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Andrillon T, Burns A, Mackay T, Windt J, Tsuchiya N. Sleeping while awake: sleep-like slow waves in wakefulness predict modulations of performance and subjective experience. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Augustinus S, Van Laarhoven HW, Cirkel GA, de Groot JW, Groot Koerkamp B, Macarulla T, Melisi D, O'Reilly EM, van Santvoort H, Mackay T, Besselink MG, Wilmink J. Timing of onset of systemic treatment in asymptomatic patients with metastatic pancreatic cancer: An international expert survey and case-vignette study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16256] [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
e16256 Background: The number of asymptomatic patients diagnosed with metastatic pancreatic cancer (mPDAC) is increasing, mostly due to increased use of imaging. Traditionally, systemic therapy is started immediately on disease detection. However, one perspective is that delaying therapy may preserve/maintain quality of life for longer. The impact on survival is unknown. The aim of this study was to gain further insights into current perspectives and clinical decision making regarding timing of start of systemic treatment in asymptomatic patients with mPDAC. Methods: An online survey (11 questions and 9 case vignettes) was sent to all first and last authors of published clinical trials on mPDAC over the past 10 years and medical oncologists of the Dutch Pancreatic Cancer Group. Differences in preferred treatment (i.e. immediate vs. delayed) between continents and years of experience (i.e. < 5 years, 5-10 years, > 11 years) were analyzed using the Fisher’s exact test. Results: Seventy-eight of 291 (27%) medical oncologists responded from 15 countries over 4 continents (62% Europe, 23% North America, 10% Asia, and 5% Australia). Most respondents worked in an academic hospital (73%) and reported more than 11 years’ experience (76%). The majority (63%) preferred immediate start of chemotherapy after diagnosis of metastastic disease. Thirty-two percent favored delayed treatment; 5% at symptom occurrence, 5% at objective disease progression, and 22% either at symptom occurrence or objective disease progression (whichever comes first). For the case vignettes, immediate treatment was preferred in 6/9 cases (67%). In the 3 remaining cases, delayed treatment was favored (case context: just one small lung metastasis, older age, significant comorbidities). The recommended timing of treatment (i.e. immediate or delayed treatment) was different between continents in 1/9 cases (11%, p = 0.012) and between years of experience in 5/7 cases (56%, all p < 0.001); medical oncologists from Europe and with < 5 years of experience preferred delayed treatment more often. Conclusions: This international survey based on case-vignettes indicated that immediate treatment was mostly preferred in asymptomatic patients with mPDAC. However, in one-third of cases, delayed treatment initiation was favored (e.g., due to patient selection and oncologists preference). The relation between timing of systemic treatment initiation and outcome in mPDAC is unknown and warrants further investigation.
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Affiliation(s)
- Simone Augustinus
- Department of Surgery, Amsterdam Umc, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Hanneke W.M. Van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Geert A. Cirkel
- 3Department of medical oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Teresa Macarulla
- Department of Medical Oncology, Vall d’Hebron Unveristy Hospital and Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Unit, University of Verona, Verona, Italy
| | | | - Hjalmar van Santvoort
- Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Ceter & St. Antonius Hospital Nieuwegein, Utrecht University, Utrecht, Netherlands
| | - Tara Mackay
- Department of Surgery, Amsterdam Umc, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam Umc, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Johanna Wilmink
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
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Augustinus S, Thurairajah G, Besselink MG, Van Laarhoven HW, van Oijen MG, Mackay T, Wilmink J. Delayed versus immediate start of chemotherapy in asymptomatic patients with metastatic cancer: A systematic review and meta-analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12126] [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
