity to transmit the mobile silencing signal from the rootstock. dcl1-8 and a dcl2 dcl3 dcl4 triple mutant are compromised in micro-RNA and siRNA biogenesis, respectively, but were unaffected in signal transmission.
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Affiliation(s)
- C A Brosnan
- Australian Research Council Centre of Excellence for Integrative Legume Research, School of Molecular and Microbial Sciences, and School of Land, Crop, and Food Sciences, University of Queensland, St. Lucia QLD 4072, Australia
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Hunt F, Austin C, Austin R, Bonnert R, Cage P, Christie J, Christie M, Dixon C, Hill S, Jewell R, Martin I, Robinson D, Willis P. SAR studies on thiazolo[4,5-d]pyrimidine based CXCR2 antagonists involving a novel tandem displacement reaction. Bioorg Med Chem Lett 2007; 17:2731-4. [PMID: 17382543 DOI: 10.1016/j.bmcl.2007.02.080] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 02/28/2007] [Accepted: 02/28/2007] [Indexed: 10/23/2022]
Abstract
As part of a Lead Optimisation programme to identify small molecule antagonists of the human CXCR2 receptor, a series of substituted thiazolo[4,5-d]pyrimidines was prepared via the application of a novel tandem displacement reaction.
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Affiliation(s)
- Fraser Hunt
- AstraZeneca R&D Charnwood, Bakewell Road, Loughborough LE11 5RH, UK.
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Doherty R, Lubinski J, Manguoglu E, Luleci G, Christie M, Craven P, Bancroft E, Mitra A, Morgan S, Eeles R. Short report. The AIDIT and IMPACT conference 2006: Outcomes and future directions. Hered Cancer Clin Pract 2007; 5:53-5. [PMID: 19723350 PMCID: PMC2736762 DOI: 10.1186/1897-4287-5-1-53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 02/01/2007] [Indexed: 12/24/2022] Open
Affiliation(s)
- R Doherty
- Translational Cancer Genetics Team, The Institute of Cancer Research, London, UK
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Doherty R, Lubinski J, Manguoglu E, Luleci G, Christie M, Craven P, Bancroft E, Mitra A, Morgan S, Eeles R. AIDIT and IMPACT: building research collaborations in targeted prostate cancer screening. J BUON 2006; 11:415-8. [PMID: 17309171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
AIDIT (Advancing International Co-operation and Developing Infrastructure for Targeted Screening of Prostate Cancer in Men with Genetic Predisposition) is a project funded by the Sixth Framework Programme of the European Community which is endeavouring to facilitate co-operation between European countries in the field of cancer research. The project also aims to raise awareness of familial prostate cancer among health professionals and the public within the associated candidate countries (ACCs) and new member states of the European Union (EU). AIDIT will focus on linking clinical and research teams in the ACCs and new member states with the IMPACT Consortium (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in BRCA1/2 mutation carriers and controls), an international team investigating screening and diagnosis for men with a genetic risk of prostate cancer predisposition genes BRCA1 or BRCA2). Cancer research has been targeted as a high priority for the European Community; however, research is most successful when centralised and well coordinated, avoiding the duplication and fragmentation associated with smaller, isolated studies. AIDIT will consolidate the current IMPACT consortium and allow research partners from across the world to benefit from shared knowledge and experience. To date, the AIDIT team has established a website to facilitate communication between project collaborators (www.impact-study.co.uk), has been represented at several international meetings and has facilitated a conference for the IMPACT study to bring together international research teams, clinicians and policy makers.
