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Esteves S, Correia de Barros F, Nunes CS, Puga A, Gomes B, Abelha F, Machado H, Ferreira M, Fernandes N, Vítor P, Pereira S, Lapa TA, Pinho-Oliveira V. Incidence of postoperative residual neuromuscular blockade - A multicenter, observational study in Portugal (INSPIRE 2). Porto Biomed J 2023; 8:e225. [PMID: 37547706 PMCID: PMC10400047 DOI: 10.1097/j.pbj.0000000000000225] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/02/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Background Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess RNMB incidence and management in Portugal. Methods Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals. The primary endpoint was the proportion of patients arriving at postanesthesia care unit (PACU) with a TOF ratio <0.9. Results A total of 366 patients were included, with a median age of 59 years, and 89.1% classified as ASA II or III. Rocuronium was the most used NMBA (99.5%). A total of 96.2% of patients received a reversal agent, 96.6% of which sugammadex and 3.4% neostigmine. Twenty patients displayed a TOF ratio <0.9 at PACU arrival, representing an RNMB incidence of 5.5% (95% CI, 3.1%-7.8%). Only two patients displayed a TOF ratio <0.7. RNMB incidence was 16.7% with neostigmine and 5.3% with sugammadex (P = .114). In patients with intraoperative neuromuscular blockade (NMB) monitoring, RNMB incidence was 5% (95% CI, 2%-8%), which varied significantly according to the type of monitoring (P = .018). Incidence of adverse events was 3.3% (2 severe and 10 moderate). Conclusions The reported overall incidence of 5.5% is numerically lower than results from similar observational studies. An appropriate pharmacological neuromuscular reversal strategy, guided by quantitative neuromuscular monitoring, has the potential to achieve even better results, converting RNMB from an unusual to a very rare or even inexistent event.
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Affiliation(s)
- Simão Esteves
- Anesthesiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Catarina S Nunes
- Departamento de Ciências e Tecnologia Universidade Aberta, Delegação do Porto and Anesthesiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Andreia Puga
- Anesthesiology Service, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Blandina Gomes
- Anesthesiology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Fernando Abelha
- Head Anesthesiology Service, Centro Hospitalar Universitário de São João, Porto and Professor Faculdade de Medicina Universidade do Porto, Porto, Portugal
| | - Humberto Machado
- Head Anesthesiology Service, Centro Hospitalar Universitário do Porto, Porto and Professor Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Milene Ferreira
- Anesthesiology Service, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Nuno Fernandes
- Anesthesiology Service, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Paula Vítor
- Anesthesiology Service, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Sandra Pereira
- Anesthesiology Service, Centro Hospitalar Tâmega e Sousa, Tâmega e Sousa, Portugal
| | - Teresa A. Lapa
- Anesthesiology Service, Centro Hospitalar e Universitário de Coimbra, Coimbra; Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
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Zhou X, Sorbo LD, Hough O, Chao B, Ali A, Brambate E, Ribeiro R, Gomes B, Nardo MD, Yeung J, Liu M, Cypel M, Wang B, Keshavjee S, Sage A. A Computational Approach to Breath-By-Breath Ventilator Waveform Data Extraction and Analysis During Ex Vivo Lung Perfusion Enables Enhanced Physiological Lung Assessment. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.038] [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: 04/05/2023] Open
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3
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Hough O, Zhou X, Nardo MD, Ali A, Brambate E, Ribeiro R, Gomes B, Cypel M, Slutsky A, Sage A, Keshavjee S, Sorbo LD. Pulmonary Stress Index During Ex Vivo Lung Perfusion is Associated with Evlp and Lung Transplant Recipient Outcomes. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.728] [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: 04/05/2023] Open
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4
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Alho AM, Vasconcelos R, Gomes B, Nunes AB. What do future public health doctors know about the One Health concept in Portugal? Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.322] [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: 11/12/2022] Open
Abstract
Abstract
Background
The One Health (OH) approach brings together a transdisciplinary collaboration between human, animal, and environmental health, to tackle emerging zoonotic diseases, antimicrobial resistance, and food safety. Therefore, incorporating of OH principles in the education of health care providers is fundamental.
Methods
To assess OH knowledge, attitudes and practices (KAP), an anonymous, multiple-choice, online self-administered survey was sent to 1st year Portuguese Public Health Medical Residents (PPHMR), during an online congress targeted to them. A descriptive analysis was performed.
Results
A 50.0% response rate was obtained out of the 42 PPHMR attendees. Only 33.3% were familiar with OH concept; 57,1% had heard of it but were not aware of its meaning, and 9.5% had never heard of it. Concerningly, 9,5% believed zoonosis were diseases transmitted between animals and 42.9% considered that “antimicrobial resistance” is applied to antibiotics only. Regarding major zoonosis, etiologic agents were not recognized for Cryptosporidiosis (47.6%), Echinococcosis (42.9%), Toxoplasmosis and Leptospirosis (38.1%), Dermatophytosis (33.3%), Rabies (28.6%), Borreliosis/Brucellosis (23.8%). Half (52.4%) were unaware of the transmission route of Brucellosis/Dermatophytosis, followed by Leptospirosis (38.1%), Toxoplasmosis (28.6%) and Borreliosis/Rabies (23.8%). Remarkably, all participants showed willingness to be informed on OH issues and agreed that prevention and speed of intervention would be higher with greater collaboration between health technicians. About education towards OH throughout their medical curricula, 61.9% classified it as low, 23.8% as absent, 14.3% as sufficient and none classified it as adequate or very adequate.
Conclusions
This is the first study assessing KAP regarding the OH concept among PPHMR. Results highlight the need to bring OH to the Portuguese medical schools’ agenda to better prepare the next generation of PPHMR to the emerging health crisis.
Key messages
• Despite the interest shown by 1st year Portuguese Public Health Medical Residents concerning One Health, a general lack of knowledge on the topic was found.
• The majority qualified as insufficient their training on this subject, highlighting the need for medical schools to improve education and raise awareness regarding this transdisciplinary approach.
