1
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Atherton P, Jungquist C, Spulecki C. An Educational Intervention to Improve Comfort with Applying and Interpreting Transcutaneous CO 2 and End-tidal CO 2 Monitoring in the PACU. J Perianesth Nurs 2022; 37:781-786. [PMID: 35691831 DOI: 10.1016/j.jopan.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/14/2022] [Accepted: 03/17/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to assess the effectiveness of an educational program about measuring ventilation using devices that assess carbon dioxide levels in patients recovering from a surgical procedure. DESIGN A pre-post survey of knowledge attainment from an educational intervention about measuring ventilation using end-tidal carbon dioxide (EtCO2) and transcutaneous carbon dioxide (tcPCO2) devices in the postanesthesia care unit (PACU) was distributed to current members of the American Society of PeriAnesthesia Nurses. METHODS Participants received a 12-question pre-intervention (five were related to demographics) and a five-question post-intervention survey. Non-demographic survey questions used a one to five Likert scale to assess comfortability or confidence. The intervention created was a voice-over presentation designed to improve PACU RN's comfort and confidence with using and interpreting tcPCO2 or EtCO2 in the PACU. FINDINGS PACU RNs (N = 108) reported they 'never' or 'rarely' used EtCO2 (n = 57, 52.7%) monitoring or tcPCO2 (n = 93, 86.1%) monitoring in the PACU. A paired t test revealed statistically significant differences in the PACU RN's pre-survey and posttest comfortability of applying and interpreting EtCO2 or tcPCO2 monitors (P < .05). CONCLUSIONS Capnography monitoring should be considered a standard of care for PACU patients. Education of registered nurses working in the PACU is critical before implementing EtCO2 or tcPCO2 monitoring.
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Affiliation(s)
| | - Carla Jungquist
- University at Buffalo (SUNY), School of Nursing, Buffalo, NY
| | - Cheryl Spulecki
- University at Buffalo (SUNY), School of Nursing, Buffalo, NY
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2
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Ratnayake CBB, Wells CI, Atherton P, Hammond JS, White S, French JJ, Manas D, Pandanaboyana S. Meta-analysis of survival outcomes following surgical and non surgical treatments for colorectal cancer metastasis to the lung. ANZ J Surg 2020; 91:255-263. [PMID: 33089924 DOI: 10.1111/ans.16383] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/24/2020] [Accepted: 09/20/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Controversy exists regarding the optimal management of colorectal lung metastases (CRLM). This meta-analysis compared surgical (Surg) versus interventional (chemotherapy and/or radiotherapy) and observational non-surgical (NSurg) management of CRLM. METHODS A systematic review of the major databases including Medline, Embase, SCOPUS and the Cochrane library was performed. RESULTS One randomized and nine observational studies including 2232 patients: 1551 (69%) comprised the Surg cohort, 521 (23%) the interventional NSurg group and 160 (7%) the observational NSurg group. A significantly higher overall survival (OS) was observed when Surg was compared to interventional NSurg at 1 year (Surg 88%, 310/352; interventional NSurg 64%, 245/383; odds ratio (OR) 2.77 (confidence interval (CI) 1.94-3.97), P = 0.001), at 3 years (Surg 59%, 857/1444; interventional NSurg 26%, 138/521; OR 2.61 (CI 1.65-4.15), P = 0.002), at 5 years (Surg 47%, 533/1144; interventional NSurg 23%, 45/196; OR 3.24 (CI 1.42-7.39), P = 0.009) and at 10 years (Surg 27%, 306/1122; interventional NSurg 1%, 2/168; OR 15.64 (CI 1.87-130.76), P = 0.031). Surg was associated with a greater OS than observational NSurg at only 1 year (Surg 92%, 98/107; observational NSurg 83%, 133/160; OR 6.69 (CI 1.33-33.58), P = 0.037) and was similar to observational NSurg at all other OS time points. Comparable survival was observed among Surg and overall NSurg cohorts at 3- and 5-year survival in articles published within the last 3 years. CONCLUSIONS Recent evidence suggests comparable survival with Surg and NSurg modalities for CRLM, contrasting to early evidence where Surg had an improved survival. Significant selection bias contributes to this finding, prompting the need for high powered randomized controlled trials and registry data.
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Affiliation(s)
- Chathura B B Ratnayake
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cameron I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Phillip Atherton
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - John S Hammond
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Steve White
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jeremy J French
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Derek Manas
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sanjay Pandanaboyana
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle, UK
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3
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Lee J, Bates M, Shepherd E, Thornley A, Kelland N, Greenhalgh D, Atherton P, Peedell C, Hatton M. P1115Cardiac SABR for ventricular tachycardia - initial UK experience. Europace 2020. [DOI: 10.1093/europace/euaa162.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
OnBehalf
United Kingdom Cardiac SABR consortium
Background
Stereotactic Ablative Body Radiotherapy (SABR) is a novel non-invasive treatment for Ventricular Tachycardia (VT) refractory to standard catheter ablation. 3 UK hospitals have started compassionate use cardiac SABR programmes, and are working in close collaboration.
Purpose
To report initial UK experience for treatment of refractory VT with cardiac SABR.
Methods
All patients had undergone prior unsuccessful invasive ablation with VT recurrence despite anti-arrhythmic drug (AAD) use. High-resolution CT imaging with 3D reconstruction was combined with 12 lead ECGs of VT and prior invasive +/- non-invasive electrophysiology mapping data to define a cardiac target. Treatment margins were modified to account for cardiac/respiratory motion and to minimise off target treatment to other organs as per clinical SABR practice. Single fraction high dose treatment (20-25 Gy) was delivered by CT guided Linear Accelerator. Patients were assessed regularly with clinical review and remote device monitoring.
Results
3 patients have been treated so far with aetiologies of prior myocarditis, non-ischaemic dilated cardiomyopathy and ischaemic cardiomyopathy. All patients successfully received planned SABR treatment in <1 hour with no peri-procedural complications. Current follow up is to 4 months. Clinical course was variable – patient 1 had a flare of VT post-SABR requiring temporary escalation of AADs before VT was suppressed, patient 2 had initial suppression of VT but died from decompensated heart failure with further VT after 4 weeks, patient 3 had further VT with a different exit site and underwent repeat invasive ablation and escalated AAD use to achieve VT suppression.
Conclusions
Cardiac SABR shows promise for VT control, but further experience and trials are needed. Integration of imaging and electrophysiology data to generate accurate targets appears critical. The effect of SABR seems to develop over several weeks after therapy. Patient selection and timing of SABR delivery is important with acknowledgement that competing causes of death exist in patients with refractory VT entering a compassionate use program.
