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Keohane CR, Westby D, Twyford M, Ahern T, Tawfick W, Walsh SR. Axial ablation versus terminal interruption of the reflux source (AAVTIRS): a randomised controlled trial. Trials 2022; 23:483. [PMID: 35689289 PMCID: PMC9188187 DOI: 10.1186/s13063-022-06440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of superficial venous reflux has been shown to improve ulcer healing time and reduce the risk of ulcer recurrence. Terminal ablation of the reflux source (TIRS) is an alternative to formal endovenous ablation or surgery which can be performed by injecting sclerosant foam into the peri-ulcer plexus of the veins. TIRS has been shown to be successful and in our experience is the option preferred by many patients, when offered as an alternative to axial ablation (AA). AIM To determine if the proportion of ulcers healed within 6 months of endovenous treatment differs between patients undergoing AA of varicose veins or TIRS by peri-ulcer foam sclerotherapy. METHODS AAVTIRS is an assessor-blinded randomised controlled trial. Patients will be recruited from a dedicated ulcer clinic in Roscommon University Hospital and from the vascular surgical clinics in University Hospital Galway. All patients attending the ulcer clinic will be screened for eligibility. RANDOMISATION Random computer-generated sequence is stratified by ulcer size. Allocation will be concealed using sealed opaque envelopes. BLINDING Assessors reviewing wounds at follow -p visits will be blinded to patient allocation. PRIMARY ENDPOINT The proportion of ulcers healed within 6 months of enrolment. DISCUSSION This will be the first time that TIRS has been evaluated with a properly powered randomised trial in the setting of venous ulcer management. Streamlining the management of venous ulcers has broad health economic benefits. If it is found that TIRS is superior or non-inferior to AA, then a less expensive, less invasive injection can be offered as an alternative to AA in an attempt to encourage the healing of venous ulcers. If AA is found to be superior to TIRS, then this would suggest that all patients undergoing ablation in the management of venous ulcers should have their superficial reflux fully treated, building on the evidence of the EVRA trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04484168. Registered on 23 July 2020.
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Affiliation(s)
- C R Keohane
- University Hospital Galway, Galway, Ireland. .,National University of Ireland Galway, Galway, Ireland.
| | - D Westby
- Roscommon University Hospital, Roscommon, Ireland.,National University of Ireland Galway, Galway, Ireland
| | - M Twyford
- University Hospital Galway, Galway, Ireland.,National University of Ireland Galway, Galway, Ireland
| | - T Ahern
- University Hospital Galway, Galway, Ireland.,National University of Ireland Galway, Galway, Ireland
| | - W Tawfick
- University Hospital Galway, Galway, Ireland.,National University of Ireland Galway, Galway, Ireland
| | - S R Walsh
- University Hospital Galway, Galway, Ireland.,Lambe Institute for Translational Research, National University of Ireland Galway, Newcastle Rd, Galway, Ireland
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Newman C, Egan AM, Ahern T, Al-Kiyumi M, Balan G, Brassill MJ, Brosnan E, Carmody L, Clarke H, Coogan Kelly C, Culliney L, Davern R, Durkan M, Fenlon M, Ferry P, Hanlon G, Higgins T, Hoashi S, Khamis A, Kinsley B, Kirwan B, Kyithar P, Liew A, Matthews L, McGurk C, McHugh C, Murphy MS, Murphy P, Nagodra D, Noctor E, Nolan M, O'Connor E, O'Halloran D, O'Mahoney L, O'Sullivan E, Peters M, Roberts G, Rooney H, Smyth A, Tarachand B, Todd M, Tuthill A, Wan Mahmood WA, Yousif O, Dunne FP. Diabetes care and pregnancy outcomes for women with pregestational diabetes in Ireland. Diabetes Res Clin Pract 2021; 173:108685. [PMID: 33548336 DOI: 10.1016/j.diabres.2021.108685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
AIMS Pre-gestational diabetes mellitus (PGDM) is associated with adverse outcomes. We aimed to examine pregnancies affected by PGDM; report on these pregnancy outcomes and compare outcomes for patients with type 1 versus type 2 diabetes mellitus; compare our findings to published Irish and United Kingdom (UK) data and identify potential areas for improvement. METHODS Between 2016 and 2018 information on 679 pregnancies from 415 women with type 1 Diabetes Mellitus and 244 women with type 2 diabetes was analysed. Data was collected on maternal characteristics; pregnancy preparation; glycaemic control; pregnancy related complications; foetal and maternal outcomes; unscheduled hospitalisations; congenital anomalies and perinatal deaths. RESULTS Only 15.9% of women were adequately prepared for pregnancy. Significant deficits were identified in availability and attendance at pre-pregnancy clinic, use of folic acid, attaining appropriate glycaemic targets and appropriate retinal screening. The majority of pregnancies (n = 567, 83.5%) resulted in a live birth but the large number of infants born large for gestational age (LGA) (n = 280, 49.4%), born prematurely <37 weeks and requiring neonatal intensive care unit (NICU) admission continue to be significant issues. CONCLUSIONS This retrospective cohort study identifies multiple targets for improvements in the provision of care to women with pre-gestational DM which are likely to translate into better pregnancy outcomes.
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Affiliation(s)
- C Newman
- Galway University Hospital, Galway, Ireland.
| | - A M Egan
- Division of Endocrinology Mayo Clinic, Rochester, United States
| | - T Ahern
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
| | - M Al-Kiyumi
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - G Balan
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - M J Brassill
- South Tipperary General Hospital, Clonmel, Co Tipperary, Ireland
| | - E Brosnan
- Mayo University Hospital, Castlebar, Co Mayo, Ireland
| | - L Carmody
- Galway University Hospital, Galway, Ireland
| | - H Clarke
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - C Coogan Kelly
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - L Culliney
- Cork University Hospital, Cork, Co Cork, Ireland
| | - R Davern
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - M Durkan
- Bons Secours Hospital, Cork, Co Cork, Ireland
| | - M Fenlon
- Wexford General Hospital, Co Wexford, Ireland
| | - P Ferry
- Letterkenny General Hospital, Letterkenny, Co Donegal, Ireland
| | - G Hanlon
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - T Higgins
- University Hospital Kerry, Tralee, Co Kerry, Ireland
| | - S Hoashi
- Mullingar Regional Hospital, Mullingar, Co Westmeath, Ireland
| | - A Khamis
- Letterkenny General Hospital, Letterkenny, Co Donegal, Ireland
| | - B Kinsley
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - B Kirwan
- Galway University Hospital, Galway, Ireland
| | - P Kyithar
- Portlaoise General Hospital, Portlaoise, Co Laois, Ireland
| | - A Liew
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - L Matthews
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
| | - C McGurk
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - C McHugh
- Sligo University Hospital, Co Sligo, Ireland
| | - M S Murphy
- South Infirmary Victoria Hospital, Cork, Co Cork, Ireland
| | - P Murphy
- Cork University Hospital, Cork, Co Cork, Ireland
| | - D Nagodra
- Portlaoise General Hospital, Portlaoise, Co Laois, Ireland
| | - E Noctor
- Limerick University Hospital, Co Limerick, Ireland
| | - M Nolan
- University Hospital Kerry, Tralee, Co Kerry, Ireland
| | - E O'Connor
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - D O'Halloran
- Cork University Hospital, Cork, Co Cork, Ireland
| | - L O'Mahoney
- Cork University Hospital, Cork, Co Cork, Ireland
| | | | - M Peters
- University Hospital Waterford, Co Waterford, Ireland
| | - G Roberts
- University Hospital Waterford, Co Waterford, Ireland
| | - H Rooney
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - A Smyth
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - B Tarachand
- University Hospital Waterford, Co Waterford, Ireland
| | - M Todd
- Mayo University Hospital, Castlebar, Co Mayo, Ireland
| | - A Tuthill
- Cork University Hospital, Cork, Co Cork, Ireland
| | - W A Wan Mahmood
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - O Yousif
- Wexford General Hospital, Co Wexford, Ireland
| | - F P Dunne
- Galway University Hospital, Galway, Ireland
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Tolley C, MacAfee L, Cantillo E, Fujii M, Ahern T, Jones E. 2524 Perioperative Non-Opioid Pain Control Adjuncts and Postoperative Opioid Use after Benign Gynecologic Surgery. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.197] [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: 11/29/2022]
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Broe A, Pottegård A, Hallas J, Ahern TP, Fedder J, Damkier P. Association between use of phthalate-containing medication and semen quality among men in couples referred for assisted reproduction. Hum Reprod 2019; 33:503-511. [PMID: 29425332 DOI: 10.1093/humrep/dey009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/10/2018] [Indexed: 12/26/2022] Open
Abstract
STUDY QUESTION Does phthalate exposure from prescription drugs affect semen quality? SUMMARY ANSWER Exposure to phthalate-containing drugs is associated with poor semen quality. WHAT IS KNOWN ALREADY Phthalates and their metabolites have been shown to disrupt the hormone signalling in animal studies. One study has shown associations between medicinal phthalate exposure and poor semen quality, suggesting similar effects in humans. STUDY DESIGN, SIZE, DURATION We included 18 515 males with poor semen quality (cases) and 31 063 males with normal semen quality (controls) registered in the Danish IVF Registry from 2006 to 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Exposure to phthalate-containing drugs was assessed from the Danish Register of Medicinal Product Statistics. Outcome measures were obtained at the first contact with the fertility clinic, and categorized according to the International Classification of Diseases (ICD-10). The association between current use of phthalate-containing medications <90 days prior to semen sampling and reduced semen quality was analysed using unconditional logistic regression, adjusting for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE In total, 57 cases and 72 controls redeemed at least one prescription for a drug containing ortho-phthalates in the 90 days before their first semen sample, yielding an adjusted odds ratio (OR) of 1.30 (95% CI: 0.91-1.85) for poor semen quality when compared to males exposed to phthalate-free generic drugs. Similarly, 81 cases and 78 controls exposed to a drug containing polymers had increased odds of poor semen quality (OR = 1.71, 95% CI: 1.24-2.35). Current exposure to polymer containing products from alimentary tract and metabolism drugs was associated with the highest OR of 2.80 (95% CI: 1.63-4.84). Comparing males exposed to drugs containing ortho-phthalates or polymers with males unexposed to prescription drugs, we found adjusted ORs of 1.32 (95% CI: 0.93-1.87) and 1.73 (95% CI: 1.26-2.36), respectively. We saw no clear relationship between degree of exposure and odds of poor semen quality. LIMITATIONS, REASONS FOR CAUTION The reliance on ICD-10 based register data restricted our ability to relate phthalate exposure to detailed semen parameters. Furthermore, due to imperfections in the registry, we could only include the first semen sample and could not follow semen quality over time. WIDER IMPLICATIONS OF THE FINDINGS Our results support the likely negative effect of phthalate exposure from medicinal drugs on semen quality. As exposures from medicinal products are readily avoidable, our findings may be of relevance to regulatory authorities. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Odense University Hospital, Denmark (Grant number A1003). None of the authors declare conflict of interest.