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Affiliation(s)
- AM Alho
- ACES Lisboa Norte, Portuguese Association Public Health Doctors , Lisbon, Portugal
| | - R Vasconcelos
- ACES Oeste Norte, Portuguese Association Public Health Doctors , Caldas da Rainha, Portugal
| | - B Gomes
- ACES Entre Douro Vouga I, Portuguese Association Public Health Doctors , Santa Maria da Feira, Portugal
| | - AB Nunes
- Portuguese Association Public Health Doctors , Lisbon, Portugal
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Gomes B, Molina-Correa G, Neves-Reina L, Oliveira AC, Macedo R, Carvalho C, Correia AM. Poly-resistant tuberculosis outbreak in Northern Portugal: a nine year tale. Pulmonology 2020; 26:412-414. [PMID: 32238328 DOI: 10.1016/j.pulmoe.2020.02.006] [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: 01/29/2020] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- B Gomes
- Entre Douro e Vouga I Public Health Unit, Northern Regional Health Administration, Santa Maria da Feira, Portugal; Department of Public Health, Northern Regional Health Administration, Porto, Portugal; Instituto de Saúde Pública da Universidade do Porto, EPIUnit, Porto, Portugal.
| | - G Molina-Correa
- Entre Douro e Vouga I Public Health Unit, Northern Regional Health Administration, Santa Maria da Feira, Portugal
| | - L Neves-Reina
- Entre Douro e Vouga I Public Health Unit, Northern Regional Health Administration, Santa Maria da Feira, Portugal
| | - A C Oliveira
- Entre Douro e Vouga I Public Health Unit, Northern Regional Health Administration, Santa Maria da Feira, Portugal
| | - R Macedo
- Head of the National Reference Laboratory for Mycobacteria, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - C Carvalho
- Department of Public Health, Northern Regional Health Administration, Porto, Portugal; Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - A M Correia
- Department of Public Health, Northern Regional Health Administration, Porto, Portugal
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Ali A, Gomes B, Wang A, Ribeiro R, Galasso M, Hough O, Beronical E, Waddell T, Liu M, Andreazza A, Keshavjee S, Cypel M. Revisiting an Old Concept in a New Era: 36 Hour Lung Preservation Using 10ºC Static Cold Storage. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hough O, Gao X, Yang C, Takahashi M, Mariscal A, Nykanen A, Gomes B, Ali A, Cypel M, Chan C, Keshavjee S, Liu M. Addition of Dialysis to Ex-Vivo Lung Perfusion Maintains Homeostasis and Stability of Donor Lungs: A Pilot Study. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Ribeiro R, Alvarez J, Gomes B, Hondjeu A, Yu F, Adamson M, Ribeiro R, Bissoondath V, Meineri M, Rao V, Cypel M, Badiwala M. Assessment of Cerebral Perfusion and Activity during Normothermic Regional Perfusion in a Porcine Model of Donation after Circulatory Death. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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9
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Michaelsen V, VP Ribeiro R, Wang A, Price C, Wannberg B, Zhang Y, Pires L, del Sorbo L, Ramadan K, Gomes B, Galasso M, Brambate E, Gazzalle A, Liu M, Keshavjee S, Cypel M. Gaseous Nitric Oxide (gNO) as a Potential Antimicrobial Therapy during Ex Vivo Lung Perfusion: An Efficacy and Safety Study. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Ali A, Nykanen A, Brambate E, Mariscal A, Chen M, Wannberg B, Price C, Gomes B, Wang A, Ribeiro R, Michaelsen V, Zhang Y, Waddell T, Liu M, Keshavjee S, Cypel M. Successful Transplantation of Porcine Lungs Following 3 Days of Preservation Using a Modified Cold Static Method Paired with Intermittent Normothermic Ex Vivo Lung Perfusion (EVLP). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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Ribeiro R, Gomes B, Hondjeu A, Yu F, Adamson M, R Ribeiro, J Alvarez, Bissoondath V, Meineri M, Rao V, M Cypel, Badiwala M. ASSESSMENT OF CEREBRAL PERFUSION AND ACTIVITY DURING NORMOTHERMIC REGIONAL PERFUSION IN A PORCINE MODEL OF DONATION AFTER CIRCULATORY DEATH. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Biscaia A, Amorim P, Esteves S, Lagarto F, Gomes B, Bismarck J, Rodrigues N, Nogueira M, Royse CF. Validation of the Portuguese Version of the Postoperative Quality Recovery Scale (PostopQRS). ACTA MEDICA PORT 2018; 31:551-560. [PMID: 30387423 DOI: 10.20344/amp.9451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/18/2017] [Accepted: 07/18/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The Postoperative Quality Recovery Scale is a brief instrument of six domains designed to assess quality of recovery from early to long term after surgery. This study aims to validate the Portuguese version of the Postoperative Quality Recovery Scale. MATERIAL AND METHODS In this observational study 101 adult patients undergoing elective surgery completed the Postoperative Quality Recovery Scale at 15 minutes and 40 minutes, one and three days after surgery. Three constructs were assessed for validity: increased recovery over time; effect of gender and recovery association with muscle strength. Reliability, responsiveness, feasibility and acceptability were also assessed. RESULTS Construct validity was shown by increased recovery over time; worse recovery for female patients in emotive, nociceptive, activities of daily living and overall recovery; improved muscle strength in recovered patients. Internal consistency for activities of daily living was acceptable at all-time points (Cronbach's α value of 0.772 or higher), indicating scale reliability. The scale was able to detect differences in postoperative quality of recovery between the neuromuscular blockade reversal agents, neostigmine and sugammadex, indicating scale responsiveness. The time to conduct the Portuguese version at baseline was 95 - 581 seconds (median 319 seconds) and it was reduced with subsequent assessments. The proportion of patients completing all scale items was 87%, 75%, 65% and 94% for the four time periods evaluated, indicating scale feasibility and acceptability. DISCUSSION This study shows that the Portuguese version of the Postoperative Quality Recovery Scale, demonstrates construct validity, reliability, responsiveness, feasibility and acceptability. CONCLUSIONS This study allowed validation of the Portuguese version of the Postoperative Quality Recovery Scale.