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Affiliation(s)
- R Doherty
- The Institute of Cancer Research, London, United Kingdom
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Majeed MA, Nayeemuddin M, Christie M. Ward nurses' knowledge of computed tomography scanning. Br J Nurs 2006; 15:825-7. [PMID: 16936607 DOI: 10.12968/bjon.2006.15.15.21690] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Patients benefit from and are reassured by advance information on procedures that they are to undergo. Ward nurses should have adequate knowledge of radiological investigations to ensure proper patient preparation and good interdepartmental communication to avoid delays and cancellations. This study was conducted to assess the ward nurses' knowledge of the process of computed tomography (CT) scanning. One hundred and twenty qualified nurses were asked to complete a questionnaire regarding CT scanning. The findings revealed a suboptimal level of awareness about the process. This is probably due to lack of formal teaching for nurses on the wards in regards the different radiological procedures and patient preparation. There is a strong case for better educational talks on rapidly changing radiological techniques for ward staff to ensure high-quality patient care.
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Affiliation(s)
- M A Majeed
- Walsgrave Hospital, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry
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Affiliation(s)
- K Karabatsou
- Department of Neurosurgery, Walsgrave Hospital, Coventry, UK
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Christie M. A comparison of alternative contingent valuation elicitation treatments for the evaluation of complex environmental policy. J Environ Manage 2001; 62:255-269. [PMID: 11475084 DOI: 10.1006/jema.2001.0439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Attempts to evaluate the economic benefits associated with complex environmental policies, using the contingent valuation (CV) method, have been dogged by controversy. In particular, debate has centred on the influence of embedding and related effects on the validity of CV willingness-to-pay (WTP) estimates. This paper discusses these effects in the context of identifying the most appropriate WTP elicitation treatment to evaluate the willingness to pay for the various elements of a multi-dimensional environmental policy. The findings of an empirical experiment demonstrate that a top-down allocation treatment, which uses independent sub-samples for individual policy components, provides the most reliable treatment to value all aspects of a multi-dimensional policy, whilst also overcoming embedding bias problems.
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Affiliation(s)
- M Christie
- Institute of Rural Studies, University of Wales, Aberystwyth, Llanbadarn Campus, Aberystwyth, SY23 3AL Wales, UK.
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Kolm-Litty V, Berlo S, Bonifacio E, Bearzatto M, Engel AM, Christie M, Ziegler AG, Wild T, Endl J. Human monoclonal antibodies isolated from type I diabetes patients define multiple epitopes in the protein tyrosine phosphatase-like IA-2 antigen. J Immunol 2000; 165:4676-84. [PMID: 11035111 DOI: 10.4049/jimmunol.165.8.4676] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Protein tyrosine phosphatase-like IA-2 autoantigen is one of the major targets of humoral autoimmunity in patients with insulin-dependant diabetes mellitus (IDDM). In an effort to define the epitopes recognized by autoantibodies against IA-2, we generated five human mAbs (hAbs) from peripheral B lymphocytes isolated from patients most of whom had been recently diagnosed for IDDM. Determination and fine mapping of the critical regions for autoantibody binding was performed by RIA using mutant and chimeric constructs of IA-2- and IA-2beta-regions. Four of the five IgG autoantibodies recognized distinct epitopes within the protein tyrosine phosphatase (PTP)-like domain of IA-2. The minimal region required for binding by three of the PTP-like domain-specific hAbs could be located to aa 777-979. Two of these hAbs cross-reacted with the related IA-2beta PTP-like domain (IA-2beta aa 741-1033). A further PTP-like domain specific hAb required the entire PTP-like domain (aa 687-979) for binding, but critical amino acids clustered in the N-terminal region 687-777. An additional epitope could be localized within the juxtamembrane domain (aa 603-779). In competition experiments, the epitope recognized by one of the hAbs was shown to be targeted by 10 of 14 anti-IA-2-positive sera. Nucleotide sequence analysis of this hAb revealed that it used a V(H) germline gene (DP-71) preferably expressed in autoantibodies associated with IDDM. The presence of somatic mutations in both heavy and light chain genes and the high affinity or this Ab suggest that the immune response to IA-2 is Ag driven.
