1
|
Lecorguillé M, Schipper MC, O'Donnell A, Aubert AM, Tafflet M, Gassama M, Douglass A, Hébert JR, de Lauzon-Guillain B, Kelleher C, Charles MA, Phillips CM, Gaillard R, Lioret S, Heude B. Impact of parental lifestyle patterns in the preconception and pregnancy periods on childhood obesity. Front Nutr 2023; 10:1166981. [PMID: 37275643 PMCID: PMC10233059 DOI: 10.3389/fnut.2023.1166981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/07/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction High prevalence of overweight and obesity already observed in preschool children suggests the involvement of early-life risk factors. Preconception period and pregnancy are crucial windows for the implementation of child obesity prevention interventions with parental lifestyle factors as relevant targets. So far, most studies have evaluated their role separately, with only a few having investigated their potential synergistic effect on childhood obesity. Our objective was to investigate parental lifestyle patterns in the preconception and pregnancy periods and their association with the risk of child overweight after 5 years. Materials and methods We harmonized and interpreted results from four European mother-offspring cohorts participating in the EndObesity Consortium [EDEN, France; Elfe, France; Lifeways, Ireland; and Generation R, Netherlands] with data available for 1,900, 18,000, 1,100, and 9,500 families, respectively. Lifestyle factors were collected using questionnaires and included parental smoking, body mass index (BMI), gestational weight gain, diet, physical activity, and sedentary behavior. We applied principal component analyses to identify parental lifestyle patterns in preconception and pregnancy. Their association with risk of overweight (including obesity; OW-OB) and BMI z-scores between 5 and 12 years were assessed using cohort-specific multivariable logistic and linear and regression models (adjusted for potential confounders including parental age, education level, employment status, geographic origin, parity, and household income). Results Among the various lifestyle patterns derived in all cohorts, the two explaining the most variance were characterized by (1) "high parental smoking, low maternal diet quality (and high maternal sedentary behavior in some cohorts)" and, (2) "high parental BMI and low gestational weight gain." Patterns characterized by high parental BMI, smoking, low diet quality or high sedentary lifestyle before or during pregnancy were associated with higher risk of OW-OB in children, and BMI z-score at any age, with consistent strengths of associations in the main cohorts, except for lifeways. Conclusion This project provides insight into how combined parental lifestyle factors in the preconception and pregnancy periods are associated with the future risk of child obesity. These findings are valuable to inform family-based and multi-behavioural child obesity prevention strategies in early life.
Collapse
Affiliation(s)
- Marion Lecorguillé
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Mireille C Schipper
- The Generation R Study Group (Na 29-15), Erasmus University Medical Center, CA, Rotterdam, Netherlands
| | - Aisling O'Donnell
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Adrien M Aubert
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Muriel Tafflet
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | | | - Alexander Douglass
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - James R Hébert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Nutrition, Connecting Health Innovations, LLC, Columbia, SC, United States
| | - Blandine de Lauzon-Guillain
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Cecily Kelleher
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Marie-Aline Charles
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
- Ined, Inserm, EFS, Joint Unit Elfe, Aubervilliers, France
| | - Catherine M Phillips
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Romy Gaillard
- The Generation R Study Group (Na 29-15), Erasmus University Medical Center, CA, Rotterdam, Netherlands
| | - Sandrine Lioret
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Barbara Heude
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| |
Collapse
|
2
|
Lecorguillé M, Schipper M, O'Donnell A, Aubert AM, Tafflet M, Gassama M, Douglass A, Hébert JR, Kelleher C, Charles MA, Phillips CM, Gaillard R, Lioret S, Heude B. Parental lifestyle patterns around pregnancy and risk of childhood obesity in four European birth cohort studies. Lancet Glob Health 2023; 11 Suppl 1:S5. [PMID: 36866482 DOI: 10.1016/s2214-109x(23)00090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND A high prevalence of excess weight in children younger than 5 years suggests the involvement of early-life risk factors. The preconception and pregnancy periods are crucial stages for the implementation of interventions to prevent childhood obesity. Most studies so far have evaluated the effects of early-life factors separately, with only a few investigating the combined effect of parental lifestyle factors. Our objective was to fill the literature gap regarding parental lifestyle factors in the preconception and pregnancy periods and to study their association with the risk of overweight in children after the age of 5 years. METHODS We harmonised and interpreted data from four European mother-offspring cohorts (EDEN [comprising 1900 families], Elfe [comprising 18 000 families], Lifeways [comprising 1100 families], and Generation R [comprising 9500 families]). Written informed consent was obtained from parents of all involved children. Lifestyle factor data collected through questionnaires comprised parental smoking, BMI, gestational weight gain, diet, physical activity, and sedentary behaviour. We applied principal component analyses to identify multiple lifestyle patterns in preconception and pregnancy. Their association with child BMI z-score and risk of overweight (including obesity, overweight and obesity, as defined by the International Task Force reference) between the ages of 5 and 12 years were assessed using cohort-specific multivariable linear and logistic regression models (adjusted for confounders including parental age, education level, employment status, geographic origin, parity, and household income). FINDINGS Among the various lifestyle patterns identified in all cohorts, the two that better explained variance were high parental smoking plus low maternal diet quality or high maternal sedentary behaviour, and high parental BMI plus low gestational weight gain. Overall, we observed that patterns characterised by high parental BMI, smoking, low-quality diet, or sedentary lifestyle before or during pregnancy were associated with higher BMI z-scores and risk of overweight and obesity in children aged 5-12 years. INTERPRETATION Our data contribute to a better understanding of how parental lifestyle factors might be associated with the risk of childhood obesity. These findings are valuable to inform future family-based and multi-behavioural child obesity prevention strategies in early life. FUNDING European Union's Horizon 2020 under the ERA-NET Cofund action (reference 727565) and European Joint Programming Initiative "A Healthy Diet for a Healthy Life" (JPI HDHL, EndObesity).
Collapse
Affiliation(s)
- Marion Lecorguillé
- Center for Research in Epidemiology and Statistics, National Institute of Health and Medical Research and National Research Institute for Agriculture, Food and the Environment, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France.
| | - Mireille Schipper
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Aisling O'Donnell
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Adrien M Aubert
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Muriel Tafflet
- Center for Research in Epidemiology and Statistics, National Institute of Health and Medical Research and National Research Institute for Agriculture, Food and the Environment, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
| | - Malamine Gassama
- UMS Elfe Team, French Institute for Demographic Studies, National Institute of Health and Medical Research, French Blood Agency, Aubervilliers, France
| | - Alexander Douglass
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - James R Hébert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Connecting Health Innovations, Columbia, SC, USA
| | - Cecily Kelleher
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Marie-Aline Charles
- Center for Research in Epidemiology and Statistics, National Institute of Health and Medical Research and National Research Institute for Agriculture, Food and the Environment, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France; UMS Elfe Team, French Institute for Demographic Studies, National Institute of Health and Medical Research, French Blood Agency, Aubervilliers, France
| | - Catherine M Phillips
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Romy Gaillard
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sandrine Lioret
- Center for Research in Epidemiology and Statistics, National Institute of Health and Medical Research and National Research Institute for Agriculture, Food and the Environment, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
| | - Barbara Heude
- Center for Research in Epidemiology and Statistics, National Institute of Health and Medical Research and National Research Institute for Agriculture, Food and the Environment, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
| |
Collapse
|
3
|
Moore Heslin A, O'Donnell A, Kehoe L, Walton J, Flynn A, Kearney J, McNulty B. Adolescent overweight and obesity in Ireland-Trends and sociodemographic associations between 1990 and 2020. Pediatr Obes 2023; 18:e12988. [PMID: 36287113 PMCID: PMC10077905 DOI: 10.1111/ijpo.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Overweight and obesity in adolescence is a growing issue and can have a range of both short- and long-term consequences on health. OBJECTIVES To analyse trends in adolescent weight status in Ireland across a 30-year period and to examine the influence of sociodemographic factors on overweight/obesity in Irish adolescents over time. METHODS Body composition and body mass index weight status of Irish adolescents were compared using data from three nationally representative, cross-sectional Irish national food consumption surveys from 1990, 2006 and 2020. Adjusted analysis of associations between socio-demographic factors with the risk of adolescent overweight/obesity at each time point were examined. RESULTS The prevalence of Irish adolescents with overweight/obesity has increased significantly in recent years, with 24% of adolescents living with overweight/obesity in 2020 compared to 18% in 2006 and 13% in 1990 (p < 0.001). Of note is a substantial increase in the prevalence of obesity, with 8% of adolescents living with obesity in 2020 compared to 3% in 2006 and 0.5% in 1990 (p < 0.001). A lower affluence social class was associated with 3.95 increased odds of adolescent overweight/obesity (95%CI 2.06-7.61) (p < 0.001) in 2020 only, with 41% of adolescents from the lowest affluence social class affected by overweight/obesity. Parental education level was inversely associated with the risk of adolescent overweight/obesity in 2006 and 2020, with a stronger effect in 2020. CONCLUSION There is an increasing prevalence of adolescents living with overweight/obesity in Ireland, with evidence of a growing socioeconomic gradient of overweight/obesity where adolescents affected by socioeconomic disadvantage are most at risk.