Abstract Figure. Example SBRT plan
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Affiliation(s)
- J Lee
- Northern General Hospital, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - M Bates
- James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - E Shepherd
- Freeman Hospital, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - A Thornley
- James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - N Kelland
- Northern General Hospital, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - D Greenhalgh
- Freeman Hospital, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - P Atherton
- Freeman Hospital, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - C Peedell
- James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - M Hatton
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
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4
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Stevenson GW, Giuvelis D, Cormier J, Cone K, Atherton P, Krivitsky R, Warner E, St Laurent B, Dutra J, Bidlack JM, Szabò L, Polt R, Bilsky EJ. Behavioral pharmacology of the mixed-action delta-selective opioid receptor agonist BBI-11008: studies on acute, inflammatory and neuropathic pain, respiration, and drug self-administration. Psychopharmacology (Berl) 2020; 237:1195-1208. [PMID: 31912192 PMCID: PMC8106974 DOI: 10.1007/s00213-019-05449-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/27/2019] [Indexed: 01/23/2023]
Abstract
RATIONALE AND OBJECTIVES The present study characterized the behavioral pharmacology of a novel, mixed-action delta-selective (78:1) opioid receptor agonist, BBI-11008. This glycopeptide drug candidate was tested in assays assessing antinociception (acute, inflammatory, and neuropathic pain-like conditions) and side-effect endpoints (respiratory depression and drug self-administration). RESULTS BBI-11008 had a 78-fold greater affinity for the delta opioid receptor than the mu receptor, and there was no binding to the kappa opioid receptor. BBI-11008 (3.2-100; 10-32 mg kg-1, i.v.) and morphine (1-10; 1-3.2 mg kg-1, i.v.) produced antinociceptive and anti-allodynic effects in assays of acute thermal nociception and complete Freund's adjuvant (CFA)-induced inflammatory pain, with BBI-11008 being less potent than morphine in both assays. BBI-11008 (1-18 mg kg-1, i.v.) had similar efficacy to gabapentin (10-56 mg kg-1, i.v.) in a spinal nerve ligation (SNL) model of neuropathic pain. In the respiration assay, with increasing %CO2 exposure, BBI-11008 produced an initial increase (32 mg kg-1, s.c.) and then decrease (56 mg kg-1, s.c.) in minute volume (MV) whereas morphine (3.2-32 mg kg-1, s.c.) produced dose-dependent decreases in MV. In the drug self-administration procedure, BBI-11008 did not maintain self-administration at any dose tested. CONCLUSIONS These results suggest that the glycopeptide drug candidate possesses broad-spectrum antinociceptive and anti-allodynic activity across a range of pain-like conditions. Relative to morphine or fentanyl, the profile for BBI-11008 in the respiration and drug self-administration assays suggests that BBI-11008 may have less pronounced deleterious side effects. Continued assessment of this compound is warranted.
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MESH Headings
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/chemistry
- Animals
- CHO Cells
- Cricetinae
- Cricetulus
- Dose-Response Relationship, Drug
- Humans
- Inflammation/drug therapy
- Inflammation/metabolism
- Inflammation/psychology
- Male
- Mice
- Morphine/administration & dosage
- Neuralgia/drug therapy
- Neuralgia/metabolism
- Neuralgia/psychology
- Pain Measurement/drug effects
- Pain Measurement/psychology
- Rats
- Rats, Sprague-Dawley
- Receptors, Opioid, delta/agonists
- Receptors, Opioid, delta/metabolism
- Receptors, Opioid, kappa/agonists
- Receptors, Opioid, kappa/metabolism
- Receptors, Opioid, mu/agonists
- Receptors, Opioid, mu/metabolism
- Respiratory Mechanics/drug effects
- Respiratory Mechanics/physiology
- Self Administration
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Affiliation(s)
- Glenn W Stevenson
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA.
- Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, USA.
| | - Denise Giuvelis
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME, 04005, USA
| | - James Cormier
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME, 04005, USA
| | - Katherine Cone
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Phillip Atherton
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Rebecca Krivitsky
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Emily Warner
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Brooke St Laurent
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Julio Dutra
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Jean M Bidlack
- Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - Lajos Szabò
- Department of Chemistry and Biochemistry, The University of Arizona, Tucson, AZ, 85721, USA
| | - Robin Polt
- Department of Chemistry and Biochemistry, The University of Arizona, Tucson, AZ, 85721, USA
| | - Edward J Bilsky
- Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, USA
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME, 04005, USA
- Department of Biomedical Sciences College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, 98901, USA
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5
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Pickles R, Atherton P, Turnbull H, Burns A, Iqbal M. Stereotactic ablative radiotherapy (SABR) for non-small cell lung cancer (NSCLC): analysis of T3N0M0 patients. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Pickles R, Atherton P, Turnbull H, Iqbal M. Effectiveness of 6-week follow-up assessments and chest x-rays for non-small cell lung cancer (NSCLC) patients treated with stereotactic ablative radiotherapy (SABR): a pilot study. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Iqbal M, Atherton P, Macgregor C, Wieczorek A, Singer J, Walther J, Little F, Harden S, Peedell C, Cyriac A, Chowdhury S, Bayne M, Yip K, Britten A, Powell C, Brock J, Datta S, Sevitt T, Mehta A, Greystoke A. Implications for UK practice of the use of durvalumab in stage III NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz067.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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8
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Iqbal M, Mian A, Bashir S, Haris N, Mcmenemin R, Atherton P, Cunnell M. The role of PCI in extensive stage small cell lung cancer treated with palliative chemotherapy and consolidative thoracic radiotherapy. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30250-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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9
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Iqbal M, Pickles R, Mackenzie L, Burns A, Turnbull H, Atherton P. Experience of stereotactic ablative radiotherapy (SABR) in early stage non-small cell lung cancer (NSCLC): an analysis of treatment response and survival outcome. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Sanganalmath P, Lester JE, Bradshaw AG, Das T, Esler C, Roy AEF, Toy E, Lester JF, Button M, Wilson P, Comins C, Atherton P, Pickles R, Foweraker K, Walker GA, Keni M, Hatton MQ. Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres. Clin Oncol (R Coll Radiol) 2018; 30:144-150. [PMID: 29336865 DOI: 10.1016/j.clon.2017.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/14/2017] [Revised: 08/27/2017] [Accepted: 11/06/2017] [Indexed: 01/15/2023]
Abstract
AIM Continuous hyperfractionated accelerated radiotherapy (CHART) remains an option to treat non-small cell lung cancer (NSCLC; NICE, 2011). We have previously published treatment outcomes from 1998-2003 across five UK centres. Here we update the UK CHART experience, reporting outcomes and toxicities for patients treated between 2003 and 2009. MATERIALS AND METHODS UK CHART centres were invited to participate in a retrospective data analysis of NSCLC patients treated with CHART from 2003 to 2009. Nine (of 14) centres were able to submit their data into a standard database. The Kaplan-Meier method estimated survival and the Log-rank test analysed the significance. RESULTS In total, 849 patients had CHART treatment, with a median age of 71 years (range 31-91), 534 (63%) were men, 55% had undergone positron emission tomography-computed tomography (PET-CT) and 26% had prior chemotherapy; 839 (99%) patients received all the prescribed treatment. The median overall survival was 22 months with 2 and 3 year survival of 47% and 32%, respectively. Statistically significant differences in survival were noted for stage IA versus IB (33.2 months versus 25 months; P = 0.032) and IIIA versus IIIB (20 months versus 16 months; P = 0.018). Response at 3 months and outcomes were significantly linked; complete response showing survival of 34 months against 19 months, 15 months and 8 months for partial response, stable and progressive disease, respectively (P < 0.001). Age, gender, performance status, prior chemotherapy and PET-CT did not affect the survival outcomes. Treatment was well tolerated with <5% reporting ≥grade 3 toxicity. CONCLUSION In routine practice, CHART results for NSCLC remain encouraging and we have been able to show an improvement in survival compared with the original trial cohort. We have confirmed that CHART remains deliverable with low toxicity rates and we are taking a dose-escalated CHART regimen forward in a randomised phase II study of sequential chemoradiotherapy against other accelerated dose-escalated schedules.
