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Hum RM, Sharma SD, Stadler M, Viatte S, Ho P, Nair N, Shi C, Yap CF, Soomro M, Plant D, Humphreys JH, MacGregor A, Yates M, Verstappen S, Barton A, Bowes J. Using Polygenic Risk Scores to Aid Diagnosis of Patients With Early Inflammatory Arthritis: Results From the Norfolk Arthritis Register. Arthritis Rheumatol 2024; 76:696-703. [PMID: 38010198 DOI: 10.1002/art.42760] [Citation(s) in RCA: 1] [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: 09/29/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE There is growing evidence that genetic data are of benefit in the rheumatology outpatient setting by aiding early diagnosis. A genetic probability tool (G-PROB) has been developed to aid diagnosis has not yet been tested in a real-world setting. Our aim was to assess whether G-PROB could aid diagnosis in the rheumatology outpatient setting using data from the Norfolk Arthritis Register (NOAR), a prospective observational cohort of patients presenting with early inflammatory arthritis. METHODS Genotypes and clinician diagnoses were obtained from patients from NOAR. Six G-probabilities (0%-100%) were created for each patient based on known disease-associated odds ratios of published genetic risk variants, each corresponding to one disease of rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, spondyloarthropathy, gout, or "other diseases." Performance of the G-probabilities compared with clinician diagnosis was assessed. RESULTS We tested G-PROB on 1,047 patients. Calibration of G-probabilities with clinician diagnosis was high, with regression coefficients of 1.047, where 1.00 is ideal. G-probabilities discriminated clinician diagnosis with pooled areas under the curve (95% confidence interval) of 0.85 (0.84-0.86). G-probabilities <5% corresponded to a negative predictive value of 96.0%, for which it was possible to suggest >2 unlikely diseases for 94% of patients and >3 for 53.7% of patients. G-probabilities >50% corresponded to a positive predictive value of 70.4%. In 55.7% of patients, the disease with the highest G-probability corresponded to clinician diagnosis. CONCLUSION G-PROB converts complex genetic information into meaningful and interpretable conditional probabilities, which may be especially helpful at eliminating unlikely diagnoses in the rheumatology outpatient setting.
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Affiliation(s)
- Ryan M Hum
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Seema D Sharma
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Michael Stadler
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Sebastien Viatte
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Pauline Ho
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Nisha Nair
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Chenfu Shi
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Chuan Fu Yap
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Mehreen Soomro
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Darren Plant
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Jenny H Humphreys
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | | | - Max Yates
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Suzanne Verstappen
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - Anne Barton
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
| | - John Bowes
- Centre for Musculoskeletal Research, NIHR Manchester Biomedical Research Centre, Lydia Becker Institute of Immunology and Inflammation, The University of Manchester, Manchester, UK
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Elkins TA, MacGregor A, Dougherty A, Olson A. Medical correlates of first-term attrition in US Navy personnel. BMJ Mil Health 2024; 170:135-140. [PMID: 36096542 DOI: 10.1136/military-2022-002151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/18/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION First-term attrition (FTA), or failure of a military service member to complete their initial service contract, is a major financial burden and source of lost manpower in the US Navy. The objective of the present study was to examine medical correlates of FTA using healthcare and disability rating data. METHODS In this retrospective cohort study, all US Navy-enlisted personnel between the years 2003 and 2018 with FTA (n=58 777) and regular discharge (n=203 084) were identified for analysis from accession dates in the Career History Archival Medical and Personnel System. Medical diagnoses from outpatient and inpatient records were abstracted from the Military Health System Data Repository. For a subgroup of the study population discharged with a disability rating (n=12 880), diagnoses were identified from the Integrated Disability Evaluation System. The FTA and regular discharge groups were compared using relative risks (RRs) and 95% CIs, and per cent differences for the disability subgroup analysis. RESULTS Compared with regular discharges, those with FTA were more likely to have outpatient and inpatient diagnoses for mental health disorders. Personality disorder yielded the strongest association with FTA in both outpatient (RR=10.45, 95% CI 9.79 to 11.16) and inpatient settings (RR=18.97, 95% CI 14.16 to 25.42). Other disorders associated with FTA included schizophrenia, substance-related disorders, poisoning by psychotropic agents and adjustment disorders. In the disability analysis, the FTA group relative to regular discharges had the largest per cent differences for 'arthritis, degenerative (hypertrophic or osteoarthritis)' (10.8% vs 2.5%) and 'tibia and fibula, impairment' (3.0% vs 0.4%). CONCLUSIONS This study provides evidence that FTA is associated with both mental and physical health conditions. Mental and physical factors related to FTA require further examination, particularly whether pre-enlistment screening or early career intervention could lead to mitigation strategies. Future research should extend this analysis to other services and population subgroups.
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Affiliation(s)
- Trevor Alan Elkins
- Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, USA
- Leidos, San Diego, California, USA
| | - A MacGregor
- Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, USA
| | - A Dougherty
- Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, USA
- Leidos, San Diego, California, USA
| | - A Olson
- Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, USA
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Danckert NP, Freidin MB, Smith IG, Wells PM, Naeini MK, Visconti A, Compte R, MacGregor A, Williams FMK. Treatment response in rheumatoid arthritis is predicted by the microbiome: a large observational study in UK DMARD-naïve patients. Rheumatology (Oxford) 2024:keae045. [PMID: 38291926 DOI: 10.1093/rheumatology/keae045] [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: 08/04/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES Disease-modifying antirheumatic drugs (DMARDs) are first line treatment in rheumatoid arthritis (RA). Treatment response to DMARDs is patient-specific, dose efficacy is difficult to predict and long-term results variable. The gut microbiota are known to play a pivotal role in prodromal and early-disease RA, manifested by Prevotella spp. enrichment. The clinical response to therapy may be mediated by microbiota, and large-scale studies assessing the microbiome are few. This study assessed whether microbiome signals were associated with, and predictive of, patient response to DMARD-treatment. Accurate early identification of those who will respond poorly to DMARD therapy would allow selection of alternative treatment (e.g. biologic therapy), and potentially improve patient outcome. METHODS A multicentre, longitudinal, observational study of stool- and saliva microbiome was performed in DMARD-naïve, newly diagnosed RA patients during introduction of DMARD treatment. Clinical data and samples were collected at baseline (n = 144) in DMARD-naïve patients and at six weeks (n = 117) and 12 weeks (n = 95) into DMARD-therapy. Samples collected (n = 365 stool, n = 365 saliva) underwent shotgun sequencing. Disease activity measures were collected at each timepoint and minimal clinically important improvement determined. RESULTS In total, 26 stool microbes were found to decrease in those manifesting a minimal clinically important improvement. Prevotella spp. and Streptococcus spp. were the predominant taxa to decline following six weeks and 12 weeks of DMARDs, respectively. Furthermore, baseline microbiota of DMARD-naïve patients were indicative of future response. CONCLUSION DMARDs appear to restore a perturbed microbiome to a eubiotic state. Moreover, microbiome status can be used to predict likelihood of patient response to DMARD.
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Affiliation(s)
- Nathan P Danckert
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
| | - Maxim B Freidin
- Department of Biology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Isabelle Granville Smith
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
| | - Philippa M Wells
- UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Maryam Kazemi Naeini
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
| | - Alessia Visconti
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
| | - Roger Compte
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
| | - Alexander MacGregor
- Norwich Medical School, University of East Anglia, Norwich, UK
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Trust, London, UK
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Hum R, Sharma S, Stadler M, Viatte S, Ho P, Nair N, Shi C, Yap CF, Soomro M, Plant D, Humphreys J, MacGregor A, Yates M, Verstappen S, Bowes J, Barton A. Harnessing genetics in the outpatient clinic using polygenic risk scores to aid diagnosis of patients with early inflammatory arthritis: results from the Norfolk Arthritis Register. Future Healthc J 2023; 10:24-25. [PMID: 38406688 PMCID: PMC10884629 DOI: 10.7861/fhj.10-3-s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Ryan Hum
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Seema Sharma
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Michael Stadler
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Sebastien Viatte
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Pauline Ho
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Nisha Nair
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Chenfu Shi
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Chuan Fu Yap
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Mehreen Soomro
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Darren Plant
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Jenny Humphreys
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
| | | | - Max Yates
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Suzanne Verstappen
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
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Jennison T, MacGregor A, Goldberg A. Hip arthroplasty practice across the Organisation for Economic Co-operation and Development (OECD) over the last decade. Ann R Coll Surg Engl 2023; 105:645-652. [PMID: 37652085 PMCID: PMC10471436 DOI: 10.1308/rcsann.2022.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION There are large variations in the number of hip replacements performed between countries, demonstrating large health inequalities; however, there has been limited research on this variation. The aims of this paper were to compare rates of hip replacements using Organisation for Economic Co-operation and Development (OECD) data for the period 2008-2018. The study also compared changes in the number of hip replacements in the total population and in only those aged over 65, and looked for a correlation of health expenditure and gross domestic product (GDP) with rates of hip replacements. METHODS The OECD collects annual data from all member countries on the numbers of hip replacements, healthcare expenditure and GDP. Data analysis was undertaken using STATA. Descriptive statistics and Pearson's correlation coefficient were performed. RESULTS The mean number of hip replacements performed in OECD countries in 2018 was 191.5 per 100,000 population per year. The largest number was 310.6 in Germany and the lowest was 8.6 in Mexico. There has been a 21.7% increase in the mean number of hip replacements across OECD countries. There was a moderate and significant Pearson coefficient of 0.468 (p = 0.009) between the number of hip replacements performed per 100,000 population in 2018 and GDP per person, and a strong and significant correlation with health expenditure (R = 0.784, p < 0.001). There was a moderate correlation (R = 0.645, p = 0.003) between the percentage change in the number of hip replacements performed per 100,000 population and the percentage change in healthcare expenditure per person between 2008 and 2018. CONCLUSIONS There is 36-fold variation in the practice of hip replacements across the OECD and the number of hip replacements has increased by more than 20% over the past decade. The number of hip replacements performed appears to be correlated with health expenditure in each country and may indicate a need that can only be met by increasing health expenditure.
