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Richmond RL, Murphy MJ, Edemobi P, Vesely MD, Cohen JM. Association of Lichen Planus with Asthma and Allergic Rhinitis in the All of Us Research Program: A Cross-Sectional Study. Clin Exp Dermatol 2024:llae101. [PMID: 38589773 DOI: 10.1093/ced/llae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
Lichen Planus was found to be associated with Asthma and Allergic Rhinitis, highlighting a possible shared immunopathogenesis. In this population-based cross-sectional study, the association remained after controlling for covariates.
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Affiliation(s)
| | | | | | - Matthew D Vesely
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut, USA
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2
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Murphy MJ, Hwang E, Singh K, Lee T, Cohen JM, Damsky W. Machine learning analysis of pretreatment skin biopsies predicts nonresponse to dupilumab in patients with eczematous dermatitis. Br J Dermatol 2023; 190:132-134. [PMID: 37818837 DOI: 10.1093/bjd/ljad389] [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: 07/23/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
While dupilumab has revolutionized the treatment of atopic dermatitis (AD), a subset of patients may fail to respond or worsen after dupilumab initiation. Using a retrospective cohort of 53 dupilumab responders and 17 nonresponders, we developed a logistic regression classifier to predict nonresponse using 7 cytokine staining and histological features derived from pretreatment biopsies. Our model demonstrated an accuracy of 95.7%, a sensitivity of 88.2%, a specificity of 98.1% and a PPV of 93.8% for predicting nonresponse using leave-one-out cross-validation, underscoring treatment-relevant immunological heterogeneity in eczema and demonstrating the potential of using machine learning and tissue biomarkers to predict dupilumab nonresponse.
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Affiliation(s)
| | | | | | | | - Jeffrey M Cohen
- Department of Dermatology
- Section of Biomedical Informatics and Data Science
| | - William Damsky
- Department of Dermatology
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
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3
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Murphy MJ, Heyang M, Fan R, Leasure AC, Damsky W, Cohen JM. Association between uveitis and Lichen planus in the all of us research program. Arch Dermatol Res 2023; 315:2729-2730. [PMID: 37488318 DOI: 10.1007/s00403-023-02675-6] [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] [Received: 06/02/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 07/26/2023]
Affiliation(s)
| | | | - Ryan Fan
- Yale School of Medicine, New Haven, CT, USA
| | - Audrey C Leasure
- Department of Dermatology, Yale School of Medicine, CT, New Haven, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, CT, New Haven, USA
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, CT, New Haven, USA.
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA.
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4
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Chen JS, Murphy MJ, Singh K, Wang A, Chow RD, Kim SR, Cohen JM, Ko CJ, Damsky W. IL17A mRNA Staining Distinguishes Palmoplantar Psoriasis from Hyperkeratotic Palmoplantar Eczema in Diagnostic Skin Biopsies. JID Innov 2023; 3:100189. [PMID: 37205304 PMCID: PMC10186614 DOI: 10.1016/j.xjidi.2023.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/04/2023] [Accepted: 01/22/2023] [Indexed: 02/11/2023] Open
Abstract
Acral dermatoses, including hyperkeratotic palmoplantar eczema (HPE), palmoplantar psoriasis (PP), and mycosis fungoides palmaris et plantaris (MFPP), can be challenging to diagnose clinically and histopathologically. In this setting, cytokine biomarkers may be able to help provide diagnostic clarity. Therefore, we evaluated IL-17A, IFN-γ, and IL-13 expression in PP, HPE, and MFPP and compared their expression profiles with nonacral sites. We used biopsy specimens from the Yale Dermatopathology database, selecting cases of HPE (n = 12), PP (n = 8), MFPP (n = 8), normal acral skin (n = 9), nonacral eczema (n = 10), and nonacral psoriasis (n = 10) with classic clinical and histopathologic features. IL17A mRNA expression by RNA in situ hybridization differentiated PP (median score 63.1 [interquartile range 9.4-104.1]) from HPE (0.8 [0-6.0]; P = 0.003), MFPP (0.6 [0-2.6]; P = 0.003), and normal acral skin (0 [0-0]; P < 0.001). Unexpectedly, both PP and HPE showed co-expression of IFNG and IL13 mRNA. In contrast, nonacral psoriasis and eczema showed divergent patterns of IFNG and IL13 mRNA expression. Taken together, we show that IL17A mRNA expression may be a useful biomarker of PP, and we further show that acral dermatoses exhibit distinct immunology compared to nonacral sites, with implications for clinical management.
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Affiliation(s)
- Jennifer S. Chen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael J. Murphy
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katelyn Singh
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alice Wang
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
- Medical Scientist Training Program, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ryan D. Chow
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sa Rang Kim
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey M. Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christine J. Ko
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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5
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Murphy MJ, Edemobi P, Leasure AC, Gulati M, Miller EJ, Damsky W, Cohen JM. Autoimmune comorbidities associated with sarcoidosis: a case-control study in the All of Us research program. Rheumatol Adv Pract 2023; 7:rkad030. [PMID: 38606002 PMCID: PMC11007907 DOI: 10.1093/rap/rkad030] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/22/2023] [Indexed: 04/13/2024] Open
Abstract
Objective The degree to which sarcoidosis patients are affected by autoimmune diseases is poorly understood. Prior studies of autoimmune co-morbidities in sarcoidosis have focused on populations outside the USA or have been impeded by small sample sizes and limited scope. This case-control study evaluated the association between sarcoidosis and autoimmune diseases in a large, diverse cohort based in the USA. Methods We used data from the All of Us research programme to conduct a case-control study involving patients ≥18 years old, from 2018 to the present, diagnosed with sarcoidosis. Sarcoidosis cases and age-, sex- and race-matched controls were identified in a 1:4 ratio. Autoimmune co-morbidities were compared between sarcoidosis patients and controls in univariable and multivariable analyses using logistic regression. The degree of association was measured using the odds ratio (OR). Results A total of 1408 sarcoidosis cases and 5632 controls were included in this study. Seven of 24 examined autoimmune diseases were significantly associated with sarcoidosis in our multivariable analysis (P < 0.05). The composite variable of any autoimmune disease was also significantly associated with sarcoidosis (OR = 2.29, P < 0.001). Conclusion We demonstrate an association between sarcoidosis and multiple autoimmune diseases in a large and diverse cohort based in the USA. These results underscore the need for careful screening of sarcoidosis patients for concomitant autoimmune disease.
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Affiliation(s)
| | | | - Audrey C Leasure
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Mridu Gulati
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, CT, USA
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, CT, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
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6
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Havlik JL, Murphy MJ, Gong N, Tang D, Krystal JH. Characteristics of Esketamine Prescribers Among Medicare Beneficiaries in the United States, 2019-2020. JAMA Netw Open 2023; 6:e2311250. [PMID: 37103934 PMCID: PMC10140803 DOI: 10.1001/jamanetworkopen.2023.11250] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/20/2023] [Indexed: 04/28/2023] Open
Abstract
This cross-sectional study examines the characteristics and geographic distribution of eskatamine prescribers among Medicare beneficiaries in the US from 2019 to 2020.
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Affiliation(s)
- John L. Havlik
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Michael J. Murphy
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Nina Gong
- Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Deanna Tang
- Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - John H. Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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7
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Murphy MJ, Shea M. Survey and conservation assessment of the land snail fauna of Coolah Tops National Park in the Hunter Valley area of New South Wales, Australia. Molluscan Research 2023. [DOI: 10.1080/13235818.2023.2183538] [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] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
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8
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Jain N, Whitaker-Worth D, Murphy MJ. Radiation-Induced Localized Bullous Pemphigoid. Am J Dermatopathol 2023; 45:210-212. [PMID: 36791375 DOI: 10.1097/dad.0000000000002385] [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: 02/17/2023]
Affiliation(s)
- Neelesh Jain
- Department of Dermatology, UConn Health, Farmington, CT
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9
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Hooper J, Beltrami EJ, Santoro F, Murphy MJ. Remember the Fite: A Case of Cutaneous Mycobacterium fortuitum Infection. Am J Dermatopathol 2023; 45:214-215. [PMID: 36729795 DOI: 10.1097/dad.0000000000002336] [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: 02/03/2023]
Affiliation(s)
- Jette Hooper
- Department of Dermatology, UConn Health, Farmington, CT
| | - Eric J Beltrami
- University of Connecticut School of Medicine, Farmington, CT
| | - Frank Santoro
- Department of Dermatology, Hartford Hospital, Hartford, CT
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10
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Clark A, Murphy MJ, King B, Cohen JM, Rosenbach M, Barbieri J, Damsky W. Patient perspectives on the lived experience of granuloma annulare. Br J Dermatol 2023; 188:134-136. [PMID: 36689498 DOI: 10.1093/bjd/ljac004] [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: 06/13/2022] [Revised: 09/02/2022] [Accepted: 09/24/2022] [Indexed: 01/22/2023]
Abstract
Granuloma annulare is a relatively common inflammatory skin disease, yet patient-centered impacts of GA have not been thoroughly investigated, including the potential psychosocial and symptomatic burden, patients’ motivation for treatment, and patients’ perception of usefulness of commonly used medications. We conducted a survey of greater than 900 patients with GA and found an unexpectedly significant impact of GA on the quality of life, a generally poor reported response to commonly used therapies, and that symptoms such as itch and discomfort are not uncommon and may be the primary motivator for seeking treatment. More effective therapies and an understanding of their effect on quality of life is needed.
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Affiliation(s)
- Abigale Clark
- College of Medicine and Biosciences, Kansas City University, Kansas City, MO, USA
| | | | | | | | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - John Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - William Damsky
- Department of Dermatology
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
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11
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Murphy MJ. Climate change and clinical biochemistry. Ann Clin Biochem 2023; 60:3-5. [PMID: 36411953 DOI: 10.1177/00045632221140991] [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: 11/23/2022]
Affiliation(s)
- Michael J Murphy
- Department of Biochemical Medicine, 3042Ninewells Hospital, Dundee, UK
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12
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Roy SF, Sarhan J, Liu X, Murphy MJ, Bunick CG, Choate KA, Damsky WB, McNiff JM. Inguinal patch in mpox (monkeypox) virus infection and eccrine syringometaplasia: report of two cases with in situ hybridization and electron microscopy. Br J Dermatol 2022; 188:574-576. [PMID: 36763786 DOI: 10.1093/bjd/ljac146] [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] [Received: 11/04/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 01/22/2023]
Abstract
We report two cases of cutaneous mpox virus infection (formerly known as “monkeypox”), one of which presented with unusual clinical findings, and demonstrate their histopathologic, RNA in situ hybridization and ultrastructural characteristics. We observed in two patients with PCR-confirmed mpox virus infection squamous syringometaplasia of the eccrine ducts, a finding that can aid in recognizing this disease and is explained by the demonstration of viral mRNA within eccrine epithelium by in situ hybridization.