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Affiliation(s)
| | | | - A G Bradshaw
- Weston Park Hospital, Sheffield, UK; Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - T Das
- Weston Park Hospital, Sheffield, UK
| | - C Esler
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A E F Roy
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - E Toy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - M Button
- Velindre Cancer Centre, Cardiff, UK
| | - P Wilson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - C Comins
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - P Atherton
- Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - R Pickles
- Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - K Foweraker
- Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - G A Walker
- Derby Hospitals NHS Trust, Royal Derby Hospital, UK
| | - M Keni
- Derby Hospitals NHS Trust, Royal Derby Hospital, UK
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11
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Iqbal M, Vashisht G, Mulvenna P, McDonald F, Turnbull H, Atherton P, Bradshaw A, Simmons T, Kovarik J, Singhal S, McMenemin R, Greystoke A. Hypofractionated concurrent chemoradiation in non-small cell lung cancer (NSCLC): efficacy and toxicity of the SOCCAR trial regime in real world practice. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30175-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Sio T, Atherton P, Zhen W, Garces Y, Ma D, Van Der Veen S, Ganti A, Schild S, Miller R. P2.14-006 A Pilot, Randomized Trial of Daily Lisinopril vs Placebo to Prevent Radiation-Induced Pulmonary Distress (Alliance MC1221). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Jansen K, Atherton P, Ballestrem C. Mechanotransduction at the cell-matrix interface. Semin Cell Dev Biol 2017; 71:75-83. [DOI: 10.1016/j.semcdb.2017.07.027] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 01/09/2023]
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14
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Pickles R, Iqbal S, Atherton P, Turnbull H, Mcmenemin R, Walker C, Pilling K, Muller M, Mott J, Mccallum H. 131 Preliminary results of prospective data for patients receiving stereotactic ablative radiotherapy (SABR) for early stage non-small cell lung cancer (NSCLC). Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Pickles R, Iqbal S, Mulvenna P, Mcmenemin R, Kelly E, Atherton P, Turnbull H, Simmons T, Bradshaw A, Mackenzie L, Raven E. 137 10 years of CHART (continuous hyperfractionated accelerated radiotherapy) for non-small cell lung cancer (NSCLC) at NCCC. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Warner E, Krivitsky R, Cone K, Atherton P, Pitre T, Lanpher J, Giuvelis D, Bergquist I, King T, Bilsky EJ, Stevenson GW. Evaluation of a Postoperative Pain-Like State on Motivated Behavior in Rats: Effects of Plantar Incision on Progressive-Ratio Food-Maintained Responding. Drug Dev Res 2015; 76:432-41. [PMID: 26494422 DOI: 10.1002/ddr.21284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 10/03/2015] [Indexed: 01/01/2023]
Abstract
There has been recent interest in characterizing the effects of pain-like states on motivated behaviors in order to quantify how pain modulates goal-directed behavior and the persistence of that behavior. The current set of experiments assessed the effects of an incisional postoperative pain manipulation on food-maintained responding under a progressive-ratio (PR) operant schedule. Independent variables included injury state (plantar incision or anesthesia control) and reinforcer type (grain pellet or sugar pellet); dependent variables were tactile sensory thresholds and response breakpoint. Once responding stabilized on the PR schedule, separate groups of rats received a single ventral hind paw incision or anesthesia (control condition). Incision significantly reduced breakpoints in rats responding for grain, but not sugar. In rats responding for sugar, tactile hypersensitivity recovered within 24 hr, indicating a faster recovery of incision-induced tactile hypersensitivity compared to rats responding for grain, which demonstrated recovery at PD2. The NSAID analgesic, diclofenac (5.6 mg/kg) completely restored incision-depressed PR operant responding and tactile sensitivity at 3 hr following incision. The PR schedule differentiated between sucrose and grain, suggesting that relative reinforcing efficacy may be an important determinant in detecting pain-induced changes in motivated behavior.
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Affiliation(s)
- Emily Warner
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Rebecca Krivitsky
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Katherine Cone
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Phillip Atherton
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Travis Pitre
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Janell Lanpher
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA
| | - Denise Giuvelis
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME, 04005, USA
| | - Ivy Bergquist
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME, 04005, USA
| | - Tamara King
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME, 04005, USA.,Center for Excellence in the Neurosciences, University of New England, ME, 04005, USA
| | - Edward J Bilsky
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME, 04005, USA.,Center for Excellence in the Neurosciences, University of New England, ME, 04005, USA
| | - Glenn W Stevenson
- Department of Psychology, University of New England, Biddeford, ME, 04005, USA.,Center for Excellence in the Neurosciences, University of New England, ME, 04005, USA
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17
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Dueck AC, Singh J, Atherton P, Liu H, Novotny P, Hines S, Loprinzi CL, Perez EA, Tan A, Burger K, Zhao X, Diekmann B, Sloan JA. Endpoint comparison for bone mineral density measurements in North Central Cancer Treatment Group cancer clinical trials N02C1 and N03CC (Alliance). Osteoporos Int 2015; 26:1971-7. [PMID: 25749740 PMCID: PMC4484303 DOI: 10.1007/s00198-015-3091-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Bone mineral density (BMD) measurement can vary depending upon anatomical site, machine, and normative values used. This analysis compared different BMD endpoints in two clinical trials. Trial results differed across endpoints. Future clinical trials should consider inclusion of multiple endpoints in sensitivity analysis to ensure sound overall study conclusions. INTRODUCTION Methodological issues hamper efficacy assessment of osteoporosis prevention agents in cancer survivors. Osteoporosis diagnosis can vary depending upon which bone mineral density (BMD) anatomical site and machine is used and which set of normative values are applied. This analysis compared different endpoints for osteoporosis treatment efficacy assessment in two clinical studies. METHODS Data from North Central Cancer Treatment Group phase III clinical trials N02C1 and N03CC (Alliance) were employed involving 774 patients each comparing two treatments for osteoporosis prevention. Endpoints for three anatomical sites included raw BMD score (RawBMD); raw machine-based, sample-standardized, and reference population-standardized T scores (RawT, TSamp, TRef); and standard normal percentile corresponding to the reference population-standardized T score (TPerc). For each, treatment arm comparison was carried out using three statistical tests using change and percentage change from baseline (CB, %CB) at 1 year. RESULTS Baseline correlations among endpoints ranged from 0.79 to 1.00. RawBMD and TPerc produced more statistically significant results (14 and 19 each out of 36 tests) compared to RawT (11/36), TSamp (8/36), and TRef (7/36). Spine produced the most statistically significant results (26/60) relative to femoral neck (20/60) and total hip (13/60). Lastly, CB resulted in 44 statistically significant results out of 90 tests, whereas %CB resulted in only 15 significant results. CONCLUSIONS Treatment comparisons and interpretations were different across endpoints and anatomical sites. Transforming via sample statistics provided similar results as transforming via reference or machine-based norms. However, RawBMD and TPerc may be more sensitive to change as clinical trial endpoints.
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Affiliation(s)
- A C Dueck
- Alliance Statistics and Data Center, Division of Health Sciences Research, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA,
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Warner E, Krivitsky R, Atherton P, Pitre T, Cone K, Lanpher J, Giuvelis D, Bilsky E, Stevenson G. Effects of Incisional Pain on Food‐Maintained Responding under Progressive Ratio Schedules of Reinforcement. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.616.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Emily Warner
- PsychologyUniversity of New EnglandBiddefordMaineUnited States
| | | | | | - Travis Pitre
- PsychologyUniversity of New EnglandBiddefordMaineUnited States
| | - Katherine Cone
- PsychologyUniversity of New EnglandBiddefordMaineUnited States
| | - Janell Lanpher
- PsychologyUniversity of New EnglandBiddefordMaineUnited States
| | - Denise Giuvelis
- Biomedical SciencesUniversity of New EnglandCollege of MedicineBiddefordMaineUnited States
| | - Edward Bilsky
- Biomedical SciencesUniversity of New EnglandCollege of MedicineBiddefordMaineUnited States
- Center for Excellence in the Neurosciences University of New EnglandBiddefordMaineUnited States
| | - Glenn Stevenson
- PsychologyUniversity of New EnglandBiddefordMaineUnited States
- Center for Excellence in the Neurosciences University of New EnglandBiddefordMaineUnited States
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Stevenson GW, Luginbuhl A, Dunbar C, LaVigne J, Dutra J, Atherton P, Bell B, Cone K, Giuvelis D, Polt R, Streicher JM, Bilsky EJ. The mixed-action delta/mu opioid agonist MMP-2200 does not produce conditioned place preference but does maintain drug self-administration in rats, and induces in vitro markers of tolerance and dependence. Pharmacol Biochem Behav 2015; 132:49-55. [PMID: 25735493 DOI: 10.1016/j.pbb.2015.02.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 09/20/2014] [Revised: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
Previous work in our laboratories provides preclinical evidence that mixed-action delta/mu receptor glycopeptides have equivalent efficacy for treating pain with reduced side effect profiles compared to widely used mu agonist analgesics such as morphine. This study evaluated the rewarding and reinforcing effects of a lead candidate, mixed-action delta/mu agonist MMP-2200, using a conditioned place preference assay as well as a drug self-administration procedure in rats. In place conditioning studies, rats underwent a 2-week conditioning protocol and were then tested for chamber preference. Rats receiving MMP-2200, at previously determined analgesic doses, could not distinguish between the drug and saline-paired chamber, whereas rats receiving the opioid agonist morphine showed a strong preference for the morphine-paired chamber. In self-administration studies, rats were trained to respond for the high efficacy mu opioid receptor agonist fentanyl on an FR5 schedule of reinforcement. Following complete dose-response determinations for fentanyl, a range of doses of MMP-2200 as well as morphine were tested. Relative to the mu agonist morphine, MMP-2200 maintained a significantly lower number of drug infusions. To begin investigating potential molecular mechanisms for the reduced side effect profile of MMP-2200, we also examined βarrestin2 (βarr2) recruitment and chronic MMP-2200 induced cAMP tolerance and super-activation at the human delta and mu receptors in vitro. MMP-2200 efficaciously recruited βarr2 to both receptors, and induced cAMP tolerance and super-activation equivalent to or greater than morphine at both receptors. The in vivo findings suggest that MMP-2200 may be less reinforcing than morphine but may have some abuse potential. The reduced side effect profile cannot be explained by reduced βarr2 recruitment or reduced cAMP tolerance and superactivation at the monomeric receptors in vitro.