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Affiliation(s)
- A Broe
- Clinical Pharmacology & Pharmacy, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark.,Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, 5000 Odense C, Denmark
| | - A Pottegård
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, 5000 Odense C, Denmark
| | - J Hallas
- Clinical Pharmacology & Pharmacy, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark.,Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, 5000 Odense C, Denmark
| | - T P Ahern
- Departments of Surgery and Biochemistry, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - J Fedder
- Centre of Andrology & Fertility Clinic, Odense University Hospital, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - P Damkier
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
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Abstract
Statin drugs have been used for more than two decades to treat hypercholesterolemia and as cardio-preventive drugs, resulting in a marked decrease in cardiovascular morbidity and mortality worldwide. Statins halt hepatic cholesterol biosynthesis by inhibiting the rate-limiting enzyme in the mevalonate pathway, hydroxymethylglutaryl-coenzyme A reductase (HMGCR). The mevalonate pathway regulates a host of biochemical processes in addition to cholesterol production. Attenuation of these pathways is likely responsible for the myriad benefits of statin therapy beyond cholesterol reduction - the so-called pleiotropic effects of statins. Chief amongst these purported effects is anti-cancer activity. A considerable body of preclinical, epidemiologic and clinical evidence shows that statins impair proliferation of breast cancer cells and reduce the risk of breast cancer recurrence. Potential mechanisms for this effect have been explored in laboratory models, but remain poorly understood and require further investigation. The number of clinical trials assessing the putative clinical benefit of statins in breast cancer is increasing. Currently, a total of 30 breast cancer/statin trials are listed at the global trial identifier website clinicaltrials.gov. Given the compelling evidence from performed trials in a variety of clinical settings, there have been calls for a clinical trial of statins in the adjuvant breast cancer setting. It would be imperative for such a trial to incorporate tumour biomarkers predictive of statin response in its design and analysis plan. Ongoing translational clinical trials aimed at biomarker discovery will help identify, which breast cancer patients are most likely to benefit from adjuvant statin therapy, and will add valuable clinical knowledge to the field.
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Affiliation(s)
- S Borgquist
- Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.,Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - O Bjarnadottir
- Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - S Kimbung
- Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - T P Ahern
- Departments of Surgery and Biochemistry, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
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Ahern TP, Cronin-Fenton DP, Broe A, Pilgaard Ulrichsen S, Cole BF, Lash TL, Toft Sørensen H, Tamimi RM, Damkier P. Abstract P6-08-14: Breast cancer risk in chronic users of phthalate-containing medications: A Danish nationwide cohort study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-08-14] [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. Phthalates are ubiquitous in consumer goods (e.g., food containers, cosmetics, and pharmaceuticals), from which they readily leach into the environment. Phthalates interfere with hormonal signaling and may affect reproductive, developmental, and cancer endpoints. Preclinical evidence implicates some phthalates in breast cancer progression—particularly dibutyl phthalate (DBP), which potentiates the estrogen receptor (ER). Associations between phthalates and breast cancer incidence have not been thoroughly investigated. Users of phthalate-containing medications have up to 70-fold higher urinary phthalate levels than other individuals, and represent a highly exposed population for efficient study of phthalate health effects.
Methods. We used the Danish Drug Information Database to identify all phthalate-containing oral medications marketed during the study period. We recorded the product code and the type and mass of phthalate per pill. We identified a nationwide cohort of women at risk for a first cancer between 2005—2015, and who had no previous exposure to a phthalate-containing drug. Using the National Prescription Registry we characterized time-varying, medication-borne phthalate exposure. Incident cancers were ascertained by linking to the Danish Cancer Registry. We fit Cox regression models to estimate associations between cumulative phthalate exposures and breast cancer incidence. Exposures were updated annually and lagged by 1 year. We adjusted for established risk factors, comorbidity, co-medications (e.g., HRT), and drug substances exposed to.
Results. We identified 481 products from 24 drug classes containing either DBP, diethyl phthalate (DEP), cellulose acetate phthalate (CAP), hypromellose phthalate (HPMCP), or polyvinyl acetate phthalate (PVAP). Drugs with phthalate-containing products also included phthalate-free products. Phthalate masses ranged from 3 µg to 1.3 g per pill. We followed 1.12 million women over 9.99 million person-years, during which 27,111 women were diagnosed with invasive breast cancer. Fourteen percent of the cohort (n=161,751) was prescribed a phthalate-containing drug. We observed no breast cancer associations with exposure to CAP, DEP, HPMCP, and PVAP. However, the highest level of cumulative DBP exposure (>10,000 mg; range: 10,024 to 71,340 mg; median=15,390 mg) was associated with an 80% increase in breast cancer risk compared with no exposure (HRadj=1.8; 95% CI: 1.0, 3.1). The association was strongest for ER+ disease (HRadj=1.9; 95% CI: 1.1, 3.5) and among premenopausal women (HRadj=2.2; 95% CI: 0.91, 5.3). There was no evidence of a linear trend in the log-hazard across categories of cumulative DBP exposure. No published evidence links exposure to the drug substances represented by the DBP-containing products (bisacodyl, budesonide, mesalazine, multienzymes, diclofenac, and lithium) with breast cancer risk.
Conclusions. High DBP exposure was associated with increased breast cancer incidence, particularly ER+ disease and among premenopausal women. This association merits further investigation. In the meantime, it may be prudent for women taking DBP-containing medications to substitute a phthalate-free version of the same drug, other considerations being equal.
Citation Format: Ahern TP, Cronin-Fenton DP, Broe A, Pilgaard Ulrichsen S, Cole BF, Lash TL, Toft Sørensen H, Tamimi RM, Damkier P. Breast cancer risk in chronic users of phthalate-containing medications: A Danish nationwide cohort study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-14.