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Affiliation(s)
- T Jennison
- Cardiff and Vale University Health Board, UK
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Sharma S, Nair N, Bowes J, MacGregor A, Verstappen S, Barton A, Viatte S. OP0088 STRATIFIED MEDICINE: GENETIC PREDICTORS OF RADIOGRAPHIC OUTCOME IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRheumatoid arthritis (RA) displays great heterogeneity between patients for susceptibility to developing erosions. Genetic variations within the HLA-DRB1 gene (the shared epitope (SE) and polymorphisms coding for Valine at position 11) have been consistently associated with both susceptibility and radiographic outcome in RA.(1) However, associations of non-HLA markers are much less conclusive. Most studies looking outside the HLA have been candidate gene studies and very few have been replicated in independent cohorts.Objectives:1. Identify all single nucleotide polymorphisms (SNPs) outside the HLA that have ever been associated with radiographic outcome in RA2. To perform a replication study to determine which of these are associated with radiographic outcome in the Norfolk Arthritis Register (NOAR), the worldwide largest prospective cohort with genetic and radiographic outcome data.MethodsA systematic literature search was conducted as shown in the Figure 1.Figure 1.Flow chart for systematic review.The Norfolk Arthritis register (NOAR) is a large primary care-based inception cohort of patients diagnosed with inflammatory polyarthritis. Patients were recruited at baseline from 1989 and followed up prospectively for up to 20 years with serial X-rays. Genome-wide genotyping was performed on the Illumina Human/Infinium Core Exome array and imputed with Minimac4 to the Haplotype Reference Consortium panel. Quality control resulted in 7.5 million SNPs available in each patient. SNPs identified from the literature were extracted and tested for an association with the presence of erosions (as a longitudinal binary variable) using a generalized estimating equation (GEE) model in STATA/IC 14.0.in NOAR.ResultsA total of 2119 participants (2440 radiographs) were identified with both genetic and radiographic data available. 66.2% of these patients were female and 33.3% were anti-CCP positive. Median age of onset was 54.5 and 74.9% satisfied the American College of Rheumatology (ACR) 1987 criteria for rheumatoid arthritis.A total of 113 different non-HLA SNPs associated with radiographic outcome in RA were identified from the literature. Of these, 102 were successfully identified within NOAR and 91 were deemed to be independent SNPs based on R2 of 0.6. 14 SNPs were found to be significantly associated with the presence of erosions within NOAR (Table 1).Table 1.SNPs found to be associated with radiographic severity within NOAR. *Significant results only; Dominant models used (Odds ratios displayed in relation to minor alleles)GeneChromosomeSNP (single nucleotide polymorphismOdds ratio (95% CI)P valueIL2RB2rs7437771.23 (1.01, 1.05)0.0398IL154rs68211710.82 (0.67, 1.00)0.0451IL45rs22432501.36 (1.08, 1.70)0.0094FOX036rs122120670.75 (0.58, 0.97)0.0278OPG8rs20736180.79 (0.64, 0.98)0.0295TRAF19rs107601301.33 (1.06, 1.65)0.0118TRAF19rs108184881.32 (1.06, 1.64)0.0141TRAF19rs29001801.32 (1.07, 1.61)0.0079IL4r16rs18050101.25 (1.01, 1.56)0.0393IL4r16rs18050111.31 (1.03, 1.66)0.0260LGALS917rs37639591.28 (1.03, 1.59)0.0260SOST17rs47929091.34 (1.09, 1.65)0.0052LILRA319rs1032940.80 (0.65, 0.98)0.0334MMP920rs119083520.70 (0.57, 0.85)0.0005Conclusion113 non-HLA SNPs have been previously reported to be associated with radiographic outcome in RA. Of these, only ~15% also showed an association in NOAR, the largest cohort with genetic and radiographic outcome data worldwide. Interestingly, rs2243250, a SNP located on chromosome 5 (IL4), previously found to be associated in a small Egyptian cohort, has been replicated in NOAR.(2) Current work consists of assessing the added clinical value of a genetic risk score based on HLA and non-HLA markers in predicting radiographic outcome when combined with clinical/serological/demographic markers.References[1]S. Viatte et al., JAMA313, 1645-1656 (2015).[2]Y. M. Hussein, A. S. El-Shal, N. A. Rezk, S. M. Abdel Galil, S. S. Alzahrani, Cytokine61, 849-855 (2013).Disclosure of InterestsNone declared.
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Aboelmagd SM, Low SB, Cahir JG, Loveday D, Marshall AT, Teh J, Vaughan P, Grainger A, MacGregor A, Toms AP. The Norwich Osteoarthritis of the Ankle MRI Score (NOAMS): a reliability study. Clin Radiol 2022; 77:e449-e457. [PMID: 35367050 DOI: 10.1016/j.crad.2022.02.009] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Abstract
AIM To define and test the inter- and intra-rater reliability of a grading system for staging osteoarthritis (OA) of the ankle with magnetic resonance imaging (MRI) (Norwich Osteoarthritis of the Ankle MRI Score, NOAMS). MATERIALS AND METHODS The MRI features to be included in the score were defined by a multidisciplinary expert panel through a Delphi process. An anonymised randomised dataset of 50 MRI studies was created from patients with concurrent plain radiographs to include 10 ankles of each of the Kellgren-Lawrence grades 0 to 4. Two experienced musculoskeletal radiologists and two trainees scored each ankle MRI twice independently and blinded to the plain radiographs. RESULTS The inter-rater kappa coefficient of agreement for cartilage disease was 0.88 (95% confidence interval [CI]: 0.85, 0.91) for experienced raters and 0.71 (95% CI: 0.67, 0.76) for trainees. Inter-rater agreement for subchondral bone marrow oedema and cysts varied from 0.73 to 0.82 for experienced raters and from 0.63 to 0.75 for trainees with lowest 95% CI of 0.48 and 0.63. When bone marrow lesions were combined into a total joint score the level of agreement increased to between 0.88 and 0.97 with lowest 95% CI of 0.86. Combining cartilage zone scores did not increase the reliability coefficients. CONCLUSION An expert panel considered that cartilage degradation and subchondral bone marrow lesions were the most important features for staging the severity of ankle OA on MRI. Experienced observers can grade the severity of ankle OA on MRI with a clinically useful high degree of reproducibility.
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Affiliation(s)
- S M Aboelmagd
- Department of Radiology, Royal Devon and Exeter NHS Trust, UK
| | - S B Low
- Department of Radiology, Norfolk & Norwich University Hospital, UK
| | - J G Cahir
- Department of Radiology, Norfolk & Norwich University Hospital, UK
| | - D Loveday
- Department of Orthopaedic Surgery, Norfolk & Norwich University Hospital, UK
| | - A T Marshall
- Department of Rheumatology, Norfolk & Norwich University Hospital, UK
| | - J Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford, UK
| | - P Vaughan
- Department of Trauma and Orthopaedics, West Suffolk Hospital, Bury St Edmunds, UK
| | - A Grainger
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - A MacGregor
- Norwich Medical School, University of East Anglia, UK
| | - A P Toms
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK; Norwich Medical School, University of East Anglia, UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
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Soomro M, Stadler M, Viatte S, MacGregor A, Verstappen S, Barton A, Bowes J. OA28 Exploring the potential of polygenic risk scores for predicting coronary artery disease in patients with rheumatoid arthritis. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac132.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Aims
Patients with rheumatoid arthritis (RA) have a higher prevalence of coronary artery disease (CAD) than the general population which contributes to early mortality. Current screening tools for CAD, which are developed in the general population, are less effective for estimating CAD risk in patients with RA. This reduced performance is mainly due to the differing contribution from traditional risk factors and the contribution from disease-specific factors. Our understanding of the genetic basis of CAD has improved over recent years and shows promise for improving risk prediction in the form of polygenic risk scores (PRS). We hypothesise that PRS can help us improve CAD risk prediction in patients with RA by providing more accurate models of risk.
Methods
Patients were recruited from the Norfolk Arthritis Register (NOAR), a detailed community-based longitudinal observational study focused on the cause and outcome of inflammatory polyarthritis, between 1990 and 2017. Analysis was restricted to patients who satisfied the 2010 ACR criteria cumulatively over five years and had detailed clinical history at baseline and follow-up. We developed a prediction model based on traditional risk factors and explored the inclusion of a PRS (49K SNPs) in a subset of patients with available genetic data. Cox proportional hazards models were used to derive risk equations for evaluation of 10-year risk of CAD. We applied multiple imputations with chained equations using the Random Forest algorithm to replace missing values. Measures of calibration and discrimination were determined in the validation cohort of 423 individuals.
Results
A total of 2123 patients were included in the analysis with 136 incident cases of self-reported CAD. The model using only traditional risk factors achieved an AUC of 0.72 (95% CI 0.71, 0.73), with a calibration slope of 1.03, and explained approximately 50% (95% CI 47, 52%) of the variance of the outcome. We found that being male reduces the risk by a factor of 0.82 (95% CI 0.68, 1.00). The hazard ratio for age was found to be 1.00 (95% CI 0.99, 1.01) indicating risk remains the same across all age groups. Inclusion of a CAD PRS increased the performance with an AUC of 0.76 (95% CI 0.75, 0.77), explained variance of 53% (95% CI 49, 56%) but with a slightly worse calibration slope of 0.91.
Conclusion
An integrated risk score, that combines traditional risk factors with a PRS, improves CAD prediction in patients with RA. Further research is required to better understand the role of heritable components contributing to CAD risk in RA patients. By refining the underlying PRS, we hope to further improve CAD risk prediction in RA patients, through this integrated approach.
Disclosure
M. Soomro: None. M. Stadler: None. S. Viatte: None. A. MacGregor: None. S. Verstappen: None. A. Barton: None. J. Bowes: None.
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Affiliation(s)
- Mehreen Soomro
- Centre for Genetics and Genomics Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Greater Manchester, UNITED KINGDOM
| | - Michael Stadler
- Centre for Genetics and Genomics Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Greater Manchester, UNITED KINGDOM
| | - Sebastien Viatte
- Centre for Genetics and Genomics Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Greater Manchester, UNITED KINGDOM
| | - Alexander MacGregor
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UNITED KINGDOM
| | - Suzanne Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Greater Manchester, UNITED KINGDOM
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Greater Manchester, UNITED KINGDOM
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Greater Manchester, UNITED KINGDOM
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Tsigarides J, Shenker NG, MacGregor A. Ready Patient One: the role of therapeutic virtual reality in the future management of chronic pain. Rheumatology (Oxford) 2021; 61:482-483. [PMID: 34320626 DOI: 10.1093/rheumatology/keab594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jordan Tsigarides
- Musculoskeletal Epidemiology Centre, University of East Anglia, Norwich, UK
| | - Nicholas G Shenker
- Department of Rheumatology, Addenbrookes University Hospital, Cambridge, UK
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Sharma S, Plant D, Bowes J, MacGregor A, Verstappen S, Barton A, Viatte S. POS0471 ASSOCIATION OF HLA-DRB1 HAPLOTYPES WITH CARDIOVASCULAR MORTALITY IN INFLAMMATORY POLYARTHRITIS: RESULTS FROM THE NORFOLK ARTHRITIS REGISTER. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Haplotypes defined by amino acids at HLA-DRB1 positions 11, 71 and 74 associated with susceptibility to rheumatoid arthritis (RA), are associated with radiological outcome, anti-TNF response and all cause-mortality in RA.(1, 2) RA is associated with cardiovascular (CV) morbidity and mortality, but the increased prevalence of risk factors of CV disease in RA only partially explains this association.Objectives:The aim was to investigate whether haplotypes associated with RA disease susceptibility and disease severity are also associated with CV mortality.Methods:The Norfolk Arthritis register (NOAR) is a primary care-based inception cohort of patients with inflammatory polyarthritis (IP).(1, 2) NOAR patients with at least 2 years of follow-up and available mortality and genetic data were included in this study. Mortality data was provided by the Office for National Statistics.Univariate Cox proportional hazard models were applied using STATA/IC 14.0. Models for CV mortality were adjusted for CV risk factors selected using stepwise regression: namely obesity, gender and hypertension. Hazard models were applied to the entire cohort of patients with inflammatory polyarthritis (IP). When calculating differences between highest and lowest risk genetic factors, bivariate analysis was used.Results:HLA-DRB1 amino acids, haplotypes or haplotype groups associated with RA susceptibility are also associated with CV mortality as shown in the table 1. HLA-DRB1 polymorphisms encoding amino-acid haplotypes associated with an increased or decreased susceptibility to RA consistently show the same magnitude and direction of association for overall and CV mortality in IP. For example, the SEA-haplotype, associated with the lowest susceptibility to RA, and the best radiographic outcome, was found to be associated with decreased CV mortality (HR 0.67, 95% CI 0.47, 0.91, p=0.023). The relative difference in CV mortality between carriers of the high susceptibility VKA haplotype and carriers of the SEA haplotype was significant (HR 1.67, 95% CI 1.13, 2.48, p=0.01).Table 1.Hazard ratios for CV mortality by genetic factors among patients with IP. Total number (n) of deaths are also displayed alongside the total number (n) of patients included in each analysis.Amino acid / Haplotype /GroupHazard Ratio (95% CI)Nvaline 111.10 (0.93, 1.30)343 (2514)serine 110.82 (0.70, 0.96)*343 (2514)Difference1.23 (1.01, 1.49)*VKA haplotype1.16 (0.94, 1.43)310 (2328)SEA haplotype0.67 (0.47, 0.94) *310 (2328)Difference1.67 (1.13, 2.48)*Group 1 †1.10 (0.93, 1.31)319 (2328)Group 4 †0.73 (0.60, 0.89)*319 (2328)Difference1.37 (1.09, 1.72)** p<0.05†Haplotype groups as defined previously (2)HLA-DRB1 haplotypes can be ranked according to the magnitude of their association with RA susceptibility and this hierarchy is conserved for various measures of disease outcome and overall mortality.(2, 3) The figure 1 shows that this risk hierarchy is also conserved for CV mortality: HLA-DRB1 haplotypes that predispose to RA also predispose to increased CV mortality, independent of known CV risk factors.Figure 1.Haplotypes with frequency >12% in NOAR are shown. X axis: susceptibility to ACPA-positive RA as ORs.(2) Y axis: CV mortality risk in IP as HRs, derived from multi-variate cox-proportional hazard models adjusted for CV risk factors. Values are on a logarithmic scale. A one-tailed p value was calculated using linear regression to determine the association between β coefficients of susceptibility and CV mortality.Conclusion:The originally reported genetic associations between HLA-DRB1 polymorphisms and overall mortality were likely driven by associations with CV mortality.References:[1]S. Viatte et al., JAMA313, 1645-1656 (2015).[2]S. Raychaudhuri et al., Nat Genet44, 291-296 (2012).[3]D. P. Symmons, A. J. Silman, Clin Exp Rheumatol21, S94-99 (2003).Disclosure of Interests:None declared
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Graham K, Birt L, MacGregor A, Watts L, Poland F. "It's my own fault": Accounts and consequences of falling when living with rheumatoid arthritis. Musculoskeletal Care 2019; 17:346-353. [PMID: 31419006 PMCID: PMC6973095 DOI: 10.1002/msc.1426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) leads to biomechanical joint changes, which increases the risk of falling. The consequence of falling may be physical injury. However, the psychological consequences, including the fear of falling, can be equally important. METHODS Participants were recruited from a larger prospective study which explored the incidence of falls in people with RA. Purposive sampling considered age, sex, time since diagnosis and fall history. The recruitment site was a regional hospital. Data were collected from semi-structured qualitative interviews and, after each fall, brief telephone interviews. Thematic analysis methods were used to investigate the psychological and social impact of falling in people with RA. RESULTS Twelve participants were interviewed (aged 64-85, mean 74 years; six had fallen between one and 23 times, and six had no reported falls in last 12 months). Data were supplemented with telephone notes from 287 post-fall telephone calls. Three themes were developed: (i) the falls imaginary illustrates that the fear of falling is not dependent on experience; (ii) agentic risk management reports on the ways people self-manage and display resilience when at risk of falling; (iii) the absence of the health professional explores the ways in which people reported being unsupported by healthcare services. CONCLUSION Fear of falling when living with RA is tangible in those who have and have not fallen. This fear may limit opportunities for full participation in life. However, some people display personal resourcefulness, continuing to live purposeful lives. Understanding personal responses to falling will support the development of community interventions specific to this high-risk group.