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Affiliation(s)
- Simon F Roy
- Department of Dermatology, Yale University School of Medicine, New Haven, USA
| | - Joseph Sarhan
- Department of Dermatology, Yale University School of Medicine, New Haven, USA
| | - Xinran Liu
- Center for Cellular & Molecular Imaging, Yale University School of Medicine, New Haven, USA
| | | | - Christopher G Bunick
- Department of Dermatology, Yale University School of Medicine, New Haven, USA.,Program in Translational Biomedicine, Yale University School of Medicine, New Haven, USA
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, USA.,Department of Pathology, Yale University School of Medicine, New Haven, USA.,Department of Genetics, Yale University School of Medicine, New Haven, USA
| | - William B Damsky
- Department of Dermatology, Yale University School of Medicine, New Haven, USA.,Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Jennifer M McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, USA.,Department of Pathology, Yale University School of Medicine, New Haven, USA
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13
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Ahmad M, Murphy MJ, Damsky W, Leventhal J. Dupilumab‐induced psoriasis in the setting of pembrolizumab therapy: an analysis of cytokine expression. Int J Dermatol 2022. [DOI: 10.1111/ijd.16538] [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] [Received: 09/19/2022] [Revised: 11/04/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Maham Ahmad
- Department of Dermatology Yale University School of Medicine New Haven CT USA
| | - Michael J. Murphy
- Department of Dermatology Yale University School of Medicine New Haven CT USA
| | - William Damsky
- Department of Dermatology Yale University School of Medicine New Haven CT USA
- Department of Pathology Yale University School of Medicine New Haven CT USA
| | - Jonathan Leventhal
- Department of Dermatology Yale University School of Medicine New Haven CT USA
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14
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Murphy MJ, Leasure AC, Damsky W, Cohen JM. Association of sarcoidosis with psoriasis: a cross-sectional study in the All of Us research program. Arch Dermatol Res 2022; 315:1439-1441. [DOI: 10.1007/s00403-022-02488-z] [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] [Received: 05/26/2022] [Revised: 10/21/2022] [Accepted: 11/17/2022] [Indexed: 11/28/2022]
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15
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Damsky W, Wang A, Kim DJ, Young BD, Singh K, Murphy MJ, Daccache J, Clark A, Ayasun R, Ryu C, McGeary MK, Odell ID, Fazzone-Chettiar R, Pucar D, Homer R, Gulati M, Miller EJ, Bosenberg M, Flavell RA, King B. Inhibition of type 1 immunity with tofacitinib is associated with marked improvement in longstanding sarcoidosis. Nat Commun 2022; 13:3140. [PMID: 35668129 PMCID: PMC9170782 DOI: 10.1038/s41467-022-30615-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/05/2022] [Indexed: 01/05/2023] Open
Abstract
Sarcoidosis is an idiopathic inflammatory disorder that is commonly treated with glucocorticoids. An imprecise understanding of the immunologic changes underlying sarcoidosis has limited therapeutic progress. Here in this open-label trial (NCT03910543), 10 patients with cutaneous sarcoidosis are treated with tofacitinib, a Janus kinase inhibitor. The primary outcome is the change in the cutaneous sarcoidosis activity and morphology instrument (CSAMI) activity score after 6 months of treatment. Secondary outcomes included change in internal organ involvement, molecular parameters, and safety. All patients experience improvement in their skin with 6 patients showing a complete response. Improvement in internal organ involvement is also observed. CD4+ T cell-derived IFN-γ is identified as a central cytokine mediator of macrophage activation in sarcoidosis. Additional type 1 cytokines produced by distinct cell types, including IL-6, IL-12, IL-15 and GM-CSF, also associate with pathogenesis. Suppression of the activity of these cytokines, especially IFN-γ, correlates with clinical improvement. Our results thus show that tofacitinib treatment is associated with improved sarcoidosis symptoms, and predominantly acts by inhibiting type 1 immunity.
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Affiliation(s)
- William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA. .,Department of Pathology, Yale School of Medicine, New Haven, CT, USA.
| | - Alice Wang
- grid.47100.320000000419368710Department of Dermatology, Yale School of Medicine, New Haven, CT USA
| | - Daniel J. Kim
- grid.47100.320000000419368710Department of Dermatology, Yale School of Medicine, New Haven, CT USA
| | - Bryan D. Young
- grid.47100.320000000419368710Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT USA
| | - Katelyn Singh
- grid.47100.320000000419368710Department of Dermatology, Yale School of Medicine, New Haven, CT USA
| | - Michael J. Murphy
- grid.47100.320000000419368710Department of Dermatology, Yale School of Medicine, New Haven, CT USA
| | - Joseph Daccache
- grid.47100.320000000419368710Department of Dermatology, Yale School of Medicine, New Haven, CT USA
| | - Abigale Clark
- grid.258405.e0000 0004 0539 5056Kansas City University of Medicine and Biosciences, Kansas City, MO USA
| | - Ruveyda Ayasun
- grid.240324.30000 0001 2109 4251Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY USA
| | - Changwan Ryu
- grid.47100.320000000419368710Seciton of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT USA
| | - Meaghan K. McGeary
- grid.47100.320000000419368710Department of Pathology, Yale School of Medicine, New Haven, CT USA
| | - Ian D. Odell
- grid.47100.320000000419368710Department of Dermatology, Yale School of Medicine, New Haven, CT USA ,grid.47100.320000000419368710Department of Immunobiology, Yale School of Medicine, New Haven, CT USA
| | - Ramesh Fazzone-Chettiar
- grid.47100.320000000419368710Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT USA
| | - Darko Pucar
- grid.47100.320000000419368710Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT USA
| | - Robert Homer
- grid.47100.320000000419368710Department of Pathology, Yale School of Medicine, New Haven, CT USA
| | - Mridu Gulati
- grid.47100.320000000419368710Seciton of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT USA
| | - Edward J. Miller
- grid.47100.320000000419368710Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT USA
| | - Marcus Bosenberg
- grid.47100.320000000419368710Department of Dermatology, Yale School of Medicine, New Haven, CT USA ,grid.47100.320000000419368710Department of Pathology, Yale School of Medicine, New Haven, CT USA ,grid.47100.320000000419368710Department of Immunobiology, Yale School of Medicine, New Haven, CT USA
| | - Richard A. Flavell
- grid.47100.320000000419368710Department of Immunobiology, Yale School of Medicine, New Haven, CT USA ,grid.47100.320000000419368710Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT USA
| | - Brett King
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.
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Oberlin TJ, DuBois CK, Sheppard M, Quam JD, Kramer AJ, Logan PW, Murphy MJ. COVID-19 aerosol transmission modeling in support of company HVAC guideline. J Occup Environ Hyg 2022; 19:327-334. [PMID: 35349386 DOI: 10.1080/15459624.2022.2058701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A company COVID-19 Heating, Ventilation, and Air Conditioning Guideline was implemented globally, as part of a larger control measure toolset, to minimize the potential for SARS-CoV-2 aerosol transmission. The COVID-19 Heating, Ventilation, and Air Conditioning Guideline informed and provided the process to optimize existing ventilation systems, set occupancy duration limits, and set clearance periods for a given space. Aerosol transmission modeling was used extensively to determine space limitations to reduce the potential for aerosol transmission in various manufacturing, lab, warehouse, aircraft, and administrative workspaces. This paper focuses on the modeling completed for administrative spaces (e.g., offices, conference rooms, restrooms, elevators) due to their lower ventilation rates, higher occupant densities, and greater vocalization levels. A detailed description of how the Guideline was implemented, with examples showing the evaluation and determinations made for specific spaces, is provided. World-wide implementation of this Guideline, as one of the layers of protection, was a key component in the overall strategy to reduce aerosol transmission of the SARS-CoV-2 virus.
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Affiliation(s)
- Ty J Oberlin
- 3M Company Corporate Safety & Health, Saint Paul, Minnesota
| | | | - Mike Sheppard
- 3M Canada Co 3M Canada Corporate EHS, London, Ontario, Canada
| | - Jodi D Quam
- 3M Company Corporate Safety & Health, Saint Paul, Minnesota
| | | | - Perry W Logan
- 3M Company Corporate Safety & Health, Saint Paul, Minnesota
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DuBois CK, Murphy MJ, Kramer AJ, Quam JD, Fox AR, Oberlin TJ, Logan PW. Use of portable air purifiers as local exhaust ventilation during COVID-19. J Occup Environ Hyg 2022; 19:310-317. [PMID: 35290164 DOI: 10.1080/15459624.2022.2053141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The purpose of this study was to determine if strategic placement of portable air purifiers would improve effectiveness of aerosol reduction in a space as compared to use as a general room air purifier. Two sizes of portable air purifiers were placed in two different positions intended to function similar to either a local exhaust ventilation hood or an air curtain to determine if strategic placement would lead to a reduction of particles in a worker's position at a desk in an office environment. Particle generators were used to introduce particulate into the air and personal aerosol monitors measured particles during each test condition. Results showed that when the medium room portable air purifiers used in this study were set to high, corresponding to 98 CFM, and placed near the breathing zone of each office worker with the unit's filter cover removed, the particle concentration was reduced 35% beyond the reduction that would be expected if the same units were placed on the floor behind the occupant's workstation. Results also indicated that the larger portable air purifier tested, positioned as close as reasonable to each occupant's breathing zone with the largest capture area possible (i.e., removing the unit's filter cover), delivers the best aerosol reduction performance. The authors concluded that as a layer of protection against transmission of airborne infectious organisms for office occupants, installing a portable air purifier, sized and operated similar to the units tested in this study on the desk 12 inches from the breathing zone of the worker, has the potential to reduce airborne particulate to a greater degree than if the same units were placed outside of the breathing zone, in the general cubicle area.