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Affiliation(s)
- Glenn W Stevenson
- Department of Psychology, University of New England, Biddeford, ME 04005, United States; Center for Excellence in the Neurosciences, University of New England, United States.
| | - Amy Luginbuhl
- Department of Psychology, University of New England, Biddeford, ME 04005, United States
| | - Catherine Dunbar
- Department of Psychology, University of New England, Biddeford, ME 04005, United States
| | - Justin LaVigne
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME 04005, United States
| | - Julio Dutra
- Department of Psychology, University of New England, Biddeford, ME 04005, United States
| | - Phillip Atherton
- Department of Psychology, University of New England, Biddeford, ME 04005, United States
| | - Brooke Bell
- Department of Psychology, University of New England, Biddeford, ME 04005, United States
| | - Katherine Cone
- Department of Psychology, University of New England, Biddeford, ME 04005, United States
| | - Denise Giuvelis
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME 04005, United States; Center for Excellence in the Neurosciences, University of New England, United States
| | - Robin Polt
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ 85721, United States
| | - John M Streicher
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME 04005, United States; Center for Excellence in the Neurosciences, University of New England, United States
| | - Edward J Bilsky
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME 04005, United States; Center for Excellence in the Neurosciences, University of New England, United States
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Naylor R, Smith K, Blake V, Rankin D, Atherton P, Piercy R. Validation of a Technique for Measuring Muscle Protein Synthesis In Vivoin the Horse. Equine Vet J 2014. [DOI: 10.1111/evj.12323_43] [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: 11/30/2022]
Affiliation(s)
| | - K. Smith
- University of Nottingham; Derby UK
| | - V. Blake
- Royal Veterinary College; London UK
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21
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Tee JH, Mulvenna P, Atherton P. Re-audit of the Use of Unimodality Radiotherapy for Treatment of Oesophageal Cancer. Clin Oncol (R Coll Radiol) 2014. [DOI: 10.1016/j.clon.2014.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Naylor R, Smith K, Rankin D, Blake V, Atherton P, Piercy R. Effect of Sedation and Exercise on Phenylalanine Pharmacokinetics in Horses. Equine Vet J 2014. [DOI: 10.1111/evj.12267_88] [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)
- R Naylor
- Royal Veterinary College; London United Kingdom
| | - K Smith
- University of Nottingham; Derby United Kingdom
| | - D Rankin
- University of Nottingham; Derby United Kingdom
| | - V Blake
- University of Nottingham; Derby United Kingdom
| | - P Atherton
- University of Nottingham; Derby United Kingdom
| | - R Piercy
- Royal Veterinary College; London United Kingdom
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Smith E, Peedell C, McMenemin R, Turnbull H, Atherton P, Mulvenna P. 155 Multi-modality treatment of Pancoast tumours: a review of regional practice. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Hatton M, Hill R, Wilson P, Atherton P, Morgan S, Dickson J, Murray K, Paul J. OC-0566: Continuous Hyperfractionated Accelerated RadioTherapy ñ Escalated Dose (CHART-ED):A Phase I study. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Kagzi M, Pickles R, McFetrich C, Macdonald A, Mulvenna P, McMenemin R, McCallum H, McDonald F, Atherton P. EP-1230 ASSESSING ACUTE RADIATION OESOPHAGITIS AFTER CHART FOR NON-SMALL CELL LUNG CANCER: A SINGLE CENTRE EXPERIENCE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Pickles R, Mulvenna P, McMenemin R, Atherton P, Mcdonald F, Kagzi M, McFetrich C. 144 Prospective data of continuous hyperfractionated accelerated radiotherapy (CHART): does performance status have an impact on radiation acute toxicities and resources? Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70145-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hutchings HA, Wareham K, Baxter JN, Atherton P, Kingham JGC, Duane P, Thomas L, Thomas M, Ch'ng CL, Williams JG. A Randomised, Cross-Over, Placebo-Controlled Study of Aloe vera in Patients with Irritable Bowel Syndrome: Effects on Patient Quality of Life. ISRN Gastroenterol 2010; 2011:206103. [PMID: 21991499 PMCID: PMC3168391 DOI: 10.5402/2011/206103] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 10/04/2010] [Indexed: 11/23/2022]
Abstract
Background. Irritable bowel syndrome (IBS) is a chronic, difficult to treat condition. The efficacy of Aloe vera in treating IBS symptoms is not yet proven. The purpose of this study was to determine if Aloe vera is effective in improving quality of life. Methods. A multicentre, randomised, double-blind, cross-over placebo controlled study design. Patients were randomised to Aloe vera, wash-out, placebo or placebo, washout, Aloe vera. Each preparation (60 mL) was taken orally twice a day. Patient quality of life was measured using the Gastrointestinal Symptoms Rating Score, Irritable Bowel Syndrome Quality of Life, EuroQol and the Short-Form-12 at baseline and treatment periods 1 and 2. Results. A total of 110 patients were randomised, but only 47 completed all questionnaires and both study arms. Statistical analysis showed no difference between the placebo and Aloe vera treatment in quality of life. Discussion. This study was unable to show that Aloe vera was superior to placebo in improving quality of life. Drop outs and other confounding factors may have impacted on the power of the study to detect a clinically important difference. Conclusion. This study failed to find Aloe vera superior to placebo in improving quality of life proven Irritable Bowel Syndrome patients.