12126 Background: The number of asymptomatic patients diagnosed with metastatic cancer is increasing. This is mostly due to increased used of imaging, especially for screening and during follow-up. Traditionally, chemotherapy is started immediately in these patients, but some argue that withholding chemotherapy until symptoms occur may be beneficial for patients, especially in terms of quality of life. However, the impact on survival and quality of life is unknown. The aim of this study is to give an overview of delayed versus immediate chemotherapy in asymptomatic patients with metastatic cancer. Methods: We systematically searched PubMed, EMBASE (Ovid), and Cochrane for studies investigating the timing of start of chemotherapy in asymptomatic patients with metastatic cancer. Primary outcome was overall survival (OS). Secondary outcomes included quality of life (QOL) and toxicity. A meta-analysis was performed on OS, including all studies that compared direct versus delayed chemotherapy. Quality of life was described using the global health status derived from the EORTC-QLQ-C30 questionnaire evaluated in the studies. Results: Four randomized controlled trials and one retrospective study with overall 919 patients were included. The studies considered colorectal cancer (n = 3), ovarian cancer (n = 1), and gastric cancer (n = 1). The median OS varied from 11.9 to 25.7 months in the immediate treatment group versus 9.0 to 27.1 months in the delayed group. A pooled analysis demonstrated no significant differences in OS between the groups (pooled HR 1.05, 95% CI 0.90-1.22, p = 0.52). Quality of life was evaluated in three studies and suggested a better QOL in the delayed treatment group. In two studies including colorectal cancer patients the global health status in the immediate treatment group was lower at all time-points compared to the delayed treatment group, with no significant differences in any of the separate domains. In the study evaluating ovarian cancer patients, among others, the time median time spent in good global health score was lower in the immediate treatment group. Toxicity was compared between the two groups in one study, and this showed no significant differences. Conclusions: This systematic review with meta-analysis on timing of start of chemotherapy in asymptomatic patients with metastatic cancer suggests that a delayed start of chemotherapy, as compared to immediate start, does not result in worse OS, while it may better preserve QOL. Future randomized trials, with specific emphasis on quality adjusted life years are needed.
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Affiliation(s)
- Simone Augustinus
- Department of Surgery, Amsterdam Umc, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Gajanan Thurairajah
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, New Zealand
| | - Marc G Besselink
- Department of Surgery, Amsterdam Umc, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Hanneke W.M. Van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Martijn G.H. van Oijen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Tara Mackay
- Department of Surgery, Amsterdam Umc, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Johanna Wilmink
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
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Crawford M, Burns R, Cooper S, Mackay T. Hereditary haemorrhagic telangiectasia in pregnancy: regional and general anaesthesia. Int J Obstet Anesth 2018; 33:84-86. [DOI: 10.1016/j.ijoa.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/01/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
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Meurs KM, Friedenberg SG, Williams B, Keene BW, Atkins CE, Adin D, Aona B, DeFrancesco T, Tou S, Mackay T. Evaluation of genes associated with human myxomatous mitral valve disease in dogs with familial myxomatous mitral valve degeneration. Vet J 2017; 232:16-19. [PMID: 29428085 DOI: 10.1016/j.tvjl.2017.12.002] [Citation(s) in RCA: 10] [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] [Received: 10/22/2017] [Revised: 12/01/2017] [Accepted: 12/02/2017] [Indexed: 12/30/2022]
Abstract
Myxomatous mitral valve disease (MMVD) is the most common heart disease in the dog. It is believed to be heritable in Cavalier King Charles spaniels (CKCS) and Dachshunds. Myxomatous mitral valve disease is a familial disease in human beings as well and genetic mutations have been associated with its development. We hypothesized that a genetic mutation associated with the development of the human form of MMVD was associated with the development of canine MMVD. DNA was isolated from blood samples from 10 CKCS and 10 Dachshunds diagnosed with MMVD, and whole genome sequences from each animal were obtained. Variant calling from whole genome sequencing data was performed using a standardized bioinformatics pipeline for all samples. After filtering, the canine genes orthologous to the human genes known to be associated with MMVD were identified and variants were assessed for likely pathogenic implications. No variant was found in any of the genes evaluated that was present in least eight of 10 affected CKCS or Dachshunds. Although mitral valve disease in the CKCS and Dachshund is a familial disease, we did not identify genetic cause in the genes responsible for the human disease in the dogs studied here.