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Murphy MJ, Dowell JS, Smith DT. Factors associated with declaration of disability in medical students and junior doctors, and the association of declared disability with academic performance: observational study using data from the UK Medical Education Database, 2002-2018 (UKMED54). BMJ Open 2022; 12:e059179. [PMID: 35361617 PMCID: PMC8977810 DOI: 10.1136/bmjopen-2021-059179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To examine factors associated with declaration of disability by medical students and doctors, and the association of declared disability with academic performance. DESIGN Observational study using record-linked data collected between 2002 and 2018. SETTING UK Medical Education Database is a repository of data relating to training of medical students and doctors. Disability and other data are record-linked. PARTICIPANTS All students starting at a UK medical school between 2002 and 2018 (n=135 930). MAIN OUTCOME MEASURES Declared disability was categorised by the Higher Education Statistics Authority. Outcomes related to undergraduate academic performance included scores in the educational performance measure (EPM), prescribing safety assessment and situational judgement test. Performance in postgraduate examinations was studied, as well as prior attainment in school examinations and aptitude tests. RESULTS Specific learning disability (SLD) was the most commonly declared disability (3.5% compared with the next most commonly declared disability at 1.0% of n=129 345 all cases in the study), and during the period covered by the data, SLD declarations increased from 1.4% (n=6440 for students starting in 2002) to 4.6% (n=8625 for students starting in 2018). In a logistic regression, the following factors predicted recording of SLD on entry to medical school ((exp(B)±95% CI), p<0.0001 unless otherwise stated): attendance at a fee-paying school (2.306±0.178), graduate status (1.806±0.205), participation of local areas quintile (1.089±0.030), age (1.034±0.012). First year medical students were less likely to declare SLD if they were from a non-white ethnic background (Asian/Asian British 0.324±0.034, black/black British 0.571±0.102, mixed 0.731±0.108, other ethnic groups 0.566±0.120), female (0.913±0.059; p=0.007) or from a low index of multiple deprivation quintile (0.963±0.029); p=0.017. In univariate analysis with Bonferroni corrections applied for multiple tests, no significant difference was observed in the recording of SLD according to socioeconomic class (χ2=5.637, p=1), whether or not a student's parents had a higher education (χ2=0.140, p=1), or whether or not a student had received a United Kingdom Clinical Aptitude Test (UKCAT) bursary (χ2=7.661, p=0.068). Students who declared SLD at some point in medical school (n=4830) had lower EPM normalised deviate values (-0.390) than those who did not (-0.119) (F=189.872, p<0.001). Those for whom SLD was recorded were as likely to complete the course successfully as those who did not declare disability (93.0% successful completion by those for whom SLD declared from year 1 (n=2480), 92.2% by those for whom SLD declared after year 1 (n=2350), 91.6% by those for whom SD not declared at any point (n=85 180)) (χ2=6.905, p=0.032). Of 3580 first year students who declared SLD, 43.1% had not sat the UKCAT Special Educational Needs aptitude test (which gives extra time for those with special educational needs), while 28% of 2400 registrants for whom SLD was recorded as medical students did not declare it at General Medical Council registration. CONCLUSIONS Substantial increases in declaration of SLD may reflect changes in the social and legal environment during the period of the study. Those who declare SLD are just as likely to gain a primary medical qualification as those who do not. For some individuals, disability declaration appears to depend on context, based on differences in numbers declaring SLD before, during and after medical school.
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Affiliation(s)
| | - Jon S Dowell
- ScotGEM, Universities of Dundee and St Andrews, Dundee and St Andrews, UK
| | - Daniel T Smith
- Education and Standards, General Medical Council, London, UK
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Murphy MJ. Exploring the Ethics of a Nurses' Strike During a Pandemic. Am J Nurs 2022; 122:49-54. [PMID: 35200190 DOI: 10.1097/01.naj.0000823000.39601.b1] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT It's usually considered a violation of professional ethics for health care workers, including nurses, to refuse to work during mass medical emergencies, especially if their refusal is over concerns like compensation. Strikes and other forms of work stoppage may result in harm to patients and, therefore, violate professional obligations of beneficence. However, in rare circumstances a health care worker's choice to remain on the job despite risk or potential harm to themselves or even their family may be considered beyond their professional obligation. During a pandemic such as COVID-19, the ethical calculus (that is, finding the right balance between beneficence and harm before deciding on a course of action) must take account of a confluence of factors, including the risks to present patients, future patients, and health care workers; the severity and duration of the risks; and the availability of ameliorative or protective steps that reduce risk and harm. The principle of beneficence to both future patients and health care workers may be thwarted if the risk analysis is confined only to short-term concerns (that is, to concerns occurring within a narrow temporal window). If a significantly elevated risk has been demonstrated to affect nurses and other health care workers of color disproportionately, racial justice must also be considered. The purpose of this article is to assess the moral framework of a work stoppage by nurses during a pandemic.
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Affiliation(s)
- Michael J Murphy
- Michael J. Murphy is a distinguished professor emeritus at the State University of New York at Cobleskill. Contact author: . The author has disclosed no potential conflicts of interest, financial or otherwise
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Murphy MJ, Grundy EMD. Slowdown in Mortality Improvement in the Past Decade: A US/UK Comparison. J Gerontol B Psychol Sci Soc Sci 2022; 77:S138-S147. [PMID: 35107166 PMCID: PMC9154273 DOI: 10.1093/geronb/gbab220] [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: 06/10/2021] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To investigate the slowdown in mortality improvement in the United States, United Kingdom, and comparator countries observed in the first decade of the twenty-first century and critically evaluate proposed explanations. METHODS Change-point analysis to identify the year of change in comparison of national mortality trends and linear spline models in the investigation of subnational differences using data from the Human Mortality Database, Global Burden of Disease cause-specific data, and, for the United Kingdom, national statistics data. Consideration of the impact of using different methods to estimate overall mortality is also concluded together with a review of methodological assumptions made in previous studies. RESULTS The results confirm the slowdown in mortality improvement observed in the early twenty-first century but indicate that proposed explanations for this are inadequate on a range of counts. DISCUSSION Mortality improvement slowed down in the early twenty-first century but the explanations advanced, such as opioid use in the United States or influenza epidemics and austerity programs in the United Kingdom, seem unlikely to account for this. Further research considering longer-term life course and cohort influences is needed.
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Affiliation(s)
- Michael J Murphy
- Address correspondence to: Michael J. Murphy, BPhil, Department of Social Policy, London School of Economics and Political Science, Houghton Street, London WC2A2AE, UK. E-mail:
| | - Emily M D Grundy
- Institute for Economic & Social Research, University of Essex, Essex, UK,Norwegian Institute of Public Health (Centre for Fertility and Health), Oslo, Norway
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Sinnatwah JD, Kenneh H, Coker AA, Harmon-Gray WM, Zankah J, Day L, Hubbell E, Murphy MJ, Izzo M, Kong D, Sylwester P, Long Q, Bertozzi E, Skrip LA. Participatory Design and Process Testing to Optimize Utility, Usability, and Acceptability of a Mobile Game for Promoting Evidence-Driven Public Health Decision-Making in Resource-Constrained Settings. Front Digit Health 2022; 3:788557. [PMID: 35059686 PMCID: PMC8763845 DOI: 10.3389/fdgth.2021.788557] [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: 10/02/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Innovative game-based training methods that leverage the ubiquity of cellphones and familiarity with phone-based interfaces have the potential to transform the training of public health practitioners in low-income countries such as Liberia. This article describes the design, development, and testing of a prototype of the Figure It Out mobile game. The prototype game uses a disease outbreak scenario to promote evidence-based decision-making in determining the causative agent and prescribing intervention measures to minimize epidemiological and logistical burdens in resource-limited settings. An initial prototype of the game developed by the US team was playtested and evaluated by focus groups with 20 University of Liberia Masters of Public Health (UL MPH) students. Results demonstrate that the learning objectives—improving search skills for identifying scientific evidence and considering evidence before decision-making during a public health emergency—were considered relevant and important in a setting that has repeatedly and recently experienced severe threats to public health. However, some of the game mechanics that were thought to enhance engagement such as trial-and-error and choose-your-own-path gameplay, were perceived by the target audience as distracting or too time-consuming, particularly in the context of a realistic emergency scenario. Gameplay metrics that mimicked real-world situations around lives lost, money spent, and time constraints during public health outbreaks were identified as relatable and necessary considerations. Our findings reflect cultural differences between the game development team and end users that have emphasized the need for end users to have an integral part of the design team; this formative evaluation has critically informed next steps in the iterative development process. Our multidisciplinary, cross-cultural and cross-national design team will be guided by Liberia-based public health students and faculty, as well as community members who represent our end user population in terms of experience and needs. These stakeholders will make key decisions regarding game objectives and mechanics, to be vetted and implemented by game design experts, epidemiologists, and software developers.
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Affiliation(s)
- James Douglas Sinnatwah
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Hajah Kenneh
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Alvan A. Coker
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Wahdae-Mai Harmon-Gray
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
- Ministry of Health, Monrovia, Liberia
| | - Joelyn Zankah
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Liam Day
- Department of Game Design and Development, Quinnipiac University, Hamden, CT, United States
| | - Emma Hubbell
- Department of Game Design and Development, Quinnipiac University, Hamden, CT, United States
| | - Michael J. Murphy
- Department of Game Design and Development, Quinnipiac University, Hamden, CT, United States
| | - Mandy Izzo
- Institute for Disease Modeling, Global Health, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - David Kong
- Institute for Disease Modeling, Global Health, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Peter Sylwester
- Institute for Disease Modeling, Global Health, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Qinghua Long
- Institute for Disease Modeling, Global Health, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Elena Bertozzi
- Department of Game Design and Development, Quinnipiac University, Hamden, CT, United States
- *Correspondence: Elena Bertozzi
| | - Laura A. Skrip
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
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22
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Hoffman MA, Murphy MJ, Koester MC, Norcross EC, Johnson ST. Lifesaving Medications Use By Athletic Trainers. J Athl Train 2021; 57:613-620. [PMID: 36170846 PMCID: PMC9528709 DOI: 10.4085/1062-6050-353-21] [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: 11/09/2022]
Abstract
The athletic trainer's (AT) emergency management skill set requires competency in the delivery of basic lifesaving medications. Some lifesaving medications have been a part of athletic training practice for decades, but that list has grown as ATs' practice setting has expanded - increasing the types of em ergent conditions that the AT may have to treat. The 2020 CAATE curricular standards require athletic training students be trained to administer the following: supplemental oxygen, nitroglycerine, low dose aspirin, bronchodilators, epinephrine using automated injection device, glucagon, and naloxone. Clinically, the conditions treated by these medications can be categorized as follows: cardiac, respiratory, hypoglycemia, or anaphylaxis. All ATs should know the indications, contraindications, administration methods, and the details of patient monitoring for each medication. Generally, these medications are safe, have clear indications for use, and few contraindications. While ATs are trained to administer these medications, they must consider state laws and local policies.