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Affiliation(s)
- André Biscaia
- Family Health Unit. Unidade de Saúde Familiar Marginal. ACES de Cascais. Cascais. Portugal
| | - Pedro Amorim
- Department of Anesthesiology. Hospital de Santo António. Porto. Portugal
| | - Simão Esteves
- Department of Anesthesiology. Hospital de Santo António. Porto. Portugal
| | - Filipa Lagarto
- Department of Anesthesiology. Hospital de Santo António. Porto. Portugal
| | - Blandina Gomes
- Department of Anesthesiology. Hospital de Santo António. Porto. Portugal
| | - José Bismarck
- Department of Anesthesiology. Hospital da Luz. Lisboa
| | | | | | - Colin F Royse
- Department of Surgery. The University of Melbourne. Melbourne. Department of Anaesthesia and Pain Management. The Royal Melbourne Hospital. Carlton. Australia
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13
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Gomes B, Leite AM, Dutra GP, Grubert CS, Avila LPB, Paula SAM, Mendes BFS, Barbosa WM, Barbosa CM, Neves VV, D'Elia VC, Watanabe CA, Amorim GHO, Luiz RR, Petriz JLP. P6424Which hematimetric parameter generates more impact on mortality after an acute coronary syndrome? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6424] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Gomes
- Hospital Barra D'or, Rio de Janeiro, Brazil
| | - A M Leite
- Hospital Barra D'or, Rio de Janeiro, Brazil
| | - G P Dutra
- Hospital Barra D'or, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | - V V Neves
- Hospital Barra D'or, Rio de Janeiro, Brazil
| | - V C D'Elia
- Hospital Barra D'or, Rio de Janeiro, Brazil
| | | | | | - R R Luiz
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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14
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Gomes B, Harnath A, Herwig V, Gatto F, Watremez S, Katus HA, Bekeredjian R. P6319First experience with the 34mm self-expanding Evolut R in a multi-center registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6319] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Gomes
- University Hospital of Heidelberg, Internal Medicine III, Heidelberg, Germany
| | - A Harnath
- Sana Heart Center Cottbus, Cottbus, Germany
| | - V Herwig
- Sana Heart Center Cottbus, Cottbus, Germany
| | - F Gatto
- Herzzentrum Saar, Völklingen, Germany
| | | | - H A Katus
- University Hospital of Heidelberg, Internal Medicine III, Heidelberg, Germany
| | - R Bekeredjian
- University Hospital of Heidelberg, Internal Medicine III, Heidelberg, Germany
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Laia F, Gomes B, Santos A, Pinheiro J. The effectiveness of cold in the recovery post-exercise in kayak sprint. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pinho S, Lagarto F, Gomes B, Costa L, Nunes CS, Oliveira C. [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]. Rev Bras Anestesiol 2018; 68:351-357. [PMID: 29615276 DOI: 10.1016/j.bjan.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 12/26/2017] [Accepted: 01/03/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Surgical patients frequently require admission in high-dependency units or intensive care units. Resources are scarce and there are no universally accepted admission criteria, so patients' allocation must be optimized. The purpose of this study was to investigate the relationship between postoperative destination of patients submitted to colorectal surgery and the scores ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) and Surgical Apgar Score (SAS) and, secondarily find cut-offs to aid this allocation. METHODS A cross-sectional prospective observational study, including all adult patients undergoing colorectal surgery during a 2 years period. Data collected from the electronic clinical process and anesthesia records. RESULTS A total of 358 patients were included. Median score for SAS was 8 and CR-POSSUM had a median mortality probability of 4.5%. Immediate admission on high-dependency units/intensive care units occurred in 51 patients and late admission in 18. Scores from ward and high-dependency units/intensive care units patients were statistically different (SAS: 8 vs. 7, p<0.001; CR-POSSUM: 4.4% vs. 15.9%, p<0.001). Both scores were found to be predictors of immediate postoperative destination (p<0.001). Concerning immediate high-dependency units/intensive care units admission, CR-POSSUM showed a strong association (AUC 0.78, p=0.034) with a ≥9.16 cut-off point (sensitivity: 62.5%; specificity: 75.2%), outperforming SAS (AUC 0.67, p=0.048), with a ≤7 cut-off point (sensitivity: 67.3%; specificity: 56.1%). CONCLUSIONS Both CR-POSSUM and SAS were associated with the clinical decision to admit a patient to the high-dependency units/intensive care units immediately after surgery. CR-POSSUM alone showed a better discriminative capacity.
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Affiliation(s)
- Sílvia Pinho
- Centro Hospitalar do Porto, Serviço de Anestesiologia, Porto, Portugal.
| | - Filipa Lagarto
- Centro Hospitalar do Porto, Serviço de Anestesiologia, Porto, Portugal
| | - Blandina Gomes
- Centro Hospitalar do Porto, Serviço de Anestesiologia, Porto, Portugal
| | - Liliana Costa
- Centro Hospitalar do Porto, Serviço de Anestesiologia, Porto, Portugal
| | - Catarina S Nunes
- Universidade Aberta, Departamento de Ciências e Tecnologia, Laboratório Associado de Energia Transportes e Aeronáutica, Porto, Portugal; Centro Hospitalar do Porto, Centro de Investigação Clínica em Anestesiologia, Porto, Portugal
| | - Carla Oliveira
- Centro Hospitalar do Porto, Serviço de Anestesiologia, Porto, Portugal
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Cardoso A, Martins Branco D, Lacerda A, Gomes B, Lopes S. Aggressiveness of care at the end of life in children with cancer: A nationwide cohort study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx382.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Martins Branco D, Lopes S, Canario R, Freire J, Sousa G, Lunet N, Gomes B. Prevalence and recent time trend in aggressiveness of cancer care near the end of life: an expanded assessment in a cohort study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx382.002] [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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19
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Etkind SN, Bone AE, Gomes B, Lovell N, Evans CJ, Higginson IJ, Murtagh FEM. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Med 2017; 15:102. [PMID: 28514961 PMCID: PMC5436458 DOI: 10.1186/s12916-017-0860-2] [Citation(s) in RCA: 325] [Impact Index Per Article: 46.4] [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: 11/18/2016] [Accepted: 04/21/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Current estimates suggest that approximately 75% of people approaching the end-of-life may benefit from palliative care. The growing numbers of older people and increasing prevalence of chronic illness in many countries mean that more people may benefit from palliative care in the future, but this has not been quantified. The present study aims to estimate future population palliative care need in two high-income countries. METHODS We used mortality statistics for England and Wales from 2006 to 2014. Building on previous diagnosis-based approaches, we calculated age- and sex-specific proportions of deaths from defined chronic progressive illnesses to estimate the prevalence of palliative care need in the population. We calculated annual change over the 9-year period. Using explicit assumptions about change in disease prevalence over time, and official mortality forecasts, we modelled palliative care need up to 2040. We also undertook separate projections for dementia, cancer and organ failure. RESULTS By 2040, annual deaths in England and Wales are projected to rise by 25.4% (from 501,424 in 2014 to 628,659). If age- and sex-specific proportions with palliative care needs remain the same as in 2014, the number of people requiring palliative care will grow by 25.0% (from 375,398 to 469,305 people/year). However, if the upward trend observed from 2006 to 2014 continues, the increase will be of 42.4% (161,842 more people/year, total 537,240). In addition, disease-specific projections show that dementia (increase from 59,199 to 219,409 deaths/year by 2040) and cancer (increase from 143,638 to 208,636 deaths by 2040) will be the main drivers of increased need. CONCLUSIONS If recent mortality trends continue, 160,000 more people in England and Wales will need palliative care by 2040. Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing on integration and boosting of palliative care across health and social care disciplines. Countries with similar demographic and disease changes will likely experience comparable rises in need.
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Affiliation(s)
- S N Etkind
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.
| | - A E Bone
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - B Gomes
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.,University of Coimbra, Faculty of Medicine, Coimbra, Portugal
| | - N Lovell
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - C J Evans
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
| | - I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - F E M Murtagh
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
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Abstract
In this work, oxidation of carbon supported Zn nanostructures was studied to elucidate their utilization as oxygen scavenging materials activated by the relative humidity in the environment. Moisture-activated nano-scavengers were produced on carbon substrates using magnetron sputtering attaining nano-islands (nanoparticles), randomly distributed on the carbon surface, with arbitrary crystallographic orientations. They possess a Zn-ZnO core-shell structure, caused by surface passivation, which provides them with a self-assembled protective layer that prevents complete oxidation of nanoparticles prior to utilization. The oxidation rate is independent of the nanoparticle size and orientation, for particles between 5 and 18 nm. The oxidation kinetics are not in complete agreement with the Cabrera and Mott theory. When exposed to a high relative humidity environment, an acceleration in the oxidation process is observed, dissolving the Zn nanoparticles and forming a layer on the carbon, which facilitates the consumption of the Zn to form ZnO. These results support the idea of its potential use in applications where high RH environments are required, such as food packaging.