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Affiliation(s)
- K M Meurs
- Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA.
| | - S G Friedenberg
- Department of Veterinary Clinical Sciences, University of Minnesota, Saint Paul, MN 55108, USA
| | - B Williams
- Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - B W Keene
- Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - C E Atkins
- Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - D Adin
- Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - B Aona
- Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - T DeFrancesco
- Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - S Tou
- Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - T Mackay
- Department of Biological Sciences, Genetics Program and Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
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Ananworanich J, Prasitsuebsai W, Kerr SJ, Hansudewechakul R, Teeratakulpisarn N, Saisawat K, Ramautarsing R, Achalapong J, Pussadee K, Keadpudsa S, Mackay T, Pankam T, Rodbamrung P, Petdachai W, Chokephaibulkit K, Sohn AH, Phanuphak N. Cervical cytological abnormalities and HPV infection in perinatally HIV-infected adolescents. J Virus Erad 2015; 1:30-37. [PMID: 26005716 PMCID: PMC4439002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Behaviourally HIV-infected adolescent females are at higher risk for abnormal cervical cytology and HPV infection compared to those who are uninfected, but data on perinatally HIV-infected adolescent females are lacking. METHODS Cervical cytology, HPV infection and E6/E7 mRNA were assessed in sexually active 12-24-year-old adolescent females: perinatally HIV-infected (group 1, n = 40), behaviourally HIV-infected (group 2, n = 10), and HIV-uninfected (group 3, n = 10). RESULTS Median age was lower in group 1 (18 years) than in groups 2 (24 years) and 3 (20.5 years) (P < 0.001), and median time since sexual debut was shorter: 2 vs 5 vs 4 years (P < 0.001). More trial participants in group 1 than group 2 were on antiretrovirals (90% vs 70%; P <0.001). Abnormal cervical cytology (atypical squamous cells of undetermined significance and higher) was observed in 30% (group 1), 40% (group 2) and 30% (group 3) (P = 0.92), whereas high-risk HPV infection was observed in 45%, 45% and 40%, respectively (P = 1.00). Positive E6/E7 mRNA was found in 28% of group 1, but not in other groups. High-risk HPV infection predicted abnormal cytology in all groups [OR 6.77, 95% confidence interval (CI) 1.99-23.0; P = 0.001). Additionally, plasma HIV RNA ≥50 copies/mL (OR 13.3, 95% CI 1.16-153.06; P = 0.04) predicted abnormal cytology in HIV-infected adolescent females. CONCLUSIONS Despite the younger age and shorter time since sexual debut, cervical cytological abnormalities and HPV infection were as common in perinatally HIV-infected as in behaviourally infected and uninfected adolescents. HPV vaccination, pre-cancer screening and antiretroviral treatment in HIV-infected female adolescents should be implemented to minimise the risk of cervical cancer.
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Affiliation(s)
- J Ananworanich
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,SEARCH,
The Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,Corresponding author: Jintanat Ananworanich,
US Military HIV Research Program,
6720A Rockledge Drive, Suite 400,
Rockville,
MD20817,
USA
| | - W Prasitsuebsai
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - S J Kerr
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,Kirby Institute of Infection and Immunity in Society,
University of New South Wales,
Sydney,
Australia
| | | | | | - K Saisawat
- Chiangrai Prachanukroh Hospital,
Chiangrai,
Thailand
| | - R Ramautarsing
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Department of Global Health, Academic Medical Center,
University of Amsterdam, Amsterdam Institute for Global Health and Development (AIGHD),
Amsterdam,
the Netherlands
| | - J Achalapong
- Chiangrai Prachanukroh Hospital,
Chiangrai,
Thailand
| | - K Pussadee
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - S Keadpudsa
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - T Mackay
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Department of Global Health, Academic Medical Center,
University of Amsterdam, Amsterdam Institute for Global Health and Development (AIGHD),
Amsterdam,
the Netherlands
| | - T Pankam
- Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - P Rodbamrung
- Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | | | - K Chokephaibulkit
- Faculty of Medicine, Siriraj Hosptial,
Mahidol University,
Bangkok,
Thailand
| | - A H Sohn
- TREAT Asia/amfAR – The Foundation for AIDS Research,
Bangkok,
Thailand
| | - N Phanuphak
- Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,SEARCH,
The Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
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7
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Ananworanich J, Prasitsuebsai W, Kerr S, Hansudewechakul R, Teeratakulpisarn N, Saisawat K, Ramautarsing R, Achalapong J, Pussadee K, Keadpudsa S, Mackay T, Pankam T, Rodbamrung P, Petdachai W, Chokephaibulkit K, Sohn A, Phanuphak N. Cervical cytological abnormalities and HPV infection in perinatally HIV–infected adolescents. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)31146-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Investigation and treatment of sleep apnoea/hypopnoea syndrome (SAHS) is placing increasing demands on healthcare resources. This workload may be reduced by using split-night studies instead of the standard full-nights of diagnostic polysomnography and continuous positive airway pressure (CPAP) titration. Split-night studies involve polysomnography in the first half of the night followed, if there is an abnormal frequency of apnoeas and hypopneas, by CPAP titration for the remainder of the night. The authors' database of all patients prescribed a CPAP trial 1991-1997 was used to compare long-term outcomes in all 49 (46 accepting CPAP) patients prescribed split-night studies with those in full-night patients, matched 1:2 using an apnoea/ hypopnoea index (AHI) of +/-15% and Epworth score of +/-3 units. Classical symptoms of SAHS were the main reason for the split-night studies (n=27). There were no differences between the groups in long-term CPAP use, median nightly CPAP use (split-night 6.0 h x night-1, interquartile range (IQR) 3.8-7.4, full-night; 6.2 h x night-1, IQR 3.7-7.0, p=0.9), post-treatment Epworth scores and frequency of nursing interventions/clinic visits required. The median time from referral to treatment was less for the split-night patients (13 months, IQR 11-20 months) than for full-night patients (22 months, IQR 12-34 months; p=0.003). Split-night studies, in selected patients, result in equivalent long-term continuous positive airway pressure use to full-night studies with shorter treatment times and less healthcare utilization.