Collapse
Affiliation(s)
- Aoibhín Moore Heslin
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| | - Aisling O'Donnell
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| | - Laura Kehoe
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Janette Walton
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - Albert Flynn
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - John Kearney
- School of Biological & Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Breige McNulty
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| |
Collapse
|
4
|
O'Donnell A, Buffini M, Kehoe L, Nugent A, Kearney J, Walton J, Flynn A, McNulty B. Application of a composite scoring protocol to identify factors that contribute to the risk of overweight and obesity in Irish children. Pediatr Obes 2022; 17:e12922. [PMID: 35604281 PMCID: PMC9541128 DOI: 10.1111/ijpo.12922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/08/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Investigations into the main drivers of childhood obesity are vital to implement effective interventions to halt the global rise in levels. The use of a composite score may help to identify children most at risk of overweight/obesity. OBJECTIVES To investigate the cumulative impact of factors associated with overweight/obesity risk in children. METHODS Data were analysed from the Irish National Children's Food Survey II which included 600 children, aged 5-12-years. The risk factors examined included social class, parental, early life, lifestyle, and dietary components. A composite score was calculated which ranged from 0 (no risk factors for overweight/obesity) to 4 (4 risk factors for overweight/obesity). RESULTS In model 1 (%BF) the four factors associated with overweight/obesity risk were having a parent with overweight/obesity (odds ratio 3.1; 95% confidence interval 1.9-4.8), having a high birth weight of ≥4 kg (2.5; 1.6-3.9), being from a low social class (2.3; 1.4-3.8) and low physical activity (1.9; 1.2-2.8). Children who scored 3-4 points on the composite score had a 10-fold (10.0; 4.2-23.9) increased risk of overweight/obesity compared to those with 0 points, a sevenfold (7.2; 3.9-13.5) increased risk compared to those with 1 point and a threefold (2.6; 1.4-4.8) increased risk compared to those with 2 points, with similar results observed in model 2 (BMI). CONCLUSION The use of a composite score is a beneficial means of identifying children at risk of overweight/obesity and may prove useful in the development of effective interventions to tackle childhood obesity.
Collapse
Affiliation(s)
- Aisling O'Donnell
- UCD Institute of Food and Health, School of Agriculture and Food ScienceUniversity College DublinDublinIreland
| | - Maria Buffini
- UCD Institute of Food and Health, School of Agriculture and Food ScienceUniversity College DublinDublinIreland
| | - Laura Kehoe
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Anne Nugent
- UCD Institute of Food and Health, School of Agriculture and Food ScienceUniversity College DublinDublinIreland,School of Biological Sciences, Institute for Global Food SecurityQueens University BelfastBelfastNorthern Ireland
| | - John Kearney
- School of Biological & Health SciencesTechnological University DublinDublinIreland
| | - Janette Walton
- Department of Biological SciencesMunster Technological UniversityCorkIreland
| | - Albert Flynn
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Breige McNulty
- UCD Institute of Food and Health, School of Agriculture and Food ScienceUniversity College DublinDublinIreland
| |
Collapse
|
5
|
Horvath L, Desai J, Sandhu S, O'Donnell A, Hill A, Deva S, Markman B, Jameson M, Chen Z, Tan X, Hou J, Lim A. Preliminary results from a subset of patients (pts) with advanced head and neck squamous carcinoma (HNSCC) in a dose-escalation and dose-expansion study of BGB-A317, an anti-PD-1 monoclonal antibody (mAb). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
6
|
O'Donnell A, Bilton D, Serisier D, Wanner A, Froehlich J, Bruinenberg P, Gonda I. A Phase 3 Study Design of Pulmaquin® in Non-Cystic Fibrosis Bronchiectasis (NCFBE) Patients Chronically Colonized with Pseudomonas aeruginosa (PA). Pneumologie 2016. [DOI: 10.1055/s-0036-1592235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
Manning L, Cutts J, Stanisic DI, Laman M, Carmagnac A, Allen S, O'Donnell A, Karunajeewa H, Rosanas-Urgell A, Siba P, Davis TME, Michon P, Schofield L, Rockett K, Kwiatkowski D, Mueller I. A Toll-like receptor-1 variant and its characteristic cellular phenotype is associated with severe malaria in Papua New Guinean children. Genes Immun 2015; 17:52-9. [PMID: 26633000 DOI: 10.1038/gene.2015.50] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 01/13/2023]
Abstract
Genetic factors are likely to contribute to low severe malaria case fatality rates in Melanesian populations, but association studies can be underpowered and may not provide plausible mechanistic explanations if significant associations are detected. In preparation for a genome-wide association study, 29 candidate single-nucleotide polymorphisms (SNPs) with minor allele frequencies >5% were examined in a case-control study of 504 Papua New Guinean children with severe malaria. In parallel, an immunological substudy was performed on convalescent peripheral blood mononuclear cells (PBMCs) from cases and controls. Following stimulation with a Toll-like receptor (TLR) 1/2 agonist, effector cytokines and chemokines were assayed. The only significant genetic association observed involved a nonsynonymous SNP (TLR1rs4833095) in the TLR1 gene. A recessive (TT) genotype was associated with reduced odds of severe malaria of 0.52 (95% confidence interval (0.29-0.90), P=0.006). Concentrations of pro-inflammatory cytokines interleukin-1β and tumour necrosis factor α were significantly higher in severe malaria cases compared with healthy controls, but lower in children with the protective recessive (TT) genotype. A genetic variant in TLR1 may contribute to the low severe malaria case fatality rates in this region through a reduced pro-inflammatory cellular phenotype.
Collapse
Affiliation(s)
- L Manning
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute, Fiona Stanley Hospital, Bull Creek, Western Australia, Australia
| | - J Cutts
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
| | - D I Stanisic
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Institute for Glycomics, Griffith University, Southport, Queensland, Australia
| | - M Laman
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute, Fiona Stanley Hospital, Bull Creek, Western Australia, Australia.,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - A Carmagnac
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia
| | - S Allen
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - A O'Donnell
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - H Karunajeewa
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia
| | - A Rosanas-Urgell
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Institute of Tropical Medicine, Antwerp, Belgium
| | - P Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - T M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - P Michon
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Faculty of Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - L Schofield
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia
| | - K Rockett
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK and Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - D Kwiatkowski
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK and Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - I Mueller
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Barcelona Center for International Health Research (CRESIB), Barcelona, Spain
| |
Collapse
|
8
|
Schmidt CS, Schulte B, Seo H, Kuhn S, O'Donnell A, Kriston L, Verthein U, Reimer J. Meta-analysis on the Effectiveness of Alcohol Screening and Brief Interventions for Patients in Emergency Care Settings. Suchttherapie 2015. [DOI: 10.1055/s-0035-1557664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
9
|
Milekic MH, Xin Y, O'Donnell A, Kumar KK, Bradley-Moore M, Malaspina D, Moore H, Brunner D, Ge Y, Edwards J, Paul S, Haghighi FG, Gingrich JA. Age-related sperm DNA methylation changes are transmitted to offspring and associated with abnormal behavior and dysregulated gene expression. Mol Psychiatry 2015; 20:995-1001. [PMID: 25092244 DOI: 10.1038/mp.2014.84] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/14/2014] [Accepted: 06/17/2014] [Indexed: 12/15/2022]
Abstract
Advanced paternal age (APA) has been shown to be a significant risk factor in the offspring for neurodevelopmental psychiatric disorders, such as schizophrenia and autism spectrum disorders. During aging, de novo mutations accumulate in the male germline and are frequently transmitted to the offspring with deleterious effects. In addition, DNA methylation during spermatogenesis is an active process, which is susceptible to errors that can be propagated to subsequent generations. Here we test the hypothesis that the integrity of germline DNA methylation is compromised during the aging process. A genome-wide DNA methylation screen comparing sperm from young and old mice revealed a significant loss of methylation in the older mice in regions associated with transcriptional regulation. The offspring of older fathers had reduced exploratory and startle behaviors and exhibited similar brain DNA methylation abnormalities as observed in the paternal sperm. Offspring from old fathers also had transcriptional dysregulation of developmental genes implicated in autism and schizophrenia. Our findings demonstrate that DNA methylation abnormalities arising in the sperm of old fathers are a plausible mechanism to explain some of the risks that APA poses to resulting offspring.
Collapse
Affiliation(s)
- M H Milekic
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - Y Xin
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - A O'Donnell
- Department of Genetics and Development, Columbia University, New York, NY, USA
| | - K K Kumar
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - M Bradley-Moore
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - D Malaspina
- 1] Department of Psychiatry, New York University, New York, NY, USA [2] Department of Psychiatry, New York University, and The NY OMH Creedmoor Psychiatric Center, New York, NY, USA
| | - H Moore
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - D Brunner
- 1] Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA [2] PsychoGenics, New York, NY, USA
| | - Y Ge
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - J Edwards
- Center for Pharmacogenomics, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - S Paul
- Helen & Robert Appel Institute for Alzheimer's Research, Mind and Brain Institute, Weill Cornell Medical School, New York, NY, USA
| | - F G Haghighi
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J A Gingrich
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
10
|
O'Donnell A, Moollan A, Baneham S, Ozgul M, Pabari RM, Cox D, Kirby BP, Ramtoola Z. Intranasal and intravenous administration of octa-arginine modified poly(lactic-co-glycolic acid) nanoparticles facilitates central nervous system delivery of loperamide. J Pharm Pharmacol 2014; 67:525-36. [DOI: 10.1111/jphp.12347] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/05/2014] [Indexed: 01/06/2023]
Abstract
Abstract
Objectives
The potential of poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) surface modified with octa-arginine (R8) for central nervous system (CNS) delivery was investigated.