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Affiliation(s)
- Karly Graham
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Linda Birt
- School of Health SciencesUniversity of East AngliaNorwichUK
| | | | - Laura Watts
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Fiona Poland
- School of Health SciencesUniversity of East AngliaNorwichUK
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Mouchti S, Whitehouse MR, Sayers A, Hunt LP, MacGregor A, Blom AW. The Association of Body Mass Index with Risk of Long-Term Revision and 90-Day Mortality Following Primary Total Hip Replacement: Findings from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. J Bone Joint Surg Am 2018; 100:2140-2152. [PMID: 30562295 DOI: 10.2106/jbjs.18.00120] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND The influence of obesity on outcomes following total hip replacement is unclear. Restriction of total hip replacement on the basis of body mass index (BMI) has been suggested. The purpose of this study was to assess the influence of BMI on the risk of revision and 90-day mortality. METHODS This was a population-based, longitudinal cohort study of the National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man. Using data recorded from April 2003 to December 2015, linked to Office for National Statistics data, we ascertained revision and 90-day mortality rates following primary total hip replacement by BMI category. The probability of revision was estimated using Kaplan-Meier methods. Associations of BMI with revision and mortality were explored using adjusted Cox proportional hazards regression models. RESULTS We investigated revision and 90-day mortality among 415,598 and 413,741 primary total hip replacements, respectively. Each data set accounts for approximately 52% of the total number of recorded operations in the NJR. Thirty-eight percent of the patients were classified as obese. At 10 years, class-III obese patients had the highest cumulative probability of revision (6.7% [95% confidence interval (CI), 5.5% to 8.2%]), twice that of the underweight group (3.3% [95% CI, 2.2% to 4.9%]). When the analysis was adjusted for age, sex, American Society of Anesthesiologists [ASA] grade, year of operation, indication, and fixation type, compared with patients with normal BMI, significantly elevated hazard ratios (HRs) for revision were observed for patients in the BMI categories of class-I obese (≥30 to <35 kg/m) (HR, 1.14 [95% CI, 1.07 to 1.22]), class-II obese (≥35 to <40 kg/m) (HR, 1.30 [95% CI, 1.19 to 1.40]), and class-III obese (≥40 to ≤60 kg/m) (HR, 1.43 [95% CI, 1.27 to 1.61]) (p < 0.0005 for all). Underweight patients had a substantially higher cumulative probability of 90-day mortality (1.17%; 95% CI, 0.86% to 1.58%) compared with patients with normal BMI (0.43%; 95% CI, 0.39% to 0.48%). The risk of 90-day mortality was significantly higher for the underweight group (HR, 2.09 [95% CI, 1.51 to 2.89]; p < 0.0005) and significantly lower for patients who were categorized as overweight (HR, 0.70; 95% CI, 0.61 to 0.81; p < 0.0005), class-I obese (HR, 0.69 [95% CI, 0.59 to 0.81]; p < 0.0005), and class-II obese (HR, 0.79 [95% CI, 0.63 to 0.98]; p = 0.049) compared with patients with normal BMI. CONCLUSIONS Although long-term revision rates following total hip replacement were higher among obese patients, we believe that the rates remained acceptable by contemporary standards and were balanced by a lower risk of 90-day mortality. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sofia Mouchti
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Linda P Hunt
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
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Pearce J, Cherrie M, Best C, Eadie D, Stead M, Amos A, MacGregor A, Currie D, Ozakinci G, Haw S. Has point-of-sale legislation led to a reduction in exposure to tobacco retailing? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Pearce
- University of Edinburgh, Edinburgh, UK
| | - M Cherrie
- University of Edinburgh, Edinburgh, UK
| | - C Best
- University of Stirling, Stirling, UK
| | - D Eadie
- University of Stirling, Stirling, UK
| | - M Stead
- University of Stirling, Stirling, UK
| | - A Amos
- University of Stirling, Stirling, UK
| | | | - D Currie
- University of St Andrews, St Andrews, UK
| | - G Ozakinci
- University of St Andrews, St Andrews, UK
| | - S Haw
- University of Stirling, Stirling, UK
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Edwards HB, Smith M, Herrett E, MacGregor A, Blom A, Ben-Shlomo Y. The Effect of Age, Sex, Area Deprivation, and Living Arrangements on Total Knee Replacement Outcomes: A Study Involving the United Kingdom National Joint Registry Dataset. JB JS Open Access 2018; 3:e0042. [PMID: 30280132 PMCID: PMC6145568 DOI: 10.2106/jbjs.oa.17.00042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Total knee replacement (TKR) is a common procedure for the treatment of osteoarthritis that provides a substantial reduction of knee pain and improved function in most patients. We investigated whether sociodemographic factors could explain variations in the benefit resulting from TKR. Methods: Data were collected from 3 sources: the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man; National Health Service (NHS) England Patient Reported Outcome Measures; and Hospital Episode Statistics. These 3 sources were linked for analysis. Pain and function of the knee were measured with use of the Oxford Knee Score (OKS). The risk factors of interest were age group, sex, deprivation, and social support. The outcomes of interest were sociodemographic differences in preoperative scores, 6-month postoperative scores, and change in scores. Results: Ninety-one thousand nine hundred and thirty-six adults underwent primary TKR for the treatment of osteoarthritis in an NHS England unit from 2009 to 2012. Sixty-six thousand seven hundred and sixty-nine of those patients had complete knee score data and were included in the analyses for the present study. The preoperative knee scores were worst in female patients, younger patients, and patients from deprived areas. At 6 months postoperatively, the mean knee score had improved by 15.2 points. There were small sociodemographic differences in the benefit of surgery, with greater area deprivation (−0.71 per quintile of increase in deprivation; 95% confidence interval [CI], −0.76 to −0.66; p < 0.001) and younger age group (−3.51 for ≤50 years compared with 66 to 75 years; 95% CI, −4.00 to −3.02; p < 0.001) associated with less benefit. Cumulatively, sociodemographic factors explained <1% of the total variability in improvement. Conclusions: Sociodemographic factors have a small influence on the benefit resulting from TKR. However, as they are associated with the clinical threshold at which the procedure is performed, they do affect the eventual outcomes of TKR. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of evidence.
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Affiliation(s)
- Hannah B Edwards
- University of Bristol, Bristol, United Kingdom.,NIHR Collaboration for Leadership in Applied Health Research and Care West, Bristol, United Kingdom
| | | | - Emily Herrett
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Ashley Blom
- University of Bristol, Bristol, United Kingdom.,North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- University of Bristol, Bristol, United Kingdom.,NIHR Collaboration for Leadership in Applied Health Research and Care West, Bristol, United Kingdom
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Skeoch S, Welsh P, Gwinnutt J, Humphreys J, Chipping J, MacGregor A, Verstappen S, Symmons D, Sattar N, Bruce IN. O10 The association of high sensitivity troponin levels with subsequent cardiovascular mortality in an inflammatory arthritis cohort: results from the Norfolk arthritis register. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah Skeoch
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal and Dermatological Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UNITED KINGDOM
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM
| | - James Gwinnutt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal and Dermatological Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UNITED KINGDOM
| | - Jennifer Humphreys
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal and Dermatological Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UNITED KINGDOM
| | | | | | - Suzanne Verstappen
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal and Dermatological Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UNITED KINGDOM
| | - Deborah Symmons
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal and Dermatological Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UNITED KINGDOM
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal and Dermatological Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UNITED KINGDOM
- Kellgren Centre for Rheumatology, NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UNITED KINGDOM
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Pearce J, Best C, Haseen F, Currie D, MacKintosh1 AM, Stead M, Eadie D, MacGregor A, Amos A, Frank J, Haw S. Electronic cigarette use and smoking initiation in Scottish adolescents: a cohort study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Pearce
- University of Edinburgh, Edinburgh, UK
| | - C Best
- University of Stirling, Stirling, UK
| | - F Haseen
- University of St Andrews, St Andrews, UK
| | - D Currie
- University of St Andrews, St Andrews, UK
| | | | - M Stead
- University of Stirling, Stirling, UK
| | - D Eadie
- University of Stirling, Stirling, UK
| | | | - A Amos
- University of Edinburgh, Edinburgh, UK
| | - J Frank
- University of Edinburgh, Edinburgh, UK
| | - S Haw
- University of Stirling, Stirling, UK
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Pallister T, Jackson MA, Martin TC, Zierer J, Jennings A, Mohney RP, MacGregor A, Steves CJ, Cassidy A, Spector TD, Menni C. Hippurate as a metabolomic marker of gut microbiome diversity: Modulation by diet and relationship to metabolic syndrome. Sci Rep 2017; 7:13670. [PMID: 29057986 PMCID: PMC5651863 DOI: 10.1038/s41598-017-13722-4] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/25/2017] [Indexed: 01/07/2023] Open
Abstract
Reduced gut microbiome diversity is associated with multiple disorders including metabolic syndrome (MetS) features, though metabolomic markers have not been investigated. Our objective was to identify blood metabolite markers of gut microbiome diversity, and explore their relationship with dietary intake and MetS. We examined associations between Shannon diversity and 292 metabolites profiled by the untargeted metabolomics provider Metabolon Inc. in 1529 females from TwinsUK using linear regressions adjusting for confounders and multiple testing (Bonferroni: P < 1.71 × 10-4). We replicated the top results in an independent sample of 420 individuals as well as discordant identical twin pairs and explored associations with self-reported intakes of 20 food groups. Longitudinal changes in circulating levels of the top metabolite, were examined for their association with food intake at baseline and with MetS at endpoint. Five metabolites were associated with microbiome diversity and replicated in the independent sample. Higher intakes of fruit and whole grains were associated with higher levels of hippurate cross-sectionally and longitudinally. An increasing hippurate trend was associated with reduced odds of having MetS (OR: 0.795[0.082]; P = 0.026). These data add further weight to the key role of the microbiome as a potential mediator of the impact of dietary intake on metabolic status and health.