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Affiliation(s)
- M A Hoffman
- Mark Hoffman, PhD, ATC, EMT, FNATA, Associate Professor, College of Public Health and Human Sciences, Oregon State University.,Mark Hoffman, PhD, ATC, FNATA, , 541-737-6787
| | - M J Murphy
- Molly Murphy, BS, Athletic Training Student, College of Public Health and Human Sciences, Oregon State University,
| | - M C Koester
- Mick Koester, MD, ATCR, Physician, Slocum Center Orthopedics and Sports Medicine,
| | - E C Norcross
- Emily Norcross MS, ATC, Instructor, College of Public Health and Human Sciences, Oregon State University,
| | - S T Johnson
- Sam Johnson PhD, ATC, Clinical Associate Professor, College of Public Health and Human Sciences, Oregon State University, , Corresponding Author
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Alvarado SM, Weston G, Murphy MJ, Stewart CL. Nivolumab induced localized genital bullous pemphigoid in a 60-year-old male. J Cutan Pathol 2021; 49:468-471. [PMID: 34881446 DOI: 10.1111/cup.14183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
A 60-year-old male with metastatic renal cell carcinoma presented with a 6-month history of a pruritic, exquisitely painful genital eruption appearing 3 months after initiation of nivolumab. Examination demonstrated a poorly defined, lichenified scrotal plaque studded with erosions, yellow crust and tense vesicles. There was no other lesion on the body or mucosae. Histopathology revealed a subepidermal blister with a mixed lymphocytic, neutrophilic and eosinophilic infiltrate. Direct immunofluorescence of perilesional skin demonstrated subclinical blister and linear/fibrillary patchy IgG and IgA along the dermoepidermal junction. Bullous pemphigoid (BP) serologies revealed normal IgG BP230 antibodies and minimally elevated IgG BP180 antibodies. Indirect immunofluorescence revealed positive IgG at the basement membrane ("epidermal pattern") in human split skin and monkey esophagus substrates; no IgA antibodies were detected. The patient was diagnosed with nivolumab-induced localized genital BP (LGBP). BP is a reported adverse effect of immune checkpoint inhibitors including nivolumab; however, cases are typically generalized.1,2 LGBP is a rare BP variant typically presenting in children and females; there are few reports of LGBP in adult males.2,3 We report a novel case of nivolumab-induced LGBP with unique histopathologic and clinical challenges. LGBP should be considered in patients on immune checkpoint inhibitor therapy with bullous genital eruptions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Gillian Weston
- Department of Dermatology, New York University Langone Medical Center
| | - Michael J Murphy
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Campbell L Stewart
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
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24
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Murphy MJ, Gruenstein D, Wang A, Peterson D, Levitt J, King B, Damsky W. Treatment of Persistent Erythema Multiforme With Janus Kinase Inhibition and the Role of Interferon Gamma and Interleukin 15 in Its Pathogenesis. JAMA Dermatol 2021; 157:1477-1482. [PMID: 34757416 PMCID: PMC8581795 DOI: 10.1001/jamadermatol.2021.4084] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 05/25/2021] [Accepted: 09/06/2021] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Persistent erythema multiforme (PEM) is poorly understood and lacks effective therapies other than glucocorticoids. OBJECTIVE To report outcomes following treatment of PEM with Janus kinase (JAK) inhibition and to elucidate cytokine drivers of erythema multiforme (EM). DESIGN, SETTING, AND PARTICIPANTS This was a retrospective case series of 4 patients with PEM treated with tofacitinib and/or upadacitinib in 2015 to 2021 at the dermatology clinics of 2 major tertiary referral centers. Four consecutive patients with PEM refractory to multiple treatment approaches were treated. In 1 patient, skin biopsy specimens were obtained for RNA sequencing and proteomic analysis before and during treatment. Molecular findings were validated through RNA in situ hybridization analysis of cytokine expression in biopsy specimens from a total of 12 patients with EM (3 treated with tofacitinib in this study and 9 historic samples). INTERVENTIONS Treatment with tofacitinib, 5 to 10 mg, twice daily or upadacitinib, 15 mg, once daily. MAIN OUTCOMES AND MEASURES Change in PEM activity was assessed in all 4 patients treated with a JAK inhibitor. Median (range) follow-up was 20.5 months (10.0-36.0 mo). RESULTS The study population of 4 female patients had a mean (SD) age of 46.2 (13.7) years and a mean (SD) disease duration of 21.75 (11.30) years. Marked clinical improvement was noted in all 4 patients. In 1 patient with a robust improvement following treatment with tofacitinib, RNA sequencing identified interferon gamma (IFN-γ) and interleukin 15 (IL-15) as cytokines with activity both highly upregulated at baseline in lesional skin and subsequently suppressed following tofacitinib treatment. Measurement of IFNG- and IL15-positive cells in additional EM biopsy specimens of 12 patients showed significant upregulation of IFNG (8.72 cells per mm; 95% CI, 2.60-14.84) and IL15 (14.13 cells per mm; 95% CI, 0.14-28.11) compared with normal skin (P = .008 and P = .045, respectively). CONCLUSIONS AND RELEVANCE The results of this case series study suggest that JAK inhibition may be effective in treating PEM and that IFN-γ and IL-15 may be important cytokine mediators of the disease.
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Affiliation(s)
- Michael J. Murphy
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Diana Gruenstein
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alice Wang
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Danielle Peterson
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Jacob Levitt
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett King
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
- Department of Pathology, Yale School of Medicine, Yale University, New Haven, Connecticut
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Bennett RP, Postnikova EN, Eaton BP, Cai Y, Yu S, Smith CO, Liang J, Zhou H, Kocher GA, Murphy MJ, Smith HC, Kuhn JH. Sangivamycin is highly effective against SARS-CoV-2 in vitro and has favorable drug properties. JCI Insight 2021; 7:153165. [PMID: 34807849 PMCID: PMC8765048 DOI: 10.1172/jci.insight.153165] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/17/2021] [Indexed: 01/08/2023] Open
Abstract
Sangivamycin is a nucleoside analog that is well tolerated by humans and broadly active against phylogenetically distinct viruses, including arenaviruses, filoviruses, and orthopoxviruses. Here, we show that sangivamycin is a potent antiviral against multiple variants of replicative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with half-maximal inhibitory concentration in the nanomolar range in several cell types. Sangivamycin suppressed SARS-CoV-2 replication with greater efficacy than remdesivir (another broad-spectrum nucleoside analog). When we investigated sangivamycin’s potential for clinical administration, pharmacokinetic; absorption, distribution, metabolism, and excretion (ADME); and toxicity properties were found to be favorable. When tested in combination with remdesivir, efficacy was additive rather than competitive against SARS-CoV-2. The proven safety in humans, long half-life, potent antiviral activity (compared to remdesivir), and combinatorial potential suggest that sangivamycin is likely to be efficacious alone or in combination therapy to suppress viremia in patients. Sangivamycin may also have the ability to help combat drug-resistant or vaccine-escaping SARS-CoV-2 variants since it is antivirally active against several tested variants. Our results support the pursuit of sangivamycin for further preclinical and clinical development as a potential coronavirus disease 2019 therapeutic.
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Affiliation(s)
- Ryan P Bennett
- Drug Discovery, OyaGen, Inc, Rochester, United States of America
| | - Elena N Postnikova
- Drug Discovery, Inegrated Research Facility NIH/NIAID, Frederick, United States of America
| | - Brett P Eaton
- Drug Discovery, Inegrated Research Facility NIH/NIAID, Frederick, United States of America
| | - Yingyun Cai
- Drug Discovery, Inegrated Research Facility NIH/NIAID, Frederick, United States of America
| | - Shuiqing Yu
- Drug Discovery, Inegrated Research Facility NIH/NIAID, Frederick, United States of America
| | - Charles O Smith
- Center for Musculoskeletal Research, University of Rochester, Rochester, United States of America
| | - Janie Liang
- Drug Discovery, Inegrated Research Facility NIH/NIAID, Frederick, United States of America
| | - Huanying Zhou
- Drug Discovery, Inegrated Research Facility NIH/NIAID, Frederick, United States of America
| | - Gregory A Kocher
- Drug Discovery, Inegrated Research Facility NIH/NIAID, Frederick, United States of America
| | - Michael J Murphy
- Drug Discovery, Inegrated Research Facility NIH/NIAID, Frederick, United States of America
| | - Harold C Smith
- Drug Discovery, OyaGen, Inc, Rochester, United States of America
| | - Jens H Kuhn
- Drug Discovery, Inegrated Research Facility NIH/NIAID, Frederick, United States of America
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Murphy MJ, Damsky W, Vesely MD. A pruritic psoriatic plaque develops at the donor site of an autologous skin graft: Koebner phenomenon. Lancet 2021; 398:1836. [PMID: 34774145 DOI: 10.1016/s0140-6736(21)02332-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 07/30/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Michael J Murphy
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Matthew D Vesely
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.