Methods
PLGA NPs containing coumarin-6 or loperamide were surface modified using R8 and characterised for size, zeta potential, drug loading and release. We examined the cellular uptake of NPs in Madin-Darby Canine Kidney (MDCK) cells and CNS delivery of loperamide in a mouse model following intranasal (i.n.) and intravenous (i.v.) administration.
Key findings
NPs were 300–350 nm in diameter and of negative zeta potential which neutralised on R8 conjugation. Cellular uptake of R8-PLGA NPs was rapid compared with PLGA NPs and correlated with a high antinociceptive effect in mice by both the i.n. and i.v. routes. Little antinociceptive effect for PLGA NPs was observed reflecting their slow uptake in the in-vitro cell model.
Conclusion
This study demonstrates the potential of R8-PLGA NPs as carriers of therapeutic agents to the CNS.
Collapse
Affiliation(s)
- Aisling O'Donnell
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Azeema Moollan
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Samantha Baneham
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Melike Ozgul
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ritesh M Pabari
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Dermot Cox
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Brian P Kirby
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | |
Collapse
|
11
|
Biddle STB, O'Donnell A, Houghton E, Creaser CS. Metabolism of norethisterone in the greyhound. Rapid Commun Mass Spectrom 2013; 27:2229-2238. [PMID: 24019188 DOI: 10.1002/rcm.6689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/17/2013] [Accepted: 07/17/2013] [Indexed: 06/02/2023]
Abstract
RATIONALE Norethisterone has been used as a successful oral contraceptive in humans for many years. It was recently permitted for use as an oestrus suppressant in racing greyhounds. To monitor the use of norethisterone as part of a routine drug surveillance programme, knowledge of its metabolism was required to enable detection. METHODS Gas chromatography/mass spectrometry and selective derivatisation techniques have been used to identify urinary metabolites of norethisterone following oral administration to the greyhound. Metabolites were extracted using solid-phase and liquid-liquid extraction techniques. RESULTS Several metabolites were identified, including reduced, mono-, di- and trihydroxylated steroids. The major metabolites observed were 17α-ethynyl-5β-estrane-3α,17β-diol, 17α-ethynyl-5α-estrane-3β,17β-diol, three 17α-ethynylestranetriol stereoisomers and two 17α-ethynylestranetetrol stereoisomers. The major metabolites were predominantly excreted as glucuronic acid conjugates and detection of the administration of norethisterone was possible for up to 8 days post-dose using the methods described. The nandrolone metabolites, 19-norepiandrosterone, estranediol and 19-noretiocholanolone, were also identified in the post-administration samples collected up to 8 h after dosing the treated animals. CONCLUSIONS The urinary metabolites identified in this study have further increased the knowledge of steroid metabolism in the greyhound, providing information to support routine drug testing programmes for greyhound racing.
Collapse
Affiliation(s)
- S T B Biddle
- HFL Sport Science, Quotient Bioresearch, Newmarket Road, Fordham, CB7 5WW, UK
| | | | | | | |
Collapse
|
12
|
Silveira-Moriyama L, Schwingenschuh P, O'Donnell A, Schneider SA, Mir P, Carrillo F, Terranova C, Petrie A, Grosset DG, Quinn NP, Bhatia KP, Lees AJ. Olfaction in patients with suspected parkinsonism and scans without evidence of dopaminergic deficit (SWEDDs). J Neurol Neurosurg Psychiatry 2009; 80:744-8. [PMID: 19276101 DOI: 10.1136/jnnp.2009.172825] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [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: 11/03/2022]
Abstract
BACKGROUND Positron emission tomography and single photon emission computed tomography scanning have 87-94% sensitivity and 80-100% specificity to differentiate patients with Parkinson's disease (PD) from control subjects and patients with essential (ET) or atypical tremor. More than 10% of patients diagnosed as early PD can have scans without evidence of dopaminergic deficiency (SWEDDs). This study investigated whether smell tests can help identify possible cases with SWEDDs. METHODS The 40 item University of Pennsylvania Smell Test (UPSIT) was used to evaluate the sense of smell in 21 SWEDDs patients. Twenty-six ET patients, 16 patients with a diagnosis of idiopathic adult onset dystonia (D), 191 non-demented PD patients and 136 control subjects were also tested. Multiple regression analyses were used to compare the mean UPSIT score in the SWEDDs group with the other four groups (ET, D, PD and controls) after adjusting for the effects of relevant covariates. RESULTS The mean UPSIT score for the SWEDDs group was greater than in the PD group (p<0.001) and not different from the mean UPSIT in the control (p = 0.7), ET (p = 0.4) or D (p = 0.9) groups. Smell tests indicated a high probability of PD in only 23.8% of SWEDDs as opposed to 85.3% of PD patients. CONCLUSIONS In a patient with suspected PD, a high PD probability on smell testing favours the diagnosis of PD, and a low PD probability strengthens the indication for dopamine transporter imaging.
Collapse
Affiliation(s)
- L Silveira-Moriyama
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 1PJ, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
Gas chromatography/mass spectrometry and selective derivatisation techniques have been used to identify urinary metabolites of methyltestosterone following oral administration to the greyhound. Several metabolites were identified including reduced, mono-, di- and trihydroxylated steroids. The major metabolites observed were 17alpha-methyl-5beta-androstane-3alpha-17beta-diol, 17alpha-methyl-5beta-androstane-3alpha,16alpha,17beta-triol, and a further compound tentatively identified as 17alpha-methyl-5z-androstane-6z,17beta-triol. The most abundant of these was the 17alpha-methyl-5beta-androstane-3alpha,16alpha,17beta-triol. This metabolite was identified by comparison with a reference standard synthesised using a Grignard procedure and characterised using trimethylsilyl (TMS) and acetonide-TMS derivatisation techniques. There did not appear to be any evidence for 16beta-hydroxylation as a phase I metabolic transformation in the greyhound. However, significant quantities of 16alpha-hydroxy metabolites were detected. Selective enzymatic hydrolysis procedures indicated that the major metabolites identified were excreted as glucuronic acid conjugates. Metabolic transformations observed in the greyhound have been compared with those of other mammalian species and are discussed here.
Collapse
Affiliation(s)
- S T B Biddle
- HFL Sport Science, Quotient Bioresearch, Newmarket Road, Fordham, Ely CB7 5WW, UK.
| | | | | | | |
Collapse
|
14
|
Hargrove M, O'Donnell A, Aherne T. Differences in displayed pump flow compared to measured flow under varying conditions during simulated cardiopulmonary bypass. Perfusion 2009; 23:227-30. [PMID: 19181755 DOI: 10.1177/0267659108100458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Errors in blood flow delivery due to shunting have been reported to reduce flow by, potentially, up to 40-83% during cardiopulmonary bypass. The standard roller-pump measures revolutions per minute and a calibration factor for different tubing sizes calculates and displays flow accordingly. We compared displayed roller-pump flow with ultrasonically measured flow to ascertain if measured flow correlated with the heart-lung pump flow reading. Comparison of flows was measured under varying conditions of pump run duration, temperature, viscosity, varying arterial/venous loops, occlusiveness, outlet pressure, use of silicone or polyvinyl chloride (PVC) in the roller race, different tubing diameters, and use of a venous vacuum-drainage device.
Collapse
Affiliation(s)
- M Hargrove
- Cardiothoracic Surgery Unit, Cork University Hospital, Wilton, Cork, Ireland.
| | | | | |
Collapse
|
15
|
Healy DG, Hargrove M, Doddakulla K, Hinchion J, O'Donnell A, Aherne T. Impact of pacing modality and biventricular pacing on cardiac output and coronary conduit flow in the post-cardiotomy patient. Interact Cardiovasc Thorac Surg 2008; 7:805-8. [DOI: 10.1510/icvts.2008.180497] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
16
|
O'Donnell A. Essays on the First Hundred Years of Anaesthesia. West J Med 2008. [DOI: 10.1136/bmj.a794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
17
|
Benson C, White J, Bono JD, O'Donnell A, Raynaud F, Cruickshank C, McGrath H, Walton M, Workman P, Kaye S, Cassidy J, Gianella-Borradori A, Judson I, Twelves C. A phase I trial of the selective oral cyclin-dependent kinase inhibitor seliciclib (CYC202; R-Roscovitine), administered twice daily for 7 days every 21 days. Br J Cancer 2006; 96:29-37. [PMID: 17179992 PMCID: PMC2360206 DOI: 10.1038/sj.bjc.6603509] [Citation(s) in RCA: 199] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Seliciclib (CYC202; R-roscovitine) is the first selective, orally bioavailable inhibitor of cyclin-dependent kinases 1, 2, 7 and 9 to enter clinical trial. Preclinical studies showed antitumour activity in a broad range of human tumour xenografts. A phase I trial was performed with a 7-day b.i.d. p.o. schedule. Twenty-one patients (median age 62 years, range: 39-73 years) were treated with doses of 100, 200 and 800 b.i.d. Dose-limiting toxicities were seen at 800 mg b.i.d.; grade 3 fatigue, grade 3 skin rash, grade 3 hyponatraemia and grade 4 hypokalaemia. Other toxicities included reversible raised creatinine (grade 2), reversible grade 3 abnormal liver function and grade 2 emesis. An 800 mg portion was investigated further in 12 patients, three of whom had MAG3 renograms. One patient with a rapid increase in creatinine on day 3 had a reversible fall in renal perfusion, with full recovery by day 14, and no changes suggestive of renal tubular damage. Further dose escalation was precluded by hypokalaemia. Seliciclib reached peak plasma concentrations between 1 and 4 h and elimination half-life was 2-5 h. Inhibition of retinoblastoma protein phosphorylation was not demonstrated in peripheral blood mononuclear cells. No objective tumour responses were noted, but disease stabilisation was recorded in eight patients; this lasted for a total of six courses (18 weeks) in a patient with ovarian cancer.