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MESH Headings
- Adult
- Amino Acid Sequence
- Animals
- Antibodies, Monoclonal/biosynthesis
- Antibodies, Monoclonal/classification
- Antibodies, Monoclonal/isolation & purification
- Autoantibodies/biosynthesis
- Autoantigens/genetics
- Autoantigens/immunology
- Base Sequence
- Binding Sites, Antibody/genetics
- Binding, Competitive/genetics
- Binding, Competitive/immunology
- Cell Line, Transformed
- Child
- Diabetes Mellitus, Type 1/enzymology
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/immunology
- Epitope Mapping
- Genetic Vectors/chemical synthesis
- Genetic Vectors/immunology
- Humans
- Immunoglobulin G/biosynthesis
- Immunoglobulin Variable Region/genetics
- Membrane Proteins/genetics
- Membrane Proteins/immunology
- Mice
- Middle Aged
- Molecular Sequence Data
- Organ Specificity/immunology
- Protein Tyrosine Phosphatase, Non-Receptor Type 1
- Protein Tyrosine Phosphatases/genetics
- Protein Tyrosine Phosphatases/immunology
- Receptor-Like Protein Tyrosine Phosphatases, Class 8
- Sequence Analysis
- Species Specificity
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Klekamp J, Dawson JM, Haas DW, DeBoer D, Christie M. The use of vancomycin and tobramycin in acrylic bone cement: biomechanical effects and elution kinetics for use in joint arthroplasty. J Arthroplasty 1999; 14:339-46. [PMID: 10220189 DOI: 10.1016/s0883-5403(99)90061-x] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We examined the effects of vancomycin on the compressive strength and fatigue life of bone cement and the pharmacokinetics and antimicrobial activity against methicillin-resistant Staphylococcus aureus of vancomycin eluted from bone cement, both alone and in combination with tobramycin. Two cements, Palacos and Simplex, were tested. Three antibiotic preparations were tested: lyophilized vancomycin (vancomycin-L), vancomycin powder (vancomycin-P), and tobramycin powder (Lilly, Indianapolis, IN). Although antibiotics did not significantly affect compressive strength, the fatigue life of bone cement was significantly decreased with vancomycin. Thus, fatigue testing revealed effects on cement strength not apparent by compression testing. Vancomycin-P had a substantially less detrimental effect on fatigue strength than vancomycin-L. Vancomycin-P elutes less efficiently than tobramycin. Although relatively little vancomycin-P eluted from bone cement, it retained biologic activity.
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Affiliation(s)
- J Klekamp
- Department of Orthopaedics and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Doyle AJ, Christie M, French G. Bone surface lesions. Radiology 1998; 209:282-3. [PMID: 9769845 DOI: 10.1148/radiology.209.1.9769845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ajuebor MN, Flower RJ, Hannon R, Christie M, Bowers K, Verity A, Perretti M. Endogenous monocyte chemoattractant protein-1 recruits monocytes in the zymosan peritonitis model. J Leukoc Biol 1998; 63:108-16. [PMID: 9469480 DOI: 10.1002/jlb.63.1.108] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The role of monocyte chemoattractant protein-1 (MCP-1) in the recruitment of blood-derived monocytes in a model of zymosan peritoneal inflammation was investigated. After zymosan injection (1 mg) a rapid influx of polymorphonuclear leukocytes (PMN) and monocytes into the peritoneal cavity associated with mouse MCP-1 (JE) gene activation and protein secretion in the exudates occurred. MCP-1 production (maximal at 4 h) preceded the accumulation of monocytes (F4/80-positive cells, maximally recovered between 16 and 24 h). Treatment of mice with a single injection of anti-mouse MCP-1 antibody inhibited 16-h monocyte accumulation by approximately 40%, however, a significant decrease in the number of PMN was also measured. Finally, intraperitoneal injection of murine recombinant MCP-1 (1 microg) produced a selective accumulation of monocytes (F4/80-positive cells) into the peritoneal cavity. In conclusion, we show the novel existence of a strict relationship between MCP-1 production and leukocyte accumulation in this model of acute inflammation.