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Affiliation(s)
- N McArdle
- Respiratory Medicine Unit, University of Edinburgh, UK
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9
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Mackay GM, McGarrity G, Ellis D, Mackay T. Benefits realised from a blood transfusion policy for elective joint arthroplasty. Health Bull (Edinb) 1995; 53:206-8. [PMID: 7665347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Transfusion practice and blood ordering policy for major joint replacement was studied during 1989-93. Existing practice requiring automatic preoperative cross-match was prospectively audited. A blood ordering policy rationalising transfusion practice, using the group and screen technique, was then introduced. This resulted in a decrease in the total number of units cross-matched and increased the transfusion fraction significantly. The percentage of blood returned to the blood bank decreased by 46% for knees and 41% for hip arthroplasty. After the introduction of low molecular weight heparin (LMWH) as routine deep vein thrombosis (DVT) prophylaxis for all major total joint arthroplasties, the total transfusion requirement did not increase. In fact, the average number of units transfused per case after its introduction was marginally less at 1.3 units per hip, and 0.9 units per knee.
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Fitzpatrick MF, Mackay T, Whyte KF, Allen M, Tam RC, Dore CJ, Henley M, Cotes PM, Douglas NJ. Nocturnal desaturation and serum erythropoietin: a study in patients with chronic obstructive pulmonary disease and in normal subjects. Clin Sci (Lond) 1993; 84:319-24. [PMID: 8384954 DOI: 10.1042/cs0840319] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [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: 01/30/2023]
Abstract
1. To clarify the relationship between nocturnal oxygen desaturation and erythropoietin production in patients with chronic obstructive pulmonary disease, we determined arterial oxygen saturation and serum immunoreactive erythropoietin levels over 24 h in eight patients with chronic obstructive pulmonary disease and in nine normal subjects. 2. In the normal subjects, there was a significant circadian variation in serum erythropoietin levels with the highest mean deviation from the geometric mean at 22.00 hours and the nadir at 05.00 hours. 3. The three patients with chronic obstructive pulmonary disease with the most marked nocturnal desaturation (lowest arterial oxygen saturation < 57%) and most marked daytime hypoxaemia (daytime arterial partial pressure of oxygen < 6 kPa) had raised nocturnal serum erythropoietin levels. In two of these patients, the serum erythropoietin level was raised throughout the 24 h and erythrocyte mass was also raised. In the other patient, the serum erythropoietin level was not raised in five daytime samples and erythrocyte mass was normal. 4. The other five patients with chronic obstructive pulmonary disease with less severe nocturnal hypoxaemia (lowest arterial oxygen saturation range 78-86%) had serum erythropoietin levels (range 14-36 m-i.u./ml) which were indistinguishable from normal (range 12-44 m-i.u./ml) and showed circadian changes which were not significantly different (P = 0.35) from those in the normal subjects. 5. Thus, mild nocturnal oxygen desaturation is not associated with elevation of serum erythropoietin levels, whereas daytime hypoxaemia with associated severe nocturnal desaturation is associated with increased serum erythropoietin levels both by day and by night.