Collapse
Affiliation(s)
- C Benson
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
- Section of Medicine, The Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey, UK
| | - J White
- Department of Medical Oncology and Beatson Oncology Centre, University of Glasgow, Glasgow, UK
| | - J De Bono
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
- Section of Medicine, The Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey, UK
| | - A O'Donnell
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
| | - F Raynaud
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
| | - C Cruickshank
- Cancer Research UK Drug Development Office, London, UK
| | | | - M Walton
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
| | - P Workman
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
| | - S Kaye
- Section of Medicine, The Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey, UK
| | - J Cassidy
- Department of Medical Oncology and Beatson Oncology Centre, University of Glasgow, Glasgow, UK
| | | | - I Judson
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK. E-mail:
| | - C Twelves
- Beatson Oncology Centre, Glasgow, UK
| |
Collapse
|
18
|
Woodrow P, May V, Buras-Rees S, Higgs D, Hendrick J, Lewis T, Whitney S, Cummings C, Boorman P, O'Donnell A, Harris P, McHenry M. Comparing no-touch and tympanic thermometer temperature recordings. ACTA ACUST UNITED AC 2006; 15:1012-6. [PMID: 17077774 DOI: 10.12968/bjon.2006.15.18.22028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/11/2022]
Abstract
Temperature is a vital sign which can be measured using various types of clinical thermometers. Pulmonary artery temperature is considered the 'gold standard', but this measurement is not usually clinically practical. There is currently no consensus for optimal alternative site or equipment. This research compares 178 simultaneous measurements from 5 clinical areas, using two types of thermometers: tympanic and no-touch temporal. No-touch thermometers were all set to oral equivalent. Tympanic thermometers were adjusted to either oral (n=105) or core (n=73) equivalent. Maximum acceptable difference was identified as 1oC. Two data sets (oral/core; oral/oral) were analysed using Bland-Altman method on Excel programmes, comparing all thermometers and separating oral and core-equivalent tympanics. The two thermometers were found not to be equivalent. As a simple comparison between two thermometers, this research cannot identify which thermometer is more accurate.
Collapse
Affiliation(s)
- P Woodrow
- East Kent Hospitals NHS Trust, Canterbury
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
The effect of maternal alpha+ -thalassaemia on pregnancy was assessed in the north coastal region of Papua New Guinea (PNG), where malaria is hyperendemic and alpha+ -thalassaemia is extremely common. In a prospective study of 987 singleton hospital deliveries, we correlated maternal alpha-globin genotype with markers of reproductive fitness (age in primigravidae, gravidity, pregnancy interval and the number of miscarriages and stillbirths), Plasmodium falciparum(P. falciparum) infection of the mother and placenta, maternal haemoglobin, preterm delivery and birthweight. The frequency of the -alpha genotype in mothers was 0.61. Markers of reproductive fitness were similar in women with and without alpha+ -thalassaemia. Median haemoglobin concentration during pregnancy and after delivery was about 1.0 g/dl lower in homozygous alpha+ -thalassaemia than in women with a normal alpha- globin genotype (P < or = 0.001). The frequency of placental P. falciparum infection and systemic malaria infection after delivery showed no consistent relationship to alpha-globin genotype. The frequency of preterm delivery and low birthweight did not vary significantly according to maternal alpha-globin genotype. Maternal alpha+ -thalassaemia does not affect reproductive fitness or susceptibility to malaria during pregnancy. Although median haemoglobin concentration was significantly lower in mothers homozygous for alpha+ -thalassaemia than those with a normal alpha-globin genotype, this did not result in an adverse outcome of pregnancy.
Collapse
Affiliation(s)
- A O'Donnell
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK.
| | | | | | | | | |
Collapse
|
20
|
O'Donnell A, Weatherall DJ, Taylor AM, Reeder JC, Allen SJ. Muscle cell injury, haemolysis and dark urine in children with falciparum malaria in Papua New Guinea. Trans R Soc Trop Med Hyg 2006; 100:817-25. [PMID: 16527319 DOI: 10.1016/j.trstmh.2005.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 11/21/2005] [Accepted: 11/21/2005] [Indexed: 11/17/2022] Open
Abstract
During a prospective study of red cell variants and severe malaria in children, a surprising observation was the occurrence of dark urine. Children were grouped according to urine findings: 22 had dark urine that contained a haem protein (Group I), 93 had urine of normal colour that contained a haem protein (Group II) and 236 had normal urine (Group III). To investigate the cause of dark urine, haemolysis and muscle cell injury were assessed. Intravascular haemolysis was greater in Group I than in Groups II and III. However, anaemia was more severe in Group III and is likely to have resulted mainly from extravascular haemolysis. Median plasma myoglobin concentrations were greater in Groups I and II than Group III (P = 0.00060). Plasma myoglobin was greater in children with cerebral malaria, hyperlactataemia and those who died but was not associated with acidosis. Urine myoglobin was greater in Group I than Groups II and III (P = 0.00054). It is likely that both haemoglobin and myoglobin contributed to dark urine. The association between muscle cell injury and coma suggests sequestration of parasitized red cells as a common underlying pathology. In malaria, hyperlactataemia may result directly from breakdown of muscle protein as well as tissue hypoxia.
Collapse
Affiliation(s)
- A O'Donnell
- Weatherall Institute of Molecular Medicine, University of Oxford, The John Radcliffe Hospital, Headington, Oxford OX3 9DS, UK.
| | | | | | | | | |
Collapse
|
21
|
O'Donnell A, Padhani A, Hayes C, Kakkar AJ, Leach M, Trigo JM, Scurr M, Raynaud F, Phillips S, Aherne W, Hardcastle A, Workman P, Hannah A, Judson I. A Phase I study of the angiogenesis inhibitor SU5416 (semaxanib) in solid tumours, incorporating dynamic contrast MR pharmacodynamic end points. Br J Cancer 2005; 93:876-83. [PMID: 16222321 PMCID: PMC2361651 DOI: 10.1038/sj.bjc.6602797] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
SU5416 (Z-3-[(2,4-dimethylpyrrol-5-yl)methylidenyl]-2-indolinone; semaxanib) is a small molecule inhibitor of the vascular endothelial growth factor receptor (VEGFR2). A Phase I dose escalation study was performed. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was used as a pharmacodynamic assessment tool. In all, 27 patients were recruited. SU5416 was administered twice weekly by fixed rate intravenous infusion. Patients were treated in sequential cohorts of three patients at 48, 65, 85 110 and 145 mg m-2. A further dose level of 190 mg m-2 after a 2-week lead in period at a lower dose was completed; thereafter, the cohort at 145 mg m-2 was expanded. SU5416 showed linear pharmacokinetics to 145 mg m-2 with a large volume of distribution and rapid clearance. A significant degree of interpatient variability was seen. SU5416 was well tolerated, by definition a maximum-tolerated dose was not defined. No reproducible changes were seen in DCE-MRI end points. Serial assessments of VEGF in a cohort of patients treated at 145 mg m-2 did not show a statistically significant treatment-related change. Parallel assessments of the impact of SU5416 on coagulation profiles in six patients showed a transient effect within the fibrinolytic pathway. Clinical experience showed that patients who had breaks of therapy longer than a week could not have treatment reinitiated at a dose of 190 mg m-2 without unacceptable toxicity. The 145 mg m-2 dose level is thus the recommended dose for future study.
Collapse
Affiliation(s)
- A O'Donnell
- Institute of Cancer Research, and Royal Marsden Hospital, Sutton SM2 5PT, UK. anne.o'
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Sibartie V, Quigley EMM, O'Donnell A, O'Halloran D, Thompson C. Gastric electrical stimulation: a report of two cases. Ir Med J 2005; 98:245-6. [PMID: 16445145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Gastroparesis refractory to prokinetic agents poses a major challenge to the physician and patient, alike. In the past 5 years, electrical methods to treat gastroparesis have emerged from animal and human experiments to a potentially valuable tool in clinical gastroenterology. One of these methods, known as gastric electrical stimulation (GES), is being increasingly used in specialized centres worldwide, but had never been tried in Ireland. We describe here our experience with the first two implantations of gastric neurostimulators performed in Ireland and the outcome with these 2 patients. Our results at 6 months show reduction in symptoms and improvement in quality of life, which is encouraging and should prompt further evaluation of GES for patients with gastroparesis refractory to medical therapy.