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Affiliation(s)
- S Calderon V
- University of Minho, Department of Physics, Campus of Azurém, 4800-058 Guimarães, Portugal.
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Lagarto F, Gomes B, Couto PS, Correia de Barros F, Moreira Z, Branco T, Fonseca L, Aguiar J, Aragão I, Miranda HP, Daniel J, Esteves S. Perioperative Predictors of Survival After Liver Transplantation for Familial Amyloid Polyneuropathy in a Portuguese Center. Transplant Proc 2017; 48:2098-101. [PMID: 27569952 DOI: 10.1016/j.transproceed.2016.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/05/2016] [Accepted: 04/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Liver transplantation (LT) has been the treatment of choice to halt the progression of familial amyloid polyneuropathy (FAP). Few studies have identified prognostic factors for post-LT survival in FAP. Our aim was to assess survival rate and to identify independent factors for survival after LT. METHODS This retrospective cohort study of FAP patients transplanted for the first time analyzed 116 transplantations from 2006 to 2014. The median follow-up period was 45.5 months. RESULTS The overall survival rates at 1 month, 1 year, and 5 years were 89%, 82% and 79%, respectively. On multivariate analysis, only number of red blood cell (RBC) units transfused during surgery, operation time, and body mass index were independent prognostic factors for patient survival. Only 30% of patients were transfused during surgery, and, in these, each RBC unit transfused increased mortality by 53%. The operation time increased mortality by 20% for every 15 minutes of surgery. CONCLUSIONS This study suggests that operation time and RBC transfused are predominant factors affecting post-LT survival in our FAP patients.
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Affiliation(s)
- F Lagarto
- Department of Anesthesiology, Intensive Care, and Emergency, Centro Hospitalar do Porto, Porto, Portugal.
| | - B Gomes
- Department of Anesthesiology, Intensive Care, and Emergency, Centro Hospitalar do Porto, Porto, Portugal
| | - P Sá Couto
- Department of Anesthesiology, Intensive Care, and Emergency, Centro Hospitalar do Porto, Porto, Portugal
| | - F Correia de Barros
- Department of Anesthesiology, Intensive Care, and Emergency, Centro Hospitalar do Porto, Porto, Portugal
| | - Z Moreira
- Department of Anesthesiology, Intensive Care, and Emergency, Centro Hospitalar do Porto, Porto, Portugal
| | - T Branco
- Department of Anesthesiology, Intensive Care, and Emergency, Centro Hospitalar do Porto, Porto, Portugal
| | - L Fonseca
- Department of Anesthesiology, Intensive Care, and Emergency, Centro Hospitalar do Porto, Porto, Portugal
| | - J Aguiar
- Department of Anesthesiology, Intensive Care, and Emergency, Centro Hospitalar do Porto, Porto, Portugal
| | - I Aragão
- Department of Anesthesiology, Intensive Care, and Emergency, Centro Hospitalar do Porto, Porto, Portugal
| | - H P Miranda
- Department of Liver Transplantation, Centro Hospitalar do Porto, Porto, Portugal
| | - J Daniel
- Department of Liver Transplantation, Centro Hospitalar do Porto, Porto, Portugal
| | - S Esteves
- Department of Anesthesiology, Intensive Care, and Emergency, Centro Hospitalar do Porto, Porto, Portugal; Department of Liver Transplantation, Centro Hospitalar do Porto, Porto, Portugal
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Donnan LT, Gomes B, Donnan A, Harris C, Torode I, Heidt C. Ilizarov tibial lengthening in the skeletally immature patient. Bone Joint J 2017; 98-B:1276-82. [PMID: 27587532 DOI: 10.1302/0301-620x.98b10.37523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 11/08/2015] [Accepted: 05/09/2016] [Indexed: 01/27/2023]
Abstract
AIMS We wished to examine the effectiveness of tibial lengthening using a two ring Ilizarov frame in skeletally immature patients. This is a potentially biomechanically unstable construct which risks the loss of axial control. PATIENTS AND METHODS We retrospectively reviewed a consecutive series of 24 boys and 26 girls, with a mean age of 8.6 years (4 to 14), who underwent 52 tibial lengthening procedures with a mean follow-up of 4.3 years (4.0 to 16.9). Tibial alignment was measured before and after treatment using joint orientation lines from the knee and a calculation of the oblique plane axis. RESULTS The mean percentage length gain was 20% (13 to 31) with a mean bone-healing index (BHI) of 34 days per centimetre (20 to 54). Age at surgery and location of the osteotomy site showed a strong relationship as the location of the osteotomy migrated more proximally with age. However, no significant correlation was found between BHI and the position of the osteotomy. The coronal and sagittal joint orientation of the lengthened tibias were within the normal range in 67% and 92% of cases, respectively. The oblique plane angulation calculation revealed a statistically significant change pre- to post-operatively in both magnitude (p < 0.05) and direction (p < 0.01), but without clinical consequence. The majority of complications were minor (n = 40 in 27 patients; 1.48 complications per segment lengthened) with no residual disability reported. CONCLUSION Two-ring tibial lengthening is effective in maintaining segmental alignment, efficient in callous production and relatively comfortable for the patient with few significant complications. Cite this article: Bone Joint J 2016;98-B:1276-82.
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Affiliation(s)
- L T Donnan
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - B Gomes
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - A Donnan
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - C Harris
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - I Torode
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - C Heidt
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
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23
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Martins-Branco D, Ribeiro C, Gomes B. Safety and effectiveness of interventions for malignant ascites with advanced cancer: Systematic review. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw384.04] [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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24
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Rieger K, Lafranconi A, Gomes B, Ploeg L, Schee genannt Halfmann S, Zurriaga Carda R. The EU Policies and the need for Leadership. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv174.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Bjegovic-Mikanovic V, Jakubowski E, Gomes B. Leadership, Education and Training in Europe: Creating a Generation of Leaders for Public Health. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv174.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Evans CJ, Bone AE, Yi D, Wei G, Gomes B, Maddocks M, Sleeman KE, Wright J, Mc Crone P, Higginson IJ. FACTORS ASSOCIATED WITH END OF LIFE TRANSITION FOR OLDER ADULTS LIVING AT HOME: ANALYSIS OF CARERS' POST-BEREAVEMENT SURVEY. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.37] [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: 11/04/2022]
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27
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Machado V, Felício M, Teixeira C, Gomes B. Avoidable mortality in the Northern Region of Portugal from 1989 to 2010. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.019] [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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Henriques AG, Oliveira JM, Gomes B, Ruivo R, da Cruz e Silva EF, da Cruz e Silva OAB. Complexing Aβ prevents the cellular anomalies induced by the Peptide alone. J Mol Neurosci 2014; 53:661-8. [PMID: 24599756 PMCID: PMC4112052 DOI: 10.1007/s12031-014-0233-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/10/2014] [Indexed: 12/01/2022]
Abstract
Retention of intracellular secreted APP (isAPP) can be provoked by the neurotoxic peptide Aβ. The latter decreases in the cerebrospinal fluid of Alzheimer’s disease (AD) patients, as a consequence of its cerebral accumulation and deposition into senile plaques. Of similar relevance, secreted APP (sAPP) levels can be associated with AD. The studies here presented, reinforce the link between sAPP and Aβ and address putative therapeutic strategies. Laminin and gelsolin are potential candidates; both prevent Aβ fibril formation by complexing with Aβ, thus attenuating its neurotoxicity. We show that preincubation of Aβ with laminin and gelsolin has the effect of rendering it less potent to isAPP accumulation in cortical neurons. This appears to be related to a decrease in F-actin polymerization, whereas Aβ alone induces the polymerization. Further, Aβ decreases gelsolin levels, and the latter is involved in Aβ removal. Our data indicates that Aβ-laminin and Aβ-gelsolin complexes are less neurotoxic and also less potent than fibrillar Aβ at inducing isAPP retention. These results validate the potential of these proteins as therapeutic strategies that prevent the Aβ-induced effects. In hence, given that Aβ decreases the levels of proteins involved in its own clearance, this may contribute to the mechanisms underlying AD pathology.