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Affiliation(s)
- H. A. Hutchings
- School of Medicine, University of Wales Swansea, Singleton Park, Swansea SA2 8PP, UK
| | - K. Wareham
- Clinical Research Unit, Morriston Hospital, Swansea NHS Trust, Swansea SA66NL, UK
| | - J. N. Baxter
- Morriston Hospital, ABM NHS Trust, Swansea SA66NL, UK
| | - P. Atherton
- Forever Living Products (UK) Ltd, Warwick, W346RB, UK
| | | | - P. Duane
- Morriston Hospital, ABM NHS Trust, Swansea SA66NL, UK
| | - L. Thomas
- Singleton Hospital, ABM NHS Trust, Swansea SA28QA, UK
| | - M. Thomas
- Clinical Research Unit, Morriston Hospital, Swansea NHS Trust, Swansea SA66NL, UK
| | - C. L. Ch'ng
- Singleton Hospital, ABM NHS Trust, Swansea SA28QA, UK
| | - J. G. Williams
- School of Medicine, University of Wales Swansea, Singleton Park, Swansea SA2 8PP, UK
- Neath Port Talbot Hospital, ABM NHS Trust, Port Talbot SA127BX, UK
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Watt KI, Jaspers RT, Atherton P, Smith K, Rennie MJ, Ratkevicius A, Wackerhage H. SB431542 treatment promotes the hypertrophy of skeletal muscle fibers but decreases specific force. Muscle Nerve 2010; 41:624-9. [DOI: 10.1002/mus.21573] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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29
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Nyasavajjala S, Srinath C, Liptrot S, Selby A, Rankin D, Atherton P, Smith K, Williams J, Lund J, Singh R, Rennie M. Depression of Muscle Protein Synthesis (MPS) with no Evidence of Elevated Muscle Protein Breakdown (MPB) Precedes Minor Muscle Wasting in Early Colorectal Cancer. Int J Surg 2010. [DOI: 10.1016/j.ijsu.2010.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Hines S, Sloan J, Atherton P, Perez E, Dakhil S, Johnson D, Reddy P, Dalton R, Mattar B, Loprinzi C. Zoledronic Acid for Treatment of Osteopenia and Osteoporosis in Women with Primary Breast Cancer (BC) Undergoing Adjuvant Aromatase Inhibitor (AI) Therapy. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Postmenopausal women with significant osteopenia/osteoporosis are at increased risk of fracture, a risk that is exacerbated by the use of Aromatase Inhibitors (AIs). Bisphosphonates may be used for these patients because there is no known interaction with estrogen and/or progesterone receptors (ER, PR). This study evaluated the concurrent use of zoledronic acid in patients with significant osteopenia or osteoporosis who received initial adjuvant letrozole therapy for primary BC, to determine if further bone mineral density (BMD) loss could be prevented.Methods: Postmenopausal women with Stage I-IIIa, ER and/or PR + BC, no evidence of metastatic disease, and a BMD T-score < -2.0 were treated with daily letrozole 2.5 mg/d, vitamin D 400 international units/d, calcium 500 mg twice daily, and 4 mg I.V. zoledronic acid every 6 months (for 5 years). The BMD was measured at baseline and at one year. Kruskall-Wallis p-value methodology was used as the method of statistical analysis. Since this was a single-arm study, the analysis plan was primarily descriptive. The primary endpoint was the mean change in lumbar spine (LS) BMD at 1 year.Results: 60 patients were enrolled; 46 completed 1 year of treatment. Mean patient age was 67 years, with 44% having taken prior tamoxifen. At 1 year (see figure 1), LS BMD increased 2.66% (p=0.01), femoral neck (FN) BMD increased 4.81% (p=0.01), and any measured endpoint (within the LS or FN) increased 4.55% (p=0.0052). 7% of patients experienced a fracture vs.13% with a pre-existing history of fracture before enrollment. No patients had disease recurrence during year 1. Toxicity was minimal with arthralgia as the most common complaint. There were no reports of osteonecrosis of the jaw.Conclusion: Zoledronic acid prevents additional bone loss in postmenopausal women with significant osteopenia or osteoporosis initiating letrozole. Treatment with zoledronic acid was associated with an improvement in BMD.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2103.
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Affiliation(s)
| | | | | | | | - S. Dakhil
- 3 Wichita Community Clinical Oncology, KS,
| | - D. Johnson
- 3 Wichita Community Clinical Oncology, KS,
| | - P. Reddy
- 3 Wichita Community Clinical Oncology, KS,
| | - R. Dalton
- 4 Immanuel-St. Joseph Hospital Mayo Health System, MN,
| | - B. Mattar
- 3 Wichita Community Clinical Oncology, KS,
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Rennie MJ, Selby A, Atherton P, Smith K, Kumar V, Glover EL, Philips SM. Facts, noise and wishful thinking: muscle protein turnover in aging and human disuse atrophy. Scand J Med Sci Sports 2009; 20:5-9. [PMID: 19558380 DOI: 10.1111/j.1600-0838.2009.00967.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surprisingly little is known about the mechanisms of muscle atrophy with aging and disuse in human beings, in contrast to rodents, from which much has been extrapolated to explain the human condition. However, this extrapolation is likely unwarranted because the time course, extent of wasting, muscle fiber involvement and alterations of muscle protein turnover are all quite different in rodent and human muscle. Furthermore, there is little evidence that static indices of protein turnover represent dynamic changes and may be misleading. With disuse there are reductions in the rate of muscle protein synthesis (MPS) large enough to explain the atrophic loss of muscle protein without a concomitant increase in proteolysis. In aging, there is no evidence that there are marked alterations in basal muscle protein turnover in healthy individuals but instead the ability to maintain muscle after feeding is compromised. This anabolic resistance is evident with physical inactivity, which exacerbates the inability to maintain muscle mass with aging. The main conclusion of this review is that in uncomplicated, non-inflammatory disuse atrophy, the facilitative change causing loss of muscle mass is a depression of MPS, exacerbated by anabolic resistance during feeding, with possible adaptive depressions, rather than increases, of muscle proteolysis.
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Affiliation(s)
- M J Rennie
- School of Graduate Entry Medicine and Health, City Hospital, University of Nottingham, Derby, UK.
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Pearson M, Atherton P, McMenemin R, McDonald F, Mazdai G, Mulvenna P, Lambert G. The Implementation of an Advanced Treatment Planning Algorithm in the Treatment of Lung Cancer with Conventional Radiotherapy. Clin Oncol (R Coll Radiol) 2009; 21:168-74. [DOI: 10.1016/j.clon.2008.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 10/20/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
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Greenhaff PL, Karagounis LG, Peirce N, Simpson EJ, Hazell M, Layfield R, Wackerhage H, Smith K, Atherton P, Selby A, Rennie MJ. Disassociation between the effects of amino acids and insulin on signaling, ubiquitin ligases, and protein turnover in human muscle. Am J Physiol Endocrinol Metab 2008; 295:E595-604. [PMID: 18577697 PMCID: PMC2536736 DOI: 10.1152/ajpendo.90411.2008] [Citation(s) in RCA: 350] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 06/21/2008] [Indexed: 01/07/2023]
Abstract
We determined the effects of intravenous infusion of amino acids (AA) at serum insulin of 5, 30, 72, and 167 mU/l on anabolic signaling, expression of ubiquitin-proteasome components, and protein turnover in muscles of healthy young men. Tripling AA availability at 5 mU/l insulin doubled incorporation of [1-(13)C]leucine [i.e., muscle protein synthesis (MPS), P < 0.01] without affecting the rate of leg protein breakdown (LPB; appearance of d(5)-phenylalanine). While keeping AA availability constant, increasing insulin to 30 mU/l halved LPB (P < 0.05) without further inhibition at higher doses, whereas rates of MPS were identical to that at 5 mU/l insulin. The phosphorylation of PKB Ser(473) and p70(S6k) Thr(389) increased concomitantly with insulin, but whereas raising insulin to 30 mU/l increased the phosphorylation of mTOR Ser(2448), 4E-BP1 Thr(37/46), or GSK3beta Ser(9) and decreased that of eEF2 Thr(56), higher insulin doses to 72 and 167 mU/l did not augment these latter responses. MAFbx and proteasome C2 subunit proteins declined as insulin increased, with MuRF-1 expression largely unchanged. Thus increasing AA and insulin availability causes changes in anabolic signaling and amounts of enzymes of the ubiquitin-proteasome pathway, which cannot be easily reconciled with observed effects on MPS or LPB.
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Affiliation(s)
- P L Greenhaff
- Centre for Integrated Systems Biology and Medicine, Univ. of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.