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Affiliation(s)
- Tess Pallister
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Matthew A Jackson
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Tiphaine C Martin
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Jonas Zierer
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK.,Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Amy Jennings
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Alexander MacGregor
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Aedin Cassidy
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK.
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Pallister T, Jackson MA, Martin TC, Glastonbury CA, Jennings A, Beaumont M, Mohney RP, Small KS, MacGregor A, Steves CJ, Cassidy A, Spector TD, Menni C, Valdes AM. Untangling the relationship between diet and visceral fat mass through blood metabolomics and gut microbiome profiling. Int J Obes (Lond) 2017; 41:1106-1113. [PMID: 28293020 PMCID: PMC5504448 DOI: 10.1038/ijo.2017.70] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/16/2017] [Accepted: 02/26/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Higher visceral fat mass (VFM) is associated with an increased risk for developing cardio-metabolic diseases. The mechanisms by which an unhealthy diet pattern may influence visceral fat (VF) development has yet to be examined through cutting-edge multi-omic methods. Therefore, our objective was to examine the dietary influences on VFM and identify gut microbiome and metabolite profiles that link food intakes to VFM. SUBJECTS/METHODS In 2218 twins with VFM, food intake and metabolomics data available we identified food intakes most strongly associated with VFM in 50% of the sample, then constructed and tested the 'VFM diet score' in the remainder of the sample. Using linear regression (adjusted for covariates, including body mass index and total fat mass), we investigated associations between the VFM diet score, the blood metabolomics profile and the fecal microbiome (n=889), and confirmed these associations with VFM. We replicated top findings in monozygotic (MZ) twins discordant (⩾1 s.d. apart) for VFM, matched for age, sex and the baseline genetic sequence. RESULTS Four metabolites were associated with the VFM diet score and VFM: hippurate, alpha-hydroxyisovalerate, bilirubin (Z,Z) and butyrylcarnitine. We replicated associations between VFM and the diet score (beta (s.e.): 0.281 (0.091); P=0.002), butyrylcarnitine (0.199 (0.087); P=0.023) and hippurate (-0.297 (0.095); P=0.002) in VFM-discordant MZ twins. We identified a single species, Eubacterium dolichum to be associated with the VFM diet score (0.042 (0.011), P=8.47 × 10-5), VFM (0.057 (0.019), P=2.73 × 10-3) and hippurate (-0.075 (0.032), P=0.021). Moreover, higher blood hippurate was associated with elevated adipose tissue expression neuroglobin, with roles in cellular oxygen homeostasis (0.016 (0.004), P=9.82x10-6). CONCLUSIONS We linked a dietary VFM score and VFM to E. dolichum and four metabolites in the blood. In particular, the relationship between hippurate, a metabolite derived from microbial metabolism of dietary polyphenols, and reduced VFM, the microbiome and increased adipose tissue expression of neuroglobin provides potential mechanistic insight into the influence of diet on VFM.
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Affiliation(s)
- T Pallister
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - M A Jackson
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - T C Martin
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - C A Glastonbury
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - A Jennings
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Beaumont
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | | | - K S Small
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - A MacGregor
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
| | - C J Steves
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - A Cassidy
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
| | - T D Spector
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - C Menni
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - A M Valdes
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK.,Academic Rheumatology Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Nottingham, UK
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MacGregor A. Book Review: ICD-NA Application of the International Classification of Diseases to Neurology. Cephalalgia 2016. [DOI: 10.1177/033310249901901002] [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: 11/16/2022]
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Abstract
A review of the literature is given, followed by a consideration of the available methods of demonstrating the lymphatic system in the area of the teeth and jaws.A new method of demonstrating this system by the injection or application of lead acetate intra vitam, is described, and the technique is explained. The method can be employed to reveal macroscopic or microscopic lymph channels in any part of the body, and is especially of value where decalcification of the hard tissues has to be carried out in the preparation of the sections.The various types of experiments which have been performed are described, and the macroscopic and microscopic results dealt with separately.Among the macroscopic results, the lymphatic drainage of various parts the jaws is described, and the large amount of anastomosis and cross anastomosis between the vessels is shown. A comparison of the lymphatic system in this region in the guinea-pig, cat, dog, and monkey is given, and it is demonstrated that the guinea-pig and monkey possess submental and supraclavicular lymph nodes which assist in the drainage of this area in addition to the submaxillary and cervical groups of nodes possessed by the cat and the dog.Among the microscopic results, the way in which the mass makes its way from the gingival tissues through the bone, and is found in the pulp, dentine, and cementum of the tooth, even where no pressure is applied, is described. The communication of the lymphatic vessels of the pulp with those of the periodontal membrane and the path of the mass down the periodontal membrane from the gingival trough, and its entry into the alveolar bone from this situation are demonstrated, and the way in which the mass reaches the pulp, dentine, and cementum of the tooth from the gingival tissues is discussed.The significance of various concentrations of the mass in the tissues, particularly the dentine, is also discussed. Control experiments are described, the conclusions which have been reached are given, and the lines on which further experiments are being continued are indicated.Finally, the application of the results to the pathology of infection in this region, particularly paradontal disease, is given, and also their application to the phenomena of injection anæsthesia.
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Smith TO, Aboelmagd T, Hing CB, MacGregor A. Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Bone Joint J 2016; 98-B:1160-6. [DOI: 10.1302/0301-620x.98b9.38024] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [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: 02/05/2016] [Accepted: 05/10/2016] [Indexed: 12/17/2022]
Abstract
Aims Our aim was to determine whether, based on the current literature, bariatric surgery prior to total hip (THA) or total knee arthroplasty (TKA) reduces the complication rates and improves the outcome following arthroplasty in obese patients. Methods A systematic literature search was undertaken of published and unpublished databases on the 5 November 2015. All papers reporting studies comparing obese patients who had undergone bariatric surgery prior to arthroplasty, or not, were included. Each study was assessed using the Downs and Black appraisal tool. A meta-analysis of risk ratios (RR) and 95% confidence intervals (CI) was performed to determine the incidence of complications including wound infection, deep vein thrombosis (DVT), pulmonary embolism (PE), revision surgery and mortality. Results From 156 potential studies, five were considered to be eligible for inclusion in the study. A total of 23 348 patients (657 who had undergone bariatric surgery, 22 691 who had not) were analysed. The evidence-base was moderate in quality. There was no statistically significant difference in outcomes such as superficial wound infection (relative risk (RR) 1.88; 95% confidence interval (CI) 0.95 to 0.37), deep wound infection (RR 1.04; 95% CI 0.65 to 1.66), DVT (RR 0.57; 95% CI 0.13 to 2.44), PE (RR 0.51; 95% CI 0.03 to 8.26), revision surgery (RR 1.24; 95% CI 0.75 to 2.05) or mortality (RR 1.25; 95% CI 0.16 to 9.89) between the two groups. Conclusion For most peri-operative outcomes, bariatric surgery prior to THA or TKA does not significantly reduce the complication rates or improve the clinical outcome. This study questions the previous belief that bariatric surgery prior to arthroplasty may improve the clinical outcomes for patients who are obese or morbidly obese. This finding is based on moderate quality evidence. Cite this article: Bone Joint J 2016;98-B:1160–6.
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Affiliation(s)
| | - T. Aboelmagd
- Norfolk and Norwich University Hospital, Norwich, UK
| | - C. B. Hing
- St George’s University Hospitals NHS Foundation
Trust, London, UK
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23
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Pallister T, Haller T, Thorand B, Altmaier E, Cassidy A, Martin T, Jennings A, Mohney RP, Gieger C, MacGregor A, Kastenmüller G, Metspalu A, Spector TD, Menni C. Metabolites of milk intake: a metabolomic approach in UK twins with findings replicated in two European cohorts. Eur J Nutr 2016; 56:2379-2391. [PMID: 27469612 PMCID: PMC5602055 DOI: 10.1007/s00394-016-1278-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 07/20/2016] [Indexed: 12/24/2022]
Abstract
Purpose Milk provides a significant source of calcium, protein, vitamins and other minerals to Western populations throughout life. Due to its widespread use, the metabolic and health impact of milk consumption warrants further investigation and biomarkers would aid epidemiological studies. Methods Milk intake assessed by a validated food frequency questionnaire was analyzed against fasting blood metabolomic profiles from two metabolomic platforms in females from the TwinsUK cohort (n = 3559). The top metabolites were then replicated in two independent populations (EGCUT, n = 1109 and KORA, n = 1593), and the results from all cohorts were meta-analyzed. Results Four metabolites were significantly associated with milk intake in the TwinsUK cohort after adjustment for multiple testing (P < 8.08 × 10−5) and covariates (BMI, age, batch effects, family relatedness and dietary covariates) and replicated in the independent cohorts. Among the metabolites identified, the carnitine metabolite trimethyl-N-aminovalerate (β = 0.012, SE = 0.002, P = 2.98 × 10−12) and the nucleotide uridine (β = 0.004, SE = 0.001, P = 9.86 × 10−6) were the strongest novel predictive biomarkers from the non-targeted platform. Notably, the association between trimethyl-N-aminovalerate and milk intake was significant in a group of MZ twins discordant for milk intake (β = 0.050, SE = 0.015, P = 7.53 × 10−4) and validated in the urine of 236 UK twins (β = 0.091, SE = 0.032, P = 0.004). Two metabolites from the targeted platform, hydroxysphingomyelin C14:1 (β = 0.034, SE = 0.005, P = 9.75 × 10−14) and diacylphosphatidylcholine C28:1 (β = 0.034, SE = 0.004, P = 4.53 × 10−16), were also replicated. Conclusions We identified and replicated in independent populations four novel biomarkers of milk intake: trimethyl-N-aminovalerate, uridine, hydroxysphingomyelin C14:1 and diacylphosphatidylcholine C28:1. Together, these metabolites have potential to objectively examine and refine milk-disease associations. Electronic supplementary material The online version of this article (doi:10.1007/s00394-016-1278-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tess Pallister
- Department of Twin Research and Genetic Epidemiology, St Thomas Hospital, King's College London, London, SE1 7EH, UK.
| | - Toomas Haller
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Barbara Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Elisabeth Altmaier
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Aedin Cassidy
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tiphaine Martin
- Department of Twin Research and Genetic Epidemiology, St Thomas Hospital, King's College London, London, SE1 7EH, UK
| | - Amy Jennings
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Christian Gieger
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Alexander MacGregor
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, St Thomas Hospital, King's College London, London, SE1 7EH, UK
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, St Thomas Hospital, King's College London, London, SE1 7EH, UK.