Collapse
Affiliation(s)
- V Sibartie
- Alimentary Pharmabiotic Centre, Department of Medicine, Cork University Hospital, Wilton.
| | | | | | | | | |
Collapse
|
23
|
Premawardhena A, Fisher CA, Olivieri NF, de Silva S, Arambepola M, Perera W, O'Donnell A, Peto TEA, Viprakasit V, Merson L, Muraca G, Weatherall DJ. Haemoglobin E beta thalassaemia in Sri Lanka. Lancet 2005; 366:1467-70. [PMID: 16243092 DOI: 10.1016/s0140-6736(05)67396-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [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: 10/25/2022]
Abstract
Haemoglobin E beta thalassaemia is the commonest form of severe thalassaemia in many Asian countries, but little is known about its natural history, the reasons for clinical diversity, or its management. We studied 109 Sri Lankan patients with the disorder over 5 years. 25 patients were not receiving transfusion; transfusion was stopped with no deleterious effect in a further 37. We identified several genetic and environmental factors that might contribute to the phenotypic diversity of the disorder, including modifiers of haemoglobin F production, malaria, and age-related changes in adaptive function. Our findings suggest that haemoglobin E beta thalassaemia can be managed without transfusion in many patients, even with low haemoglobin levels. Age-related changes in the pattern of adaptation to anaemia suggest that different and more cost-effective approaches to management should be explored.
Collapse
Affiliation(s)
- A Premawardhena
- National Thalassaemia Centre, General Hospital, Kurunegala, Sri Lanka
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Crosby TF, O'Donnell A, O'Doherty JV, Quinn PJ, Evans ACO. Effects of exogenous progesterone on gestation length, foetal survival and colostrum yield in ewes. Theriogenology 2005; 64:1121-9. [PMID: 16125556 DOI: 10.1016/j.theriogenology.2005.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Revised: 01/24/2005] [Accepted: 01/26/2005] [Indexed: 11/28/2022]
Abstract
Twin bearing mature ewes (n=40) were treated with exogenous progesterone (100mg daily in oil) or vehicle (oil control) from Day 143 of gestation until lambing to investigate the effects on gestation length, foetal survival and colostrum yield and composition. Compared to control ewes, progesterone treated ewes had increased (P<0.05) serum progesterone concentrations (by 4.3 ng/ml) before lambing and in the first day post-partum (by 10 ng/ml). Progesterone treatment increased gestation length (150.4+/-0.6 days versus 147.8+/-0.6 days, P<0.05) and colostrum yield at 1h after lambing (P<0.05) but the colostrum had a lower concentration of IgG (P=0.02). In the first 24h after lambing, total colostrum and IgG yields were not different between groups. Four (20%) of the progesterone treated ewes produced either one or two dead lambs, while one ewe died on day 155 without initiating the birth process. We conclude that the daily administration of 100mg progesterone resulted in extended gestation length and reduced lamb survival but did not lower colostrum yield.
Collapse
Affiliation(s)
- T F Crosby
- Department of Animal Science, University College Dublin, Faculty of Agri-food and the Environment, Belfield, Dublin 4, Ireland.
| | | | | | | | | |
Collapse
|
25
|
Harmon D, Eustace N, Ghori K, Butler M, O'Callaghan S, O'Donnell A, Moore-Groarke GM, Shorten G. Plasma concentrations of nitric oxide products and cognitive dysfunction following coronary artery bypass surgery. Eur J Anaesthesiol 2005; 22:269-76. [PMID: 15892404 DOI: 10.1017/s0265021505000451] [Citation(s) in RCA: 9] [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: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Prospective longitudinal studies now indicate that cognitive dysfunction following coronary artery bypass surgery (CABG) is both common and persistent. This dysfunction is due in part to the inflammatory response and cerebral ischaemia-reperfusion, with nitric oxide (NO) as an important mediator of both. We hypothesized that a clinically significant association exists between plasma concentrations of nitrate/nitrite (NO3-/NO2-) and cognitive dysfunction after CABG. METHODS Cognitive assessment was performed on 36 adult patients the day before CABG, on the fourth postoperative day and 3 months postoperatively. Patient spouses (n = 10) were also studied. RESULTS A new cognitive deficit was present in 22/36 (62%) 4 days postoperatively and in 16/35 (49%) of patients, 3 months postoperatively. Patients who had cognitive dysfunction 3 months postoperatively were more likely to have cognitive dysfunction and increased plasma NO3-/NO2- concentrations compared to the non-deficit group preoperatively (22.6 (9.2) vs. 27.6 (8.4)) (P = 0.002). Plasma NOx (NO3- plus NO2-) concentrations were greater in patients with cognitive dysfunction 3 months postoperatively, 2 h (24.2 (6.3) vs. 19.1 (5.2)) (P = 0.002), and 12 h postoperatively (24.8 (7.6) vs. 18.8 (5.6)) (P = 0.001). There was, however, a time course similarity in NOx elevations for both deficit and non-deficit groups. CONCLUSIONS Perioperative plasma NOx concentrations do not serve as an effective biomarker of cognitive deficit after CABG.
Collapse
Affiliation(s)
- D Harmon
- Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Veillonella species is a rare cause of endocarditis. We report a case of a 49-year-old man with Veillonella parvula prosthetic valve endocarditis who presented with acute cardiac failure due to valvular dehiscence. His clinical course was complicated by cortical blindness and limb paresis as a result of cerebral embolism. The endocarditis was successfully treated with urgent valve replacement surgery and a prolonged course of metronidazole.
Collapse
Affiliation(s)
- T W Boo
- Department of Microbiology, University Hospital, Wilton Road, Cork, Ireland.
| | | | | | | |
Collapse
|
27
|
Shuhaibar MN, Hargrove M, Millat MH, O'Donnell A, Aherne T. How much heparin do we really need to go on pump? A rethink of current practices. Eur J Cardiothorac Surg 2004; 26:947-50. [PMID: 15519187 DOI: 10.1016/j.ejcts.2004.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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] [Received: 08/26/2003] [Revised: 06/01/2004] [Accepted: 07/01/2004] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Patients undergoing myocardial revascularisation using extracorporeal circulation require heparin anticoagulation. We aimed to evaluate the effect of reducing heparin dosage on target activated clotting time (ACT) and postoperative blood loss. METHODS In a prospective randomised trial, 195 patients undergoing isolated primary CABG were randomised into four groups A, B, C, and D receiving an initial heparin dosage of 100, 200, 250 and 300 iu/kg, respectively. Extra incremental heparin (50 iu/kg) was added if required to achieve a target ACT of 480 s before initiating cardiopulmonary bypass. Postoperative blood loss was measured from the time of heparin reversal to drain removal 24h later. RESULTS Target ACT was achieved in 0, 63, 68.3 and 82.4% of patients in groups A, B, C and D, respectively, after the initial dose of heparin. In group B, of those not achieving target act a single increment of heparin was sufficient to achieve target ACT in further 18.6%. The mean ACT after the initial dose in groups B, C and D was 482.9, 519 and 588 s, respectively (P<0.05). Postoperative blood loss in millilitre per kilogram was directly proportional to preoperative heparin dose. CONCLUSIONS Patients receiving lower dose of heparin has lower postoperative blood loss. Of those achieving the target ACT, group B was significantly the closest to the target ACT. A starting dose of 200 iu/kg of heparin and if necessary one 50 iu/kg increment achieved target ACT in 81.5% of patients. The added benefit of significant drop in postoperative blood loss is evident.
Collapse
|
28
|
Harries M, O'Donnell A, Scurr M, Reade S, Cole C, Judson I, Greystoke A, Twelves C, Kaye S. Phase I/II study of DHA-paclitaxel in combination with carboplatin in patients with advanced malignant solid tumours. Br J Cancer 2004; 91:1651-5. [PMID: 15494716 PMCID: PMC2410023 DOI: 10.1038/sj.bjc.6602196] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
DHA-paclitaxel is a conjugate of paclitaxel and the fatty acid, docosahexaenoic acid. Preclinical studies have demonstrated increased activity, relative to paclitaxel, with the potential for an improved therapeutic ratio. We conducted a phase I study to determine the maximum tolerated doses of DHA-paclitaxel and carboplatin when administered in combination. Two cohorts of patients were treated: carboplatin AUC 5 with DHA-paclitaxel 660 mg m(-2) and carboplatin AUC 5 with DHA-paclitaxel 880 mg m(-2). Both drugs were given on day 1 every 21 days. A total of 15 patients were enrolled with a median age of 59 years (range 33-71). All patients had advanced cancer refractory to standard treatment, performance status 0-2 and were without major organ dysfunction. A total of 54 cycles of treatment were delivered. No dose-limiting toxicity (DLT) was seen in the first cohort of three patients. In an expanded second cohort, neutropenia was the main DLT, occurring in the first cycle of treatment in five of 12 patients: three of these patients and one additional patient also experienced dose-limiting grade 3 transient rises in liver transaminases. No alopecia was seen and one patient developed clinically significant neuropathy. One partial response was seen in a patient with advanced adenocarcinoma of the oesophago-gastric junction and 12 patients had stable disease with a median time to progression of 184 days (range 60-506 days). The recommended phase II dose in pretreated patients is Carboplatin AUC 5 and DHA-paclitaxel 660 mg m(-2) given every 21 days. Further studies with Carboplatin AUC 5 and DHA-paclitaxel 880 mg m(-2), given every 28 days, are warranted in chemo-naive patients.