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Affiliation(s)
- TP Ahern
- University of Vermont, Burlington, VT; Aarhus University, Aarhus, Denmark; University of Southern Denmark, Odense, Denmark; Emory University, Atlanta, GA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - DP Cronin-Fenton
- University of Vermont, Burlington, VT; Aarhus University, Aarhus, Denmark; University of Southern Denmark, Odense, Denmark; Emory University, Atlanta, GA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - A Broe
- University of Vermont, Burlington, VT; Aarhus University, Aarhus, Denmark; University of Southern Denmark, Odense, Denmark; Emory University, Atlanta, GA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - S Pilgaard Ulrichsen
- University of Vermont, Burlington, VT; Aarhus University, Aarhus, Denmark; University of Southern Denmark, Odense, Denmark; Emory University, Atlanta, GA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - BF Cole
- University of Vermont, Burlington, VT; Aarhus University, Aarhus, Denmark; University of Southern Denmark, Odense, Denmark; Emory University, Atlanta, GA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - TL Lash
- University of Vermont, Burlington, VT; Aarhus University, Aarhus, Denmark; University of Southern Denmark, Odense, Denmark; Emory University, Atlanta, GA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - H Toft Sørensen
- University of Vermont, Burlington, VT; Aarhus University, Aarhus, Denmark; University of Southern Denmark, Odense, Denmark; Emory University, Atlanta, GA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - RM Tamimi
- University of Vermont, Burlington, VT; Aarhus University, Aarhus, Denmark; University of Southern Denmark, Odense, Denmark; Emory University, Atlanta, GA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - P Damkier
- University of Vermont, Burlington, VT; Aarhus University, Aarhus, Denmark; University of Southern Denmark, Odense, Denmark; Emory University, Atlanta, GA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA
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Karaconji B, Lloyd B, Campbell N, Meaney D, Ahern T. Effect of an anti-gonadotropin-releasing factor vaccine on sexual and aggressive behaviour in male pigs during the finishing period under Australian field conditions. Aust Vet J 2016; 93:121-3. [PMID: 25817977 DOI: 10.1111/avj.12307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of an anti-gonadotropin-releasing factor vaccine in controlling sexual and aggressive behaviour of male pigs in the late finishing period under Australian field conditions. METHODS Male pigs from four consecutive batches over a 4-month period were randomly assigned to two groups: an untreated control group (n = 434) or a group treated with Improvac® (n = 433). The vaccine was administered at 10 and 16 weeks of age. Pigs were housed under commercial conditions in ecoshelters, a commonly used housing system in Australia in which pigs are kept in large pens often containing >100 animals. The occurrence of sexual and aggressive behaviours was recorded and evaluated after second vaccination until slaughter at 22 weeks of age. RESULTS Male pigs treated with Improvac demonstrated significant reductions in mounting, fighting, pushing, head butting and tail manipulation when compared with control animals. CONCLUSION This study confirms that vaccination with Improvac can improve the welfare of entire male pigs by inhibiting sexual and aggressive behaviour.
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Affiliation(s)
- B Karaconji
- Zoetis Australia Pty Ltd, Level 6, 5 Rider Boulevard, Rhodes, New South Wales, 2138, Australia.
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Ahern TP, Hertz DL, Damkier P, Ejlertsen B, Hamilton-Dutoit SJ, Rae JM, Regan MM, Thompson AM, Lash TL, Cronin-Fenton DP. Abstract P3-07-23: CYP2D6 genotype and breast cancer recurrence in tamoxifen treated patients: An evaluation of the importance of loss-of-heterozygosity. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-23] [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: Tamoxifen therapy for estrogen receptor positive (ER+) breast cancer reduces recurrence risk by about half. Steady-state concentrations of endoxifen, a potent anti-estrogenic tamoxifen metabolite, are reduced in women whose CYP2D6 genotypes confer poor enzyme function. Many studies have measured associations between genetically impaired CYP2D6 function and tamoxifen resistance. It has been suggested that the subset of studies using DNA extracted from tumor-infiltrated tissue may have been susceptible to genotyping error induced by loss of heterozygosity (LOH); the putative non-differential genotype misclassification may have biased these studies' estimates toward the null. We reviewed the clinical epidemiology studies conducted to date to assess the importance of loss-of-heterozygosity (LOH) at the CYP2D6 locus and its implications for assessing tamoxifen effectiveness.
Methods: We searched for the terms "tamoxifen" and "CYP2D6" in PubMed, including all papers and abstracts through 31 May 2015 on the association of CYP2D6 gene variants and the risk of breast cancer recurrence or mortality. We used a quantitative bias analysis (QBA) to evaluate the importance of genotype misclassification in studies that extracted DNA from tumor-infiltrated tissue. We conducted a random effects meta-analysis to evaluate all studies simultaneously, and within groups according to whether DNA was derived from tumor-infiltrated tissue or non-neoplastic tissue.
Results: Thirty-one studies investigated CYP2D6 genotype and breast cancer recurrence, yielding relative effect estimates ranging from 0.08 to 14. DNA was extracted from blood or non-neoplastic tissue in 21 of these 31 studies (68%), and from tumor-infiltrated tissue in the remaining 10 (32%). Our analysis of the association between variant/variant genotype compared with wildtype/wildtype genotype included 21 of the 31 studies. Sixteen (76%) of these 21 studies extracted DNA from blood or non-neoplastic tissue and five (24%) extracted DNA from tumor-infiltrated tissue. Genotype misclassification parameters for the QBA were estimated from six concordance studies. There was little difference between the effect estimates (EE) and 95% confidence/simulation intervals (95% CI/SI) before and after QBA (EE=1.71, 95%CI=1.24, 2.36, and 1.80 95%SI=1.28, 2.54, respectively). Studies using non-neoplastic DNA had higher variance than those based on tumor-infiltrated tissue DNA, half reported implausibly high EE, and many were susceptible to design and analysis errors that would bias estimates of association away from the null.
Conclusions: We found little relative bias in the summary estimates of association, either overall or when limited to the tumor-infiltrated tissue DNA studies. Three guideline panels, based on robust evidence, recommend against CYP2D6 genotype-guided tamoxifen therapy. Alternatives for optimizing the effectiveness of tamoxifen therapy, such as assuring adherence and persistence, are more likely to achieve clinically important benefits.
Citation Format: Ahern TP, Hertz DL, Damkier P, Ejlertsen B, Hamilton-Dutoit SJ, Rae JM, Regan MM, Thompson AM, Lash TL, Cronin-Fenton DP. CYP2D6 genotype and breast cancer recurrence in tamoxifen treated patients: An evaluation of the importance of loss-of-heterozygosity. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-23.
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Affiliation(s)
- TP Ahern
- University of Vermont College of Medicine, Burlington, VT; University of Michigan College of Pharmacy, Ann Arbor, MI; Odense University Hospital, Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; University of Michigan Medical Center, Ann Arbor, MI; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; University of Texas MD Anderson Cancer Center, Houston, TX; Emory University, Atlanta, GA; Aarhus University, Aarhus, Denmark
| | - DL Hertz
- University of Vermont College of Medicine, Burlington, VT; University of Michigan College of Pharmacy, Ann Arbor, MI; Odense University Hospital, Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; University of Michigan Medical Center, Ann Arbor, MI; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; University of Texas MD Anderson Cancer Center, Houston, TX; Emory University, Atlanta, GA; Aarhus University, Aarhus, Denmark
| | - P Damkier
- University of Vermont College of Medicine, Burlington, VT; University of Michigan College of Pharmacy, Ann Arbor, MI; Odense University Hospital, Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; University of Michigan Medical Center, Ann Arbor, MI; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; University of Texas MD Anderson Cancer Center, Houston, TX; Emory University, Atlanta, GA; Aarhus University, Aarhus, Denmark
| | - B Ejlertsen
- University of Vermont College of Medicine, Burlington, VT; University of Michigan College of Pharmacy, Ann Arbor, MI; Odense University Hospital, Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; University of Michigan Medical Center, Ann Arbor, MI; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; University of Texas MD Anderson Cancer Center, Houston, TX; Emory University, Atlanta, GA; Aarhus University, Aarhus, Denmark
| | - SJ Hamilton-Dutoit
- University of Vermont College of Medicine, Burlington, VT; University of Michigan College of Pharmacy, Ann Arbor, MI; Odense University Hospital, Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; University of Michigan Medical Center, Ann Arbor, MI; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; University of Texas MD Anderson Cancer Center, Houston, TX; Emory University, Atlanta, GA; Aarhus University, Aarhus, Denmark
| | - JM Rae
- University of Vermont College of Medicine, Burlington, VT; University of Michigan College of Pharmacy, Ann Arbor, MI; Odense University Hospital, Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; University of Michigan Medical Center, Ann Arbor, MI; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; University of Texas MD Anderson Cancer Center, Houston, TX; Emory University, Atlanta, GA; Aarhus University, Aarhus, Denmark
| | - MM Regan
- University of Vermont College of Medicine, Burlington, VT; University of Michigan College of Pharmacy, Ann Arbor, MI; Odense University Hospital, Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; University of Michigan Medical Center, Ann Arbor, MI; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; University of Texas MD Anderson Cancer Center, Houston, TX; Emory University, Atlanta, GA; Aarhus University, Aarhus, Denmark
| | - AM Thompson
- University of Vermont College of Medicine, Burlington, VT; University of Michigan College of Pharmacy, Ann Arbor, MI; Odense University Hospital, Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; University of Michigan Medical Center, Ann Arbor, MI; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; University of Texas MD Anderson Cancer Center, Houston, TX; Emory University, Atlanta, GA; Aarhus University, Aarhus, Denmark
| | - TL Lash
- University of Vermont College of Medicine, Burlington, VT; University of Michigan College of Pharmacy, Ann Arbor, MI; Odense University Hospital, Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; University of Michigan Medical Center, Ann Arbor, MI; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; University of Texas MD Anderson Cancer Center, Houston, TX; Emory University, Atlanta, GA; Aarhus University, Aarhus, Denmark
| | - DP Cronin-Fenton
- University of Vermont College of Medicine, Burlington, VT; University of Michigan College of Pharmacy, Ann Arbor, MI; Odense University Hospital, Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; University of Michigan Medical Center, Ann Arbor, MI; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; University of Texas MD Anderson Cancer Center, Houston, TX; Emory University, Atlanta, GA; Aarhus University, Aarhus, Denmark
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Ahern TP, Tamimi RM, Chen WY, Garber JE, Eliassen AH, Borgquist S. Abstract PD1-02: Statin use and breast cancer incidence in the Nurses' health study. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd1-02] [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
Statin drugs lower cholesterol and prevent cardiovascular disease. Laboratory and epidemiologic evidence suggests that statins may also have anti-cancer properties. Published associations between statin use and breast cancer incidence are heterogeneous. Few studies have comprehensively addressed confounding by lifestyle and reproductive factors, or detection bias due to potentially higher screening rates among medication users. The most recent study on this topic reported an increased risk of invasive breast cancer among statin users.