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Affiliation(s)
- M N Ajuebor
- Department of Biochemical Pharmacology, The William Harvey Research Institute, London, United Kingdom
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Seissler J, Morgenthaler NG, Achenbach P, Lampeter EF, Glawe D, Payton M, Christie M, Scherbaum WA. Combined screening for autoantibodies to IA-2 and antibodies to glutamic acid decarboxylase in first degree relatives of patients with IDDM. The DENIS Study Group. Deutsche Nikotinamid Interventions-Studie. Diabetologia 1996; 39:1351-6. [PMID: 8933004 DOI: 10.1007/s001250050582] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To determine the value of antibodies to the intracytoplasmic domain of the tyrosine phosphatase IA-2 (anti-IA-2ic) and glutamic acid decarboxylase (GADA) for identification of subjects at risk for insulin-dependent diabetes mellitus (IDDM) we investigated 1238 first degree relatives of patients with IDDM for the presence of anti-IA-2ic and GADA and compared the results with cytoplasmic islet cell antibodies (ICA). Anti-IA-2ic were observed in 54 (4.4%) first degree relatives, in 51 of 86 (59.3%) ICA positive relatives and in 3 of 4 individuals who developed overt IDDM within a follow-up period of 1 to 28 months. GADA were found in 78 of 1238 (6.3%) first degree relatives. They were detected in 22 of 35 (62.9%) sera with ICA alone and in 1 of 3 subjects with anti-IA-2ic in the absence of ICA. Of the 1238 subjects 37 (3.0%) sera were positive for all three antibodies. Both anti-IA-2ic and GADA were positively correlated with high levels of ICA. Anti-IA-2ic and GADA were detected in 39.1 and 47.8% of subjects with ICA of less than 20 Juvenile Diabetes Foundation units (JDF-U) but in 66.7 and 76.2% of individuals with ICA of 20 JDF-U or more, respectively (p < 0.05). The levels of ICA and GADA in first degree relatives with at least one additional marker were significantly higher than in subjects with ICA alone (p < 0.005) or GADA alone (p < 0.03). The combination of anti-IA-2ic and GADA identified 84.9% of all ICA positive subjects and 93.7% of individuals with high level ICA (> or = 20 IDF-U). All 4 individuals who progressed to IDDM had either IA-2ic or GADA. Our data indicate that primary screening for anti-IA-2ic and GADA provides a powerful approach with which to identify subjects at risk for IDDM in large-scale population studies which may represent the basis for the design of new intervention strategies.
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Affiliation(s)
- J Seissler
- Department of Internal Medicine III, University of Leipzig, Germany
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Abstract
Increasing recreation in the wilderness raises questions about the value of providing advanced life support (ALS) care in the backcountry. Since 1989 the Reach and Treat (RAT) team has provided ALS care in the wilderness area that surrounds Mount Hood, Oregon. The purpose of our study was to describe patient demographics, terrain, injuries, and ALS treatment in the wilderness environment. We utilized a retrospective, observational analysis of RAT missions from 1989 to 1994 based on data sheets maintained by the RAT team, prehospital run sheets, and hospital charts. Of the 114 missions analyzed, the median time of missions was 3 h, 9 min (range, 44 min-76 h) and 20% required technical climbing skills. Of the 74 patients treated, 55 (90%) received ALS care: 8 were intubated, 52 had intravenous lines established, and 24 received morphine for pain. Twenty patients were entered into the local trauma system. The most common injuries were extremity injuries (58), head injuries (18), and hypothermia (15). Mean time from arrival to return to staging area was 95 min. No injuries to RAT team members occurred during these missions, although two minor injuries occurred during training and testing. We found that wilderness-trained paramedics safely provided ALS care in a backcountry environment. This care may improve patient comfort during long extrication and speeds the arrival of potentially life-saving interventions such as advanced airway management.