Collapse
Affiliation(s)
- M Harries
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - A O'Donnell
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - M Scurr
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - S Reade
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - C Cole
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - I Judson
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - A Greystoke
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - C Twelves
- The Beatson Oncology Centre, Glasgow, UK
| | - S Kaye
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
- CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK. E-mail:
| |
Collapse
|
29
|
Pacey S, Rea D, Steven N, Brock C, Knowlton N, Shand N, Hazell K, Zoellner U, O'Donnell A, Judson I. Results of a phase 1 clinical trial investigating a combination of the oral mTOR-inhibitor Everolimus (E, RAD001) and Gemcitabine (GEM) in patients (pts) with advanced cancers. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Pacey
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - D. Rea
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - N. Steven
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - C. Brock
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - N. Knowlton
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - N. Shand
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - K. Hazell
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - U. Zoellner
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - A. O'Donnell
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - I. Judson
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| |
Collapse
|
30
|
Rowinsky EK, Pacey S, Patnaik A, O'Donnell A, Mita MM, Atadja P, Peng B, Dugan M, Scott JW, De Bono JS. A phase I, pharmacokinetic (PK) and pharmacodynamic (PD) study of a novel histone deacetylase (HDAC) inhibitor LAQ824 in patients with advanced solid tumors. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. K. Rowinsky
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - S. Pacey
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - A. Patnaik
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - A. O'Donnell
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - M. M. Mita
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - P. Atadja
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - B. Peng
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - M. Dugan
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - J. W. Scott
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - J. S. De Bono
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| |
Collapse
|
31
|
Scurr M, Judson I, Brock C, O'Donnell A, Tan S, Partridge EA, D'Souza RA, Roberts DW. Assessment of metabolism, excretion and pharmacokinetics of a single dose of [ 14C]-ZD6126 in patients with solid malignant tumors. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Scurr
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - I. Judson
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - C. Brock
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - A. O'Donnell
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - S. Tan
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - E. A. Partridge
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - R. A. D'Souza
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - D. W. Roberts
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| |
Collapse
|
32
|
O'Donnell A, Judson I, Dowsett M, Raynaud F, Dearnaley D, Mason M, Harland S, Robbins A, Halbert G, Nutley B, Jarman M. Hormonal impact of the 17alpha-hydroxylase/C(17,20)-lyase inhibitor abiraterone acetate (CB7630) in patients with prostate cancer. Br J Cancer 2004; 90:2317-25. [PMID: 15150570 PMCID: PMC2409523 DOI: 10.1038/sj.bjc.6601879] [Citation(s) in RCA: 319] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A series of three dose escalating studies were conducted to investigate the ability of the 17α-hydroxylase/C17,20-lyase inhibitor abiraterone acetate, to cause maximum suppression of testosterone synthesis when delivered to castrate and noncastrate males with prostate cancer. Study A was a single dose study in castrate males. Study B was a single dose study in noncastrate males and study C was a multiple dose study in noncastrate males. The drug was given orally in a once-daily dose and blood samples taken to assess pharmacokinetic (PK) parameters and hormone levels in all patients. The study drug was well tolerated with some variability in PKs. Suppression of testosterone levels to <0.14 nmol l−1 was seen in four out of six castrate males treated with a single dose of 500 mg. At 800 mg given days 1–12 in noncastrate males, target suppression was achieved in three out of three patients, but a two- to three-fold increase of Luteinising Hormone (LH) levels in two out of three patients overcame suppression within 3 days. All patients in the multiple dose study developed an abnormal response to a short Synacthen test by day 11, although baseline cortisol levels remained normal. This is the first report of the use of a specific 17α-hydroxylase/17,20-lyase inhibitor in humans. Repeated treatment of men with intact gonadal function with abiraterone acetate at a dose of 800 mg can successfully suppress testosterone levels to the castrate range. However, this level of suppression may not be sustained in all patients due to compensatory hypersecretion of LH. The enhanced testosterone suppression achieved in castrate men merits further clinical study as a second-line hormonal treatment for prostate cancer. Adrenocortical suppression may necessitate concomitant administration of replacement glucocorticoid.
Collapse
Affiliation(s)
- A O'Donnell
- Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT, UK
- CR UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - I Judson
- Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT, UK
- CR UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
- Clinical Pharmacology, Institute of Cancer Research, E-Block, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK. E-Mail:
| | - M Dowsett
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - F Raynaud
- CR UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - D Dearnaley
- Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT, UK
- Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - M Mason
- Department of Clinical Oncology, Velindre Hospital, Whitchurch, Cardiff CF4 7XL, UK
| | - S Harland
- Department of Oncology, University College of London, The Middlesex Hospital Mortimer St, London W1N 8AA, UK
| | - A Robbins
- Drug Development Office, Cancer Research UK, PO Box 123, London WC2A 3PX, UK
| | - G Halbert
- Cancer Research UK Formulation Unit, University of Strathclyde, Glasgow G1 1XW, UK
| | - B Nutley
- CR UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - M Jarman
- CR UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| |
Collapse
|
33
|
|
34
|
Yim CT, O'Donnell A, Yach K, Morin FG, Reven L. Deuterium NMR Study of the Dynamics of Self-Assembled Hexadecanoate Monolayers on Zirconium Oxide. J Phys Chem B 2003. [DOI: 10.1021/jp0347623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. T. Yim
- Department of Chemistry, Dawson College, 3040 Sherbrooke Street West, Westmount, Québec, Canada H3Z 1A4
| | - A. O'Donnell
- Department of Chemistry, McGill University, 801 Sherbrooke Street West, Montréal, Québec, Canada H3A 2K6
| | - K. Yach
- Department of Chemistry, McGill University, 801 Sherbrooke Street West, Montréal, Québec, Canada H3A 2K6
| | - F. G. Morin
- Department of Chemistry, McGill University, 801 Sherbrooke Street West, Montréal, Québec, Canada H3A 2K6
| | - L. Reven
- Department of Chemistry, McGill University, 801 Sherbrooke Street West, Montréal, Québec, Canada H3A 2K6
| |
Collapse
|
35
|
Abstract
Insertion of a chest drain can be associated with serious complications. It is recommended that the drain is inserted with blunt dissection through the chest wall but there is no specific instrument to aid this task. We describe a new reusable forceps that has been designed specifically to facilitate the insertion of chest drains.A feasibility study of its use in patients who required a chest drain as part of elective cardiothoracic operations was undertaken. The primary end-point was successful and accurate placement of the drain. The operators also completed a questionnaire rating defined aspects of the procedure. The new instrument was used to insert the chest drain in 30 patients (19 male, 11 female; median age 61.5 years (range 16-81 years)). The drain was inserted successfully without the trocar in all cases and there were no complications. Use of the instrument rated as significantly easier relative to experience of previous techniques in all specified aspects. The new device can be used to insert intercostal chest drains safely and efficiently without using the trocar or any other instrument.
Collapse
Affiliation(s)
- Emmet Andrews
- Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland.
| | | | | | | | | | | |
Collapse
|
36
|
Hargrove M, Ramish BC, O'Donnell A, Aherne T. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures. Perfusion 2003; 17:369-72. [PMID: 12243442 DOI: 10.1191/0267659102pf592oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed.
Collapse
Affiliation(s)
- M Hargrove
- Cardiothoracic Surgery Unit, Cork University Hospital, Wilton, Ireland.
| | | | | | | |
Collapse
|
37
|
Nölke L, Haque A, Kumar K, O'Donnell A. A needle aspirated into the thyroid vein! Ir Med J 2003; 96:151. [PMID: 12846280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
|
38
|
Beale P, Judson I, O'Donnell A, Trigo J, Rees C, Raynaud F, Turner A, Simmons L, Etterley L. A Phase I clinical and pharmacological study of cis-diamminedichloro(2-methylpyridine) platinum II (AMD473). Br J Cancer 2003; 88:1128-34. [PMID: 12671715 PMCID: PMC2376375 DOI: 10.1038/sj.bjc.6600854] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AMD473 is a novel sterically hindered platinum cytotoxic with demonstrated ability to overcome acquired resistance to cisplatin in vitro and in human tumour xenografts. A single-agent dose escalating Phase I study was performed. AMD473 was initially administered intravenously as a 1 h infusion every 21 days to patients with advanced solid tumours. In total, 42 patients received a total of 147 cycles (median 3, range 1-8) of treatment at doses of 12, 24, 48, 96, 110, 120, 130, and 150 mg m(-2). Dosing intervals of 21 and 28 days were explored at the recommended dose. Neutropenia and thrombocytopenia proved dose limiting. Other toxicities included moderate nausea, vomiting, anorexia, and a transient metallic taste. There was no significant alopecia. The maximum tolerated dose was 150 mg m(-2). Plasma pharmacokinetics were linear. Two patients with heavily pretreated ovarian cancer showed partial response. Five patients (mesothelioma, ovary, nonsmall cell lung, and melanoma) showed prolonged stable disease. AMD473 demonstrates encouraging activity in patients, including those with prior platinum exposure. Toxicity is predictable with linear pharmacokinetics, as was predicted by preclinical studies. A dose of 120 mg m(-2) every 21 days is recommended for Phase II evaluation although there is evidence that chemo-naive patients and those of good performance status may tolerate a higher dose.