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Affiliation(s)
- M F Fitzpatrick
- Department of Medicine (RIE), City Hospital, Edinburgh, Scotland, U.K
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11
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Fitzpatrick MF, Mackay T, Walters C, Tai PC, Church MK, Holgate ST, Douglas NJ. Circulating histamine and eosinophil cationic protein levels in nocturnal asthma. Clin Sci (Lond) 1992; 83:227-32. [PMID: 1327639 DOI: 10.1042/cs0830227] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [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: 12/26/2022]
Abstract
1. To investigate the role of mast cells and eosinophils in the pathogenesis of nocturnal asthma, the plasma methylhistamine concentration, serum eosinophil cationic protein level and peak expiratory flow rate were measured 2-hourly for 24 h in 10 patients with nocturnal asthma and in 10 healthy control subjects. Nocturnal asthma was defined as at least one nocturnal awakening per week due to cough, wheeze or breathlessness with an average overnight fall in peak expiratory flow rate of at least 15% during a 2-week run-in period. 2. The lowest peak expiratory flow rate occurred at 02.00-04.00 hours in the group with nocturnal asthma, whose overnight fall in peak expiratory flow rate was 29 +/- 5% in comparison with 5 +/- 1% (means +/- SEM) in the normal subjects. 3. Plasma methylhistamine levels at night (0.200-04.00 hours) were lower than during the day (10.00-20.00 hours) in both asthmatic patients and normal subjects (asthmatic patients: day, median 0.22 ng/ml, 95% confidence intervals 0.18-0.34 ng/ml; night, 0.17 ng/ml, 0.13-0.24 ng/ml; P < 0.01; normal subjects: day, 0.31 ng/ml, 0.24-0.41 ng/ml; night, 0.24 ng/ml, 0.21-0.33 ng/ml; P < 0.01). 4. The serum eosinophil cationic protein level was higher by day (30 ng/ml, 8-47 ng/ml) than by night (21 ng/ml, 5-34 ng/ml; P < 0.04) in the group with nocturnal asthma, but did not change significantly with the time of day in the normal subjects (day: 8 ng/ml, 4-14 ng/ml; night: 8 ng/ml, 5-21 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)
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12
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Fitzpatrick MF, Mackay T, Driver H, Douglas NJ. Salmeterol in nocturnal asthma: a double blind, placebo controlled trial of a long acting inhaled beta 2 agonist. BMJ 1990; 301:1365-8. [PMID: 1980220 PMCID: PMC1664533 DOI: 10.1136/bmj.301.6765.1365] [Citation(s) in RCA: 128] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether inhaled salmeterol, a new long acting inhaled beta adrenergic agonist, reduces nocturnal bronchoconstriction and improves sleep quality in patients with nocturnal asthma. DESIGN Randomised, double blind, placebo controlled crossover study. SETTING Hospital outpatient clinics in Edinburgh. SUBJECTS Twenty clinically stable patients (13 women, seven men) with nocturnal asthma, median age 39 (range 18-60) years. INTERVENTIONS Salmeterol 50 micrograms and 100 micrograms and placebo taken each morning and evening by metered dose inhaler. Rescue salbutamol inhalers were provided throughout the run in and study periods. MAIN OUTCOME MEASURES Improvement in nocturnal asthma as measured by peak expiratory flow rates and change in sleep quality as measured by electroencephalography. RESULTS Salmeterol improved the lowest overnight peak flow rate at both 50 micrograms (difference in median values (95% confidence interval for difference in medians) 69 (18 to 88) l/min) and 100 micrograms (72 (23 to 61) l/min) doses twice daily. While taking salmeterol 50 micrograms twice daily patients had an objective improvement in sleep quality, spending less time awake or in light sleep (-9 (-4 to -44) min) and more time in stage 4 sleep (26 (6-34) min). CONCLUSIONS Salmeterol is an effective long acting inhaled bronchodilator for patients with nocturnal asthma and at a dose of 50 micrograms twice daily improves objective sleep quality.
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Affiliation(s)
- M F Fitzpatrick
- University Respiratory Medicine Unit, City Hospital, Edinburgh
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13
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Mackay T. Mental handicap: a community nursing service analysis. Nurs Stand 1989; 4:32-5. [PMID: 2510024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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