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Affiliation(s)
- T A Schmidt
- Department of Emergency Medicine, Oregon Health Sciences University, Portland 97201, USA
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Kirby RL, Coughlan SG, Christie M. Could changes in the wheelchair delivery system improve safety? CMAJ 1995; 153:1585-91. [PMID: 7489551 PMCID: PMC1488010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Despite emerging evidence about the high incidence and severity of wheelchair-related injuries, regulations governing wheelchair safety are almost nonexistent in Canada. The authors believe that, to improve wheelchair safety, a concerted effort by government, manufacturers, purchasing groups, users and clinicians is needed. Health Canada's Health Protection Branch should treat wheelchairs as medical devices (as defined in the Food and Drugs Act 1985) and improve its injury-reporting network. Manufacturers should give a higher priority to safety in wheelchair design, improve their educational materials and formalize postmarketing surveillance. Purchasing groups should try to ensure that they do not stifle innovation in wheelchair design by setting unrealistic reimbursement ceilings and should use their market power more effectively. Users should obtain their wheelchairs in specialized settings, heed safety warnings and make more effective use of litigation when such action is warranted. Clinicians should ensure that patients are equipped with the most appropriate wheelchair for their needs, that they are given adequate training in safe wheelchair use and that they understand the dangers involved. Rapid changes in wheelchair technology and emerging evidence about the high incidence and severity of injuries related to wheelchair use suggest that such changes are needed in the wheelchair delivery system.
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Affiliation(s)
- R L Kirby
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, Dalhousie University, Halifax, NS
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Affiliation(s)
- S Chopra
- Departments of Pathology, Surgery, and Medicine, Al Hada Armed Forces Hospital, Taif, Saudi Arabia
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Shelley E, Daly L, Collins C, Christie M, Conroy R, Gibney M, Hickey N, Kelleher C, Kilcoyne D, Lee P. Cardiovascular risk factor changes in the Kilkenny Health Project. A community health promotion programme. Eur Heart J 1995; 16:752-60. [PMID: 7588918 DOI: 10.1093/oxfordjournals.eurheartj.a060993] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The Kilkenny Health Project was a community research and demonstration programme which aimed to reduce risk of cardiovascular disease in a county in the south-east of Ireland with a total population of approximately 70,000. The health promotion programme was carried out in Kilkenny from 1985 to 1992. Outcome evaluation was by means of population surveys of independent samples of men and women aged 35 to 64 years in Kilkenny (n approximately 800) and in the reference county (n approximately 600) in 1985/1986 and in 1990/1991. Survey methods for health behaviour questionnaires and risk factor measurements were similar to those of the WHO MONICA Project. Mean systolic blood pressure (SBP) declined significantly (P < 0.01) in men and women in both counties, from 144.0 by 5.4 mmHg and from 143.2 by 5.4 mmHg in men and from 139.5 by 7.7 mmHg and from 136.5 by 6.6 mmHg in women in the intervention and reference counties. The prevalence of hypertension declined from 23.1% by 2.8% and from 26.1% by 6.0% in men in the two counties. Prevalence declined from 24.1% by 6.2% (P < 0.05) in women in the intervention county but was unchanged, increasing by 0.5% from 17.5%, in women in the reference county. Mean serum total cholesterol declined from 6.04 mmol.l-1 by 0.09 mmol.l-1 and from 6.00 by 0.44 mmol.l-1 (P < 0.01) in men and from 6.01 by 0.36 (P < 0.01) and from 5.90 by 0.31 (P < 0.01) in women in the intervention and reference counties, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E Shelley
- Department of Epidemiology and Preventive Medicine, Royal College of Surgeons, Ireland
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Coughlan SG, Kirby RL, Christie M. The learned intermediary doctrine and prescription wheelchairs. Health Law Can 1994; 15:65-71. [PMID: 10141077] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Abstract
A case of complete thrombosis of the superior sagittal sinus in a pregnant women with multiple haemorrhages and hydrocephalus is described. Due to acute onset and progressive neurological deterioration, the decision was taken to remove the clot surgically. A sinotomy was performed removing the thrombotic material followed by local infusion of tissue plasminogen activator (t-PA). The combination of surgical removal and thrombolysis was life-saving for this young patient.