Methods
To improve upon the present evidence base we studied the association between statin use and incident breast cancer among 79,518 postmenopausal women in the Nurses' Health Study cohort. We followed these women from 2000 (the year statin exposure was first ascertained prospectively) until the first of breast cancer diagnosis, death from any cause, or the end of follow-up in 2012. We defined statin exposure as current or former use (both factored with duration) or never use. We fit Cox regression models to estimate associations, encoding statin use and covariates as time-dependent variables updated every two years. We evaluated confounding by adiposity, reproductive history, menopausal hormone therapy, family history of breast cancer, history of benign breast disease and diabetes, alcohol consumption, physical activity, and use of co-medications. We also measured associations among those cohort members who underwent screening mammograms every two years.
Results
Over 823,086 person-years of follow-up, 3,055 cases of invasive breast cancer were diagnosed (1,078 of which were among statin users). Compared with non-users, statin users were somewhat older, had a higher mean BMI, were more likely to be users of aspirin, beta blockers, calcium channel blockers, digoxin, and ACE inhibitors, had a higher prevalence of diabetes, and were more likely to undergo mammographic screening. Current users of any statin had a similar rate of breast cancer incidence as never users (for current users of ≥8 years' duration, HRadj=1.1, 95% CI: 0.91, 1.3). Analyses of specific statin exposures among new initiators of therapy in 2004 returned similarly null associations (for current use of hydrophilic statins, HRadj=1.0, 95% CI: 0.82, 1.3; for current use of lipophilic statins, HRadj=1.1, 95% CI: 0.95, 1.3). Associations did not vary substantially by duration of statin use or according to breast cancer subtypes defined by histology (invasive ductal vs. invasive lobular disease) or estrogen receptor status. Statin use was not associated with incident breast carcinoma in situ. These results were similar in analyses restricted to women who underwent regular screening mammograms.
Conclusions
Our results indicate that cholesterol-lowering statin therapy neither increases nor decreases breast cancer incidence rate in postmenopausal women. Considering the latest report indicated an increased breast cancer risk among statin users, our neutral findings should reassure physicians that statin therapy for the prevention of cardiovascular disease is safe with respect to breast cancer risk.
Citation Format: Ahern TP, Tamimi RM, Chen WY, Garber JE, Eliassen AH, Borgquist S. Statin use and breast cancer incidence in the Nurses' health study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD1-02.
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Affiliation(s)
- TP Ahern
- University of Vermont; Brigham and Women's Hospital; Dana-Farber Cancer Institute; Lund University
| | - RM Tamimi
- University of Vermont; Brigham and Women's Hospital; Dana-Farber Cancer Institute; Lund University
| | - WY Chen
- University of Vermont; Brigham and Women's Hospital; Dana-Farber Cancer Institute; Lund University
| | - JE Garber
- University of Vermont; Brigham and Women's Hospital; Dana-Farber Cancer Institute; Lund University
| | - AH Eliassen
- University of Vermont; Brigham and Women's Hospital; Dana-Farber Cancer Institute; Lund University
| | - S Borgquist
- University of Vermont; Brigham and Women's Hospital; Dana-Farber Cancer Institute; Lund University
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Abstract
BACKGROUND People with severe obesity (body mass index [BMI] > 40 kg/m(2)) have an 85% higher mortality than people with a healthy BMI. Poor physical function may contribute to this excess mortality. Lymphoedema-like swelling can affect the legs of severely obese people with normal lymphoscintigraphy. AIM We sought to determine the relationship between the presence of lymphoedema-like swelling and physical function in the severely obese. DESIGN AND METHODS In people with severe obesity, we ascertained whether lower leg lymphoedema-like swelling was present and determined the circumference of the lower leg, time taken to ascend and descend a 17-cm step 50 times and time taken to walk 500 m. RESULTS The 330 participants, 33% of whom were male, were aged 43.4 ± 12.7 years (mean ± standard deviation) and had a BMI of 51.7 ± 8.4 kg/m(2). Lymphoedema-like swelling was present in approximately one-third (n = 108) in whom a prior history of cellulitis and venous thromboembolism was more common (relative risks 6.16 and 3.86, respectively) than in those without lymphoedema-like swelling. Participants with lymphoedema-like swelling, compared with non-affected counterparts, had a higher lower leg circumference (35.0 ± 7.1 vs. 32.4 ± 4.8 cm), a slower step speed (0.40 ± 0.12 vs. 0.43 ± 0.10 steps/s) and a slower walking speed (0.97 ± 0.37 vs. 1.08 ± 0.30 m/s, P < 0.05 for all comparisons). CONCLUSIONS In this cross-sectional study, 33% of our severely obese participants had lymphoedema-like swelling. Participants with lymphoedema-like swelling had worse physical function than those without. This association was independent of BMI. The presence of obesity-related chronic lymphoedema-like swelling should lead to interventions that improve physical function.
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Affiliation(s)
- E O'Malley
- From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - T Ahern
- From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C Dunlevy
- From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C Lehane
- From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - B Kirby
- From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D O'Shea
- From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Lietzen LW, Ahern T, Christiansen P, Jensen AB, Sørensen HT, Lash TL, Cronin-Fenton DP. Glucocorticoid prescriptions and breast cancer recurrence: a Danish nationwide prospective cohort study. Ann Oncol 2014; 25:2419-2425. [PMID: 25223486 DOI: 10.1093/annonc/mdu453] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Treatment with synthetic glucocorticoids (GCs) depresses the immune response and may therefore modify cancer outcomes. We investigated the association between GC use and breast cancer recurrence. MATERIALS AND METHODS We conducted a population-based cohort study to examine the risk of breast cancer recurrence associated with GC use among incident stage I-III female breast cancer patients aged >18 years diagnosed 1996-2003 in Denmark. Data on patients, clinical and treatment factors, recurrence, and comorbidities as well as data on GC prescriptions and potential confounders were obtained from Danish population-based medical registries. GCs were categorized according to administrative route: systemic, inhaled, or intestinal. Women were followed for up to 10 years or until 31 December 2008. We used Cox proportional hazards regression models to compute hazard ratios (HRs) and associated 95% confidence intervals (95% CIs) to evaluate the association between GC use and recurrence. Time-varying drug exposures were lagged by 1 year. RESULTS We included 18 251 breast cancer patients. Median recurrence follow-up was 6.9 years; 3408 women developed recurrence during follow-up. Four thousand six hundred two women filled at least one GC prescription after diagnosis. In unadjusted models, no association was observed among users of systemic, inhaled, and intestinal GCs (HRsystemic = 1.1, 95% CI 0.9-1.3; HRinhaled = 0.9, 95% CI 0.7-1.0; and HRintestinal = 1.0, 95% CI 0.9-1.2) versus nonusers. In adjusted models, the results were also near null (HRsystemic = 1.1, 95% CI 0.9-1.2; HRinhaled = 0.8, 95% CI 0.7-1.0; and HRintestinal = 1.0, 95% CI 0.8-1.2). CONCLUSION We found no evidence of an effect of GC use on breast cancer recurrence.