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Klapper R, Mulvenna P, Mazdai G, McMenemin R, Atherton P, Mcdonald F. Results of a prospective database and a patient satisfaction survey, in the delivery of continuous hyperfractionated accelerated radiotherapy (CHART). Lung Cancer 2008. [DOI: 10.1016/s0169-5002(08)70086-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sloan JA, Huschka M, Atherton P, Degner LF, Hack T, Smith T, Rummans T, Clark M. What role do cancer patients want to play in treatment decision making: A pooled-analysis. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8521 Background: The extent of patient involvement in the decision making process for cancer treatment can impact satisfaction with care. A pooled-analysis of clinical studies from the US and Canada incorporating the Control Preferences Scale (CPS) was conducted to produce normalized data regarding patient preferences and examine differences in role preference related to country, tumor type, gender and other demographics. Methods: Patient data culled from six trials indicated the treatment decision making role preferred and the role actually experienced clinically. Fisher’s Exact Tests were performed to compare role distribution concordance and association with clinical and demographic variables. Results: Data available for 3,491 patients indicated that 25% preferred an active role, 46% a collaborative role, and 29% a passive role in their medical treatment decision making. In terms of actual experience, 30% of patients reported taking on an active role, 34% collaborative, and 36% passive. Overall, 61% of patients reported playing the role they prefer. Differences between genders in the preferred role were slight, but males achieved their preferred role more often than females (66% vs. 60%, p=0.011). More women actually took a passive role than men (40% vs. 24%, p<0.0001) as did more patients in the US than Canada (84% vs. 54%, p<0.001). Canadian patients preferred more passive than active roles (33% vs 22.4%) and US patients preferred more active to passive roles (31.9% vs 14.2%) (p<0.001). Older patients preferred a more passive role and took on that role. Differences in role preference across tumor types were negligible. Conclusions: Roughly one half of the cancer patients studied indicated that they preferred to have a collaborative relationship with physicians, the remaining patients split equally between an active and passive role. The US cohort seemed to want to be more assertive than their Canadian counterparts and women ended up playing a more passive role than they preferred. Given these gender and cross-county differences these findings highlight the need for individualized patient communication styles to be incorporated into treatment plans No significant financial relationships to disclose.
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Affiliation(s)
- J. A. Sloan
- Mayo Clinic, Rochester, MN; University of Manitoba, Winnipeg, MB, Canada; American Cancer Society, Atlanta, GA
| | - M. Huschka
- Mayo Clinic, Rochester, MN; University of Manitoba, Winnipeg, MB, Canada; American Cancer Society, Atlanta, GA
| | - P. Atherton
- Mayo Clinic, Rochester, MN; University of Manitoba, Winnipeg, MB, Canada; American Cancer Society, Atlanta, GA
| | - L. F. Degner
- Mayo Clinic, Rochester, MN; University of Manitoba, Winnipeg, MB, Canada; American Cancer Society, Atlanta, GA
| | - T. Hack
- Mayo Clinic, Rochester, MN; University of Manitoba, Winnipeg, MB, Canada; American Cancer Society, Atlanta, GA
| | - T. Smith
- Mayo Clinic, Rochester, MN; University of Manitoba, Winnipeg, MB, Canada; American Cancer Society, Atlanta, GA
| | - T. Rummans
- Mayo Clinic, Rochester, MN; University of Manitoba, Winnipeg, MB, Canada; American Cancer Society, Atlanta, GA
| | - M. Clark
- Mayo Clinic, Rochester, MN; University of Manitoba, Winnipeg, MB, Canada; American Cancer Society, Atlanta, GA
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Barton DL, Loprinzi C, Wender D, Dalton R, Balcueva E, Atherton P, Bernath A, Dekrey W, Larson T, Bearden J, Sloan J. Transdermal testosterone in female cancer survivors with decreased libido. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8507 Background: Problems with sexual functioning are an issue negatively affecting the quality of life of female cancer survivors. Testosterone has been implicated as an important hormone in sexual functioning such as libido. Studies of transdermal testosterone have shown benefit in enhancing libido in women who have been diagnosed with hypoactive sexual desire disorder after bilateral oophorectomy. This phase III placebo-controlled clinical trial evaluated whether transdermal testosterone would increase libido in female cancer survivors. Methods: Women with a history of cancer, currently without evidence of disease, were eligible if they reported a decrease in sexual desire and had a sexual partner. Women must have been postmenopausal. Eligible women were randomized to receive 2% testosterone in Vanicream (10 mg daily) versus placebo Vanicream for four weeks, then crossed over to the opposite treatment. The primary endpoint, libido, was measured via the desire subscales of the Changes in Sexual Functioning Questionnaire (CSFQ), which were completed at baseline and at the end of 4 and 8 weeks of treatment. The primary endpoint was the average intra-patient change from baseline to four weeks in the CSFQ subscales between the two arms. A total of 64 patients per group were needed to provide 80% power to detect a difference of 8 units between the treatment means. Two-sided alternative hypothesis testing and a 5% Type I error rate were used. Results: One hundred fifty women were enrolled onto this study. Complete data were available for 132 women. For those on active testosterone cream, serum bioavailable testosterone levels increased significantly over placebo, with a mean change from baseline of 12 and 10 ng/dl for the first and second period, respectively (p<.0001). The average intra-patient change from baseline to week 4 in libido was 5.5 on testosterone and 4.4 on placebo (p=0.58). No carryover effect was detected. The difference in average intra-patient changes from baseline for the entire crossover design between the two arms was only 1.1 points (95% confidence interval of -1.2 to 3.4, p=0.35). Conclusion: Testosterone is not a panacea for libido troubles in women with a history of cancer. Further studies are needed to determine whether there is a role for transdermal testosterone in this population. No significant financial relationships to disclose.
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Affiliation(s)
- D. L. Barton
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
| | - C. Loprinzi
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
| | - D. Wender
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
| | - R. Dalton
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
| | - E. Balcueva
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
| | - P. Atherton
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
| | - A. Bernath
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
| | - W. Dekrey
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
| | - T. Larson
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
| | - J. Bearden
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
| | - J. Sloan
- Mayo Clinic College of Medicine, Rochester, MN; Siouxland Regional Cancer Center, Sioux City, IA; Duluth Clinic, Duluth, MN; Seton Cancer Institute, Saginaw, MI; Geisinger Medical Center, Danville, PA; Altru Cancer Center, Grand Forks, ND; Metro-Minnesota CCOP, St. Louis Park, MN; Upstate Carolina CCOP, Spartanburg, SC
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Dueck A, Atherton P, Tan A, Sloan J. How much missing data is too much? A single study exploration. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6116 Background: Analyses of patient-reported outcomes rely on the dependability of patients to complete and submit assessments in a timely manner – not all data is obtained. In recent work focusing on quality of life (QOL) data and imputation, it has been found that most methods do not alter study results. But how much data can be missing before study results are affected? Methods: Missing data was investigated using a 2-arm study (109 patients) who completed Linear Analogue Self Assessments at 4 intervals. Patients (11%) had missing data at the second interval. Existing data was analysed for differences in scores between arms, then cases were randomly deleted to create increasing percentages (12%-20%) of missing data. Ten simulations were conducted per percent. Imputation methods applied were carrying forward the last value (LVCF), average value (AVCF), and maximum value (MVCF). Student’s t-tests were performed between arms for each simulation. Results: Imputation did not alter results of our study data which was statistically significant (SS) between arms for overall QOL (p=0.036) and spiritual well-being (SWB) (p=0.006), and not statistically significant (NS) for mental well-being (MWB) (p=0.174). After data deletion and t-test calculations, AVCF did not impact results. For overall QOL, data deletion changed the p-value to NS in 1 of 10 simulations starting at 12% missing data and 5 of 10 simulations starting at 16% missing data. No matter what percentage of missing data, imputation produced a SS p-value over 80% of the time. Data deletion and subsequent imputation did not affect the study decision for SWB. For MWB, all differences between arms were NS prior to imputation. After imputation, there was at most a 7% disagreement in conclusions. LVCF and MVCF performed equally in all simulations. Conclusions: For this particular study, when p-values are close to the study-defined alpha, the increase in missing data can change the study results and imputation methods are more likely to determine SS differences. The further the p-values are from the study alpha, there is little effect from increasing missing data or applying imputation. These results are for one particular study and further research is needed. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - A. Tan