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Stead M, Eadie D, MacKintosh AM, Best C, Miller M, Haseen F, Pearce JR, Tisch C, Macdonald L, MacGregor A, Amos A, van der Sluijs W, Frank JW, Haw S. Young people's exposure to point-of-sale tobacco products and promotions. Public Health 2016; 136:48-56. [PMID: 27178132 DOI: 10.1016/j.puhe.2016.03.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/22/2016] [Accepted: 03/26/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Point of sale (POS) displays are one of the most important forms of tobacco marketing still permitted in many countries. Reliable methods for measuring exposure to such displays are needed in order to assess their potential impact, particularly on smoking attitudes and uptake among young people. In this study we use a novel method for evaluating POS exposure based on young people's use of retail outlets and recall of tobacco displays and observational data on the characteristics of displays. STUDY DESIGN Observational audit of retail outlets (n = 96) and school-based pupil survey (n = 1482) in four Scottish communities reflecting different levels of social deprivation and urbanisation, conducted in 2013 before legislation to remove POS displays was implemented in supermarkets. METHODS Measures were taken of: visibility and placement of tobacco displays; internal and external advertising; display unit size, branding and design; visibility of pack warnings; proximity of tobacco products to products of potential interest to children and young people; pupils' self-reported frequency of visiting retail outlets; and pupils' recall of tobacco displays. Variation in POS exposure across social and demographic groups was assessed. RESULTS Displays were highly visible within outlets and, in over half the stores, from the public footway outside. Tobacco products were displayed in close proximity to products of interest to children (e.g. confectionery, in 70% of stores). Eighty percent of pupils recalled seeing tobacco displays, with those from deprived areas more likely to recall displays in small shops. When confectioners, tobacconists and newsagents (CTNs) and grocery/convenience stores (two of the outlet types most often visited by young people) were examined separately, average tobacco display unit sizes were significantly larger in those outlets in more deprived areas. CONCLUSIONS POS displays remain a key vector in most countries for advertising tobacco products, and it is important to develop robust measures of exposure. The data reported in this paper provide a baseline measure for evaluating the efficacy of legislation prohibiting such displays.
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Affiliation(s)
- M Stead
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - D Eadie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - A M MacKintosh
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - C Best
- School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - M Miller
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | - F Haseen
- Child and Adolescent Health Research Unit (CAHRU), School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews KY16 9TF, UK.
| | - J R Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, EH8 9XP, UK.
| | - C Tisch
- Institute of Geography, University of Edinburgh, Drummond Street, Edinburgh EH8 9XP, UK.
| | - L Macdonald
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - A MacGregor
- ScotCen Social Research, Scotiabank House (2nd Floor), 6 South Charlotte Street, Edinburgh EH2 4AW, UK.
| | - A Amos
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | - W van der Sluijs
- Child and Adolescent Health Research Unit (CAHRU), School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews KY16 9TF, UK.
| | - J W Frank
- University of Edinburgh, 30 West Richmond Street, Edinburgh EH8 9DX, UK.
| | - S Haw
- School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
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Abstract
OBJECTIVE To determine the mortality rate following total ankle replacement (TAR) and incidence of 90 day pulmonary embolism (PE) along with the associated risk factors. DESIGN Data-linkage study of the UK National Joint Registry (NJR) data and Hospital Episodes Statistics (HES) database. Linkage was performed in a deterministic fashion. HES episodes 90 days after the index procedure were analysed for PE. Mortality data were obtained pertaining to all the index procedures from the NJR for analysis. PARTICIPANTS All primary and revision ankle replacement patients captured on the NJR between February 2008 and February 2013. RESULTS The 90-day mortality following TAR was 0.13% (95% CI 0.03 to 0.52) and 1-year mortality was 0.72% (95% CI 0.40 to 1.30); no deaths were as a result of PE. The incidence of PE within 90 days following primary TAR was 0.51% (95% CI 0.23 to 1.13). There was only one PE following revision surgery. Patients with an Royal College of Surgeons Charlson score greater than zero were at 13 times greater risk of PE (p=0.003). CONCLUSIONS There is low incidence of PE following TAR, but multiple comorbidities are a leading risk factor for its occurrence.
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Affiliation(s)
- Razi Zaidi
- Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | | | - Suzie Cro
- Clinical Trials Unit at UCL, Medical Research Council (MRC), London, UK
| | - Andy Goldberg
- Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, London, UK
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Best C, van der Sluijs W, Haseen F, Eadie D, Stead M, MacKintosh AM, Pearce J, Tisch C, MacGregor A, Amos A, Miller M, Frank J, Haw S. Does exposure to cigarette brands increase the likelihood of adolescent e-cigarette use? A cross-sectional study. BMJ Open 2016; 6:e008734. [PMID: 26908512 PMCID: PMC4769402 DOI: 10.1136/bmjopen-2015-008734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/17/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the relationship between tobacco cigarette brand recognition, and e-cigarette use in adolescents. DESIGN Cross-sectional observational study. SETTING High schools in Scotland. PARTICIPANTS Questionnaires were administered to pupils in Secondary 2 (S2 mean age: 14.0 years) and Secondary 4 (S4 mean age: 15.9 years) across 4 communities in Scotland. An 86% response rate with a total sample of 1404 pupils was achieved. MAIN OUTCOME MEASURES Self-reported previous use of e-cigarettes and self-reported intention to try e-cigarettes in the next 6 months. RESULTS 75% (1029/1377) of respondents had heard of e-cigarettes (69.5% S2, 81.1% S4), and of these, 17.3% (10.6% S2, 24.3% S4 n=1020) had ever tried an e-cigarette. 6.8% (3.7% S2, 10.0% S4 n=1019) reported that they intended to try an e-cigarette in the next 6 months. Recognition of more cigarette brands was associated with greater probability of previous e-cigarette use (OR 1.20, 99% CI 1.05 to 1.38) as was having a best friend who smoked (OR 3.17, 99% CI 1.42 to 7.09). Intention to try e-cigarettes was related to higher cigarette brand recognition (OR 1.41, 99% CI 1.07 to 1.87), hanging around in the street or park more than once a week (OR 3.78, 99% CI 1.93 to 7.39) and living in areas of high tobacco retail density (OR 1.20, 99% CI 1.08 to 1.34). Never having smoked was a protective factor for both future intention to try, and past e-cigarette use (OR 0.07, 99% CI 0.02 to 0.25; and OR 0.10, 99% CI 0.07 to 0.16, respectively). CONCLUSIONS Higher cigarette brand recognition was associated with increased probability of previous use and of intention to use e-cigarettes. The impact of tobacco control measures such as restricting point-of-sale displays on the uptake of e-cigarettes in young people should be evaluated.
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Affiliation(s)
- C Best
- School of Health Sciences, University of Stirling, Stirling, UK
| | - W van der Sluijs
- Child and Adolescent Health Research Unit, University of St Andrews, St Andrews, UK
| | - F Haseen
- Child and Adolescent Health Research Unit, University of St Andrews, St Andrews, UK
| | - D Eadie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - M Stead
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - AM MacKintosh
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - J Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - C Tisch
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | | | - A Amos
- Usher Institute of Population Health Sciences and Informatics, School of Medicine, University of Edinburgh, Edinburgh, UK
| | - M Miller
- Usher Institute of Population Health Sciences and Informatics, School of Medicine, University of Edinburgh, Edinburgh, UK
| | - J Frank
- Public Health Research and Policy, The Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - S Haw
- School of Health Sciences, University of Stirling, Stirling, UK
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Welch AA, Kelaiditi E, Jennings A, Steves CJ, Spector TD, MacGregor A. Dietary Magnesium Is Positively Associated With Skeletal Muscle Power and Indices of Muscle Mass and May Attenuate the Association Between Circulating C-Reactive Protein and Muscle Mass in Women. J Bone Miner Res 2016; 31:317-25. [PMID: 26288012 DOI: 10.1002/jbmr.2692] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 04/16/2015] [Revised: 07/29/2015] [Accepted: 08/13/2015] [Indexed: 01/06/2023]
Abstract
Age-related loss of skeletal muscle mass and strength are risk factors for sarcopenia, osteoporosis, falls, fractures, frailty, and mortality. Dietary magnesium (Mg) could play a role in prevention of age-related loss of skeletal muscle mass, power, and strength directly through physiological mechanisms or indirectly through an impact on chronic low-grade inflammation, itself a risk factor for loss of skeletal muscle mass and strength. In a cross-sectional study of 2570 women aged 18 to 79 years, we examined associations between intakes of Mg, estimated using a food-frequency questionnaire (FFQ), dual-energy X-ray absorptiometry (DXA)-derived measures of muscle mass (fat-free mass as a percentage of body weight [FFM%], fat-free mass index [FFMI, kg/m(2)]), leg explosive power (LEP), and grip strength (n = 949 only). We also examined associations between circulating hs-CRP (C-reactive protein) and muscle mass and LEP, and explored the potential attenuation of these relationships by Mg. We compared our findings with those of age and protein intake. Endpoints were calculated by quintile of Mg and adjusted for relevant confounders. Significant positive associations were found between a higher Mg and indices of skeletal muscle mass and LEP, and also with hs-CRP, after adjustment for covariates. Contrasting extreme quintiles of Mg intake showed differences of 2.6% for FFM% (p trend < 0.001), 0.4 kg/m(2) for FFMI (p trend = 0.005), and 19.6 watts/kg for LEP (p trend < 0.001). Compared with protein, these positive associations were 7 times greater for FFM% and 2.5 times greater for LEP. We also found that higher hs-CRP was negatively associated with skeletal muscle mass and, in statistical modeling, that a higher dietary Mg attenuated this negative relationship by 6.5%, with greater attenuation in women older than 50 years. No association was found between Mg and grip strength. Our results suggest that dietary magnesium may aid conservation of age-related loss of skeletal muscle mass and power in women of all ages.
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Affiliation(s)
- Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Amy Jennings
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
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Jennings A, MacGregor A, Spector T, Cassidy A. Amino Acid Intakes Are Associated With Bone Mineral Density and Prevalence of Low Bone Mass in Women: Evidence From Discordant Monozygotic Twins. J Bone Miner Res 2016; 31:326-35. [PMID: 26334651 PMCID: PMC4832262 DOI: 10.1002/jbmr.2703] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 12/02/2022]
Abstract
Although a higher protein intake, particularly from vegetable sources, has been shown to be associated with higher bone mineral density (BMD) the relative impact of specific amino acids on BMD and risk of osteoporosis remains to be determined. Mechanistic research suggests that a number of specific amino acids, including five nonessential amino acids--alanine, arginine, glutamic acid, glycine, and proline--may play a role in bone health, principally through improved production of insulin and insulin-like growth factor 1 and the synthesis of collagen and muscle protein. However to date, no previous studies have examined the associations between habitual intake of amino acids and direct measures of BMD and prevalence of osteoporosis or osteopenia, and no studies have examined this relationship in discordant identical twin-pairs. In these analyses of female monozygotic twin-pairs discordant for amino acid intake (n = 135), twins with higher intakes of alanine and glycine had significantly higher BMD at the spine than their co-twins with within-pair differences in spine-BMD of 0.012 g/cm(2) (SE 0.01; p = 0.039) and 0.014 g/cm(2) (SE 0.01; p = 0.026), respectively. Furthermore, in cross-sectional multivariable analyses of 3160 females aged 18 to 79 years, a higher intake of total protein was significantly associated with higher DXA-measured BMD at the spine (quartile Q4 to quartile Q1: 0.017 g/cm(2), SE 0.01, p = 0.035) and forearm (Q4 to Q1: 0.010 g/cm(2), SE 0.003, p = 0.002). Intake of six amino acids (alanine, arginine, glutamic acid, leucine, lysine, and proline) were associated with higher BMD at the spine and forearm with the strongest association observed for leucine (Q4 to Q1: 0.024 g/cm(2), SE 0.01, p = 0.007). When intakes were stratified by protein source, vegetable or animal, prevalence of osteoporosis or osteopenia was 13% to 19% lower comparing extreme quartiles of vegetable intake for five amino acids (not glutamic acid or proline). These data provide evidence to suggest that intake of protein and several amino acids, including alanine and glycine, may be beneficial for bone health, independent of genetic background.