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Affiliation(s)
- L W Lietzen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | - T Ahern
- Departments of Surgery and Biochemistry, College of Medicine, University of Vermont, Burlington
| | | | - A B Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - T L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - D P Cronin-Fenton
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Affiliation(s)
- M. Lynch
- Dermatology; St Vincent's University Hospital; Elm Park Dublin 4 Ireland
| | - A.-M. Tobin
- Dermatology Department; Adelaide and Meath Hospital; Tallaght Ireland
| | - T. Ahern
- Endocrinology Departments; St Vincent's University Hospital; Elm Park Dublin 4 Ireland
| | - D. O'Shea
- Endocrinology Departments; St Vincent's University Hospital; Elm Park Dublin 4 Ireland
| | - B. Kirby
- Dermatology; St Vincent's University Hospital; Elm Park Dublin 4 Ireland
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Ahern T, Khattak A, O'Malley E, Dunlevy C, Kilbane M, Woods C, McKenna MJ, O'Shea D. Association between vitamin D status and physical function in the severely obese. J Clin Endocrinol Metab 2014; 99:E1327-31. [PMID: 24735426 DOI: 10.1210/jc.2014-1704] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Mortality is 85% higher in severely obese subjects (body mass index [BMI] > 40 kg/m(2)) than in subjects with a healthy BMI; poor physical function may be contributory. Hypovitaminosis D is common in obese subjects and is associated with physical dysfunction in the elderly. OBJECTIVE We determined the relationship between vitamin D status and physical function in severely obese subjects. DESIGN, SETTING, AND PATIENTS We conducted a clinic-based, cross-sectional study of severely obese subjects. Participants were stratified into three groups according to the Institute of Medicine (IOM) vitamin D status categorization. MAIN OUTCOME MEASURES We compared levels of self-reported activity and times taken to walk 500 m and to ascend and descend a 17-cm step 50 times. RESULTS We recruited 252 subjects (age, 43.7 ± 11.2 y; BMI, 50.7 ± 9.7 kg/m(2)); 25-hydroxyvitamin D (25OHD) concentrations were less than 30 nmol/L in 109 participants. Participants with a 25OHD > 50 nmol/L, compared to those with a 25OHD < 30 nmol/L, had the highest activity levels (3.1 ± 3.4 h/wk versus 1.5 ± 2.5 h/wk; P = .015) and the shortest 500-m walk times (6.2 ± 1.1 min versus 7.4 ± 1.5 min; P = .003). Serum 25OHD concentrations had a weakly positive association with activity level (r = 0.19; P = .008) and a moderately negative association with 500-m walk time (r = -0.343; P < .001). CONCLUSIONS Vitamin D status had a significant relationship with physical activity and physical function in this cohort of severely obese subjects. Low activity levels are likely to perpetuate the problem of hypovitaminosis D due to less time spent outdoors. Studies exploring the effects of vitamin D supplementation in this population are warranted.
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Affiliation(s)
- T Ahern
- Weight Management Service (T.A., A.K., E.O., C.D., C.W., D.O.), St Columcille's Hospital, Loughlinstown, County Dublin, Ireland; Obesity Research Group, Education and Research Centre (T.A., A.K., C.W., D.O.), Department of Endocrinology (T.A., A.K., C.W., M.J.M., D.O.), and Metabolism Laboratory (M.K., M.J.M.), St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Affiliation(s)
- C.T. Reid
- Department of Dermatology; St Vincent's University Hospital; Dublin Ireland
| | - A.M. Tobin
- Department of Dermatology; St Vincent's University Hospital; Dublin Ireland
| | - T. Ahern
- Department of Endocrinology; St Vincent's University Hospital; Dublin Ireland
| | - D. O'Shea
- Department of Endocrinology; St Vincent's University Hospital; Dublin Ireland
| | - B. Kirby
- Department of Dermatology; St Vincent's University Hospital; Dublin Ireland
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Khan M, McCreesh K, Saeed A, Ahern T, Fraser A. AB0741 Can musculoskeletal ultrasonography examination (msus) predict outcome in shoulder impingement syndrome (sis)? a prospective blinded study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Ahern T, Tobin AM, Corrigan M, Hogan A, Sweeney C, Kirby B, O'Shea D. Glucagon-like peptide-1 analogue therapy for psoriasis patients with obesity and type 2 diabetes: a prospective cohort study. J Eur Acad Dermatol Venereol 2012; 27:1440-3. [PMID: 22691169 DOI: 10.1111/j.1468-3083.2012.04609.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diabetes and obesity are more prevalent amongst psoriasis patients as is disturbance of the innate immune system. GLP-1 analogue therapy considerably improves weight and glycaemic control in people with type 2 diabetes and its receptor is present on innate immune cells. OBJECTIVE We aimed to determine the effect of liraglutide, a GLP-1 analogue, on psoriasis severity. METHODS Before and after 10 weeks of liraglutide therapy (1.2 mg subcutaneously daily) we determined the psoriasis area and severity index (PASI) and the dermatology life quality index (DLQI) in seven people with both psoriasis and diabetes (median age 48 years, median body mass index 48.2 kg/m(2) ). We also evaluated the immunomodulatory properties of liraglutide by measuring circulating lymphocyte subset numbers and monocyte cytokine production. RESULTS Liraglutide therapy decreased the median PASI from 4.8 to 3.0 (P = 0.03) and the median DLQI from 6.0 to 2.0 (P = 0.03). Weight and glycaemic control improved significantly. Circulating invariant natural killer T (iNKT) cells increased from 0.13% of T lymphocytes to 0.40% (P = 0.03). Liraglutide therapy also effected a non-significant 54% decrease in the proportion of circulating monocytes that produced tumour necrosis factor alpha (P = 0.07). CONCLUSION GLP-1 analogue therapy improves psoriasis severity, increases circulating iNKT cell number and modulates monocyte cytokine secretion. These effects may result from improvements in weight and glycaemic control as well as from direct immune effects of GLP-1 receptor activation. Prospective controlled trials of GLP-1 therapies are warranted, across all weight groups, in psoriasis patients with and without type 2 diabetes.
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Affiliation(s)
- T Ahern
- Obesity Research Group, andDermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Collins LC, Frieling GW, Ahern TP, Hu R, Hankinson SE, Tamimi RM. P4-02-12: Plasma Estradiol Levels and Degree of Estrogen Receptor Positivity by Image Analysis in a Large Cohort of Breast Cancer Cases: Results from the Nurses' Health Study. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-02-12] [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
Breast cancer risk is strongly associated with endogenous reproductive hormones. There is also good evidence to suggest that endogenous estradiol levels are more strongly associated with the development of estrogen receptor (ER) positive breast cancers than with ER negative cancers. However, the degree of ER positivity in those cancers that develop is not yet established. Therefore, we sought to evaluate the proportion and intensity of tumor cells demonstrating ER positivity using image analysis in a large cohort of breast cancers for which we also had plasma estradiol levels.
Design: Tissue microarray (TMA) sections of breast cancers from women enrolled in the Nurses’ Health Study were immunostained for ER (1D5, Dako Corporation, Carpinteria, CA). Slides were then scanned using the ScanScope slide scanning system (Aperio Technologies Inc., Vista, CA) and ER staining was assessed for both intensity and percent of nuclei staining positively using a specific algorithm, Nuclear v9, which evaluates nuclear size, intensity, roundness, curvature, compactness, and elongation. Plasma samples were collected prior to the date of diagnosis for all women in the study and estradiol levels were determined by radioimmunoassay following extraction and celite column chromatography.
Result: Image analysis data for ER was available for 691 breast cancers. The mean percent of tumor cell positivity was approximately uniformly distributed, with a mean of 44.5%, (median=41.3%, max=99.6%). The proportion of tumor cells staining for ER from the TMA cores was positively associated with patient age (p<0.0001), and postmenopausal status (p=0.008), while inversely associated with tumor grade (p<0.0001). Among women with image analysis data for ER, plasma estradiol data were also available for 320 postmenopausal women. Estrogen receptor positivity (by proportion or intensity) did not vary according to plasma estradiol levels (p=0.17).
Conclusion: While high concentrations of plasma estradiol are more strongly associated with the development of estrogen receptor positive breast cancer versus estrogen receptor negative cancers, the degree of estrogen receptor positivity in the breast cancers that develop is not influenced by this variable.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-02-12.