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Murphy MJ, Jones HA, Koen T. A seven‐year study of the response of woodland birds to a large‐scale wildfire and the role of proximity to unburnt habitat. AUSTRAL ECOL 2021. [DOI: 10.1111/aec.13049] [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: 11/28/2022]
Affiliation(s)
- Michael J. Murphy
- NSW National Parks and Wildlife Services PO Box 952 Moama New South Wales 2731Australia
| | - Hugh A. Jones
- NSW Department of Planning Industry and Environment Sydney New South WalesAustralia
| | - Terry Koen
- NSW Department of Planning Industry and Environment Sydney New South WalesAustralia
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Murphy MJ, Dow AA. Clinical Studies of the Safety and Efficacy of Macroalgae Extracts in Cosmeceuticals. J Clin Aesthet Dermatol 2021; 14:37-41. [PMID: 34976289 PMCID: PMC8711622] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is a growing body of in-vitro and in-vivo laboratory research on the skin bioactive properties of macroalgae. OBJECTIVE We sought to examine the scientific literature for evidence supporting the clinical safety and efficacy of macroalgae-derived ingredients in cosmeceuticals. METHODS We performed a systematic review of scientific and medical electronic databases for published, peer-reviewed, randomized controlled trials and nonrandomized reports on the clinical bioactivity of topical macroalgae extracts in skin. RESULTS Several human studies report scientific data supporting the safety and efficacy of macroalgae-based skincare products, focusing on skin-moisturizing, anti-melanogenic, and anti-cellulite (slimming) benefits. CONCLUSIONS Further clinical research is necessary to determine the long-term safety, efficacy, optimal concentration and formulation of macroalgae extracts in cosmeceuticals with respect to previously reported and yet uninvestigated skin-directed potential functionally and bioactivity.
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Affiliation(s)
- Michael J Murphy
- Dr. Murphy is with the Department of Dermatology, UConn Health in Farmington, Connecticut
- Ms. Dow is with si SKIN Organics® in Canton, Connecticut
| | - Aileen A Dow
- Dr. Murphy is with the Department of Dermatology, UConn Health in Farmington, Connecticut
- Ms. Dow is with si SKIN Organics® in Canton, Connecticut
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Murphy MJ, Dow AA. Natural Cosmeceutical Ingredients for the Management of Hyperpigmentation in Hispanic and Latino Women. J Clin Aesthet Dermatol 2021; 14:52-56. [PMID: 34840659 PMCID: PMC8570660] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Disorders of hyperpigmentation, such as melasma, postinflammatory pigmentary alteration, and lentigines, pose significant cosmetic concerns for women of Hispanic or Latino race and ethnicity. Natural ingredients are gaining popularity as alternative, safe, and effective topical depigmenting agents. OBJECTIVE We sought to review clinical studies evaluating the use of natural ingredients in the topical management of hyperpigmentation in Hispanic and Latino women. METHODS We conducted a systematic review of scientific and medical electronic databases to identity randomized controlled trials (RCTs) and nonrandomized reports on topical natural agents for the treatment of disorders of hyperpigmentation, using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS Our review of the literature revealed relatively few (N=7) clinical studies (including six RCTs) that evaluated the topical management of hyperpigmentation using natural ingredients with specific reference to women of Hispanic or Latino race and ethnicity. Despite limited research data, a small number (N=7) of natural ingredients demonstrated efficacy and safety as depigmenting agents in this cohort, including niacinamide, soy, azelaic acid, ascorbic acid, licorice, emblica, and belides. CONCLUSION Several natural ingredients have scientific data supporting their potential efficacy as topical treatments for disorders of hyperpigmentation in women of Hispanic or Latino race and ethnicity. However, the paucity of robust cosmetic trials in this setting reflects the generalized low representation of Hispanic and Latino individuals in clinical studies of other skin conditions. Many in-vivo cutaneous trials of natural ingredients are limited by their study design, including with respect to subject selection and short duration. Further research is needed to determine long-term efficacy, safety, optimal concentration, and formulation of natural ingredients for the topical management of hyperpigmentation in Hispanic and Latino women.
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Affiliation(s)
- Michael J Murphy
- Dr. Murphy is with the Department of Dermatology, UConn Health in Farmington, Connecticut
- Ms. Dow is with Si Skin Organics in Canton, Connecticut
| | - Aileen A Dow
- Dr. Murphy is with the Department of Dermatology, UConn Health in Farmington, Connecticut
- Ms. Dow is with Si Skin Organics in Canton, Connecticut
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Wang A, Fogel AL, Murphy MJ, Panse G, McGeary MK, McNiff JM, Bosenberg M, Vesely MD, Cohen JM, Ko CJ, King BA, Damsky W. Cytokine RNA In Situ Hybridization Permits Individualized Molecular Phenotyping in Biopsies of Psoriasis and Atopic Dermatitis. JID Innovations 2021; 1:100021. [PMID: 34909719 PMCID: PMC8659380 DOI: 10.1016/j.xjidi.2021.100021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 12/13/2022] Open
Abstract
Detection of individual cytokines in routine biopsies from patients with inflammatory skin diseases has the potential to personalize diagnosis and treatment selection, but this approach has been limited by technical feasibility. We evaluate whether a chromogen-based RNA in situ hybridization approach can be used to detect druggable cytokines in psoriasis and atopic dermatitis. A series of psoriasis (n = 20) and atopic dermatitis (n = 26) biopsies were stained using RNA in situ hybridization for IL4, IL12B (IL-12/23 p40), IL13, IL17A, IL17F, IL22, IL23A (IL-23 p19), IL31, and TNF (TNF-α). NOS2 and IFNG, canonical psoriasis biomarkers, were also included. All 20 of the psoriasis cases were positive for IL17A, which tended to be the predominant cytokine, although some cases had relatively higher levels of IL12B, IL17F, or IL23A. The majority of cytokine expression in psoriasis was epidermal. A total of 22 of 26 atopic dermatitis cases were positive for IL13, also at varying levels; a subset of cases had significant IL4, IL22, or IL31 expression. Patterns were validated in independent bulk RNA-sequencing and single-cell RNA-sequencing datasets. Overall, RNA in situ hybridization for cytokines appears highly specific with virtually no background staining and may allow for individualized evaluation of treatment-relevant cytokine targets in biopsies from patients with inflammatory skin disorders.
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Murphy MJ, Brandie F, Ebare M, Harrison M, Dow E, Bartlett WA, Craig D. Personalising laboratory medicine in the 'real world': Assessing clinical utility, by clinical indication, of serum total B 12 and Active-B 12® (holotranscobalamin) in the diagnosis of vitamin B 12 deficiency. Ann Clin Biochem 2021; 58:445-451. [PMID: 33715445 PMCID: PMC8458683 DOI: 10.1177/00045632211003605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessing the pre- and post-test probability of disease in the context of routine health care is challenging. We wished to study how test performance parameters relating to clinical utility vary by clinical indication in a 'real-world' setting. METHODS The diagnostic accuracy of serum total B12 and Active-B12® (holotranscobalamin) was evaluated in a primary care population, using serum methylmalonic acid as the reference standard. We used electronic requesting to establish the clinical indication for each request. Routine requests from primary care for serum total B12 were included if creatinine was also measured and estimated glomerular filtration rate was at least 60 mL/min/1.73 m2. RESULTS Clinical indications included peripheral neuropathy (n = 168), anaemia (n = 168), cognitive decline (n = 125), suspected dietary deficiency (n = 76), other (n = 362). For peripheral neuropathy, the area under the receiver operator curve ± 95% confidence interval (AUC ± CI) was 0.63 (0.54-0.71) (P = 0.002) for total B12 and 0.68 (0.60-0.77) (P < 0.0001) for Active-B12®. For anaemia, AUC ± CI was 0.56 (0.47-0.66) (P = 0.10) for total B12 and 0.69 (0.59-0.78) (P < 0.0001) for Active-B12®. For cognitive decline, AUC ± CI was 0.54 (0.43-0.65) (P = 0.26) for total B12 and 0.69 (0.58-0.80) (P = 0.0002) for Active-B12®. The pre-post-test change in probability of disease varied by clinical indication. CONCLUSION Combining diagnostic accuracy studies and electronic testing in a 'real-world' setting allows clinical utility to be assessed by clinical indication. Wider application of this would permit more personalised laboratory medicine. In this study, diagnostic performance of total B12 and Active-B12® varied across all indications. Active-B12® provided better discrimination, but this may have reflected the cut-offs used.
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Affiliation(s)
- Michael J Murphy
- Department of Biochemical Medicine, Ninewells Hospital & Medical School, Dundee, UK
| | - Fiona Brandie
- Department of Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Mildred Ebare
- General Practice Training, NHS Education Scotland, Dundee, UK
| | - Michelle Harrison
- Department of Haematology, Ninewells Hospital & Medical School, Dundee, UK
| | - Ellie Dow
- Department of Biochemical Medicine, Ninewells Hospital & Medical School, Dundee, UK
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Zubkov MR, LaRosa CL, Makkar HS, Murphy MJ. Unilesional granulomatous pigmented purpuric dermatosis in a 7-year-old boy. Pediatr Dermatol 2021; 38:506-507. [PMID: 33543790 DOI: 10.1111/pde.14533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
Granulomatous pigmented purpuric dermatoses (PPD) are rarely reported. We present a case of granulomatous PPD in a 7-year-old boy, one of only two pediatric cases with reported solitary disease. The pathogenesis of unilesional granulomatous PPD may be different from the more commonly described multifocal/widespread disease variant.
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Affiliation(s)
- Micaella R Zubkov
- Division of Dermatopathology, Department of Dermatology, UConn Health, Farmington, CT, USA
| | | | | | - Michael J Murphy
- Division of Dermatopathology, Department of Dermatology, UConn Health, Farmington, CT, USA
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Affiliation(s)
- Michael J Murphy
- Department of Biochemical Medicine, Ninewells Hospital & Medical School, Dundee, UK
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Drozdowski R, Torre K, Murphy MJ. CK20-positive/CK7-negative metastatic breast carcinoma to the skin. J Cutan Pathol 2021; 48:1212-1213. [PMID: 33547821 DOI: 10.1111/cup.13978] [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: 11/05/2020] [Revised: 01/04/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Roman Drozdowski
- Department of Dermatology, UConn Health, Farmington, Connecticut, USA
| | - Kristin Torre
- Department of Dermatology, UConn Health, Farmington, Connecticut, USA
| | - Michael J Murphy
- Department of Dermatology, UConn Health, Farmington, Connecticut, USA
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Murphy MJ, Cohen JM, Vesely MD, Damsky W. Paradoxical eruptions to targeted therapies in dermatology: A systematic review and analysis. J Am Acad Dermatol 2020; 86:1080-1091. [PMID: 33307146 DOI: 10.1016/j.jaad.2020.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Antibody-based therapies that inhibit proinflammatory cytokine signaling are commonly used in dermatology. Paradoxically, these medications may induce or exacerbate inflammatory disorders. OBJECTIVE To summarize the spectrum of manifestations, incidence, timing, potential mechanisms of, and general management approaches to paradoxical cutaneous reactions induced by cytokine-targeted antibodies in dermatology. METHODS We performed a systematic review and analysis of published cases of cutaneous paradoxical reactions (PRs) reported in association with tumor necrosis factor α, interleukin (IL) 12/23 (p40), IL-17A/17R, IL-23 (p19), and IL-4Rα inhibitors. RESULTS We identified 313 articles reporting 2049 cases of PRs. Tumor necrosis factor α inhibitors resulted in 91.2% (1869/2049) of all cases, followed by IL-17/17R (3.5%), IL-4Rα (2.7%), IL-12/23 (2.4%), and IL-23 (0.01%) inhibitors. Psoriasiform and eczematous eruptions were the most commonly reported, but a wide spectrum of patterns were described. Phenotypically overlapping reaction patterns were common. Time to onset typically ranged from weeks to months but could occur more than a year later. Improvement or resolution upon discontinuation of the inciting drug was common. LIMITATIONS This was a retrospective analysis. CONCLUSIONS Familiarity with the clinical features of PRs from cytokine-blocking antibodies may facilitate efficient recognition and management.