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Affiliation(s)
- Amy Jennings
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alexander MacGregor
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tim Spector
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Aedín Cassidy
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
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Eadie D, Stead M, MacKintosh AM, MacDonald L, Purves R, Pearce J, Tisch C, van der Sluijis W, Amos A, MacGregor A, Haw S. E-cigarette marketing in UK stores: an observational audit and retailers' views. BMJ Open 2015; 5:e008547. [PMID: 26362665 PMCID: PMC4567676 DOI: 10.1136/bmjopen-2015-008547] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/16/2015] [Accepted: 08/04/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To explore how e-cigarettes are being promoted at point of sale in the UK and how retailers perceive market trends. SETTING Fixed retail outlets subject to a ban on the display of tobacco products. PARTICIPANTS Observational audit of all stores selling tobacco products (n=96) in 4 Scottish communities, conducted over 2 waves 12 months apart (2013-2014), and qualitative interviews with small retailers (n=25) in 4 matched communities. PRIMARY AND SECONDARY OUTCOME MEASURES The audit measured e-cigarette display characteristics, advertising materials and proximity to other products, and differences by area-level disadvantage. Interviews explored retailers' perceptions of e-cigarette market opportunities and risks, and customer responses. RESULTS The number of e-cigarette point-of-sale display units and number of brands displayed increased between waves. E-cigarettes were displayed close to products of interest to children in 36% of stores. Stores in more affluent areas were less likely to have external e-cigarette advertising than those in deprived areas. Although e-cigarettes delivered high profit margins, retailers were confused by the diversity of brands and products, and uncertain of the sector's viability. Some customers were perceived to purchase e-cigarettes as cessation aids, and others, particularly low-income smokers, as a cheaper adjunct to conventional tobacco. CONCLUSIONS E-cigarette point-of-sale displays and number of brands displayed increased over 12 months, a potential cause for concern given their lack of regulation. Further scrutiny is needed of the content and effects of such advertising, and the potentially normalising effects of placing e-cigarettes next to products of interest to children.
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Affiliation(s)
- D Eadie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - M Stead
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - A M MacKintosh
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - L MacDonald
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - R Purves
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - J Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - C Tisch
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - W van der Sluijis
- Child and Adolescent Health Research Unit, University of St Andrews, St Andrews, UK
| | - A Amos
- Centre for Population Health Sciences, School of Molecular Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - S Haw
- School of Health Sciences, University of Stirling, Stirling, UK
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Verstappen S, Sergeant J, Luben R, Bhaniani A, Anuj S, MacGregor A, Wareham N, Symmons D, Khaw K, Bruce I. OP0268 Anti-Citrullinated Protein Antibody (ACPA) Status in the General Population and as a Predictor of Future Inflammatory Polyarthritis: The EPIC-2-Noar Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4793] [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]
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Sergeant J, Verstappen S, Morgan C, Luben R, Bhaniani A, Anuj S, MacGregor A, Wareham N, Symmons D, Khaw KT, Bruce I. OP0047 Metabolic and Lifestyle Predictors of Inflammatory Polyarthritis in the EPIC-2-NOAR Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Micoulaud-Franchi JA, MacGregor A, Fond G. A preliminary study on cognitive enhancer consumption behaviors and motives of French Medicine and Pharmacology students. Eur Rev Med Pharmacol Sci 2014; 18:1875-1878. [PMID: 25010616] [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: 06/03/2023]
Abstract
BACKGROUND Pharmaceutical neuroenhancer consumption in college students is a rather unknown phenomenon in Europe and particularly in France, where surprisingly only one study was conducted in 1988. AIM Our objective is to assess prevalence and motivations for licit (use inside medical indication) and illicit pharmaceutical neuroenhancer consumption (tablet form) in a non-selected French sample of Medicine and Pharmacology students. SUBJECTS AND METHODS A validated questionnaire was send to French sample of Medicine and Pharmacology students using email. The questionnaire investigate motives for use of pharmaceutical licit (vitamin C and caffeine tablets) and illicit (methylphenidate, amphetamines, modafinil, piracetam). RESULTS Among 206 undergraduate students, 139 students (67.4%) declared to have consumed at least one cognitive enhancer in the past 12 months. Twelve students (8.6% of cognitive enhancers users and 5.8% of our total sample) used illicit pharmaceutical neuroenhancer. The motivations were first to improve their academic performances, second to improve their wakefulness/ vigilance, and third to improve their attention/concentration. CONCLUSIONS Neuroenhancement is a widespread means of using pharmaceutical drugs in French as well as in US college campuses. Despites some limitations, these preliminary results highlight the need to boost the interest of professionals for the neuroenhancement issue in French and European students.
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Affiliation(s)
- J-A Micoulaud-Franchi
- Unité de Neurophysiologie, Psychophysiologie et Neurophénoménologie (UNPN), Solaris, Pôle de Psychiatrie Universitaire, Hôpital Sainte-Marguerite, Marseille, France.
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Birt L, Pfeil M, MacGregor A, Armon K, Poland F. Adherence to home physiotherapy treatment in children and young people with joint hypermobility: a qualitative report of family perspectives on acceptability and efficacy. Musculoskeletal Care 2014; 12:56-61. [PMID: 23818237 DOI: 10.1002/msc.1055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Joint hypermobility can lead to pain and motor developmental problems in children and young people (CYP). Exercise programmes may help CYP with joint hypermobility strengthen core muscle groups. Non- adherence to home physiotherapy is common. The present study aimed to understand how families experienced an intensive multidisciplinary intervention. METHOD This was a qualitative study nested within a randomized controlled trial of a multidisciplinary treatment intervention, including physiotherapy, for children aged five to 17 years. Twenty-eight families were recruited following the intervention. Semi-structured interviews were used to examine the views and expectations of parents and CYP, and examine adherence to the exercise programme. Thematic analysis of data was used to develop findings. RESULTS Parents and CYP reported that exercise reduced the symptoms of hypermobility. Parental motivation, adapting family routines, making exercise a family activity and seeing benefit increased adherence to exercise. Non-adherence to exercise was linked to lower levels of parental supervision, not understanding the treatment, not seeing benefit and not having specific time to dedicate to doing the exercises. CONCLUSION Even when exercise is seen to benefit a child's well-being, families experience challenges in adhering to a physiotherapy programme for hypermobility. Therapists can utilize findings on what enhances adherence to help CYP effectively exercise in the home setting.
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Affiliation(s)
- Linda Birt
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Yates M, Mukhtyar C, Igali L, Watts R, MacGregor A. SAT0153 Giant Cell Arteritis – Incidence and Mortality. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1879] [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]
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Nikiphorou E, Morris S, MacGregor A, Cooper N, Chipping J, Symmons D, Young A. THU0525 A Prospective, Multi-Centre, Prevalence-Based Cost-of-Illness Study of RA in the UK. Relative Costs of Biologics and Orthopaedic Surgery in Established Disease. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fleischmann R, van Vollenhoven RF, Smolen J, Emery P, Florentinus S, Rathmann S, Kupper H, Kavanaugh A, Taylor P, Genovese M, Keystone EC, Drescher E, Berclaz PY, Lee C, Fidelus-Gort R, Schlichting D, Beattie S, Luchi M, Macias W, Kavanaugh A, Emery P, van Vollenhoven RF, Dikranian AH, Alten R, Klearman M, Musselman D, Agarwal S, Green J, Gabay C, Weinblatt ME, Schiff MH, Fleischmann R, Valente R, van der Heijde D, Citera G, Zhao C, Maldonado MA, Rakieh C, Nam JL, Hunt L, Villeneuve E, Bissell LA, Das S, Conaghan P, McGonagle D, Wakefield RJ, Emery P, Wright HL, Thomas HB, Moots R, Edwards SW, Hamann P, Heward J, McHugh N, Lindsay MA, Haroon M, Giles JT, Winchester R, FitzGerald O, Karaderi T, Cohen CJ, Keidel S, Appleton LH, Macfarlane GJ, Siebert S, Evans D, Paul Wordsworth B, Plant D, Bowes J, Orozco G, Morgan AW, Wilson AG, Isaacs J, Barton A, Williams FM, Livshits G, Spector T, MacGregor A, Williams FM, Scollen S, Cao D, Memari Y, Hyde CL, Zhang B, Sidders B, Ziemek D, Shi Y, Harris J, Harrow I, Dougherty B, Malarstig A, McEwen R, Stephens JL, Patel K, Shin SY, Surdulescu G, He W, Jin X, McMahon SB, Soranzo N, John S, Wang J, Spector TD, Baker J, Litherland GJ, Rowan AD, Kite KA, Bayley R, Yang P, Smith JP, Williams J, Harper L, Kitas GD, Buckley C, Young SP, Fitzpatrick MA, Young SP, McGettrick HM, Filer A, Raza K, Nash G, Buckley C, Muthana M, Davies H, Khetan S, Adeleke G, Hawtree S, Tazzyman S, Morrow F, Ciani B, Wilson G, Quirke AM, Lugli E, Wegner N, Charles P, Hamilton B, Chowdhury M, Ytterberg J, Potempa J, Fisher B, Thiele G, Mikuls T, Venables P, Adebajo AO, Kavanaugh A, Mease P, Gomez-Reino JJ, Wollenhaupt J, Hu C, Stevens R, Sieper J, van der Heijde D, Dougados M, Van den Bosch F, Goupille P, Rathmann SS, Pangan AL, van der Heijde D, Sieper J, Maksymowych WP, Brown MA, Rathmann S, Pangan AL, Sieper J, van der Heijde D, Elewaut D, Pangan AL, Anderson J, Haroon M, Ramasamy P, O'Rourke M, Murphy C, Fitzgerald O, Jani M, Moore S, Mirjafari H, Macphie E, Chinoy H, Rao C, McLoughlin Y, Preeti S. Oral Abstracts 7: RA Clinical * O37. Long-Term Outcomes of Early RA Patients Initiated with Adalimumab Plus Methotrexate Compared with Methotrexate Alone Following a Targeted Treatment Approach. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Menni C, Zhai G, MacGregor A, Prehn C, Römisch-Margl W, Suhre K, Adamski J, Cassidy A, Illig T, Spector TD, Valdes AM. Targeted metabolomics profiles are strongly correlated with nutritional patterns in women. Metabolomics 2013; 9:506-514. [PMID: 23543136 PMCID: PMC3608890 DOI: 10.1007/s11306-012-0469-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/21/2012] [Indexed: 01/06/2023]
Abstract
Nutrition plays an important role in human metabolism and health. Metabolomics is a promising tool for clinical, genetic and nutritional studies. A key question is to what extent metabolomic profiles reflect nutritional patterns in an epidemiological setting. We assessed the relationship between metabolomic profiles and nutritional intake in women from a large cross-sectional community study. Food frequency questionnaires (FFQs) were applied to 1,003 women from the TwinsUK cohort with targeted metabolomic analyses of serum samples using the Biocrates Absolute-IDQ™ Kit p150 (163 metabolites). We analyzed seven nutritional parameters: coffee intake, garlic intake and nutritional scores derived from the FFQs summarizing fruit and vegetable intake, alcohol intake, meat intake, hypo-caloric dieting and a "traditional English" diet. We studied the correlation between metabolite levels and dietary intake patterns in the larger population and identified for each trait between 14 and 20 independent monozygotic twins pairs discordant for nutritional intake and replicated results in this set. Results from both analyses were then meta-analyzed. For the metabolites associated with nutritional patterns, we calculated heritability using structural equation modelling. 42 metabolite nutrient intake associations were statistically significant in the discovery samples (Bonferroni P < 4 × 10-5) and 11 metabolite nutrient intake associations remained significant after validation. We found the strongest associations for fruit and vegetables intake and a glycerophospholipid (Phosphatidylcholine diacyl C38:6, P = 1.39 × 10-9) and a sphingolipid (Sphingomyeline C26:1, P = 6.95 × 10-13). We also found significant associations for coffee (confirming a previous association with C10 reported in an independent study), garlic intake and hypo-caloric dieting. Using the twin study design we find that two thirds the metabolites associated with nutritional patterns have a significant genetic contribution, and the remaining third are solely environmentally determined. Our data confirm the value of metabolomic studies for nutritional epidemiologic research.