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Affiliation(s)
- LC Collins
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Channing Laboratory, Brigham and Women's Hospital, Boston; Harvard School of Public Health, Boston
| | - GW Frieling
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Channing Laboratory, Brigham and Women's Hospital, Boston; Harvard School of Public Health, Boston
| | - TP Ahern
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Channing Laboratory, Brigham and Women's Hospital, Boston; Harvard School of Public Health, Boston
| | - R Hu
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Channing Laboratory, Brigham and Women's Hospital, Boston; Harvard School of Public Health, Boston
| | - SE Hankinson
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Channing Laboratory, Brigham and Women's Hospital, Boston; Harvard School of Public Health, Boston
| | - RM Tamimi
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Channing Laboratory, Brigham and Women's Hospital, Boston; Harvard School of Public Health, Boston
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Hogan AE, Tobin AM, Ahern T, Corrigan MA, Gaoatswe G, Jackson R, O’Reilly V, Lynch L, Doherty DG, Moynagh PN, Kirby B, O’Connell J, O’Shea D. Glucagon-like peptide-1 (GLP-1) and the regulation of human invariant natural killer T cells: lessons from obesity, diabetes and psoriasis. Diabetologia 2011; 54:2745-54. [PMID: 21744074 PMCID: PMC3188710 DOI: 10.1007/s00125-011-2232-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 06/01/2011] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS The innate immune cells, invariant natural killer T cells (iNKT cells), are implicated in the pathogenesis of psoriasis, an inflammatory condition associated with obesity and other metabolic diseases, such as diabetes and dyslipidaemia. We observed an improvement in psoriasis severity in a patient within days of starting treatment with an incretin-mimetic, glucagon-like peptide-1 (GLP-1) receptor agonist. This was independent of change in glycaemic control. We proposed that this unexpected clinical outcome resulted from a direct effect of GLP-1 on iNKT cells. METHODS We measured circulating and psoriatic plaque iNKT cell numbers in two patients with type 2 diabetes and psoriasis before and after commencing GLP-1 analogue therapy. In addition, we investigated the in vitro effects of GLP-1 on iNKT cells and looked for a functional GLP-1 receptor on these cells. RESULTS The Psoriasis Area and Severity Index improved in both patients following 6 weeks of GLP-1 analogue therapy. This was associated with an alteration in iNKT cell number, with an increased number in the circulation and a decreased number in psoriatic plaques. The GLP-1 receptor was expressed on iNKT cells, and GLP-1 induced a dose-dependent inhibition of iNKT cell cytokine secretion, but not cytolytic degranulation in vitro. CONCLUSIONS/INTERPRETATION The clinical effect observed and the direct interaction between GLP-1 and the immune system raise the possibility of therapeutic applications for GLP-1 in inflammatory conditions such as psoriasis.
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Affiliation(s)
- A. E. Hogan
- Department of Endocrinology, St Vincent’s University Hospital, University College Dublin, Dublin 4, Ireland
- Obesity Immunology Group, ERC, Conway Institute, St Vincent’s University Hospital, UCD, Dublin, Ireland
| | - A. M. Tobin
- Obesity Immunology Group, ERC, Conway Institute, St Vincent’s University Hospital, UCD, Dublin, Ireland
- Department of Dermatology, St Vincent’s University Hospital, UCD, Dublin, Ireland
| | - T. Ahern
- Department of Endocrinology, St Vincent’s University Hospital, University College Dublin, Dublin 4, Ireland
- Obesity Immunology Group, ERC, Conway Institute, St Vincent’s University Hospital, UCD, Dublin, Ireland
| | - M. A. Corrigan
- Department of Endocrinology, St Vincent’s University Hospital, University College Dublin, Dublin 4, Ireland
- Obesity Immunology Group, ERC, Conway Institute, St Vincent’s University Hospital, UCD, Dublin, Ireland
| | - G. Gaoatswe
- Department of Endocrinology, St Vincent’s University Hospital, University College Dublin, Dublin 4, Ireland
- Obesity Immunology Group, ERC, Conway Institute, St Vincent’s University Hospital, UCD, Dublin, Ireland
| | - R. Jackson
- Molecular Immunology Group, Institute of Immunology, National University of Ireland, Maynooth, Ireland
| | - V. O’Reilly
- Human Immunology Group, Institute of Molecular Medicine, SJUH, Trinity College Dublin, Dublin, Ireland
| | - L. Lynch
- Department of Endocrinology, St Vincent’s University Hospital, University College Dublin, Dublin 4, Ireland
- Obesity Immunology Group, ERC, Conway Institute, St Vincent’s University Hospital, UCD, Dublin, Ireland
| | - D. G. Doherty
- Human Immunology Group, Institute of Molecular Medicine, SJUH, Trinity College Dublin, Dublin, Ireland
| | - P. N. Moynagh
- Molecular Immunology Group, Institute of Immunology, National University of Ireland, Maynooth, Ireland
| | - B. Kirby
- Department of Dermatology, St Vincent’s University Hospital, UCD, Dublin, Ireland
| | - J. O’Connell
- Department of Endocrinology, St Vincent’s University Hospital, University College Dublin, Dublin 4, Ireland
| | - D. O’Shea
- Department of Endocrinology, St Vincent’s University Hospital, University College Dublin, Dublin 4, Ireland
- Obesity Immunology Group, ERC, Conway Institute, St Vincent’s University Hospital, UCD, Dublin, Ireland
- Department of Endocrinology, St Columcille’s Hospital, Health Service Executive, Loughlinstown, Ireland
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Doherty K, Ahern T, Billfalk-Kelly A, Maeve D, Fitzpatrick P, Gilroy I, Mulholland U, Rossiter E, O'Shea D, Kelleher C. P2-387 Health professionals are not systematic in obesity detection and measurement. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976l.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- R Cohen
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
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Balding J, Livingstone WJ, Pittock SJ, Mynett-Johnson L, Ahern T, Hodgson A, Smith OP. The IL-6 G-174C polymorphism may be associated with ischaemic stroke in patients without a history of hypertension. Ir J Med Sci 2006; 173:200-3. [PMID: 16323614 DOI: 10.1007/bf02914551] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent data suggest that inflammatory reactions are involved in the pathogenesis of cerebral ischaemia. AIM To investigate whether certain inflammatory genetic polymorphisms are associated with the occurrence of ischaemic stroke. METHODS We investigated the prevalence of six polymorphisms in cytokine genes (IL-6, TNF-alpha, TNF-beta, IL-1beta, IL-10, and IL-1Ralpha) in a group of ischaemic stroke patients (n = 105) and in a control population (n = 389). We analysed the prevalence of these polymorphisms in different stroke subtypes and in relation to outcome six months post-stroke. RESULTS There was no significant variation in cytokine gene polymorphism frequencies between control and stroke populations or for different stroke subtypes. Subgroup analysis demonstrated that the prevalence of the IL-6 -174 CC genotype was significantly lower in stroke patients without a history of hypertension compared to controls. CONCLUSION The IL6 -174 CC genotype may be protective against stroke in those patients who have no history of hypertension. Further studies are required to verify these findings.
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Affiliation(s)
- J Balding
- Thrombosis and Haemostasis Laboratory, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
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Bednar MM, Gross CE, Russell SR, Fuller SP, Ahern TP, Howard DB, Falck JR, Reddy KM, Balazy M. 16(R)-hydroxyeicosatetraenoic acid, a novel cytochrome P450 product of arachidonic acid, suppresses activation of human polymorphonuclear leukocyte and reduces intracranial pressure in a rabbit model of thromboembolic stroke. Neurosurgery 2000; 47:1410-8; discussion 1418-9. [PMID: 11126912] [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: 02/18/2023] Open
Abstract
OBJECTIVE Activated polymorphonuclear leukocytes (PMNs) have been suggested to contribute to the development of increased intracranial pressure (ICP). We recently demonstrated that human PMNs produce a novel cytochrome P450-derived arachidonic acid metabolite, 1 6(R)-hydroxyeicosatetraenoic acid [16(R)-HETE], that modulates their function. It was thus of interest to examine this novel mediator in an acute stroke model. METHODS 16-HETE was assessed initially in a variety of human PMN and platelet in vitro assays and subsequently in an established rabbit model of thromboembolic stroke. A total of 50 rabbits completed a randomized, blinded, four-arm study, receiving 16(R)-HETE, tissue plasminogen activator, both, or neither. Experiments were completed 7 hours after autologous clot embolization. The primary end point for efficacy was the suppression of increased ICP. RESULTS In in vitro assays, 16(R)-HETE selectively inhibited human PMN adhesion and aggregation and leukotriene B4 synthesis. In the thromboembolic stroke model, animals that received 16(R)-HETE demonstrated significant suppression of increased ICP (7.7 +/- 1.2 to 13.1 +/- 2.7 mm Hg, baseline versus final 7-h time point, mean +/- standard error), compared with either the vehicle-treated group (7.7 +/- 0.9 to 15.8 +/- 2.6 mm Hg) or the tissue plasminogen activator-treated group (7.6 +/- 0.6 to 13.7 +/- 2.1 mm Hg). The group that received the combination of 16(R)-HETE plus tissue plasminogen activator demonstrated no significant change in ICP for the duration of the protocol (8.6 +/- 0.6 to 11.1 +/- 1.2 mm Hg). CONCLUSION 16(R)-HETE suppresses the development of increased ICP in a rabbit model of thromboembolic stroke and may serve as a novel therapeutic strategy in ischemic and inflammatory pathophysiological states.