- Mayo Clinic, Rochester, MN
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Galanis E, Okuno SH, Nascimento AG, Lewis BD, Lee RA, Oliveira AM, Sloan JA, Atherton P, Edmonson JH, Erlichman C, Randlev B, Wang Q, Freeman S, Rubin J. Phase I-II trial of ONYX-015 in combination with MAP chemotherapy in patients with advanced sarcomas. Gene Ther 2005; 12:437-45. [PMID: 15647767 DOI: 10.1038/sj.gt.3302436] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
ONYX-015 is a provisionally replication competent adenovirus with oncolytic activity in cells with malfunctioning p53. Sarcomas represent a rational target for this approach given the high frequency of p53 mutations (40-75%) and MDM-2 amplification (10-30%). We, therefore, undertook a phase I/II study of ONYX-015, days 1-5 every month administered intratumorally under radiographic guidance, in combination with MAP (mitomycin-C, doxorubicin, cisplatin) chemotherapy in patients with advanced sarcoma. Six patients were treated. Injected lesions included liver metastases in four patients and chest wall metastases in two patients. Sarcoma histologies were gastrointestinal stromal tumors (GIST, two patients), leiomyosarcoma (two patients), liposarcoma (one patient), and malignant peripheral nerve sheath tumor (1 patient). Dose escalation was performed from 10(9) plaque forming units (PFU)/dose (total dose of 5 x 10(9) PFU/cycle) to 10(10) PFU/dose (total dose of 5 x 10(10) PFU/cycle) without dose-limiting toxicity being encountered. Immunohistochemistry of the metastatic lesions prior to treatment showed that five out of six patients were positive for p53, while two patients also had mdm-2 overexpression. Adenoviral replication was detected in two out of six patient biopsies on day 5 of the first cycle, by in situ hybridization (ISH). Both patients were treated at the highest dose level. ONYX-015 viral DNA was detected by quantitative PCR in the plasma of 5/6 patients on day 5 of the first cycle, and up to day 12 (7 days after the last viral dose) in one patient who had extended sampling for viral kinetics performed, suggesting viral replication in sarcoma tissue. One patient with p53 mutation and MDM-2 amplification achieved a partial response to treatment that lasted 11 months. In conclusion, intratumoral administration of ONYX-015 in combination with MAP chemotherapy is well tolerated with no significant toxicity due to ONYX-015 being encountered. Detection of viral DNA in post treatment tumor specimens by ISH and detection of the ONYX-015 genome in the peripheral blood by quantitative PCR, up to 7 days after the last viral dose provide evidence for adenoviral replication. There was evidence of antitumor activity in one out of six patients. Further investigation of this approach in patients with recurrent sarcomas is warranted.
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Affiliation(s)
- E Galanis
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
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Goldberg RM, Kaufmann SH, Atherton P, Sloan JA, Adjei AA, Pitot HC, Alberts SR, Rubin J, Miller LL, Erlichman C. A phase I study of sequential irinotecan and 5-fluorouracil/leucovorin. Ann Oncol 2002; 13:1674-80. [PMID: 12377659 DOI: 10.1093/annonc/mdf260] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Irinotecan (CPT-11) and 5-fluorouracil (5-FU)/leucovorin are active agents in colorectal cancer. A sequence-dependent synergism of SN-38 followed by 5-FU/leucovorin in vitro led us to conduct a phase I trial of CPT-11 followed by 5-FU/leucovorin to determine the maximum tolerated dose (MTD) and toxicities of this regimen and to obtain preliminary indications of its activity in patients with advanced solid tumors. PATIENTS AND METHODS Fifty-six patients were enrolled in sequential cohorts to receive escalating doses of CPT-11 (90 min infusion) on day 1, followed by leucovorin 20 mg/m(2) (intravenous push) and 5-FU (90 min infusion) on days 2-5 of each 21-day cycle. RESULTS A total of 347 treatment cycles (median 4, range 1-25) were administered. Dose-limiting toxicities were diarrhea, neutropenia and fatigue. Nine patients with colorectal cancer and one with gastric cancer had partial or minor responses. Eight of the 10 had prior chemotherapy. CONCLUSIONS CPT-11 and 5-FU/leucovorin, as constituents of this novel mechanism-based schedule, have promising activity in patients who have received prior chemotherapy. The recommended phase II/III starting doses are CPT-11 275 mg/m(2) over 90 min on day 1, and 5-FU 400 mg/m(2) plus leucovorin 20 mg/m(2) on days 2-5 every 21 days. This combination can be administered safely to this schedule if there is strict adherence to the 90 min infusion time for both CPT-11 and 5-FU.
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Affiliation(s)
- R M Goldberg
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
PURPOSE We developed limited sampling models (LSMs) for predicting the area under the curve (AUC) of irinotecan (CPT-11) and its metabolites SN-38 and SN-38 glucuronide (SN-38G). PATIENTS AND METHODS Regression models were developed based on data from a phase I clinical trial involving 34 patients with advanced solid tumor malignancies who received CPT-11 as a 90-min infusion on an every 3-week dosing schedule. Multiple stepwise regression procedures were supplemented by all possible subsets regression analysis. Alternative clinically based and empirically derived LSMs were determined via model validation assessment including bootstrap simulation testing. RESULTS The best LSMs for CPT-11 AUC included concentrations recorded at the end of infusion and 4 h later with an option to include a blood draw at 7.5 h from infusion start. For SN-38 and SN-38G AUC, optimal LSMs included the additional metabolite concentration at 48 h after infusion. The LSMs were able to predict most patient AUC values to within 10% of the true value. CONCLUSION CPT-11 AUC can be modeled with acceptable accuracy using only two or three plasma concentration time-points. A variety of LSM alternatives provided comparable accuracy in predicting AUC. Given the wide variety of LSM alternatives, clinical considerations and patient burden become more important performance parameters than statistical considerations for the choice of time-points in constructing LSMs.
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Affiliation(s)
- J A Sloan
- Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
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Galanis E, Goldberg R, Reid J, Atherton P, Sloan J, Pitot H, Rubin J, Adjei AA, Burch P, Safgren SL, Witzig TE, Ames MM, Erlichman C. Phase I trial of sequential administration of raltitrexed (Tomudex) and 5-iodo-2'-deoxyuridine (IdUrd). Ann Oncol 2001; 12:701-7. [PMID: 11432631 DOI: 10.1023/a:1011182123545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Raltitrexed (Tomudex) is a specific inhibitor of thymidylate synthase with clinical activity in colorectal cancer. The combination of raltitrexed and 5-iodo-2'-deoxyuridine (IdUrd, a cytotoxic pyrimidine analog) resulted in increased IdUrd incorporation into DNA and exhibited in vitro synergism against colon and bladder human carcinoma cell lines. We designed a phase I trial to determine the MTD, pharmacokinetics, and biologic effects of escalating doses of the combination of IdUrd given as a 24-hour infusion after a raltitrexed 15-minute infusion every three weeks. Thirty-four patients received 95 courses of raltitrexed and IdUrd at doses ranging from raltitrexed 1 mg/m2 and IdUrd 750 mg/m2 to raltitrexed 2.5 mg/m2 and IdUrd 10,400 mg/m2. The median number of cycles administered was 2 (range 1-10). Dose limiting hematologic toxicity occurred at doses of raltitrexed 2.5 mg/m2 and IdUrd 10,400 mg/m2. In addition, we determined the mean plasma concentrations C(SS) of IdUrd, the iodouracil level at 22 hours and the IdUrd clearance. Raltitrexed did not appear to affect the pharmacokinetics of IdUrd in the dose range tested. The recommended phase II dose is raltitrexed 2 mg/m2 and IdUrd 10,400 mg/m2 repeated every three weeks. Evidence of potential antitumor activity was observed: 1 patient (with colon cancer) had a partial response while 15 others had stable disease.