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Affiliation(s)
- A. G. Henriques
- Laboratório de Neurociências, Centro de Biologia Celular, SACS, Universidade de Aveiro, Aveiro, Portugal
| | - J. M. Oliveira
- Laboratório de Neurociências, Centro de Biologia Celular, SACS, Universidade de Aveiro, Aveiro, Portugal
| | - B. Gomes
- Laboratório de Neurociências, Centro de Biologia Celular, SACS, Universidade de Aveiro, Aveiro, Portugal
| | - R. Ruivo
- Laboratório de Neurociências, Centro de Biologia Celular, SACS, Universidade de Aveiro, Aveiro, Portugal
| | - E. F. da Cruz e Silva
- Laboratório de Neurociências, Centro de Biologia Celular, SACS, Universidade de Aveiro, Aveiro, Portugal
| | - O. A. B. da Cruz e Silva
- Laboratório de Neurociências, Centro de Biologia Celular, SACS, Universidade de Aveiro, Aveiro, Portugal
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Evans CJ, Bone A, Morgan M, McCrone P, Gaoi W, Wright J, Hall S, Gomes B, Gordon E, Lindsey F, Bruni C, Taherzadeh S, Higginson IJ. OPTIMISING PALLIATIVE CARE FOR FRAIL ELDERS IN COMMUNITY SETTINGS; PREFERENCES FOR CARE AND PALLIATIVE OUTCOMES IN THE LAST MONTHS OF LIFE. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.21] [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: 11/03/2022]
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30
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Semedo C, Silva LND, Pratas A, Millán A, Gomes B, Oliveira M, Beleca I, Coelho P. Retrospective analysis of 73 orbital floor fractures. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Pinto J, Egyir-Yawson A, Vicente J, Gomes B, Santolamazza F, Moreno M, Charlwood J, Simard F, Elissa N, Weetman D, Donnelly M, Caccone A, Della Torre A. Geographic population structure of the African malaria vector Anopheles gambiae suggests a role for the forest-savannah biome transition as a barrier to gene flow. Evol Appl 2013; 6:910-24. [PMID: 24062800 PMCID: PMC3779092 DOI: 10.1111/eva.12075] [Citation(s) in RCA: 27] [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: 08/28/2012] [Accepted: 04/29/2013] [Indexed: 11/30/2022] Open
Abstract
The primary Afrotropical malaria mosquito vector Anopheles gambiae sensu stricto has a complex population structure. In west Africa, this species is split into two molecular forms and displays local and regional variation in chromosomal arrangements and behaviors. To investigate patterns of macrogeographic population substructure, 25 An. gambiae samples from 12 African countries were genotyped at 13 microsatellite loci. This analysis detected the presence of additional population structuring, with the M-form being subdivided into distinct west, central, and southern African genetic clusters. These clusters are coincident with the central African rainforest belt and northern and southern savannah biomes, which suggests restrictions to gene flow associated with the transition between these biomes. By contrast, geographically patterned population substructure appears much weaker within the S-form.
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Affiliation(s)
- J Pinto
- Unidade de Parasitologia Médica, Centro de Malária e outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa Lisbon, Portugal
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Harding R, Simms V, Calanzani N, Higginson IJ, Hall S, Gysels M, Meñaca A, Bausewein C, Deliens L, Ferreira P, Toscani F, Daveson BA, Ceulemans L, Gomes B. If you had less than a year to live, would you want to know? A seven-country European population survey of public preferences for disclosure of poor prognosis. Psychooncology 2013; 22:2298-305. [PMID: 23508972 DOI: 10.1002/pon.3283] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 12/17/2012] [Accepted: 02/18/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE With increasing European cancer deaths, clinicians must manage information regarding poor prognosis. This study aimed to determine European citizens' preferences, within a scenario of serious illness such as cancer with less than a year to live, for information disclosure regarding poor prognosis, the likely symptoms and problems, and the care options available, to measure variations between countries and to identify factors associated with preferences. METHODS A population-based cross-national telephone survey using random digit dialling in seven countries was conducted. RESULTS Among 9344 respondents, data revealed an international preference (73.9%) to always be informed in the scenario of having a serious illness such as cancer with less than a year to live. This varied from 67.6% in Italy to 80.7% in Flanders. A minority (21.1%) did not want such information unless they ask, or at all. People younger than 70 years (OR 0.72, 95% CI 0.62-0.83, p < 0.001), men (OR 1.23, 95% CI 1.10-1.37, p < 0.001), those with experience of illness (OR = 1.20. 95% CI 1.01-1.43, p < 0.05) and with more education (OR = 1.20, 95% CI 1.09-1.32, p < 0.001) were more likely to want to know of limited time left. CONCLUSIONS The models confirmed the influence of four factors in more than one country (age, gender, education and most concerning problem) and added 11 country-specific factors to which national policies and clinical practice should respond. These findings confirm a majority public preference to be informed in a scenario of poor prognosis. Policy clinical practice should facilitate elucidation and delivery of preferences. Evidence for effective communication skills-building interventions for clinicians is required.