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Affiliation(s)
- M M Bednar
- Division of Neurosurgery, University of Vermont, Burlington 05405-0068, USA.
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Lau C, Cameron DA, Nishimura SC, Ahern T, Freedman RA, Ellenbogen K, Greenberg S, Baker J, Meacham D. A cardiac evoked response algorithm providing threshold tracking: a North American multicenter study. Clinical Investigators of the Microny-Regency Clinical Evaluation Study. Pacing Clin Electrophysiol 2000; 23:953-9. [PMID: 10879378 DOI: 10.1111/j.1540-8159.2000.tb00880.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to evaluate a pacing system using the recognition of cardiac evoked response for the automatic adjustment of pacing output. Patients were prospectively followed after primary implantation of VVIR pacemakers using AutoCapture (St. Jude Medical CRMD). Sensing and pacing thresholds, polarization signal, evoked response, and AutoCapture performance were evaluated with serial visits and 24-hour Holter monitoring. Three hundred ninety-eight patients (mean age 71 +/- 15 years) were followed for an average duration of 1 year (3 days-1.75 years) with the algorithm functional in > 90% of patients. Backup pacing in the event of exit block was confirmed in all patients. Pacing thresholds remained stable at 0.89 +/- 0.34 V with a pulse width of 0.31 ms (with chronic output autoset at 0.3 V above the actual threshold). Evoked response exhibited a small but statistically significant increase with time (8.92 mV at implant, 9.60 mV at 12 months), however, this finding did not result in any change in AutoCapture function during our follow-up period. The polarization signal remained stable with minimal variation (1.12 mV at implant, 1.18 at 12 months). No clinical adverse events were observed using the AutoCapture algorithm. In this initial experience with the AutoCapture algorithm the evoked response and polarization measurements remained adequate, allowing the system to function in the majority of patients with safe, low output pacing. High energy backup pacing provided an added safety feature over fixed output devices in cases of unexpected threshold rises. Longer follow-up is required for continued long-term validation of the algorithm.
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Affiliation(s)
- C Lau
- Sunnybrook and Women's College Health Sciences Center, University of Toronto, Canada
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VanderLugt JT, Mattioni T, Denker S, Torchiana D, Ahern T, Wakefield LK, Perry KT, Kowey PR. Efficacy and safety of ibutilide fumarate for the conversion of atrial arrhythmias after cardiac surgery. Circulation 1999; 100:369-75. [PMID: 10421596 DOI: 10.1161/01.cir.100.4.369] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial arrhythmias occur commonly after cardiac surgery and are a cause of significant morbidity and increased hospital costs, yet there is no well-studied treatment strategy to deal with them expeditiously. The purpose of this study was to determine the efficacy and safety of ibutilide fumarate, an approved drug for the rapid conversion of atrial fibrillation and flutter, in patients after cardiac surgery. METHODS AND RESULTS Patients with atrial fibrillation or flutter occurring 1 to 7 days after surgery and lasting 1 hour to 3 days were randomized to receive two 10-minute blinded infusions of placebo or 0.25, 0.5, or 1.0 mg of ibutilide fumarate. Treatment was considered successful if sinus rhythm was restored for any period of time by hour 1.5. A total of 302 patients were randomized, 201 with fibrillation and 101 with flutter. Treatment with ibutilide resulted in significantly higher conversion rates than placebo, and efficacy was dose related (placebo 15%; ibutilide 0.25 mg 40%, 0.5 mg 47%, and 1.0 mg 57%). Conversion rates at all doses were higher for atrial flutter than for atrial fibrillation. Mean time to conversion decreased as the dose was increased. Polymorphic ventricular tachycardia was the most serious adverse effect and occurred in 1.8% of the ibutilide-treated patients compared with 1.2% of patients who received placebo. CONCLUSIONS Ibutilide is a useful and safe treatment alternative for the atrial arrhythmias that occur after cardiac surgery.
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Abstract
The upper limit of vulnerability (ULV) is the strength at or above which VF is not induced when a stimulus is delivered during the vulnerable phase of the cardiac cycle. Previous studies have demonstrated a statistically significant correlation between the ULV and the defibrillation threshold (DFT) in groups of patients. However, the correlation between ULV and DFT may not be close in individual patients. This imperfect correlation may be due to physiological factors or to limitations of the measurement methods. The reproducibility of either DFT or ULV has not been studied critically. The purpose of this study was to compare the reproducibility of clinically applicable methods for determination of DFT and ULV. We prospectively studied 25 patients with a transvenous implantable cardioverter defibrillator (Medtronic 7219D) at postoperative electrophysiological study. DFT was defined as the lowest energy that defibrillated after 10 seconds of VF. The ULV was defined as the lowest energy that did not induce VF with three shocks at 0, 20, and 40 ms before the peak of the T wave in ventricular paced rhythm at a cycle length of 500 ms. Both the DFT and the ULV were determined twice for biphasic pulses using a three-step, midpoint protocol. There was no significant difference between the two determinations of DFT (10.1 +/- 5.9 J vs 10.4 +/- 5.8 J), the two determinations of ULV (13.4 +/- 6.8 J vs 13.8 +/- 6.6) or the DFT-ULV Pearson correlation coefficients for each determination (0.84, P < 0.001 vs 0.75, P < 0.001). To analyze reproducibility, Lin concordance coefficients for second determination versus first determination were constructed for both ULV and DFT. This coefficient is similar to the Pearson correlation coefficient, but measures closeness to the line of identity rather than the line of regression. The Lin concordance coefficient for ULV was higher than that for DFT (0.93, 95% CI 0.85-0.97 vs 0.64, 95% CI 0.33-0.82; P < 0.01). For paired comparison of defibrillation efficacy under different experimental conditions, the sample sizes required to detect differences of 2 J, 3 J, and 4 J (80% power, P < 0.05) were 52, 24, and 15 for DFT versus 15, 8, and 6 for ULV. We conclude that a simple, clinically applicable method for determination of ULV is more reproducible than the single point DFT. Measured correlations between the ULV and single point are limited by the reproducibility of the DFT measurement.
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Affiliation(s)
- C D Swerdlow
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Swerdlow CD, Ahern T, Kass RM, Davie S, Mandel WJ, Chen PS. Upper limit of vulnerability is a good estimator of shock strength associated with 90% probability of successful defibrillation in humans with transvenous implantable cardioverter-defibrillators. J Am Coll Cardiol 1996; 27:1112-8. [PMID: 8609329 DOI: 10.1016/0735-1097(95)00603-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [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] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The goals of this study were to determine the probability of successful defibrillation at the upper limit of vulnerability and to evaluate a minimal safety margin for implantable cardioverter-defibrillator first shocks based solely on the upper limit of vulnerability. BACKGROUND The upper limit of vulnerability is the strength at or above which ventricular fibrillation is not induced when a stimulus is delivered during the vulnerable phase of the cardiac cycle. It has been proposed as an estimate of defibrillation efficacy because it correlates with the defibrillation threshold and can be determined with a single episode of fibrillation. METHODS We studied 40 patients prospectively at implantation of transvenous cardioverter-defibrillators. Defibrillation threshold was defined as the weakest biphasic shock that defibrillated after 10 s of ventricular fibrillation. The upper limit of vulnerability was defined as the weakest biphasic shock that did not induce ventricular fibrillation when given at 0, 20 and 40 ms before the peak of the T wave in ventricular paced rhythm at cycle length 500 ms. After determination of the upper limit of vulnerability and defibrillation threshold, patients underwent six additional fibrillation-defibrillation episodes. The strength of five of the defibrillation shocks was equal to the upper limit of vulnerability; the strength of one of the six shocks was randomly selected to be equal to the upper limit of vulnerability plus 3 J. The implantable cardioverter-defibrillator was tested at the upper limit of vulnerability plus 3 J in 28 patients. RESULTS The defibrillation threshold was 8.8 +/- 5.0 J (mean +/- SD), and upper limit of vulnerability was 11.3 +/- 4.6 J; the defibrillation threshold and upper limit of vulnerability were highly correlated (r = 0.89, p < 0.001). The success rate for the 200 defibrillation shocks with strength equal to the upper limit of vulnerability was 90% (95% confidence intervals based on proportion of successes in 40 patients: 86% to 94%). All five defibrillation test shocks at the upper limit of vulnerability were successful in 24 patients (60%); four of five were successful in 12 patients (30%); and three of five were successful in 4 patients (10%). All 40 test shocks and 28 implantable cardioverter-defibrillator shocks with a strength equal to the upper limit of vulnerability plus 3 J were successful. CONCLUSIONS The upper limit of vulnerability is a good estimator of the shock strength associated with 90% probability of successful defibrillation (DFT90). A strength of 3 J above the upper limit of vulnerability is a good estimate of the minimal acute safety margin for implantable cardioverter-defibrillator first shocks.