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Affiliation(s)
- H Kourtopoulos
- Department of Neurosurgery and Cardiology, Al Hada Military Hospital, Taif, Saudi Arabia
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Christie M, Stolpmann B. [2 women--2 parents. Interview by Lisbet Harstad]. Jordmorbladet 1994:18-20. [PMID: 7953177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Epstein RM, Christie M, Frankel R, Rousseau S, Shields C, Suchman AL. Understanding fear of contagion among physicians who care for HIV patients. Fam Med 1993; 25:264-8. [PMID: 8319856] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Fear of contagion has been identified as a potential deterrent for primary care physicians who would otherwise care for HIV patients. This study examines physicians' fears of occupational HIV transmission and the ways that they cope with those fears. METHODS Thirty community-based primary care physicians who were caring for HIV patients were interviewed about their experiences with HIV patients and the meanings they ascribe to those experiences. Qualitative content and narrative analysis were used. RESULTS Fear of contagion was common despite the relatively low reported self-assessment of risk by primary care physicians. Most physicians considered their level of risk acceptable, but for some it seemed to take a high emotional toll. Some physicians identified their fear as "irrational." Physicians reported tension between fear of contagion and ethical responsibility to care for HIV patients. Some physicians were overattentive to infection control measures, whereas others used universal precautions inconsistently. Physicians continued to care for HIV patients despite their fears. Some physicians' family members needed information and reassurance about transmission of HIV. CONCLUSIONS Some physicians who care for HIV patients are poorly equipped to deal with their own fears. There is a need to examine in greater depth the relationship between fear of contagion and willingness to provide care, and to examine other factors that may be contributing to the expression of these fears.
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Affiliation(s)
- R M Epstein
- Highland Hospital, Program for Biopsychosocial Study, Rochester, N.Y
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Epstein RM, Christie M, Frankel R, Rousseau S, Shields C, Williams G, Suchman AL. Primary care of patients with human immunodeficiency virus infection. The physician's perspective. Arch Fam Med 1993; 2:159-67. [PMID: 8275185 DOI: 10.1001/archfami.2.2.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To examine physicians' perceptions, motivations, and influences on their willingness to care for patients with human immunodeficiency virus (HIV). DESIGN Interviews with 30 physicians. Qualitative content and narrative analyses were performed. SETTINGS Community-based primary care practices in six moderate-sized cities in the northeastern United States with at least a moderate incidence or prevalence of reported acquired immunodeficiency syndrome cases. PARTICIPANTS Thirty community-based primary care physicians who had cared for at least two patients with HIV during the previous 2 years. MAIN OUTCOME MEASURE Qualitative study designed to provide rich descriptive data. RESULTS Care of patients with HIV was regarded as part of the scope of primary care, and was perceived to be similar to the care of patients with other chronic illnesses. Many physicians were motivated by personal rewards in taking care of patients, intellectual challenge, and desire to serve the underserved. Most believed that practicing physicians have an ethical obligation to care for all patients, regardless of diagnosis. No one "type" of physician could be identified who provides care to patients with HIV. CONCLUSIONS Primary care physicians can apply their skills in the management of other chronic diseases to the care of patients with HIV. Practicing physicians can find caring for patients with HIV rewarding, stimulating, and enjoyable. Educational programs for physicians need to emphasize psychosocial aspects of HIV care. In addition, physicians need opportunities to recognize and deal effectively with their own emotional responses to the care of patients with HIV.
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Affiliation(s)
- R M Epstein
- Department of Family Medicine, Highland Hospital, Rochester, NY
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