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Affiliation(s)
- R Harding
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, SE5 9PJ, UK
| | - V Simms
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, SE5 9PJ, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - N Calanzani
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, SE5 9PJ, UK
| | - I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, SE5 9PJ, UK
| | - S Hall
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, SE5 9PJ, UK
| | - M Gysels
- Barcelona Centre for International Health Research (CRESIB - Hospital Clínic), Universitat de Barcelona, Barcelona, Spain
| | - A Meñaca
- Barcelona Centre for International Health Research (CRESIB - Hospital Clínic), Universitat de Barcelona, Barcelona, Spain
| | - C Bausewein
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, SE5 9PJ, UK.,Deutsche Gesellschaft für Palliativmedizin, Berlin, Germany
| | - L Deliens
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.,Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Palliative Care Center of Expertise, VU University Medical Center, Amsterdam, the Netherlands
| | - P Ferreira
- Centre for Health Studies and Research, University of Coimbra (CEISUC), Coimbra, Portugal
| | - F Toscani
- Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni - ONLUS, Cremona, Italy
| | - B A Daveson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, SE5 9PJ, UK
| | | | - B Gomes
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, SE5 9PJ, UK
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Bispo AVS, Dos Santos LO, Burégio-Frota P, Galdino MB, Duarte AR, Leal GF, Araújo J, Gomes B, Soares-Ventura EM, Muniz MTC, Santos N. Effect of chromosome constitution variations on the expression of Turner phenotype. Genet Mol Res 2013; 12:4243-50. [PMID: 23546984 DOI: 10.4238/2013.march.13.13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Turner syndrome (TS) is a chronic disease related to haploinsufficiency of genes that are normally expressed in both X chromosomes in patients with female phenotype that is associated with a wide range of somatic malformations. We made detailed cytogenetic and clinical analysis of 65 patients with TS from the region of Recife, Brazil, to determine the effects of different chromosome constitutions on expression of the TS phenotype. Overall, patients with X-monosomy exhibited a tendency to have more severe phenotypes with higher morbidity, showing its importance in TS prognosis. Additionally, we found rare genetic and phenotypic abnormalities associated with this syndrome. To the best of our knowledge, this is the first case of 45,X,t(11;12)(q22;q22) described as a TS karyotype. Turner patients usually have normal intelligence; however, moderate to severe levels of mental retardation were found in 5 TS cases, which is considerate a very uncommon feature in this syndrome.
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Affiliation(s)
- A V S Bispo
- Departamento de Genética, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Recife, PE, Brasil
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Robichon C, Annereau J, Gomes B, Pillon A, de Vries L, Cussac D, Meyer N, Lamant L, Kruczynski A, Guilbaud N. Establishment of Novel Preclinical Melanoma Models Resistant to Vemurafenib. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt047.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Robichon C, Annereau JP, Gomes B, Pillon A, de Vries L, Cussac D, Meyer N, Lamant L, Kruczynski A, Guilbaud N, Kluza J, Jendoubi M, Corazao-Rozas P, Andre F, Jonneaux A, Guerreschi P, Formstecher P, Mortier L, Marchetti PHI, Bozkurt E, Atmaca H, Uzunoglu S, Uslu R, Karaca B, Erenpreisa J, Jackson TR, Huna A, Salmina K, Innashkina I, Jankevics E, Townsend PA, Cragg MS, Atmaca H, Bozkurt E, Uzunoglu S, Uslu R, Karaca B, Ramos SP, Bin M, Neto MDS, Curvello R, de Souza ACS, Nunes M, Weiswald LB, Vrignaud P, Vacher S, Turlotte E, Richon S, Roman-Roman S, Bieche I, Dangles-Marie V, Morais-Santos F, Pinheiro C, Vieira A, Schmitt F, Paredes J, Baltazar F, Zhang T, Lee YW, Rui YF, Cheng TY, Li G, Sreelatha KH, Reshma RS, Veena S, Rakesh SN, Thara S, Jem P, Priya S, Veena S, Sreelatha KH, Reshma RS, Rakesh SN, Priya S. Poster session 5. Translational research. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt047] [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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36
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Simon S, Gomes B, Koeskeroglu P, Higginson I, Bausewein C. Population, mortality and place of death in Germany (1950–2050) – Implications for end-of-life care in the future. Public Health 2012; 126:937-46. [DOI: 10.1016/j.puhe.2012.06.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 05/08/2012] [Accepted: 06/27/2012] [Indexed: 10/27/2022]
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37
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Gomes B, Higginson IJ, Calanzani N, Cohen J, Deliens L, Daveson BA, Bechinger-English D, Bausewein C, Ferreira PL, Toscani F, Meñaca A, Gysels M, Ceulemans L, Simon ST, Pasman HRW, Albers G, Hall S, Murtagh FEM, Haugen DF, Downing J, Koffman J, Pettenati F, Finetti S, Antunes B, Harding R. Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann Oncol 2012; 23:2006-2015. [PMID: 22345118 DOI: 10.1093/annonc/mdr602] [Citation(s) in RCA: 365] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences for place of death cross-nationally. METHODS A telephone survey of a random sample of individuals aged ≥16 in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We determined where people would prefer to die if they had a serious illness such as advanced cancer, facilitating circumstances, personal values and experiences of illness, death and dying. RESULTS Of 9344 participants, between 51% (95% CI: 48% to 54%) in Portugal and 84% (95% CI: 82% to 86%) in the Netherlands would prefer to die at home. Cross-national analysis found there to be an influence of circumstances and values but not of experiences of illness, death and dying. Four factors were associated with a preference for home death in more than one country: younger age up to 70+ (Germany, the Netherlands, Portugal, Spain), increased importance of dying in the preferred place (England, Germany, Portugal, Spain), prioritizing keeping a positive attitude (Germany, Spain) and wanting to involve family in decisions if incapable (Flanders, Portugal). CONCLUSIONS At least two-thirds of people prefer a home death in all but one country studied. The strong association with personal values suggests keeping home care at the heart of cancer EoLC.