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Affiliation(s)
- C D Swerdlow
- Department of Cardiovascular Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Swerdlow CD, Ahern T, Chen PS, Hwang C, Gang E, Mandel W, Kass RM, Peter CT. Underdetection of ventricular tachycardia by algorithms to enhance specificity in a tiered-therapy cardioverter-defibrillator. J Am Coll Cardiol 1994; 24:416-24. [PMID: 8034878 DOI: 10.1016/0735-1097(94)90298-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The goal of this study was to determine the incidence and clinical significance of underdetection in 125 patients treated with a tiered-therapy cardioverter-defibrillator, the Medtronic PCD. BACKGROUND Underdetection, distinct from undersensing, is a unique, potential complication of new algorithms that enhance specificity in tiered-therapy cardioverter-defibrillators. These algorithms may delay or prevent recognition of ventricular tachycardia even though electrograms are sensed accurately and RR intervals meet the programmed interval criterion. METHODS Underdetection was defined as delay in detection > 5 s at electrophysiologic study or symptomatic delay or detection failure at follow-up of 15 +/- 8 months. RESULTS We identified six specific mechanisms of underdetection caused by algorithms to discriminate sustained ventricular tachycardia from sinus tachycardia, atrial fibrillation, ventricular fibrillation and nonsustained ventricular tachycardia. Underdetection caused detection delays in 13 (1.9%) of 677 induced ventricular tachyarrhythmia episodes in 12 patients (9.6%). During follow-up, underdetection occurred in 7 (9.9%) of 71 patients in whom ventricular tachycardia therapies were programmed. Failure to detect ventricular tachycardia occurred in 6 (0.6%) of 988 spontaneous ventricular tachycardia episodes in four patients (5.6%); 2 episodes required external cardioversion. After defibrillator reprogramming, underdetection did not occur. CONCLUSIONS Algorithms to enhance specificity cause underdetection of ventricular tachycardia in a significant minority of patients with tiered-therapy cardioverter-defibrillators. Optimal programming can minimize underdetection.
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Affiliation(s)
- C D Swerdlow
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
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Ahern T, Nydegger C, McCormick DJ, Maquilan M, Schuster M, Kutalek SP. Incidence and timing of activity parameter changes in activity responsive pacing systems. Pacing Clin Electrophysiol 1992; 15:762-70. [PMID: 1382279 DOI: 10.1111/j.1540-8159.1992.tb06843.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The incidence and timing of rate response parameter reprogramming in activity responsive pacing systems during the year after implantation was evaluated in two groups of patients: 24 patients in whom a VVI,R system was implanted (Activitrax, Medtronic, Inc.), and 21 patients in whom a DDD,R system was implanted (Synchrony, Siemens Pacesetter, Inc.). Activity parameter changes in Activitrax patients were made based on the presence of symptoms, while in Synchrony patients, changes were based on objective data obtained using a sensor indicated rate histogram with a slow and fast walk protocol. No significant difference in the incidence of activity parameter reprogramming was noted at various time intervals during the first year in Activitrax patients; in Synchrony patients a greater incidence of reprogramming changes was noted at the 1-month follow-up visit compared to later follow-up visits (P less than 0.02). Further, the incidence of changes at 1 month was greater for Synchrony compared to Activitrax patients (P less than 0.001), while no difference was detected between groups at subsequent follow-up intervals. Use of the slow and fast walk protocol, by permitting serial evaluation of sensor response, demonstrated alterations in sensor drive rates with similar levels of activity over the initial 4 to 6 postimplant weeks. This may result from postoperative changes at the pacemaker insertion site. Based on this experience, predischarge programming may not predict long-term rate response requirements. We recommend evaluation of sensor function using an exercise protocol performed at 4 to 6 postimplant weeks in all rate responsive pacing systems that utilize a piezoelectric crystal.
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Affiliation(s)
- T Ahern
- Cardiac Electrophysiology Laboratory, Hahnemann University, Philadelphia, Pennsylvania
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Affiliation(s)
- T Ahern
- Likoff Cardiovascular Institute, Department of Medicine of Hahnemann University Hospital, Philadelphia, PA 191102
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Ahern T, Taylor GA, Sanderson CJ. An evaluation of an assay for DNA synthesis in lymphocytes with [3H]thymidine and harvesting on to glass fibre filter discs. J Immunol Methods 1976; 10:329-36. [PMID: 956665 DOI: 10.1016/0022-1759(76)90027-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Different grades of glass fibre filter paper have been compared for harvesting cells labelled with tritium using a semi-automatic harvester. Grade GF/C (Whatman Ltd) was selected for routine use although GF/B was found to be useful for whole blood cultures. The factors affecting the choice of thymidine concentration and activity are discussed and 1 mjCi or [3H]thymidine (5 Ci/mMol)/0.2 ml culture is shown to give a linear relationship with total DNA synthesis for up to 22 h.
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Ahern T, Sanderson CJ. Stimulation of lymphocytes by antigen in microplate cultures; absence of an effect of transfer factor in vitro. Clin Exp Immunol 1976; 23:499-506. [PMID: 1084813 PMCID: PMC1538377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The best conditions for the optimum stimulation of human leucocytes by antigens, including protein purified derivative (PPD), streptokinase-streptodornase varidase (SKSD) and tetanus toxoid have been studied in microplate cultures. The leucocytes of each donor have their own characteristic response to antigen which depends on the culturing conditions such as antigen concentrations, cell concentrations and the time of measuring the rate of DNA synthesis. Thus, no conditions provide a universal optimum for antigen stimulation in vitro. Leucocyte dialysates, i.e. potential transfer factors, have been prepared from donors, who between them are strongly positive to the antigens PPD, SKSD, tetanus toxoid, diphtheria toxoid and Keyhole limpet haemocyanin. In contrast to some previous reports these leucocyte dialysates had no effect on the thymidine incorporation by leucocytes grown in the presence of these antigens. It is suggested that the selection of optimal conditions for the response to antigen may have obscured the effect of any non-specific enhancement of reactivity b lyeucocyte dialysates.
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Kay JE, Ahern T, Lindsay VJ, Sampson J. The control of protein synthesis during the stimulation of lymphocytes by phytohaemagglutinin. III. Poly(U) translation and the rate of polypeptide chain elongation. Biochim Biophys Acta 1975; 378:241-50. [PMID: 1125228 DOI: 10.1016/0005-2787(75)90112-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
1. Cell-free systems from phytohaemagglutinin-stimulated pig lymphocytes are much more active in both endogenous protein synthesis and the translation of poly(U) than those from unstimulated lymphocytes. 2. Addition of tRNA stimulates the translation of poly(U) and greatly reduces the difference between systems from stimulated and unstimulated lymphocytes. Endogenous protein synthesis is not increased by added tRNA. 3. Systems from stimulated lymphocytes have an increased capacity to form aminoacyl-tRNA with several different amino acids. This reaction is limited by the amount of tRNA present in the cell-free system. 4. The rate of polypeptide elongation is not affected by lymphocyte stimulation. The increased rate of protein synthesis must therefore be due to an increase in the frequency of initiation of the synthesis of protein molecules.
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Ahern T, Kay JE. The control of protein synthesis during the stimulation of lymphocytes by phytohaemagglutinin. II. Studies with cell-free systems. Biochim Biophys Acta 1973; 331:91-101. [PMID: 4761104 DOI: 10.1016/0005-2787(73)90422-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kay JE, Ahern T, Atkins M. Control of protein synthesis during the activation of lymphocytes by phytohaemagglutinin. Biochim Biophys Acta 1971; 247:322-34. [PMID: 5126947 DOI: 10.1016/0005-2787(71)90680-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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