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Affiliation(s)
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven
| | | | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven.
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Dow AA, Murphy MJ. Hispanic/Latinos and Skincare: Disparities in Product Development, Marketing, and Toxicity. J Drugs Dermatol 2020; 19:1258-1260. [PMID: 33346516 DOI: 10.36849/jdd.2020.5567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
“Hispanic” and “Latino” (also known as Mestizo) describe a diverse racial and ethnic group, with a range of cultures, languages, and biological ancestry. It includes individuals of Mexican, Central-to-South American, and Spanish-Caribbean (eg, Cuban, Puerto Rican, and Dominican) descent.1 Individuals of Hispanic/Latino race and ethnicity represent a heterogenous group of people with different skin tones and Fitzpatrick phototypes. Hispanic/Latinos are the fastest growing population in the United States (US) - projected to increase from 55 million in 2014 to 119 million in 2060, an increase of 115%.2 By 2060, more than one-quarter (29%) of the US is projected to be Hispanic/Latino.2.
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Lim JJ, Dixon F, Leitch DC, Kowalski J, Nilson M, Goss C, Flanagan R, Hayes S, Murphy MJ. Playing with Fire? A Safe and Effective Deactivation of Raney Cobalt using Aqueous Sodium Nitrate. Org Process Res Dev 2020. [DOI: 10.1021/acs.oprd.0c00053] [Citation(s) in RCA: 1] [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] [Indexed: 11/28/2022]
Affiliation(s)
- John Jin Lim
- Chemical Development, API Chemistry, GlaxoSmithKline, Upper Providence, Pennsylvania 19426, United States
| | - Frank Dixon
- Product Development & Supply, Process Safety, GlaxoSmithKline, Upper Providence, Pennsylvania 19426, United States
| | - David C. Leitch
- Chemical Development, API Chemistry, GlaxoSmithKline, Upper Providence, Pennsylvania 19426, United States
| | - John Kowalski
- Chemical Development, API Chemistry, GlaxoSmithKline, Upper Providence, Pennsylvania 19426, United States
| | - Mark Nilson
- Chemical Development, API Chemistry, GlaxoSmithKline, Upper Providence, Pennsylvania 19426, United States
| | - Charles Goss
- Chemical Development, Product and Process Engineering, GlaxoSmithKline, Upper Providence, Pennsylvania 19426, United States
| | - Roy Flanagan
- Product Development & Supply, Process Safety, GlaxoSmithKline, Zebulon, North Carolina 27597, United States
| | - Sean Hayes
- NPI Technical, Pharma Supply Chain, GlaxoSmithKline, Cork T12 P6PT, Ireland
| | - Michael J. Murphy
- NPI Technical, Pharma Supply Chain, GlaxoSmithKline, Cork T12 P6PT, Ireland
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Lipson AL, Durham JL, LeResche M, Abu-Baker I, Murphy MJ, Fister TT, Wang L, Zhou F, Liu L, Kim K, Johnson D. Improving the Thermal Stability of NMC 622 Li-Ion Battery Cathodes through Doping During Coprecipitation. ACS Appl Mater Interfaces 2020; 12:18512-18518. [PMID: 32239908 DOI: 10.1021/acsami.0c01448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Increasing the Ni content of LiNixMnyCo1-x-yO2 (NMC) cathodes can increase the capacity, but additional stability is needed to improve safety and longevity characteristics. In order to achieve this improved stability, Mg and Zr were added during the coprecipitation to uniformly dope the final cathode material. These dopants reduced the capacity of the material to some extent, depending on the concentration and calcination temperature. However, these dopants can impart substantial stabilization. It was found that the degree of stabilization is strongly dependent on the calcination temperature of the material. In addition, we used synchrotron X-ray diffraction during thermal breakdown to better understand why the different dopants impact the thermal stability and confirm the stabilization effects of the dopants.
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Affiliation(s)
- Albert L Lipson
- Applied Materials Division, Argonne National Laboratory, 9700 S. Cass Ave., Lemont, Illinois 60439, United States
| | - Jessica L Durham
- Applied Materials Division, Argonne National Laboratory, 9700 S. Cass Ave., Lemont, Illinois 60439, United States
| | - Michael LeResche
- Applied Materials Division, Argonne National Laboratory, 9700 S. Cass Ave., Lemont, Illinois 60439, United States
| | - Ismael Abu-Baker
- Applied Materials Division, Argonne National Laboratory, 9700 S. Cass Ave., Lemont, Illinois 60439, United States
| | - Michael J Murphy
- Applied Materials Division, Argonne National Laboratory, 9700 S. Cass Ave., Lemont, Illinois 60439, United States
| | - Timothy T Fister
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 S. Cass Ave., Lemont, Illinois 60439, United States
| | - Lixin Wang
- A123 Systems, LLC., 200 West Street Waltham, Massachusetts 02451, United States
| | - Fu Zhou
- A123 Systems, LLC., 200 West Street Waltham, Massachusetts 02451, United States
| | - Lei Liu
- A123 Systems, LLC., 200 West Street Waltham, Massachusetts 02451, United States
| | - Kitae Kim
- A123 Systems, LLC., 200 West Street Waltham, Massachusetts 02451, United States
| | - Derek Johnson
- A123 Systems, LLC., 200 West Street Waltham, Massachusetts 02451, United States
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Daugherty CE, Lento HG, Adams ML, Beckert EW, Bender ML, Berman S, Chow L, Davis C, Gedang D, Howe K, Murphy MJ, Porcuna M, Sabolish G, Shen CSJ, Smith NM, Tessaro A. Chloroform-Methanol Extraction Method for Determination of Fat in Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/66.4.927] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Achloroform-methanol extraction method (complete extraction of fat in 3 min) for determining fat in processed and prepared foods has been studied collaboratively. Fourteen collaborators reported single replicate fat results on 7 samples representative of various food types and 2 spiked samples by the proposed method. Each sample was accompanied by a blind duplicate. For statistical purposes, the blind duplicates were treated as paired observations, and there were 2 laboratory outliers. There was a 97.9% agreement among the results from the remaining 12 collaborators and the Associate Referee for the unfortified samples. Recoveries of 93.8 and 98.3% were obtained on fortified samples, based on results obtained from 11 collaborators. The statistical analysis of the results indicate (ranges for standard deviations were Sr = 0.083-0.528, Sb = 0.101-0.379, Sd = 8.130-0.631, for fat values ranging from 1.58 to 26.91%) that this method is adequate for quantitating the fat content in a wide variety of processed foods for nutritional labeling. The method has been adopted official first action.
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Affiliation(s)
- Chester E Daugherty
- Campbell Institute for Research and Technology, Campbell Soup Co., Camden, Nf 08101
| | - Harry G Lento
- Campbell Institute for Research and Technology, Campbell Soup Co., Camden, Nf 08101
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Murphy MJ. Back-scattered light during laser-tattoo removal treatments is hugely significant. Lasers Med Sci 2019; 35:1227-1229. [PMID: 31760514 DOI: 10.1007/s10103-019-02915-0] [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] [Received: 06/06/2019] [Accepted: 11/06/2019] [Indexed: 11/28/2022]
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Murphy MJ, Newby JM, Butow P, Loughnan SA, Joubert AE, Kirsten L, Allison K, Shaw J, Shepherd HL, Smith J, Andrews G. Randomised controlled trial of internet-delivered cognitive behaviour therapy for clinical depression and/or anxiety in cancer survivors (iCanADAPT Early). Psychooncology 2019; 29:76-85. [PMID: 31659822 DOI: 10.1002/pon.5267] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 09/26/2019] [Accepted: 10/13/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate internet-delivered cognitive behavioural therapy (iCBT) on clinical depression and/or anxiety, distress, fear of cancer recurrence, and quality of life in cancer survivors. METHODS Random assignation of 114 participants to iCBT or treatment-as-usual (TAU). The clinician-supervised iCBT program (iCanADAPT Early) consisted of eight lessons over 16 weeks. Self-report questionnaires occurred at baseline, midpoint, and posttreatment for both groups with 3-month follow-up for iCBT participants. A mixed modelling approach to compare groups occurred. RESULTS iCBT was superior to TAU on all outcome measures at posttreatment. Compared with TAU, the iCBT group showed a significant decrease over time in anxiety and depression symptoms (primary outcome, Hospital Anxiety and Depression Scale, Hedges g = 1.51). Additionally the iCBT group had significantly lower general distress (Kessler-10, g = 1.56), fear of cancer recurrence (Fear of Cancer Recurrence Inventory, g = 0.39), and significantly higher quality of life (Functional Assessment of Cancer Therapy-General, g = 0.74) at posttreatment compared with the TAU group. High adherence and satisfaction were found for iCBT with low clinician time. CONCLUSION Clinician-supervised iCBT has significant benefits for cancer survivors with clinical depression and anxiety disorders.