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Affiliation(s)
- Cristina Menni
- Department of Twin Research & Genetic Epidemiology, King’s College London, St Thomas Hospital, London, SE17EH UK
| | - Guangju Zhai
- Department of Twin Research & Genetic Epidemiology, King’s College London, St Thomas Hospital, London, SE17EH UK
- Faculty of Medicine, Memorial University of Newfoundland, St John’s, NL Canada
| | - Alexander MacGregor
- Department of Twin Research & Genetic Epidemiology, King’s College London, St Thomas Hospital, London, SE17EH UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Cornelia Prehn
- Helmholtz Zentrum München, Institute of Experimental Genetics, Genome Analysis Center, Neuherberg, Germany
| | - Werner Römisch-Margl
- Helmholtz Zentrum München, Institute of Bioinformatics and Systems Biology, Neuherberg, Germany
| | - Karsten Suhre
- Helmholtz Zentrum München, Institute of Bioinformatics and Systems Biology, Neuherberg, Germany
- Department of Physiology and Biophysics, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, State of Qatar
- Faculty of Biology, Ludwig-Maximilians-Universität, Großhaderner Str. 2, Planegg-Martinsried, Germany
| | - Jerzy Adamski
- Helmholtz Zentrum München, Institute of Experimental Genetics, Genome Analysis Center, Neuherberg, Germany
- Lehrstuhl für Experimentelle Genetik, Technische Universität München, Freising-Weihenstephan, Germany
| | - Aedin Cassidy
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Thomas Illig
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Tim D. Spector
- Department of Twin Research & Genetic Epidemiology, King’s College London, St Thomas Hospital, London, SE17EH UK
| | - Ana M. Valdes
- Department of Twin Research & Genetic Epidemiology, King’s College London, St Thomas Hospital, London, SE17EH UK
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Abstract
With the established success of the National Joint Registry and the emergence of a range of new national initiatives for the capture of electronic data in the National Health Service, orthopaedic surgery in the United Kingdom has found itself thrust to the forefront of an information revolution. In this review we consider the benefits and threats that this revolution poses, and how orthopaedic surgeons should marshal their resources to ensure that this is a force for good.
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Affiliation(s)
- A J Goldberg
- Royal National Orthopaedic Hospital NHS Trust, UCL Institute of Orthopaedics & Musculoskeletal Science, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
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Heathfield S, Parker B, Zeef L, Bruce I, Alexander Y, Collins F, Stone M, Wang E, Williams AS, Wright HL, Thomas HB, Moots RJ, Edwards SW, Bullock C, Chapman V, Walsh DA, Mobasheri A, Kendall D, Kelly S, Bayley R, Buckley CD, Young SP, Rump-Goodrich L, Middleton J, Chen L, Fisher R, Kollnberger S, Shastri N, Kessler BM, Bowness P, Nazeer Moideen A, Evans L, Osgood L, Williams AS, Jones SA, Nowell MA, Mahadik Y, Young S, Morgan M, Gordon C, Harper L, Giles JL, Paul Morgan B, Harris CL, Rysnik OJ, McHugh K, Kollnberger S, Payeli S, Marroquin O, Shaw J, Renner C, Bowness P, Nayar S, Cloake T, Bombardieri M, Pitzalis C, Buckley C, Barone F, Barone F, Nayar S, Cloake T, Lane P, Coles M, Buckley C, Williams EL, Edwards CJ, Cooper C, Oreffo RO, Dunn S, Crawford A, Wilkinson M, Le Maitre C, Bunning R, Daniels J, Phillips KLE, Chiverton N, Le Maitre CL, Kollnberger S, Shaw J, Ridley A, Wong-Baeza I, McHugh K, Keidel S, Chan A, Bowness P, Gullick NJ, Abozaid HS, Jayaraj DM, Evans HG, Scott DL, Choy EH, Taams LS, Hickling M, Golor G, Jullion A, Shaw S, Kretsos K, Bari SF, Rhys-Dillon B, Amos N, Siebert S, Phillips KLE, Chiverton N, Bunning RD, Haddock G, Cross AK, Le Maitre CL, Kate I, Phillips E, Cross A, Chiverton N, Haddock G, Bunning RAD, Le Maitre CL, Ceeraz S, Spencer J, Choy E, Corrigall V, Crilly A, Palmer H, Lockhart J, Plevin R, Ferrell WR, McInnes I, Hutchinson D, Perry L, DiCicco M, Humby F, Kelly S, Hands R, Buckley C, McInnes I, Taylor P, Bombardieri M, Pitzalis C, Mehta P, Mitchell A, Tysoe C, Caswell R, Owens M, Vincent T, Hashmi TM, Price-Forbes A, Sharp CA, Murphy H, Wood EF, Doherty T, Sheldon J, Sofat N, Goff I, Platt PN, Abdulkader R, Clunie G, Ismajli M, Nikiphorou E, Young A, Tugnet N, Dixey J, Banik S, Alcorn D, Hunter J, Win Maw W, Patil P, Hayes F, Main Wong W, Borg FA, Dasgupta B, Malaviya AP, Ostor AJ, Chana JK, Ahmed AA, Edmonds S, Hayes F, Coward L, Borg F, Heaney J, Amft N, Simpson J, Dhillon V, Ayalew Y, Khattak F, Gayed M, Amarasena RI, McKenna F, Amarasena RI, McKenna F, Mc Laughlin M, Baburaj K, Fattah Z, Ng N, Wilson J, Colaco B, Williams MR, Adizie T, Dasgupta B, Casey M, Lip S, Tan S, Anderson D, Robertson C, Devanny I, Field M, Walker D, Robinson S, Ryan S, Hassell A, Bateman J, Allen M, Davies D, Crouch C, Walker-Bone K, Gainsborough N, Gullick NJ, Lutalo PM, Davies UM, Walker-Bone K, Mckew JR, Millar AM, Wright SA, Bell AL, Thapper M, Roussou T, Cumming J, Hull RG, Thapper M, Roussou T, McKeogh J, O'Connor MB, Hassan AI, Bond U, Swan J, Phelan MJ, Coady D, Kumar N, Farrow L, Bukhari M, Oldroyd AG, Greenbank C, McBeth J, Duncan R, Brown D, Horan M, Pendleton N, Littlewood A, Cordingley L, Mulvey M, Curtis EM, Cole ZA, Crozier SR, Georgia N, Robinson SM, Godfrey KM, Sayer AA, Inskip HM, Cooper C, Harvey NC, Davies R, Mercer L, Galloway J, Low A, Watson K, Lunt M, Symmons D, Hyrich K, Chitale S, Estrach C, Moots RJ, Goodson NJ, Rankin E, Jiang CQ, Cheng KK, Lam TH, Adab P, Ling S, Chitale S, Moots RJ, Estrach C, Goodson NJ, Humphreys J, Ellis C, Bunn D, Verstappen SM, Symmons D, Fluess E, Macfarlane GJ, Bond C, Jones GT, Scott IC, Steer S, Lewis CM, Cope A, Mulvey MR, Macfarlane GJ, Symmons D, Lovell K, Keeley P, Woby S, Beasley M, McBeth J, Viatte S, Plant D, Lunt M, Fu B, Parker B, Galloway J, Solymossy C, Worthington J, Symmons D, Dixey J, Young A, Barton A, Williams FM, Osei-Bordom DC, Popham M, MacGregor A, Spector T, Little J, Herrick A, Pushpakom S, Ennis H, McBurney H, Worthington J, Newman W, Ibrahim I, Plant D, Hyrich K, Morgan A, Wilson A, Isaacs J, Barton A, Sanderson T, Hewlett S, Calnan M, Morris M, Raza K, Kumar K, Cardy CM, Pauling JD, Jenkins J, Brown SJ, McHugh N, Nikiphorou E, Mugford M, Davies C, Cooper N, Brooksby A, Bunn D, Symmons D, MacGregor A, Dures E, Ambler N, Fletcher D, Pope D, Robinson F, Rooke R, Hewlett S, Gorman CL, Reynolds P, Hakim AJ, Bosworth A, Weaver D, Kiely PD, Skeoch S, Jani M, Amarasena R, Rao C, Macphie E, McLoughlin Y, Shah P, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Patel Y, Baguley E, Jani M, Halsey J, Severn A, Bukhari M, Selvan S, Price E, Husain MJ, Brophy S, Phillips CJ, Cooksey R, Irvine E, Siebert S, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Griffiths B, Foggo H, Edgar S, Vadivelu S, Coady D, McHugh N, Ng WF, Dasgupta B, Taylor P, Iqbal I, Heron L, Pilling C, Marks J, Hull R, Ledingham J, Han C, Gathany T, Tandon N, Hsia E, Taylor P, Strand V, Sensky T, Harta N, Fleming S, Kay L, Rutherford M, Nicholl K, Kay L, Rutherford M, Nicholl K, Eyre T, Wilson G, Johnson P, Russell M, Timoshanko J, Duncan G, Spandley A, Roskell S, Coady D, West L, Adshead R, Donnelly SP, Ashton S, Tahir H, Patel D, Darroch J, Goodson NJ, Boulton J, Ellis B, Finlay R, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Vadivelu S, Coady D, McHugh N, Griffiths B, Foggo H, Edgar S, Ng WF, Murray-Brown W, Priori R, Tappuni T, Vartoukian S, Seoudi N, Picarelli G, Fortune F, Valesini G, Pitzalis C, Bombardieri M, Ball E, Rooney M, Bell A, Merida AA, Isenberg D, Tarelli E, Axford J, Giles I, Pericleous C, Pierangeli SS, Ioannou J, Rahman A, Alavi A, Hughes M, Evans B, Bukhari M, Parker B, Zaki A, Alexander Y, Bruce I, Hui M, Garner R, Rees F, Bavakunji R, Daniel P, Varughese S, Srikanth A, Andres M, Pearce F, Leung J, Lim K, Regan M, Lanyon P, Oomatia A, Petri M, Fang H, Birnbaum J, Amissah-Arthur M, Gayed M, Stewart K, Jennens H, Braude S, Gordon C, Sutton EJ, Watson KD, Gordon C, Yee CS, Lanyon P, Jayne D, Isenberg D, Rahman A, Akil M, McHugh N, Ahmad Y, Amft N, D'Cruz D, Edwards CJ, Griffiths B, Khamashta M, Teh LS, Zoma A, Bruce I, Dey ID, Kenu E, Isenberg D, Pericleous C, Garza-Garcia A, Murfitt L, Driscoll PC, Isenberg D, Pierangeli S, Giles I, Ioannou Y, Rahman A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Segeda I, Shevchuk S, Kuvikova I, Brown N, Bruce I, Venning M, Mehta P, Dhanjal M, Mason J, Nelson-Piercy C, Basu N, Paudyal P, Stockton M, Lawton S, Dent C, Kindness K, Meldrum G, John E, Arthur C, West L, Macfarlane MV, Reid DM, Jones GT, Macfarlane GJ, Yates M, Loke Y, Watts R, MacGregor A, Adizie T, Christidis D, Dasgupta B, Williams M, Sivakumar R, Misra R, Danda D, Mahendranath KM, Bacon PA, Mackie SL, Pease CT. Basic science * 232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes108] [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: 11/13/2022] Open
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Williams D, Khamashta M, Ostensen M, Nelson-Piercy C, Emery P, Parmar M, Barton A, Clinch J, Silman AJ, Grahame R, Hakim A, Lemmey A, Hurkmans E, Knittle K, Vlieland TV, Manning V, Frith J, Bearne L, Macfarlane GJ, MacGregor A, Silman AJ, Dixon W, Maffulli N, Hughes C, Bull A, Longo UG, Maffulli N, Diamond B, Isenberg D, Isaacs J, Denton CP, Rahman A, Hill J, Foster NE, Hewlett S, Sanderson T, Conaghan P. Reproductive issues in rheumatology: do you know how to advise your patients? * I1. Is pregnancy a stress test for subsequent development of autoimmunity? Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes106] [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: 11/14/2022] Open