Collapse
Affiliation(s)
- P Beale
- Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, New South Wales, Australia
| | - I Judson
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK. E-mail:
| | - A O'Donnell
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
| | - J Trigo
- Hospital Universitari de la Vall d'Hebron, Passeig de la Vall d'Hebron, Barcelona, Spain
| | - C Rees
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
| | - F Raynaud
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
| | - A Turner
- Cancer Research UK, PO Box 123, Lincoln's Inn Fields, London WC2A 3PX, UK
| | - L Simmons
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
| | - L Etterley
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
| |
Collapse
|
39
|
O'Connor PA, Nölke L, O'Donnell A, Lingham KM. Retrosternal dislocation of the clavicle associated with a traumatic pneumothorax. Interact Cardiovasc Thorac Surg 2003; 2:9-11. [PMID: 17669976 DOI: 10.1016/s1569-9293(02)00066-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Retrosternal dislocation of the clavicle is a rare injury that is easily overlooked. Significant complications can occur both immediately following the initial injury and in the long term. We report a case of a young male in which the medial aspect of the clavicle was dislocated deep into the pleura abutting the aortic arch. Knowledge of these injuries allows for early detection and intervention, avoiding long-term sequelae.
Collapse
Affiliation(s)
- P A O'Connor
- Department of Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland.
| | | | | | | |
Collapse
|
40
|
Abstract
Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Allergic bronchopulmonary aspergillosis (ABPA) is a syndrome seen in patients with asthma and cystic fibrosis, and is characterized by hypersensitivity to chronic colonization of the airways with A. fumigatus. We report the case of a patient with ABPA presenting with pleural effusion. A 27-year-old male was referred with recurrent right pleural effusion. Past medical history was remarkable for asthma, allergic sinusitis, and recurrent pleurisy. Investigations revealed peripheral eosinophilia with elevated serum immunoglobulin E and bilateral pleural effusions with bilateral upper lobe proximal bronchiectasis. Precipitating serum antibodies to A. fumigatus were positive and the A. fumigatus immediate skin test yielded a positive reaction. A diagnosis of ABPA associated with bilateral pleural effusions was made and the patient was commenced on prednisolone. At review, the patient's symptoms had considerably improved and his pleural effusions had resolved. ABPA may present with diverse atypical syndromes, including paratracheal and hilar adenopathy, obstructive lung collapse, pneumothorax and bronchopleural fistula, and allergic sinusitis. Allergic bronchopulmonary aspergillosis is a rare cause of pleural effusion and must be considered in the differential diagnosis of patients presenting with a pleural effusion, in particular those with a history of asthma.
Collapse
Affiliation(s)
- T M O'Connor
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | | | | | | |
Collapse
|
41
|
MacLeod C, O'Donnell A, Tattersall MH, Dalrymple C, Firth I. Locally advanced cervix cancer: chemotherapy prior to definitive surgery or radiotherapy. A single institutional experience. Australas Radiol 2001; 45:491-5. [PMID: 11903183 DOI: 10.1046/j.1440-1673.2001.00961.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary or neoadjuvant chemotherapy prior to definitive local therapy has potential advantages for locally advanced cervix cancer. It can downstage a cancer and allow definitive local therapy to be technically possible (surgery), or potentially more effective (radiotherapy). It can also eradicate subclinical systemic metastases. This report reviews a single institution's experience of neoadjuvant chemotherapy prior to definitive local therapy for cervix cancer over a 13-year period. One hundred and six patients were treated with this intent. The patients were analysed for their response to chemotherapy, treatment received, survival, relapse and toxicity. The chemotherapy was feasible and the majority of patients had a complete or partial response (58.5%). Eight patients did not proceed to local treatment. Forty-six patients had definitive surgery and 52 had definitive radiotherapy. The 5-year overall survival was 27% and the majority of patients died with disease. The first site of relapse was usually in the pelvis (46.2%). Late complications that required ongoing medical therapy (n=6) or surgical intervention (n=2) were recorded in eight patients (7.5%). On univariate analysis stage (P=0.04), tumour size (P=0.01), lymph node status (P=0.003), response to chemotherapy (P=0.045) and treatment (P=0.003) were all significant predictors of survival. On multivariate analysis, tumour size (P < 0.0001) and nodal status (P=0.02) were significant predictors of survival. Despite the impressive responses to chemotherapy of advanced cervix cancer, there is evidence from randomized trials that it does not improve or compromise survival prior to radiotherapy. As its role prior to surgery remains unclear, it should not be used in this setting outside a prospective randomized trial.
Collapse
Affiliation(s)
- C MacLeod
- Department of Radiation Oncology, Murray Valley Cancer Centre, Wodonga, Victoria, Australia.
| | | | | | | | | |
Collapse
|
42
|
Halpenny M, Lakshmi S, O'Donnell A, O'Callaghan-Enright S, Shorten GD. Fenoldopam: renal and splanchnic effects in patients undergoing coronary artery bypass grafting. Anaesthesia 2001. [DOI: 10.1111/j.1365-2044.2001.02220.x] [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]
|
43
|
Halpenny M, Lakshmi S, O'Donnell A, O'Callaghan-Enright S, Shorten GD. Fenoldopam: renal and splanchnic effects in patients undergoing coronary artery bypass grafting. Anaesthesia 2001; 56:953-60. [PMID: 11576097 DOI: 10.1046/j.1365-2044.2001.02220.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Impairment of renal and splanchnic perfusion during and after cardiopulmonary bypass may be responsible for acute renal failure and endotoxin-mediated systemic inflammation, respectively. We hypothesised that fenoldopam, a selective dopamine receptor agonist, would preserve renal function after cardiopulmonary bypass through its selective renal vasodilatory and natriuretic effects, and increase gastrointestinal mucosal perfusion by selective splanchnic vasodilation. We examined the effects of fenoldopam on haemodynamic parameters, creatinine clearance, fractional excretion of sodium, urine output, free water clearance and gastric mucosal pH in 31 patients undergoing elective coronary revascularisation. Patients were randomly assigned to receive continuous infusions of fenoldopam 0.1 microg x kg(-1) x min(-1) (n = 16) or placebo (n = 15). Renal parameters were measured: during a 24-h period before hospital admission, during cardiopulmonary bypass, from completion of cardiopulmonary bypass until 4 h later, from 4 to 8 h after cardiopulmonary bypass, and from 8 to 14 h after cardiopulmonary bypass. Gastric intramucosal pH was measured using a gastric tonometer before, during and after cardiopulmonary bypass. In the placebo group, but not the fenoldopam group, mean (SD) creatinine clearance decreased after separation from cardiopulmonary bypass, from 107 (36) to 71 (22) ml x min(-1) (p < 0.01) and from 107 (36) to 79 (26) ml x min(-1) (p < 0.01) for the 0-4 h and 4-8 h intervals after cardiopulmonary bypass, respectively. Changes in intramucosal pH were similar in both groups. The findings are consistent with the hypothesis that fenoldopam possesses a renoprotective effect in patients undergoing cardiopulmonary bypass.
Collapse
Affiliation(s)
- M Halpenny
- Department of Anaesthesia and Intensive Care Medicine, Mercy Hospital and University College Cork, Ireland.
| | | | | | | | | |
Collapse
|
44
|
Coleman ET, Hargrove M, Mahony CO, O'Donnell A, Shorten G, Aherne T. The effects of venous cannulation technique and cardioplegia type on plasma potassium concentration and arterial blood pressure during cardiopulmonary bypass. J Extra Corpor Technol 2001; 33:148-52. [PMID: 11680727] [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: 02/22/2023]
Abstract
The cannulation method and cardioplegia solution used during cardiopulmonary bypass (CPB) may both influence plasma potassium concentrations ([K+]) and mean arterial blood pressure (MAP). Bi-caval or right atrial cannulation methods are routinely used in conjunction with crystalloid or blood cardioplegia. We investigated the influence of cannulation method and cardioplegia solutions on plasma [K+] and MAP during cardiopulmonary bypass. Sixty consecutive patients undergoing elective coronary artery bypass grafting (CABG) using CPB were studied. They were randomly divided into three groups of 20 patients. Patients in Group A underwent bi-caval venous cannulation and received crystalloid cardioplegia. Group B patients underwent right atrial cannulation and received crystalloid cardioplegia. Group C patients underwent right atrial cannulation and received blood cardioplegia. In each case. cardioplegia was administered antegrade via the aortic root. Plasma [K+], MAP. and hemoglobin concentration (Hb) were measured over an 8-min period following cardioplegia administration (pilot studies indicated pressure changes occuring post cardioplegia administration up to this time). The combination of bi-caval cannulation and crystalloid cardioplegia (Group A) was associated with the least increase in plasma [K+] and no decrease in MAP. The maximum [K+] for this Group was 4.2 mmol/L (4.6% increase). The minimum mean pressure was 57 mmHg (13.6% increase). Both right atrial cannulation groups (B and C) showed a large rise in plasma [K+] and a decrease in MAP. Group B maximum [K+] was 5.2 mmol/L (27.5% increase). Group C was also 5.2 mmol/L (26.0% increase). Group C showed the largest pressure decrease, the minimum mean pressure was 45 mmHg (21.3% decrease). The Group B minimum mean pressure was 45 mmHg (8.7% decrease). Our results show that patients undergoing CPB operations who are deemed to be at increased risk of suffering adverse effects from hypotensive episodes may benefit from bicaval cannulation and caval snaring, in preference to right atrial cannulation. Crystalloid cardioplegia may be preferable to blood cardioplegia in these cases to maintain the MAP.