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Affiliation(s)
- E Galanis
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Adjei AA, Erlichman C, Sloan JA, Reid JM, Pitot HC, Goldberg RM, Peethambaram P, Atherton P, Hanson LJ, Alberts SR, Jett J. Phase I and pharmacologic study of sequences of gemcitabine and the multitargeted antifolate agent in patients with advanced solid tumors. J Clin Oncol 2000; 18:1748-57. [PMID: 10764436 DOI: 10.1200/jco.2000.18.8.1748] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Multitargeted antifolate (MTA) is an investigational agent that, like gemcitabine, exhibits broad activity in solid tumors. A phase I trial of MTA and gemcitabine was undertaken, based on the demonstration of preclinical cytotoxic synergy. PATIENTS AND METHODS Thirty-five patients (group I) received 164 courses (median, four; range, one to 14 courses) of treatment of gemcitabine at doses of 1,000 and 1,250 mg/m(2) on days 1 and 8 and MTA at doses of 200, 300, 400, 500, and 600 mg/m(2), given 90 minutes after gemcitabine on day 1. Courses were repeated every 3 weeks. Because the day 8 dose of gemcitabine was reduced or omitted in 57% of courses due to neutropenia, 21 patients (group II) were treated on an alternate schedule, with MTA administered on day 8 rather than day 1. This group received 85 treatment courses (median, four; range, one to 10 courses). RESULTS The most common and dose-limiting toxicity was neutropenia. Other toxicities included nausea, fatigue, rash, and elevated hepatic transaminases. The maximum-tolerated dose was gemcitabine/MTA 1,000/500 mg/m(2) for group I and 1,250/500 mg/m(2) for group II. Thirteen objective responses were documented (colorectal cancer, n = 3; non-small-cell lung cancer, n = 3; cholangiocarcinoma, n = 2; ovarian carcinoma, n = 2; mesothelioma, n = 1; breast cancer, n = 1; and adenocarcinoma of unknown primary site, n = 1). Gemcitabine had no effect on the disposition of MTA. CONCLUSION The gemcitabine/MTA combination is broadly active and warrants further evaluation. The sequence of gemcitabine administered on days 1 and 8 with MTA administered on day 8 is better tolerated and is recommended for further study at doses of gemcitabine/MTA 1,250/500 mg/m(2).
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Affiliation(s)
- A A Adjei
- Department of Oncology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
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Adjei AA, Erlichman C, Davis JN, Cutler DL, Sloan JA, Marks RS, Hanson LJ, Svingen PA, Atherton P, Bishop WR, Kirschmeier P, Kaufmann SH. A Phase I trial of the farnesyl transferase inhibitor SCH66336: evidence for biological and clinical activity. Cancer Res 2000; 60:1871-7. [PMID: 10766174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Farnesyl protein transferase (FT), an enzyme that catalyzes the first step in the posttranslational modification of ras and a number of other polypeptides, has emerged as an important target for the development of anticancer agents. SCH66336 is one of the first FT inhibitors to undergo clinical testing. We report a Phase I trial to assess the maximum tolerated dose, toxicities, and biological effectiveness of SCH66336 in inhibiting FT in vivo. Twenty patients with solid tumors received 92 courses of escalating SCH66336 doses given orally twice a day (b.i.d.) for 7 days out of every 3 weeks. Gastrointestinal toxicity (nausea, vomiting, and diarrhea) and fatigue were dose-limiting at 400 mg of SCH66336 b.i.d. Moderate reversible renal insufficiency, secondary to dehydration from gastrointestinal toxicity, was also seen. Inhibition of prelamin A farnesylation in buccal mucosa cells of patients treated with SCH66336 was demonstrated, confirming that SCH66336 inhibits protein farnesylation in vivo. One partial response was observed in a patient with previously treated metastatic non-small cell lung cancer, who remained on study for 14 months. This study not only establishes the dose for future testing on this schedule (350 mg b.i.d.) but also provides the first evidence of successful inhibition of FT in the clinical setting and the first hint of clinical activity for this class of agents.
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Affiliation(s)
- A A Adjei
- Department of Oncology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Adjei AA, Klein CE, Kastrissios H, Goldberg RM, Alberts SR, Pitot HC, Sloan JA, Reid JM, Hanson LJ, Atherton P, Rubin J, Erlichman C. Phase I and pharmacokinetic study of irinotecan and docetaxel in patients with advanced solid tumors: preliminary evidence of clinical activity. J Clin Oncol 2000; 18:1116-23. [PMID: 10694565 DOI: 10.1200/jco.2000.18.5.1116] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The goals of this study were to determine the maximum-tolerated dose and describe the toxicities of the combination of irinotecan and docetaxel administered every 3 weeks to patients with advanced malignancies and, also, to evaluate the effect of irinotecan on the disposition of docetaxel and describe preliminary evidence of antitumor activity. PATIENTS AND METHODS Eighteen patients received 85 courses (median, two courses; range, one to 15 courses) of treatment with irinotecan, administered over 90 minutes by intravenous infusion, followed by docetaxel, administered over 60 minutes by intravenous infusion. Four escalating dose levels of irinotecan/docetaxel (160/50 mg/m(2), 160/65 mg/m(2), 200/65 mg/m(2), and 200/75 mg/m(2)) were studied. Pharmacokinetic analyses were performed to evaluate the effect of irinotecan on the disposition of docetaxel. RESULTS The most common and dose-limiting toxicity was myelosuppression, which consisted of neutropenia that was severe (National Cancer Institute common toxicity criteria [NCI CTC] grade 4) but brief (< 5 days) in 11 patients, with three episodes of febrile neutropenia. Nonhematologic toxicities of anorexia, nausea, and stomatitis were mild to moderate (NCI CTC grades 1 and 2), but there was one incidence each of both CTC grade 3 anorexia and nausea. All patients had total alopecia. Diarrhea was dose-dependent and severe in four patients who failed to take adequate antidiarrhea therapy. Five out of 16 assessable patients, one with cholangiocarcinoma, one with leiomyosarcoma, and three with non-small-cell lung cancer, achieved partial remissions. CONCLUSION The combination of irinotecan and docetaxel causes significant reversible myelosuppression, which was dose limiting but led to no serious sequelae. There was no evidence of a clinically significant interaction using these two agents in this sequence. The combination showed antitumor activity at all the dose levels tested and should be further studied in a number of tumor types. The recommended phase II dose on this schedule is irinotecan 160 mg/m(2) and docetaxel 65 mg/m(2).
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Affiliation(s)
- A A Adjei
- Department of Oncology, Mayo Clinic and Foundation, Rochester, MN, USA.
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Abstract
Some recent studies appear to show topical and orally administered aloe vera preparations in patients with chronic venous leg ulcers may aid healing. Despite encouraging results, in the absence of larger research studies, the author cautions against generalisation of this complementary treatment.
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Abstract
It remains common practice to treat skin lesions overlying cartilage with electrons, apparently because of an assumption that radiation absorption qualities of non-calcified cartilage are similar to those of bone. We present data based on tissue composition and calculated mass absorption coefficients, supporting the view that such lesions may safely be treated with superficial X-rays.
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Affiliation(s)
- P Atherton
- Department of Oncology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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Abstract
OBJECTIVE To report a case of an unusual worm infestation of the eye. CLINICAL FEATURES A 28-year-old veterinary surgeon complained of the intermittent appearance of a worm in her eyes. Her previous camping travels in west and central Africa suggested the diagnosis of Loa loa, which was confirmed on surgical removal of the worm from beneath the conjunctiva. Laboratory investigations showed peripheral blood eosinophilia, negative thick blood film examinations for microfilariae and positive results of filarial serology. INTERVENTION AND OUTCOME The worm was removed intact after incision of the overlying conjunctiva. Diethylcarbamazine was prescribed and the patient remained asymptomatic in the subsequent 12 months. CONCLUSIONS The sighting of a worm in the eye is rare in Australia and usually occurs in immigrants or returned travellers. Loa loa is the most common offending species and is identifiable and treatable.
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Atherton P, Buxton J, Honigsberger L, Mould J. Drug-induced encephalopathy after previous ifosfamide treatment. Lancet 1988; 2:1084. [PMID: 2460709 DOI: 10.1016/s0140-6736(88)90108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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