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Campbell R, Hofmann D, Hatch S, Gordon P, Lempp H, Das L, Blumbergs P, Limaye V, Vermaak E, McHugh N, Edwards MH, Jameson K, Sayer AA, Dennison E, Cooper C, Salvador FB, Huertas C, Isenberg D, Jackson EJ, Middleton A, Churchill D, Walker-Bone K, Worsley PR, Mottram S, Warner M, Morrissey D, Gadola S, Carr A, Cooper C, Stokes M, Srivastava RN, Sanghi D, Srivastava RN, Sanghi D, Elbaz A, Mor A, Segal G, Drexler M, Norman D, Peled E, Rozen N, Goryachev Y, Debbi EM, Haim A, Rozen N, Wolf A, Debi R, Mor A, Segal G, Debbi EM, Cohen MS, Igolnikov I, Bar Ziv Y, Benkovich V, Bernfeld B, Rozen N, Elbaz A, Collins J, Moots RJ, Clegg PD, Milner PI, Ejtehadi HD, Nelson PN, Wenham C, Balamoody S, Hodgson R, Conaghan P, Wilkie R, Blagojevic M, Jordan KP, Mcbeth J, Peffers MJ, Beynon RJ, Thornton DJ, Clegg PD, Chapman R, Chapman V, Walsh D, Kelly S, Hui M, Zhang W, Doherty S, Rees F, Muir K, Maciewicz R, Doherty M, Snelling S, Davidson RK, Swingler T, Price A, Clark I, Stockley E, Hathway G, Faas H, Auer D, Chapman V, Hirsch G, Hale E, Kitas G, Klocke R, Abraham A, Pearce MS, Mann KD, Francis RM, Birrell F, Tucker M, Mellon SJ, Jones L, Price AJ, Dieppe PA, Gill HS, Ashraf S, Chapman V, Walsh DA, McCollum D, McCabe C, Grieve S, Shipley J, Gorodkin R, Oldroyd AG, Evans B, Greenbank C, Bukhari M, Rajak R, Bennett C, Williams A, Martin JC, Abdulkader R, MacNicol C, Brixey K, Stephenson S, Clunie G, Andrews RN, Oldroyd AG, Evans B, Greenbank C, Bukhari M, Clark EM, Gould VC, Carter L, Morrison L, Tobias JH, Pye SR, Vanderschueren D, O'Neill TW, Lee DM, Jans I, Billen J, Gielen E, Laurent M, Claessens F, Adams JE, Ward KA, Bartfai G, Casanueva F, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi I, Kula K, Lean ME, Pendleton N, Punab M, Wu FC, Boonen S, Mercieca C, Webb J, Shipley J, Bhalla A, Fairbanks S, Moss KE, Collins C, Sedgwick P, Clark EM, Gould VC, Morrison L, Tobias JH, Parker J, Greenbank C, Evans B, Oldroyd AG, Bukhari M, Harvey NC, Cole ZA, Crozier SR, Ntani G, Mahon PA, Robinson SM, Inskip HM, Godfrey KM, Dennison EM, Cooper C, Bridges M, Ruddick S, Holroyd CR, Mahon P, Crozier SR, Godfrey K, Inskip HM, Cooper C, Harvey NC, Bridges M, Ruddick S, McNeilly T, McNally C, Beringer T, Finch M, Coda A, Davidson J, Walsh J, Fowlie P, Carline T, Santos D, Patil P, Rawcliffe C, Olaleye A, Moore S, Fox A, Sen D, Ioannou Y, Nisar S, Rankin K, Birch M, Finnegan S, Rooney M, Gibson DS, Malviya A, Ferris CM, Rushton SP, Foster HE, Hanson H, Muthumayandi K, Deehan DJ, Birt L, Poland F, MacGregor A, Armon K, Pfeil M, McErlane F, Beresford MW, Baildam EM, Thomson W, Hyrich K, Chieng A, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Gibson DS, Finnegan S, Newell K, Evans A, Manning G, Scaife C, McAllister C, Pennington SR, Duncan M, Moore T, Rooney M, Pericleous C, Croca SC, Giles I, Alber K, Yong H, Isenberg D, Midgely A, Beresford MW, Rahman A, Ioannou Y, Rzewuska M, Mallen C, Strauss VY, Belcher J, Peat G, Byng-Maddick R, Wijendra M, Penn H, Roddy E, 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Verstappen S, Lunt M, Bunn D, Scott DG, Symmons D, Kinloch AJ, Brintnell W, Alzabin S, Wilson E, Barran L, Wegner N, Bell DA, Cairns E, Venables PJ, Mercer LK, Davies R, Lunt M, Galloway J, Watson KD, Dixon W, MacGregor A, Guile G, Skinner J, Fairweather-Tait S, Cassidy A, Richards B, Spector T, Wang W, Ling S, Chitale S, Sharpley D, Moots R, Estrach C, Goodson NJ, Mattey DL, Dawson SR, Healey EL, Packham JC. Concurrent oral 3 - Environmental and genetic factors: OP16. In Patients with Early Inflammatory Polyarthritis, Younger Age, Acpa Positivity, Shared Epitope, And Inefficacy of the First Dmard are Associated with the Need to Start a Biological Therapy: Results from the Norfolk Arthritis Register (NOAR). Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker071] [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: 11/13/2022] Open
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Symmons D, Zink A, Ryland J, Isenberg D, MacGregor A, Isaacs J, McHugh N, Keat A, Dixon W, Askling J, Symmons D. Lessons for clinical practice from biologics registers: IP10. Establishing and Running a Biologics Register: Manchester - United. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker046] [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: 11/14/2022] Open
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Mucci G, Barber B, Semrud-Clikeman M, Goldenring J, Bledsoe J, Vroman L, Crow S, Zimmerman A, Mazur-Mosiewicz A, Roberds E, Dean R, Sokol D, Hole M, Teat R, Paquett B, Albano J, Broshek D, Elias J, Brennan L, Chakravarti P, Schultheis L, Kibby M, Weisser V, Hynd G, Ang J, Crockett D, Puente A, Weiss E, Longman R, Antoniello D, Axelrod B, McGinley J, Gomes W, Masur D, Davis A, Lutz J, Roberds E, Williams R, Gupta A, Estes B, Dennison A, Schiff W, Hertza J, Ferrari M. 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MacGregor A. Joseph Norman Blau. West J Med 2010. [DOI: 10.1136/bmj.c4246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lloyd M, Makadsi R, Ala A, Connor P, Gwynne C, Rhys Dillon B, Lawson T, Emery P, Mease PJ, Rubbert-Roth A, Curtis JR, Muller-Ladner U, Gaylis N, Armstrong GK, Reynard M, Tyrrell H, Joshi N, Loke Y, MacGregor A, Malaiya R, Rachapalli SM, Parton T, King L, Parker G, Nesbitt A, Schiff M, Sheikzadeh A, Formosa D, Domanska B, Morgan D, van Vollenhoven R, Cifaldi M, Roy S, Chen N, Gotlieb L, Malaise M, Langtree M, Lam M, Malipeddi A, Hassan W, El Miedany Y, El Gaafary M, Palmer D, Dutta S, Breslin A, Ahmad Y, Morcos PN, Zhang X, Grange S, Schmitt C, Malipeddi AS, Neame R, Isaacs JD, Olech E, Tak PP, Deodhar A, Keystone E, Emery P, Yocum D, Hessey E, Read S, Blunn KJ, Williams RB, McDowell JA, Rees DH, Young A, Marks JL, Westlake SL, Baird J, Kiely PD, Ostor AJ, Quinn MA, Taylor PC, Edwards CJ, Vagadia V, Bracewell C, McKay N, Collini A, Kidd E, Wright D, Watson K, Williams E, Mossadegh S, Ledingham J, Combe B, Schwartzman S, Massarotti E, Keystone EC, Luijtens K, van der Heijde D, Mariette X, Kivitz A, Isaacs JD, Stohl W, Tak PP, Jones R, Jahreis A, Armstrong G, Shaw T, Westhovens R, Strand V, Keystone EC, Purcaru O, Khanna D, Smolen J, Kavanaugh A, Keystone EC, Fleischmann RM, Emery P, Dougados M, Baldassare AR, Armstrong GK, Linnik M, Reynard M, Tyrrell H, McInnes IB, Combe B, Burmester G, Schiff M, Keiserman M, Codding C, Songcharoen S, Berman A, Nayiager S, Saldate C, Aranda R, Becker JC, Zhao C, Le Bars M, Dougados M, Burmester GR, Kary S, Unnebrink K, Guerette B, Oezer U, Kupper H, Dougados M, Keystone EC, Guerette B, Patra K, Lavie F, Gasparyan AY, Sandoo A, Stavropoulos-Kalinoglou A, Kitas GD, Dubash SR, Linton S, Emery P, Genovese MC, Fleischmann RM, Matteson EL, Hsia EC, Xu S, Doyle MK, Rahman MU, Keystone E, Curtis J, Fleischmann R, Mease P, Khanna D, Smolen J, Coteur G, Combe B, van Vollenhoven R, Smolen J, Schiff M, Fleischmann R, Combe B, Goel N, Desai C, Curtis J, Keystone E, Emery P, Choy E, Van Vollenhoven R, Keystone E, Furie R, Blesch A, Wang CD, Curtis JR, Hughes LD, Young A, Done DJ, Treharne G, van Vollenhoven RF, Emery P, Bingham CO, Keystone EC, Fleischmann RM, Furst DE, Macey K, Sweetster MT, Lehane PB, Farmer P, Long SG, Kremer JM, Russell AS, Emery P, Abud-Mendoza C, Szechinski J, Becker JC, Wu G, Westhovens R, Keystone EC, Kavanaugh A, van der Heijde D, Sinisi S, Guerette B, Keystone EC, Fleischmann R, Smolen J, Strand V, Landewe R, Combe B, Mease P, Ansari Z, Goel N, van der Heijde D, Emery P, Alavi A, Fitzgerald O, Collins ES, Fraser O, Tarelli E, Ng VC, Breshnihan B, Veale DJ, Axford JS, Aletaha D, Alasti F, Smolen JS, Keystone EC, Schiff MH, Rovensky J, Taylor M, John AK, Balbir-Gurman A, Hughes LD, Young A, John Done D, Treharne GJ, Ezard C, Willott R, Butt S, Gadsby K, Deighton C, Tsuru T, Terao K, Suzaki M, Nakashima H, Akiyama A, Nishimoto N, Smolen J, Wordsworth P, Doyle MK, Kay J, Matteson EL, Landewe R, Hsia E, Zhou Y, Rahman MU, Van Vollenhoven R, Siri D, Furie R, Krasnow J, Alecock E, Alten R, Nishimoto N, Kawata Y, Aoki C, Mima T, van Vollenhoven RF, Nishimoto N, Yamanaka H, Woodworth T, Schiff MH, Taylor A, Pope JE, Genovese MC, Rubbert A, Keystone EC, Hsia EC, Buchanan J, Klareskog L, Murphy FT, Wu Z, Parasuraman S, Rahman MU, Kay J, Wordsworth P, Doyle MK, Smolen J, Buchanan J, Matteson EL, Hsia EC, Landewe R, Zhou Y, Shreekant P, Rahman MU, Smolen JS, Gomez-Reino JJ, Davies C, Alecock E, Rubbert-Roth A, Emery P. Rheumatoid Arthritis: Treatment [151-201]: 151. Should we be Looking More Carefully for Methotrexate Induced Liver Disease? Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq725] [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
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Lorgelly P, Davies C, Shemilt I, Mugford M, MacGregor A. Which prostheses are cost-effective? Knee 2009; 16:419. [PMID: 20050378 DOI: 10.1016/s0968-0160(09)00191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Paula Lorgelly
- Section of Public Health and Health Policy, University of Glasgow, UK
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