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Affiliation(s)
- B Gomes
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
| | - I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - N Calanzani
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - J Cohen
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - L Deliens
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Palliative Care Center of Expertise, VU University Medical Center, Amsterdam, the Netherlands; End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - B A Daveson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - D Bechinger-English
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - C Bausewein
- Deutsche Gesellschaft für Palliativmedizin, Berlin, Germany; King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - P L Ferreira
- Centre for Health Studies and Research, University of Coimbra (CEISUC), Coimbra, Portugal
| | - F Toscani
- Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni ONLUS, Cremona, Italy
| | - A Meñaca
- Barcelona Centre for International Health Research (CRESIB-Hospital Clínic), Universitat de Barcelona, Barcelona, Spain
| | - M Gysels
- Barcelona Centre for International Health Research (CRESIB-Hospital Clínic), Universitat de Barcelona, Barcelona, Spain
| | | | - S T Simon
- Center for Palliative Medicine and Clinical Trials Unit, University Hospital Cologne, Cologne, Germany; Institute of Palliative Care (ipac), Oldenburg, Germany
| | - H R W Pasman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Palliative Care Center of Expertise, VU University Medical Center, Amsterdam, the Netherlands
| | - G Albers
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Palliative Care Center of Expertise, VU University Medical Center, Amsterdam, the Netherlands
| | - S Hall
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - F E M Murtagh
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - D F Haugen
- European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Haukeland University Hospital, Bergen, Norway
| | - J Downing
- Formerly African Palliative Care Association (APCA), Kampala, Uganda
| | - J Koffman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - F Pettenati
- Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni ONLUS, Cremona, Italy
| | - S Finetti
- Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni ONLUS, Cremona, Italy
| | - B Antunes
- Centre for Health Studies and Research, University of Coimbra (CEISUC), Coimbra, Portugal; King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - R Harding
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
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Kruczynski A, Pillon A, Créancier L, Vandenberghe I, Gomes B, Brel V, Cartron V, Chansard N, Verdier J, Guilbaud N, Annereau JP. 925 F14512, a Polyamine Vectorized Anti-cancer Drug Exhibits a Marked Antileukemic Activity, Alone and in Combination With AraC. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71552-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gomes B, Mourão L, Massart A, Figueiredo P, Vilas-Boas J, Santos A, Fernandes R. Gross Efficiency and Energy Expenditure in Kayak Ergometer Exercise. Int J Sports Med 2012; 33:654-60. [DOI: 10.1055/s-0032-1301907] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B. Gomes
- University of Coimbra, Faculty of Sport Sciences and Physical Education, CIDAF, Coimbra, Portugal
| | - L. Mourão
- Porto Polytechnic Institute, Industrial Studies and Management Superior School, Vila do Conde, Portugal
| | - A. Massart
- University of Coimbra, Faculty of Sport Sciences and Physical Education, CIDAF, Coimbra, Portugal
| | - P. Figueiredo
- University of Porto, Faculty of Sport, CIFI2D, Porto, Portugal
| | - J. Vilas-Boas
- University of Porto, Faculty of Sport, CIFI2D, Porto, Portugal
- University of Porto, LABIOMEP, Porto, Portugal
| | - A.M. Santos
- University of Coimbra, Faculty of Sport Sciences and Physical Education, CIDAF, Coimbra, Portugal
| | - R. Fernandes
- University of Porto, Faculty of Sport, CIFI2D, Porto, Portugal
- University of Porto, LABIOMEP, Porto, Portugal
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41
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Nguyen AR, Ling J, Gomes B, Antoniou G, Sutherland LM, Cundy PJ. Slipped capital femoral epiphysis: rising rates with obesity and aboriginality in South Australia. ACTA ACUST UNITED AC 2011; 93:1416-23. [PMID: 21969445 DOI: 10.1302/0301-620x.93b10.26852] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We analysed the incidence of slipped capital femoral epiphysis (SCFE) in South Australia, investigating possible associations between an increased incidence of SCFE, the local indigenous population and the Australian obesity epidemic during the last 20 years. Data including race, age and gender were collected to obtain a profile of the South Australian SCFE patient, and were then compared with epidemiological data for South Australian adolescents. We concluded that the incidence of both obesity and SCFE is increasing. We also noted that the median weight of SCFE patients has increased and the mean age at diagnosis has decreased. Despite weight profiles comparable with those of the general population, we noted that an indigenous child was three times more likely to develop SCFE than a non-indigenous child. As far as we know there is no published literature on the predisposition of Aboriginal Australians to SCFE.
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Affiliation(s)
- A R Nguyen
- Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia 5006, Australia.
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Pillon A, Pesnel S, Faure V, Moulin G, Verdier J, Blanchet J, Créancier L, Vandenbergh I, Gomes B, Josse G, Guilbaud N, Bailly C, Kruczynski A. R158: Modèle expérimental de métastases hépatiques chez la souris - Apport de l’imagerie optique et ultrasonore pour la caractérisation du modèle et le suivi de la réponse thérapeutique. Bull Cancer 2010. [DOI: 10.1016/s0007-4551(15)31079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gomes B, Dores G, Ribeiro P, Mela M, Billoët C. 993 CARE THE CARE. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60996-4] [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: 11/29/2022]
Affiliation(s)
- B. Gomes
- Pain Unit — Anaesthesia Department, Hospital Garcia da Orta, EPE, Almada, Portugal
| | - G.Ç. Dores
- Acute Pain Unit — Anaesthesia Department, Centro Hospitalar do Porto, EPE, Porto, Portugal
| | - P. Ribeiro
- Anaesthesia Department, CHC — Hospital Pediátrico de Coimbra, Coimbra, Portugal
| | - M. Mela
- Pain Unit — Anaesthesia Department, Hospital Garcia da Orta, EPE, Almada, Portugal
| | - C. Billoët
- Air Liquide santé International, Paris, France
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Veale CA, Bernstein PR, Bohnert CM, Brown FJ, Bryant C, Damewood JR, Earley R, Feeney SW, Edwards PD, Gomes B, Hulsizer JM, Kosmider BJ, Krell RD, Moore G, Salcedo TW, Shaw A, Silberstein DS, Steelman GB, Stein M, Strimpler A, Thomas RM, Vacek EP, Williams JC, Wolanin DJ, Woolson S. Orally active trifluoromethyl ketone inhibitors of human leukocyte elastase. J Med Chem 1997; 40:3173-81. [PMID: 9379436 DOI: 10.1021/jm970250z] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This paper describes the development a series of peptidyl trifluoromethyl ketone inhibitors of human leukocyte elastase which are found to have excellent pharmacological profiles. Methods have been developed that allow for the synthesis of these inhibitors in stereochemically pure form. Two of these compounds, 1k and 1l, have high levels of oral bioavailability in several species. Compound 1l has entered development as ZD8321 and is presently undergoing clinical evaluation. These compounds demonstrate that peptidyl trifluoromethyl ketone inhibitors can achieve high levels of oral activity and bioavailability, and therefore they may prove useful as therapeutic agents in the treatment of diseases in which elastase is implicated.
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Affiliation(s)
- C A Veale
- Department of Medicinal Chemistry, ZENECA Pharmaceuticals, A Business Unit of ZENECA Inc., Wilmington, Delaware 19897, USA
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45
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Edwards PD, Andisik DW, Bryant CA, Ewing B, Gomes B, Lewis JJ, Rakiewicz D, Steelman G, Strimpler A, Trainor DA, Tuthill PA, Mauger RC, Veale CA, Wildonger RA, Williams JC, Wolanin DJ, Zottola M. Discovery and biological activity of orally active peptidyl trifluoromethyl ketone inhibitors of human neutrophil elastase. J Med Chem 1997; 40:1876-85. [PMID: 9191965 DOI: 10.1021/jm960819g] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Previously we had shown that tripeptidyl trifluoromethyl ketones (TFMKs) possessing an N-terminal diarylacylsulfonamide, such as ICI 200,880 and ICI 200,355, displayed unparalleled protection against the lung damage induced by human neutrophil elastase (HNE) when the inhibitors were administered intratracheally. Since the diarylacylsulfonamides were designed specifically to afford a long residence time in the lung, it was not unexpected that inhibitors from this class of TFMKs were not active when administered orally. Upon evaluating a large number of peptidyl TFMKs possessing a variety of N-terminal groups, several compounds were identified which demonstrated oral activity. Compounds were evaluated for their oral activity by measuring their ability to inhibit the increase in lung weight relative to body weight (Lw/Bw), the increase in red blood cells, and the increase in white blood cells induced by intratracheally administered HNE (100 micrograms/hamster). A number of tripeptidyl trifluoromethyl ketones containing neutral N-terminal groups displayed good oral activity, while those containing basic, acidic, or polar groups did not. Compound 50, possessing an N-terminal 4-(CH3O)C6H4CO group, was particularly effective, reducing Lw/Bw by 77%, red cells by 89%, and white cells by 91% when dosed at 37.5 mg/kg orally. Thus, by modifying the N-terminal group of tripeptidyl TFMKs, inhibitors can be designed which are effective in vivo when administered either orally or intratracheally.