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Affiliation(s)
- M J Murphy
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - J M Newby
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia.,School of Psychology, Faculty of Science, UNSW, NSW, Australia
| | - P Butow
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - S A Loughnan
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - A E Joubert
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - L Kirsten
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia.,Nepean Cancer Care Centre, NSW, Australia
| | - K Allison
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - J Shaw
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - H L Shepherd
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - J Smith
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - G Andrews
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
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Moloney F, Twomey M, James K, Kavanagh RG, Fama D, O'Neill S, Grey TM, Moore N, Murphy MJ, O'Connor OJ, Maher MM. A phantom study of the performance of model-based iterative reconstruction in low-dose chest and abdominal CT: When are benefits maximized? Radiography (Lond) 2019; 24:345-351. [PMID: 30292504 DOI: 10.1016/j.radi.2018.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/08/2018] [Revised: 03/26/2018] [Accepted: 04/23/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The aim of this study was to assess and compare the effects of CT image reconstruction techniques on low-dose CT image quality using phantoms. METHODS Anthropomorphic torso and spatial/contrast-resolution phantoms were scanned at decreasing tube currents between 400 and 10 mA. CT thorax and abdomen/pelvis series were reconstructed with filtered back projection (FBP) alone, combined 40% adaptive statistical iterative reconstruction & FBP (ASIR40), and model-based iterative reconstruction (MBIR) [(resolution-preference 05 (RP05) and RP20 in the thorax and RP05 and noise-reduction 05 (NR05) in the abdomen)]. Two readers rated image quality quantitatively and qualitatively. RESULTS In thoracic CT, objective image noise on MBIR RP05 data sets outperformed FBP at 200, 100, 50 and 10 mA and outperformed ASIR40 at 50 and 10 mA (p < 0.001). MBIR RP20 outperformed FBP at 50 and 10 mA and outperformed ASIR40 at 10 mA (p < 0.001). Compared with both FBP and ASIR40, MBIR RP05 demonstrated significantly better signal-to-noise ratio (SNR) at 10 mA. In abdomino-pelvic CT, MBIR RP05 and NR05 outperformed FBP and ASIR at all tube current levels for objective image noise. NR05 demonstrated greater SNR at 200, 100, 50 and 10 mA and RP05 demonstrated greater SNR at 50 and 10 mA compared with both FBP and ASIR. MBIR images demonstrated better subjective image quality scores. Spatial resolution, low-contrast detectability and contrast-to-noise ratio (CNR) were comparable between image reconstruction techniques. CONCLUSION CTs reconstructed with MBIR have lower image noise and improved image quality compared with FBP and ASIR. These effects increase with reduced radiation exposure confirming optimal use for low-dose CT imaging.
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Affiliation(s)
- F Moloney
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - M Twomey
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - K James
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - R G Kavanagh
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland.
| | - D Fama
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - S O'Neill
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - T M Grey
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - N Moore
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - M J Murphy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - O J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - M M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, University College Cork, Cork, Ireland
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Hakim JB, Murphy MJ, Trayanova NA, Boyle PM. Arrhythmia dynamics in computational models of the atria following virtual ablation of re-entrant drivers. Europace 2019; 20:iii45-iii54. [PMID: 30476053 DOI: 10.1093/europace/euy234] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 12/19/2022] Open
Abstract
Aims Efforts to improve ablation success rates in persistent atrial fibrillation (AF) patients by targeting re-entrant driver (RD) sites have been hindered by weak mechanistic understanding regarding emergent RDs localization following initial fibrotic substrate modification. This study aimed to systematically assess arrhythmia dynamics after virtual ablation of RD sites in computational models. Methods and results Simulations were conducted in 12 patient-specific atrial models reconstructed from pre-procedure late gadolinium-enhanced magnetic resonance imaging scans. In a previous study involving these same models, we comprehensively characterized pre-ablation RDs in simulations conducted with either 'average human AF'-based electrophysiology (i.e. EPavg) or ±10% action potential duration or conduction velocity (i.e. EPvar). Re-entrant drivers seen under the EPavg condition were virtually ablated and the AF initiation protocol was re-applied. Twenty-one emergent RDs were observed in 9/12 atrial models (1.75 ± 1.35 emergent RDs per model); these dynamically localized to boundary regions between fibrotic and non-fibrotic tissue. Most emergent RD locations (15/21, 71.4%) were within 0.1 cm of sites where RDs were seen pre-ablation in simulations under EPvar conditions. Importantly, this suggests that the level of uncertainty in our models' ability to predict patient-specific ablation targets can be substantially mitigated by running additional simulations that include virtual ablation of RDs. In 7/12 atrial models, at least one episode of macro-reentry around ablation lesion(s) was observed. Conclusion Arrhythmia episodes after virtual RD ablation are perpetuated by both emergent RDs and by macro-reentrant circuits formed around lesions. Custom-tailoring of ablation procedures based on models should take steps to mitigate these sources of AF recurrence.
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Affiliation(s)
- Joe B Hakim
- Institute for Computational Medicine and Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St, 208 Hackerman Hall, Baltimore, MD, USA
| | - Michael J Murphy
- Institute for Computational Medicine and Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St, 208 Hackerman Hall, Baltimore, MD, USA
| | - Natalia A Trayanova
- Institute for Computational Medicine and Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St, 208 Hackerman Hall, Baltimore, MD, USA
| | - Patrick M Boyle
- Institute for Computational Medicine and Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St, 208 Hackerman Hall, Baltimore, MD, USA.,Department of Bioengineering, University of Washington, N310H Foege, Box 355061, Seattle WA, USA
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Boyle PM, Hakim JB, Zahid S, Franceschi WH, Murphy MJ, Prakosa A, Aronis KN, Zghaib T, Balouch M, Ipek EG, Chrispin J, Berger RD, Ashikaga H, Marine JE, Calkins H, Nazarian S, Spragg DD, Trayanova NA. The Fibrotic Substrate in Persistent Atrial Fibrillation Patients: Comparison Between Predictions From Computational Modeling and Measurements From Focal Impulse and Rotor Mapping. Front Physiol 2018; 9:1151. [PMID: 30210356 PMCID: PMC6123380 DOI: 10.3389/fphys.2018.01151] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 05/30/2018] [Accepted: 07/31/2018] [Indexed: 12/19/2022] Open
Abstract
Focal impulse and rotor mapping (FIRM) involves intracardiac detection and catheter ablation of re-entrant drivers (RDs), some of which may contribute to arrhythmia perpetuation in persistent atrial fibrillation (PsAF). Patient-specific computational models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) has the potential to non-invasively identify all areas of the fibrotic substrate where RDs could potentially be sustained, including locations where RDs may not manifest during mapped AF episodes. The objective of this study was to carry out multi-modal assessment of the arrhythmogenic propensity of the fibrotic substrate in PsAF patients by comparing locations of RD-harboring regions found in simulations and detected by FIRM (RDsim and RDFIRM) and analyze implications for ablation strategies predicated on targeting RDs. For 11 PsAF patients who underwent pre-procedure LGE-MRI and FIRM-guided ablation, we retrospectively simulated AF in individualized atrial models, with geometry and fibrosis distribution reconstructed from pre-ablation LGE-MRI scans, and identified RDsim sites. Regions harboring RDsim and RDFIRM were compared. RDsim were found in 38 atrial regions (median [inter-quartile range (IQR)] = 4 [3; 4] per model). RDFIRM were identified and subsequently ablated in 24 atrial regions (2 [1; 3] per patient), which was significantly fewer than the number of RDsim-harboring regions in corresponding models (p < 0.05). Computational modeling predicted RDsim in 20 of 24 (83%) atrial regions identified as RDFIRM-harboring during clinical mapping. In a large number of cases, we uncovered RDsim-harboring regions in which RDFIRM were never observed (18/22 regions that differed between the two modalities; 82%); we termed such cases “latent” RDsim sites. During follow-up (230 [180; 326] days), AF recurrence occurred in 7/11 (64%) individuals. Interestingly, latent RDsim sites were observed in all seven computational models corresponding to patients who experienced recurrent AF (2 [2; 2] per patient); in contrast, latent RDsim sites were only discovered in two of four patients who were free from AF during follow-up (0.5 [0; 1.5] per patient; p < 0.05 vs. patients with AF recurrence). We conclude that substrate-based ablation based on computational modeling could improve outcomes.
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Affiliation(s)
- Patrick M Boyle
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Joe B Hakim
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Sohail Zahid
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - William H Franceschi
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Michael J Murphy
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Adityo Prakosa
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | | | - Tarek Zghaib
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Muhammed Balouch
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Esra G Ipek
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Jonathan Chrispin
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Ronald D Berger
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Hiroshi Ashikaga
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Joseph E Marine
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Hugh Calkins
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Saman Nazarian
- Penn Heart & Vascular Center, University of Pennsylvania, Philadelphia, PA, United States
| | - David D Spragg
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
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Johnstone JS, Murphy MJ. Prospective analysis of phoned potassium results and what general practitioners do with them: a pilot study. Ann Clin Biochem 2018; 55:710-712. [PMID: 30019589 DOI: 10.1177/0004563218790298] [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: 11/17/2022]
Abstract
Background Communicating abnormal results to requesting clinicians is an essential part of clinical authorisation. Guidance from the Royal College of Pathologists on communication of critical/unexpected results is issued as 'advice to pathologists'. The 2017 guidelines advise rapid communication of serum potassium results ≤2.5 mmol/L and ≥6.5 mmol/L. Little is known about what happens after the results have been communicated. We wished to establish answers to the following questions: Are phoned results acted on? If so, when? What is the outcome of any action taken? Methods A prospective study of primary care potassium results authorised out of hours was undertaken. Potassium requests from primary care were retrieved from the laboratory information management system. The potassium result was recorded, along with other data. Data were analysed for potassium results that were validated out of hours (18:00 h-08:00 h). Results Over six months, 220 potassium results <3.1 mmol/L and >5.9 mmol/L from primary care were validated out of hours. A subset of these (27) were phoned to the general practice out of hours 'hub', and 16 patients referred to hospital out of hours, on account of the potassium results. The remaining potassium results phoned out of hours were acted on subsequently. Conclusions Critical potassium results were phoned urgently and are acted on, although not always out of hours. For potassium results phoned out of hours, the most frequent action was to refer to hospital out of hours. Different actions occurred for similar potassium results, reflecting the fact that actions taken and their urgency depend on the patient, the clinician and the practice policy for handling results.