Collapse
Affiliation(s)
- E T Coleman
- Cardiothoracic Theatre, Cork University Hospital, Ireland.
| | | | | | | | | | | |
Collapse
|
45
|
Moënne-Loccoz Y, Tichy HV, O'Donnell A, Simon R, O'Gara F. Impact of 2,4-diacetylphloroglucinol-producing biocontrol strain Pseudomonas fluorescens F113 on intraspecific diversity of resident culturable fluorescent pseudomonads associated with the roots of field-grown sugar beet seedlings. Appl Environ Microbiol 2001; 67:3418-25. [PMID: 11472913 PMCID: PMC93037 DOI: 10.1128/aem.67.8.3418-3425.2001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The impact of the 2,4-diacetylphloroglucinol-producing biocontrol agent Pseudomonas fluorescens F113Rif on the diversity of the resident community of culturable fluorescent pseudomonads associated with the roots of field-grown sugar beet seedlings was evaluated. At 19 days after sowing, the seed inoculant F113Rif had replaced some of the resident culturable fluorescent pseudomonads at the rhizoplane but had no effect on the number of these bacteria in the rhizosphere. A total of 498 isolates of resident fluorescent pseudomonads were obtained and characterized by molecular means at the level of broad phylogenetic groups (by amplified ribosomal DNA restriction analysis) and at the strain level (with random amplified polymorphic DNA markers) as well as phenotypically (55 physiological tests). The introduced pseudomonad induced a major shift in the composition of the resident culturable fluorescent Pseudomonas community, as the percentage of rhizoplane isolates capable of growing on three carbon substrates (erythritol, adonitol, and L-tryptophan) not assimilated by the inoculant was increased from less than 10% to more than 40%. However, the pseudomonads selected did not display enhanced resistance to 2,4-diacetylphloroglucinol. The shift in the resident populations, which was spatially limited to the surface of the root (i.e., the rhizoplane), took place without affecting the relative proportions of phylogenetic groups or the high level of strain diversity of the resident culturable fluorescent Pseudomonas community. These results suggest that the root-associated Pseudomonas community of sugar beet seedlings is resilient to the perturbation that may be caused by a taxonomically related inoculant.
Collapse
Affiliation(s)
- Y Moënne-Loccoz
- BIOMERIT Research Centre, Microbiology Department, National University of Ireland, Cork, Ireland
| | | | | | | | | |
Collapse
|
46
|
O'Donnell A, Scurr M, Banerji U, Benson C, Gallagher N, Cortes P, Judson I. ZD9331 in combination with gemcitabine in patients with refractory solid tumours - a phase I study. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80755-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
O'Donnell A. Lest we forget. Interview by Steven Black. Nurs Stand 2001; 15:22-3. [PMID: 12211819] [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: 02/26/2023]
|
48
|
Cutrer FM, O'Donnell A, Sanchez del Rio M. Functional neuroimaging: enhanced understanding of migraine pathophysiology. Neurology 2001; 55:S36-45. [PMID: 11089518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Research into migraine pathophysiology has been hampered by the episodic nature and unpredictable onset of migraine attacks. Recently, newer imaging techniques have been providing noninvasive methods of studying metabolism and hemodynamics in the brains of migraineurs during and between acute attacks. 133Xe blood flow techniques, transcranial Doppler, and SPECT have all been employed to investigate hemodynamic changes during migraine aura. PET has been useful in the study of migraine without aura, with findings of increased blood flow related to pain in cortical areas and in the medial brainstem. Currently, three functional MRI imaging techniques are being used in migraine research. Diffusion-weighted imaging has shown normal findings in measures of the ability of neurons to maintain osmotic gradients. Studies using perfusion-weighted imaging have shown alterations in relative cerebral blood flow (CBF), relative cerebral blood volume, and mean transit time during migraine visual aura. The blood oxygen level-dependent technique can supply information related to neuronal activation during acute migraine aura. MRS has been used with mixed success to look for evidence of abnormal energy metabolism in the brains of migraineurs. Magnetoencephalography studies support the presence of a spreading depression-like phenomenon in migraine with aura. Two groups have used transcranial magnetic stimulation to assess whether neurons in the occipital cortex are hyperexcitable, predisposing patients to develop aura symptoms. Despite conflicting findings, migraine with visual aura appears to be generally associated with transient decreases in regional CBF.
Collapse
Affiliation(s)
- F M Cutrer
- Partners Headache Center, Department of Neurology, Massachusetts General Hospital, Boston, 02129, USA
| | | | | |
Collapse
|
49
|
Halpenny M, Lakshmi S, O'Donnell A, O'Callaghan-Enright S, O'Connell D, Shorten G. The effects of fenoldopam on coronary conduit blood flow after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2001; 15:72-6. [PMID: 11254844 DOI: 10.1053/jcan.2001.20374] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To quantify the effects of fenoldopam, 0.1 microg/kg/min, on left internal mammary artery (LIMA) and saphenous vein blood flow after coronary anastomosis. DESIGN Prospective, randomized, double-blind, placebo-controlled trial. SETTING University teaching hospital, single institution. PARTICIPANTS Thirty-one American Society of Anesthesiologists III patients undergoing elective coronary revascularization. INTERVENTIONS A perivascular ultrasonic flow probe (Linton Instrumentation, Norfolk, UK) was placed around the LIMA and saphenous vein graft after coronary anastomosis. MEASUREMENTS AND MAIN RESULTS Immediately before and at 5-minute intervals for 15 minutes after starting the infusion, blood flow was measured in the LIMA and one saphenous vein graft using a transit time ultrasonic flow probe. Heart rate, blood pressure, and central venous pressure were documented at these time points. Administration of fenoldopam, 0.1 microg/kg/min, did not alter heart rate or blood pressure. A small, nonsignificant increase in LIMA blood flow occurred during the 15-minute study period (30 +/- 12 to 35 +/- 10 mL/min) in patients who received fenoldopam. No significant changes occurred in the placebo group. CONCLUSIONS The findings indicate that fenoldopam, 0.1 microg/kg/min, did not influence coronary conduit blood flow to a clinically significant extent. The small increase in LIMA blood flow may be of greater importance in high-risk patients or in the prevention of coronary arterial spasm.
Collapse
Affiliation(s)
- M Halpenny
- Department of Anesthesia, Cork University Hospital, Wilton, Ireland
| | | | | | | | | | | |
Collapse
|
50
|
Barker AF, Couch L, Fiel SB, Gotfried MH, Ilowite J, Meyer KC, O'Donnell A, Sahn SA, Smith LJ, Stewart JO, Abuan T, Tully H, Van Dalfsen J, Wells CD, Quan J. Tobramycin solution for inhalation reduces sputum Pseudomonas aeruginosa density in bronchiectasis. Am J Respir Crit Care Med 2000; 162:481-5. [PMID: 10934074 DOI: 10.1164/ajrccm.162.2.9910086] [Citation(s) in RCA: 268] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a placebo-controlled, double-blind, randomized study to evaluate the microbiological efficacy and safety of inhaled tobramycin for treatment of patients with bronchiectasis and Pseudomonas aeruginosa. Patients were randomly assigned to receive either tobramycin solution for inhalation (TSI) (n = 37) or placebo (n = 37), which was self-administered twice daily for 4 wk and followed by 2-wk off-drug. At Week 4, the TSI group had a mean decrease in P. aeruginosa density of 4.54 log(10) colony-forming units (cfu)/g sputum compared with no change in the placebo group (p < 0.01). At Week 6, P. aeruginosa was eradicated in 35% of TSI patients but was detected in all placebo patients. Investigators indicated that 62% of TSI patients showed an improved medical condition compared with 38% of placebo patients (odds ratio = 2.7, 95% confidence interval [CI] 1.1 to 6.9). Tobramycin-resistant P. aeruginosa strains developed in 11% of TSI patients and 3% of placebo patients (p = 0.36). The mean percent change in FEV(1) percent predicted from Week 0 to Week 4 was similar for the TSI and placebo groups (p = 0.41). More TSI-treated patients than placebo patients reported increased cough, dyspnea, wheezing, and noncardiac chest pain, but the symptoms did not limit therapy. Additional study is warranted to further evaluate TSI in bronchiectasis patients.
Collapse
Affiliation(s)
- A F Barker
- Pulmonary and Critical Care Division, Oregon Health Sciences University, Portland, Oregon, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|