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Affiliation(s)
- P D Edwards
- Department of Medicinal Chemistry, ZENECA Pharmaceuticals, A Business Unit of ZENECA Inc., Wilmington, Delaware 19850-5437, USA
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Edwards PD, Andisik DW, Strimpler AM, Gomes B, Tuthill PA. Nonpeptidic inhibitors of human neutrophil elastase. 7. Design, synthesis, and in vitro activity of a series of pyridopyrimidine trifluoromethyl ketones. J Med Chem 1996; 39:1112-24. [PMID: 8676347 DOI: 10.1021/jm950684z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Using molecular modeling and the information derived from X-ray crystal structures of human neutrophil elastase (HNE) and porcine pancreatic elastase (PPE) complexed to peptidic ligands, we have developed a new series of nonpeptidic inhibitors of HNE, the pyridopyrimidine trifluoromethyl ketones (TFMKs). These bicyclic inhibitors were designed to extend the concept of the related pyridone trifluoromethyl ketones by incorporating a rigidly positioned carbonyl group to participate in a hydrogen bonding interaction with the backbone NH groups of Gly-218 and Gly-219 of the enzyme. In addition, the pyrimidine ring serves as a scaffold to vector substituents toward the S5-S4 subsites of the enzyme's extended binding pocket. Furthermore, the heteroatoms of the pyrimidine ring generally increase the aqueous solubility of the pyridopyrimidines relative to pyridone TFMKs. Pyridopyrimidine TFMKs containing a 6-phenyl substituent afforded potent inhibitors of elastase, and several inhibitors from this class of compounds possessed aqueous solubilities of > 0.1 mg/mL and Ki values of < or = 10 nM.
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Affiliation(s)
- P D Edwards
- Department of Medicinal Chemistry, ZENECA Pharmaceuticals, Wilmington, Delaware 19850-5437, USA
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Veale CA, Bernstein PR, Bryant C, Ceccarelli C, Damewood JR, Earley R, Feeney SW, Gomes B, Kosmider BJ, Steelman GB. Nonpeptidic inhibitors of human leukocyte elastase. 5. Design, synthesis, and X-ray crystallography of a series of orally active 5-aminopyrimidin-6-one-containing trifluoromethyl ketones. J Med Chem 1995; 38:98-108. [PMID: 7837246 DOI: 10.1021/jm00001a015] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The effects of changes in substitution in a series of 5-amino-2-pyrimidin-6-ones on both in vitro activity and oral activity in an acute hemorrhagic assay have been explored. These compounds contained either a trifluoromethyl ketone or a boronic acid moiety to bind covalently to the Ser-195 hydroxyl of human leukocyte elastase (HLE). Boronic acid-containing inhibitors were found to be more potent than the corresponding trifluoromethyl ketones in vitro but were less active upon oral administration. Compound 13b was found to offer the best combination of oral potency, duration of action, and enzyme selectivity and, as such, was selected for further biological testing. X-ray crystallography of a cocrystallized complex of compound 19m and porcine pancreatic elastase demonstrated that the inhibitor is bound to the enzyme in a manner similar to that found previously for a closely related series of pyridone-containing inhibitors of HLE.
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Affiliation(s)
- C A Veale
- Department of Medicinal Chemistry, ZENECA Pharmaceuticals, Wilmington, Delaware 19897
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Veale CA, Damewood JR, Steelman GB, Bryant C, Gomes B, Williams J. Non-peptidic inhibitors of human leukocyte elastase. 4. Design, synthesis, and in vitro and in vivo activity of a series of beta-carbolinone-containing trifluoromethyl ketones. J Med Chem 1995; 38:86-97. [PMID: 7837244 DOI: 10.1021/jm00001a014] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A novel series of human leukocyte elastase (HLE) inhibitors containing the beta-carbolinone ring system are reported. The design of these trifluoromethyl ketone-based inhibitors used a combination of structural information obtained from X-ray crystallography and molecular modeling investigations. The beta-carbolinone ring in these compounds serves as a highly efficient peptidiomimetic for the P2-P3 region of peptidyl trifluoromethyl ketone inhibitors of HLE. Several of the beta-carbolinones exhibit significant in vitro potency, with Ki values in the nanomolar range. Using aqueous molecular dynamics simulations, realistic models for the molecular recognition of these inhibitors by HLE have been obtained and are discussed. This series of compounds are found to have excellent selectivity for HLE over a number of other proteolytic enzymes, including closely related enzymes such as porcine pancreatic elastase.
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Affiliation(s)
- C A Veale
- Department of Medicinal Chemistry, ZENECA Pharmaceuticals, Wilmington, Delaware 19897
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49
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Warner P, Green RC, Gomes B, Strimpler AM. Non-peptidic inhibitors of human leukocyte elastase. 1. The design and synthesis of pyridone-containing inhibitors. J Med Chem 1994; 37:3090-9. [PMID: 7932532 DOI: 10.1021/jm00045a014] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Human leukocyte elastase (HLE) is a serine protease produced by neutrophils that has been implicated in diseases such as emphysema and cystic fibrosis. An HLE inhibitor may have therapeutic value in these diseases. An active site model of HLE bound to a tripeptidic trifluoromethyl ketone (TFMK) inhibitor, 2, was created from X-ray structures of HLE and porcine pancreatic elastase. Analysis of the model indicated a preferred binding conformation for the tripeptide and potentially important interactions between it and the enzyme. This information was used to aid in the design of a series of novel, pyridone-containing, non-peptidic HLE inhibitors such as 2-[3-[[(benzyloxy)carbonyl]amino]-2-oxo- 1,2-dihydro-1-pyridyl]-N-(3,3,3-trifluoro-1-isopropyl-2-oxopropyl)ace tam ide (5b) (Ki = 280 +/- 78 nM). Inspection of the active site model suggested that a benzyl substituent at the 5-position of the pyridone ring might improve potency by forming a lipophilic interaction with the enzyme S2 pocket. Synthesis and biological evaluation of a series of 5-benzylpyridone TFMKs provided evidence for this proposition. Further analysis of the model indicated that substitution on the 3-amino group of the pyridone ring with a hydrogen bond acceptor could potentially lead to interactions with the NH atoms of glycine-218 and/or -219. The oxalate derivative 2-[5-benzyl- 3-(carboxycarbonyl)-2-oxo-1,2-dihydro-1-pyridyl]-N-(3,3,3-trifl uor o-1- isopropyl-2-oxopropyl)acetamide (5v) was synthesized and found to have a Ki of 48 +/- 9 nM. Unfortunately, none of the compounds tested was active in an in vivo model of HLE-induced lung injury when dosed orally.
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Affiliation(s)
- P Warner
- Department of Medicinal Chemistry, A Business Unit of ZENECA Inc., Wilmington, Delaware 19897
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Gomes B. Locating communicative competence: the dialogue of immigrant students and American teachers. ASHA Monogr 1993:17-31. [PMID: 7887998] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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