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Affiliation(s)
- Jennifer S Johnstone
- Department of Biochemical Medicine, Ninewells Hospital & Medical School, Dundee, UK
| | - Michael J Murphy
- Department of Biochemical Medicine, Ninewells Hospital & Medical School, Dundee, UK
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Boyle PM, Hakim JB, Zahid S, Franceschi WH, Murphy MJ, Vigmond EJ, Dubois R, Haïssaguerre M, Hocini M, Jaïs P, Trayanova NA, Cochet H. Comparing Reentrant Drivers Predicted by Image-Based Computational Modeling and Mapped by Electrocardiographic Imaging in Persistent Atrial Fibrillation. Front Physiol 2018; 9:414. [PMID: 29725307 PMCID: PMC5917348 DOI: 10.3389/fphys.2018.00414] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/04/2018] [Indexed: 02/06/2023] Open
Abstract
Electrocardiographic mapping (ECGI) detects reentrant drivers (RDs) that perpetuate arrhythmia in persistent AF (PsAF). Patient-specific computational models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) identify all latent sites in the fibrotic substrate that could potentially sustain RDs, not just those manifested during mapped AF. The objective of this study was to compare RDs from simulations and ECGI (RDsim/RDECGI) and analyze implications for ablation. We considered 12 PsAF patients who underwent RDECGI ablation. For the same cohort, we simulated AF and identified RDsim sites in patient-specific models with geometry and fibrosis distribution from pre-ablation LGE-MRI. RDsim- and RDECGI-harboring regions were compared, and the extent of agreement between macroscopic locations of RDs identified by simulations and ECGI was assessed. Effects of ablating RDECGI/RDsim were analyzed. RDsim were predicted in 28 atrial regions (median [inter-quartile range (IQR)] = 3.0 [1.0; 3.0] per model). ECGI detected 42 RDECGI-harboring regions (4.0 [2.0; 5.0] per patient). The number of regions with RDsim and RDECGI per individual was not significantly correlated (R = 0.46, P = ns). The overall rate of regional agreement was fair (modified Cohen's κ0 statistic = 0.11), as expected, based on the different mechanistic underpinning of RDsim- and RDECGI. nineteen regions were found to harbor both RDsim and RDECGI, suggesting that a subset of clinically observed RDs was fibrosis-mediated. The most frequent source of differences (23/32 regions) between the two modalities was the presence of RDECGI perpetuated by mechanisms other than the fibrotic substrate. In 6/12 patients, there was at least one region where a latent RD was observed in simulations but was not manifested during clinical mapping. Ablation of fibrosis-mediated RDECGI (i.e., targets in regions that also harbored RDsim) trended toward a higher rate of positive response compared to ablation of other RDECGI targets (57 vs. 41%, P = ns). Our analysis suggests that RDs in human PsAF are at least partially fibrosis-mediated. Substrate-based ablation combining simulations with ECGI could improve outcomes.
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Affiliation(s)
- Patrick M Boyle
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Joe B Hakim
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Sohail Zahid
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - William H Franceschi
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Michael J Murphy
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Edward J Vigmond
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France
| | - Rémi Dubois
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France
| | - Mélèze Hocini
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France
| | - Pierre Jaïs
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Hubert Cochet
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France
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Abstract
INTRODUCTION Dark material has been observed embedded within glass slides following Q-switched Nd:YAG laser treatment of tattoos. It appears that these fragments are ejected at high speed from the skin during the treatment. METHOD Light microscopic analysis of the slides reveals aggregates of dark fragmented material, presumably tattoo ink, with evidence of fractured/melted glass. Photomicrographs reveal that the sizes of these aggregates are in the range 12 μm to 0.5 mm. RESULTS Tattoo ink fragments were clearly observed on the surface and embedded within glass slides. Surface aggregates were observed as a fine dust and were easily washed off while deeper fragments remained in situ. The embedded fragments were not visible to the unaided eye. Some fragments appeared to have melted yielding an "insect-like" appearance. These were found to be located between approximately 0.2 and 1 mm deep in the glass. CONCLUSION Given the particle masses and kinetic energies attained by some of these aggregates their velocities, when leaving the skin, may be hundreds to thousands of metres per second. However, the masses of the aggregates are minuscule meaning that laser operators may be subjected to these high-speed aggregates without their knowledge. These high-speed fragments of ink may pose a contamination risk to laser operators. Lasers Surg. Med. 9999:1-7, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Michael J Murphy
- DermaLase Training Services, 120 Queens Drive, Glasgow, G42, United Kingdom
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Jeffery SC, Hosking J, Jeffery AN, Murphy MJ, Voss LD, Wilkin TJ, Pinkney J. Insulin resistance is higher in prepubertal girls but switches to become higher in boys at age 16: A Cohort Study (EarlyBird 57). Pediatr Diabetes 2018; 19:223-230. [PMID: 28851041 DOI: 10.1111/pedi.12571] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/20/2017] [Accepted: 07/21/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The risk of type 2 diabetes is increasing in teenage girls, and is associated with their greater insulin resistance (IR). HYPOTHESIS We hypothesized that the adverse metabolic profile of girls (compared with boys) would persist from childhood through adolescence. PATIENTS AND METHODS Community-based longitudinal cohort of 292 children (147 boys) studied annually from 9 to 16 years. MEASURES IR (homeostasis-model-assessment-2), high-density lipoprotein-cholesterol (HDL-C), triglycerides, % body-fat (dual-energy x-ray absorptiometry), pubertal stage (age at peak height velocity), physical activity (accelerometry). Multi-level modelling established the age-related trends in IR and lipids and the influence of covariates. RESULTS Each year from 9 to 15 years, girls had 21% to 63% higher IR than boys (girls mean IR 0.73-1.33, boys 0.51-0.89, P < .005). At 16 years the gender difference was not significant (girls IR 0.60, boys 0.56, P = .45). Girls had lower HDL-C from 9 to 12 years, higher triglycerides from 9 to 14 years, greater adiposity throughout, and earlier puberty, but boys were more active than girls (all P < .05). After adjustment for %-fat, puberty and activity, the gender difference in IR between girls and boys aged 9 to 15 years became non-significant (IR girls 0.66-1.01, boys 0.65-1.04, P > .07). However, after adjustment at 16 years, girls' IR was 25% lower than boys' (girls 0.44, boys 0.63, P = .001), and they had 22% higher HDL-C (P < .001) and 20% lower triglycerides (P = .003). CONCLUSIONS The higher IR of prepubertal and early pubertal girls diminishes during late puberty, and boys begin to exhibit greater metabolic risk. Despite being leaner and more active, boys at 16 years have higher IR than girls, suggesting future higher risk for diabetes, thus we reject our hypothesis.
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Affiliation(s)
- Sarah C Jeffery
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.,Newcastle University Medical School, Newcastle, UK
| | - Joanne Hosking
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Alison N Jeffery
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Michael J Murphy
- Division of Pathology and Neuroscience, University of Dundee, Dundee, UK
| | - Linda D Voss
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Terence J Wilkin
- Division of Endocrinology and Metabolism, Exeter Medical School, University of Exeter, Exeter, UK
| | - Jonathan Pinkney
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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50
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Boyle PM, Murphy MJ, Karathanos TV, Zahid S, Blake RC, Trayanova NA. Termination of re-entrant atrial tachycardia via optogenetic stimulation with optimized spatial targeting: insights from computational models. J Physiol 2017; 596:181-196. [PMID: 29193078 DOI: 10.1113/jp275264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 09/12/2017] [Accepted: 11/22/2017] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Optogenetics has emerged as a potential alternative to electrotherapy for treating heart rhythm disorders, but its applicability for terminating atrial arrhythmias remains largely unexplored. We used computational models reconstructed from clinical MRI scans of fibrotic patient atria to explore the feasibility of optogenetic termination of atrial tachycardia (AT), comparing two different illumination strategies: distributed vs. targeted. We show that targeted optogenetic stimulation based on automated, non-invasive flow-network analysis of patient-specific re-entry morphology may be a reliable approach for identifying the optimal illumination target in each individual (i.e. the critical AT isthmus). The above-described approach yields very high success rates (up to 100%) and requires dramatically less input power than distributed illumination We conclude that simulations in patient-specific models show that targeted light pulses lasting longer than the AT cycle length can efficiently and reliably terminate AT if the human atria can be successfully light-sensitized via gene delivery of ChR2. ABSTRACT Optogenetics has emerged as a potential alternative to electrotherapy for treating arrhythmia, but feasibility studies have been limited to ventricular defibrillation via epicardial light application. Here, we assess the efficacy of optogenetic atrial tachycardia (AT) termination in human hearts using a strategy that targets for illumination specific regions identified in an automated manner. In three patient-specific models reconstructed from late gadolinium-enhanced MRI scans, we simulated channelrhodopsin-2 (ChR2) expression via gene delivery. In all three models, we attempted to terminate re-entrant AT (induced via rapid pacing) via optogenetic stimulation. We compared two strategies: (1) distributed illumination of the endocardium by multi-optrode grids (number of optrodes, Nopt = 64, 128, 256) and (2) targeted illumination of the critical isthmus, which was identified via analysis of simulated activation patterns using an algorithm based on flow networks. The illuminated area and input power were smaller for the targeted approach (19-57.8 mm2 ; 0.6-1.8 W) compared to the sparsest distributed arrays (Nopt = 64; 124.9 ± 6.3 mm2 ; 3.9 ± 0.2 W). AT termination rates for distributed illumination were low, ranging from <5% for short pulses (1/10 ms long) to ∼20% for longer stimuli (100/1000 ms). When we attempted to terminate the same AT episodes with targeted illumination, outcomes were similar for short pulses (1/10 ms long: 0% success) but improved for longer stimuli (100 ms: 54% success; 1000 ms: 90% success). We conclude that simulations in patient-specific models show that light pulses lasting longer than the AT cycle length can efficiently and reliably terminate AT in atria light-sensitized via gene delivery. We show that targeted optogenetic stimulation based on analysis of AT morphology may be a reliable approach for defibrillation and requires less power than distributed illumination.
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Affiliation(s)
- Patrick M Boyle
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael J Murphy
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas V Karathanos
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sohail Zahid
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Robert C Blake
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Natalia A Trayanova
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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